Ida M Moore

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• Hsiao, C. P., Moore, I. M., Insel, K. C., & Merkle, C. J. (2017). High perceived stress is linked to afternoon cortisol levels and greater symptom distress in patients with localized prostate cancer. Cancer nursing, 34(6), 470-8.
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  Patients treated with radical prostatectomy (RP) or radiation therapy (RT) for prostate cancer can experience stress and symptoms that impact quality of life.
• Moore, I. M., Lupo, P. J., Insel, K., Harris, L. L., Pasvogel, A., Koerner, K. M., Adkins, K. B., Taylor, O. A., & Hockenberry, M. J. (2017). Neurocognitive Predictors of Academic Outcomes Among Childhood Leukemia Survivors. Cancer nursing, 39(4), 255-62.
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  Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes.
• O'Haver, J., Moore, I. M., Insel, K. C., Reed, P. G., Melnyk, B. M., & Lavoie, M. (2010). Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis. Pediatric nursing, 36(6), 284-91; quiz 292.
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  When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts.
• Taylor, O. A., Hockenberry, M. J., McCarthy, K., Gundy, P., Montgomery, D., Ross, A., Scheurer, M. E., & Moore, I. M. (2017). Evaluation of Biomarkers of Oxidative Stress and Apoptosis in Patients With Severe Methotrexate Neurotoxicity: A Case Series. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 32(5), 320-5.
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  Central nervous system (CNS) treatment is an essential part of acute lymphocytic leukemia (ALL) therapy, and the most common CNS treatment is intrathecal (IT) and high-dose intravenous (IV) methotrexate (MTX). Treatment with MTX may cause neurotoxicity, which is often accompanied by neurologic changes, delays in treatment, and prolonged hospital stays. This article reports clinical presentations of 3 patients with severe MTX toxicity as well as levels of oxidative stress and apoptosis biomarkers in cerebrospinal fluid (CSF). Oxidative stress was measured by oxidized phosphatidylcholine (PC), oxidized phosphatidylinositol (PI), and F2 isoprostanes; apoptosis was measured by caspase 3/7 activity. Most consistent biomarker changes in all 3 cases were increases in caspase 3/7 and F2 isoprostanes prior to acute toxicity while increases in oxidized phospholipids occurred slightly later. Progressive increases in F2 isoprostanes and caspase 3/7 activity prior to and/or during acute toxicity suggests MTX induces oxidative stress and an associated increase in apoptosis. These findings support the role of oxidative stress in MTX-related neurotoxicity.
• Moore, I. M., Merkle, C. J., Byrne, H., Ross, A., Hawkins, A. M., Ameli, S. S., & Montgomery, D. W. (2016). Effects of Intraventricular Methotrexate on Neuronal Injury and Gene Expression in a Rat Model: Findings From an Exploratory Study. Biological research for nursing, 18(5), 505-14.
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  Central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia, used to prevent disease recurrence in the brain, is essential for survival. Systemic and intrathecal methotrexate, commonly used for CNS-directed treatment, have been associated with cognitive problems during and after treatment. The cortex, hippocampus, and caudate putamen, important brain regions for learning and memory, may be involved in methotrexate-induced brain injury. Objectives of this study were to (1) quantify neuronal degeneration in selected regions of the cortex, hippocampus, and caudate putamen and (2) measure changes in the expression of genes with known roles in oxidant defense, apoptosis/inflammation, and protection from injury. Male Sprague Dawley rats were administered 2 or 4 mg/kg of methotrexate diluted in artificial cerebrospinal fluid (aCSF) or aCSF only into the left cerebral lateral ventricle. Gene expression changes were measured using customized reverse transcription (RT)(2) polymerase chain reaction arrays. The greatest percentage of degenerating neurons in methotrexate-treated animals was in the medial region of the cortex; percentage of degenerating neurons in the dentate gyrus and cornu ammonis 3 regions of the hippocampus was also greater in rats treated with methotrexate compared to perfusion and vehicle controls. There was a greater percentage of degenerating neurons in the inferior cortex of control versus methotrexate-treated animals. Eight genes involved in protection from injury, oxidant defense, and apoptosis/inflammation were significantly downregulated in different brain regions of methotrexate-treated rats. To our knowledge, this is the first study to investigate methotrexate-induced injury in selected brain regions and gene expression changes using a rat model of intraventricular drug administration.
• Rodgers, C., Sanborn, C., Taylor, O., Gundy, P., Pasvogel, A., Moore, I. M., & Hockenberry, M. J. (2016). Fatigue and Oxidative Stress in Children Undergoing Leukemia Treatment. Biological research for nursing, 18(5), 515-20.
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  Fatigue is a frequent and distressing symptom in children undergoing leukemia treatment; however, little is known about factors influencing this symptom. Antioxidants such as glutathione can decrease symptom severity in adult oncology patients, but no study has evaluated antioxidants' effects on symptoms in pediatric oncology patients. This study describes fatigue patterns and associations of fatigue with antioxidants represented by reduced glutathione (GSH) and the reduced/oxidized glutathione (GSH/GSSG) ratio among children receiving leukemia treatment. A repeated measures design assessed fatigue and antioxidants among 38 children from two large U.S. cancer centers. Fatigue was assessed among school-age children and by parent proxy among young children. Antioxidants (GSH and GSH/GSSG ratio) were assessed from cerebrospinal fluid at four phases during leukemia treatment. Young children had a steady decline of fatigue from the end of induction treatment through the continuation phase of treatment, but no significant changes were noted among the school-age children. Mean antioxidant scores varied slightly over time; however, the GSH/GSSG ratios in these children were significantly lower than the normal ratio. Mean GSH/GSSG ratios significantly correlated to fatigue scores of the school-age children during early phases of treatment. Children with low mean GSH/GSSG ratios demonstrated oxidative stress. The low ratios noted early in therapy were significantly correlated with higher fatigue scores during induction and postinduction treatment phases. This finding suggests that increased oxidative stress during the more intensive phases of therapy may explain the experience of fatigue children report.
• Hockenberry, M. J., Krull, K. R., Insel, K. C., Harris, L. L., Gundy, P. M., Adkins, K. B., Pasvogel, A. E., Taylor, O. A., Koerner, K. M., Montgomery, D. W., Ross, A. K., Hill, A., & Moore, I. M. (2015). Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia. Oncology nursing forum, 42(5), 542-9.
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  To examine associations among oxidative stress, fine and visual-motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL).
• Hockenberry, M. J., Taylor, O. A., Pasvogel, A., Rodgers, C., McCarthy, K., Gundy, P., Montgomery, D. W., Ribbeck, P., Scheurer, M. E., & Moore, I. M. (2014). The influence of oxidative stress on symptom occurrence, severity, and distress during childhood leukemia treatment. Oncology nursing forum, 41(4), E238-47.
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  To explore the symptom trajectory during the first 16 months of childhood leukemia treatment and any associations with the oxidative stress pathway measured by cerebrospinal fluid (CSF) concentration of oxidized phosphatidylcholine (PC), the predominant glycerophospholipid in the brain and cell membranes.
• Hsiao, C. P., Moore, I. M., Insel, K. C., & Merkle, C. J. (2014). Symptom self-management strategies in patients with non-metastatic prostate cancer. Journal of clinical nursing, 23(3-4), 440-9.
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  To explore the association between symptoms, symptom distress and symptom self-management and to identify effective strategies of symptom self-management in men with non-metastatic prostate cancer following radical prostatectomy or radiation therapy.
• Moore, I. M., & Badger, T. A. (2014). The future of oncology nursing research: Research priorities and professional development. Oncology Nursing Forum, 41(1), 93-93.
• Moore, I. M., & Badger, T. A. (2014). The future of oncology nursing research: Research priorities and professional development. Oncology Nursing Forum, 41(1), 93-94.
• Moore, I. M., & Badger, T. A. (2014). The future of oncology nursing research: research priorities and professional development. Oncology nursing forum, 41(1), 93-4.
• Krull, K. R., Hockenberry, M. J., Miketova, P., Carey, M., & Moore, I. M. (2013). Chemotherapy-related changes in central nervous system phospholipids and neurocognitive function in childhood acute lymphoblastic leukemia. Leukemia & lymphoma, 54(3), 535-40.
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  Long-term survivors of childhood leukemia are at risk for neurocognitive impairment, although the neurophysiological basis is not well understood. The purpose of this study was to explore associations between changes in cerebrospinal fluid (CSF) phospholipids and neurocognitive function in children undergoing chemotherapy for acute lymphoblastic leukemia. Seventy-six children were followed prospectively from diagnosis. CSF samples were collected during scheduled lumbar punctures and phospholipids were extracted. Neurocognitive evaluations were conducted annually beginning shortly after diagnosis. Concentrations of sphingomyelin (SM) increased following induction (p = 0.03) and consolidation (p = 0.04), while lysophosphatidylcholine (LPC) increased following induction (p = 0.003). Multivariable analyses demonstrated associations between post-induction SM and motor speed at 1 year (p < 0.001), 2 years (p = 0.001) and 3 years (p = 0.02) following diagnosis. Post-induction LPC was associated with verbal working memory (p = 0.007). Results indicate that early changes in phospholipids are related to neurocognitive decline and suggest a chemotherapy impact on white matter integrity.
