Medicine and Health Sciences Commons^™

Dynamic Changes In Methadone Utilisation For Opioid Use Disorder Treatment: A Retrospective Observational Study During The Covid-19 Pandemic, Amy L. Kennalley, Jessica L. Fanelli, John A. Furst, Nicholas J. Mynarski, Margaret A. Jarvis, Stephanie D. Nicholas, Kenneth L. Mccall, Brian J. Piper

Pharmacy Faculty Scholarship

Objectives: Opioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown to be effective in reducing the risk of overdose and improving overall health and quality of life. This study analysed the distribution of methadone for the treatment of OUD across the USA over the past decade and through the COVID-19 pandemic. Design: Retrospective observational study using secondary data analysis of the Drug Enforcement Administration and Medicaid Databases. Setting: USA. Participants: Patients who were dispensed methadone at US opioid treatment …

Social Capital Associates With Better Cognitive Health, Oral Health And Epigenetic Age Deceleration: Findings From The Canadian Longitudinal Study On Aging., Aileen Liang, Noha Gomaa

Department of Medicine Publications

Background: Social exposures are linked to an array of health outcomes, especially around aging. In this study, we examined the association of social capital, defined as social relationships and networks, with clinical and biological outcomes including cognitive health, oral inflammation, and epigenetic aging. Methods: We used data from the Canadian Longitudinal Study on Aging (CLSA) (n =1,479; aged 45–85 years), categorizing social capital as structural and cognitive capital. Oral inflammation was determined as the presence of gum bleeding. Epigenetic aging was computed as the difference between chronological age and DNA methylation age. We constructed multivariable regression models adjusted for covariates …

Palliative Care Quality Of Life Outcomes In Adults With Chronic Illness, Jackie Steigerwald

Master of Science in Nursing Family Nurse Practitioner

In adult populations with chronic illnesses, implementation of palliative care may provide the opportunity to slow the disease process, manage symptoms, and improve patients' overall quality of life. Without palliative care implementation, the aspects of psychosocial needs may go clinically unaddressed with disease progression. Palliative care provides an opportunity for multidisciplinary providers to make interventions to improve all aspects of quality of life. The aim of this project is to evaluate the implementation of palliative care services in patients with chronic illnesses, the World Health Organization Quality of Life Abbreviated (WHOQOL BREF) quality of life scale and compare them with …

Community Health Workers, Stress Reduction, And Racial Equity In Infant Vitality, Justin Rex

ICS Fellow Lectures

How can communities help mothers reduce stress during pregnancy and provide the social supports that contribute to infant vitality? This talk presented findings from an evaluation of the Northwest Ohio Pathways HUB program, a nationally recognized best practice program model that pairs at-risk mothers with community health workers (CHWs) who connect mothers to services that reduce pregnancy risks. The talk included stories from mothers and CHWs about the challenges and stresses they face as well as data from interviews and surveys that quantify the impact CHWs have for reducing mothers' stress and providing supports that help mothers and their children …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Showcase And Preserve The Medical Library History Using The Tmc Library's Digital Commons Exhibits, Alice Sherwood

Library Staff Publications

Presented at The Medical Institutional Repositories in Libraries (MIRL) Symposium conference.

Association Between Trigeminal Neuralgia And Degenerative Cervical Myelopathy: A Cross‐Sectional Study Using Us Data, Robert J. Trager

Faculty Scholarship

Background: Limited research has suggested that trigeminal neuralgia (TN), an often-idiopathic pain disorder affecting the face and head, may arise from compression of the cervical spinal cord due to involvement of the spinal trigeminal tract. We hypothesized that adults with TN would have a greater likelihood of concurrent degenerative cervical myelopathy (DCM) compared to matched adults without TN. Methods: We retrieved de-identified data from a US network (TriNetX, Inc.) including medical records of >113 million patients, with a query date of October 1, 2023, and data spanning the previous 20 years. We created two groups of adults (aged ≥18 years): …

Concussion Exposure And Suicidal Ideation, Planning, And Attempts Among Us High School Students, Jacob J. Kay, Colt A. Coffman, Adam Harrison, Abbas S. Tavakoli Drph, Mph, Me, Toni Torres-Mcgehee Phd, Lat, Atc, Steven P. Broglio, Robert Davis Moore Ms, Ph.D.

