Laura Robbins

Exploring concerns of children with cancer

BackgroundAggressive treatment protocols in pediatric oncology have major effects on the lives of children with cancer. The effects of lifestyle changes such as hospitalization and home schooling on quality of life have not been investigated. This study explores lifestyle effects of cancer therapy on the quality of life of children with cancer. The goals of this study were to identify important quality-of-life issues from the perspectives of children with cancer and to identify how they think their experience with cancer treatment could be improved.Materials and methodsPediatric oncology patients age 5–21 were interviewed individually. Sample questions included, “Ever since you got sick, what has bothered you the most?” and “How has having this illness affected your life?” Responses were analyzed using standard qualitative techniques.ResultsThirty-one patients were interviewed in depth. Four major themes emerged including (1) loneliness and isolation: the loss of a normal childhood, (2) decreased pleasure from food, (3) physical discomfort and disability, and (4) emotional responses to cancer, specifically anger and fear. Their suggestions for improvement included better-tasting food, more comfortable hospital décor, and social activities with children their own age.ConclusionsChildren cited concerns regarding pleasures taken away as well as pain inflicted due to cancer treatment. In addition to traditionally mentioned side effects, children complained of difficulty enjoying food and restricted social activity. To improve the quality of life of children with cancer, healthcare providers should focus on potentially modifiable variables including food-related pleasure, hospital aesthetics, and social activity.

Measuring Recovery after a Hip Fracture Using the SF-36 and Cummings Scales

Abstract: The objective of this study was to assess outcomes of traditional treatment of fractures using the SF-36 and the Cummings Hip Scale. In designing randomized clinical trials, it is necessary to determine the timing of assessment either for progress or for the main outcome. We set out to document the recovery of patients after surgery for hip fracture using current standard methods of medical care. This was a prospective study of a cohort of patients. Patients who were receiving standard medical care completed the SF-36 and the Cummings Hip Scale at previously determined times postoperatively. The SF-36 has eight subscales, including assessments of physical function, physical role behaviors, bodily pain, mental health, social role, emotional role, vitality and general health. Thirty-eight patients completed the questionnaires at 1 year postoperatively as well as previous time points. On the Cummings Hip Scale and the physical function, bodily pain, mental health, social function, emotional role, vitality and general health subscales of the SF-36, recovery is near complete at 6 months. Only the physical role subscale differs, with a statistically significant difference between the values at 6 months and 1 year, (p= 0.02). Patients attained over 90% of the 1 year value by 6 months for all except the physical role subscale. The physical role subscale reached 85%. For a hip fracture patient who is on the road to recovery, the majority of the recovery has therefore taken place by 6 months.

Results of intervention for lupus patients with self-perceived cognitive difficulties.

The authors developed an 8-week psychoeducational group intervention for patients with systemic lupus erythematosus (SLE) who reported cognitive dysfunction but were not globally impaired on neuropsychological testing. Results of a nonrandomized, uncontrolled pilot study of this program in 17 women with SLE suggest that metamemory and memory self-efficacy improve after participation. One hundred percent retention throughout the study further suggests that patients with SLE are willing and capable of successfully completing the program.

Quality of life in paediatric lupus

Paediatric systemic lupus erythematosus (SLE) is associated with significant morbidity and has biopsychosocialimplications resulting from the disease and its treatment. The aim of this study was to identify domains of quality of life (QOL) impacted by SLE in children. Children with SLE and their parents were asked a single open-ended question related to lupus. Themes derived from children’s responsesfocused primarily on coping and maintaining control of their life despite SLE. Themes from the parents’ responses were twofold: a) efforts to cope with their child having SLE; and b) appreciation/sadness in connection with their children’s coping process. Qualitative exploration of differentfacets of QOL in these children is critical for the understandingof specific factors that assist/ease the coping process and formulating interventions for improving children’s/family’s self-efficacy and disease management.

Proposals for change in orthopaedic education: recommendations from an orthopaedic residency directors' peer forum.

Orthopaedic residency education currently faces a number of difficult challenges. Among them are the explosion of knowledge, the need to teach both the basics of orthopaedic research and surgical techniques, work-hour restrictions, the limited number of trainees, the growth in demand for surgery, greater specialization and complexity of patient care, more complicated resident evaluations, and the changing demographics, lifestyles, and values of the residents1-7. Although most orthopaedic residency programs around the country face the challenges listed above, and while several professional organizations recognize the current challenges to traditional orthopaedic residency training, there seems to be a lack of urgency to address them. The Hospital for Special Surgery convened a forum of educators, all of whom were program directors, from well-regarded residency programs across the country. The invited programs were chosen as representatives of a group of institutions that have shown leadership in residency training, have at least twenty residents in their programs, and reflected geographic variety. The invited educators were asked first through a mailed survey and then in a face-to-face meeting to (1) evaluate whether the traditional residency model is appropriate for the training of future surgeons, and (2) discuss current approaches that have been successfully implemented in orthopaedic training programs. The aim of the meeting was to issue a call for action to those who provide oversight to residency requirements by identifying areas where recommendations need to be developed. The aim of the meeting was to identify consensus areas of need, not to suggest solutions. Twelve orthopaedic educators from nine different programs (Table I) participated in the meeting, which was held on May 2 and 3, 2008. The group produced a set of twenty-two general recommendations for improvement. View this table: TABLE I Participants in the Hospital for Special Surgery Orthopaedic Residency Peer Forum To focus the discussion on …

Novel Use of Patient-Derived Vignettes to Foster Self-Efficacy in an Asthma Self-Management Workbook

This article describes the development of an interactive self-management workbook to increase asthma knowledge and self-efficacy. Its format encourages readers to write in their own personal experiences and perspectives. The knowledge component was developed from standard materials and organized into thematic chapters. The self-efficacy component was developed from interviews with patients in the outpatient setting, emergency room, and hospital; it consists of three sections explaining why confidence is necessary to be an effective self-manager and offers techniques to increase confidence. The component’s cornerstone is vignettes of patients describing what triggers their asthma and what behaviors they use to successfully manage it. This novel approach to fostering self-efficacy allows patients to see themselves in others’ success stories. Although not a substitute for self-management courses, the workbook promotes self-management by offering a practical and readily available option to in-person instruction and peer contact, which are accessible to only a small number of patients.

Restructuring the orthopedic resident research curriculum to increase scholarly activity.

BACKGROUND Limited time and funding are challenges to meeting the research requirement of the orthopedic residency curriculum. OBJECTIVE We report a reorganized research curriculum that increases research quality and productivity at our academic orthopedic medical center. METHODS Changes made to the curriculum, which began in 2006 and were fully phased in by 2008, included research milestones for each training year, a built-in support structure, use of an accredited bio-skills laboratory, mentoring by National Institutes of Health-funded scientists, and protected time to engage in required research and prepare scholarly peer-reviewed publications. RESULTS Total grant funding of resident research increased substantially, from

Major life events as antecedents to hip fracture.

15,000 in 2007 (8 graduates) to

Creating an Academy of Medical Educators: How and Where to Start

380,000 in 2010 (9 graduates), and the number of publications also increased. The 12 residents who graduated in 2005 published 16 papers from 2000 to 2006, compared to 84 papers published by the 9 residents who graduated in 2010. The approximate costs per year included

The State of the Science in the Prevention and Management of Osteoarthritis

19,000 (0.3 full-time equivalent) for an academic research coordinator;