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

Szegénység és projektvilág

A rendszerváltás óta erősödik az ország területi és társadalmi polarizációja, és makacs következetességgel termelődnek újra a tartós szegénységet tápláló, fenntartó strukturális okok. Tanulmányunkban arra keressük a választ, hogy a szegénység mérséklését célul kitűző, hazai és uniós forrásokat felhasználó programok képesek - e, s ha igen, milyen mértékben és feltételek mellett mérsékelni a szegénységet, a szegénység újratermelődésének esélyeit. Következtetéseink öt különböző vidéki – közöttük két alföldi – térségben végzett empirikus kutatásunkra épülnek

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

A five year longitudinal study investigating the prevalence of childhood obesity: comparison of BMI and waist circumference.

Objective: The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR). Study design: Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years. Methods: WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children. Results: Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%). Conclusion: Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls

Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian childhood obesity treatment trial (MASCOT)

Context. Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world. Aim. To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia. Methods. Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days). Results. The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p < 0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group. Conclusions. Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes

Kraftig anemi hos tax

The Clinical Pathology Laboratory at SLU in Uppsala has analysed several blood samples from Dachshunds with severe anemia. As there are no previous studies on this topic, a study was performed to evaluate if Dachshunds are more prone to severe anemia compared with other breeds. In addition, a retrospective case study on Dachshunds with severe anemia was done to search for common risk factors or diseases. Hemoglobin values in samples from 1272 Dachshunds and 2269 German Shepherds analyzed from September 1994 to October 2007 were used to compare the frequency of severe anemia in Dachshund and German shepherd. The samples were identified by laboratory information system. It was more common with severe anemia in Dachshunds compared with German Shepard dogs (G-test, p< 0,0001). In the retrospective case study fifteen Dachshunds with severe anemia (Hb < 63,5g/L or EVF < 19 %) were included. The records were studied with concern to gender, age, anamnestic data, symptoms, laboratory results, treatment and diagnosis. The average age of the Dachshunds was 7,5 years. Nine of the dogs were female and six were male. Eight of the Dachshunds had regenerative anemia and seven had non-regenerative anemia. The span of diseases or conditions causing severe anemia in the individual cases was very wide. The diseases found in the fifteen Dachshunds was immunomediated hemolytic anemia (3 cases), hemolysis caused by snake bites, hemorrhage caused by whelping, chronic renal failure, neoplastic conditions causing bone marrow suppression (4 cases) and side effects from cytotoxic drugs. Five of the dogs in the study survived, one died and nine were euthanized. In conclusion, an increased frequency of Dachshunds with severe anemia in comparison to German shepherds was observed. No specific risk factors or diseases could be identified in this study.På klinisk kemiska laboratoriet vid SLU i Uppsala tycker man sig ha haft förhållandevis många blodprover från taxar med kraftig anemi. Eftersom det inte finns några tidigare studier inom området gjordes denna undersökning för att utvärdera om taxar drabbas av kraftig anemi i större utsträckning än andra hundar. Avsikten med studien var dessutom att utvärdera om det finns några gemensamma riskfaktorer eller bakomliggande sjukdomar hos taxar med kraftig anemi. Hemoglobinvärden från 1272 taxar och 2269 schäfrar analyserade mellan 1994-09-01 och 2007-09-30 användes för att jämföra frekvensen av kraftig anemi mellan tax och schäfer. Proverna identifierades via klinisk kemiska laboratoriets datasystem. Det var signifikant fler taxar som hade kraftig anemi jämfört med schäfer (p<0,001 med G-test). Journaler från femton taxar med kraftig anemi (Hb <63,5 g/L eller EVF <19 L/L) ingick i den retrospektiva fallstudien. Journalerna studerades avseende kön, ålder, anamnestiska uppgifter, symptom, laboratoriedata, behandling samt diagnos. Medelåldern på taxarna var 7,5 år. Nio av hundarna var tikar och sex var hanhundar. Femtiotre procent av taxarna hade regenerativ anemi och fyrtiosju procent hade icke regenerativ anemi. Panoramat av sjukdomar eller tillstånd, som givit upphov till kraftig anemi hos de enskilda fallen var mycket brett. De grundorsaker till kraftig anemi som sågs i studien var immunmedierad hemolytisk anemi (3 st), hemolys i samband med ett ormbett, blodförlust i samband med en valpning, kronisk njursvikt, neoplastiska tillstånd som orsakat benmärgssuppression (4 st) samt biverkning efter cytostatikabehandling. I fyra av fallen fanns ingen verifierad diagnos. Fem av hundarna i studien överlevde, en självdog och nio hundar avlivades. Sammanfattningsvis sågs en tydligt ökad frekvens av taxar med kraftig anemi jämfört med schäfer. Inga specifika riskfaktorer eller bakomliggande sjukdomar hos taxar med kraftig anemi kunde identifieras i denna studie

