ABSTRATC Study based on Heidegger's existential phenomenology. The objective was to understand the experience of parents of children with cancer in treatment failure conditions. Participants were eight parents of eight patients seen at an oncology center from January to May 2014. Interviews were conducted guided by the question: Tell me about your experience of being a family member of a child with cancer in treatment failure conditions? Three ontological themes emerged: the phenomenon unveiled in the discovery of the child's cancer; experiencing the process involving the child's cancer; unveiling the possibility of the child's death. It was evidenced that the experience of these parents was permeated by intense and devastating feelings towards the early loss, annihilating dreams of a desired future. It is essential for nursing to look more attentively at the family of terminal patients.

No abstract

No abstract

BackgroundA care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient’s home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope.Methods/DesignAn observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. We will include and follow during 1 year 1,000 patients. The study consists of 3 work-packages:- Cost of pathwayThe aim of this WP is to calculate the overall costs of the early BC pathway at 1 year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production).- Patient satisfaction and work reintegrationThree questionnaires will assess the patients’ satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 (‘breast cancer’ module, SCNS-BR8); and the OUTPASSAT-35 questionnaire.- Quality, coordination and access to innovationQuality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care.The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient’s access to innovation.DiscussionThe assessment of care pathways encourages the implementation of new payment models. Our approach could help health care professionals and policymakers to establish other cost-of-illness studies and plan the allocation of resources on a patient basis rather than a visit basis.

Case reportA 32 year old nulliparous woman was referred at 28 weeks of gestation because of severe pre-eclampsia in a dichorionic twin pregnancy conceived naturally. Her pregnancy was uneventful until 22 weeks of gestation, when a routine ultrasound scan revealed severe intrauterine growth restriction and reversed umbilical blood flow in one twin, while the other had normal development. At 28 weeks of gestation, the woman developed pre-eclampsia, with a blood pressure greater than 160/100 mmHg, proteinuria, headache and oedema.In our centre, ultrasound examination confirmed growth restriction (weight estimation: 570 g) and reversed umbilical flow with cerebral redistribution in one twin, with a normal co-twin (estimated weight: 1270 g). The woman's clinical state was stable using a calcium channel blocker (nicardipine 100 mg given intravenously per day) to control her blood pressure. The degree of proteinuria was 2.16 g per day. After discussion with the parents and because of the poor prognosis for the growth-restricted twin, expectant management was decided, in order to avoid prematurity in the co-twin. Her proteinuria increased ( Fig. 1) and control of her blood pressure required the addition of labetalol (600 mg intravenously per day). At 32 weeks of gestation, her proteinuria was 6.5 g per day. Ultrasound examination did not show evidence of any growth of the restricted twin and confirmed severe Doppler abnormalities, while the co-twin's assessment was reassuring. After discussion with the parents and in accordance with French law, selective termination of the compromised twin was performed by the administration of an intracardiac injection of potassium chloride.From this point, her symptoms of pre-eclampsia disappeared, the proteinuria started a dramatic decrease (Fig. 1) and her blood pressure remained normal with a low dose of oral nicardipine (60 mg per day). Close follow up was maintained and her pregnancy remained uneventful. The woman was discharged home at 34 weeks of gestation. At 38 weeks, a healthy baby girl weighing 2560 g was born by vaginal delivery and a stillborn boy weighing 330 g was delivered immediately after. Her postpartum course was uneventful. Macroscopic and histologic examination confirmed a dichorionic pregnancy, with two placentas separated by two amnions and chorions. DiscussionPre-eclampsia is a disorder specific to pregnancy characterised by increased blood pressure and proteinuria. It affects 3 -5% of pregnancies and is a major cause of maternal and perinatal mortality 1 . The cause of pre-eclampsia remains elusive in spite of many attempts to understand the mechanisms responsible for its pathogenesis. Studies over the past decades suggest several possible origins of pre-eclampsia 2 . The initiating event could be reduced uteroplacental perfusion due to abnormal trophoblastic invasion of the spiral arterioles 3 . However, recent findings are more suggestive of an inappropriate maternal inflammatory response 4 that could involve a superantigen-like effect 5 . Some authors spec...