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Neurophysiologic Tests the neuromuscular function of the pelvic floor is dependent on the integrity of the nervous system medicine 4212 cheap lamotrigine 200 mg on line. Injury can theoretically occur anywhere along these nerves medicine symbol buy lamotrigine 100 mg mastercard, from the cell body located in Onuf’s nucleus in the ventral part of the spinal cord symptoms ringworm discount lamotrigine 50 mg fast delivery, along its axon medications like abilify generic lamotrigine 50mg online, to the neuromuscular junction. Pelvic floor neurophysiology utilizes techniques applied to nerves and skeletal muscles elsewhere in the body to document neuromuscular integrity or evidence of injury. These tests are not routinely used in the clinical evaluation of most incontinent women. Using a specialized electrode affixed over the index finger, the pudendal nerve is electrically stimulated near the ischial spine (either transrectally or transvaginally), and the resulting muscular response is measured. The latency time may be within the normal range when only smaller nerve fibers are affected; thus, neurologic dysfunction may exist in the presence of a normal latency time. Similar to the clinically obtained anal wink or bulbocavernosus reflex, electrically induced sacral reflexes can gather information about both the afferent and efferent arc in the pelvic nerves. A short train of dual impulses delivered next to the clitoris and measured at the anal sphincter is termed the clitoroanal reflex and provides information about the integrity of the afferent and efferent arm of the somatic pudendal nerve. A stimulating electrode placed in the bladder sends these signals along the visceral, autonomic fibers to the spinal cord, and a reflex signal will return along the pudendal nerve to the anal sphincter. Somatosensory Evoked Potentials Normal pelvic floor and pelvic organ function ultimately is controlled by higher centers in the central nervous system, including the cerebral cortex. Recording electrodes located on the scalp near the motor cortex allow the signal transmission speed between a skeletal muscle and the brain to be measured. Repeated electrical stimuli, called somatosensory evoked potentials, at a muscle of interest are used to assess the integrity of the central afferent limb. In a reverse fashion, electrical or magnetically induced stimuli can be delivered at the motor cortex (or along the spine), and the induced muscle action potentials can be detected. It is best used for simply describing the pattern and coordination of muscle activity but is less useful in providing more specific assessments. An increase in fiber density is evidence of previous nerve injury with successful reinnervation. Emerging Technologies Positron emission tomography and functional magnetic resonance imaging studies are yielding preliminary insights into the neural control of continence; these technologies are used in the research setting only. Nonsurgical Treatment Treatment of urinary incontinence can be either nonsurgical or surgical. The approach to treatment is based on the clinical findings and the degree of discomfort experienced by the patient, who should be fully informed of the risks and expected outcome. Lifestyle Changes Lifestyle interventions can decrease stress urinary incontinence in many women (45). There is good level 1 evidence that weight loss in both morbidly and moderately obese women decreases both stress and urge urinary incontinence (31). Postural changes (such as crossing the legs during periods of increased intra-abdominal pressure) often prevent stress urinary incontinence. There is some evidence that decreasing caffeine intake improves continence; however, fluid intake in general seems to play a minor role in the pathogenesis of incontinence. Although smokers are at greater risk for incontinence, no data were reported on whether smoking cessation resolves incontinence. Physical Therapy Medical evidence from well-designed randomized clinical trials shows that supervised pelvic floor muscle training (Kegel exercises) is an effective treatment for stress urinary incontinence. The Cochrane Incontinence Group concluded that pelvic floor muscle training is consistently better than no treatment or placebo treatment for stress incontinence and should be offered as first-line conservative management to women. Intensive training sessions that include personal contact with a health care professional to teach and supervise pelvic floor muscle training may be more beneficial than standard care. Biofeedback provides no added benefit over pelvic floor muscle training alone in women with stress urinary incontinence (46). Several factors improve the likelihood that pelvic muscle training will relieve stress urinary incontinence. The woman must do the exercises correctly, regularly, and for an adequate duration. Based on exercise training of skeletal muscles elsewhere in the body, many physical therapists recommend training sessions three to four times per week, with three repetitions of eight to ten sustained contractions each time. Electrical stimulation therapy was used to treat incontinence by delivering low levels of current via a probe placed in the vagina or rectum. When compared with sham devices and pelvic floor exercises, electrostimulation