Pediatric Cancer Hospital Research Articles

Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

Genomes for Nurses: Understanding and Overcoming Barriers to Nurses Utilizing Genomics.

Background: Genomic testing is an increasingly important technology within pediatric oncology that aids in cancer diagnosis, provides prognostic information, identifies therapeutic targets, and reveals underlying cancer predisposition. However, nurses lack basic knowledge of genomics and have limited self-assurance in using genomic information in their daily practice. This single-institution project was carried out at an academic pediatric cancer hospital in the United States with the aim to explore the barriers to achieving genomics literacy for pediatric oncology nurses. Method: This project assessed barriers to genomic education and preferences for receiving genomics education among pediatric oncology nurses, nurse practitioners, and physician assistants. An electronic survey with demographic questions and 15 genetics-focused questions was developed. The final survey instrument consisted of nine sections and was pilot-tested prior to administration. Data were analyzed using a ranking strategy, and five focus groups were conducted to capture more-nuanced information. The focus group sessions lasted 40 min to 1 hour and were recorded and transcribed. Results: Over 50% of respondents were uncomfortable with or felt unprepared to answer questions from patients and/or family members about genomics. This unease ranked as the top barrier to using genomic information in clinical practice. Discussion: These results reveal that most nurses require additional education to facilitate an understanding of genomics. This project lays the foundation to guide the development of a pediatric cancer genomics curriculum, which will enable the incorporation of genomics into nursing practice.

Employee investigation and contact tracing program in a pediatric cancer hospital to mitigate the spread of COVID-19 among the workforce, patients, and caregivers.

Case investigations and contact tracing are essential disease control measures used by health departments. Early in the pandemic, they were seen as a key strategy to stop COVID-19 spread. The CDC urged rapid action to scale up and train a large workforce and collaborate across public and private agencies to halt COVID-19 transmission. We developed a program for case investigation and contact tracing that followed CDC and local health guidelines, compliant with the Occupational Safety and Health Administration (OSHA) regulations and tailored to the needs and resources of our institution. Program staff were trained and assessed for competency before joining the program. From March 2020 to May 2021, we performed 838 COVID-19 case investigations, which led to 136 contacts. Most employees reported a known SARS-CoV-2 exposure from the community (n = 435) or household (n = 343). Only seven (5.1%) employees were determined as more likely than not to have SARS-CoV-2 infection related to workplace exposure, and when so, lapses in following the masking recommendations were identified. Between June 2021-February 2022, our program adjusted to the demand of the different waves, particularly omicron, by significantly reducing the amount of data collected. No transmission from employees to patients or caregivers was observed during this period. Prompt implementation of case investigation and contact tracing is possible, and it effectively reduces workplace exposures. This approach can be adapted to suit the specific needs and requirements of various healthcare settings, particularly those serving the most vulnerable patient populations.

Challenges to Widespread Use of Fertility Preservation Facilities for Pediatric Cancer Patients in Japan.

Purpose: Although fertility preservation for pediatric cancer patients is becoming more widespread in Japan, some facilities do not provide sufficient information regarding fertility. This study aimed to elucidate the problems pertaining to the lack of information about fertility among patients. Methods: Based on a 2020 survey, seminars addressing fertility preservation were held from the Designated Pediatric Cancer Care Hospitals in each of the seven blocks in Japan to their partner hospital (pediatric cancer hospitals). The seminar consisted of lectures and group discussions, and a questionnaire was also administered after each seminar. Results: In the group discussions, a lack of explanations to patients and explanatory materials for children were cited as issues by many facilities. The survey results revealed a lack of material explaining fertility preservation and a lack of knowledge among health care providers. There were also many requests to use the patient explanation videos presented at the seminar. Conclusion: The results indicate that further education for health care providers by seminar and other sources and enhancement of explanatory materials are important for fertility preservation in pediatric cancer hospitals in Japan.

Cancer incidence and type of treatment hospital among children, adolescents, and young adults in Japan, 2016-2018.