• Krull, K. R., Hockenberry, M. J., Miketova, P., Carey, M., & Moore, I. M. (2013). Chemotherapy-related changes in central nervous system phospholipids and neurocognitive function in childhood acute lymphoblastic leukemia. Leukemia and Lymphoma, 54(3), 535-540.
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  PMID: 22856670;PMCID: PMC3845091;Abstract: Long-term survivors of childhood leukemia are at risk for neurocognitive impairment, although the neurophysiological basis is not well understood. The purpose of this study was to explore associations between changes in cerebrospinal fluid (CSF) phospholipids and neurocognitive function in children undergoing chemotherapy for acute lymphoblastic leukemia. Seventy-six children were followed prospectively from diagnosis. CSF samples were collected during scheduled lumbar punctures and phospholipids were extracted. Neurocognitive evaluations were conducted annually beginning shortly after diagnosis. Concentrations of sphingomyelin (SM) increased following induction (p = 0.03) and consolidation (p = 0.04), while lysophosphatidylcholine (LPC) increased following induction (p = 0.003). Multivariable analyses demonstrated associations between post-induction SM and motor speed at 1 year (p < 0.001), 2 years (p = 0.001) and 3 years (p = 0.02) following diagnosis. Post-induction LPC was associated with verbal working memory (p = 0.007). Results indicate that early changes in phospholipids are related to neurocognitive decline and suggest a chemotherapy impact on white matter integrity. © 2013 Informa UK, Ltd.
• Moore, I., & Moore, I. M. (0). Advancing biobehavioral research in childhood cancer. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 21(3).
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  Research on individual and family responses to a child's or adolescent's cancer diagnosis and treatment is important because of significant advances in the field of pediatric oncology. To date, the majority of research has been behavioral or psychosocial in nature. It could be argued that a more holistic perspective that includes psychological, sociocultural, and biological dimensions would advance knowledge about individual and family responses to the experience of childhood cancer. Biobehavioral research refers to investigations that link behavioral and biological underpinnings in specific areas of science. The purpose of this article is to review research in two broad areas that could benefit from a biobehavioral perspective-psychosocial functioning/behavioral adjustment, and CNS treatment outcomes. Studies that include biological measures are highlighted. Advantages, challenges, and strategies for advancing biobehavioral research in childhood cancer are proposed.
• Moore, I., Hsiao, C., Loescher, L. J., & Moore, I. M. (0). Symptoms and symptom distress in localized prostate cancer. Cancer nursing, 30(6).
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  For over a decade, symptom distress has been a key concept in several studies of cancer. However, the definition of symptom distress is still unclear, and there are few measures targeting symptom distress, in general, and specific cancers, in particular. Prostate cancer is the sixth most common cancer worldwide and the second leading cause of death in American men. Many men with clinically localized prostate cancer may experience unique and multidimensional symptoms that occur from diagnosis through treatment, and thereafter. These symptoms associated with the disease and its treatments are in the form of physical and psychological sequelae such as urinary and bowel problems and sexual dysfunction. The purposes of this article are to (1) systematically review literature on symptoms and symptom distress in localized prostate cancer and (2) synthesize evidence of symptom distress applications and measurement in this group. A comprehensive, systematic review was conducted to identify original, data-based studies of symptoms and symptom distress in localized prostate cancer. Clarification of symptom distress and more comprehensive information about symptoms and symptom distress will provide nurses with a better foundation for developing self-management interventions aimed at ameliorating symptom distress and, ultimately, enhancing the quality of life of patients with localized prostate cancer.
• Insel, K. C., Moore, I. M., Vidrine, A. N., & Montgomery, D. W. (2012). Biomarkers for cognitive aging part II: oxidative stress, cognitive assessments, and medication adherence. Biological research for nursing, 14(2), 133-8.
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  The purpose of this study was to further examine potential biomarkers of cognitive aging by looking at the associations among oxidative stress, cognitive abilities, and medication adherence in a community-based sample of middle-aged and older adults (n = 42; mean age = 69 years) prescribed at least one medication for hypertension. In addition to measures described in Part I, "Biomarkers for Cognitive Aging," a 12-hr urine collection for F(2)-isoprostanes served as an indicator of oxidative stress. Participants completed a battery of cognitive assessments and 8 weeks of electronic medication monitoring for adherence to one antihypertensive agent. Oxidative stress was significantly associated with logical memory, immediate (r = -.38, p < .01) and delayed recall (r = -.42, p < .01), and recognition memory (r = -.42, p < .01) from the Wechsler Memory Scale III, number of perseveration errors (r = .26, p < .05) and categories achieved (r = -.26, p < .01) on the Wisconsin Card Sorting Test (WSCT), and medication adherence (r = -.34, p
• Moore, I. M., Hockenberry, M. J., Anhalt, C., McCarthy, K., & Krull, K. R. (2012). Mathematics intervention for prevention of neurocognitive deficits in childhood leukemia. Pediatric blood & cancer, 59(2), 278-84.
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  Despite evidence that CNS treatment is associated with cognitive and academic impairment, interventions to prevent or mitigate these problems are limited. The purpose was to determine if early intervention can prevent declines in mathematics abilities.
• Moore, I., Pasvogel, A. E., Miketova, P., & Moore, I. M. (2010). Differences in CSF phospholipid concentration by traumatic brain injury outcome. Biological research for nursing, 11(4).
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  Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. A cascade of events is initiated with TBI that leads to degradation of the membrane lipid bilayer of neurons and neuroglia. The purpose of this study was to (a) describe changes in the cerebrospinal fluid (CSF) phospholipid concentration over time for those who survived and those who died following TBI; and (b) determine whether there were differences in the CSF phospholipid concentration between those who survived and those who died following TBI. Thirty-nine CSF samples were obtained from 10 participants who sustained a TBI. Following extraction, phospholipids were separated and quantified by normal-phase high performance liquid chromatography with ultraviolet detector. For those who died, the highest median concentration was on Day 1 after TBI for lysophosphatidylcholine and on Day 4 after TBI for phosphatidylethanolamine, phosphatidylserine, phosphatidylcholine, and sphingomyelin. For those who survived, the highest median concentration was on Day 1 after TBI for phosphatidylcholine, on Day 3 after TBI for phosphatidylethanolamine and phosphatidylserine, on Day 4 after TBI for sphingomyelin, and on Day 5 after TBI for lysophosphatidylcholine. There were significant differences in the concentrations of phosphatidylethanolamine and phosphatidylserine on Days 1-2 and of phosphatidylethanolamine, phosphatidylcholine, and sphingomyelin on Days 3-4 after TBI between those who survived and died, with the highest concentrations in those who died. These findings provide preliminary evidence of greater disruption of central nervous system membrane phospholipids in participants who died after TBI.
• O'Haver, J., Moore, I. M., Insel, K. C., Reed, P. G., Melnyk, B. M., & Lavoie, M. (2010). Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis.. Pediatric nursing, 36(6), 284-291; quiz 292.
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  PMID: 21291044;Abstract: When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts.
• Pasvogel, A. E., Miketova, P., & Moore, I. M. (2010). Differences in CSF phospholipid concentration by traumatic brain injury outcome. Biological Research for Nursing, 11(4), 325-331.
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  PMID: 20338895;Abstract: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. A cascade of events is initiated with TBI that leads to degradation of the membrane lipid bilayer of neurons and neuroglia. The purpose of this study was to (a) describe changes in the cerebrospinal fluid (CSF) phospholipid concentration over time for those who survived and those who died following TBI; and (b) determine whether there were differences in the CSF phospholipid concentration between those who survived and those who died following TBI. Thirty-nine CSF samples were obtained from 10 participants who sustained a TBI. Following extraction, phospholipids were separated and quantified by normal-phase high performance liquid chromatography with ultraviolet detector. For those who died, the highest median concentration was on Day 1 after TBI for lysophosphatidylcholine and on Day 4 after TBI for phosphatidylethanolamine, phosphatidylserine, phosphatidylcholine, and sphingomyelin. For those who survived, the highest median concentration was on Day 1 after TBI for phosphatidylcholine, on Day 3 after TBI for phosphatidylethanolamine and phosphatidylserine, on Day 4 after TBI for sphingomyelin, and on Day 5 after TBI for lysophosphatidylcholine. There were significant differences in the concentrations of phosphatidylethanolamine and phosphatidylserine on Days 1-2 and of phosphatidylethanolamine, phosphatidylcholine, and sphingomyelin on Days 3-4 after TBI between those who survived and died, with the highest concentrations in those who died. These findings provide preliminary evidence of greater disruption of central nervous system membrane phospholipids in participants who died after TBI. © The Author(s) 2010.
• Stenzel, S. L., Krull, K. R., Hockenberry, M., Jain, N., Kaemingk, K., Miketova, P., & Moore, I. M. (2010). Oxidative stress and neurobehavioral problems in pediatric acute lymphoblastic leukemia patients undergoing chemotherapy. Journal of Pediatric Hematology/Oncology, 32(2), 113-118.