produced mixed results in the treatment of stress urinary incontinence but may be more helpful in women with overactive bladders (47–50). Further research is needed to determine what niche this treatment may fill for women with urinary incontinence. Behavioral Therapy and Bladder Training Bladder training focuses on modifying bladder function by changing voiding habits. Behavioral therapy focuses on improving voluntary control rather than bladder function (51). After reviewing the patient’s voiding diary, an initial voiding interval is chosen that represents the longest interval between voiding that is comfortable. She is instructed to empty her bladder when she awakes, and then every time during the day that the interval is reached (for example, every 30 to 60 minutes). When the patient feels the urge to void during that interval, she is instructed to use urgesuppression strategies, such as distraction or relaxation techniques, until she gets to the stated interval. Effective distraction strategies include mental exercises (such as mathematical problems), deep breathing, or “singing” the words to a song silently. The main goal is to avoid running to the bathroom at the moment of severe urgency. Another strategy is to quickly contract the pelvic muscle several times in a row (“freeze and squeeze”), which often lessens urgency. Gradually, the interval is increased (usually weekly) until the patient voids every 2 to 3 hours. Bladder training is most effective when women record every void and check in (by telephone or in person) with a health care provider weekly. Bladder training is effective; in a trial in which bladder training was compared with treatment with oxybutynin, 73% of women in the bladder training group were clinically cured (52). The primary technique of behavioral training is pelvic floor muscle training, as described previously, but with a focus on urge inhibition. Mastering voluntary pelvic floor muscle contractions helps to strengthen the outlet (decreasing leakage) and inhibit detrusor contractions. Other components of therapy may include voiding schedules, urge-inhibitions strategies, and fluid management. Patients with neurogenic detrusor overactivity, rather than idiopathic detrusor overactivity, do not respond as well to behavioral therapy because the problem is actually one of neural pathway destruction rather than the need to reestablish cortical control mechanisms. Frequently, these patients have a trigger volume of urine that sets off a contraction that they cannot control voluntarily. They may benefit from a timed schedule in which they void at regular intervals (such as every 2 hours) to keep their bladder volume below the trigger point. In a randomized trial, the guidance of a simple self-help booklet was only somewhat less effective in reducing leakage (mean reduction in leakage episodes 43%) than behavioral training (mean reduction 69%) or behavioral training plus electrical stimulation (mean reduction 72%) (53). Vaginal and Urethral Devices Vaginal devices (pessaries) and urethral inserts are available for treating stress urinary incontinence. In a tertiary care population, approximately two-thirds of women with stress urinary incontinence offered a trial of vaginal devices chose to undergo pessary fitting (54). Of those who took a pessary home to manage their stress urinary incontinence, approximately one-half used it for more than 6 months. In an intent-to-treat analysis of a recent large multisite randomized trial, 3 months after beginning either pessary or behavioral therapy, 40% of those randomized to pessary and 49% of those doing behavioral therapy were “very much” or “much” better. By 12 months there were no group differences in outcomes and patient satisfaction was greater than 50% for each group (55). Some women are pleased to be able to avoid surgery or to use a “crutch” while waiting for the effect of pelvic muscle training; others prefer a treatment option (like surgery) that does not require daily intervention. Urethral inserts are sterile inserts placed into the urethra by the patient and removed before a void, after which a new sterile insert is placed. Such inserts are appropriate for women with relatively pure stress incontinence, no history of recurrent urinary tract infections, and no serious contraindications to bacteriuria. Several other urethral inserts and urethral occlusion devices were marketed with good effectiveness but were withdrawn from the market. In a 5-year, multicenter trial involving 150 women with a mean follow-up of 15 months, a statistically significant reduction in incontinence episodes and pad weight were observed with 93% of the women having a negative pad test at 12 months. Urethral inserts have not developed a widespread acceptance but may offer a viable treatment option for some select patients.
