This study explored blood and marrow transplantation (BMT) patients' perceptions of an art-making experience during BMT treatment. Participants including patients receiving BMT for a variety of cancers (10 men/10 women, aged 20-68) were offered a 1 hour tile-painting activity during treatment. Participants with cognitive impairment and respiratory precautions were excluded from the study. Researchers followed immune precaution protocols for the safety of participants. Data were collected through semi-structured, in-depth interviews with 20 participants to gather information about their perceptions of the art-making experience in a BMT clinic setting. Interview recordings were transcribed verbatim and analysed. Researchers coded transcripts independently and discussed outcomes together to achieve agreement on themes. Twelve themes emerged from the data, with the three most prevalent themes being Occupying Time (20.5%), Creative Expression (13.5%), and Reactions to Tile Painting (13.5%). Other themes included Support (12.2%), Side Effects (7.3%), Other Activities Suggested by Patients (7%), BMT Treatment Process (6.2%), Shared Painting Experience (5.9%), Life Outlook (5.2%), BMT Life Changes (3.8%), Spirituality (3%) and Barriers (1.9%). Through analysis of these themes, researchers have identified this art-making experience as a diversional or meaningful way to spend time during treatment, a medium for creative expression, and a distraction from negative side effects of the BMT process.

Syncope is a common and a typically benign clinical problem in children and adolescents. The majority of tests ordered in otherwise healthy pediatric patients presenting with syncope have low diagnostic yield. This study quantifies testing and corresponding patient charges in a group of pediatric patients presenting for outpatient evaluation for syncope. Patients seen between 3/2011 and 4/2013 in the multi-disciplinary Syncope Clinic at Cincinnati Children's Hospital Medical Center were enrolled in a registry which was reviewed for patient information. The electronic medical record was used to determine which syncope patients underwent cardiac (electrocardiogram, echocardiogram, or exercise testing) or neurologic (head CT/MRI or electroencephalogram) testing within the interval from 3 months before to 3 months after the Syncope Clinic visit. Testing charges were obtained through hospital billing records. 442 patients were included for analysis; 91% were Caucasian; 65.6% were female; median age was 15.1 years (8.1-21.2 years). Cardiac and neurologic testing was common in this population. While some testing was performed during the Syncope Clinic visit, 46% of the testing occurred before or after the visit. A total of $1.1 million was charged to payers for cardiac and neurological testing with an average total charge of $2488 per patient. Despite the typically benign etiology of pediatric syncope, patients often have expensive and unnecessary cardiac and/or neurologic testing. Reducing or eliminating this unnecessary testing could have a significant impact on healthcare costs, especially as the economics of healthcare shift to more capitated systems.

Background--Fontan survivors demonstrate diminished vascular function and functional outcomes, but the relationships between these measures have not been established.

This study demonstrates that the CPET can be used in pediatric cancer survivors with prior exposure to chemotherapy to demonstrate impaired cardiopulmonary exercise tolerance, which is demonstrated on submaximal and maximal effort testing.

Introduction: Fontan survivors demonstrate diminished vascular function and functional outcomes. The relationships between measures of vascular function and functional outcomes have not been established. Methods: Cross-sectional single-institution study of Fontan survivors ages 8-25 years. Multimodality assessment of endothelial function (reactive hyperemia index [RHI] and flow mediated dilation [FMD]) and arterial stiffness (augmentation index [AI] and baseline pulse amplitude [BPA]) was performed with peripheral arterial tonometry (PAT), brachial FMD and pulse wave analysis (PWA). Aerobic capacity was determined using cardiopulmonary exercise testing with cycle ergometry and a ramp protocol. Quality of life (QOL) was assessed using the pediatric QOL inventory (PedsQL) and physical activity (PA) was assessed using the PA Questionnaire (PAQ). Vascular measures served as predictor variables while functional outcome measures served as outcome variables. Bivariate predictors (p<0.1) were candidates for inclusion in multivariable models. Model development utilized linear regression and ordered logistic regression techniques. Results: Sixty patients (52% male) completed the protocol with a mean age of 13.9 ± 4.1 years and duration of Fontan circulation of 9.9 ± 4.2 years. Maximal (max) exercise was achieved in 54 subjects with mean peak and %-predicted oxygen consumption (VO 2 ) of 27.8 ± 7.6 ml/kg/min and 71.0 ± 21.2%, respectively. FMD-RHI (p<0.05) was associated with VO 2 at anaerobic threshold (AT, R 2 0.33). PAT-BPA (p<0.05) was associated with the ratio of minute ventilation to carbon dioxide at AT (R 2 0.40). FMD-RHI, PAT-AI and PWA-AI (p<0.05) were associated with max VO 2 (R 2 0.36-0.53), %-predicted max VO 2 (R 2 0.40-0.56) and max O 2 pulse (R 2 0.26-0.31). PAT-AI and PAT-BPA (p<0.05) were associated with PedsQL total (R 2 0.19-0.34) and physical heath summary score (R 2 0.36-0.41). FMD max and PAT-BPA (p<0.05) were associated with PAQ score (R 2 0.33-0.38). Conclusions: Increased arterial stiffness and decreased endothelial function are associated with lower aerobic capacity, QOL and physical activity in adolescent and young adult Fontan survivors. Vascular dysfunction may be an important target for future therapeutic trials.