Emerging options in growth hormone therapy: an update

Growth hormone (GH) was first used to treat a patient in 1958. For the next 25 years it was available only from cadaver sources, which was of concern because of safety considerations and short supply. In 1985, GH produced by recombinant DNA techniques became available, expanding its possible uses. Since that time there have been three indications approved by the US Food and Drug Administration (FDA) for GH-deficiency states and nine indications approved for non-GH-deficiency states. In 2003 the FDA approved GH for use in idiopathic short stature (ISS), which may indirectly cover other diagnoses that have short stature as a feature. However, coverage for GH therapy is usually more reliably obtainable for a specific indication, rather than the ISS indication. Possible future uses for GH therapy could include the treatment of syndromes such as Russell–Silver syndrome or chondrodystrophy. Other non-short-stature indications could include wound healing and burns. Other uses that have been poorly studied include aging and physical performance, in spite of the interest already shown by elite athletes in using GH. The safety profile of GH developed over the past 25 years has shown it to be a very safe hormone with few adverse events associated with it. The challenge for the future is to follow these patients into adulthood to determine whether GH therapy poses any long-term risks

Managing idiopathic short stature: role of somatropin (rDNA origin) for injection

Idiopathic short stature (ISS) is a term that describes short stature in children who do not have growth hormone (GH) deficiency and in whom the etiology of the short stature is not identified. Between 1985 and 2000, more than 40 studies were published regarding GH therapy for ISS. Only 12 of these had data to adult height, of which only 4 were controlled studies. A subsequent placebo-controlled study that followed subjects to adult height indicated that there was a gain of 3.7–7.5 cm in height with GH treatment. In 2003, the US Federal Drug Administration (FDA) approved GH for treatment of short stature. Even before FDA approval, patients with ISS made up about 20% of patients in GH databases, which is largely unchanged since FDA approval. There remains some controversy as to whether GH should be used to treat ISS. This controversy centers on the fact that there has been no definitive demonstration that short stature results in a disadvantage or problems with psychological adjustment, and thus, no demonstration that GH therapy results in improvement in quality of life

BESTFACT Best Practice Handbook 3

The Best Practice Handbook (BPH) gives an overview about current concepts, strategies and actions in freight transport all over Europe. It is disseminating information on successful projects and practices to increase awareness and share experiences. It is enabling knowledge transfer and supporting transferability for best practices. The third and last Best Practice Handbook focuses on the work done over the entire project, with 157 inventory cases and 60 in-depth analyses. After four years of case collection a wide field of solutions is available. The main findings of the BESTFACT cases are cross-checked and summarised for each of the cluster topics. The consistent form of collection and information provision broadens the structural understanding of best practice cases. The synthesis of cases per topic shows that under consideration of barriers and framework conditions replicable impacts are achievable. Main editors are Martin Ruesch & Simon Bohne (Rapptrans) and Jacques Leonardi (UoW). Project leader is Marcel Huschebeck (PTV)

The diagnostic work up of growth failure in secondary health care; An evaluation of consensus guidelines

Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods: Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC - Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results: Twenty four percent of children older than 3 years were inappropriately referred (NCR). Of the correctly referred children 74-88% were short corrected for parental height, 40-61% had a height SDS <-2.5 and 21% showed height deflection (Δ HSDS < -0.25/yr or Δ HSDS < -1). In none of the children a complete detailed routine diagnostic work up was performed and in more than 30% no routine laboratory examination was done at all. Pathologic causes of short stature were found in 27 children (5%). Conclusion: Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls

Grundlagen der Logistik

Logistikprozesse unterliegen einem ständigen Verbesserungs- und Optimierungsgebot. Lediglich den Status quo zu erhalten, ist keine Strategie und führt nicht zum Erfolg. Im Gegenteil: Gerade in der Logistik ist Stillstand ein sicheres Indiz dafür, dass man überholt wird. Zukunftsthemen wie die Digitalisierung und Automatisierung sind jedoch auch kein Allheilmittel. Sie bilden den Grundstein für die Transparenz von Logistikprozessen und -systemen, indem sie auf verbesserte Überwachung von Objekten und Prozessen setzen, die Vernetzung von Akteuren fördern, auch in Form von digitalen Zwillingen. Die Ansätze zur Verbesserung, Umgestaltung und Anpassung von Logistiksystemen und -operatoren kann auch in Zukunft nur durch eine(n) gut ausgebildete(n) Logistiker*in erfolgen. Das vorliegende Buch soll deshalb als beispielhafte Anleitung und in diesem Sinne als Handwerkszeug für Logistiker*innen und -interessierte dienen. Die konkrete Umsetzung und Verbesserung, sei es in Richtung einer Effizienzsteigerung oder einer Neugestaltung, muss immer durch den Menschen selbst vorgenommen werden