Catalyst combined two categories to treatment group buy 50 mg lamotrigine overnight delivery create the Low-Mid Level Officials & Managers and Professionals level of the “Women in 11 Fortune 500 Companies” chart symptoms 7 days after iui generic 25 mg lamotrigine otc. Page | 130 Prepared by the Majority Staff of the Joint Economic Committee Invest in Women medicine quest buy lamotrigine 200mg with amex, Invest in America: December 2010 A Comprehensive Review of Women in the U treatment urinary incontinence order lamotrigine 50mg. Catalyst divided the sample of companies into four sections based on women’s representation. The top quartile included the companies with the highest average percentage of women leaders, while the bottom quartile included the companies with the lowest average percentage of women leaders. The race/ethnicity category definitions used by Catalyst were established by the 12 U. Examples include positions within functions such as human resources, corporate affairs, legal, and finance. Furthermore, companies must disclose the total compensation of up to two additional individuals who would have been top earners except for the fact that these individuals were not 14 employed as Named Executive Officers as of the company’s fiscal year end. In 2009, Catalyst defined top earners as those current Executive Officers whose total compensation is among the top five amounts disclosed; prior to 2009 Catalyst defined top earners as those current Corporate Officers whose total compensation is among the top five amounts disclosed. Because Catalyst views the representation of women top earners as a proxy for status in the organization rather than a method to measure pay inequity, Catalyst does not track the compensation amounts of top earners. The sum of stock price appreciation plus reinvestment of dividends declared over a calendar year. Prepared by the Majority Staff of the Joint Economic Committee Page | 131 Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee Endnotes 1 2009 analysis is based on 496 companies. However, this industry has fewer than 10 companies in the 2009 Fortune 500 list, making comparisons inappropriate. Census Bureau, Office of Management and Budget, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Page | 132 Prepared by the Majority Staff of the Joint Economic Committee Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee Prepared by the Majority Staff of the Joint Economic Committee Page | 133 Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. My name is Michelle Budig, and I am an Associate Professor of Sociology and Faculty Associate at the Center for Public Policy Administration at the University of Massachusetts. My expertise is in gender, work, and family issues, and most relevant to today, the wage penalty for motherhood and work-family policy. Today I will testify that a significant portion of the persistent gender gap in earnings, among workers with equivalent qualifications and in similar jobs, is attributable to parenthood. Specifically, to the systematically lower earnings of mothers and higher earnings of fathers, among comparable workers. Thus, public policies that target the difficulties families face in balancing work and family responsibilities, as well as discrimination by employers by workers’ parental status, may be the most effective at reducing the gender pay gap. First, I will discuss the relative absence of wives and mothers among managers and leaders of organizations. Second, I will compare gender pay gaps among young childless workers and among parents. Third, I will summarize statistical evidence of unaccountably lower wages for mothers and higher wages for fathers. Finally, I will present research on work-family policies and their impact on the wage penalty for motherhood, with an eye to drawing policy implications for the United States. This begs the question, where are the older, more educated and experienced, female mangersfi A generation ago we might have hypothesized this relative absence of more senior women was simply due to the lack of Page | 134 Prepared by the Majority Staff of the Joint Economic Committee Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee qualified and experienced women in potential pool of women managers. However, since the 1980s, these qualifications and experience differences between women and men have eroded, so 1 much so that women now earn college degrees at higher rates than men. If a lack of qualified candidates cannot explain the absence of experienced female managers, what canfi My research and others demonstrates that a significant portion of gender-based differences in employment, earnings, and experiences of discrimination are increasingly related to parenthood, and the greater struggles of mothers to balance careers and family demands. Wives and mothers are relatively more absent among managers, compared with the representation of husbands and fathers. If we subtract the rates of marriage among men from those among women, we might compute a Managerial Gender Marriage Gap: Women managers are far less likely to be married overall, compared with male managers. This gap in marital rates ranges from 8 to 19 percentage points across industries, with an average gap of 15 percentage points. Second, if we subtract the rates of parenthood among men from those among women, we would compute a Managerial Gender Parenthood Gap: Women managers are less likely to be mothers, and have smaller family sizes, relative to male managers. The parenthood gap ranges from 0 to 9 percentage points across industries, with an average gap of 6 percentage points. The absence of mothers and the rise in childlessness among highly skilled women is also found in national data. Table 1 in your handout shows that, controlling for differences in age, marital status, education, and other