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7. Gastroenterology
S47
193 Major differences in pancreatic enzyme replacement in Scandinavia
195 The Stewart Ultrasound Score (SUSS): a new tool for quantitative assessment of CFLD
L. Hjelte1 , H.V. Olesen2 , K. Nilsson1 , I.E. Moen3 , T. Pressler4 , A. Lindblad5 , G. Fluge6 , for the Scandinavian CF Study Consortium. 1 Karolinska University Hospital Huddinge, Stockholm, Sweden; 2 Aarhus University Hospital, Aarhus, Denmark; 3 Ullevaal University Hospital, Oslo, Norway; 4 Rigshospitalet, Copenhagen, Denmark; 5 Goteborg University Hospital, Gothenburg, Sweden; 6 Haukeland University Hospital, Bergen, Norway
L. Stewart1 , H. Alton1 , M. Desai2 , I. van Mourik3 . 1 Radiology, BCH, Birmingham, United Kingdom; 2 Respiratory, BCH, Birmingham, United Kingdom; 3 Hepatology, BCH, Birmingham, United Kingdom
898 (430 F) Scandinavian CF patients took part in a comprehensive study of their nutritional status, 7/8 CF centers participating. Median age was 18.3 (0.3−65.9) y. As part of the study the pancreatic enzyme replacement therapy was investigated. Results: 771 patients were pancreatic insufficient. Enzyme preparations used: low dose (5,500 lipase) 28%, medium dose (10,000 lipase) 51% and high dose (25,000 lipase) 17%. Use of high lipase preparations increased with age and differed markedly between centres (from Copenhagen 0% to Oslo 48%). Units of lipase differed between countries and between children and adults. Median units of lipase/kg BW per principal meal for children (adults) were: Denmark 3077 (2069), Norway 1389 (842), Sweden 1852 (912) (all p < 0.001 except adults in N and S). Patients on proton pump blockers had a higher intake of units of lipase. Boys had a higher lipase intake than girls, though not significant (p = 0.12). There was no correlation between units of lipase/kg BW per principal meal and frequency of DIOS. Preliminary data show reported amount lipase intake to be higher than that registered in the 7-day precoded dietary food record. Conclusions: Danish CF patients had a higher intake of lipase than CF patients in Norway and Sweden but used no high lipase preparations. A subgroup of patients having a large intake of lipase needs to be investigated further. Supported by: Swedish Heart Lung Foundation, Stiftelsen Frimurare-Barnhuset i Stockholm, Norwegian CF Association, Swedish CF Association and an unrestricted grant by Solvay Pharma (Denmark, Sweden and Norway).
194 Pancreatitis in cystic fibrosis patients A. Sojo1 , C. Bouso˜no2 , M.D. Garcia-Novo3 , S. Heredia4 , J. Manzanares5 , F. Baranda6 , C. Vazquez6 . 1 Gastroenterology, Hospital Cruces, Bilbao, Spain; 2 Gastroenterology, HCU, Oviedo, Spain; 3 Gastroenterology, Hospital Ni˜ no Jesus, Madrid, Spain; 4 Gastroenterology, Hospital Miguel Servet, Zaragoza, Spain; 5 Gastronterology, Hospital Doce de Octubre, Madrid, Spain; 6 Pulmonology, Hospital Cruces, Bilbao, Spain Introduction: Patients with Cystic Fibrosis (CF) may develop single or sometimes recurrent bouts of acute pancreatitis and this complication has been mostly reported in adolescents or adults with a pancreatic sufficient (PS) phenotype. In addition patients with idiopathic chronic pancreatitis are often found to carry mild CFTR mutations. Goal: To describe the features of a group of CF patients who had pancreatitis and to investigate its prevalence and possible risk-factors. Patients and Methods: The clinical records of patients with CF under care in 5 CF Units who had a diagnosis of pancreatitis were reviewed and clinical and genetic details are presented. Results: Fifteen out of 485 (3.1%) patients had pancreatitis, 66.7% males, average age 15.04 years. In 3 (20%) pancreatitis preceded the diagnosis of CF. Eight (53.3%) had a single episode, 4 (26.7%) had 2 and 3 (20%) had multiple bouts. Clinical features: Nutrition (Weight >P10 80%, Heigth >P10 73.3%), No & Mild lung disease 73.3%, Pancreatic insufficiency (PI) 53.3%, Nasal polyps & Sinusitis 46.6%, Liver disease 33.3%, Hypochloremic alcalosis 33.3%, Meconium ileus/DIOS 20%, Glucose intolerance 13.3% Genotype: F508del/F508del 3 (All PI), F508del/− 5 (2 PI), F508del/R347H 1 (PS), F508del/G85E 1 (PI), F508del/3272−26A>G 1 (PS), F508del/R334W 1 (PS), L206W/S549R 1 (PS), G542X/2789+5G>A 1 (PI), R347P/− 1 (PI). Conclusions: The prevalence of pancreatitis in this study was 3.1% and over half of the patients had pancretic insufficiency underlying that this complication in not restricted to patients carrying mild mutations.
Introduction: Cystic Fibrosis (CF) is the commonest genetically inherited disease. Abnormal bile composition causes biliary stasis leading to CF liver disease (CFLD) & portal hypertension. Increased longevity means CFLD is now associated with with significant morbidity. Many patients present with established CFLD, when potential therapies eg ursodeoxycholic acid (UDCA) are ineffective. Current diagnostic tests (clinical examination, LFTs) are insufficient for early detection of CFLD. Detailed US scanning may be more sensitive in early detection & prospective evaluation of CFLD. Aims: To describe the use of a new ultrasound (US) scoring system-the Stewart Ultrasound Score (SUSS), in CF children with & without clinical/biochemical evidence of liver disease. Methods: Annual review (prospective & retrospective) of 241 CF children over 2 years: 66 CFnoLD patients (4 m-16 yrs) & 175 CFLD (3 m – 17 yrs).CFnoLD = normal LFTs/clinical examination. Data analysed: abdominal US, LFTs, lung function, height/weight & clinical examination.SUSS evaluation of all US scans was performed. Areas evaluated included liver parenchyma (category A = normal, B = increased echogenicity, C = coarse). Numerical scores (1 = normal, 2 = abnormal)were assigned to hepatic Doppler traces, portal tracts and spleen size amongst others. Score range A5 (normal)–C11 (abnormal). Results: SUSS for CFnoLD and CFLD group at baseline and at 1 year showed that 64% CFLD group had abnormal parenchyma & 42% abnormal scores. In the CFnoLD group this was 19% and 9% respectively, whilst 27% and 74% had mild changes. Conclusion: Early results suggest that SUSS can be used for very early detection of CFLD, even before LD becomes clinically & biochemically evident. It will be helpful in defining the natural history of CFLD.
196 Liver transplantation in children with cystic fibrosis: single centre experience S. Loganathan1 , I. van Mourik1 , J. Clarke2 , D.A. Kelly1 . 1 Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom; 2 Respiratory department, Birmingham Children’s Hospital, Birmingham, United Kingdom Introduction: Advances in medical management have improved life expectancy in patients with cystic fibrosis (CF). With prolonged survival CF associated liver disease (CFLD) is now recognised as a major manifestation of CF with significant morbidity. Liver transplantation (LTx) is effective therapy in patients with CFLD and hepatic dysfunction prior to deterioration of lung function. Aim: To assess the long term outcome of LTx in children with CFLD in our unit. Methods: Retrospective review of all children with CFLD transplanted between 1989– 2006. Data reviewed: demographic details, indications for LTx, diabetic status, survival, renal function [calculated glomerular filtration rate (cGFR) ml/min/1.73m2], lung function and nutritional status. Results: 19 children (12M, 7F) had LTx. Median age at transplant was 11.5 years (2.1−16.5). Indications were progressive liver failure with deteriorating pulmonary function (n = 18)and acute liver failure (n = 1).14/19 are alive. Median follow up is 7.5 years (0.6−15.5). 2/19 had retransplant (1 primary graft failure, 1 chronic rejection after 9 years). 6 were diabetic pre LTx and 6 developed IDDM post LTx. Summary: One and 5 year survival was 95% and 80% respectively, with an overall long term survival rate of 72%.LTx for CFLD does not improve nutritional status, but leads to improvement in lung function during first two years. Conclusion: LTx is effective therapy for CFLD. Time
Pre LTx, n = 19
Post 24 m, n = 17
Post 60 m, n = 11
Weight SDS Median (range) Height SDS Median (range) cGFR Median (range) FEV1 SDS Median (range) FVC SDS Median (range)
−0.6* (−4.2−1.2) −1.3 (−3.0−1.1) 121.7 (77–165) −1.5 (−3.7−0.8) −0.8 (−3.7−1.3)
−0.9 (−4.5−0.6) −1.5 (−4.2−0.6) 77.1 (53–149) −1.1 (−3.8−0.5) −0.4 (−2.8−0.8)
−1.7* (−5.2−0.08) −1.4 (−4.3−0.8) 85.2 (38.0–105)
*p = 0.03, student T-test
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Coaching Standardized Patients


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Author : Peggy Wallace
language : en
Publisher: Springer Publishing Company
Release Date : 2007

Coaching Standardized Patients written by Peggy Wallace and has been published by Springer Publishing Company this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Medical categories.


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Objective Structured Clinical Examinations


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Author : Sondra Zabar
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-19

Objective Structured Clinical Examinations written by Sondra Zabar and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-19 with Medical categories.


Objective structured clinical examinations/exercises (OSCEs) using standardized patients (SPs) are an efficient means of surveying a diverse range of ability at any point along the continuum of medical education. An OSCE station can address multiple competency assessments across undergraduate, graduate, and continuing medical education. Nevertheless, organizing and enacting OSCEs is a major undertaking and, as with most other educational projects, collaborating within and across specialties and disciplines only enriches the process. The production of an effective OSCE program requires strong leaders committed to the benefits of such assessments, as well as many individuals to plan, prepare, and implement the program. To address the need for general guidelines of best practice and consistent organizational stratagem, Objective Structured Clinicl Exams is a comprehensive how-to manual for OSCE implementation. It contains an overview of and criteria for best practice, a review of relevant literature, insight into the program’s influence throughout the healthcare system, and techniques for fine-tuning existing programs. Accompanying charts, graphs and sample forms are included to make this book the single resource for any educator interested in creating or improving a standardized patient program.

Comprehensive Healthcare Simulation Implementing Best Practices In Standardized Patient Methodology


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Author : Gayle Gliva-McConvey
language : en
Publisher: Springer Nature
Release Date : 2020-10-15

Comprehensive Healthcare Simulation Implementing Best Practices In Standardized Patient Methodology written by Gayle Gliva-McConvey and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-10-15 with Medical categories.


This book brings to life best practices of Human Simulation; maximizing the Standardized Patient (SP) methodology that has played a major role in health professions learning and assessment since the 1960s. Each chapter reflects the Association of SP Educators Standards of Best Practices (SOBPs) and provides guidance for implementation. Multiple insights are offered through embedded interviews with international experts to provide examples illustrating successful strategies. The Human Simulation Continuum Model, a practical and theoretical framework, is introduced to guide educators in decision-making processes associated with the full range of human simulation. The Continuum Model spans improvisations, structured role-play, embedded participants, and simulated-standardized patients. This book also provides the full “how-to” for SP methodology covering topics including; case/scenario development, creating training material, training techniques for case portrayal, training communication and feedback skills, GTA/MUTA/PTA training, SP program administration and professional development for SP Educators. A pragmatic, user-friendly addition to the Comprehensive Healthcare Simulation series, Implementing Best Practices in Standardized Patient Methodology is the first book framed by the ASPE SOBPs, embracing best practices in human simulation and marshaling the vast expertise of a myriad of SP Educators.

The Simulated Patient Handbook


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Author : Fiona Dudley
language : en
Publisher: CRC Press
Release Date : 2018-12-12

The Simulated Patient Handbook written by Fiona Dudley and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-12-12 with Medical categories.


A simulated patient is an individual who, by pretending to be a patient in a consultation, offers health professionals an opportunity to learn, explore and develop their expertise. Simulated patients are also highly effective when used as an aid for consultation skills assessment. In recent years the rapid rise of simulated patients in healthcare training has led to many more people working as and with simulated patients. There is now a growing need for guidance on its benefits and also its potential complications. The Simulated Patient Handbook is full of practical, hands-on advice and procedures for simulated patients covering all aspects of their work. It includes comprehensive guidelines on the essential skills of characterisation and the giving of feedback. This is the only manual currently available for simulated patients to learn best practice. The wide-ranging, accessible reference also offers concise, realistic advice to facilitators about setting up, running and participating in sessions using simulated patients - using this extroadinary educational resource to its greatest advantage.

Comprehensive Healthcare Simulation Obstetrics And Gynecology


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Author : Shad Deering
language : en
Publisher: Springer
Release Date : 2018-12-31

Comprehensive Healthcare Simulation Obstetrics And Gynecology written by Shad Deering and has been published by Springer this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-12-31 with Medical categories.


This practical volume presents an overview for the use of simulation in obstetrics and gynecology. Chapters provide an introduction to simulation for OBGYN, simulation modalities and technologies, minimally invasive surgery, invasive obstetric procedures, simulation for global health, and the future of simulation for obstetrics and gynecology. Written and edited by leaders in the field, Comprehensive Healthcare Simulation: Obstetrics and Gynecology offers a variety of learners, including medical students, residents, practicing pediatricians, and health-related professionals, a comprehensive and easy-to-read guide on the use of simulation. This book is part of the Comprehensive Healthcare Simulation Series which provides focused volumes on the use of simulation in a single specialty or on a specific simulation topic and emphasizes practical considerations and guidance.

Training Standardized Patients To Have Physical Findings


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Author : Howard S. Barrows
language : en
Publisher:
Release Date : 1999-07-01
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Training Standardized Patients To Have Physical Findings written by Howard S. Barrows and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999-07-01 with Medicine categories.


Virtual Reality For Psychological And Neurocognitive Interventions


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Author : Albert 'Skip' Rizzo
language : en

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Publisher: Springer Nature
Release Date : 2019-08-24

Virtual Reality For Psychological And Neurocognitive Interventions written by Albert 'Skip' Rizzo and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-08-24 with Medical categories.


This exciting collection tours virtual reality in both its current therapeutic forms and its potential to transform a wide range of medical and mental health-related fields. Extensive findings track the contributions of VR devices, systems, and methods to accurate assessment, evidence-based and client-centered treatment methods, and—as described in a stimulating discussion of virtual patient technologies—innovative clinical training. Immersive digital technologies are shown enhancing opportunities for patients to react to situations, therapists to process patients’ physiological responses, and scientists to have greater control over test conditions and access to results. Expert coverage details leading-edge applications of VR across a broad spectrum of psychological and neurocognitive conditions, including: Treating anxiety disorders and PTSD. Treating developmental and learning disorders, including Autism Spectrum Disorder, Assessment of and rehabilitation from stroke and traumatic brain injuries. Assessment and treatment of substance abuse. Assessment of deviant sexual interests. Treating obsessive-compulsive and related disorders. Augmenting learning skills for blind persons. Readable and relevant, Virtual Reality for Psychological and Neurocognitive Interventions is an essential idea book for neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists. Researchers across the behavioral and social sciences will find it a roadmap toward new and emerging areas of study.