Parent reports of children’s working memory,coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study

Neurocognitive problems in childhood survivors of brain tumors are well documented. Further, research has shown that problems in cognitive functioning may be associated with impairment in the use of complex strategies needed to cope with stress, including secondary control coping strategies (e.g., acceptance and cognitive reappraisal) which have been associated with fewer adjustment problems. The present study measured cognitive function, coping strategies, and adjustment in children ages 6–16 years at the time of brain tumor diagnosis and at two follow-up time-points up to 1 year post-diagnosis. In a prospective design, working memory was assessed in a total of 29 pediatric brain tumor patients prior to undergoing surgery, child self-reported coping was assessed at 6 months post-diagnosis, and parent-reported child adjustment was assessed at 12 months post-diagnosis. Significant correlations were found between working memory difficulties and secondary control coping. Secondary control coping was also negatively correlated with child attention and total problems. Regression analyses did not support secondary control coping mediating the association between working memory difficulties and child attention or total problems. These findings represent the first longitudinal assessment of the association between working memory, coping, and adjustment across the first year of a child’s brain tumor diagnosis and suggest a possible role for early interventions addressing both working memory difficulties and coping in children with brain tumors.     

Increasing Utilization of Cancer Genetic Counseling Services Using a Patient Navigator Model

Rarely has utilization of genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) been studied separately from utilization of testing. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic counseling. To increase the volume of genetic counseling appointments, a patient navigator approach was pilot tested in a randomized-controlled trial over 3 months. A total of 125 members were referred for HBOC genetic counseling (55 randomized to PN, 70 randomized to usual care). Utilization of referrals for Navigator-assisted members was 44%, compared to 31% in the usual care arm (p=0.16). The patient navigator significantly decreased time to appointment, with over 80% of Navigator-assisted members seen for genetic counseling less than three months from referral date, compared to 32% in usual care (p=0.002). patient navigator assistance shortens time from referral to appointment for HBOC genetic counseling, and may increase utilization of such services.     

Risk Assessment and Genetic Counseling for Hereditary Breast and Ovarian Cancer: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial and ethical implications of identifying at-risk individuals for hereditary breast and ovarian cancer (HBOC) through cancer risk assessment, with or without genetic susceptibility testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors’ Familial Cancer Risk Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment as well as the professional expertise of genetic counselors with significant experience in education and counseling regarding hereditary breast and ovarian cancer. Critical components of the process include the ascertainment of medical and family histories, determination and communication of cancer risk, assessment of risk perception, education regarding the genetics of HBOC, discussion of molecular testing for HBOC if appropriate (including benefits, risks and limitations) and any necessary follow-up. These recommendations do not dictate an exclusive course of management or guarantee a specific outcome. Moreover, they do not replace the professional judgment of a health care provider based on the clinical situation of a client.     

Recommendations from Multi-disciplinary Focus Groups on Cascade Testing and Genetic Counseling for Fragile X-associated Disorders

The purpose of this paper is to report the outcome of a collaborative project between the Fragile X Research and Treatment Center at the Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute at the University of California at Davis, the National Fragile X Foundation (NFXF), and the Centers for Disease Control and Prevention (CDC). The objective of this collaboration was to develop and disseminate protocols for genetic counseling and cascade testing for the multiple disorders associated with the fragile X mental retardation 1 (FMR1) mutation. Over the last several years, there has been increasing insight into the phenotypic range associated with both the premutation and the full mutation of the FMR1 gene. To help develop recommendations related to screening for fragile X-associated disorders, four, two day advisory focus group meetings were conducted, each with a different theme. The four themes were: (1) fragile X-associated tremor/ataxia syndrome (FXTAS); (2) premature ovarian failure (POF) and reproductive endocrinology; (3) psychiatric, behavioral and psychological issues; and (4) population screening and related ethical issues.     

个体化医疗和大数据时代的机遇和挑战

随着分子生物学的发展,高通量测序技术的引入和“大数据”处理能力的提高,现代医学正在经历巨大的变革,由传统的标准化医疗模式向个体化医疗模式转变。随着人类基因组计划和DNA元素百科全书计划的完成及人类和肿瘤基因图谱的绘制,我们正逐步解开人类基因组的奥秘。这极大地推进了人们对疾病,尤其是对肿瘤的认识。作为疾病诊断的“金标准”,病理学也在经历着深刻的变革,逐渐向个体化病理学发展。个体化医疗时代的到来,使医学各领域和社会多方面都面临新的机遇和挑战。     

妇科恶性肿瘤患者保留女性正常生理功能的思考

妇科医生需重视对妇科恶性肿瘤患者进行保留女性正常生理功能的治疗。对少女、育龄期妇女及早期患者治疗恶性肿瘤的同时,应尽量保留其正常的生理功能。需对患者进行全面评估,严格掌握实施保留生育功能手术的适应证;为预防放化疗对卵巢功能的损害,可以采取卵巢移位、卵巢组织冷冻移植,也可通过辅助生殖技术进行未成熟卵泡培养、卵子冷冻、卵母细胞冷冻及胚胎冷冻等。     

螺旋CT小肠造影及传统气钡双重对比造影检查在诊断小肠肿瘤性疾病中的价值比较

为了探讨螺旋CT小肠造影（CT enterograph,CTEG）及传统气钡双重对比造影检查在诊断小肠肿瘤性疾病中的价值。回顾性分析小肠肿瘤50例,患者先后行CTEG及传统气钡双重对比造影检查,所得图像由3位放射科医师进行评价。结果显示,50例小肠肿瘤性病变CTEG检查敏感性94％,准确性90％。传统气钡双重对比造影检查敏感性100％,准确性86％。两种方法相结合准确性98％。CTEG及传统气钡双重对比造影检查结合应用可作为小肠肿瘤诊断和评估治疗的必要的检查方法。     

骨巨细胞瘤外科治疗几个问题的思考

骨巨细胞瘤是临床上常见的骨肿瘤,其治疗方式由以前的截肢术发展到保肢术,一直到现在的多种局部切除与功能重建方式,透过其治疗理念的更新,以及手术技术的转变,不难看出临床医生应重视循证医学实践,不断更新观念,坚持个体化治疗,明确切除范围、切除方式与重建方法及肢体功能之间的关系,不断改善患者的生活质量。     

女性盆腔结核的误诊分析

结核病近年来呈全球性回升趋势。肺结核由于具有比较典型的症状、体征而较易诊断。而肺外结核尤其是女性盆腔腹膜结核,临床表现多样,无特异性诊断指标,误诊误治的情况屡见不鲜。现就女性盆腔结核性包块正确的诊断方法作一综述。     

对肿瘤研究的思考：观测与结果

从哲学的角度,对肿瘤研究中的常用方法即观测与测定进行了理性的思考,探讨理论背景、观测仪器和测量过程对观测和测量的结果存在影响,肿瘤发生机理的基因异常理论的片面性,提出肿瘤发生的非平衡自组织观点、亚细胞水平成分测不准的可能性和肿瘤细胞及机体研究的黑箱方法。