The American Academy of Pediatrics (AAP) is committed to the development of rational, equitable, and effective parental leave policies that are sensitive to the needs of pediatric residents, ...families, and developing infants and that enable parents to spend adequate and good-quality time with their young children. It is important for each residency program to have a policy for parental leave that is written, that is accessible to residents, and that clearly delineates program practices regarding parental leave. At a minimum, a parental leave policy for residents and fellows should conform legally with the Family Medical Leave Act as well as with respective state laws and should meet institutional requirements of the Accreditation Council for Graduate Medical Education for accredited programs. Policies should be well formulated and communicated in a culturally sensitive manner. The AAP advocates for extension of benefits consistent with the Family Medical Leave Act to all residents and interns beginning at the time that pediatric residency training begins. The AAP recommends that regardless of gender, residents who become parents should be guaranteed 6 to 8 weeks, at a minimum, of parental leave with pay after the infant's birth. In addition, in conformance with federal law, the resident should be allowed to extend the leave time when necessary by using paid vacation time or leave without pay. Coparenting, adopting, or fostering of a child should entitle the resident, regardless of gender, to the same amount of paid leave (6-8 weeks) as a person who takes maternity/paternity leave. Flexibility, creativity, and advanced planning are necessary to arrange schedules that optimize resident education and experience, cultivate equity in sharing workloads, and protect pregnant residents from overly strenuous work experiences at critical times of their pregnancies.
Purpose
The pharmacokinetics of trabectedin has never been reported in patients with impaired renal function or in patients on hemodialysis.
Methods
We examined trabectedin PK in a patient on ...hemodialysis, starting trabectedin therapy at a standard dose for recurrence of a retroperitoneal myxoid liposarcoma that had occurred under immunosuppressive drugs for kidney transplant.
Results
As compared with a population with normal renal function, the study patient presented a higher
C
max
and AUC, with lower clearance, terminal half-life, and volume of distribution. The low dialysis clearance, accounting for a minor part of the total body clearance and the absence of detectable trabectedin in the dialysate samples, suggests that hemodialysis does not efficiently clear trabectedin. Trabectedin tolerance was good.
Conclusions
This case reports for the first time the feasibility of trabectedin therapy in a hemodialyzed patient. Given the rising incidence of cancer in patients with end-stage renal disease, it is crucial to provide data that improve the management of anticancer drugs in dialyzed patients.
Patient:
9-year-old African American male.
Chief Complaint:
Recently diagnosed with acute lymphoblastic leukemia (ALL) after investigation into a large anterior mediastinal mass causing airway ...compression.
History of Present Illness:
The day before the unexpected urgent glucose-6-phosphate dehydrogenase (G6PD) request, the patient was diagnosed with an aggressive form of leukemia and a significant tumor mass causing airway compression. A computed tomography (CT) scan indicated potential renal involvement. Based on this information and the size of the mass, the patient was referred for immediate chemotherapy. However, there was a concern that he could develop tumor lysis syndrome (TLS) during treatment. To avoid this condition, the pediatric intensive care unit (ICU) sought to pretreat the child with rasburicase, which led to the emergency G6PD request.
Previous Medical History:
Unknown.
Family History:
Largely unknown, but no apparent chronic diseases.
Physical Examination Findings:
Three weeks of progressively worsening lymphadenopathy, coughing, night sweats, mild hepatosplenomegaly, and breathing difficulty when supine. The patient arrived at the medical center for airway management and had a temperature of 36.1°C; blood pressure, 120/87 mmHg; pulse, 115 bpm; respiratory rate, 22 breaths per minute, with labored breathing but normal O2 saturation while upright and awake, in room air.
Principle Laboratory Findings:
Table 1.
The purpose of this study is to better understand Nutritionist-Dietician opinions concerning WIC Program strategies to promote breastfeeding in Puerto Rico. Four groups of nutritionists-dietitians ...were recruited to take part in focus group discussions. Each focus group lasted for approximately 1 h and the researchers completed a debriefing sheet after each meeting. The group discussions were taped and transcribed. The participants identified hospital barriers, lack of family support and problems related to the mother as the three principal reasons that Puerto Rican mothers do not breastfeed their babies or stop breastfeeding early. An individual meeting was the most frequently mentioned WIC strategy that was meant to convince mothers to breastfeed their infants. Nevertheless, the focus group participants recognized that the effort and time available for such meetings is limited. From these groups, one theme that emerged is that the WIC Program in Puerto Rico should collaborate with hospitals to arrange for WIC-sponsored nutritionist-dietitians to visit the WIC participants during their maternity hospital stay, and in their homes.
Review application of telemedicine support for penetrating trauma. Clinical context: Special Operations Resuscitation Team (SORT) deployed in Africa Area of Responsibility (AOR) Organic expertise: ...Internal Medicine physician, two Special Operations Combat medics (SOCMs), and one radiology technician Closest surgical support: Non-US surgical support 20km away; a nonsurgeon who will perform surgeries; neighboring country partner-force surgeon 2 hours by fixedwing flight. Earliest evacuation: Evacuated 4 days after presentation to a neighboring country with surgical capability.
The selection of a medical specialty has been associated with multiple factors, such as personal
preferences, academic exposure, motivational factors and sociodemographic factors,
such as gender. The ...number of women in the medical field has increased in recent years. In
Latin America, we have not found any studies that explore this relationship.Secondary analysis of the Collaborative Working Group for the Research of Human
Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first
year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students
who referred intention to choose a certain medical specialty were considered as
participants.There is an association between the female gender and the intention to choose Obstetrics/
Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend
conducting studies that consider other factors that can influence the choice of a medical
specialty.
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