Kristin A. Loiselle

Use of Low-Dose Ketamine Infusion For Pediatric Patients With Sickle Cell Disease-Related Pain: A Case Series.

ObjectivesSickle cell disease-related pain is difficult to treat adequately. Pain secondary to vasoocclusive episodes (VOE) may be unresponsive to high-dose intravenous opiates. Alternative treatment options for VOE are needed. We sought to review our experience with low-dose ketamine for children hospitalized with VOE. MethodsRetrospective medical chart reviews were conducted for hospitalized patients treated with ketamine for sickle cell VOE. Data gathered included vital signs, pain scores, opiate utilization, and adverse events. ResultsFive children and adolescents received a low-dose ketamine infusion for the treatment of sickle cell-related pain. Four received the infusion in addition to opiates (delivered via patient controlled analgesia) as a rescue intervention after several days of inadequate pain relief and 1 patient received ketamine in place of opiates. Two of the 5 patients achieved what seems to be clinically significant pain control with a low-dose ketamine infusion, whereas 1 additional patient had significant reduction in opiate utilization. DiscussionFurther research into ketamine for vasoocclusive pain is warranted.

Retrospective evaluation of pain assessment and treatment for acute vasoocclusive episodes in children with sickle cell disease.

This study was conducted to assess the care of pediatric patients hospitalized for sickle cell disease‐related vasoocclusive episodes (VOE). The aim of this research was to illustrate the course of pain scores and methods of therapeutic intervention during hospitalization.

Posttraumatic Growth in Young Adults Who Experienced Serious Childhood Illness: A Mixed-Methods Approach

Sixty young adult survivors of a serious childhood illness completed quantitative and qualitative measures assessing the relationship between specific disease and distress factors and posttraumatic growth (PTG). Individuals who had recovered from their illness reported greater growth than those who were currently experiencing their illness. The regression model accounted for 47% of the variance in PTG, with perceived severity, illness status, and posttraumatic stress symptoms emerging as significant predictors. Qualitative analyses identified salient positive and negative factors associated with having had an illness, such as a positive shift in perspective and frequent medical requirements. Being past the daily demands of illness management may allow for greater PTG. Realization of positive aspects of having had an illness may require prompting.

Predictors of Long-Term Health-Related Quality of Life in Adolescent Solid Organ Transplant Recipients

OBJECTIVES This study aimed to identify prospective predictors of health-related quality of life (HRQOL) for adolescent solid organ (kidney, liver, heart, lung) transplant recipients. METHODS Data regarding demographics, individual/transplant characteristics, and environmental characteristics were gathered from 66 adolescent transplant recipients and their families at baseline and used to predict the physical functioning, mental health, and general health perceptions domains of HRQOL 18 months later. RESULTS Baseline levels of HRQOL explained the greatest amount of variance in levels of HRQOL at follow-up; however, specific demographic (i.e., income), individual/transplant (i.e., adherence, frequency of rescheduled clinic appointments, and presence of a rejection episode), and environmental factors (i.e., family conflict) contributed to the variance in HRQOL domains beyond baseline levels. CONCLUSIONS This study identified certain modifiable individual and environmental factors and non-modifiable risk factors associated with lower future HRQOL. Transplant centers should begin screening and addressing these factors to potentially improve HRQOL.

Posttraumatic growth associated with a relative's serious illness.

Posttraumatic growth (PTG) involves personal psychological growth in response to a traumatic or very stressful event. Using theoretical guidance from Tedeschi and Calhouns cognitive model, this study evaluated the relationship between specific individual, distress, and stress-processing factors and PTG among young adults who experienced an illness-related trauma earlier in life through a relatives serious illness. Sixty individuals with a relative with a serious illness completed measures of PTG, posttraumatic stress symptoms (PTSS), anxiety, and coping. PTG was positively associated with trait anxiety, PTSS, and the use of active, problem-focused coping strategies. Factors associated with PTG development in individuals who have a relative with a chronic illness are similar to that of individuals who had a serious illness themselves. The relationship between PTSS and PTG is moderated by whether the relatives current illness status is resolved versus not resolved. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Systematic and Meta-Analytic Review: Medication Adherence Among Pediatric Patients With Sickle Cell Disease

OBJECTIVE To provide a comprehensive summary (systematic review) of medication adherence rates by assessment method and medication type for pediatric patients with sickle cell disease (SCD), as well as identify important correlates for future research. METHODS Articles assessing medication adherence and published between 1982 and February 2015 (n = 49) were identified using electronic databases. A meta-analysis of 14 studies examining demographic, medical, and psychosocial factors and medication adherence was conducted. RESULTS Adherence rates ranged from 12% to 100% across all medications. Approximately 30% of studies reported associations between adherence and key demographic, medical, and psychosocial correlates. Mean effect sizes were small to moderate (r = .02-.53). CONCLUSIONS The wide range of adherence rates reported in the literature may be because of, in part, the use of variable assessment strategies. Future studies examining pediatric SCD adherence should incorporate key correlates with the goal of replication.

A pilot study evaluating an abbreviated version of the cognitive remediation programme for youth with neurocognitive deficits

Primary objective: To determine the effectiveness of an abbreviated version of an established cognitive remediation programme for children with neurological disorders and attention problems in an outpatient setting. Methods and procedures: Eighteen 6–15-year-old children diagnosed with neurological and attention difficulties completed a six-module training programme aimed at improving attention. This programme was a shorter version of the Cognitive Remediation Programme (CRP), which has been successfully implemented with children with neurocognitive deficits. Parents completed measures of their childrens attention and children completed neuropsychological measures of attention. Main outcomes and results: The programme was associated with improvement in several aspects of parent-reported attention and childrens performance on tasks measuring attention. Conclusions: The shortened version of the CRP shows promise as a brief treatment for attention problems in outpatient neurological populations. Future research should assess programme effectiveness using a control group, longer-term follow-up and teacher reports.

Do Children with Sickle Cell Disease Receive Disparate Care for Pain in the Emergency Department

BACKGROUND There may be disparities in pain management practice in the emergency department (ED) for sickle cell disease patients (SCD) with vaso-occlusive episodes (VOE). OBJECTIVES To compare pain management practice for children who presented to the ED with VOE to those with isolated long bone fractures (LBF). METHODS Children who presented with a VOE or a LBF to a childrens hospital ED during 2005 were included. A retrospective medical chart review was conducted for each patient visit. Data collected included demographics, pain scores, time from triage to analgesia, and analgesic intervention. RESULTS Seventy-seven patients with SCD had 152 visits to the ED for pain, and 219 patients had 221 visits for LBF. Fifty-five patients (108 visits) with SCD and 123 patients (124 visits) with LBF received opiates. Subsequent analysis was done on these groups. Patients with SCD were older, less likely to be male and more likely to be African-American than the LBF group. Patients with SCD had higher triage pain scores (7.7 ± 2.5 vs. 6.7 ± 3.0, p = 0.005) and spent less time in the waiting room (7.4 ± 9.0 vs. 12.1 ± 26.8 min, p = 0.10), were given higher initial opiate doses (0.09 ± 0.03 vs. 0.07 ± 0.03 mg/kg morphine, p < 0.001); however, time from triage to analgesic intervention did not differ (69.0 ± 42.6 vs. 70.4 ± 57.1 min, p = 0.92). CONCLUSIONS No disparities in care for children with sickle cell pain were identified. More timely administration of opiates needs to be encouraged, assuming other factors such as time of day, ED census, and acuity permit.

Behavioral predictors of medication adherence trajectories among youth with newly diagnosed epilepsy

OBJECTIVE This study aimed to identify psychosocial predictors of two-year antiepileptic drug (AED) adherence trajectories among youth with newly diagnosed epilepsy, controlling for known demographic and medical factors. METHOD This study is part of a large, prospective, longitudinal observational study of AED adherence and medical outcomes in youth with newly diagnosed epilepsy. Parents completed questionnaires of psychosocial and family functioning at one month and one year following diagnosis. Chart review and questionnaires were used to collect medical variables and seizure outcomes. Previously established two-year AED adherence trajectories (Severe Early Nonadherence, Variable Nonadherence, Moderate Nonadherence, High Adherence) were used as the outcome variable. RESULTS Participants were 91 parents of youth with epilepsy (7.3±2.8years of age; 60% male) and their families. Early (one month following diagnosis) predictors of two-year adherence trajectories included socioeconomic status, epilepsy knowledge, family problem-solving, and family communication. Significant predictors one year following diagnosis included socioeconomic status, parent fears and concerns, and parent life stress. CONCLUSION There are modifiable parent and family variables that predict two-year adherence trajectories above and beyond known medical (e.g., seizures, side effects) factors. Psychosocial interventions delivered at key points during the course of epilepsy treatment could have a positive impact on adherence outcomes.

Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy

OBJECTIVE The objective of this study was to identify two-year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. METHODS Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month postdiagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data were collected via MEMS TrackCaps, and medical information was collected through chart review. RESULTS Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality-of-life trajectories remained predominantly stable during the two-year period following treatment initiation. The number of AEDs, internalizing problems, and externalizing problems emerged as the most consistent predictors across the HRQOL domains. SIGNIFICANCE Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease.