[Position paper by the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH) on psycho-social care for pediatric oncology and hematology patients in hospital]. / Positionspapier der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) und der Deutschen Leukämie-Forschungshilfe (DLFH) zur psychosozialen Versorgung pädiatrisch-onkologischer und -hämatologischer Patienten in der Akutklinik.

Psychosocial Care has been an integral part of the overall treatment in pediatric oncology for 25 years. The need for it and its effectiveness are well documented in several reputable studies and psychosocial service has proved its worth in everyday clinical settings. In order to secure comparable quality standards and in consequence of reorganisations within the health-care system a position paper has been prepared and adopted by the Psychosoziale Arbeitsgemeinschaft in der Pädiatrischen Onkologie und Hämatologie (PSAPOH), the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH). The following article gives a short survey of this position paper and provides insight into the goals, conditions and outcomes of psychosocial care in pediatric oncology and hematology.

[Supporting severely ill and dying children. Suggestions for practical interventions]. / Begleitung schwer kranker und sterbender Kinder. Empfehlungen für die Praxis.

In our culture, the death of a child is a rare, but shocking experience. Supporting severely ill or dying children requires knowledge of developmental psychology and consideration of their social environment. This article summarizes aspects of children's concepts of death and outlines the psychological reactions of seriously ill children and adolescents. Finally, the authors provide practical suggestions for meaningful interventions.

Health-related quality of life of pediatric patients receiving allogeneic stem cell or bone marrow transplantation: results of a longitudinal, multi-center study.

The results of a 5-year longitudinal prospective study about the health-related quality of life (HRQL) of pediatric patients receiving allogeneic bone marrow or stem cell transplantation (BMT) are described. The patients' HRQL was assessed twice before, and five times after BMT, the end point being 1 year after BMT. For the measurement of HRQL, standardized questionnaires were completed by patients, parents and physicians. The final sample consisted of 68 patients aged 4-18 years, of which 19 were lost in the course of the study owing to relapse, transplant rejection and/or death. The worst HRQL was seen shortly after transplant and HRQL thereafter improved steadily, although the improvement was not always linear and not all patients drew benefit from this average positive evolution. Compromised emotional functioning, a high level of worry and reduced communication during the acute phase of treatment had a negative impact on HRQL 1 year after BMT. Nausea and pain during the acute phase of treatment did not have an effect on later HRQL. The interobserver agreement of HRQL reports between parents and their children was moderate to good, and generally better than child-physician and parent-physician agreement.

[Injury to body and soul--psychiatric consequences of road traffic accidents in children and adolescents]. / Verletzung von Körper und Seele--Psychiatrische Folgen von Verkehrsunfällen bei Kindern und Jugendlichen.

Road traffic accidents are a major cause for severe injury in children and adolescents. Many victims also suffer from psychological consequences, such as posttraumatic stress disorder, traffic-related fears or mood disturbances. High levels of distress during and immediately after the accident are associated with severe posttraumatic stress symptoms. Routine consideration of the psychological impact of road traffic accidents should receive the same priority as screening for physical injury.

[Symptom or illness? The exhausting life of an adolescent with chronic fatigue syndrome]. / Symptom oder Krankheit? Der erschöpfende Weg eines Jugendlichen mit chronischer Müdigkeit.

This case report presents the assessment of a 16-year old boy with chronic fatigue syndrome (CFS). Questions on the etiology, dynamics, diagnostics and treatment of this complex condition are briefly discussed.

Pediatric hematology and oncology at the University Children's Hospital, Basel, Switzerland.

The department offers the management and research of benign and malignant pediatric hematology and oncology at a comparable European standard. It serves as a referring department for BMT, thoracic and visceral pediatric surgery, and pediatric orthopedic surgery and is equipped with all facilities of modern oncology and surgery. Psychooncology is a continuing interest at our department and may help children and their families to better understand and accept their situation and to receive the support necessary for coping with the threat of malignant diseases. Our department aims at practicing a highly sophisticated communication culture essential for a multidisciplinary approach to the child with cancer, representing a central condition for the success of the treatment of malignant diseases.

Road traffic accidents: early psychological consequences in children and adolescents.

BACKGROUND: Although road traffic accidents are a major cause of injury and death in children and adolescents, research into their psychological consequences consists mainly of case reports. METHOD: A prospective study was made of young road traffic accident victims: 57 subjects, aged 5-18 years, who had been injured in road traffic accidents, and their parents, were interviewed 2-16 days post-accident and re-examined after 12-15 weeks. RESULTS: Post-accident stress symptoms occurred at both times. There was a decrease of symptom severity between the two interviews, but at the later time, 14% still suffered from moderate or severe post-traumatic stress disorder, 17% from serious traffic-related fears, and parents reported increased mood disturbance in their children compared with the pre-accident period. High levels of distress during and immediately after the accident were associated with severe post-traumatic stress symptoms. CONCLUSIONS: There is an urgent need for healthcare staff working with children and adolescents involved in road traffic accidents to be aware of the potential psychological consequences and the importance of the immediate accident experience on subsequent coping.

