Pediatric oncology patients with an external central venous catheter (CVC) in situ can be discharged from the hospital. Caregivers are expected to learn how to care for the CVC prior to discharge while also dealing with their child's new cancer diagnosis. This study aimed to evaluate the perceptions of a CVC education program received by caregivers to identify opportunities for improvement. A qualitative study was conducted in 3 stages, using an evidence-based co-design approach, involving caregivers and one adolescent patient discharged from the British Columbia Children's Hospital Oncology/Hematology/BMT inpatient unit. Stage I involved semi-structured interviews to gain feedback on the existing CVC education program. In Stage II, educational resources were updated or developed and implemented. For Stage III, the revised CVC education program was evaluated through a focus group and semi-structured interviews. Interview transcripts were analyzed using QSR NVivo®. The original CVC education program was overall well received. Repeated instruction and support provided by nurses was reported to have increased confidence with performing CVC skills. Participants appreciated the multimodal approach to meet learning needs and expressed interest in additional visual aids. Inconsistencies in nurses’ practice and offers of “tips and tricks” were identified to be challenging for caregivers while learning a new skill. Videos depicting CVC care were developed to provide an additional visual tool, decreased inconsistencies in care, and support to caregivers at home. Caring for a CVC at home is challenging and overwhelming for caregivers. A standardized multimodal education program is required to support caregivers at home.
Background:
High-dose methotrexate is part of the treatment of pediatric cancers. To reduce the risk of toxicity, supportive measures, including hydration and alkalinization, are recommended. At our institution, we switched from intravenous sodium bicarbonate to Lactated Ringers during a worldwide shortage.
Procedure:
This was a retrospective cohort of children who received high-dose methotrexate from January 1, 2016 to August 31, 2018. The primary outcome was the prevalence of delayed methotrexate clearance. Secondary outcomes were proportion of cycles with delayed methotrexate clearance, time to methotrexate clearance, adverse events, risk factors for delayed clearance, and association between hydration type and delayed clearance.
Results:
Eighty-two patients, with a total of 325 methotrexate cycles, were included. Forty-four patients received sodium bicarbonate, 31 received Lactated Ringers, and 7 received both. There was no difference in the prevalence of delayed methotrexate clearance between those who received sodium bicarbonate and Lactated Ringers (64% vs. 68%). The proportion of cycles with delayed methotrexate clearance, time to methotrexate clearance, and adverse events were similar between groups. Cancer type, methotrexate dose, and vomiting were associated with delayed clearance.
Conclusions:
Our study suggests that Lactated Ringers may be used in place of sodium bicarbonate for intravenous hydration during high-dose methotrexate.
The purpose of this article is to report the effects of arm ergometry training on upper extremity strength, body composition, and oxygen uptake in a 13-year-old adolescent with myelodysplasia. The subject trained three times a week for eight weeks at 75% of maximum heart rate. The following measurements were determined before and after the training period: maximal and submaximal heart rate and oxygen uptake, percent body fat, and peak torque of the elbow and shoulder flexor and extensor muscles. The results indicated that maximal oxygen uptake and percent body fat did not change, but maximal physical work capacity increased from 274 kg . m/min to 569 kg X m/min. Heart rate and oxygen uptake decreased at each submaximal work load, and peak torque increased an average of 22.3% for the movements tested. We concluded that arm ergometry training in an adolescent with myelodysplasia can reduce the energy cost of performing submaximal arm ergometry work.
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