Object In general, patients who present with low Glasgow Coma Scale (GCS) scores and/or fixed and dilated pupils are not expected to do well following arteriovenous malformation (AVM) hemorrhage. However, there is a sense among neurosurgeons that pediatric patients may make a better recovery than adults following such an event. There have been few studies focusing on the outcome of pediatric patients with poor neurological status following AVM hemorrhage. The purpose of this study was to characterize functional outcome in pediatric patients with severe disability after AVM hemorrhage. Methods This was a retrospective analysis of clinical presentation and outcome in 15 patients seen at the authors' pediatric hospital presenting with low GCS scores (defined as GCS ≤ 8) following AVM hemorrhage. Results Initial GCS scores ranged from 3 to 6, and 11 of 14 patients had fixed pupils on clinical examination (data were not available in 1 patient). Eight of 15 patients suffered primarily a lobar hemorrhage, 3 suffered primarily infratentorial bleeding, 2 suffered primarily hemorrhages of the basal ganglia, and 2 suffered intraventricular hemorrhage. The overall mortality rate was 20% (3 of 15 patients). The clinical outcome of survivors was defined by the Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores at follow-up. One year after AVM hemorrhage, 7 (58%) of the 12 surviving patients showed normal or mild disability (PCPC Score 1 or 2), whereas 5 (42%) of 12 patients had moderate or severe disability (PCPC Score 3 or 4). No patients were in a coma or vegetative state, and 11 (92%) of the 12 patients were functioning independently (POPC Score 1, 2, or 3) 1 year after AVM hemorrhage. All patients were functionally independent by last follow-up, with 8 patients (67%) in the normal or mild disability PCPC category, and 4 in the moderate category (PCPC Score 3). All 12 survivors made a meaningful recovery and went on to live independent lives. Conclusions Pediatric patients suffering AVM hemorrhage have a good outcome and are able to function independently, despite a poor neurological state initially.

Considerable need exists to raise awareness of breast cancer (BC) treatment-induced bone loss and provide management and preventative strategies. We describe the development and evaluation process of an educational pamphlet for BC survivors on achieving and maintaining bone health. A Participatory Design approach was used. The pamphlet was first critically evaluated by interdisciplinary healthcare professionals and less vulnerable members of the target audience prior to evaluation by 45 BC survivors, who completed two questionnaires inquiring about demographics and pamphlet evaluation and satisfaction. Pamphlet effectiveness was correlated with income and education to determine differences between socioeconomic groups. Perceived knowledge increased significantly after reading the brochure for all groups. Socioeconomic status had no impact on pamphlet effectiveness. This methodological approach is presented as a blueprint to promote knowledge translation in cancer patient education contexts aiming to provide cancer patients with the best possible resources for effective self-management of their conditions.