household income, the gender employment gap among the childless is minimal whereas the gender employment gap among parents is quite large. In 2004, among college educated white women in their 40s, fully 27% were 3 childless. Researchers estimate about 44% of this childlessness is voluntary, while 56% is due to 4 age-related infertility. A major reason why women delay or forego motherhood is due to the 5 perceived and experienced incompatibility between careers and motherhood. Prepared by the Majority Staff of the Joint Economic Committee Page | 135 Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee Thus, high-achieving women are forgoing families at rates not observed among highachieving men. Before we move on to considering the link between the persistent gender pay gap and parenthood among the employed, we need to recognize that we are missing the mothers from these statistics. Thus, the mothers who persist are a qualitatively select group, or potentially the cream of the crop, if you will. This implies that our current estimates of the gender pay gap may be much smaller than they would be if mothers were not disproportionately absent from the work force. The shrinking gender gap among young childless workers has captured national attention this month with the highly publicized study by James Chung of Reach Advisors, on the lack of a gender gap among childless workers. Chung, who analyzes data from the American Community Survey, shows that among 20-something unmarried, childless workers in urban areas, there is no 6 gender pay gap. Estimates from my research of the gender pay gaps among full-time workers are presented in table 2 in your handout. Whereas childless women earn 94 cents of a childless man’s dollar, mothers earn only 60 cents of a father’s dollar. Unadjusted Gender Pay Gap for Full-time Employed Civilians, Aged 25 to 49 Childless Woman’s Pay Women’s Pay per $1 Male Mother’s Pay per $1 per $1 Childless Man’s Dollar Father Dollar Dollar 79fi 60fi 94fi Note: Author’s calculations from Current Population Survey data. While causality is complex, there is a strong empirical association between the gender gap (pay differences between women and men) and the family gap (pay differences between households 8 9 10 with and without children). Moreover, Waldfogel (1998b) shows that while the gender pay gap has been decreasing, the pay gap related to parenthood is increasing. Page | 136 Prepared by the Majority Staff of the Joint Economic Committee Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee this greater gender inequality found among parents brings me to my next point, the wage penalty for motherhood. This penalty ranges in size from 15% per child among low-wage workers to about 4% per child among high-wage workers. That mothers work less and may accept lower earnings for more family-friendly jobs explains part of the penalty experienced by low wage workers, and that mothers have less experience, due to interruptions for childbearing, explains a part of the penalty for high-wage workers. But a significant motherhood penalty persists even in estimates that account for these differences, such that the size of the wage penalty after all factors are controlled is roughly 18 3% per child. This means we would expect the typical full-time female worker in 2009 to earn roughly $1,100 less per child in annual wages, all else equal. Prepared by the Majority Staff of the Joint Economic Committee Page | 137 Invest in Women, Invest in America: December 2010 A Comprehensive Review of Women in the U. Economy Joint Economic Committee What lies behind this motherhood penalty that is unexplained by measurable characteristics of workers and jobsfi It is difficult to obtain data on discrimination and virtually impossible to match it to outcomes in large-scale national surveys.
Increased risk for recurrence in older patients was related to symptoms of dehydration discount lamotrigine 100 mg overnight delivery a higher incidence of grade 3 tumors or unfavorable histologic subtypes; however shinee symptoms mp3 purchase 200 mg lamotrigine visa, age appears to treatment 1st degree av block purchase discount lamotrigine be an independent prognostic variable medicine reviews discount lamotrigine 100mg. Increasing patient age appears to be independently associated with disease recurrence in endometrial cancer. In one study, the mean age at diagnosis of patients who had recurrence or died of disease was 68. None of the patients younger than 50 years of age developed recurrent cancer, compared with 12% of patients aged 50 to 75 years and 33% of patients older than 75 years (149). Histologic Type Nonendometrioid histologic subtypes account for about 10% of endometrial cancers and carry an increased risk for recurrence and distant spread (150,151). In a retrospective review of 388 patients treated at the Mayo Clinic for endometrial cancer, 52 (13%) had an uncommon histologic subtype, including 20 adenosquamous, 14 serous, 11 clear cell, and 7 undifferentiated carcinomas. In contrast to the 92% survival rate among patients with endometrioid tumors, the overall survival for patients with one of these more aggressive subtypes was only 33%. At the time of surgical staging, 62% of the patients with an unfavorable histologic subtype had extrauterine spread of disease (150). Histologic Grade Histologic grade of the endometrial tumor is strongly associated with prognosis (132,141,149,152–156). Patients with grade 3 tumors were in excess of fivetimes more likely to have a recurrence than were patients with grades 1 and 2 tumors. The 5-year disease-free survival rates for patients with grades 1 and 2 tumors were 92% and 86%, respectively, compared with 64% for patients with grade 3 tumors (149). Another study reported similar results, noting recurrences in 9% of patients with grades 1 and 2 tumors compared with 39% of patients with grade 3 lesions (153). Increasing tumor anaplasia is associated with deep myometrial invasion, cervical extension, lymph node metastasis, and both local recurrence and distant metastasis. Tumor Size Tumor size is a significant prognostic factor for lymph node metastasis and survival in patients with endometrial cancer (142,157). One report determined tumor size in 142 patients with clinical stage I endometrial cancer and found lymph node metastasis in 4% of patients with tumors 2 cm or smaller, in 15% of patients with tumors larger than 2 cm, and in 35% of patients with tumors involving the entire uterine cavity (156). Tumor size better defined an intermediate-risk group for lymph nodes metastasis. Overall, these patients had a 10% risk for lymph node metastasis, but there was no nodal metastasis associated with tumors 2 cm or smaller, compared with 18% when tumors were larger than 2 cm. Five-year survival rates were 98% for patients with tumors 2 cm or smaller, 84% for patients with tumors larger than 2 cm, and 64% for patients with tumors involving the whole uterine cavity (137,157). Hormone Receptor Status Estrogen receptor and progesterone receptor levels are prognostic indicators for endometrial cancer independent of grade in several studies (158–164). Patients whose tumors are positive for one or both receptors have longer survival times than patients whose carcinomas lack the corresponding receptors. Even patients with metastasis have an improved prognosis with receptor-positive tumors (161). Progesterone receptor levels appear to be stronger predictors of survival than estrogen receptor levels, and the higher the absolute level of the receptors, the better the prognosis. The proportion of nondiploid tumors increases with stage, lack of tumor differentiation, and depth of myometrial invasion. Myometrial Invasion Because access to the lymphatic system increases as cancer invades into the outer one-half of the myometrium, increasing depth of invasion is associated with increasing likelihood of extrauterine spread and recurrence (153,155,175). The association of depth of myometrial invasion with extrauterine disease and lymph node metastases was reported (175). Of patients without demonstrable myometrial invasion, only 1% had pelvic lymph node metastasis, compared with patients with outer one-third myometrial invasion who had 25% pelvic and 17% aortic lymph node metastases. Deep myometrial invasion (>50% for all stages; fi66% for stage I) is the strongest predictor of hematogenous recurrence (176). In general, patients with noninvasive or superficially invasive tumors have an 80% to 90% 5-year survival rate, whereas those with deeply invasive tumors have a 60% survival rate. The most sensitive indicator of the effect of myometrial invasion on survival is distance from the tumor–myometrial junction to the uterine serosa. Patients with tumors that are less than 5 mm from the serosal surface are at much higher risk for recurrence and death than those with tumors greater than 5 mm from the serosal surface (177,178). Isthmus and Cervix Extension the location of the tumor within the uterus is important. Involvement of the uterine isthmus, cervix, or both is associated with an increased risk for extrauterine disease, lymph node metastasis, and recurrence. Cervical stromal invasion was a strong predictor of lymphatic dissemination and lymphatic recurrence, especially for pelvic lymph nodes (182). One study reported that if the fundus of the uterus alone was involved with tumor, there was a 13% recurrence rate, whereas if the lower uterine segment or cervix was involved with occult tumor, there was a 44% recurrence rate (151). Patients with cervical involvement tended to have higher-grade, larger, and more deeply invasive tumors, undoubtedly contributing to the increased risk for recurrence. Peritoneal Cytology Several reports noted increased recurrence rates and decreased survival rates and, on this basis, recommended treatment for positive cytology (184–186). Most of the studies included patients with other evidence of extrauterine disease spread and were performed without appropriate multivariate analysis and with patients who were incompletely staged. Considering only the 697 patients for whom peritoneal cytology status and adequate follow-up were available, 25 (29%) of 86 patients with positive cytology developed recurrence, compared with 64 (10. They noted that 17 of the 25 recurrences in the positive cytology group were outside the peritoneal cavity. In contrast to these reports, an equal number of studies found no significant relationship between malignant peritoneal cytology and an increased incidence of disease recurrence in the absence of other risk factors such as extrauterine disease (186–189). Patients with positive peritoneal