Pediatric pharmacotherapy and its unique challenges: amalgamation of professionalism and Emotional Quotient (EQ).

Pharmacotherapeutics in children follows the same principles as pharmacotherapy for adults (1); and focuses primarily on the physiology of the children as well as the pharmacology of the medications. Children react to medications differently i.e., incomplete absorption, distribution, metabolism and excretion, causing increased or decreased efficacy or safety (2)

Historien om medikamentell behandling av sykdom hos barn

Medikamentell behandling av barn må følge samme prinsipper og retningslinjer som hos voksne. Pinlig nøyaktighet er påkrevet når det administreres medikamenter til barn fordi effekten av legemidler i forhold til barnets fysiologi, biokjemi, og vekst er annerledes enn hos voksne. Legens ansvar til å forskrive medikamenter til barn må alltid ses i sammenheng med plikten til å utøve forsvarlig legevirksomhet (Lov om helsepersonell). Et godt eksempel for de mange utfordringene er risikoen for etseskader ved bruk av klorheksidin til huddesinfeksjon til premature barn

Characteristics of babies who unexpectedly survive long term after withdrawal of intensive care

Aim Occasional babies survive long term after withdrawal of intensive care despite a poor prognosis. We aimed to review in detail the clinical cases, characteristics, and outcomes of neonates with unexpected protracted survival following planned withdrawal of intensive cardiorespiratory support. Methods We reviewed infants who unexpectedly survived for more than one week following planned withdrawal of intensive care in two tertiary‐level NICUs over a seven‐year period. Results We identified eight long‐term survivors (six term, two preterm) between 2007 and 2013. All had a clinical diagnosis of grade 3 hypoxic‐ischaemic encephalopathy and severely abnormal electroencephalography and neuroimaging prior to intensive care withdrawal. Intensive care was withdrawn at five days postnatal age (range: two to nine days), but the possibility of protracted survival was discussed beforehand in only two cases. Three infants died before three months of age. Five infants remain alive, currently aged from 2.0 to 6.5 years, and all have significant neurodevelopmental problems. Conclusion Unexpected long‐term survival after neonatal intensive care withdrawal occurs occasionally but unpredictably. Significant neurodevelopmental adversity was invariable in those surviving beyond infancy. Ventilator dependency along with severely abnormal electroencephalography and neuroimaging is still compatible with long‐term survival. The possibility of protracted survival should be discussed routinely with parents before intensive care withdrawal

Optimization of the All-D peptide D3 for Aβ oligomer elimination

The aggregation of amyloid-{beta} (A{beta}) is postulated to be the crucial event in Alzheimer's disease (AD). In particular, small neurotoxic A{beta} oligomers are considered to be responsible for the development and progression of AD. Therefore, elimination of thesis oligomers represents a potential causal therapy of AD. Starting from the well-characterized d-enantiomeric peptide D3, we identified D3 derivatives that bind monomeric A{beta}. The underlying hypothesis is that ligands bind monomeric A{beta} and stabilize these species within the various equilibria with A{beta} assemblies, leading ultimately to the elimination of A{beta} oligomers. One of the hereby identified d-peptides, DB3, and a head-to-tail tandem of DB3, DB3DB3, were studied in detail. Both peptides were found to: (i) inhibit the formation of Thioflavin T-positive fibrils; (ii) bind to A{beta} monomers with micromolar affinities; (iii) eliminate A{beta} oligomers; (iv) reduce A{beta}-induced cytotoxicity; and (v) disassemble preformed A{beta} aggregates. The beneficial effects of DB3 were improved by DB3DB3, which showed highly enhanced efficacy. Our approach yielded A{beta} monomer-stabilizing ligands that can be investigated as a suitable therapeutic strategy against AD

Stronger and More Vulnerable: A Balanced View of the Impacts of the NICU Experience on Parents

For parents, the experience of having an infant in the NICU is often psychologically traumatic. No parent can be fully prepared for the extreme stress and range of emotions of caring for a critically ill newborn. As health care providers familiar with the NICU, we thought that we understood the impact of the NICU on parents. But we were not prepared to see the children in our own families as NICU patients. Here are some of the lessons our NICU experience has taught us. We offer these lessons in the hope of helping health professionals consider a balanced view of the NICU's impact on families

Stronger and More Vulnerable: A Balanced View of the Impacts of the NICU Experience on Parents

For parents, the experience of having an infant in the NICU is often psychologically traumatic. No parent can be fully prepared for the extreme stress and range of emotions of caring for a critically ill newborn. As health care providers familiar with the NICU, we thought that we understood the impact of the NICU on parents. But we were not prepared to see the children in our own families as NICU patients. Here are some of the lessons our NICU experience has taught us. We offer these lessons in the hope of helping health professionals consider a balanced view of the NICU's impact on families

Aβ oligomers peak in early stages of Alzheimer's disease preceding tau pathology

INTRODUCTION Soluble amyloid beta (Aβ) oligomers have been suggested as initiating Aβ related neuropathologic change in Alzheimer's disease (AD) but their quantitative distribution and chronological sequence within the AD continuum remain unclear. METHODS A total of 526 participants in early clinical stages of AD and controls from a longitudinal cohort were neurobiologically classified for amyloid and tau pathology applying the AT(N) system. Aβ and tau oligomers in the quantified cerebrospinal fluid (CSF) were measured using surface-based fluorescence intensity distribution analysis (sFIDA) technology. RESULTS Across groups, highest Aβ oligomer levels were found in A+ with subjective cognitive decline and mild cognitive impairment. Aβ oligomers were significantly higher in A+T− compared to A−T− and A+T+. APOE ε4 allele carriers showed significantly higher Aβ oligomer levels. No differences in tau oligomers were detected. DISCUSSION The accumulation of Aβ oligomers in the CSF peaks early within the AD continuum, preceding tau pathology. Disease-modifying treatments targeting Aβ oligomers might have the highest therapeutic effect in these disease stages. Highlights Using surface-based fluorescence intensity distribution analysis (sFIDA) technology, we quantified Aβ oligomers in cerebrospinal fluid (CSF) samples of the DZNE-Longitudinal Cognitive Impairment and Dementia (DELCODE) cohort Aβ oligomers were significantly elevated in mild cognitive impairment (MCI) Amyloid-positive subjects in the subjective cognitive decline (SCD) group increased compared to the amyloid-negative control group Interestingly, levels of Aβ oligomers decrease at advanced stages of the disease (A+T+), which might be explained by altered clearing mechanism

The Quality of Internationally Trained Medical Doctors : An empirical study of the skills of internationally trained medical doctors after their authorization in Norway. An approach to aid in the integration of foreign-trained physicians into the Norwegian workforce.

This paper examines what we know, and don t know, about migration of international physicians. It sought to determine if internationally trained medical doctors have similar work qualifications as Scandinavian trained physicians and if the current national integration process is a cause of concern. It addresses the issue of the quality of the primary health care provided by IMGs, resident in Norway, as experienced by their Norwegian professional peers. Questionnaires were sent to 485 physicians. 327 returned the filled-in questionnaires and reported about their experiences with colleagues with a non-Scandinavian medical education. The returned questionnaires show how the respondents assess the professional, cultural, and communication skills of the foreign-trained physicians after their authorization as medical doctors in Norway. Interviews were conducted with representatives from the medical faculty, SAFH and the Norwegian Board of Health to discuss their plans for the future assessment and support of IMGs. Results: 1. Respondents express low satisfaction with IMGs trained in Eastern Europe, Asia, Africa and South America, and point to inadequate language and communication skills as the number-one problem among these physicians. 2. Respondents report that the problems they see with the foreign trained physicians were compromising the quality of health care provided. Substantial proportions (5%) of all reports conclude that poor communication skills are a very or fairly serious problem for patients, and of even greater concern, 4,6% of all respondents say that as a result of poor communication quality of care suffers and may put patients at risk. 3. Beyond the problems with communication, the Eastern Europe and World groups are united when it comes to IMGs medical professional skills (core medical knowledge, technical skills). Almost one third of the respondents pointed out that they are poorly satisfied with the quality of the professional skills of these IMGs. 4. Only a minority of respondents had concerns about IMGs respect for the autonomy of patients. 5. The solutions to the quality problems identified by the respondents and the interviewees include mandatory increased support and good parenting practices, better opportunities for continuing education and a stronger social and cultural training. To conclude, this study indicates that there are greater variations in the skill mix among internationally trained medical doctors than among their Scandinavian trained colleagues in tertiary health care. About one third of the reports point to more or less impaired quality of care. In 5 per cent of the reports these quality problems are closely linked to patient and colleague (dis)satisfaction. The problems are so grave in these cases that they may affect patient safety. The single most important problem identified in this report is inadequate language and communication skills. Given these results, it is clearly not a problem limited to certain facilities, professions, regions or places of education. Those working closely with foreign-trained physicians do, however, think that it is possible to introduce an educational program that might significantly alleviate the problems identified through this study