The role of parental presence in the context of children's medical procedures: a systematic review.

BACKGROUND: There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature. METHODS: Based on a comprehensive literature search, studies investigating parental presence in the paediatric treatment room were included in the review if they had a concurrent control group (i.e. a parent-absent group). RESULTS: A total of 28 studies met inclusion criteria, which included 1256 children with a parent present and 1025 children without a parent present. There were mixed findings regarding the effect of parental presence on measures of child distress and affect, however, studies of lower levels of evidence were more likely to report significant results. Parents who were present during their child's medical intervention were either better off or no different from parents who were absent with regard to their levels of distress and satisfaction. There was no evidence of increased technical complications nor elevated staff anxiety for health professionals attending to children with a parent present as compared to attending to children without their parents. DISCUSSION: Although parental presence may not have a clear, direct influence on child distress and behavioural outcomes, there are potential advantages for parents. It seems appropriate that clinicians provide parents with the opportunity to be present during their child's painful procedure.

Accounting for differences in dieting status: steps in the refinement of a model.

OBJECTIVE: The overriding objective of this paper is to outline the steps involved in refining a structural model to explain differences in dieting status. METHODS: Cross-sectional data (representing the responses of 1,644 teenage girls) derive from the preliminary testing in a 3-year longitudinal study. A battery of measures assessed social influence, vulnerability (to conformity) disposition, protective (social coping) skills, and aspects of positive familial context as core components in a model proposed to account for the initiation of dieting. Path analyses were used to establish the predictive ability of those separate components and their interrelationships in accounting for differences in dieting status. RESULTS: Several components of the model were found to be important predictors of dieting status. The model incorporates significant direct, indirect (or mediated), and moderating relationships. Taking all variables into account, the strongest prediction of dieting status was from peer competitiveness, using a new scale developed specifically for this study. CONCLUSION: Systematic analyses are crucial for the refinement of models to be used in large-scale multivariate studies. In the short term, the model investigated in this study has been shown to be useful in accounting for cross-sectional differences in dieting status. The refined model will be most powerfully employed in large-scale time-extended studies of the initiation of dieting to lose weight.

Primary mediastinal large cell lymphoma in children: a report from the Childrens Cancer Group.

Malignant lymphomas arising in the mediastinum account for approximately 60% of all mediastinal tumors in children; two-thirds are non-Hodgkin's lymphomas and one-third represent Hodgkin's disease. In contrast to adults, in children mediastinal non-Hodgkin's lymphomas are usually synonymous with lymphoblastic lymphoma, and nonlymphoblastic lymphomas are rare. We describe nine children with primary mediastinal large cell lymphoma who were treated with the Children's Cancer Group protocol CCG-503, a randomized phase III protocol for disseminated nonlymphoblastic lymphoma. Histologic subclassification revealed three immunoblastic lymphomas, three multilobated large cell lymphomas, one with clear cell features, and two large noncleaved cell lymphomas. Sclerosis, of variable degrees, was seen in all tumors. Immunophenotyping revealed all tumors to be of B cell lineage. Thymic epithelial cells could be demonstrated, utilizing antibody to keratin, in two of nine patients, suggesting that some of the tumors are of thymic origin. None of the patients had central nervous system or bone marrow involvement. It appears that primary mediastinal nonlymphoblastic lymphomas in children, although much less common, are similar to those seen in adults. These tumors must be differentiated from lymphoblastic lymphoma and Hodgkin's disease, as the therapeutic approach may depend on histologic subtype. Primary mediastinal large cell lymphoma in children appears curable with aggressive treatment in the majority of patients.

Anaplastic large-cell lymphoma presenting primarily in bone in a patient with AIDS.

Non-Hodgkin's lymphomas have been recognized as an important and frequently fatal part of the spectrum of diseases associated with HIV infection. These are most often high-grade B-cell lymphomas usually of immunoblastic and small cell non-cleaved subtypes. Sporadic reports of T-cell lymphomas associated with HIV infection are found in the literature. Two have been reported to be CD30 positive presenting with lymph node and skin involvement. We report a case of an AIDS patient with a T-cell anaplastic large-cell lymphoma that was CD30-positive and presented in bone. This is most probably a sporadic event rather than another part of the AIDS-associated spectrum of disease.

Acquired hemoglobin H in refractor sideroblastic anemia. A preleukemic marker.

Two patients with idiopathic refractory sideroblastic anemia (IRSA) were found to have acquired hemoglobin H. Both developed leukemic syndromes. Six other patients with IRSA had normal hemoglobin electrpohoretic patterns, and none has developed acute leukemia in up to five years. We suggest that hemoglobin electrphoresis be performed routinely in IRSA. The finding of hemoglobin H in this population may be a relatively frequent occurrence and may serve to distinguish the preleukemic patients from those not destined to develop leukemia.