Cancer in children, adolescents, and young adults (AYAs) although rare, is the leading disease-specific cause of death in Japan. This study aims to investigate cancer incidence and type of treatment hospital among children and AYAs in Japan. Cancer incidence data (2016-2018) for those aged 0-39 years were obtained from the Japanese population-based National Cancer Registry. Cancer types were classified according to the 2017 update of the International Classification of Childhood Cancer (Third Edition), and AYA Site Recode 2020 Revision. Cases were also categorized into three groups: those treated at core hospitals for pediatric cancer treatment (pediatric cancer hospitals [PCHs]), those treated at designated cancer care hospitals, and those treated at nondesignated hospitals. The age-standardized incidence rate was 166.6 (per million-person years) for children (age 0-14 years) and 579.0 for AYAs (age 15-39 years) (including all cancers and benign or uncertain-behavior central nervous system [CNS] tumors). The type of cancer varied with age: hematological malignancies, blastomas, and CNS tumors were common in children under 10 years, malignant bone tumors and soft tissue sarcomas were relatively common in teenagers, and in young adults over 20 years, carcinomas in thyroid, testis, gastrointestinal, female cervix, and breast were common. The proportion of cases treated at PCHs ranged from 20% to 30% for children, 10% or less for AYAs, and differed according to age group and cancer type. Based on this information, the optimal system of cancer care should be discussed.

The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention

BackgroundSome studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old.MethodThis quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers’ knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test.ResultsThe preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother’s practice concerning child’s oral health, mother’s practice concerning personal oral health in the MI group (p-value < 0.001).ConclusionsConsidering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment.Trial registrationThe study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5).

Healthcare workers’ mental health and perception towards vaccination during COVID-19 pandemic in a Pediatric Cancer Hospital

The consistent increase of Coronavirus disease 2019 (COVID-19) cases parallel with the rate of deaths and the controversial response regarding the vaccines caused an increase in the burden of psychological diseases. This study aimed to evaluate the psychological condition of healthcare workers (HCWs) in a pediatric cancer hospital and to identify the knowledge, attitude, and perception (KAP) of HCWs toward COVID-19 vaccination. A cross-sectional observational study was conducted between April to May 2021. A validated, confidential survey was employed to measure the mental health of HCWs and the KAP toward COVID-19 vaccines. The total responses were 395, of which 11.4% physicians, 18.5% pharmacists, and 70.1% were nurses. Sixty-six percent of HCWs had different degrees of anxiety and depression. Nurses significantly accounted for the highest anxiety levels (P = 0.003), while the cumulative anxiety score was significantly higher in HCWs who had a positive history of COVID-19 infection (P = 0.026). Although 67.6% of HCWs believe that “vaccines are essential for us,”, the vaccination rate was 21.3%. The Factors associated with not receiving the vaccine were younger ages (P = 0.014), nurses (P = 3.6987 × 10–7), negative history of COVID-19 infection (P = 0.043) and believing that infections can happen after taking the vaccine (P = 1.5833 × 10–7). Healthcare organizations must take serious intervention to decrease the mental load on HCWs and facilitate the vaccination process.

A case-control study of Clostridioides difficile symptomatic infections in a pediatric cancer hospital.

The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer. This is a retrospective case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was performed by age and underlying disease, and for each case, the number of controls varied from 1 to 3. Logistic regression models were used to assess risk factors. We analyzed 63 cases of documented infection by C. difficile and 125 controls. Diarrhea was present in all cases, accompanied by fever higher than 38°C in 52.4% of the patients. Mortality was similar among cases (n=4; 6.3%) and controls (n=6; 4.8%; p=0.7). In all, 71% of patients in the case group and 53% in the control group received broad-spectrum antibiotics prior to the infection. For previous use of vancomycin, the Odds Ratio for C. difficile infection was 5.4 (95% confidence interval [95%CI] 2.3-12.5); for meropenem, 4.41 (95%CI 2.1-9.2); and for cefepime, 2.6 (95%CI 1.3-5.1). For the antineoplastic agents, the Odds Ratio for carboplatin was 2.7 (95%CI 1.2-6.2), melphalan 9.04 (95%CI 1.9-42.3), busulfan 16.7 (95%CI 2.1-134.9), and asparaginase 8.97 (95%CI 1.9-42.9). C. difficile symptomatic infection in children with cancer was associated with previous hospitalization and the use of common antibiotics in cancer patients, such as vancomycin, meropenem, and cefepime, in the last 3 months. Chemotherapy drugs, such as carboplatin, melphalan, busulfan, and asparaginase, were also risk factors.

Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families.

Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families. The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals. This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis. Two themes emerged: (1) living with conflicts intrinsic to the relationships , which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience , which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful. The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts. This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.

Retrospective Study on Very Early Relapse of Childhood Acute Lymphoblastic Leukemia at a Reference Centre in Indonesia

Introduction: The cure rate of Acute Lymphoblastic Leukemia (ALL) in low and middle-income countries is still low. Many factors contribute to relapses event, thus leading to failure of the treatment outcome. However, there are limited studies regarding the relapse of childhood cancer in Indonesia. This study determined demography, clinical, and characteristic laboratory differentiation between relapse and non-relapse in the bone marrow childhood ALL group.Methods: This was a retrospective descriptive study in children newly diagnosed with ALL ages 0-18 who completed the induction phase using the 2013 treatment protocol during the 2018 period in Pediatrics Hematology-Oncology Unit at a reference center hospital in Indonesia. Of 78 data collected from the Indonesian Pediatric Cancer Registry (IP-CAR) and Hospital Information System after excluding abandoned treatment or death during treatment, only 35 patients completed the overall therapy. We evaluated bone marrow relapse and classified it into 'very early' relapse that occurs at least 18 months from diagnosis, 'early' relapse between 18 and 36 months, and more than 36 months is called 'late' relapse. Chi-square test was used to elaborate association between relapse and sex, leukocyte count, morphological classification, risk stratification, nutritional status. Kruskal Wallis tests were used to elaborate on the association between relapse, age, and induction duration. P value&lt;0.05 was considered statistically significant.Results: Among 35 patients in this study, seven patients experienced bone marrow relapse. Relapses were dominant in four male patients, four patients aged from 1-10 years old, six patients with leukocytes count below 50.000/mm3, six normal nutritional status patients, and six patients classified as L2 patients. All relapse events occurred in a very early stage. Four patients are classified as standard risk, and three patients are high risk. There were no significant differences among characteristics of the relapse and non-relapse groups.Conclusions: The observed relapse onset is less than 18 months from diagnosis (very early relapse) during maintenance treatment. However, we found no significant demography, clinical, and laboratory differentiation between relapse and non-relapse groups.

Deciphering Multidrug-Resistant Acinetobacter baumannii from a Pediatric Cancer Hospital in Egypt.

ABSTRACTInfection by multidrug-resistant (MDR) Acinetobacter baumannii is one of the major causes of hospital-acquired infections worldwide. The ability of A. baumannii to survive in adverse conditions as well as its extensive antimicrobial resistance make it one of the most difficult to treat pathogens associated with high mortality rates. The aim of this study was to investigate MDR A. baumannii that has spread among pediatric cancer patients in the Children’s Cancer Hospital Egypt 57357. Whole-genome sequencing was used to characterize 31 MDR A. baumannii clinical isolates. Phenotypically, the isolates were MDR, with four isolates showing resistance to the last-resort antibiotic colistin. Multilocus sequence typing showed the presence of eight clonal groups, two of which were previously reported to cause outbreaks in Egypt, and one novel sequence type (ST), Oxf-ST2246. Identification of the circulating plasmids showed the presence of two plasmid lineages in the isolates, strongly governed by sequence type. A large number of antimicrobial genes with a range of resistance mechanisms were detected in the isolates, including β-lactamases and antibiotic efflux pumps. Analysis of insertion sequences (ISs) revealed the presence of ISAba1 and ISAba125 in all the samples, which amplify β-lactamase expression, causing extensive carbapenem resistance. Mutation analysis was used to decipher underlying mutations responsible for colistin resistance and revealed novel mutations in several outer membrane proteins, in addition to previously reported mutations in pmrB. Altogether, understanding the transmissibility of A. baumannii as well as its resistance and virulence mechanisms will help develop novel treatment options for better management of hospital-acquired infections.IMPORTANCE Acinetobacter baumannii represents a major health threat, in particular among immunocompromised cancer patients. The rise in carbapenem-resistant A. baumannii, and the development of resistance to the last-resort antimicrobial agent colistin, complicates the management of A. baumannii outbreaks and increases mortality rates. Here, we investigate 31 multidrug resistant A. baumannii isolates from pediatric cancer patients in Children’s Cancer Hospital Egypt (CCHE) 57357 via whole-genome sequencing. Multilocus sequence typing (MLST) showed the presence of eight clonal groups including a novel sequence type. In silico detection of antimicrobial-resistant genes and virulence factors revealed a strong correlation between certain virulence genes and mortality as well as several point mutations in outer membrane proteins contributing to colistin resistance. Detection of CRISPR/Cas sequences in the majority of the samples was strongly correlated with the presence of prophage sequences and associated with failure of bacteriophage therapy. Altogether, understanding the genetic makeup of circulating A. baumannii is essential for better management of outbreaks.