cytology as the only site of extrauterine disease. These patients have an associated 5-year survival of 98% to 100% even when not treated with adjuvant therapy (148,191,192). On the other hand, patients with positive cytology in addition to poor prognostic factors demonstrate a high rate (47%) of distant extra-abdominal failure and may potentially benefit from systemic chemotherapy. Positive peritoneal cytology seems to have an adverse effect on survival only if the endometrial cancer has spread to the adnexa, peritoneum, or lymph nodes, not if the disease is otherwise confined to the uterus (188,189,191). The following conclusions may be reached regarding the prognostic implications of positive peritoneal cytology: Positive peritoneal cytology is associated with other known poor prognostic factors. Positive peritoneal cytology in the absence of other evidence of extrauterine disease or poor prognostic factors has no significant effect on recurrence and survival. Positive peritoneal cytology, when associated with other poor prognostic factors or extrauterine disease, increases the likelihood for distant as well as intra-abdominal disease recurrence and has a significant adverse effect on survival. Use of several different therapeutic modalities has not resulted in any proven benefit to patients with endometrial cancer and positive peritoneal cytology. One series described treatment of all patients with serosal or adnexal invasion (or both) with whole-abdomen radiotherapy. Failures were observed outside the abdomen in 100% of patients with full thickness myometrial invasion or uterine serosal invasion, and in 20% to 25% of cases in the presence of isolated adnexal invasion (132,193). Lymph Node Metastasis Lymph node metastasis is the most important prognostic factor in clinical early-stage endometrial cancer. Of patients with clinical stage I disease, about 10% will have pelvic and 6% will have para-aortic lymph node metastases. Patients with lymph node metastases have almost a sixfold higher likelihood of developing recurrent cancer than patients without lymph node metastases. One study reported a recurrence rate of 48% with positive lymph nodes, including 45% with positive pelvic nodes and 64% with positive aortic nodes, compared with 8% with negative nodes. The 5-year disease-free survival rate for patients with lymph node metastases was 54%, compared with 90% for patients without lymph node metastases (148). Of 48 para-aortic node–positive patients, 28 (58%) developed progressive or recurrent cancer, and only 36% of these patients were alive at 5 years, compared with 85% of patients without para-aortic node involvement (194). One series examined patients with lymph nodes metastases in addition to other extrauterine sites of disease (vagina, uterine serosa, positive peritoneal cytology, adnexal invasion). The recurrence rateswere67% (41% extranodal) for those with lymphatic dissemination versus. Intraperitoneal Metastases Extrauterine metastasis, excluding peritoneal cytology and lymph node metastasis, occurs in about 4% to 6% of patients with clinical stage I endometrial cancer. Gross intraperitoneal spread is highly correlated with lymph node metastases; one study noted that 51% of patients with intraperitoneal tumor had positive lymph nodes, whereas only 7% of patients without gross peritoneal spread had positive nodes (141). Extrauterine spread other than lymph node metastasis issignificantly associated with tumor recurrence.
Caregiver burden and depressive symptoms: Analysis of common outcomes in caregivers of elderly patients medications that cause weight gain buy discount lamotrigine 25mg online. Breast Cancer Husband How to treatment yeast overgrowth order 25mg lamotrigine amex Help Your Wife (and Yourself) Through Diagnosis medicines360 safe 25mg lamotrigine, Treatment treatment 8th february generic 200 mg lamotrigine with mastercard, and Beyond Silver, M. Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. A comparison of calorie and protein intake in hospitalized pediatric oncology patients dining with a caregiver versus patients dining alone: A randomized, prospective clinical trial. Family caregivers of elderly patients with cancer: Understanding and minimizing the burdens of care. Caregiving and Loss: Family Needs, Professional Responses Hospice Foundation of America Website: store. Averting the Caregiving Crisis: Why We Must Act Now (October 2010) Rosalynn Carter Institute for Caregiving Website. Family Caregivers in Cancer: Roles and Challenges National Cancer Institute Website. Help for Cancer Caregivers Help for Cancer Caregivers, a new resource, helps cancer caregivers manage their own health and wellness needs. It is an interactive, personalized web tool that gives the right information at the right time to help lessen stress throughout the caregiving experience. Navigating Cancer Caregiver Survey Navigating Cancer surveyed 326 cancer caregivers through an online survey in October 2010. The survey results revealed significant emotional, financial and physical strain on the cancer caregiver community, as well as a lack of comprehensive resources to support their needs. Orientation to Caregiving: A Handbook for Family Caregivers of Patients with Serious Illness A handbook on what to expect as a family caregiver. Partners in Healing this site provides