Psychoneuroimmunology and the pediatric surgeon

Psychoneuroimmunological Markers of Psychological Intervention in Pediatric Cancer: A Systematic Review and New Integrative Model

PURPOSE

Pediatric cancer is a serious problem and still becomes a global challenge today. Various complex stressors due to diagnosis, disease symptoms, and various side-effects from the treatment that children with cancer undergo will cause problems in the child's psychoneuroimmunological aspects. Psychological interventions designed to modulate the stress response include psychoneuroimmunological markers. Unfortunately, there is little evidence to support the effect of psychological interventions on psychoneuroimmunological markers. This systematic review aims to assess the effectiveness of psychological interventions on psychoneuroimmunological markers in children with cancer and to provide a new integrative model for further research.

METHODS

This systematic review uses four main databases (Scopus, PubMed, ScienceDirect, and ProQuest). The guideline used Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Selecting articles used the Rayyan application. The quality study was conducted using Joanna Briggs Institute (JBI)'s critical appraisal tools. The data were analyzed using the population, intervention, comparison, outcome, and study design (PICO) Synthesis based on similarities and differences in study characteristics to interpret the results.

RESULTS

The search results in this systematic review found 1653 articles, 21 of which matched the predetermined inclusion and exclusion criteria. Most of the designs used were randomized controlled trials (57.1%). Massage therapy was the most common type of psychological intervention (14.2%). Almost half of the studies measured psychological responses (38.0%), and psycho-physiological responses (42.9%), and only a small proportion assessed the effectiveness of psychological interventions on neuroimmunological markers in pediatric cancer.

CONCLUSIONS

We recommend the use of psychological interventions as an additional intervention in managing psychoneuroimmunological markers of pediatric cancer. This study offers a new integrative model demonstrating the interaction between stress and psychological intervention involving neuroendocrine and immune mechanisms. However, future researchers need to test all domains of these new integrative models. This will reveal the complex interactions among these components and understand their relevance to health outcomes.

You are never too small to make the difference A message for everyone and a push for pediatric surgeons in training

Surgery, and training in surgery, is complex as it requires to master and to transmit both technical and non-technical skills. This is particularly true when the patient is a child with its family. Academies are called to ensure that the skills needed to guarantee the optimal care to the ill child, and to its parents, are conveyed to the new generations. In this paper, after shortly reviewing the history of academic pediatric surgery and the structure of pediatric surgery training in Italy, we will give a personal view on some of the most important non-technical challenges a young pediatric surgeon will face during his/her career, that make this discipline one of the hardest and the most rewarding at the same time.

National Survey of Pediatric Intestinal Rehabilitation Programs in the United States

BACKGROUND

Pediatric intestinal rehabilitation (PIR) programs are associated with improved outcomes in children with intestinal failure but remain heterogeneous nationally. This study characterizes PIR program components to aid those seeking to establish or expand a program.

METHODS

Members of the Children's Hospital Association reporting a PIR program to the US News and World Report completed a 14-item questionnaire using the Qualtrics Online Survey Software. Programs were categorized as small or large (≤50 vs >50 patients) and new or established (≤10 vs >10 years).

RESULTS

Seventy-one programs were identified and 61 surveys were returned for a response rate of 86%. Majority of programs had gastroenterology, surgery, nutrition, nursing, and social work services involved. Large programs (n = 34; 59%) were more likely to serve as referral centers; have greater participation by nursing, social work, and primary care; have more dedicated time by gastroenterology, surgery, nursing, nutrition, and social work; have more frequent meetings; and have various funding sources (P < .05).

CONCLUSION

Critical components of a PIR program include gastroenterology, surgery, and nutrition services with strong nursing and social work support. These data document the components of modern PIR programs, though further studies on the relationship between program structure and patient outcomes are warranted.

Hypnosis Influence on the Perfusion in Perforator Flaps in Early Postoperative Period: A Series of 18 Cases

In practice worldwide, there are experiences affecting different body functions via central control mechanisms with the help of psychotherapy methods. In plastic and reconstructive surgery, there is the experience of applying hypnosis, with the main goal of eliminating pain. The aim of this research is to study the impact of hypnosis on the perfusion level in perforator flaps in the early postoperative period, which could enhance flap survival.