Multiple biochemical blood testing as a case-finding tool in ambulatory medical patients.

PURPOSE: The usefulness and costs of multiple biochemical blood tests as a case-finding tool in ambulatory medical patients are not well known. Recommendations are lacking or based upon results of screening asymptomatic persons. We designed a study to determine prospectively the yield, potential disadvantages, and patient charges of routine biochemical testing at our medical outpatient clinic. PATIENTS AND METHODS: Twenty-three biochemical parameters were evaluated in 493 consecutive patients. Parameters not considered indicated for diagnostic or management purposes by the staff physicians at the first visit were classified as routine tests. The main outcome measures were the number and the nature of new diagnoses leading to a new management, the number of additional tests and visits, and patient charges. RESULTS: New diagnoses resulting in new management were found in 25 patients (5%). They were mainly lipid disorders. Seven additional visits and 74 further tests were caused by abnormal results of routine tests. The net charges for the detection of the new diagnoses leading to new management were $12,682. Secondary analysis revealed that the determination of only three routine tests (cholesterol, glucose, alanine aminotransferase) would have detected all clinically important diagnoses and would have reduced the charges by 30%. CONCLUSIONS: Routine biochemical testing is a useful case-finding tool with acceptable costs in middle-aged medical outpatients of a university teaching setting. However, the spectrum of newly detected disorders leading to changes in patient management is small. The results suggest that a reduced routine battery consisting of cholesterol, glucose, and alanine aminotransferase might be preferable because it will detect the clinically important diagnoses and lead to a substantial reduction of patient charges.

[Asymptomatic microhematuria: follow-up in 39 patients]. / Asymptomatische Mikrohämaturie: Verlaufsbeobachtung bei 39 Patienten.

We have studied 39 patients with asymptomatic microhematuria (AM) over a mean period of 3.7 years (2.6 to 5.3). In 28 patients, the etiology of the AM had remained unknown despite extensive work-up at the time of AM diagnosis. During follow-up, the urine was examined by the dipstick method and a urine sediment was prepared by standard techniques. Erythrocyturia was judged as grade I or grade II (3-9 or less than 9 erythrocytes/hpf) and classified by phase-contrast microscopy as glomerular or non-glomerular (greater than 30% or less than 30% of erythrocytes with glomerular characteristics). The results were as follows. All patients were in good health during the whole follow-up. None developed significant proteinuria or gross hematuria. AM persisted in 28 of the 39 patients (72%) and in 22 of the 28 with AM of unknown etiology (79%). Persistence of AM was independent of grade and morphology of AM. Among the patients with AM of unknown cause, the fifteen who initially showed grade I AM had grade I AM in 92% and grade II AM in 8% of follow-up urinalyses, and the seven with grade II AM at the first examination had grade II AM in 65% and grade I AM in 35% of follow-up urinalyses (p = 0.007). The last morphologic classification of AM corresponded to the first in all patients with grade II AM, but only in 74% of patients with grade I AM. The following conclusions were drawn. (1) Most AM of unknown etiology persists over several years irrespective of grade and morphology of erythrocyturia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Etiology of diarrheal diseases in immunocompetent and HIV-positive patients]. / Atiologie von Durchfallserkrankungen bei immunkompetenten und HIV-positiven Patienten.

In 1986 and 1987 the stool samples of 206 patients of the Medical Outpatient Clinic Basel were examined prospectively for bacteria, protozoa and worms. Clinical data of the patients were recorded by questionnaire. The patient group comprised 63 immunocompetent patients as well as 23 HIV-infected patients, all with symptoms of acute enteritis. The control group consisted of 120 healthy persons. Pathogenic organisms were found in the stools of 17.5% of the immunocompetent patients with enteritis. The most common germs were Campylobacter jejuni, Giardia lamblia and Salmonella enteritidis. Isospora belli, found in 2 cases (8.7%), was the only pathogen found in HIV-infected patients. The most frequent pathogen found in 7.5% of the control group was Giardia lamblia. The facultative pathogenic protozoon Blastocystis hominis was found in 16.7-19.0% of the 3 groups. There was no correlation between clinical symptoms and the results of stool examinations. Stool examinations in the immunocompetent patients corresponded to the known distribution of pathogenic germs in Switzerland. The homogeneous distribution of Blastocystis hominis in the 3 groups examined proves the high rate of infection. There is no evidence of a significant correlation between clinical symptoms of enteritis and infection with Blastocystis hominis in immunocompetent patients.