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With 7.3% of children under the age of 18 experiencing the death of a parent and more who experience a loss of a loved one bereavement is a common experience in the lives of children and youth. The current study sought to evaluate the effectiveness of an 8-week, school-based grief group treatment program in reducing symptoms of grief, dysregulation, and improving social support. A total of 296 children and youth (age 11-18) participated in the grief programming provided by a local hospice agency. With a retention rate of 76% the researchers identified a significant reduction in grief symptomology, frequency of emotion dysregulation, and a significant increase in perceived social support from pre- to post-8-week school-based grief programming. A reduction in intensity of dysregulation was not significant. Implications for school personnel and parental support of children and youth experiencing loss are discussed., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Our objective was to assess human immunodeficiency virus (HIV) knowledge and sexual behaviors in 294 perinatally HIV-infected youth aged 18 to 25 years from a psychosocial support group in Kampala using a self-administered survey. Seventy-nine percent reported an undetectable viral load, 9.5% detectable, and 12% did not know. Of those with sexual partners, 19% did not know the HIV status of their partner, 64% knew negative, and 22% knew positive. Sixty-two percent disclosed their HIV status to their partner. Seventy-two percent of participants previously had sex, and of those, 57% were sexually active in the last three months. Sixty-eight percent of participants used methods to prevent pregnancy. Seventy percent of participants denied physical, sexual, or emotional intimate partner violence. There was good adherence to antiretroviral therapy and a high proportion of contraceptive use, highlighting the importance of integrating these topics into psychosocial support programs for youth living with HIV., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Participation on a collaborative team is an attractive option for conducting research, especially in pediatric hematology/oncology nursing, where the patient population is small. The Consortium to Study Symptoms in Adolescents and Young Adults with Cancer (CS 2 AYAC) is a nursing research team that has been in existence for over a decade. Purpose: The authors share the process by which CS 2 AYAC formed and describe key features that contribute to its sustainability. Results: While the team developed organically rather than via the tenets of team science, key aspects of success include principles related to mentorship, communication, building trust, establishing shared goals, and managing conflict. Conclusions: This description of one team's experience may help other nurses build their own teams for research. Strong, collaborative research teams will advance pediatric hematology/oncology nursing science and scholarship and can be an important source of collegiality and support.

The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses' operational definition of PRC, (2) nurses' roles in PRC, and (3) nurses' preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.

Objective: To review primary literature of gastric acid suppressive agents and vitamin B 12 deficiency., Data Synthesis: From the published articles, proton pump inhibitors (PPIs) are associated with a higher risk of inducing vitamin B 12 deficiency than histamine-2 receptor antagonists (H2RAs). Literature suggests that there is an increased risk of developing vitamin B 12 deficiency in patients who are exposed to extended durations of therapy with PPIs. There are, however, some conflicting data in elderly patients suggesting that the PPI use for more than 3 years does not increase the risk of vitamin B 12 deficiency. No evidence was found to support the extended use of H2RA monotherapy causing vitamin B 12 deficiency. The inconsistency of results reported could be due to the differing patient populations studied, such as Zollinger-Ellison syndrome (ZES) and elderly patients. Overall, the lack of consistent evidence shows the need for more research in this area., Conclusion: To investigate the clinical significance of vitamin B 12 deficiency caused by acid suppression with PPIs and H2RAs, longer prospective studies are needed. These studies should focus on patient-centered outcomes to accurately determine the extended usage of PPI and H2RA and the true effects on vitamin B 12 deficiency.

Developing an abstract for presentation at a professional meeting is an important means for pediatric hematology/oncology nurses to disseminate results of research and scholarly projects. Although the process for developing a successful abstract may be viewed as challenging, attention to directions for composing the abstract as well as seeking mentorship can result in a submission that is accepted for presentation.

Symptom management research is a priority for both children and adults with cancer. The UCSF Symptom Management Theory (SMT) is a middle range theory depicting symptom management as a multidimensional process. A theory analysis using the process described by Walker and Avant evaluated the SMT with attention to application in research involving children with cancer. Application of the SMT in studies involving children has been limited to descriptive studies testing only portions of the theory. Findings of these studies have provided empiric support for the relationships proposed within the SMT. Considerations for future research involving children include attention to measurement of symptoms and clarity regarding the location of the parents and family within the model. With additional testing and refinement, the SMT has the potential to guide nursing research and practice to improve symptoms for children with cancer.

As the scope of pediatric hematology and oncology nursing expands, nurses are challenged with staying current in the evidence guiding their practice. Nurse-reported barriers to accessing and utilizing research include lack of time as well as difficulty in accessing, understanding, and synthesizing findings. Journal clubs provide a process to guide nurses in the review of current literature related to their practice and promote utilization of research and evidence-based practice among nurses. This article describes the transition of an in-person journal club to an electronically delivered "Article of the Month." The "Article of the Month" is offered six times each year and is posted on the service line's password-protected intranet website. Oversight of the "Article of the Month" is provided by the service line clinical nurse specialist who selects articles based on an annual learning needs assessment and develops a quiz to assess learning and promote critical thinking among nursing staff. Outcomes include anecdotal reports of increased staff confidence in managing emergent patient care needs and greater appreciation of nursing care issues for children with cancer. Areas for future development include exploring options for increasing in-person discussion of issues addressed in the "Article of the Month" among staff members, extending the "Article of the Month" to nurses in other service areas who care for children with cancer, and increasing staff participation in article selection and quiz item development. An ultimate goal is to develop formal evaluation strategies to link this educational strategy to clinical outcomes.

As the number of specialty pediatric oncology units increases, many units are hiring increasing numbers of newly graduated registered nurses. Intense specialty training and an emotionally demanding work environment place new nurses at risk for job frustration and early job resignation. The purpose of this study is to investigate experiences of pediatric oncology nurses during their first year of hire using a phenomenological approach. Participants were 6 nurses employed on an inpatient pediatric oncology unit in a tertiary care center located in the Intermountain West. A purposive sampling approach was used. Data were collected via semistructured interviews, which were analyzed for specific statements and themes providing description and meaning to nurses' experiences. Eleven themes in the categories of professional role development, a unique practice, and personal reflection were identified. Practice implications include supporting new nurses beyond the acquisition of skills and knowledge and including opportunities for personal reflection as part of the orientation experience. Successful role development is essential to ensure the retention of new pediatric oncology nurses as well as their future achievements within the subspecialty.

There is much discussion about the appropriate timing and intensity of rehabilitation after reconstruction of the anterior cruciate ligament with a patellar tendon autograft. The purpose of this study was to look at two extremes (complete immobilization and vigorous, forced exercise) on the extent of scar formation and mechanical properties of the host tendon. Three groups of six Flemish Giant rabbits had the central third patellar tendon removed in one limb. Group I was sacrificed immediately after surgery. Group II was exercised on a treadmill for 12 weeks. In Group III the limb was immobilized for 12 weeks. After 3 months, average length and cross-sectional area from Group II were greater than those of the controls and Group III tendons. Structural properties of all tests limbs were similar to each other but different from controls. Tensile modulus of Group III tendons did not decrease as much that of Group II tendons. Histology revealed a clear demarcation between the central defect and host tendon in Group III, whereas Group II tendons remodeled throughout their cross-sections. We propose that early joint mobility produces large multiaxial stresses in original tendon leading to microdamages and repair processes within the entire host tissue. Less aggressive exercise or delay in joint mobility may help control tissue remodeling.

Three groups of dogs were used for this study. All dogs had the medial third of the patellar tendon removed from one knee, while the contralateral knee was used as a control. The time zero group was immediately sacrificed; the other two groups were sacrificed at 3 and 6 months. Once the tissues were harvested, the patellar tendon was isolated and biomechanical and histologic analyses were conducted. Three and 6 months after surgery, there was a large amount of visible scar tissue in the tendon. The cross-sectional area of the tendons was 275% and 288% of controls at 3 and 6 months, respectively. The tensile modulus of the tendon was statistically less than controls at both 3 and 6 months. The energy to failure and stiffness of the operated tendons were not statistically different than controls at 3 or 6 months after surgery. The results of this study directly contrast with those of an earlier study of the removal of the central third of the patellar tendon. While a number of factors could explain differences observed between removal of a central or medical third, this study confirms the short-term damaging effects of surgical removal of a portion of the patellar tendon to reconstruct a torn anterior cruciate ligament.