Publications

CONTEXT: Interest is growing in the association between repetitive concussions and mental health. However, studies on the relationship between concussion frequency and adverse mental health outcomes among female and male youth are lacking. OBJECTIVES: To examine the association between self-reported concussion frequency and nonfatal suicidal behaviors among youth and to explore the possible interaction of biological sex. DESIGN: Retrospective cross-sectional survey. SETTING: National Youth Risk Behavior Surveillance System. PATIENTS OR OTHER PARTICIPANTS: United States secondary school students (N = 28 442). MAIN OUTCOME MEASURE(S): Exposure variables were the frequency of self-reported sport- or recreation-related concussion in the previous 12 months …

The Lived Experience Of Second-Degree Nursing Students’ Anxiety Before And During Their Initial Clinical Rotation, Shelly Wheatley

Graduate Theses, Dissertations, and Capstones

Anxiety in nursing students can impact learning. Literature has shown that nursing students, especially those in second-degree nursing programs, report higher stress levels compared to other undergraduate students (Penprase & Koczara, 2009). Nursing clinicals can be jarring for students and present many stressors that can impeded learning and cause poor clinical performance. Much research has been done about traditional undergraduate students’ feelings of anxiety. There is a noted gap in research of second-degree, accelerated nursing students and their feelings about their initial clinical placement. Comparisons have often been made between traditional and nontraditional students, but the lived experiences of second-degree …

Screensafefuture: A Parent-Empathetic And Practical Mhealth Application For Toddlers' Brain Development Addressing Screen-Addiction Challenges, Nafisa Anjum

Master of Science in Information Technology Theses

The surging incidents of infants and toddlers screen addiction in the United States are becoming a pressing concern due to its detrimental and compound impact on cognitive development, mental health, and physical growth. To address this era's critical child health and human development problem, we propose an innovative mHealth application-- ScreenSafeFuture-- in this paper. ScreenSafeFuture provides practical and parent-friendly solutions that seamlessly fit into parents' busy lifestyles, also acknowledging the effectiveness and convenience of smartphones as a healthcare tool. Our offering includes essential features designed to enhance the experience between parents and their children under 3 years old. With an …

Candida Auris-Macrophage Cellular Interactions And Transcriptional Response, Pedro Miramón, Andrew W Pountain, Michael C Lorenz

Faculty, Staff and Student Publications

The pathogenic yeast Candida auris represents a global threat of the utmost clinical relevance. This emerging fungal species is remarkable in its resistance to commonly used antifungal agents and its persistence in the nosocomial settings. The innate immune system is one the first lines of defense preventing the dissemination of pathogens in the host. C. auris is susceptible to circulating phagocytes, and understanding the molecular details of these interactions may suggest routes to improved therapies. In this work, we examined the interactions of this yeast with macrophages. We found that macrophages avidly phagocytose C. auris; however, intracellular replication is …

First-Line Selpercatinib Or Chemotherapy And Pembrolizumab In Ret Fusion-Positive Nsclc, Caicun Zhou, Benjamin Solomon, Herbert H Loong, Keunchil Park, Maurice Pérol, Edurne Arriola, Silvia Novello, Baohui Han, Jianying Zhou, Andrea Ardizzoni, M Perez Mak, Fernando C Santini, Yasir Y Elamin, Alexander Drilon, Jürgen Wolf, Nalin Payakachat, Minji K Uh, Deborah Rajakumar, Hongmei Han, Tarun Puri, Victoria Soldatenkova, A Bence Lin, Boris K Lin, Koichi Goto, Libretto-431 Trial Investigators

Faculty, Staff and Student Publications

Background: Selpercatinib, a highly selective potent and brain-penetrant RET inhibitor, was shown to have efficacy in patients with advanced RET fusion-positive non-small-cell lung cancer (NSCLC) in a nonrandomized phase 1-2 study.

Methods: In a randomized phase 3 trial, we evaluated the efficacy and safety of first-line selpercatinib as compared with control treatment that consisted of platinum-based chemotherapy with or without pembrolizumab at the investigator's discretion. The primary end point was progression-free survival assessed by blinded independent central review in both the intention-to-treat-pembrolizumab population (i.e., patients whose physicians had planned to treat them with pembrolizumab in the event that they were …

Circulating Metabolites May Illustrate Relationship Of Alcohol Consumption With Cardiovascular Disease, Yi Li, Mengyao Wang, Xue Liu, Jian Rong, Patricia Emogene Miller, Roby Joehanes, Tianxiao Huan, Xiuqing Guo, Jerome I Rotter, Jennifer A Smith, Bing Yu, Matthew Nayor, Daniel Levy, Chunyu Liu, Jiantao Ma

Faculty, Staff and Student Publications

BACKGROUND: Metabolite signatures of long-term alcohol consumption are lacking. To better understand the molecular basis linking alcohol drinking and cardiovascular disease (CVD), we investigated circulating metabolites associated with long-term alcohol consumption and examined whether these metabolites were associated with incident CVD.

METHODS: Cumulative average alcohol consumption (g/day) was derived from the total consumption of beer, wine, and liquor on average of 19 years in 2428 Framingham Heart Study Offspring participants (mean age 56 years, 52% women). We used linear mixed models to investigate the associations of alcohol consumption with 211 log-transformed plasma metabolites, adjusting for age, sex, batch, smoking, diet, …

Primary Care Patient Interest In Multi-Cancer Early Detection For Cancer Screening, Ronald Myers, Mie Hallman, Ayako Shimada, Melissa Dicarlo, Kaitlyn Davis, William Leach, Hattie Jackson, Amanda Indictor, Christopher Chambers

Department of Medical Oncology Faculty Papers

Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. …

Identification Of Cdk1, Pbk, And Chek1 As An Oncogenic Signature In Glioblastoma: A Bioinformatics Approach To Repurpose Dapagliflozin As A Therapeutic Agent, Harold A Chinyama, Li Wei, Ntlotlang Mokgautsi, Bashir Lawal, Alexander T H Wu, Hsu-Shan Huang

Faculty, Staff and Student Publications

Glioblastoma multiforme (GBM) is the most aggressive and lethal primary brain tumor whose median survival is less than 15 months. The current treatment regimen comprising surgical resectioning, chemotherapy with Temozolomide (TMZ), and adjuvant radiotherapy does not achieve total patient cure. Stem cells' presence and GBM tumor heterogeneity increase their resistance to TMZ, hence the poor overall survival of patients. A dysregulated cell cycle in glioblastoma enhances the rapid progression of GBM by evading senescence or apoptosis through an over-expression of cyclin-dependent kinases and other protein kinases that are the cell cycle's main regulatory proteins. Herein, we identified and validated the …

Cytomulate: Accurate And Efficient Simulation Of Cytof Data, Yuqiu Yang, Kaiwen Wang, Zeyu Lu, Tao Wang, Xinlei Wang

Faculty, Staff and Student Publications

Recently, many analysis tools have been devised to offer insights into data generated via cytometry by time-of-flight (CyTOF). However, objective evaluations of these methods remain absent as most evaluations are conducted against real data where the ground truth is generally unknown. In this paper, we develop Cytomulate, a reproducible and accurate simulation algorithm of CyTOF data, which could serve as a foundation for future method development and evaluation. We demonstrate that Cytomulate can capture various characteristics of CyTOF data and is superior in learning overall data distributions than single-cell RNA-seq-oriented methods such as scDesign2, Splatter, and generative models like LAMBDA.