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  PMID: 20098337;PMCID: PMC3392027;Abstract: Neurobehavioral problems after chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL) have been a recent focus of investigation. This study extended previous research that suggested oxidative stress as a potential mechanism for chemotherapy-induced central nervous system injury by examining early markers of oxidative stress in relation to subsequent neurobehavioral problems. Oxidized and unoxidized components of phosphatidylcholine (PC) were measured in the cerebrospinal fluid of 87 children with ALL at diagnosis, induction, and consolidation. Behavioral assessments were conducted postconsolidation and at the end of chemotherapy. Results revealed a significant association between physiologic reactivity (high vs. low PC changes from diagnosis) and behavioral outcomes (high vs. low pathology). Elevated oxidized PC fraction change was predictive of increased problems with aggression at the end of therapy as well as postconsolidation adaptability. Furthermore, symptoms of hyperactivity systematically changed over time in relation to both unoxidized PC and oxidized PC fraction reactivity. These findings suggest that symptoms of behavioral problems occur early in the course of chemotherapy and that increases in the cerebrospinal fluid PC markers of oxidative stress during induction and consolidation may help to predict certain future behavioral problems. Copyright © 2010 by Lippincott Williams & Wilkins.
• Stenzel, S. L., Krull, K. R., Hockenberry, M., Jain, N., Kaemingk, K., Miketova, P., & Moore, I. M. (2010). Oxidative stress and neurobehavioral problems in pediatric acute lymphoblastic leukemia patients undergoing chemotherapy. Journal of pediatric hematology/oncology, 32(2), 113-8.
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  Neurobehavioral problems after chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL) have been a recent focus of investigation. This study extended previous research that suggested oxidative stress as a potential mechanism for chemotherapy-induced central nervous system injury by examining early markers of oxidative stress in relation to subsequent neurobehavioral problems. Oxidized and unoxidized components of phosphatidylcholine (PC) were measured in the cerebrospinal fluid of 87 children with ALL at diagnosis, induction, and consolidation. Behavioral assessments were conducted postconsolidation and at the end of chemotherapy. Results revealed a significant association between physiologic reactivity (high vs. low PC changes from diagnosis) and behavioral outcomes (high vs. low pathology). Elevated oxidized PC fraction change was predictive of increased problems with aggression at the end of therapy as well as postconsolidation adaptability. Furthermore, symptoms of hyperactivity systematically changed over time in relation to both unoxidized PC and oxidized PC fraction reactivity. These findings suggest that symptoms of behavioral problems occur early in the course of chemotherapy and that increases in the cerebrospinal fluid PC markers of oxidative stress during induction and consolidation may help to predict certain future behavioral problems.
• Caron, J. E., Krull, K. R., Hockenberry, M., Jain, N., Kaemingk, K., & Moore, I. M. (2009). Oxidative stress and executive function in children receiving chemotherapy for acute lymphoblastic leukemia. Pediatric Blood and Cancer, 53(4), 551-556.
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  PMID: 19499584;PMCID: PMC3928629;Abstract: Background. Neurocognitive sequelae following treatment for pediatric acute lymphoblastic leukemia (ALL) has been reported in a significant proportion of survivors, including those treated only with chemotherapy. Early identification of children "at risk" for neurocognitive problems is not yet reliable. Biomarkers of oxidative stress (e.g., oxidated phosphatidylcholine) in cerebral spinal fluid (CSF) have been correlated with intensity of methotrexate (MTX) treatment, suggesting an association with acute central nervous system toxicity. Procedure. This study examined the association between oxidized CSF phospholipids and executive functions throughout chemotherapy. Measures of oxidative stress and executive functions were examined in 88 children newly diagnosed with ALL. The children were followed over 3 years with neurocognitive testing and parent ratings of executive functions. Results. Results demonstrated an association between increased oxidative stress following induction and consolidation and decreased executive function 2 years later. Younger age at diagnosis was associated with both an increase in oxidative stress and in executive dysfunction; younger age was associated with poorer ability to organize materials in one's environment (r(48)=0.28, P
• Caron, J. E., Krull, K. R., Hockenberry, M., Jain, N., Kaemingk, K., & Moore, I. M. (2009). Oxidative stress and executive function in children receiving chemotherapy for acute lymphoblastic leukemia. Pediatric blood & cancer, 53(4), 551-6.
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  Neurocognitive sequelae following treatment for pediatric acute lymphoblastic leukemia (ALL) has been reported in a significant proportion of survivors, including those treated only with chemotherapy. Early identification of children "at risk" for neurocognitive problems is not yet reliable. Biomarkers of oxidative stress (e.g., oxidated phosphatidylcholine) in cerebral spinal fluid (CSF) have been correlated with intensity of methotrexate (MTX) treatment, suggesting an association with acute central nervous system toxicity.
• Moore, I. M., Miketova, P., Hockenberry, M., Krull, K., Pasvogel, A., Carey, M., & Kaemingk, K. (2008). Methotrexate-induced alterations in beta-oxidation correlate with cognitive abilities in children with acute lymphoblastic leukemia. Biological Research for Nursing, 9(4), 311-319.
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  PMID: 18398226;Abstract: Treatment advances, including central nervous system (CNS) treatment with methotrexate, have led to significant gains in disease-free survival from childhood acute lymphoblastic leukemia (ALL). However, methotrexate has been associated with neurological problems such as declines in cognitive and academic abilities. The purpose of this study was to investigate methotrexate-induced changes in beta-oxidation in children with ALL receiving methotrexate for CNS treatment. Specific aims were to investigate effects of methotrexate on beta-oxidation of the two most prevalent fatty acids (palmitic acid and stearic acid) in cerebrospinal fluid (CSF) samples and correlate the ratio of monounsaturation to saturation of these fatty acids with cognitive and academic abilities. The sample included 12 females and 14 males with low-risk (n = 7), standard-risk ( n = 13), or high-risk (n = 6) ALL. Mean age at diagnosis was 94.1 months (SD = 34.4). CSF samples were obtained in conjunction with diagnostic lumbar punctures; subsequent samples were obtained prior to intrathecal methotrexate administration during the induction, consolidation, and continuation phases of treatment. Fatty acids were analyzed by gas chromatography. Results showed a significant increase in the ratio of monounsaturation to saturation of both fatty acids, which was greatest during the most intensive phase of treatment. Ratios of monounsaturated to saturated fatty acids were negatively correlated with full-scale IQ, verbal IQ, and math calculations. Findings suggest that methotrexate alters beta-oxidation and that the resulting increase in fatty acid monounsaturation is related to declines in some domains of cognitive ability. © 2008 Sage Publications.
• Moore, I. M., Miketova, P., Hockenberry, M., Krull, K., Pasvogel, A., Carey, M., & Kaemingk, K. (2008). Methotrexate-induced alterations in beta-oxidation correlate with cognitive abilities in children with acute lymphoblastic leukemia. Biological research for nursing, 9(4), 311-9.
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  Treatment advances, including central nervous system (CNS) treatment with methotrexate, have led to significant gains in disease-free survival from childhood acute lymphoblastic leukemia (ALL). However, methotrexate has been associated with neurological problems such as declines in cognitive and academic abilities. The purpose of this study was to investigate methotrexate-induced changes in beta-oxidation in children with ALL receiving methotrexate for CNS treatment. Specific aims were to investigate effects of methotrexate on beta-oxidation of the two most prevalent fatty acids (palmitic acid and stearic acid) in cerebrospinal fluid (CSF) samples and correlate the ratio of monounsaturation to saturation of these fatty acids with cognitive and academic abilities. The sample included 12 females and 14 males with low-risk (n = 7), standard-risk ( n = 13), or high-risk (n = 6) ALL. Mean age at diagnosis was 94.1 months (SD = 34.4). CSF samples were obtained in conjunction with diagnostic lumbar punctures; subsequent samples were obtained prior to intrathecal methotrexate administration during the induction, consolidation, and continuation phases of treatment. Fatty acids were analyzed by gas chromatography. Results showed a significant increase in the ratio of monounsaturation to saturation of both fatty acids, which was greatest during the most intensive phase of treatment. Ratios of monounsaturated to saturated fatty acids were negatively correlated with full-scale IQ, verbal IQ, and math calculations. Findings suggest that methotrexate alters beta-oxidation and that the resulting increase in fatty acid monounsaturation is related to declines in some domains of cognitive ability.
• Moore, I., Pasvogel, A. E., Miketova, P., & Moore, I. M. (2008). Cerebrospinal fluid phospholipid changes following traumatic brain injury. Biological research for nursing, 10(2).
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  Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, with approximately 1.4 million people suffering a TBI each year. With TBI, a cascade of events is initiated including the activation of phospholipases, which leads to the disruption of the lipid bilayer of the membrane of neurons and neuroglia. The purpose of this study is to describe phospholipid changes following TBI. A total of 39 cerebrospinal fluid samples were obtained from the ventricular catheter system of 10 participants who received a TBI as a result of a motor vehicle crash, being struck by a vehicle as a pedestrian, or a fall. Phospholipids were extracted from samples and measured by normal-phase high-performance liquid chromatography with ultraviolet detector at a wavelength of 206 nm. The highest mean concentration of lysophosphatidylcholine occurred on Day 1 after injury. The concentration of phosphatidylserine was variable, with the highest mean concentration occurring on Day 2 after injury. The highest mean concentrations of phosphatidylethanolamine, phosphatidylcholine, and sphingomyelin occurred on Day 4 after injury. Findings provide preliminary evidence for disruption of central nervous system membrane phospholipids following TBI.