Bekämpning av extremism i demokratins försvar : En kritisk diskursanalys om framställningen av våldsbejakande extremism i socialarbetares utbildningsmaterial

The aim of this study was to examine social workers educational material about violent extremism. This included investigating how violent extremism and risk behaviors are produced and how they can be interpreted by social workers. In many ways extremism and democracy can be regarded as contradictory to each other. Therefore an important part of the preventive work aims to protect the democracy against external threats and supporting the democratization of future citizens. However, there is a problematic delimitation and a risk of distinguishing extremism from peaceful activism. A risk that allows innocent individuals to be suspected as well as their constitutional rights are jeopardized. A critical discourse analysis was carried out, as defined by Norman Fairclough. The results showed a disproportionate focus on the various extremist environments with portrayal of the white power environment and Islamist extremism as more violent and dangerous than the autonomous environment. Further results showed a general uncertainty in the material of what signals the risk of extremism and when a professional should act or remain passive. Finally the analysis confirmed the previously identified security policy discourse. The discourse clarifies the increased responsibility of street-level bureaucrats and professionals to monitor control and report on suspicion of radicalization. An intervention associated with the risk of being counterproductive in relation to democracy and human faith in both authorities and the democratic order

Samhällsvåld och moral hos unga vuxna

Nyligen utgivna rapporter visar att våldet i det svenska samhället ökar, vilket leder till en rad konsekvenser för både samhälle och individ. Tidigare psykologisk forskning pekar på att hög exponering för samhällsvåld har en negativ inverkan på individers kognitiva funktioner och moral. Syftet med denna uppsats var därför att undersöka relationen mellan exponering för samhällsvåld och individens benägenhet att använda moralfrånkopplingtekniker. En enkätundersökning utfördes på myndiga elever vid gymnasieskolor i Skåne och resultatet visade att individer med hög exponering för samhällsvåld uppvisade en ökad benägenhet att använda moralfrånkopplingstekniker. Vidare visade studien att denna ökade benägenhet att använda moralfrånkopplingstekniker hos respondenter med hög rapporterad exponering för samhällsvåld endast gällde tre specifika tekniker; moraliskt rättfärdigande, förskönande omskrivning samt dehumanisering

Pediatric Obesity: Looking into Treatment

Prevalence of pediatric obesity continues to rise worldwide. Increasing the number of health care practitioners as well as pediatricians with expertise in obesity treatment is necessary. Because many obese patients suffer obesity-associated cardiovascular, metabolic and other health complications that could increase the severity of obesity, it is fundamental not only to identify the child prone to obesity as early as possible, but to recognize, treat and monitor obesity-related diseases during adolescence. This short review outlines the treatment of pediatric obesity that may have applications in the primary care setting. It examines current information on eating behavior, sedentary behavior, and details studies of multidisciplinary, behavior-based, obesity treatment programs. We also report the less common and more aggressive forms of treatment, such as medication and bariatric surgery. We emphasize that health care providers have the potential to improve outcomes by performing early identification, helping families create the best possible home environment, and by providing structured guidance to obese children and their families

A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

OBJECTIVE: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. METHODS: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child\u27s lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. RESULTS: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the \u27Reduction of TV advertising of high fat and/or high sugar foods and drinks to children\u27, \u27Laparoscopic adjustable gastric banding\u27 and the \u27multi-faceted school-based programme with an active physical education component\u27 interventions. CONCLUSIONS: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions