Publications by authors named "Jichuan Wang"

143 Publications

Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity.

Health Commun 2021 Jun 9:1-13. Epub 2021 Jun 9.

College of Education, Wayne State University.

Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.
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http://dx.doi.org/10.1080/10410236.2021.1936750DOI Listing
June 2021

Variability in the reported surgical techniques and methods for intercalary reconstruction following tumor resection.

Surg Oncol 2021 May 29;38:101610. Epub 2021 May 29.

Department of Orthopaedic Surgery, Montefiore Health System, Bronx, NY, USA; Department of Pediatrics, Montefiore Health System, Bronx, NY. 3400 Bainbridge Ave., Bronx, NY, 10467, USA. Electronic address:

Introduction: There is currently no consensus regarding the best techniques or surgical strategies with which to maximize intercalary allograft reconstruction outcomes. The purpose of the current study was to assess which techniques and methods are being utilized by North American orthopaedic oncologists.

Methods: Members of the Musculoskeletal Tumor Society (MSTS) were invited to complete an anonymous online questionnaire. The survey presented participants with two clinical scenarios and interrogated them on their preferred type of allograft, method of compression and fixation, and additional techniques used.

Results: One hundred and twenty-six physicians completed the questionnaire. The majority studied in the United States (82%) and worked at an academic medical center (71%). Over half (54%) reported seeing over 10 primary bone tumors every year. Respondents were split between preferring a structural allograft alone or using a combined allograft-vascularized fibular graft. A majority indicated a preference for plate(s) and screw fixation but were divided between the use of two compression plates with a spanning plate, a single compression plate with a spanning plate, and two compression plates with an intramedullary nail. Screw fixation preferences were split between the use of unicortical locking only, bicortical locking only, and a combination of unicortical and bicortical locking. Almost equal percentages of respondents reported they would have used two, three, or four screws in both scenarios. Respondents were split between placing screws equidistantly and placing them peripherally within the allograft, adjacent to the allograft-host junction.

Discussion: There is no clear surgical preference for intercalary reconstruction following tumor extirpation within this sample of orthopaedic oncologists. The current survey demonstrates variability across nearly every aspect of allograft reconstruction, which may, in part, explain the wide spectrum of outcomes reported within the literature. Prospective studies are warranted to better evaluate technique-specific outcomes in an effort to maximize reconstructive longevity and minimize allograft related complications.
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http://dx.doi.org/10.1016/j.suronc.2021.101610DOI Listing
May 2021

The intersectionality of gender and poverty on symptom suffering among adolescents with cancer.

Pediatr Blood Cancer 2021 Aug 1;68(8):e29144. Epub 2021 Jun 1.

George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.

Background: To determine if the intersectionality of gender and poverty is associated with health disparities among adolescents with cancer. We hypothesized unobserved latent classes of patients exist with respect to cancer-related symptoms; and class classification varies by gender-poverty combinations.

Procedure: Cross-sectional data were collected among adolescents with cancer and families (N = 126 dyads) at four tertiary pediatric hospitals. Adolescents were aged 14-21 years, English speaking, cancer diagnosis, not developmentally delayed, psychotic, homicidal, suicidal, or severely depressed. Latent class analysis and multinomial logit models were used for analysis. Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures, Short forms, evaluated anxiety, depressive symptoms, pain interference, and fatigue. Family-reported household income used 2016 Federal Poverty Level (FPL) guidelines.

Results: Three distinct groups of patients were identified using PROMIS symptom patterns: High Distress-25%; High Physical/Low Psychological Distress-14%; and Low Distress-62%. Female adolescents living in households with incomes at or below the 2016 FPL had 30 times the odds of being classified in the High Distress class (higher probabilities of experiencing anxiety, depressive symptoms, pain interference, and fatigue) compared to those in the High Physical/Low Psychological Distress class (female and poverty: AOR = 30.27, 95% CI 1.23, 735.10), and this was statistically significant (β = 3.41, 95% CI 0.21, 6.60; p = .04) but not compared to those in Low Distress.

Conclusion: Adolescent females with cancer with households in poverty had significantly greater odds of experiencing high symptom distress, compared to those with high physical but low psychological distress. More comprehensive screening and intervention, as needed, may decrease disparities.
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http://dx.doi.org/10.1002/pbc.29144DOI Listing
August 2021

Impact of Personal Social Network Types on Breastfeeding Practices in United States-Born Black and White Women.

Breastfeed Med 2021 May 18. Epub 2021 May 18.

Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA.

An individual's personal social network influences behavior; one is more likely to adopt behaviors consistent with norms within the network to avoid social stigma. Personal social network types, which are associated with individual behaviors, have been identified for new mothers: exclusive (kin centric) and expansive (not kin centric). To analyze the impact of personal social network type on breastfeeding practices in U.S.-born Black and White mothers. Mothers of infants <6 months old completed surveys about their personal social networks and feeding practices. Multinomial logit models examined how social network types moderated effects of sociodemographic factors on feeding practices. Of 402 mothers, 67% self-identified as Black and 33% as White. Forty-six percent were exclusively breastfeeding; 26% were mixed breast and formula feeding. The likelihood of exclusively breastfeeding was positively associated with percentage of network members who had breastfed; this association was stronger for mothers with exclusive networks than those with expansive networks ( = 2.74,  < 0.001 versus  = 1.78,  = 0.03). Black race was positively correlated with exclusive breastfeeding or mixed feeding for mothers with exclusive networks ( = 1.50,  = 0.046;  = 1.86,  = 0.02, respectively). Lower educational level was negatively correlated with exclusive breastfeeding; this correlation was stronger for mothers with exclusive networks ( = -1.91,  = 0.002 versus  = -1.70,  = 0.04). Lower educational level was also negatively correlated with mixed feeding for mothers with exclusive networks ( = -1.61,  = 0.02). Mothers' personal social network type likely moderates the relationship between sociodemographic variables and feeding practices. While the influence of having network members with breastfeeding experience is important, the magnitude of influence is stronger in exclusive networks.
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http://dx.doi.org/10.1089/bfm.2021.0037DOI Listing
May 2021

Pediatric Advance Care Planning and Families' Positive Caregiving Appraisals: An RCT.

Pediatrics 2021 Jun 6;147(6). Epub 2021 May 6.

Center for Translational Research and

Background And Objectives: Little is known about how families respond to pediatric advance care planning. Physicians are concerned that initiating pediatric advance care planning conversations with families is too distressing for families. We examined the effect of family centered pediatric advance care planning intervention for teens with cancer (FACE-TC) advance care planning on families' appraisals of their caregiving, distress, and strain.

Methods: In a randomized clinical trial with adolescents with cancer and their families conducted from July 2016 to April 2019 in 4 tertiary pediatric hospitals, adolescents and family dyads were randomly assigned at a 2:1 intervention/control ratio to either the 3 weekly sessions of FACE-TC (Advance Care Planning Survey; Next Steps: Respecting Choices; Five Wishes) or treatment-as-usual. Only the family member was included in this study. Generalized estimating equations assessed the intervention effect measured by Family Appraisal of Caregiving Questionnaire.

Results: Families' ( = 126) mean age was 46 years; 83% were female, and 82% were white. FACE-TC families significantly increased positive caregiving appraisals at 3-months postintervention, compared with those in the control group (β = .35; 95% confidence interval [CI] 0.19 to 0.36; = .03). No significant differences were found between groups for strain (β = -.14; 95% CI = -0.42 to 0.15; = .35) or distress (β = -.01; CI = -0.35 to 0.32; = .93).

Conclusions: Families benefited from participation in FACE-TC, which resulted in positive appraisals of their caregiving for their child with cancer, while not significantly burdening them with distress or strain. Clinicians can be assured of the tolerability of this family-supported model.
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http://dx.doi.org/10.1542/peds.2020-029330DOI Listing
June 2021

The Role of Religiousness and Spirituality in Health-related Quality of Life of Persons Living with HIV: A Latent Class Analysis.

Psycholog Relig Spiritual 2020 Nov 30;12(4):494-504. Epub 2020 Jan 30.

Children's National Hospital, Children's National Research Institute, Center for Translational Research, 111 Michigan Ave. NW, Washington, DC 20010.

Purpose: Understanding how religion and spirituality influence health-related quality of life (HRQoL) is important for developing holistic, patient-centered treatment. This study determined distinct latent classes of religiousness/spirituality for adult persons living with HIV (PLWH) and associations between latent class membership and HRQoL.

Methods: Baseline data was collected from 223 patients in the FAmily CEntered (FACE) Advance Care Planning (ACP) clinical trial for PLWH. Patients completed the Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS-adapted), Patient Health Questionnaire (PHQ-9), Medical Outcome Study-HIV Survey (MOS-HIV) and the Palliative care Outcome Scale (POS). The optimal number of latent classes was determined by comparing K-Class model with (K-1)-Class model iteratively. The relationship between latent class membership, HRQoL and demographic characteristics was assessed.

Results: Patients were 56.1% male, 86.1% Black/African American, aged 22-77 (Mean=50.83). 75.3% were Christian. LCA identified three classes: traditionally religious (35%), privately religious (47.1%), and spiritual but not religious (17.9%). MOS-HIV mental health ( < 0.001), MOS-HIV quality of life ( = 0.014) and MOS-HIV health transition ( = 0.016) scores were significantly higher among patients who were traditionally religious. These patients were more likely to be 40+ years and Black. Patients in the privately religious group had the lowest levels of mental health and HRQoL.

Conclusions: Understanding how religiousness and spirituality influence HRQoL can help the medical community develop holistic, patient-centered and culturally-sensitive interventions that could improve outcomes for PLWH and potentially mitigate the impact of health disparities within the Black and LGBTQ communities.
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http://dx.doi.org/10.1037/rel0000301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992907PMC
November 2020

The interaction of SKP2 with p27 enhances the progression and stemness of osteosarcoma.

Ann N Y Acad Sci 2021 04 16;1490(1):90-104. Epub 2021 Feb 16.

Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Osteosarcoma is a highly aggressive malignancy for which treatment has remained essentially unchanged for years. Our previous studies found that the F-box protein SKP2 is overexpressed in osteosarcoma, acting as a proto-oncogene; p27 (p27) is an inhibitor of cyclin-dependent kinases and a downstream substrate of SKP2-mediated ubiquitination. Overexpression of SKP2 and underexpression of p27 are common characteristics of cancer cells. The SCF E3 ligase ubiquitinates Thr187-phosphorylated p27 for proteasome degradation, which can be abolished by a Thr187Ala knock-in (p27 KI) mutation. RB1 and TP53 are two major tumor suppressors commonly coinactivated in osteosarcoma. We generated a mouse model with a double knockout (DKO) of Rb1 and Trp53 within cells of the osteoblastic lineage, which developed osteosarcoma with full penetrance. When p27 KI mice were crossed on to the DKO background, p27 protein was found to accumulate in osteosarcoma tumor tissues. Furthermore, p27 promoted apoptosis in DKO tumors, slowed disease progression, and significantly prolonged overall survival. RNA sequencing analysis also linked the SCF -p27 axis to potentially reduced cancer stemness. Given that RB1 and TP53 loss or coinactivation is common in human osteosarcoma, our study suggests that inhibiting the SKP2-p27 axis may represent a desirable therapeutic strategy for this cancer.
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http://dx.doi.org/10.1111/nyas.14578DOI Listing
April 2021

Advance Care Planning-Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT.

Am J Hosp Palliat Care 2021 Jun 3;38(6):634-643. Epub 2021 Feb 3.

Center for Translational Research/Children's Research Institute, Washington, DC, USA.

Context: The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied.

Objective: To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls.

Methods: Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis.

Findings: 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class.

Conclusion: ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.
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http://dx.doi.org/10.1177/1049909121991807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085073PMC
June 2021

Can respondent driven sampling be used to recruit new mothers? A mixed methods study in metropolitan Washington DC.

PLoS One 2021 2;16(2):e0246373. Epub 2021 Feb 2.

Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America.

Background: Respondent driven sampling (RDS) is employed to recruit populations that are hard-to-reach, "hidden," or without a sampling frame. For new mothers (those with infants <6 months) in countries without national health care systems or registries, there is no sampling frame, and random samples may only be attained through costly strategies, e.g., random-dial calling.

Objective: To assess the feasibility of RDS to recruit new mothers.

Methods: In the initial study, we recruited 30 new mothers ("seeds") from a single birth hospital; each was given 3 referral coupons to give to other mothers ("referrals"). When our sample did not self-perpetuate with referrals, additional seeds were recruited. Demographics of seeds and referrals were compared. A subset of mothers participated in focus groups and were asked about their experience with RDS. We also conducted a second survey of new mothers to further assess feasibility of RDS in this population.

Results: Of the 402 mothers recruited in the initial study, 305 were seeds and only 97 were referrals. Referrals were more likely to be White, highly educated, older, and privately insured (all p≤0.001). Focus group participants indicated that the time required to meet other mothers was an important barrier. In the second survey we recruited 201 mothers; only 53.7% knew ≥1 mother whom they could invite to the study.

Conclusions: New mothers are not easily recruited using RDS because they have a limited number of contacts who are also new mothers. Those recruited through RDS are more likely to be older, Caucasian and of high socioeconomic status, indicating it is not an effective way to recruit a representative sample of new mothers.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246373PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853470PMC
July 2021

A graphic guide to the percutaneous tripod acetabular reconstruction for metastatic cancer.

J Surg Oncol 2021 Apr 1;123(5):1316-1327. Epub 2021 Feb 1.

Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Symptomatic peri-acetabular metastatic lesions are often treated with open surgery such as modified Harrington procedures. In an effort to avoid surgical complications inherently associated with open surgical approaches, we developed and recently reported a novel Tripod percutaneous screw technique. The tripod technique is minimally invasive and was found to yield excellent outcomes regarding both pain control and functionality. The procedure is performed in a standard operative theater using fluoroscopic guided percutaneous screws. Despite the simplicity of intraoperative set-up and instrumentation, it is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging for even an experienced orthopedic surgeon. The technique and bony conduits were previously described in the trauma literature, however, there are key points of difference in the setting of metastatic disease. Here we provide a compilation of a stepwise graphic guide for the tripod model in the setting of metastatic peri-acetabular lesions, as well as the tips and tricks based on our own experience. These encompass preoperative preparation, operating room settings, intraoperative fluoroscopic guidance, postoperative care, and subsequent conversion to a cemented total hip arthroplasty, if needed.
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http://dx.doi.org/10.1002/jso.26409DOI Listing
April 2021

What Do Adults With HIV Want? End-of-Life Care Goals, Values and Beliefs by Gender, Race, Sexual Orientation.

Am J Hosp Palliat Care 2021 Jun 19;38(6):610-617. Epub 2021 Jan 19.

George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Objective: We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH).

Methods: 223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACE™-HIV Advance Care Planning clinical trial.

Findings: The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, = 0.0113; saving larger doses for worse pain, = 0.0067; and dying in the hospital, = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, = 0.0397, and less likely to only take pain medicines when pain is severe, = 0.0091.

Conclusion: Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.
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http://dx.doi.org/10.1177/1049909120988282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085160PMC
June 2021

Social network influences on new mothers' infant sleep adjustments.

Soc Sci Med 2021 01 6;269:113585. Epub 2020 Dec 6.

Department of Pediatrics University of Virginia, Charlottesville, VA, USA.

Despite public awareness campaigns, some parents continue to engage in infant sleep practices that are considered risky by health experts, such as bedsharing or placing their infants on their stomachs. This study examines the role their social networks play in shaping parents' responsiveness to new information and/or suggestions about how they should place their infants for sleep, paying attention to the respective effects of health professionals and their close interpersonal ties. We collected data from a sample of 323 new mothers in Washington, D.C., who described their infant sleep practices and perceived personal social networks. We find evidence that mothers' social networks play a significant role in the likelihood that they adjust their infant sleep practices within the first few months of their infants' lives. Mothers are more likely to change sleep practices when health professionals and/or (lay) family members advise them to do so. The influence of network members is not always positive. For mothers who initially follow safe practices, their probability of change increases if their network members substantially espouse unsafe practices. Among mothers with initially unsafe practices, network members' level of support for safe sleep practices is not predictive of the likelihood of sleep practice change. Implications for potential interventions are discussed.
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http://dx.doi.org/10.1016/j.socscimed.2020.113585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794038PMC
January 2021

The Effect of FAmily-CEntered (FACE) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families.

J Fam Nurs 2020 11;26(4):315-326

Children's National Hospital & Center for Translational Research, Washington, DC, USA.

Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE ( = 54 dyads) or control ( = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE intervention than control (β = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], = .008). Male family members were less anxious than female family members (β = -4.55, 95% CI = [-6.96, -2.138], .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (β = 3.32, 95% CI = [0.254, 6.38], = .034). Clinicians can be assured this structured, facilitated FACE pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.
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http://dx.doi.org/10.1177/1074840720964093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015181PMC
November 2020

Subjective Toxicity Profiles of Children in Treatment for Cancer: A New Guide to Supportive Care?

J Pain Symptom Manage 2021 06 20;61(6):1188-1195.e2. Epub 2020 Oct 20.

Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, District of Columbia, USA; Epidemiology and Biostatistics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.

Context: Children and adolescents with cancer experience treatment-related, subjective adverse events (AEs). Identifying distinct groups of patients who predictably experience higher prevalence of AEs could guide patient care.

Objectives: Study aims were to 1) identify groups of children and adolescents reporting AEs using the Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE); 2) determine whether demographic and clinical characteristics predict AE group membership; and 3) examine whether AE group membership was related to the distal outcome of psychological stress.

Methods: Four hundred seventy-seven patients self-reported AEs via the Ped-PRO-CTCAE at T1 (beginning of treatment) and the PROMIS Pediatric Psychological Stress measure at T2 (7-28 days later). Latent class analysis was conducted to identify groups of patients and the relationships of the groups with demographic and clinical characteristics, and with stress.

Results: Three distinct a priori unknown AE groups were identified (high AE prevalence, moderate AE prevalence, and low AE prevalence). Females, blacks, patients with high psychological stress, and patients more recently diagnosed were more likely to be in the high AE prevalence group. Gender, age, race, and time since diagnosis were associated with psychological stress.

Conclusion: Children with cancer are heterogeneous in experiencing subjective AEs. Gender, race, and time since diagnosis were significantly associated with higher subjective AE prevalence that may lead to psychological stress.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055722PMC
June 2021

Shared spiritual beliefs between adolescents with cancer and their families.

Pediatr Blood Cancer 2020 12 12;67(12):e28696. Epub 2020 Sep 12.

George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

Background: FAmily CEntered (FACE) Advance Care Planning helps family decision makers to understand and honor patients' preferences for future health care, if patients cannot communicate. Spiritual well-being is a key domain of pediatric oncology care and an integral dimension of pediatric advance care planning.

Procedure: As part of four-site randomized controlled trial of FACE for teens with cancer, the functional assessment of chronic illness therapy-spiritual well-being- version 4 (FACIT-Sp-EX-4) was completed independently by 126 adolescents with cancer/family dyads. The prevalence-adjusted and bias-adjusted kappa (PABAK) measured congruence on FACIT-Sp-EX-4.

Results: Adolescents (126) had mean age of 16.9 years, were 57% female and 79% White. Religious/spiritual classifications were: Catholic (n = 18), Protestant (n = 76), Mormon (n = 3), none/atheist (n = 22), other (n = 5), and unknown (n = 2). Agreement at item level between spiritual well-being of adolescents and families was assessed. Three items had ≥90% agreement and Excellent PABAK: "I have a reason for living," "I feel loved," "I feel compassion for others in the difficulties they are facing." Three items had <61% agreement and Poor PABAK: "I feel a sense of harmony within myself," "My illness has strengthened my faith or spiritual beliefs," "I feel connected to a higher power (or God)." Dyadic congruence was compared by social-demographics using median one-way analysis. Male family members (median = 72%) were less likely to share spiritual beliefs with their adolescent than female family members (median = 83%), P = .0194.

Conclusions: Family members may not share spiritual beliefs with adolescents and may be unaware of the importance of spiritual well-being for adolescents.
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http://dx.doi.org/10.1002/pbc.28696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699821PMC
December 2020

Wnt Signaling in Osteosarcoma.

Adv Exp Med Biol 2020 ;1258:125-139

Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Wnt molecules are a class of cysteine-rich secreted glycoproteins that participate in various developmental events during embryogenesis and adult tissue homeostasis. Since its discovery in 1982, the roles of Wnt signaling have been established in various key regulatory systems in biology. Wnt signals exert pleiotropic effects, including mitogenic stimulation, cell fate specification, and differentiation. The Wnt signaling pathway in humans has been shown to be involved in a wide variety of disorders including colon cancer, sarcoma, coronary artery disease, tetra-amelia, Mullerian duct regression, eye vascular defects, and abnormal bone mass. The canonical Wnt pathway functions by regulating the function of the transcriptional coactivator β-catenin, whereas noncanonical pathways function independent of β-catenin. Although the role of Wnt signaling is well established in epithelial malignancies, its role in mesenchymal tumors is more controversial. Some studies have suggested that Wnt signaling plays a pro-oncogenic role in various sarcomas by driving cell proliferation and motility; however, others have reported that Wnt signaling acts as a tumor suppressor by committing tumor cells to differentiate into a mature lineage. Wnt signaling pathway also plays an important role in regulating cancer stem cell function. In this review, we will discuss Wnt signaling pathway and its role in osteosarcoma.
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http://dx.doi.org/10.1007/978-3-030-43085-6_8DOI Listing
December 2020

Skp2 depletion reduces tumor-initiating properties and promotes apoptosis in synovial sarcoma.

Transl Oncol 2020 Oct 2;13(10):100809. Epub 2020 Jul 2.

Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. Electronic address:

Synovial sarcoma (SS) is an aggressive soft-tissue cancer with a poor prognosis and a propensity for local recurrence and distant metastasis. In this study, we investigated whether S phase kinase-associated protein (Skp2) plays an oncogenic role in tumor initiation, progression, and metastasis of SS. Our study revealed that Skp2 is frequently overexpressed in SS specimens and SS18-SSX transgenic mouse tumors, as well as correlated with clinical stages. Next, we identified that genetic depletion of Skp2 reduced mesenchymal and stemness markers, and inhibited the invasive and proliferative capacities of SS cell lines. Furthermore, Skp2 depletion markedly suppressed the growth of SS xenografts tumors. Treatment of SS cell lines with the skp2 inhibitor flavokawain A (FKA) reduced Skp2 expression in a dose-dependent manner and resulted in cell cycle arrest and apoptosis. FKA also suppressed the invasion and tumor-initiating properties in SS, similar to the effects of Skp2 knockdown. In addition, a combination of FKA and conventional chemotherapy showed a synergistic therapeutic efficacy. Taken together, our results suggest that Skp2 plays an essential role in the biology of SS by promoting the mesenchymal state and cancer stemness. Given that chemotherapy resistance is often associated with cancer stemness, strategies of combining Skp2 inhibitors with conventional chemotherapy in SS may be desirable.
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http://dx.doi.org/10.1016/j.tranon.2020.100809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334610PMC
October 2020

Association of Religious and Spiritual Factors With Patient-Reported Outcomes of Anxiety, Depressive Symptoms, Fatigue, and Pain Interference Among Adolescents and Young Adults With Cancer.

JAMA Netw Open 2020 06 1;3(6):e206696. Epub 2020 Jun 1.

Division of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC.

Importance: The associations of spiritual and religious factors with patient-reported outcomes among adolescents with cancer are unknown.

Objective: To model the association of spiritual and religious constructs with patient-reported outcomes of anxiety, depressive symptoms, fatigue, and pain interference.

Design, Setting, And Participants: This cross-sectional study used baseline data, collected from 2016 to 2019, from an ongoing 5-year randomized clinical trial being conducted at 4 tertiary-referral pediatric medical centers in the US. A total of 366 adolescents were eligible for the clinical trial, and 126 were randomized; participants had to be aged 14 to 21 years at enrollment and be diagnosed with any form of cancer. Exclusion criteria included developmental delay, scoring greater than 26 on the Beck Depression Inventory II, non-English speaking, or unaware of cancer diagnosis.

Exposures: Spiritual experiences, values, and beliefs; religious practices; and overall self-ranking of spirituality's importance.

Main Outcomes And Measures: Variables were taken from the Brief Multidimensional Measurement of Religiousness/Spirituality (ie, feeling God's presence, daily prayer, religious service attendance, being very religious, and being very spiritual) and the spiritual well-being subscales of the Functional Assessment of Chronic Illness Therapy (meaning/peace and faith). Predefined outcome variables were anxiety, depressive symptoms, fatigue, and pain interference from Patient-Reported Outcomes Measurement Information System pediatric measures.

Results: A total of 126 individuals participated (72 [57.1%] female participants; 100 [79.4%] white participants; mean [SD] age, 16.9 [1.9] years). Structural equation modeling showed that meaning and peace were inversely associated with anxiety (β = -7.94; 95% CI, -12.88 to -4.12), depressive symptoms (β = -10.49; 95% CI, -15.92 to -6.50), and fatigue (β = -8.90; 95% CI, -15.34 to -3.61). Feeling God's presence daily was indirectly associated with anxiety (β = -3.37; 95% CI, -6.82 to -0.95), depressive symptoms (β = -4.50; 95% CI, -8.51 to -1.40), and fatigue (β = -3.73; 95% CI, -8.03 to -0.90) through meaning and peace. Considering oneself very religious was indirectly associated with anxiety (β = -2.81; 95% CI, -6.06 to -0.45), depressive symptoms (β = -3.787; 95% CI, -7.68 to -0.61), and fatigue (β = -3.11, 95% CI, -7.31 to -0.40) through meaning and peace. Considering oneself very spiritual was indirectly associated with anxiety (β = 2.11; 95% CI, 0.05 to 4.95) and depression (β = 2.8, 95% CI, 0.07 to 6.29) through meaning and peace. No associations were found between spiritual scales and pain interference.

Conclusions And Relevance: In this study, multiple facets of spirituality and religiousness were associated with anxiety, depression, and fatigue, all of which were indirectly associated with the participant's sense of meaning and peace, which is a modifiable process. Although these results do not establish a causal direction, they do suggest palliative interventions addressing meaning-making, possibly including a spiritual or religious dimension, as a novel focus for intervention development.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.6696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298609PMC
June 2020

Congruence Gaps Between Adolescents With Cancer and Their Families Regarding Values, Goals, and Beliefs About End-of-Life Care.

JAMA Netw Open 2020 05 1;3(5):e205424. Epub 2020 May 1.

George Washington University School of Medicine and Health Sciences, Washington, DC.

Importance: Lack of pediatric advance care planning has been associated with poor communication, increased hospitalization, poor quality of life, and legal actions. Clinicians presume that families understand adolescents' treatment preferences for end-of-life care.

Objective: To examine patient-reported end-of-life values and needs of adolescents with cancer and congruence with their families' understanding of these needs.

Design, Setting, And Participants: This cross-sectional survey was conducted among adolescent-family dyads from July 16, 2016, to April 30, 2019, at 4 tertiary care pediatric US hospitals. Participants included 80 adolescent-family dyads (160 participants) within a larger study facilitating pediatric advance care planning. Adolescent eligibility criteria included being aged 14 to 21 years, English speaking, being diagnosed with cancer at any stage, and knowing their diagnosis. Family included legal guardians for minors or chosen surrogate decision-makers for those aged 18 years or older. Data analysis was performed from April 2019 to November 2019.

Exposure: Session 1 of the 3-session Family Centered Pediatric Advance Care Planning for Teens With Cancer intervention.

Main Outcomes And Measures: The main outcome was congruence between adolescents with cancer and their families regarding adolescents' values, goals, and beliefs about end-of-life care. Prevalence-adjusted and bias-adjusted κ (PABAK) values were used to measure congruence on the Lyon Advance Care Planning Survey-Revised (Patient and Surrogate versions).

Results: A total of 80 adolescent-family dyads (160 participants) were randomized to the intervention group in the original trial. Among the adolescents, 44 (55.0%) were female and 60 (75.0%) were white, with a mean (SD) age of 16.9 (1.8) years. Among family members, 66 (82.5%) were female and 65 (81.3%) were white, with a mean (SD) age of 45.3 (8.3) years. Family members' understanding of their adolescent's beliefs about the best time bring up end-of-life decisions was poor: 86% of adolescents wanted early timing (before getting sick, while healthy, when first diagnosed, when first sick from a life-threatening illness, or all of the above), but only 39% of families knew this (PABAK, 0.18). Families' understanding of what was important to their adolescents when dealing with their own dying was excellent for wanting honest answers from their physician (PABAK, 0.95) and understanding treatment choices (PABAK, 0.95) but poor for dying a natural death (PABAK, 0.18) and being off machines that extend life, if dying (PABAK, 0).

Conclusions And Relevance: Many families had a poor understanding of their adolescent's values regarding their own end-of-life care, such as when to initiate end-of-life conversations and preference for being off machines that extend life. Pediatric advance care planning could minimize these misunderstandings with the potential for a substantial impact on quality of care.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.5424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237980PMC
May 2020

Effect of FAmily CEntered (FACE®) Advance Care Planning on Longitudinal Congruence in End-of-Life Treatment Preferences: A Randomized Clinical Trial.

AIDS Behav 2020 Dec;24(12):3359-3375

George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Trial tested effect of advance care planning on family/surrogates' understanding of patients' end-of-life treatment preferences longitudinally. A multisite, assessor-blinded, intent-to-treat, parallel-group, randomized controlled clinical trial in five hospital-based HIV clinics enrolled 449 participants aged 22 to 77 years during October 2013-March 2017. Patients living with HIV/family dyads were randomized at 2:1 ratio to 2 weekly ~ 60-min sessions either ACP (n = 155 dyads)-(1) ACP facilitated conversation, (2) Advance directive completion; or Control (n = 68 dyads)-(1) Developmental/relationship history, (2) Nutrition/exercise tips. ACP families/surrogates were more likely to accurately report patients' treatment preferences at Time 1 (T) and 12 months post-intervention (T) compared to controls, experiencing high congruence longitudinally (high→high transition), [63·6% vs 37·7% (difference = 25·9%, 95% CI: 11·3%, 40·4%, χ = 11·52, p = 0·01)], even as patients' preferences changed over time. ACP families/surrogates had eight times the odds of controls of having an excellent understanding of patients' treatment preferences (Adjusted Odds Ratio 7.91, 95%CI: 3.08, 20.3). Conversations matter.
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http://dx.doi.org/10.1007/s10461-020-02909-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699823PMC
December 2020

Risk of Disordered Eating Behaviors in Adolescents with Type 1 Diabetes.

J Pediatr Psychol 2020 06;45(5):583-591

Children's National Hospital.

Objective: Management of type 1 diabetes (T1D) may be difficult for adolescents, who often fail to meet glycemic targets. Adolescents are also at an increased risk for negative affect (i.e., anxiety, depressive symptoms) and are prone to disordered eating behaviors (DEB). This study hypothesized that negative affect would be associated with DEB, self-management, and glycemic control, but that this would be moderated by negative urgency (the urge to engage in impulsive behaviors in response to negative affect), such that this relationship would be significant only for those with higher negative urgency.

Methods: The Eating in Adolescents with T1D Study recruited 100 caregiver-adolescent dyads (55% male youth, 48% Caucasian) to complete questionnaires reporting on the adolescent's negative affect, negative urgency, DEB, and diabetes management. Glycemic control 3-4 months following survey completion was extracted from the medical record.

Results: A total of 61% of adolescents reported elevated symptoms of anxiety or depression and 25% reported elevated disordered eating symptoms. A total of 81% of adolescents had an A1c level above recommended targets. Negative affect was associated with DEB, suboptimal T1D self-management, and suboptimal glycemic outcomes, moderated by higher levels of negative urgency. Negative affect was associated directly with suboptimal self-management and glycemic control, but not DEB, at all levels of negative urgency.

Conclusions: Adolescents reported high levels of negative affect, DEB, and suboptimal glycemic control. Interventions that target negative affect and negative urgency in adolescents with T1D are needed in order to reduce the risk for DEB and negative diabetes health outcomes.
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http://dx.doi.org/10.1093/jpepsy/jsaa027DOI Listing
June 2020

A Novel Tripod Percutaneous Reconstruction Technique in Periacetabular Lesions Caused by Metastatic Cancer.

J Bone Joint Surg Am 2020 Apr;102(7):592-599

Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Background: Metastatic lesions in the periacetabular region can cause pain and immobility. Symptomatic patients are often treated surgically with a total hip replacement using various modified Harrington methods. These open surgical procedures confer inherent risks. Prolonged recovery and potential complications may delay adjuvant radiation and systemic therapy.

Methods: We describe a novel technique for acetabular reconstruction. Three large-bore cannulated screws are placed percutaneously under fluoroscopy in a tripod configuration to reinforce the mechanical axes of the acetabulum. Increased stability improves pain control and permits weight-bearing.

Results: Twenty consecutive patients with periacetabular metastases were treated using the tripod technique. Eighteen patients (90%) had Harrington class-III lesions, and 2 patients had Harrington class-II lesions. The mean surgical time was 2.3 hours. Sixteen patients (80%) were able to get out of bed on postoperative day 1. At 3 months postoperatively, there was significant improvement in pain as documented on their visual analog scale (p < 0.01) and in functionality as measured by the Eastern Cooperative Oncology Group score (p < 0.01). The mean follow-up time was 7 months (range, 0.6 to 20 months). At the most recent follow-up, only 3 among the 16 surviving patients were using opioids chronically for pain. Total hip arthroplasty was performed in 4 patients (20%) in a staged fashion using the previously placed screws as support for a cemented cup and obviating the need for a cage device. Of the 16 patients, 15 could walk either independently (6 patients) or using an ambulatory aid (9 patients). Eight patients with the primary tripod reconstruction survived >6 months postoperatively. They were found to have either new bone formation filling the defects or healing of the pathological fractures. There has been no implant loosening or failure.

Conclusions: The tripod technique is a novel application to provide safe and effective pain relief in the context of periacetabular metastatic disease. It can be easily converted to support a cemented acetabular cup for a total hip replacement should disease progression occur. This technique provides an alternative to open surgery as currently practiced in these patients.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.19.00936DOI Listing
April 2020

Patterns of sexual health in patients with breast cancer in China: a latent class analysis.

Support Care Cancer 2020 Nov 14;28(11):5147-5156. Epub 2020 Feb 14.

School of Nursing, Fudan University, Shanghai, China.

Purpose: This study aimed to identify unobserved distinct latent classes/subgroups of breast cancer (BC) patients in China with respect to various sexual health measures and examine the association of the latent membership with individual characteristics.

Methods: In a cross-sectional study, 123 BC patients were analyzed. Their sexual health was measured using the Female Sexual Functioning Index (FSFI). Latent class analysis (LCA) was used to examine the patterns of sexual health in patients. Associations of the latent class membership with individual characteristics were examined using multinomial logistic regression.

Results: Three a priori unknown distinct latent classes of patients were identified with respect to the 19 FSFI sexual health measures: 50 patients (41.6%) were classified in class 1 "No Impairment Group," 49 patients (39.4%) in class 2 "Organic Sexual Dysfunction Group," and 24 patients (19.1%) in class 3 "Poor Sexual Health Group." Income and anxiety were positively, whereas disease duration was negatively associated with the likelihood of being in class 2 than in class 1, patients with recurrence of cancer were likely to be in classes 2 and 3. Patients classified in class 3 were more likely to have better prior body image and have more severe menopausal symptoms, whereas less likely to have better post body image and have better partner relationships.

