Pediatric hospice has become an important service for children and their families in the past decade. In this article we present unique aspects of StarShine, the hospice of Children's Hospital Medical Center in Cincinnati, Ohio. Length-of-service data demonstrate the need to find innovative ways of encouraging earlier referral to hospice. Several specialized aspects of care, such as long-term bereavement, pet visitation and social services for the family are presented. The initiation of a novel in-home pain management program is described. StarShine has not followed an adult hospice model, and as such, we discuss those unique aspects of dying pediatric patients and suggest specific solutions and interventions designed for children.

Child↗

PubMedDate not supplied

The effects of different percentages of dietary fat intake, exercise, and calorie restriction on body composition and body weight in obese females.

PURPOSE: The goal of this study was to determine the effect of varying the amount of dietary fat, while holding calories at 1,200 kcals/day, on body weight and percent body fat in 35 obese women. DESIGN: A pretest, midtest, posttest experimental design was employed, and subjects were randomly divided into one of four dietary fat groups, with 10%, 20%, 30%, or 40% of caloric intake as dietary fat. INTERVENTION: Subjects consumed 1,200 kcals/day and a specified percentage of total energy as fat, depending on their dietary group. Protein was held constant at 20%. All subjects engaged in a five day/week walking program. SETTING: Participants were recruited from the general community using newspaper advertisements. SUBJECTS: Thirty-five obese women 25 to 45 years of age (means=38 +/- 4.97) served as subjects. All were at least 20% above ideal weight and 30% to 52% body fat. MEASURES: Percent body fat, body weight, and anthropomorphic measurements were taken at baseline, six and 12 weeks. Dietary intake was recorded daily by each subject, and exercise walking logs were maintained by each participant. RESULTS: All subjects lost body weight and body fat; however, there were no significant differences in the rate or amount of body weight or percent body fat lost across the four groups during the intervention. CONCLUSIONS: It appears that during calorie restriction and exercise for 12 weeks, percent of calories derived from dietary fats does not influence loss of body weight or percent body fat in adult obese women.

Adult↗

PubMedDate not supplied

Pre-dialysis education. A change in clinical practice. How effective is it?

The last decade has seen a great expansion in the provision of pre-dialysis education within the UK, with our programme in operation since 1996. In order to evaluate its impact on patient care, two methodologies were employed: the first used a satisfaction survey with which to examine patient perception of the programme; the second approach examined resource utilisation, in particular length of stay, as an outcome measure. Difficulties have arisen in discerning the impact of the programme amongst the other education interventions to which the patient is exposed. Comparative length of stay data was used as an alternative means of assessment. The results of the audit led us to question the effectiveness of the methodology that we employed and has led us to propose the development of a standard. It is hoped that the adoption of a more structured approach will not only aid the effectiveness of the programme itself but also facilitate the evaluation process.

Humans↗

PubMedDate not supplied

Incidence of anti Hsp 90 and 70 antibodies in children with SLE, juvenile dermatomyositis and juvenile chronic arthritis.

OBJECTIVE: To determine the incidence of anti-hsp90 and 70 antibodies in children with SLE, juvenile dermatomyositis and juvenile chronic arthritis. METHODS: We utilized a previously described ELISA to detect the presence of antibodies to mammalian hsp90 and 70 in 33 children with SLE, 55 with juvenile chronic arthritis (JCA) and 11 with dermatomyositis. Sera from 19 children with non-autoimmune conditions served as controls. RESULTS: Antibodies reactive with hsp90 and/or 70 were detected in 35% of the children with SLE, and the numbers of children with SLE who have raised IgG anti-hsp90 antibodies (24%) is very similar to our adult onset cases, although the prevalence of IgM antibodies is much smaller. However, serum antibodies to hsp70 were as infrequent in children with SLE or JCA as in adults with SLE or RA, although IgG antibodies to hsp70 were detected in 50% of the synovial fluid of JCA patients. CONCLUSION: The incidence of antibodies to hsp90 in childhood-onset SLE resembles that described in adult onset disease suggesting that, despite clinical differences between the two, a subset of each may share a similar pathological mechanism of disease.

Adolescent↗