• Pasvogel, A. E., Miketova, P., & Moore, I. M. (2008). Cerebrospinal fluid phospholipid changes following traumatic brain injury. Biological Research for Nursing, 10(2), 113-120.
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  PMID: 18829594;Abstract: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, with approximately 1.4 million people suffering a TBI each year. With TBI, a cascade of events is initiated including the activation of phospholipases, which leads to the disruption of the lipid bilayer of the membrane of neurons and neuroglia. The purpose of this study is to describe phospholipid changes following TBI. A total of 39 cerebrospinal fluid samples were obtained from the ventricular catheter system of 10 participants who received a TBI as a result of a motor vehicle crash, being struck by a vehicle as a pedestrian, or a fall. Phospholipids were extracted from samples and measured by normal-phase high-performance liquid chromatography with ultraviolet detector at a wavelength of 206 nm. The highest mean concentration of lysophosphatidylcholine occurred on Day 1 after injury. The concentration of phosphatidylserine was variable, with the highest mean concentration occurring on Day 2 after injury. The highest mean concentrations of phosphatidylethanolamine, phosphatidylcholine, and sphingomyelin occurred on Day 4 after injury. Findings provide preliminary evidence for disruption of central nervous system membrane phospholipids following TBI. © 2008 Sage Publications.
• Carey, M. E., Hockenberry, M. J., Moore, I. M., Hutter, J. J., Krull, K. R., Pasvogel, A., & Kaemingk, K. L. (2007). Brief report: Effect of intravenous methotrexate dose and infusion rate on neuropsychological function one year after diagnosis of acute lymphoblastic leukemia. Journal of Pediatric Psychology, 32(2), 189-193.
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  PMID: 16675716;Abstract: Objective: To compare the effects of two intravenous (IV) methotrexate (MTX) infusion protocols on cognitive function in children newly diagnosed with acute lymphoblastic leukemia (ALL). Methods: We compared 19 children treated with 1 g/m2 of IV MTX over 24 hr (Group 1) to 13 children treated with 2 g/m2 of IV MTX over 4 hr (Group 2) on measures of working memory, nonverbal, and verbal skills shortly after diagnosis (Time 1) and 1 year later (Time 2). Results: A significant Group×Time interaction was found for a composite measure of working memory with Group 2 declining from Time 1 to Time 2. Group 2 performed significantly worse than Group 1 on a composite measure of nonverbal skills at both time points. Conclusions: Findings suggest that difficulties in working memory and nonverbal skills may be evident during the first year of treatment for ALL and that severity may be dependent on IV MTX dose and/or infusion rate. © The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
• Carey, M. E., Hockenberry, M. J., Moore, I. M., Hutter, J. J., Krull, K. R., Pasvogel, A., & Kaemingk, K. L. (2007). Brief report: effect of intravenous methotrexate dose and infusion rate on neuropsychological function one year after diagnosis of acute lymphoblastic leukemia. Journal of pediatric psychology, 32(2), 189-93.
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  To compare the effects of two intravenous (IV) methotrexate (MTX) infusion protocols on cognitive function in children newly diagnosed with acute lymphoblastic leukemia (ALL).
• Hockenberry, M., Krull, K., Moore, K., Gregurich, M. A., Casey, M. E., & Kaemingk, K. (2007). Longitudinal evaluation of fine motor skills in children with leukemia. Journal of Pediatric Hematology/Oncology, 29(8), 535-539.
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  PMID: 17762494;Abstract: BACKGROUND: Improved survival for children with acute lymphocytic leukemia (ALL) has allowed investigators to focus on the adverse or side effects of treatment and to develop interventions that promote cure while decreasing the long-term effects of therapy. Although much attention has been given to the significant neurocognitive sequelae that can occur after ALL therapy, limited investigation is found addressing fine motor function in these children and motor function that may contribute to neurocognitive deficits in ALL survivors. METHODS: Fine motor and sensory-perceptual performances were examined in 82 children with ALL within 6-months of diagnosis and annually for 2 years (year 1 and year 2, respectively) during therapy. RESULTS: Purdue Pegboard assessments indicated significant slowing of fine motor speed and dexterity for the dominant hand, nondominant hand, and both hands simultaneously for children in this study. Mean Visual-Motor Integration (VMI) scores for children with low-risk and high-risk ALL decreased from the first evaluation to year 1 and again at year 2. Mean VMI scores for children with standard risk ALL increased from the first evaluation to year 1 and then decreased at year 2. Significant positive correlations were found between the Purdue and the VMI at both year 1 and year 2, suggesting that the Pegboard performance consistently predicts the later decline in visual-motor integration. Significant correlations were found between the Purdue Pegboard at baseline and the Performance IQ during year 1, though less consistently during year 2. A similar pattern was also observed between the baseline Pegboard performance and performance on the Coding and Symbol Search subtests during year 1 and year 2. CONCLUSIONS: In this study, children with ALL experienced significant and persistent visual-motor problems throughout therapy. These problems continued during the first and second years of treatment. These basic processing skills are necessary to the development of higher-level cognitive abilities, including nonverbal intelligence and academic achievement, particularly in arithmetic and written language. © 2007 Lippincott Williams & Wilkins, Inc.
• Hsiao, C., Loescher, L. J., & Moore, I. M. (2007). Symptoms and symptom distress in localized prostate cancer. Cancer Nursing, 30(6), E19-E32.
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  PMID: 18025909;Abstract: For over a decade, symptom distress has been a key concept in several studies of cancer. However, the definition of symptom distress is still unclear, and there are few measures targeting symptom distress, in general, and specific cancers, in particular. Prostate cancer is the sixth most common cancer worldwide and the second leading cause of death in American men. Many men with clinically localized prostate cancer may experience unique and multidimensional symptoms that occur from diagnosis through treatment, and thereafter. These symptoms associated with the disease and its treatments are in the form of physical and psychological sequelae such as urinary and bowel problems and sexual dysfunction. The purposes of this article are to (1) systematically review literature on symptoms and symptom distress in localized prostate cancer and (2) synthesize evidence of symptom distress applications and measurement in this group. A comprehensive, systematic review was conducted to identify original, data-based studies of symptoms and symptom distress in localized prostate cancer. Clarification of symptom distress and more comprehensive information about symptoms and symptom distress will provide nurses with a better foundation for developing self-management interventions aimed at ameliorating symptom distress and, ultimately, enhancing the quality of life of patients with localized prostate cancer. © 2007 Lippincott Williams & Wilkins, Inc.
• Nathan, P. C., Patel, S. K., Dilley, K., Goldsby, R., Harvey, J., Jacobsen, C., Kadan-Lottick, N., McKinley, K., Millham, A. K., Moore, I., Okcu, M. F., Woodman, C. L., Brouwers, P., & Armstrong, F. D. (2007). Guidelines for identification of, advocacy for, and intervention in neurocognitive problems in survivors of childhood cancer: A report from the Children's Oncology Group. Archives of Pediatrics and Adolescent Medicine, 161(8), 798-806.
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  PMID: 17679663;Abstract: With modern therapies and supportive care, survival of childhood cancer has increased considerably. Patients who have survived cancers involving the central nervous system or who have received therapy toxic to the developing brain are at risk of long-term neurocognitive sequelae. Negative outcomes are observed most frequently in survivors of acute lymphoblastic leukemia and brain tumors. The Children's Oncology Group Long-term Follow-up Guidelines Task Force on Neurocognitive/Behavioral Complications After Childhood Cancer has generated risk-based, exposure-related guidelines designed to direct the follow-up care of survivors of pediatric malignancies based on a comprehensive literature review and expert opinion. This article expands on these guidelines by reviewing the risk factors for the development of neurocognitive sequelae and describing the expected pattern of these disabilities. We herein present recommendations for the screening and management of neurocognitive late effects and outline important areas of school and legal advocacy for survivors with disabilities. Finally, we list resources that can guide patients, their parents, and their medical caregivers as they face the long-term neurocognitive consequences of cancer therapy. ©2007 American Medical Association. All rights reserved.
• Jelínek, D., Miketová, P., Khailová, L., Schram, K. H., Moore, I. M., & Vytrasová, J. (2006). Identification of Arcobacter species using phospholipid and total fatty acid profiles. Folia microbiologica, 51(4), 329-36.
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  High-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) were used to analyze the phospholipids and fatty acids of four Arcobacter species (becoming routinely isolated from a wide variety of food sources, especially of animal origin) to provide information for the identification within these species. Phospholipid differences were observed in the HPLC profiles. GC-MS analysis provided a complete fatty acid composition for each arcobacter that after pattern recognition analysis allows taxonomic classification of each species.
• Moore, I. M., Merkle, C. J., Miketova, P., Salyer, R. K., Torres, B. J., Schaeffer, R. C., & Montgomery, D. W. (2006). Cytosine arabinoside induces programmed endothelial cell death through the caspase-3 pathway. Biological research for nursing, 7(4), 289-96.