Effectiveness of Theraplay in Internalizing and Externalizing Problems in Bereaved Siblings of Children with Cancer

Background: Sibling relationships are very significant relationships, and their termination due to death will have profound long-term effects on the life of the surviving children. Objectives: The purpose of the current study was to determine the effectiveness of theraplay on internalizing and externalizing problems in bereaved siblings. Methods: This study was carried out using a single-subject multiple baseline design with follow-up. The statistical population included siblings and mothers of children aged 6 - 10 years who were on treatment at Mahak Pediatric Cancer Hospital and died one or two years ago. From this population, four mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 theraplay sessions once a week (45-min sessions). The assessments were carried out using the Child Behavior Checklist (CBCL) at baseline and in the intervention sessions and follow-up. Visual analysis of graphic displays of level, Reliable Change Index (RCI), and clinical significance were used to analyze the data. Data analysis and drawing the graphs were performed in Microsoft Excel 2016. Results: The results of the visual and quantitative data analysis showed a significant reduction in the four participants' internalizing problems during therapy. The reduction in the scores of this subscale in participants 1, 2, and 3 continued into the follow-up period and was noticeable. The results also showed that theraplay reduced the externalizing problems of most participants. A large proportion of these results persisted into the follow-up period. Conclusions: Theraplay appears to effectively reduce the internalizing and externalizing problems of bereaved siblings.

Explanation of Spiritual Experiences of Mothers of Cancer Children: A Descriptive Phenomenological Study

Introduction: occurrence of ancer in children affects the quality of life of family directly or indirectly. Meanwhile, mothers are the main caregivers and the psychological distress that mothers experience are more than those experienced by other family members. Since in Iran many people resort to spiritual beliefs in dealing with life difficulties, getting aware of the spiritual experiences of mothers of cancer children is very important and useful. Therefore, the objective of this study was to explain the spiritual experiences of mothers of cancer children. Methods: This qualitative study was conducted using a descriptive phenomenological method. statistical population of the study included mothers of cancer children hospitalized in Mahak Pediatric Cancer Hospital in Tehran in 2018. Twenty mothers were selected using purposive sampling. data were collected via semi-structrued interviews and data collection continued until theoretical data saturation. data were analyzed using Colaizzi's seven‐step method. Results: Three main categories and thirteen subcategories were identified in this study. main categories included Experiencing spiritual moments and closeness to God, The mothers’ deep psychological and emotional experiences, and The improvement of family interactions. Conclusion: results of this study indicated that mothers of cancer children gain valuable spiritual experiences concerning their closeness to God as well as psychological and emotional dimensions. These experiences help to change the view of mothers toward their children’s disease.

Therapeutic Landscape as a Healthcare Facility in Egypt: Design and Evaluation Process

Outdoor natural environments are well proven to have psychological, physical, and social benefits, particularly those attached to healthcare facilities. Despite that, the Egyptian Codes devoid of data related to the design of such gardens, which hinders the design process and the inclusion of these spaces within health care facilities. Thus, this paper seeks to reach a set of considerations for the design of different types of therapeutic gardens by summarizing the findings and recommendations of some evidence-based design (EBD) research and post-occupancy evaluations (POEs). Post-occupancy evaluations lack to determining the percentage of achieving the design principles in the garden. Therefore, in addition to the behavioral and visual observations to evaluate Children's Cancer Hospital garden in Egypt (CCHE), an audit tool was integrated to combine the advantages of audit tools and POEs. With this merging, we can reach a steady form of post-occupancy evaluations of pediatric cancer hospital’s gardens to be a guide for future researches and landscape architects.

Abstract IA02: The Treehouse Childhood Cancer Initiative

Abstract Each year over 4,000 children with cancer in the US lack adequate treatment options for their disease, underscoring the urgent need for new therapeutic targets and new therapies. Cancer genomic investigations focusing on the identification of recurrent DNA changes in tumors that could be targeted by therapies have been disappointing in the majority of pediatric cancers, as these diseases have lower rates of somatic mutation compared to adult cancers. To address this challenge, the UC Santa Cruz Genomics Institute launched the Treehouse Childhood Cancer Initiative, an innovative program that identifies novel therapeutic targets for difficult-to-treat pediatric cancers through leveraging the power of large, shared tumor RNA-sequencing datasets. Treehouse partners with pediatric cancer hospitals, including Lucille Packard Children’s Hospital at Stanford, UCSF Benioff Children’s Hospital, Children’s Hospital of Orange County, Nationwide Children’s Hospital, and British Columbia Children’s Hospital, to investigate whether the comparative RNA-seq approach is feasible and useful when applied to patients prospectively. A preliminary analysis of 126 patients from four hospitals showed that comparative RNA-seq analysis can identify druggable targets for over 74.3% of difficult-to-treat pediatric cancer patients, while state-of-the-art DNA analysis finds potential therapeutic options for only 45.9% of patients. Current work focuses on determining the clinical utility of the Treehouse approach. Citation Format: David Haussler. The Treehouse Childhood Cancer Initiative [abstract]. In: Proceedings of the AACR Special Conference on Advancing Precision Medicine Drug Development: Incorporation of Real-World Data and Other Novel Strategies; Jan 9-12, 2020; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_1):Abstract nr IA02.

Genotypic characterization of multiple drug resistant Escherichia coli isolates from a pediatric cancer hospital in Egypt

Infection with multiple drug resistant (MDR) Escherichia coli poses a life threat to immunocompromised pediatric cancer patients. Our aim is to genotypically characterize the plasmids harbored in MDR E. coli isolates recovered from bacteremic patients of Children’s Cancer Hospital in Egypt 57357 (CCHE 57357). In this study, 21 carbapenem-resistant E. coli (CRE) isolates were selected that exhibit Quinolones and Aminoglycosides resistance. Plasmid shot-gun sequencing was performed using Illumina next- generation sequencing platform. Isolates demonstrated resistant to all beta-lactams, carbapenems, aminoglycosides and quinolones. Of the 32 antimicrobial resistant genes identified that exceeded the analysis cutoff coverage, the highest represented genes were aph(6)-Id, sul2, aph(3″)-Ib, aph(3′)-Ia, sul1, dfrA12, TEM-220, NDM-11. Isolates employed a wide array of resistance mechanisms including antibiotic efflux, antibiotic inactivation, antibiotic target replacements and antibiotic target alteration. Sequenced isolates displayed diverse insertion sequences, including IS26, suggesting dynamic reshuffling of the harbored plasmids. Most isolates carried plasmids originating from other bacterial species suggesting a possible horizontal gene transfer. Only two isolates showed virulence factors with iroA gene cluster which was found in only one of them. Outside the realms of nosocomial infections among patients in hospitals, our results indicate a transfer of resistant genes and plasmids across different organisms.

A Quality Improvement Intervention to Decrease Postoperative Opioid Prescriptions in Pediatric Oncology Patients.

This quality improvement initiative aimed to minimize opioid prescribing after oncologic pediatric surgery. Retrospective surgical data collected at a pediatric cancer hospital from July 2016 to June 2018 included hospitalization details, oral morphine equivalents prescribed, unplanned visits/calls because of pain, and parental/patient satisfaction with pain control. The quality improvement initiative promoted opioid prescription at discharge on the basis of prior inpatient requirements and education regarding nonopioid analgesia. Upon commencing this project in July 2018, we collected data prospectively. The retrospective and the prospective cohorts included 271 and 99 patients, respectively. Mean (SD) oral morphine equivalents (mg/kg) prescribed upon discharge was significantly reduced in the prospective (0.75±1.34) versus retrospective cohorts (5.48±6.94, P<0.001). The unplanned visits/calls regarding pain were 23 (retrospective, 8.5%) and 2 (prospective, 2.0%). In total, 44 patients (44.4%) received an opioid prescription at discharge in the prospective cohort, significantly fewer than retrospective cohort (251, 92.6%, P<0.001), and used a mean of 34.3 of 159.8 (21.5%) doses dispensed. Length of stay was comparable (P=0.88) between cohorts. Prospective satisfaction rate was 96.2%, leaving 3 patients (3.8%) not satisfied with their pain control regimen. Dramatic reduction of opioid prescriptions after oncologic surgery can be achieved without detriment to patient satisfaction or readmissions. Level V.