Conclusion: The findings revealed the heterogeneity of sexual health among BC patients in China and may guide to identify the high-risk patients and enable early intervention.
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http://dx.doi.org/10.1007/s00520-020-05332-0DOI Listing
November 2020

Symptom- and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders.

Pediatr Nephrol 2020 05 9;35(5):807-814. Epub 2020 Jan 9.

Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA.

Background: Accurately diagnosing urinary tract infections (UTI) in children with neuropathic bladders can be difficult given the lack of specificity of both clinical symptoms and routine screening tests. We aimed to identify a priori unknown classes/groups of children with neuropathic bladder with respect to symptoms and UA results and examine their relationships with odds of UTI.

Methods: We used latent class analysis (LCA) to identify unobserved classes/groups of children with neuropathic bladder based on symptoms and urinalysis (UA) results, respectively. Demographic and clinical data were gathered by retrospective chart review of a cohort with neuropathic bladder. Symptoms and UA results were obtained by chart review of visits where urine culture was ordered.

Results: Around 193 patients were included in UA results analysis and 179 in symptom-based analysis. Two latent classes of patients were identified with respect to symptoms, labeled "pyelonephritis class" and "cystitis class," and two, with respect to UA results, were labeled "positive UA class" and "negative UA class." The pyelonephritis class had significantly higher odds of UTI compared to the asymptomatic class. While odds of UTI in cystitis class were higher than the asymptomatic class, this difference was not statistically significant. Positive UA class had significantly higher odds of UTI compared to negative UA class.

Conclusion: Two unobserved classes/groups exist in children with neuropathic bladder with respect to symptoms, corresponding to cystitis and pyelonephritis, and two classes of UA results that correspond with either a positive or negative UA. Our results suggest a differential approach to treatments may be considered.
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http://dx.doi.org/10.1007/s00467-019-04448-8DOI Listing
May 2020

Racial Minority Families' Preferences for Communication in Pediatric Intensive Care Often Overlooked.

J Natl Med Assoc 2020 Feb 22;112(1):74-81. Epub 2019 Oct 22.

Children's National Health System, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Objective: To compare the communication experiences and preferences of racial/ethnic minority and non-Hispanic white (NHW) families in the pediatric intensive care unit (PICU), including their interactions with bedside nurses.

Methods: Retrospective cohort study performed at a quaternary university-affiliated children's hospital with 70 pediatric intensive care beds. From October 2013 to December 2014, English-speaking family members of children admitted to the PICU were asked about their experiences communicating with PICU caregivers using a survey tool.

Results: 107 participants were included for analysis, of which 60 self-identified as a racial minority and 47 as NHW. Overall, 11% of families chose family meetings as their preferred setting for receiving information, as compared to family-centered rounds or unplanned bedside meetings. Only 50% of those with a family meeting felt they learned new information during the meeting. Chi-square statistics or Fisher's exact tests showed that minority families were less likely to report their bedside nurses spent enough time speaking with them (minority 67%, NHW 85%; p = 0.03) and less likely to receive communication from the medical team in their preferred setting (minority 63%, NHW 85%; p = 0.01). Logistic regression, controlling for covariates including education, insurance, and risk of mortality, showed that the relationship between minority status and concordance of preferred setting persisted (OR = 0.32, 95% C·I.: 0.11, 0.91).

Conclusion: In general, families of PICU patients prefer meeting with the medical team during rounds or unplanned bedside meetings as opposed to formal family meetings. Despite this preference, minority families are less likely to receive communication from the medical team in their preferred settings. Meeting all families' communication setting needs may improve their communication experiences in the PICU.
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http://dx.doi.org/10.1016/j.jnma.2019.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073286PMC
February 2020

Parental Conflict, Regret, and Short-term Impact on Quality of Life in Tracheostomy Decision-Making.

Pediatr Crit Care Med 2020 02;21(2):136-142

Children's Research Institute at Children's National Health System, Children's National Health System, Washington, DC.

Objectives: The prevalence of tracheostomy-dependence in critically ill children is increasing in the United States. We do not know the impact of this decision on parental outcomes. We aimed to determine the prevalence of decisional conflict and regret and explore the impact on quality of life among parents considering tracheostomy placement for their child.

Subjects: Parents facing tracheostomy decision for their child.

Design: Prospective, mixed-methods longitudinal study.

Setting: PICU, cardiac ICU, and neonatal ICU of a single quaternary medical center.

Interventions: None.

Measurements And Main Results: Parents completed a decisional conflict survey at the time of tracheostomy decision and decisional regret and quality of life surveys at 2 weeks and 3 months after the decision regarding tracheostomy placement was made. We enrolled 39 parents, of which 25 completed surveys at all three time points. Thirty-five of 39 (89.7%) reported at least some decisional conflict, most commonly from feeling uninformed and pressured to make a decision. At 2 weeks, 13 of 25 parents (52%) reported regret, which increased to 18 of 25 participants (72%) at 3 months. Regret stemmed from feeling uninformed, ill-chosen timing of placement, and perceptions of inadequate medical care. At 2 weeks, the quality of life score was in the mid-range, 78.8 (SD 13.8) and decreased to 75.5 (SD 14.2) at 3 months. Quality of life was impacted by the overwhelming medical care and complexity of caring for a child with a tracheostomy, financial burden, and effect on parent's psychosocial health.

Conclusions: The decision to pursue tracheostomy among parents of critically ill children is fraught with conflict with worsening regret and quality of life over time. Strategies to reduce contributing factors may improve parental outcomes after this life-changing decision.
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http://dx.doi.org/10.1097/PCC.0000000000002109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007816PMC
February 2020

The influence of religious beliefs and practices on health care decision-making among HIV positive adolescents.

AIDS Care 2020 07 19;32(7):896-900. Epub 2019 Sep 19.

Division of Adolescent and Young Adult Medicine, Children's National, Washington, DC, USA.

It is unknown if religiousness/spirituality influences end-of-life treatment preferences among adolescents. Investigators assessed whether religiousness/spirituality moderates the relationship between an advance care planning intervention and end-of-life treatment preferences among 85 primarily African-American adolescents living with HIV/AIDS in outpatient-hospital-based HIV-specialty clinics in the United States. Adolescents aged 14-21 years living with HIV/AIDS and their families were randomized to three-weekly-60-minute sessions either: advance care planning (survey, goals of care conversation, advance directive); or control (developmental history, safety tips, nutrition/exercise). At 3-months post-intervention the intervention effect ( the likelihood of choosing to continue treatments in ) was significantly moderated by religiousness/spirituality. Highly religious/spiritual adolescents were four times more likely to choose to continue treatments in . Thus, intensive treatments at end-of-life may represent health equity, rather than health disparity. The belief believed that HIV is a punishment from God at baseline (15%, 14/94) was not associated with end-of-life treatment preferences. Twelve percent (11/94) reported they had stopped taking HIV medications for more than 3 days because of the belief in a miracle. Religiousness moderates adolescent's medical decision-making. Adolescents who believe in miracles should receive chaplaincy referrals to help maintain medication adherence.
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http://dx.doi.org/10.1080/09540121.2019.1668523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080568PMC
July 2020

Mediation Analysis of Peer Norms, Self-Efficacy, and Condom Use Among Chinese Men Who Have Sex with Men: A Parallel Process Latent Growth Curve Model.

Arch Sex Behav 2020 01 18;49(1):287-297. Epub 2019 Sep 18.

Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China.

The objective of this study was to examine direct and indirect relationships among peer norms, self-efficacy, and condom use among Chinese men who have sex with men (MSM). A longitudinal study determined the effectiveness of a condom use video promotion among Chinese MSM in 2015. In this analysis, 804 Chinese MSM were recruited at baseline and then followed at 3 weeks and 3 months after the intervention. Parallel process latent growth curve modeling (LGM) with multiple indicators and bootstrapping was conducted using Mplus 7.4. The LGM model fit indexes were good with RMSEA = 0.046, 90% CI (0.044, 0.048), CFI = 0.956, TLI = 0.955. Our results showed that the initial measure of peer norms affected the initial measure of condom use indirectly through the initial measure of self-efficacy (αβ = 0.414, 95% CI 0.260-0.759). The rate of change in peer norms over time also significantly affected the rate of change in condom use through the rate of change in self-efficacy (αβ = 0.101, 95% CI 0.014-0.262). Self-efficacy mediated the association between peer norms and condom use, indicating a strong potential of causal relationship between peer norms and self-efficacy among Chinese MSM.
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http://dx.doi.org/10.1007/s10508-019-1459-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187081PMC
January 2020

Distribution of circulating tumor cell phenotype in early cervical cancer.

Cancer Manag Res 2019 17;11:5531-5536. Epub 2019 Jun 17.

Radiotherapy Department, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, People's Republic of China.

Circulating tumor cells (CTCs) can be classified into three phenotypes based on epithelial-to-mesenchymal transition (EMT) markers, including epithelial CTCs, mesenchymal CTCs, and mixed phenotypic CTCs. This study is aimed to analyze the correlation between CTC phenotypes and the clinicopathological features of patients with early cervical cancer. Peripheral blood samples were obtained from 90 patients with early cervical cancer. CTCs were isolated and classified. The correlations of CTC counts and CTC phenotypes with clinicopathological features of patients were analyzed. The positivity rate for CTCs in patients with stage I-IIA cervical cancer was 90%. An increased CTC number was observed in patients with FIGO stage II, pelvic lymph node metastasis, and lymphovascular involvement. There were 38.89% epithelial CTCs, 23.33% mesenchymal CTCs, and 14.44% mixed phenotypic CTCs, Mesenchymal CTCs were more common in patients with FIGO stage II, pelvic lymph node metastasis, lymphovascular involvement, and deep stromal invasion. CTCs with mesenchymal phenotypes are closely related to pelvic lymph node metastasis and lymphatic vascular invasion in stage I-IIA cervical cancer. Detection of circulating tumor cell phenotypes is helpful for the early diagnosis of cervical cancer micro-metastasis and for the assessment of disease status.
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http://dx.doi.org/10.2147/CMAR.S198391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588089PMC
June 2019

Family caregivers of children and adolescents with rare diseases: a novel palliative care intervention.

BMJ Support Palliat Care 2019 Jul 25. Epub 2019 Jul 25.

Biostatistics, Children's National Health System, Washington, DC, USA.

Objective: To develop and pilot test a palliative care intervention for family caregivers of children with rare diseases (FAmily-CEntered pediatric Advance Care Planning-Rare (FACE-Rare)).

Methods: FACE-Rare development involved an iterative, family-guided process including review by a Patient and Family Advisory Council, semistructured family interviews and adaptation of two evidence-based person-centred approaches and pilot testing their integration. Eligible families were enrolled in FACE-Rare (the Carer Support Needs Assessment Tool (CSNAT) Approach Paediatric sessions 1 and 2; Respecting Choices Next Steps pACP intervention sessions 3 and 4). Satisfaction, quality of communication and caregiver appraisal were assessed.

Results: Parents were mean age 40 years, and children 7 years. Children's diseases were rare enough that description would identify patients. All children were technology dependent. Telemedicine, used with four of seven families, was an effective engagement strategy and decreased subject burden. Families found FACE-Rare valuable following a strategy that elicited palliative care needs and a support plan. Eight families were approached for pilot testing. Of the seven mothers who agreed to participate, six began session 1, and of those, 100% completed: all four FACE-Rare sessions, baseline and 2-week postintervention assessments, and a written pACP which described their preferences for medical decision-making to share with their providers. 100% reported FACE-Rare was helpful. The top three CSNAT concerns were: knowing what to expect in the future, having enough time for yourself and financial issues. Benchmarks were achieved and questionnaires were acceptable to parents and thus feasible to use in a larger trial.

Conclusions: FACE-Rare provides an innovative, structured approach for clinicians to deliver person-centred care.
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http://dx.doi.org/10.1136/bmjspcare-2019-001766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040699PMC
July 2019
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