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  The anti-cancer effects of cytosine arabinoside (ARA-C) are well known. However, effects on nonmalignant cells have not been elucidated and may be important to understanding treatment-related toxicity. The purpose of this study was to examine the effect of ARA-C on nondividing vascular endothelial cells. The objectives were to determine the effects of ARA-C on cell viability and to ascertain whether ARA-C caused apoptosis in cultured vascular endothelial cells and hydrocortisone blunted caspase-3-induced apoptosis. Endothelial cells were cultured until confluent and mitotically quiescent then exposed to ARA-C (10(-7)to 10(-3) M) for 1 to 4 days. Some experiments involved cotreatment with hydrocortisone (10(-11),10(-10),10(-4), and 10(-3) M). Light microscopy and the colorimetric MTS assay were used to measure viability. Fluorescent annexin-V and DNA fragmentation assays were used to measure apoptosis, and a fluorescence-based enzymatic assay was used to measure caspase-3 activity, which is one pathway involved in the apoptosis cascade. Two-way ANOVA or the appropriate nonparametric test was used to determine statistical significance in studies of viability and apoptosis. Oneway ANOVA was used to determine statistical significance for caspase-3 activity. Viability was decreased with higher concentrations of ARA-C and increased days of treatment. The percentage of apoptotic cells increased with higher concentrations of ARA-C and increased days of treatment. ARA-C-treated samples showed DNA fragmentation, indicative of apoptosis. Caspase-3 activity increased after ARA-C addition; hydrocortisone blunted this increase. ARA-C caused apoptosis in nondividing endothelial cells in culture. Hydrocortisone may protect against ARA-C-induced apoptosis by reducing caspase-3 activity.
• Miketova, P., Kaemingk, K., Hockenberry, M., Pasvogel, A., Hutter, J., Krull, K., & Moore, I. M. (2005). Oxidative changes in cerebral spinal fluid phosphatidylcholine during treatment for acute lymphoblastic leukemia. Biological Research for Nursing, 6(3), 187-195.
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  PMID: 15583359;Abstract: Central nervous system (CNS) treatment contributes to improved long-term disease-free survival from childhood acute lymphoblastic leukemia (ALL) by sigificantly decreasing the rate of disease relapse. Methotrexate (MTX), a drug commonly used for CNS treatment, has been associated with cognitive and academic problems, white-matter changes, perfusion defects, and brain atrophy. This study investigated oxidative stress as a possible mechanism of chemotherapy-induced CNS injury. Unoxidized and oxidized components of phosphatidylcholine (PC), the most prevalent phospholipid in CNS cellular membranes, were measured in cerebral spinal fluid (CSF) samples obtained from 21 children diagnosed with low- (n = 7), standard- (n = 7), or high- (n = 7) risk ALL. Children with high-risk ALL received the most MTX, especially during the most intensive phase of treatment (consolidation). Phospholipids were extracted from CSF samples obtained at diagnosis and during the induction, consolidation, and continuation treatment phases. Unoxidized and oxidized PC were measured by normal-phase high-performance liquid chromatography at 2 ultraviolet wavelengths (206 and 234 nm, respectively). Data were analyzed by 2-way repeated-measures analysis of variance. Results support the hypotheses that the highest levels of oxidized PC would be observed during the most intensive phase of ALL therapy and in the high-risk ALL group. Findings provide preliminary evidence for chemotherapy-induced oxidative stress in CNS membrane phospholipids. Copyright © 2005 Sage Publications.
• Moore, I., Miketova, P., Kaemingk, K., Hockenberry, M., Pasvogel, A., Hutter, J., Krull, K., & Moore, I. M. (2005). Oxidative changes in cerebral spinal fluid phosphatidylcholine during treatment for acute lymphoblastic leukemia. Biological research for nursing, 6(3).
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  Central nervous system (CNS) treatment contributes to improved long-term disease-free survival from childhood acute lymphoblastic leukemia (ALL) by significantly decreasing the rate of disease relapse. Methotrexate (MTX), a drug commonly used for CNS treatment, has been associated with cognitive and academic problems, white-matter changes, perfusion defects, and brain atrophy. This study investigated oxidative stress as a possible mechanism of chemotherapy induced CNS injury. Unoxidized and oxidized components of phosphatidylcholine (PC), the most prevalent phospholipid in CNS cellular membranes, were measured in cerebral spinal fluid (CSF) samples obtained from 21 children diagnosed with low (n = 7), standard (n= 7), or high (n= 7) risk ALL. Children with high-risk ALL received the most MTX, especially during the most intensive phase of treatment (consolidation). Phospholipids were extracted from CSF samples obtained at diagnosis and during the induction, consolidation, and continuation treatment phases. Unoxidized and oxidized PC were measured by normal phase high-performance liquid chromatography at 2 ultraviolet wavelengths (206 and 234 nm, respectively). Data were analyzed by 2-way repeated-measures analysis of variance. Results support the hypotheses that the highest levels of oxidized PC would be observed during the most intensive phase of ALL therapy and in the high-risk ALL group. Findings provide preliminary evidence for chemotherapy-induced oxidative stress in CNS membrane phospholipids.
• Kaemingk, K. L., Carey, M. E., Moore, I. M., Herzer, M., & Hutter, J. J. (2004). Math Weaknesses in Survivors of Acute Lymphoblastic Leukemia Compared to Healthy Children. Child Neuropsychology, 10(1), 14-23.
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  PMID: 14977512;Abstract: Difficulties in math are the most frequently reported area of academic deficit in survivors of acute lymphoblastic leukemia (ALL) and the most frequent academic complaint among parents of ALL survivors. However, previous studies that included measures of math skills have been limited by the use of only a single measure of math skills, most often a measure of written calculations, without any assessment of math reasoning or math application skills. Further, the nature of these math difficulties has not been adequately investigated. The purpose of this study was to examine the performance of ALL survivors using multiple measures of math skills. Performance was compared to a group of healthy controls matched for age and sex as well as to normative levels. Other measures of neuropsychological function were also administered, and the relationships between these measures and the math measures were explored. Converging evidence for math difficulties in ALL survivors compared to healthy controls and normative levels was found. While ALL survivors generally performed within the average range on measures of math skills, math performance was mostly related to memory function and dominant-hand psychomotor speed. By contrast, math performance of healthy children was mostly related to basic reading skills and visual-motor integration. These findings shed light on the nature of math difficulties in ALL survivors and have implications for intervention.
• Kaemingk, K. L., Carey, M. E., Moore, I. M., Herzer, M., & Hutter, J. J. (2004). Math weaknesses in survivors of acute lymphoblastic leukemia compared to healthy children. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence, 10(1), 14-23.
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  Difficulties in math are the most frequently reported area of academic deficit in survivors of acute lymphoblastic leukemia (ALL) and the most frequent academic complaint among parents of ALL survivors. However, previous studies that included measures of math skills have been limited by the use of only a single measure of math skills, most often a measure of written calculations, without any assessment of math reasoning or math application skills. Further, the nature of these math difficulties has not been adequately investigated. The purpose of this study was to examine the performance of ALL survivors using multiple measures of math skills. Performance was compared to a group of healthy controls matched for age and sex as well as to normative levels. Other measures of neuropsychological function were also administered, and the relationships between these measures and the math measures were explored. Converging evidence for math difficulties in ALL survivors compared to healthy controls and normative levels was found. While ALL survivors generally performed within the average range on measures of math skills, math performance was mostly related to memory function and dominant-hand psychomotor speed. By contrast, math performance of healthy children was mostly related to basic reading skills and visual-motor integration. These findings shed light on the nature of math difficulties in ALL survivors and have implications for intervention.
• Moore, I. M. (2004). Advancing biobehavioral research in childhood cancer. Journal of Pediatric Oncology Nursing, 21(3), 128-131.
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  PMID: 15296039;Abstract: Research on individual and family responses to a child's or adolescent's cancer diagnosis and treatment is important because of significant advances in the field of pediatric oncology. To date, the majority of research has been behavioral or psychosocial in nature. It could be argued that a more holistic perspective that includes psychological, sociocultural, and biological dimensions would advance knowledge about individual and family responses to the experience of childhood cancer. Biobehavioral research refers to investigations that link behavioral and biological underpinnings in specific areas of science. The purpose of this article is to review research in two broad areas that could benefit from a biobehavioral perspective-psychosocial functioning/behavioral adjustment, and CNS treatment outcomes. Studies that include biological measures are highlighted. Advantages, challenges, and strategies for advancing biobehavioral research in childhood cancer are proposed.
• Challinor, J., Moore, I., Kramer, R., Pasvogel, A., Leung, K., Amylon, M., Hutter, J., & Matthay, K. (2003). Development and Testing of the School Competency Assessment Scale. Journal of Pediatric Oncology Nursing, 20(2), 56-64.
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  PMID: 12709932;
• Hinds, P. S., Baggott, C., DeSwarte-Wallace, J., Dodd, M., Haase, J., Hockenberry, M., Hooke, C., Cullen, P. M., Moore, I., Roll, L., & Ruccione, K. (2003). Online exclusive: functional integration of nursing research into a pediatric oncology cooperative group: finding common ground.. Oncology nursing forum, 30(6), E121-126.
