Karen Moody - Academia.edu (original) (raw)
Papers by Karen Moody
Journal of Palliative Medicine, 2018
Background: The Institute of Medicine and the American Academy of Pediatrics has called for impro... more Background: The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives. Design: A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatric faculty on facilitating the PPC-PBL. In Part 1, students identified domains of palliative care for a child with refractory leukemia and self-assigned questions to research and present at the follow-up session. In Part 2, students were expected to develop a care plan demonstrating the three PPC objectives. Measurements: Measures included a knowledge exam and a survey instrument to assess secondary outcomes. Results: Students' declarative knowledge, perceived exposure, and self-assessed competency in all three PPC learning objectives improved significantly after the PPC-PBL, p = 0.002, p < 0.001, and p < 0.001, respectively. There were no significant differences in faculty knowledge test scores from baseline to follow-up, but scores were generally high (median >80%). Students and faculty rated palliative care education as ''important or very important'' at baseline and follow-up. Conclusions: This study suggests that key concepts in PPC can be taught to medical students utilizing a PBL format and pediatric faculty resulting in improved knowledge and self-assessed competency in PPC.
Children
The pain and suffering of children with cancer became national news in the winter of 2000 with th... more The pain and suffering of children with cancer became national news in the winter of 2000 with the publication of Wolfe’s landmark paper in the New England Journal of Medicine, “Symptoms and Suffering Children with Cancer” [...]
Children
Terminal cancer pain remains one of the most distressing aspects of pediatric oncology practice. ... more Terminal cancer pain remains one of the most distressing aspects of pediatric oncology practice. Opioids are the cornerstone of cancer pain management at end-of-life and fortunately, most pain at end-of-life can be managed successfully. This article presents a practical step-by-step approach to alleviating pediatric terminal cancer pain, which can be delivered across settings.
Children
Background: Professional education pertaining to end-of-life care with pediatric oncology patient... more Background: Professional education pertaining to end-of-life care with pediatric oncology patients is limited. Pediatric trainees learn about end-of-life conversations largely from the provider’s perspective. Bereaved parents can inform the education of oncologists and the interdisciplinary team by sharing their perceptions and preferences through personal narratives. Methods: The aim of this project was to enhance the healthcare teams’ understanding of bereaved parents’ end-of-life care preferences through narratives. Bereaved parents were recruited from our institution’s Pediatric Supportive Care Committee membership. Parents were tasked with identifying elements of care that were of the greatest importance to them, based upon their personal experiences during their child’s end-of-life care. Narratives were analyzed using standard qualitative methods. Results: Parents of five patients participated, including four mothers and three fathers. Ten themes summarizing essential elements...
Palliative Care in Pediatric Oncology, 2017
Pediatric oncology has the potential to bring joy and job satisfaction and enrich the lives of he... more Pediatric oncology has the potential to bring joy and job satisfaction and enrich the lives of healthcare workers that choose to work in this field. However, the tremendous burden of caring for sick, suffering, and sometimes terminally ill children, and supporting their families, can be overwhelming, especially in the context of a complicated healthcare system, long hours on the job, challenging work environments, and a number of other potential interpersonal conflicts involving staff, patients, and/or family members. All of these factors can eventually lead to significant clinician distress. In this chapter, we describe four types of distress that affect clinicians; burnout, compassion fatigue, moral distress, and spiritual distress, from various clinician perspectives and report on prevalence and risk factors. In addition, we review types of interventions that can be implemented on an individual and/or an institutional level to help prevent and reduce this growing problem among healthcare providers.
Pediatric Blood & Cancer, 2022
BackgroundSickle cell disease (SCD) is a chronic illness that is associated with frequent admissi... more BackgroundSickle cell disease (SCD) is a chronic illness that is associated with frequent admissions for vaso‐occlusive episodes (VOE). Opioids are frequently utilized in pain management, but dosing is often provider dependent. Opioids cause both short‐term and long‐term side effects, so the minimal effective dose is desired. This study examined demand‐only patient‐controlled analgesia (PCA) in pediatric patients.MethodsA new clinical practice guideline (CPG) for a single institution was implemented, which eliminated basal infusion dosing for PCAs on hospital admission. The primary aim of this retrospective study was to evaluate length of stay (LOS) before and after implementation of a CPG of demand‐only PCA and, in a selected subpopulation, addition of short‐term methadone. Secondary aims included opioid utilization, acute chest syndrome (ACS), and hypoxia. Inclusion criteria included SCD, ≤21 years of age, uncomplicated VOE admission, and ≥ 3 and ≤ 8 hospital admissions for SCD pa...
Palliative Medicine Reports, 2021
Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided,... more Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided, case-based discussion of high-risk infants on Neonatal Intensive Care Unit (NICU) physician (MD) and Advanced Practice Provider (APP) perceptions of pediatric palliative care (PPC). Study Design: The study setting was a level IV academic NICU in a United States midwestern children’s hospital. A pre/post design was used to evaluate the effects of a weekly palliative care-guided, case-based discussion of high-risk infants on neonatology providers’ (MD and APP) perspectives of palliative and end-of-life care in the NICU using a previously published survey instrument. Surveys were completed at baseline and after 12 months of implementation. Data was analyzed with a Wilcoxon Signed Rank test with significance set at p < 0.05. Results: Thirty-one providers (13 APPs and 18 MDs) completed both pre- and post-intervention surveys. Post-intervention, providers were more likely to endorse that t...
Journal of The Society for Integrative Oncology, 2010
In response to rising interests from patients, many comprehensive cancer centers now offer an int... more In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, ...
Oncologic Critical Care, 2019
AM:STARs: Case Studies in Adolescent Health, Vol. 23, No. 2, 2012
Journal of Pediatric Nursing, 2021
While overall survival has improved significantly for children with cancer over the past 75 years... more While overall survival has improved significantly for children with cancer over the past 75 years, cancer remains the leading cause of death from disease among children and adolescents. Further, despite the many advances in medical and nursing care, children with cancer still experience significant physical and emotional suffering over the course of their illness, especially at the end of life (EOL). Children endure significant rates of high-intensity medical interventions (e.g., intubation, intensive care unit admission) at the EOL despite many parents, adolescents, and young adult patients identifying home as their preferred location of death. Hospice care has the potential to ease suffering at the EOL and facilitate home deaths, and yet, most children still die in acute care settings without hospice care. Numerous barriers prevent timely enrollment in hospice among children with cancer who are in the EOL period. This report describes the development and testing of a palliative care/EOL communication intervention designed to overcome some of these barriers and improve EOL outcomes (i.e., earlier hospice enrollment, less use of high-intensity medical interventions, reduced pain and suffering) among children with cancer and their parents (i.e., less emotional distress and uncertainty, improved hope and healthcare satisfaction).
Blood, 2008
Hydroxyurea therapy is associated with reduced morbidity among patients with sickle cell disease ... more Hydroxyurea therapy is associated with reduced morbidity among patients with sickle cell disease (SCD). Avascular necrosis of the femoral head (AVN) is one potentially debilitating complication of SCD. In this study, we examined the relationship between hydroxyurea use and the prevalence of AVN among children with SCD. We performed a retrospective chart review of 202 children with SCD, aged 10–21 years, followed in the pediatric hematology program at the Children’s Hospital at Montefiore (Bronx, NY) between July 2007 and 2008. Abstracted data included age, ethnicity, SCD genotype, frequency of hospitalization, hip radiograph results, laboratory data and hydroxyurea use. Hip radiographs were performed prospectively as part of SCD health maintenance from 2005–2008. Forty-four patients were excluded because they did not have a screening hip radiograph. Descriptive statistics were calculated for independent variables. T-tests and chi-square tests were used to compare clinical and demogr...
Pediatric Blood & Cancer, 2019
Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micron... more Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micronutrients in a subset of children with cancer (n = 23) participating in a randomized trial of the neutropenic diet. Ninety‐six percent of children had ≥1 micronutrient deficiency and 39% had ≥3 micronutrient deficiencies. Eighty‐six percent of children had vitamin C deficiency, 87% had 25‐hydroxyvitamin D deficiency, 50% had zinc deficiency, and 13% had vitamin A deficiency. Dietary intake did not correlate with micronutrient deficiency status. More data are needed regarding the prevalence and etiology of micronutrient deficiencies in children with cancer to further understand their implications and treatment.
Journal of palliative medicine, Jan 2, 2017
The Institute of Medicine and the American Academy of Pediatrics has called for improvement in ed... more The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives. A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatr...