Prevalence and Effects of Hypertension and Tachycardia after Pediatric Hematopoietic Cell Transplantation

Background Hypertension and tachycardia (H/T) are frequently found after hemopoietic cell transplantation (HCT) and are often underrecognized and undertreated. Maintenance of appropriate hemodynamic parameters after HCT may prevent cardiac dysfunction and other adverse cardiovascular outcomes. We sought to determine trends of H/T after HCT as well as the resolution of H/T after hemodynamic medication (HM) and the association between H/T and significant adverse cardiac events (CE). Methods We performed a retrospective review of all patients undergoing non-autologous HCT from 2015 through 2017 at a pediatric cancer hospital, examining vital sign data before HCT and at specified intervals within 100 days of HCT. H/T were determined by published criteria, and records were queried for the use of HM—ace inhibitor, beta blocker, or calcium channel blocker—and the presence of CE during the study period. Results 140 patients were examined [79 male, median age: 9.33]. Hypertension (HTN) was found in 107 (76.4%) patients. Tachycardia (TAC) was found in 97 (68.8%) patients. Figure 1 demonstrates the trend of H/T in the sample. Of patients who experienced HTN, 68 (70%) also experienced TAC. Hypertensive patients were more likely to be male and were 2.2 years younger than the median age, Tachycardic patients were more likely to be male and were 1.7 years older than the median age. 71% of the sample received HM during the study period. The table examines the effects of H/T in treated and untreated patients, showing the proportion of H/T resolution, the median time to resolution, and the presence of CE within each group. Patients who underwent treatment for TAC were more likely to have resolution than those without treatment (OR=3.68, 95%CI: 1.49-9.07, p=0.005). TAC resolution occurred 29.9 days sooner in the treated vs untreated group (p=0.003). The lower likelihood of HTN resolution in the treated vs. untreated groups and the shorter duration of such did not reach statistical significance. Given low event rates, there were no associations between groups and CEs. Conclusions In this pediatric HCT sample, H/T were common. Patients treated for TAC had higher rates of TAC resolution and resumption of normal vitals in a shorter duration of time. In this highly treated sample, cardiac events were rare. Careful surveillance and treatment of H/T after HCT may allow for prevention of cardiovascular complications.

“Getting to Know You and Your Child” screening questionnaire: Results from a Chicago pediatric collaborative.

163 Background: In 2012, a congressional symposium identified the need for services to address psychosocial issues of children with cancer. In 2013, the Institute of Medicine recommended supportive oncology services be initiated at cancer diagnosis. Chicago providers of pediatric cancer are collaborating to improve care for children with cancer and their families focusing on psychosocial stressors and quality of life. Methods: The collaborative conducted a structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; with input from providers on stressors throughout the care continuum. The resulting screening tool was created and piloted in English and Spanish at 7 pediatric cancer hospitals. Social workers (SW) informally reported assessment of its usefulness. Results: Parents (n = 85) completed “Getting to Know You and Your Child” screening tool which inquired about caregivers, siblings, child’s interests, school, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported families found the tool useful “to think about support needs.” The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.4 (range 0-11). Most frequent stressors included: lack of support from friends, family, community (29%), paying for food (26%), job flexibility (26%), paying for utilities (25%), medical costs (23%), emotional support for family (22%), school concerns (21%). All who reported temporary residence also reported difficulty paying for housing (p &lt; 0.01). Ten SWs reported this screening tool generated new insight into family structures, identified stressors and informed resolution efforts. Provider recommended adjustments to the screening tool: simplify terms for siblings, hobbies and spiritual, add pet question. Conclusions: Pilot testing of a psychosocial screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Six of the seven pilot sites are implementing this tool as a standard practice. Preliminary data suggests patients and providers find the screener easy to use and informative.

Arash: A social robot buddy to support children with cancer in a hospital environment.

This article presents the thorough design procedure, specifications, and performance of a mobile social robot friend Arash for educational and therapeutic involvement of children with cancer based on their interests and needs. Our research focuses on employing Arash in a pediatric hospital environment to entertain, assist, and educate children with cancer who suffer from physical pain caused by both the disease and its treatment process. Since cancer treatment causes emotional distress, which can reduce the efficiency of medications, using social robots to interact with children with cancer in a hospital environment could decrease this distress, thereby improving the effectiveness of their treatment. Arash is a 15 degree-of-freedom low-cost humanoid mobile robot buddy, carefully designed with appropriate measures and developed to interact with children ages 5-12 years old. The robot has five physical subsystems: the head, arms, torso, waist, and mobile-platform. The robot's final appearance is a significant novel concept; since it was selected based on a survey taken from 50 children with chronic diseases at three pediatric hospitals in Tehran, Iran. Founded on these measures and desires, Arash was designed, built, improved, and enhanced to operate successfully in pediatric cancer hospitals. Two experiments were devised to evaluate the children's level of acceptance and involvement with the robot, assess their feelings about it, and measure how much the robot was similar to the favored conceptual sketch. Both experiments were conducted in the form of storytelling and appearance/performance evaluations. The obtained results confirm high engagement and interest of pediatric cancer patients with the constructed robot.