Endoscopic Retrograde Cholangiopancreatography-Related Early Perforations: A Study Of Effects Of Procedure Duration, Complexity, And Endoscopist Experience, Mark Aloysius, Hemant Goyal, Tejas Nikumbh, Niraj James Shah, Ghassan M Hammoud, Pritesh Mutha, Mairin Joseph-Talreja, Savio John, Ganesh Aswath, Vaibhav Wadhwa, Nirav Thosani

Faculty, Staff and Student Publications

BACKGROUND: Perforations (Perf) during endoscopic retrograde cholangiopancreatography (ERCP) are rare (< 1%) but potentially fatal events (up to 20% mortality). Given its rarity, most data is through case series studies from centers or analysis of large databases. Although a meta-analysis has shown fewer adverse events as a composite (bleeding, pancreatitis, Perf) during ERCP performed at high-volume centers, there is very little real-world data on endoscopist and center procedural volumes, ERCP duration and complexity on the occurrence of Perf.

AIM: To study the profile of Perf related to ERCP by center and endoscopist procedure volume, ERCP time, and complexity from a national endoscopic repository.

METHODS: Patients from clinical outcomes research initiative-national endoscopic database (2000-2012) who underwent ERCP were stratified based on the endoscopist and center volume (quartiles), and total procedure duration and complexity grade of the ERCP based on procedure details. The effects of these variables on the Perf that occurred were studied. Continuous variables were compared between Perf and no perforations (NoPerf) using the Mann-Whitney U test …

Internet Analytics Of An Innovative Digital Educational Resource Of Type 1 Diabetes Hellotype1 In Local Languages For People Living With Diabetes Families And Healthcare Professionals In Southeast Asia, Sze May Ng, I V Malene, Thy Khue Nguyen, Khuong Le, Yang Xian Lucas Lim, Ngee Lek, Samantha Seal, Steffen Yun Tange, Azriyanti Anuar Zaini, Taninee Sahakitrungruang, Anne Charlotte Ficheroulle

Faculty, Staff and Student Publications

BACKGROUND: There is minimal data of health outcomes for Type 1 Diabetes (T1D) in Southeast Asia (SEA) where government funding of insulin and blood glucose monitoring either do not exist or is limited. The full impact of Covid-19 pandemic on the national economies of SEA remain unknown. In the midst of the pandemic, in 2021, HelloType1 was developed by Action4Diabetes (A4D), a non-government organisation charity in collaboration with Southeast Asia local healthcare professionals as an innovative digital educational resource platform of T1D in local languages. HelloType1 was launched in Cambodia, Vietnam, Thailand and Malaysia in 2021 to 2022 with Memorandums …

Loss Of Cftr Function In Macrophages Alters The Cell Transcriptional Program And Delays Lung Resolution Of Inflammation, Dianne Wellems, Yawen Hu, Scott Jennings, Guoshun Wang

School of Graduate Studies Faculty Publications

Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the CF Transmembrane-conductance Regulator (CFTR) gene. The most severe pathologies of CF occur in the lung, manifesting as chronic bacterial infection, persistent neutrophilic inflammation, and mucopurulent airway obstruction. Despite increasing knowledge of the CF primary defect and the resulting clinical sequelae, the relationship between the CFTR loss of function and the neutrophilic inflammation remains incompletely understood. Here, we report that loss of CFTR function in macrophages causes extended lung inflammation. After intratracheal inoculation with Pseudomonas aeruginosa, mice with a macrophage-specific Cftr-knockout (Mac-CF) were able to mount an …

The Associations Of Parental Smoking, Quitting And Habitus With Teenager E-Cigarette, Smoking, Alcohol And Other Drug Use In Gui Cohort ’98, Salome Sunday, Luke Clancy, Joan Hanafin

Articles

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1–3 of Growing Up in Ireland (Cohort ’98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with …

Mixed Methods Evaluation Of Handshake Antimicrobial Stewardship On Adult Inpatient Medicine Floors, Elizabeth A Neuner, Andrew Atkinson, Dan Ilges, Tamara Krekel, David J Ritchie, Alice F Bewley, Michael J Durkin, Kevin Hsueh, Sena Sayood

2020-Current year OA Pubs

OBJECTIVE: To evaluate the effects of handshake antimicrobial stewardship on medicine floors at a large tertiary care hospital.