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  PMID: 14603364;Abstract: PURPOSE/OBJECTIVES: To provide a brief description of the historic role of nursing and nursing research in the culture of previous pediatric oncology cooperative groups and compare the research language used in cooperative groups with the language used in nursing research. DATA SOURCES: Published empirical, clinical, and methodologic reports. DATA SYNTHESIS: The culture and language of nursing research differ from those of medical research and the pediatric oncology cooperative group, the Children's Oncology Group (COG). Different approaches exist to integrate nursing research priorities into the priorities of COG, including freestanding protocols, companion protocols, and research objectives included in therapeutic protocols. CONCLUSIONS: Full integration of nursing research into COG is feasible but dependent on recognition of cultural and language differences among researchers. Integration will be demonstrated by the number of concepts and protocols contributed to or developed by active nurses in COG. IMPLICATIONS FOR NURSING: Significant advances exist for nurses conducting research in COG. These research efforts are facilitated by a familiarity with the science language used by other disciplines in COG and an understanding of COG's research processes. Increased interdisciplinary scientific collaborations involving nurses in COG particularly benefit pediatric patients with cancer.
• Moore, I. M., Challinor, J., Pasvogel, A., Matthay, K., Hutter, J., & Kaemingk, K. (2003). Online exclusive: behavioral adjustment of children and adolescents with cancer: teacher, parent, and self-report.. Oncology nursing forum, 30(5), E84-91.
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  PMID: 12949601;Abstract: PURPOSE/OBJECTIVES: To describe behavioral adjustment in children and adolescents with acute lymphoblastic leukemia (ALL) and to determine whether behavioral adjustment is correlated with cognitive and academic abilities. DESIGN: Descriptive, cross-sectional design. SETTING: Two pediatric oncology treatment centers. SAMPLE: 47 children and adolescents who had been receiving ALL therapy for at least one year or who were off therapy for no more than three years and their parents and teachers. Wechsler Intelligence Scale for Children-Revised (WISC-R) and Wide Range Achievement Test-Revised (WRAT-R) data were available on a subset of 17 subjects. METHODS: Parent, teacher, and self-report Behavioral Assessment System for Children (BASC) ratings were used to measure behavioral adjustment. WISC-R measured cognitive abilities, and WRAT-R measured academic abilities. Demographic, family, and treatment-related data also were collected. MAIN RESEARCH VARIABLES: Behavioral adjustment and cognitive and academic abilities. FINDINGS: At least 20% of teacher ratings for somatization, learning problems, leadership, and study skills; parent ratings for somatization, adaptability, attention problems, withdrawal, anxiety, social skills, and depression; and self-report ratings for anxiety and attitude to school were in the at-risk range (i.e., presence of significant problems that require treatment). The majority of teacher BASC ratings were correlated significantly with WISC-R and WRAT-R scores. Self-report depression and social stress ratings were correlated significantly with some WISC-R and WRAT-R scores. Treatment-related experiences such as body image alterations and mental and emotional problems were associated with problematic behaviors, including depression, somatization, withdrawal, and social stress. CONCLUSIONS: Youth with ALL are at risk for some behavioral adjustment problems, particularly anxiety, somatization, adaptability, attention, and withdrawal. Cognitive and academic abilities are associated with some dimensions of behavioral adjustment. IMPLICATIONS FOR NURSING: Findings suggest the need for ongoing assessment of behavioral adjustment and cognitive and academic abilities of children with ALL. Behavioral interventions that target at-risk mannerisms, such as somatization, depression, anxiety, and social stress, are needed. Central nervous system treatment may contribute to behavioral adjustment problems, as well as to cognitive and academic problems. Strategies to improve academic abilities also may have a positive effect on behavioral adjustment.
• Nelson, A., Challinor, J., Moore, I., Noll, R. B., White, N. C., O'Neill, J. B., & Clarke-Steffen, L. (2003). Consensus Statements: Development and Testing of the School Competency Assessment Scale. Journal of Pediatric Oncology Nursing, 20(2), 71-72.
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  PMID: 12709934;
• James, K., Keegan-Wells, D., Hinds, P. S., Kelly, K. P., Bond, D., Hall, B., Mahan, R., M, I., Roll, L., & Speckhart, B. (2002). The care of my child with cancer: parents' perceptions of caregiving demands.. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 19(6), 218-228.
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  PMID: 12444574;Abstract: Parents are actively involved in the direct care of their ill child receiving cancer treatment by providing and monitoring therapy and by managing symptoms related to the therapy or to the disease itself. Little is known about parents' perception of what helps or hinders them with their caregiving responsibilities or what effect the caregiving role has on the parent. In this descriptive, exploratory study, 151 parents responded to one or more of six open-ended questions that were part of the newly developed instrument, Care of My Child with Cancer. The 1,280 responses were analyzed using a semantic content analysis technique. The most frequently reported effect on parental caregiving involved negative physical and emotional health. One parent responded, "You feel like you lose all control over your life. It's no longer your own." The most desired forms of assistance with the caregiving role were periodic relief from direct caregiving, ongoing assistance with household responsibilities, and different forms of conveniences that could save time and energy. Two types of actual assistance found to be most helpful by parental caregivers included timely education about their child's health status from health care providers and emotional support from family members, friends, and others. These study findings provide the basis for future interventions that may diminish the effect that caregiving demands place on parents of children with cancer. Copyright 2002 by Association of Pediatric Oncology Nurses
• Wells, D. K., James, K., Stewart, J. L., Moore, I. M., Kelly, K. P., Moore, B., Bond, D., Diamond, J., Hall, B., Mahan, R., Roll, L., & Speckhart, B. (2002). The care of my child with cancer: A new instrument to measure caregiving demand in parents of children with cancer. Journal of Pediatric Nursing, 17(3), 201-210.
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  PMID: 12094361;Abstract: The growing societal trend toward delivering more and more illness-related care in the home, driven both by family preferences and by mandates from third-party reimbursers, places additional responsibilities for increasingly complex caregiving on parents of children with serious illness. This article reports on the development and initial field test of The Care of My Child with Cancer, a caregiving demand instrument specific to the childhood cancer population. The instrument demonstrated strong internal consistency and test-retest reliability, and exploratory factor analysis provided initial evidence for the instrument's construct validity. The instrument will now be applied in a collaborative program of nursing research to further investigate caregiving demand and ultimately to develop nursing interventions to maximize medical and quality of life outcomes for children with cancer and their families. Copyright 2002, Elsevier Science (USA). All rights reserved.
• Espy, K. A., Moore, I. M., Kaufmann, P. M., Kramer, J. H., Matthay, K., & Hutter, J. J. (2001). Chemotherapeutic CNS prophylaxis and neuropsychologic change in children with acute lymphoblastic leukemia: A prospective study. Journal of Pediatric Psychology, 26(1), 1-9.
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  PMID: 11145727;Abstract: Objective: To determine whether prophylactic CNS chemotherapy for childhood acute lymphoblastic leukemia is associated with declines in neuropsychological abilities. Methods: Growth curve analysis was used to examine neuropsychological outcome and treatment-related change in children (N = 30) who were treated at two childhood cancer centers. A comprehensive test battery was administered at baseline (8 months), 2, 3, and 4 years postdiagnosis (age at diagnosis M = 5.90 years, SD = 4.20). Results: Results indicated modest declines in arithmetic, visual motor integration, and verbal fluency. Intrathecal and systemic treatment was related to poorer visual motor integration at 4 years postdiagnosis and a faster rate of decline in visual motor integration skills across the observation period than intrathecal treatment alone. Arithmetic proficiency at 4 years after diagnosis was related to maternal education, but the rate of decline was not. Verbal fluency was unrelated to demographic or treatment variables. Conclusions: These findings suggest that neuropsychological outcome and declines are related to both demographic and treatment characteristics depending on the cognitive domain examined.
• Challinor, J., Miaskowski, C., Moore, I., Slaughter, R., & Franck, L. (2000). Review of research studies that evaluated the impact of treatment for childhood cancers on neurocognition and behavioral and social competence: nursing implications.. Journal of the Society of Pediatric Nurses : JSPN, 5(2), 57-74.
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  PMID: 10879361;Abstract: ISSUES AND PURPOSE: Given the increasing incidence of childhood cancer, increasing survivor rates, and documented incidence of sequelae, nurses need evidence on which to base interventions for families at risk. The authors review and critique research studies that evaluated the impact of treatment for childhood cancers. Implications for nursing practice are discussed. CONCLUSIONS: Research to evaluate the effects of treatment on neurocognition and behavioral and social competency of children with cancer has produced conflicting results. Most studies found deleterious effects on all three areas associated with childhood cancer treatment. Some studies, however, found no differences between childhood cancer survivors and children on therapy compared to normative data or healthy controls. PRACTICE IMPLICATIONS: Knowledge of the short- and long-term impact of treatment for childhood cancer on neurocognition and behavioral and social competence allows nurses to design interventions that mitigate neurocognitive effects, decrease behavioral problems, and improve social competence.
• Ida, M. (2000). The stress-response sequence model of stress in pediatric oncology nurses. Journal of Pediatric Oncology Nursing, 17(2), 72-75.
• Moore, I. M., & Reed, P. (2000). The stress-response sequence model of stress in pediatric oncology nurses.. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 17(2), 72-75.
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  PMID: 10810830;
• Moore, I. M., Espy, K. A., Kaufmann, P., Kramer, J., Kaemingk, K., Miketova, P., Mollova, N., Kaspar, M., Pasvogel, A., Schram, K., Wara, W., Hutter, J., & Matthay, K. (2000). Cognitive consequences and central nervous system injury following treatment for childhood leukemia.. Seminars in oncology nursing, 16(4), 279-290; discussion 291.