practical tools, encouragement and inspiration to those wanting to be a source of healing for a loved one. Focuses on simple massage and touch techniques that caregivers can use for their loved ones. Standards for Social Work Practice with Family Caregivers of Older Adults National Association of Social Workers Website. The Cancer Institute of New Jersey, Robert Wood Johnson Medical School – New Brunswick, New Jersey Website. Norris Cotton Cancer Center – Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire Website: cancer. The James – Ohio State University Comprehensive Cancer Center, Columbus, Ohio Website: cancer. Sidney Kimmel Comprehensive Cancer Center – Johns Hopkins University, Baltimore, Maryland Website. University of Michigan Comprehensive Cancer Center – Ann Arbor, Michigan Website: mcancer. Vanderbilt-Ingram Cancer Center – Vanderbilt University, Nashville, Tennessee Website. Pain Management, Palliative, and Long-Term Care in the Elderly Section Description: this section includes Clinical Practice Guidelines on the Management of Pain in the Elderly from the American Geriatric Society and the American Medical Directors Association. Book order forms are available that address pain management in the elderly and in the long-term care setting. Biological, clinical, and psychosocial correlates at the Interface of Cancer and Aging Research. End-of-life nursing education consortium geriatric training program improving palliative care in community geriatric care settings. The use of algorithms in assessing and managing persistent pain in older adults, American Journal of Nursing, 111(3), 34-43. Pain assessment in the patient unable to selfreport: position statement with clinical practice recommendations. Palliative care needs of chronically ill nursing home residents in Germany: Focusing on living, not dying. Evidence-Based Geriatric Nursing Protocols for Best Practice, 4 Edition Boltz, M. Use of pain-behavioral assessment tools in the nursing home: Expert consensus recommendations for practice. Nurses’ perceived barriers to optimal pain management in older adults on acute medical units. Integrating nonpharmacologic and alternative strategies into a comprehensive management approach for older adults with pain. A 9-year follow-up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster. American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons (2009). The guideline is directed toward the entire interdisciplinary team as well as patients and their families in order to achieve effective pain management. The Management of Persistent Pain in Older Persons Clinical Practice Guidelines from the American Geriatrics Society. State of the Art Review of Tools for Assessment of Pain in Nonverbal Older Adults Herr, K. Pediatrics Section Description: this section covers perinatal through young adults and includes City of Hope publications, recommended books, studies, informational articles, and pamphlets as well as policy statements from professional organizations on pediatric topics. Topics include pain & symptom management, palliative and hospice care, spirituality, ethics, advance directives, grief & bereavement. Additional sections include educational materials and related organizational links. Psychosocial care for adolescent and young adult hematopoietic cell transplant patients. Use of complementary and alternative medical interventions for the management of procedure-related pain, anxiety, and distress in pediatric oncology: An integrative review. Transitioning childhood cancer survivors to adult-centered healthcare: Insights from parents, adolescent, and young adult survivors. Appraisal of the pediatric end-of-life nursing education consortium training program. Palliative and End of Life Care for Children and Young People: Home, Hospice, Hospital Grinyer, A. Healthcare reform and concurrent curative care for terminally ill children: A policy analysis. A narrative review summarizing the state of the evidence on the health-related quality of life among childhood cancer survivors. The role of professional chaplains on pediatric palliative care teams: Perspectives from physicians and chaplains. Treatment of pain in children after limb-sparing surgery: An institution’s 26-year experience. Quality of life for children with life-limiting and life-threatening illnesses: Description and evaluation of a regional, collaborative model for pediatric palliative care. Childhood experiences of cancer: An interpretative phenomenological analysis approach. A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. The effect of an educational session on pediatric nurses’ perspectives toward providing spiritual care. Why is end-of-life care so sporadic: A quantitative look at the barriers to and facilitators of providing end-of-life care in the neonatal intensive care unit. Parental experience at the end-of-life in children with cancer: ‘Preservation’ and ‘letting go’ in relation to loss. A Gift of Time: Continuing Your Pregnancy When Your Baby’s Life is Expected to Be Brief Kuebelbeck, A. Children with advanced cancer: Responses to a spiritual quality of life interview. Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukemia. Family support in pediatric palliative care: How are families impacted by their children’s illnessesfi
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