DESIGN: Retrospective observational study.

SETTING: 1,278-bed academic hospital.

PATIENTS: Adults admitted to non-ICU medicine services.

INTERVENTIONS: A handshake stewardship team consisting of an infectious diseases (ID) physician and pharmacist reviewed charts of patients receiving antimicrobials on medicine floors without a formal ID consult. Recommendations were communicated in-person to providers and acceptance rates were examined with descriptive statistics. Additional data regarding program perception among providers were obtained via surveys. Antibiotic usage trends were extracted from National Healthcare Safety Network Antimicrobial Use option data …

Two Phase 3 Trials Of Gantenerumab In Early Alzheimer's Disease, Randall J Bateman, Et Al.

2020-Current year OA Pubs

BACKGROUND: Monoclonal antibodies that target amyloid-beta (Aβ) have the potential to slow cognitive and functional decline in persons with early Alzheimer's disease. Gantenerumab is a subcutaneously administered, fully human, anti-Aβ IgG1 monoclonal antibody with highest affinity for aggregated Aβ that has been tested for the treatment of Alzheimer's disease.

METHODS: We conducted two phase 3 trials (GRADUATE I and II) involving participants 50 to 90 years of age with mild cognitive impairment or mild dementia due to Alzheimer's disease and evidence of amyloid plaques on positron-emission tomography (PET) or cerebrospinal fluid (CSF) testing. Participants were randomly assigned to receive gantenerumab …

Perspectives On Research Needs In Healthcare Epidemiology, Infection Prevention, And Antimicrobial Stewardship: What's On The Horizon-Part Ii, Jonas Marschall, Rachael E Snyders, Hugo Sax, Jason G Newland, Thais Guimarães, Jennie H Kwon

2020-Current year OA Pubs

In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the "neighbors," 9) novel research methodologies, and 10) the …

Contribution Of Macrophages To Neural Survival And Intracochlear Tissue Remodeling Responses Following Cochlear Implantation, Muhammad Taifur Rahman, Brian J Mostaert, Bryce Hunger, Utsow Saha, Alexander D Claussen, Ibrahim Razu, Farjana Nasrin, Nashwaan Ali Khan, Peter Eckard, Sarah Coleman, Jacob Oleson, Jonathon R Kirk, Keiko Hirose, Marlan R Hansen

2020-Current year OA Pubs

BACKGROUND: Cochlear implants (CIs) restore hearing to deafened patients. The foreign body response (FBR) following cochlear implantation (post-CI) comprises an infiltration of macrophages, other immune and non-immune cells, and fibrosis into the scala tympani, a space that is normally devoid of cells. This FBR is associated with negative effects on CI outcomes including increased electrode impedances and loss of residual acoustic hearing. This study investigates the extent to which macrophage depletion by an orally administered CSF-1R specific kinase (c-FMS) inhibitor, PLX-5622, modulates the tissue response to CI and neural health.

MAIN TEXT: 10- to 12-week-old CX3CR1 + /GFP Thy1 + …

Utilizing Stakeholder Input Within The Tennessee Heart Health Network To Improve Cardiovascular Health Outcomes In Tennessee, Abigail C. Bennett

Longitudinal Scholar's Project

Background: Tennessee ranks sixth nationwide for most deaths related to heart disease. The Tennessee Heart Health Network (TN-HHN), an initiative coordinated by the Tennessee Population Health Consortium (TN-PHC), was created to combat this issue. The TN-HHN is a statewide network of primary care practices, health systems, and academic centers committed to implementing patient-centered outcomes research (PCOR) approaches to demonstrably improve cardiovascular disease (CVD) health outcomes and health equity across Tennessee.