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  PMID: 11109272;Abstract: OBJECTIVES: To determine the relationship between membrane damage and intellectual and academic abilities in children with acute lymphoblastic leukemia (ALL) and pilot test a math intervention for children with ALL who were affected. DATA SOURCES: Research studies and review articles. CONCLUSIONS: Despite the prophylactic central nervous system (CNS) treatment for long-term disease-free survival, many children with ALL subsequently experience declines in intellectual and academic skills. IMPLICATIONS FOR NURSING PRACTICE: Improving academic abilities in children who have received CNS treatment is of high priority and may have longlasting implications on quality of life.
• Challinor, J. M., Miaskowski, C. A., Franck, L. S., Slaughter, R. E., Matthay, K. K., Kramer, R. F., Veatch, J. J., Paul, S. M., Amylon, M. D., & Moore, I. M. (1999). Cross-cultural adaptation of a health status classification system in children with cancer. First results of the french adaptation of the Health Utilities Index Marks 2 and 3. International Journal of Cancer, 112-118.
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  Abstract: Our objective was to adapt and validate the Health Utilities Index Mark 2 (HUI 2) and HUI 3 health status classification systems self-report questionnaire in a population of children with cancer, a group of 42 children already included in a multi-centre database designed by the Group on Brain Tumors in Children of the French Society for Pediatric Oncology. Children were recruited during a routine consultation. Most of them had completed treatment. The version of the questionnaire for French adults was adapted linguistically for children. Open-ended queries by children about the comprehensiveness of the questions and very low non-response rates showed a good acceptability of the questionnaire. The main psychometric properties of the HUI 2 and HUI 3 classification systems were assessed in 3 groups of raters (child, parent, physician): construct validity was tested against the rating of the child's health state on a Likert scale and through comparison with clinical data, and internal consistency was determined through multi- trait analysis. Weighted and un-weighted kappa values were used to measure the inter-rarer agreement between the child's, parent's and physician's assessment of the child's health state. The convergent validity was satisfactory, with better results when the physician's assessment was used. The most affected attributes were the expected ones (i.e., cognition, pain and emotion). Disagreement was observed between the 3 raters, more often in the same direction: taking the child's assessment as the reference, the parents tended to under-estimate the health status while physicians tended to over-estimate it.
• Wiley, F. M., Ruccione, K., Moore, I. M., McGuire-Cullen, P., Fergusson, J., Waskerwitz, M. J., Perin, G., Jeff, G. e., & Sather, H. N. (1999). Parents' perceptions of randomization in pediatric clinical trials. Cancer Practice, 7(5), 248-256.
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  PMID: 10687594;Abstract: OBJECTIVES: The purpose of this study was to investigate parents' knowledge and perceptions about randomization in clinical trials for children with cancer, and to determine whether parents' decisions were influenced by demographic factors, randomization circumstances, the clinical characteristics of the child with cancer, or a combination. MATERIALS AND METHODS: This study collected information from 192 parents of patients with various forms of childhood cancer who either accepted or refused randomization. A comparative case-control design was used. The Clinical Investigation Randomization Scale was administered to all participants. This scale included 32 questionnaire items (QIs) pertaining to randomization as well as a mixture of open-ended questions to obtain information about demographic and other factors. RESULTS: A predictor model was developed that accurately predicted acceptance or refusal of randomization 87% of the time. Demographic information was found to have less influence than expected on parents' decision regarding randomization. Knowledge deficits were found among both groups of parents, those who accepted and those who refused randomization. CONCLUSIONS: What most distinguished parents who refused from those who accepted randomization was not their knowledge and information about randomized clinical trials. By far, the majority of QIs that accurately predicted acceptors and refusers involved parents' beliefs, values, and perceptions. Further research is needed to determine interventions that may enable the healthcare team to provide information and decisional support most effectively to improve the informed consent process.
• Gilliss, C. L., Moore, I. M., & Martinson, I. M. (1997). Measuring parental grief after childhood cancer: Potential use of the SCL-90R. Death Studies, 21(3), 277-287.
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  PMID: 10169695;Abstract: To contribute to a better understanding of the utility of the Symptom Checklist. 90-Revised (SCL-90R; L. Derogatis, 1983) with bereaved samples, an exploratory factor analysis was conducted on SGL-90R responses of 97 parents 2 years after the death of their child from cancer. The factor analysis revealed one significant factor that accounted for 30% of the variance in this administration. This factor included many items that reflected the theme of somatic complaints.
• Bradlyn, A. S., Ritchey, A. K., Harris, C. V., Moore, I. M., O'Brien, R. T., Parsons, S. K., Patterson, K., & Pollock, B. H. (1996). Quality of life research in pediatric oncology: Research methods and barriers. Cancer, 78(6), 1333-1339.
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  PMID: 8826959;
• Mollova, N. N., Moore, I. M., Hutter, J., & Schram, K. H. (1995). Fast atom bombardment mass spectrometry of phospholipids in human cerebrospinal fluid. Journal of Mass Spectrometry, 30(10), 1405-1420.
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  Abstract: Lipid extracts of cerebrospinal fluid (CSF) collected from children with leukemia were separated on normal-phase high-performance liquid chromatography (HPLC) and analyzed by fast atom bombardment mass spectrometry (FABMS) and tandem FABMS/MS. CSF samples from 13 children with leukemia receiving chemotherapy and radiation treatment were analyzed. Analysis of the results permits the identification of phosphatidylcholine (PC), sphingomyelin (SM), diacylglycerol (DAG) and lysophosphatidylcholine (LPC) molecular species. The following changes in the CSF phospholipid composition during treatment with chemotherapy were identified: (i) presence of DAGs and LPCs and (ii) increase in SM relative to PC. A predominance of the C18:1 SM was observed during radiation treatment. To our knowledge, this is the first report of the application of HPLC and FABMS for the analysis of human CSF. The possibility of Using FABMS and FABMS/MS for the direct analysis of the total CSF lipid extracts in cancer patients is demonstrated.
• Moore, I., & Moore, I. M. (1995). Central nervous system toxicity of cancer therapy in children. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 12(4).
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  Cancer treatment of the central nervous system has contributed positively to long-term disease-free survival from childhood cancers such as acute leukemia and medulloblastoma. However, intrathecal chemotherapy and whole brain radiation are associated with acute, subacute, and delayed toxicities. The purpose of this review article is to summarize what is known about critical events in prenatal and postnatal brain development; the pathophysiology of radiation and chemotherapy neurotoxicity and clinical manifestations and risk factors for acute, subacute, and delayed toxicities. The importance of long-term follow-up and for multidisciplinary interventions that focus on prevention as well as management of identified problems are addressed.
• Moore, I., Hoyer, G. L., Nolan, P. E., LeDoux, J. H., & Moore, I. M. (1995). Selective stability-indicating high-performance liquid chromatographic assay for recombinant human regular insulin. Journal of chromatography. A, 699(1-2).
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  This report presents a selective HPLC assay capable of separating recombinant human regular insulin from insulin decomposition and transformation products. The assay utilizes an isocratic delivery of mobile phase, a C18 peptide column, UV detection and is performed at ambient temperature. The standard curve ranges from 0.2 to 2.5 U/ml. The inter-day and intra-day variabilities are less than 7 and 5%, respectively, at the concentrations studied. The accuracy and precision are within 5% over the range of the standard curve.
• Wilson, K., Neglia, J., & Moore, K. (1993). Workshop 4: Consequences of cure: Late effects of childhood cancer treatment. Journal of Pediatric Oncology Nursing, 10(2), 50-.
• Halberg, F. E., Kramer, J. H., Moore, I. M., Wara, W. M., Matthayi, K. K., & Ablin, A. R. (1992). Prophylactic cranial irradiation dose effects on late cognitive function in children treated for acute lymphoblastic leukemia. International Journal of Radiation Oncology, Biology, Physics, 22(1), 13-16.
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  PMID: 1727109;Abstract: Prophylactic central nervous system treatment has dramatically improved the disease-free survival of children with acute lymphoblastic leukemia (ALL). Long-term neuropsychological sequelae are documented in children who received 2400 cGy prophylactic cranial irradiation. The dose was reduced to 1800 cGy. Available reports on developmental consequences, with short follow-up, have yielded inconsistent results. This study assesses radiation dose effects on cognitive function in children with leukemia who received central nervous system prophylaxis with 2400 cGy versus 1800 cGy whole brain radiotherapy. All leukemic children also received intrathecal methotrexate. A control group of children (treated for Wilms' tumor) received no central nervous system therapy. Nineteen children were treated with 2400 cGy, 16 children with 1800 cGy. The 12 control children received no irradiation. All patients were off therapy for at least 70 months. The 1800 cGy and 2400 cGy patient groups were off therapy for equivalent periods of time (range 70-123 mo) at follow-up testing. Mean age at diagnosis was 49 months, at testing: 142 months. The male to female ratio was 1 1. Standardized psychological tests were administered. Full-Scale, Verbal, and Performance IQ were measured with the Wechsler Intelligence Scale for Children-Revised. Wide Range Achievement Testing evaluated reading, spelling, and arithmetic abilities. Children treated with 1800 cGy performed significantly better than those who received 2400 cGy, and at the same level as controls. There were statistically significant differences between the 1800 cGy and 2400 cGy subjects in all measures. 2400 cGy patients had deficiencies in IQ and academic performance. 1800 cGy patients scored approximately 12 points higher than 2400 cGy children. Eleven children, two in the control group, two in the 1800 cGy, and seven in the 2400 cGy group had IQ scores of less than 90. Eight of the nine irradiated children with deficits had radiotherapy before age 5. These results indicate a mild, but diffuse information processing deficit in children who received 2400cGy, but not in children who received 1800 cGy. These findings with a minimum of 6 years of follow-up provide new information on late effects of CNS prophylaxis in ALL. Reducing the cranial RT dose from 2400 cGy to 1800 cGy reduced neurotoxicity to acceptable levels. © 1991.
