Computer Based Simulation in Pediatric Emergency Care

Objectives To give the student a better understanding of emergency paediatrics (or of other medical specialities) by means of computer simulation of clinical cases. To develop a tool for examining students in medical disciplines (e.g., paediatrics) using computer simulation during Objective Structured Clinical Examinations (OSCEs). See Bouhuijs and co-workers (Medical Teacher, 9, 183-191). The Problem Although both theoretical and practical skills are important aspects of medical training, it is rarely possible to train independent decision making, as a more experienced doctor is always formally responsible. Moreover, it is seldom possible to train the management of the severely ill as not only are such patients scarce but naturally they are even more in need of an experienced physician. Nonetheless, all doctors must have certain procedures and treatment alternatives at their fingertips, despite the practical difficulty of training them to manage these situations in practice. One way is by using dolls or volunteers during emergency or accident training programs, though this is a cumbersome procedure. Thus, there is no readily available and simple teaching tool that can be used to provide this kind of training. The Solution The solution is to develop a program package divided into two parts. The Emergency Writer is the first part being developed in which the teacher designs the cases that will be presented to the student. The cases created with this powerful tool are linked together to lessons. They will be constructed in collaboration with other paediatric departments in Sweden. The second part will be the Emergency Paediatrics, which will present the cases to the student. The Emergency Paediatrics is under preparation and the Emergency Writer is completed. The medical students may choose English or Swedish as language for their training. It will be possible to choose a new lesson or to restart an old one. In examination mode the software only gives limited feedback and forces the student to complete a given lesson. The student has access to a log of all events during a lesson and a summary statistics

Switching From Originator to Biosimilar Human Growth Hormone Using Dialogue Teamwork: Single-Center Experience From Sweden

INTRODUCTION: A new treatment plan was implemented at Skåne University Hospital, on economic grounds, for children requiring recombinant human growth hormone (rhGH) treatment. This involved switching patients from treatment with originator rhGHs to treatment with a biosimilar rhGH, somatropin (Omnitrope(®)), using a Dialogue Teamwork approach. The feasibility of using this approach to implement the switch of treatment was assessed, as well as the impact of the switch on treatment efficacy and cost of therapy. METHODS: As part of the Dialogue Teamwork approach, patients/parents received several opportunities for dialogue and sources of information, including discussions with the Head of Department, the responsible physician and a specialized endocrinology nurse. Height and height standard deviation score (HSDS) data were plotted for each individual patient (N = 98). A modeling approach was also used, to predict growth after switching to biosimilar rhGH; the predictions were then compared to the actual observed height after the switch. Costs to the clinic of rhGH therapy were calculated between May–August 2009 and May–August 2012. RESULTS: Of the 102 patients offered the switch, 98 accepted. Height and HSDS data indicated there was no negative impact on growth velocity after the switch to biosimilar rhGH. Modeling demonstrated that observed growth following the switch was consistent with predicted growth based on data before patients were switched. There were no reports of serious or unexpected adverse drug reactions following the switch to biosimilar rhGH. Following the switch, the cost to the clinic of rhGH treatment decreased from approximately 6 million SEK (May–August 2009) to approximately 4 million SEK (May–August 2012). This corresponds to an annual saving of 6 million SEK (€650,000). CONCLUSION: Patients were successfully switched from originator to biosimilar rhGH (somatropin), with no negative impact on growth, and no serious or unexpected adverse drug reactions. The switch from originator to biosimilar rhGH is associated with substantial cost savings

Parental feeding practices and associations with child weight status. Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S. ..

Vitamin D and Osteogenesis Imperfecta in Pediatrics

Osteogenesis Imperfecta (OI) is a heterogeneous group of inherited skeletal dysplasias characterized by bone fragility. The study of bone metabolism, in these disease, is problematic in terms of clinical and genetic variability. The aims of our study were to evaluate the importance of Vitamin D levels in OI bone metabolism, reviewing studies performed on this topic and providing advice reflecting our experience using vitamin D supplementation. A comprehensive review on all English-language articles was conducted in order to analyze the influence of vitamin D in OI bone metabolism in pediatric patients. Reviewing the studies, contradictory data were found on the relationship between 25OH vitamin D levels and bone parameters in OI, and in several studies the baseline levels of 25OH D were below the threshold value of 75 nmol/L. In conclusion, according to the literature and to our experience, we highlight the importance of adequate vitamin D supplementation in children with OI

The influence of growth hormone on pediatric body composition: A systematic review

Background: Growth hormone (GH) affects metabolism and regulates growth in childhood. The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature. In adult-onset GHD, lean body mass (LBM) is reduced, and visceral fat mass (FM) increased. Beneficial effects of GH treatment on body composition in adults with GHD, including an increase in muscle mass and a decrease in FM, are well established. Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency. This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD. Methods: The PubMed, Science Direct, Cochrane Trials, and Embase databases, were searched with keywords including "GH", "body composition", "children", and "growth hormone" for English-language articles, published between January 1999 and March 2021. Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment, regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy. Data extracted from each study included study quality, study sample characteristics, study interventions, and body composition. Data on fat-free mass and LBM were combined into a single category of LBM. Results: Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy. Conclusion: Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD

Familjeterapi tillämplig även i somatiska vården. Studieöversikt över medicinskt orienterad familjeterapi

By observing and analyzing the influence of the therapist on the family as well as interactions between family members, the encounter with a family in a medical setting can serve to improve the health of its members, by improving their ability to use their own resources. This method of focusing on the interaction between individuals in a family or other systems has been a valuable addition to medical treatment of chronic disease. Family therapy has been shown to effectively improve treatment of diabetes, asthma and obesity. A review of the literature is presented

Obesity and hyperlipoproteinaemia in children : epidemiological, biochemical and clinical studies and the effects of family therapy

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