Objective: Evaluate stakeholder experiences in participating in the Network in an effort to assess partner satisfaction and improve the TN-HHN as a whole.

Methods: Eligible stakeholders were invited via …

Weight Loss In Obese Adults On The Ketogenic Diet, Abigail Velasquez

Master of Science in Nursing Family Nurse Practitioner

The ketogenic diet is a successful and sustainable diet for obese adults to lose weight. One aim of this project is to provide evidentiary support for the ketogenic diet. An additional aim is to disseminate up to date literature to primary care providers in order to offer the ketogenic diet as a sustainable option for weight loss, to reverse disease risk, and, essentially, regain optimal health.

Risk Factors For Cmv And Bk Infections In An Elderly Veteran Population Following Kidney Transplantation: Implications For Immunosuppression Induction And Management, Anne Thorndyke, Cara Joyce, Manpreet Samra, Laura Cotiguala, Christine Trotter, Oswaldo Aguirre, W. James Chon, Rupinder Sodhi, Reynold I. Lopez-Soler

Biostatistics Collaborative Core: Faculty Publications and Other Works

Cytomegalovirus (CMV) and BK Polyomavirus (BKPyV) are the most common opportunistic pathogens following kidney transplantation. We evaluated 102 patients with a median age of 63 at Edward Hines VA Hospital from November 2020 to December 2022. Our primary interest was the incidence of CMV and BKPyV infections, as well as CMV and BKPyV coinfection. Secondary interests included time to infection, rejection, and graft and patient survival. There were no statistically significant differences in patient age, donor age, race, transplant type, incidence of delayed graft function, or induction in both cohorts (any infection (N = 46) vs. those without (N = …

Nurses’ Compliance With Handover Practices In Adult Medical Surgical Units At A Tertiary Care Hospital In Karachi, Pakistan, Amber Qasim Ali

MSCN 2023

Background: The exchange of the shift changeover report of patient, from nurse to nurse at the patient's bedside is known as "bedside handover." Although this method is becoming more and more popular in the nursing sector, not many people genuinely practice it.
Purpose: To determine the different factors impacting nurses' compliance and to evaluate the compliance rate of nurses to comply with bedside handover guidelines. Methods: A cross-sectional observational study was conducted in the medical surgical ward at the Aga Khan University Hospital, Karachi. During the study, the structured bedside handover technique known as "kardex," which adheres to SBAR (Situation, …

Nurses' Compliance With Central Line Maintenance (Handling) Guidelines At A Tertiary Care Setting In Karachi, Pakistan- A Descriptive Cross-Sectional Study, Alina Amir Ali

MSCN 2023

Background: Central venous catheters (CVCs) are integral to modern healthcare, facilitating critical treatments. However, the risk of complications, particularly infections, necessitates strict adherence to central line maintenance protocols. This study explores the compliance of nurses in executing these protocols.
Purpose: In a tertiary care facility in Karachi, Pakistan, this study sought to evaluate nurses' adherence to each item on the central line management checklist as well as the checklist's total adherence in the Special Care Units.
Method: A total of 119 registered nurses were assessed, using a quantitative structured observational design for central line handling in adult medical surgical special …

Parents’ Emotional And Psychological Perspective Of Caring Children With Oncological Disorders: A Descriptive Qualitative Study, Ambreen Navroz Ali Salyani

MSCN 2023

Background: Childhood cancer has a profound effect on the emotional and psychological well-being of parents, yet often their own psychological health is overlooked as the primary focus while treating the child. These parents silently suffer from psychological distress while caring for their children. They use their own coping strategies to overcome the situation. However, limited studies have been carried out in low- and middle-income countries (LMIC) regarding parents’ emotional and psychological perspectives of caring their children with oncological disorder.
Purpose: The objective of this study was to explore the psychological perspectives that parents of children with cancer diagnosis, treatment, social …