• Moore, I. M., Kramer, J. H., Wara, W., Halberg, F., & Ablin, A. R. (1991). Cognitive function in children with leukemia: Effect of radiation dose and time since irradiation. Cancer, 68(9), 1913-1917.
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  PMID: 1913542;Abstract: The effect of two cranial radiation (CRTX) doses and the time since radiation therapy on cognitive functioning were studied in 35 children who completed therapy for acute lymphoblastic leukemia (ALL). The patients were grouped according to CRTX dose (2400 or 1800 cGy) and evaluated for general intelligence, academic achievement, and visual motor integration. Those who received 2400 cGy (n = 20) scored ten points below those treated with 1800 cGy (n = 15) on verbal intelligence quotient and achievement tests of reading, spelling, and arithmetic. The effect of time since radiation therapy on these measures of cognitive function was significant (P = 0.001 to 0.03); the effect of CRTX dose was not. Visual motor integration scores in both groups fell below the 33rd percentile. The effect of CRTX dose and time since radiation therapy on visual motor integration and performance intelligence quotient were not significant. Thus, the interval between treatment and the emergence of cognitive impairments may be longer after lower CRTX doses, and deficits in nonverbal areas such as visual motor integration may appear first. A larger study is needed to confirm these findings from a limited sample of long-term survivors of ALL.
• Ruccione, K., Kramer, R. F., Moore, I. K., & Perin, G. (1991). Informed consent for treatment of childhood cancer: Factors affecting parents' decision making. Journal of Pediatric Oncology Nursing, 8(3), 112-121.
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  PMID: 1930801;Abstract: Both the treatment for childhood cancer and the legal requirements for gaining parents' consent to treatment have become increasingly complex. The purpose of the exploratory investigation reported here was to identify influential circumstances surrounding the consent process in the pediatric setting, to describe the relationship of parental anxiety to these factors, and to delineate related practice and research implications. Twenty-eight parents of children entered on one of four protocols for the treatment of newly diagnosed acute lymphoblastic leukemia at the Childrens Hospital Los Angeles and the University of California San Francisco were asked to complete two questionnaires within 48 hours after consenting to treatment: the State-Trait Anxiety Index and the Parent Informed Consent Questionnaire. Results of the study confirmed clinical experience that parents are given complex information and asked to make decisions about their child's life in a highly anxious state. Although participants were generally satisfied with the informed consent process 48 hours after signing a consent form, further research is needed to document how well parents understand and remember key information, as well as the influence of time, experience, and changes in state anxiety on their perceptions of the adequacy of the consent process. In current clinical practice, simple strategies can be applied to improve the informed consent process for families of children with cancer. © 1991.
• Kramer, J., & Moore, I. M. (1989). Late effects of cancer therapy on the central nervous system. Seminars in Oncology Nursing, 5(1), 22-28.
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  PMID: 2646664;Abstract: The number of studies documenting the long-term morbidity of CNS treatment has increased dramatically in recent years. Cranial irradiation, in particular, has been associated with cognitive deficits and neuroanatomic pathology. Children who are treated at an early age and individuals who receive higher doses (2,400 cGy or greater) appear to be at greatest risk for these sequelae. Much more research on the pathogenesis of delayed injury following CNS treatment is needed. Although several compelling mechanisms have been proposed, little empirical evidence is available. This knowledge is essential to the identification of agents that may protect normal brain tissue from injury. Even less is known about the effects of age at time of treatment, type of treatment (radiation v chemotherapy), or dose of radiation in relation to delayed injury. Of utmost importance are studies that will establish the predictive relationship between brain injury and cognitive deficits. This would allow clinicians to predict patients who are at risk for cognitive impairment in order to institute appropriate preventive or remedial interventions. © 1989.
• Moore, I. M., & Klopovich, P. (1989). Future perspectives. Seminars in Oncology Nursing, 5(1), 70-.
• Moore, I. M., & Klopovich, P. M. (1989). Introduction. Seminars in Oncology Nursing, 5(1), 1-3.
• Moore, I. M., & Ruccione, K. (1989). Challenges to conducting research with children with cancer.. Oncology nursing forum, 16(4), 587-589.
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  PMID: 2755865;
• Kramer, J. H., Norman, D., Brant-Zawadzki, M., Ablin, A., & Moore, I. M. (1988). Absence of white matter changes on magnetic resonance imaging in children treated with CNS prophylaxis therapy for leukemia. Cancer, 61(5), 928-930.
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  PMID: 3422180;Abstract: Previous studies have shown that magnetic resonance imaging (MRI) is sensitive to white matter changes in children receiving cranial radiation of 3000 cGy or greater. The current study used MRI to investigate the integrity of white matter in children receiving 1800 to 2400 cGy of cranial radiation. Ten survivors of acute lymphoblastic leukemia (ALL) who received intrathecal methotrexate (MTX) and either 1800 or 2400 cGy of cranial radiation were studied with MRI and neuropsychologic testing. Magnetic resonance (MR) scans were normal in nine of ten patients. One patient had prominent and asymmetrical lateral ventricles and mildly enlarged cortical sulci. White matter tracts were normal in appearance. However, seven of nine children had below average intellectual functioning. Results indicate that children receiving less than 2500 cGy of caranial radiation fail to show white matter changes on MRI, despite evidence of cognitive impairment.
• Marie, I., Glasser, M. E., & Ablin, A. R. (1988). The late psychosocial consequences of childhood cancer. Journal of Pediatric Nursing, 3(3), 150-158.
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  PMID: 3164070;Abstract: As more children survive childhood cancer, the long-term emotional sequelae of the disease and its therapy become of considerable importance. This study investigated the overall psychosocial functioning and specific concerns of 36 children who were long-term survivors of acute lymphoblastic leukemia or a solid tumor that did not involve the central nervous system. Findings from the Deasy-Spinetta Behavioral Questionnaire reveal that children treated for leukemia were functioning at a level below school peers. Differences between parent and teacher appraisal of the cancer survivor underscore the importance of ongoing communication. Finally, the results indicate a possible relationship between cognitive and emotional problems. © 1988.
• Moore, I. M., Gilliss, C. L., & Martinson, I. (1988). Psychosomatic symptoms in parents 2 years after the death of a child with cancer. Nursing Research, 37(2), 104-107.
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  PMID: 3347517;Abstract: Forty-five mothers and 30 fathers, representing 58 families, completed the Symptom Checklist 90-Revised, a measure of current psychological and somatic symptoms, 24 months after the death of a child with cancer. The mean scores from six symptom dimensions (somatization, obsessive-compulsive,interpersonal sensitivity, depression, anxiety, and hostility) and a global measure of the depth of symptomatology, the Global Severity Index, were contrasted with those of the nonpatient and psychiatric outpatient norms reported by Derogatis (1983). Two years after the child's death parents showed a symptom profile reflecting significantly greater distress than that reported by nonbereaved, nonpatient adults. The results highlight important distinctions between bereaved parents and psychiatric outpatients.
• Moore, I. M., Piper, B., Dodd, M. J., & Hudes, M. (1987). Measuring oncology nursing practice: results from one graduate program.. Oncology nursing forum, 14(1), 45-49.
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  PMID: 3643589;
• Moore, I. M. (1986). Research problems in clinical practice.. Journal of the Association of Pediatric Oncology Nurses, 3(1), 27, 31.
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  PMID: 3637240;
• Moore, I. M., Kramer, J., & Ablin, A. (1986). Late effects of central nervous system prophylactic leukemia therapy on cognitive functioning.. Oncology nursing forum, 13(4), 45-51.
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  PMID: 3460030;
• Moore, I. M., Kramer, R. F., & Perin, G. (1986). Care of the family with a child with cancer: diagnosis and early stages of treatment.. Oncology nursing forum, 13(5), 60-66.
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  PMID: 3638721;
• Moore, I. M. (1985). Research: an overview of quasi-experimental design.. Journal of the Association of Pediatric Oncology Nurses, 2(4), 38-39, 42.
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  PMID: 3854357;
• Piper, B., Moore, I. M., & Dodd, M. (1985). Changes in cancer-related knowledge and attitudes: one graduate curriculum's experience.. Cancer nursing, 8(5), 272-277.
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  PMID: 3854963;
• Kramer, R. F., & Moore, I. M. (1983). Childhood cancer: meeting the special needs of healthy siblings.. Cancer Nursing, 6(3), 213-217.
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  PMID: 6552936;
• Moore, I. M. (1982). Nontherapeutic research using children as subjects.. MCN. The American journal of maternal child nursing, 7(5), 285, 289-294.
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  PMID: 6811816;
• Moore, I. M., & Triplett, J. L. (1980). Students with cancer: a school nursing perspective.. Cancer Nursing, 3(4), 265-270.
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  PMID: 6901637;