Journal of Pain and Symptom Management, 2017
Context. Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acut... more Context. Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acute pain in pediatrics and the most common SCD complication. Pain management recommendations in SCD include nonpharmacological interventions. Yoga is one nonpharmacological intervention that has been shown to reduce pain in some populations; however, evidence is lacking in children with VOC. Objectives. The primary objective of this study was to compare the effect of yoga vs. an attention control on pain in children with VOC. The secondary objectives were to compare the effect of yoga vs. an attention control on anxiety, lengths of stay, and opioid use in this population. Methods. Patients were eligible if they had a diagnosis of SCD, were 5e21 years old, were hospitalized for uncomplicated VOC, and had an admission pain score of $7. Subjects were stratified based on disease severity and randomized to the yoga or control group. Results. Eighty-three percent of patients approached (N ¼ 73) enrolled on study. There were no significant differences in baseline clinical or demographic factors between groups. Compared with the control group, children randomized to yoga had a significantly greater reduction in mean pain score after one yoga session (À0.6 AE 0.96 vs. 0.0 AE 1.37; P ¼ 0.029). There were no significant differences in anxiety, lengths of stay, or opioid use between the two groups. Conclusion. This study provides evidence that yoga is an acceptable, feasible, and helpful intervention for hospitalized children with VOC. Future research should further examine yoga for children with SCD pain in the inpatient and outpatient settings.
Journal of Pediatric Oncology Nursing, 2013
Background. Burnout, a syndrome of emotional exhaustion, depersonalization, and diminished feelin... more Background. Burnout, a syndrome of emotional exhaustion, depersonalization, and diminished feelings of accomplishment, is common among pediatric oncology staff. This study explores a mindfulness-based course (MBC) to decrease burnout in a multidisciplinary group of pediatric oncology staff members in the United States and Israel. Materials and methods. Forty-eight participants, mostly nurses, were randomized to either the MBC intervention or a control group. MBC participants received eight weekly sessions of mindfulness education. The primary outcome studied was burnout. Secondary outcomes studied included depression and perceived stress. Results. Nearly 100% of the subjects exhibited signs of burnout at baseline and MBC did not result in any significant improvement in scores on burnout, perceived stress or depression scales. Qualitative analysis of diaries kept by subjects revealed reduced stress, improved inner peace, compassion and joy, better focus and self-awareness and less so...
Journal of Pain and Symptom Management, 2019
Journal of Palliative Medicine, 2018
Background: The Institute of Medicine and the American Academy of Pediatrics has called for impro... more Background: The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives. Design: A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatric faculty on facilitating the PPC-PBL. In Part 1, students identified domains of palliative care for a child with refractory leukemia and self-assigned questions to research and present at the follow-up session. In Part 2, students were expected to develop a care plan demonstrating the three PPC objectives. Measurements: Measures included a knowledge exam and a survey instrument to assess secondary outcomes. Results: Students' declarative knowledge, perceived exposure, and self-assessed competency in all three PPC learning objectives improved significantly after the PPC-PBL, p = 0.002, p < 0.001, and p < 0.001, respectively. There were no significant differences in faculty knowledge test scores from baseline to follow-up, but scores were generally high (median >80%). Students and faculty rated palliative care education as ''important or very important'' at baseline and follow-up. Conclusions: This study suggests that key concepts in PPC can be taught to medical students utilizing a PBL format and pediatric faculty resulting in improved knowledge and self-assessed competency in PPC.
Children
The pain and suffering of children with cancer became national news in the winter of 2000 with th... more The pain and suffering of children with cancer became national news in the winter of 2000 with the publication of Wolfe’s landmark paper in the New England Journal of Medicine, “Symptoms and Suffering Children with Cancer” [...]
Children
Terminal cancer pain remains one of the most distressing aspects of pediatric oncology practice. ... more Terminal cancer pain remains one of the most distressing aspects of pediatric oncology practice. Opioids are the cornerstone of cancer pain management at end-of-life and fortunately, most pain at end-of-life can be managed successfully. This article presents a practical step-by-step approach to alleviating pediatric terminal cancer pain, which can be delivered across settings.
Children
Background: Professional education pertaining to end-of-life care with pediatric oncology patient... more Background: Professional education pertaining to end-of-life care with pediatric oncology patients is limited. Pediatric trainees learn about end-of-life conversations largely from the provider’s perspective. Bereaved parents can inform the education of oncologists and the interdisciplinary team by sharing their perceptions and preferences through personal narratives. Methods: The aim of this project was to enhance the healthcare teams’ understanding of bereaved parents’ end-of-life care preferences through narratives. Bereaved parents were recruited from our institution’s Pediatric Supportive Care Committee membership. Parents were tasked with identifying elements of care that were of the greatest importance to them, based upon their personal experiences during their child’s end-of-life care. Narratives were analyzed using standard qualitative methods. Results: Parents of five patients participated, including four mothers and three fathers. Ten themes summarizing essential elements...
Palliative Care in Pediatric Oncology, 2017
Pediatric oncology has the potential to bring joy and job satisfaction and enrich the lives of he... more Pediatric oncology has the potential to bring joy and job satisfaction and enrich the lives of healthcare workers that choose to work in this field. However, the tremendous burden of caring for sick, suffering, and sometimes terminally ill children, and supporting their families, can be overwhelming, especially in the context of a complicated healthcare system, long hours on the job, challenging work environments, and a number of other potential interpersonal conflicts involving staff, patients, and/or family members. All of these factors can eventually lead to significant clinician distress. In this chapter, we describe four types of distress that affect clinicians; burnout, compassion fatigue, moral distress, and spiritual distress, from various clinician perspectives and report on prevalence and risk factors. In addition, we review types of interventions that can be implemented on an individual and/or an institutional level to help prevent and reduce this growing problem among healthcare providers.
Pediatric Blood & Cancer, 2022
BackgroundSickle cell disease (SCD) is a chronic illness that is associated with frequent admissi... more BackgroundSickle cell disease (SCD) is a chronic illness that is associated with frequent admissions for vaso‐occlusive episodes (VOE). Opioids are frequently utilized in pain management, but dosing is often provider dependent. Opioids cause both short‐term and long‐term side effects, so the minimal effective dose is desired. This study examined demand‐only patient‐controlled analgesia (PCA) in pediatric patients.MethodsA new clinical practice guideline (CPG) for a single institution was implemented, which eliminated basal infusion dosing for PCAs on hospital admission. The primary aim of this retrospective study was to evaluate length of stay (LOS) before and after implementation of a CPG of demand‐only PCA and, in a selected subpopulation, addition of short‐term methadone. Secondary aims included opioid utilization, acute chest syndrome (ACS), and hypoxia. Inclusion criteria included SCD, ≤21 years of age, uncomplicated VOE admission, and ≥ 3 and ≤ 8 hospital admissions for SCD pa...
Palliative Medicine Reports, 2021
Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided,... more Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided, case-based discussion of high-risk infants on Neonatal Intensive Care Unit (NICU) physician (MD) and Advanced Practice Provider (APP) perceptions of pediatric palliative care (PPC). Study Design: The study setting was a level IV academic NICU in a United States midwestern children’s hospital. A pre/post design was used to evaluate the effects of a weekly palliative care-guided, case-based discussion of high-risk infants on neonatology providers’ (MD and APP) perspectives of palliative and end-of-life care in the NICU using a previously published survey instrument. Surveys were completed at baseline and after 12 months of implementation. Data was analyzed with a Wilcoxon Signed Rank test with significance set at p < 0.05. Results: Thirty-one providers (13 APPs and 18 MDs) completed both pre- and post-intervention surveys. Post-intervention, providers were more likely to endorse that t...
Journal of The Society for Integrative Oncology, 2010
In response to rising interests from patients, many comprehensive cancer centers now offer an int... more In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, ...
Oncologic Critical Care, 2019
AM:STARs: Case Studies in Adolescent Health, Vol. 23, No. 2, 2012
Journal of Pediatric Nursing, 2021
While overall survival has improved significantly for children with cancer over the past 75 years... more While overall survival has improved significantly for children with cancer over the past 75 years, cancer remains the leading cause of death from disease among children and adolescents. Further, despite the many advances in medical and nursing care, children with cancer still experience significant physical and emotional suffering over the course of their illness, especially at the end of life (EOL). Children endure significant rates of high-intensity medical interventions (e.g., intubation, intensive care unit admission) at the EOL despite many parents, adolescents, and young adult patients identifying home as their preferred location of death. Hospice care has the potential to ease suffering at the EOL and facilitate home deaths, and yet, most children still die in acute care settings without hospice care. Numerous barriers prevent timely enrollment in hospice among children with cancer who are in the EOL period. This report describes the development and testing of a palliative care/EOL communication intervention designed to overcome some of these barriers and improve EOL outcomes (i.e., earlier hospice enrollment, less use of high-intensity medical interventions, reduced pain and suffering) among children with cancer and their parents (i.e., less emotional distress and uncertainty, improved hope and healthcare satisfaction).
Blood, 2008
Hydroxyurea therapy is associated with reduced morbidity among patients with sickle cell disease ... more Hydroxyurea therapy is associated with reduced morbidity among patients with sickle cell disease (SCD). Avascular necrosis of the femoral head (AVN) is one potentially debilitating complication of SCD. In this study, we examined the relationship between hydroxyurea use and the prevalence of AVN among children with SCD. We performed a retrospective chart review of 202 children with SCD, aged 10–21 years, followed in the pediatric hematology program at the Children’s Hospital at Montefiore (Bronx, NY) between July 2007 and 2008. Abstracted data included age, ethnicity, SCD genotype, frequency of hospitalization, hip radiograph results, laboratory data and hydroxyurea use. Hip radiographs were performed prospectively as part of SCD health maintenance from 2005–2008. Forty-four patients were excluded because they did not have a screening hip radiograph. Descriptive statistics were calculated for independent variables. T-tests and chi-square tests were used to compare clinical and demogr...
Pediatric Blood & Cancer, 2019
Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micron... more Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micronutrients in a subset of children with cancer (n = 23) participating in a randomized trial of the neutropenic diet. Ninety‐six percent of children had ≥1 micronutrient deficiency and 39% had ≥3 micronutrient deficiencies. Eighty‐six percent of children had vitamin C deficiency, 87% had 25‐hydroxyvitamin D deficiency, 50% had zinc deficiency, and 13% had vitamin A deficiency. Dietary intake did not correlate with micronutrient deficiency status. More data are needed regarding the prevalence and etiology of micronutrient deficiencies in children with cancer to further understand their implications and treatment.
Journal of palliative medicine, Jan 2, 2017
The Institute of Medicine and the American Academy of Pediatrics has called for improvement in ed... more The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives. A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatr...
Journal of Pain and Symptom Management, 2017
Context. Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acut... more Context. Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acute pain in pediatrics and the most common SCD complication. Pain management recommendations in SCD include nonpharmacological interventions. Yoga is one nonpharmacological intervention that has been shown to reduce pain in some populations; however, evidence is lacking in children with VOC. Objectives. The primary objective of this study was to compare the effect of yoga vs. an attention control on pain in children with VOC. The secondary objectives were to compare the effect of yoga vs. an attention control on anxiety, lengths of stay, and opioid use in this population. Methods. Patients were eligible if they had a diagnosis of SCD, were 5e21 years old, were hospitalized for uncomplicated VOC, and had an admission pain score of $7. Subjects were stratified based on disease severity and randomized to the yoga or control group. Results. Eighty-three percent of patients approached (N ¼ 73) enrolled on study. There were no significant differences in baseline clinical or demographic factors between groups. Compared with the control group, children randomized to yoga had a significantly greater reduction in mean pain score after one yoga session (À0.6 AE 0.96 vs. 0.0 AE 1.37; P ¼ 0.029). There were no significant differences in anxiety, lengths of stay, or opioid use between the two groups. Conclusion. This study provides evidence that yoga is an acceptable, feasible, and helpful intervention for hospitalized children with VOC. Future research should further examine yoga for children with SCD pain in the inpatient and outpatient settings.
Journal of Pediatric Oncology Nursing, 2013
Background. Burnout, a syndrome of emotional exhaustion, depersonalization, and diminished feelin... more Background. Burnout, a syndrome of emotional exhaustion, depersonalization, and diminished feelings of accomplishment, is common among pediatric oncology staff. This study explores a mindfulness-based course (MBC) to decrease burnout in a multidisciplinary group of pediatric oncology staff members in the United States and Israel. Materials and methods. Forty-eight participants, mostly nurses, were randomized to either the MBC intervention or a control group. MBC participants received eight weekly sessions of mindfulness education. The primary outcome studied was burnout. Secondary outcomes studied included depression and perceived stress. Results. Nearly 100% of the subjects exhibited signs of burnout at baseline and MBC did not result in any significant improvement in scores on burnout, perceived stress or depression scales. Qualitative analysis of diaries kept by subjects revealed reduced stress, improved inner peace, compassion and joy, better focus and self-awareness and less so...
Journal of Pain and Symptom Management, 2019