Day 2 :
New York University School of Medicine, USA
Keynote: Pediatric Cochlear Implantation
Time : 09:05-09:45
Susan B. Waltzman, PhD is the Marica F. Vilcek Professor of Otolaryngology and Co-Director of the NYU Cochlear Implant Center. Her research is focused on two main areas: outcomes with cochlear and brainstem implants and isolating the variables which affect performance including the impact of new technology on outcomes in children, adolescents, older adults and special populations. The most current research at the cochlear implant center focuses on the treatment of those with single-sided deafness, residual hearing and children with compromised auditory nerves. She has been the PI on numerous device-related clinical trials over the past 20 years, the most current trial being the use of auditory brainstem implants in children with compromised auditory nerves. Dr. Waltzman is the author of more than 110 peer-reviewed articles, numerous book chapters and in 2014, the third edition of a textbook with Dr. J. Thomas Roland titled Cochlear Implants. She also has been invited as a Visiting Professor at many institutions world-wide and is a frequent contributor and invited speaker at national and international conferences.
As a result of newborn hearing screening and improved evaluation tools, many children with severe-to-profound hearing loss are being diagnosed as infants, which affords the opportunity to provide these children access to cochlear implantation although medical challenges must be addressed. The purpose of this presentation if to review all aspects of pediatric cochlear implantation including safety and efficacy in very young children. Anesthesia risks, blood volume, skull size and thickness, skull growth and device positon will be discussed in addition to candidacy and variable affecting outcome in various pediatric age groups.
Erasmus University Medical Centre, Rotterdam and University of Amsterdam
Keynote: Eye Movement Desensitization and Reprocessing (EMDR) in children with unprocessed medical related trauma. A randomized controlled intervention study
Time : 09:45-10:15
Utens serves as the chairperson of the National Network of Paediatric Psychology (Pediatrische Psychologie-NL) and is a member of the Steering committee of the Psychosocial Working Group of the European Association of Paediatric Cardiology. Utens has funded her research from the numerous external grants she has acquired. Under her supervision, eight PhD candidates have now completed their doctoral thesis on her line of research. Utens has authored numerous international articles which have been published in authoritative academic journals, including the European Heart Journal, International Journal of Cardiology, etc.
Utens studies psychosocial outcomes, particularly anxiety, depression and post-traumatic stress, in children with a physical disorder (such as congenital heart disease, inflammatory bowel disease, cystic fibrosis and HIV) as well as the influence of anaesthesia and psychological preparation of children for surgery. Her research includes examining which factors predict these psychosocial outcomes in the long term. She has carried out both cross-sectional and longitudinal patient-related studies and in recent years has focused primarily on intervention studies, including the effectiveness of cognitive behavioural therapy on anxiety and depression in adolescents with inflammatory bowel diseases, and the effects of sports activities on emotional problems in adolescents with congenital heart disease.
Background. About 3 in every 10 children and adolescents admitted to a hospital or undergoing invasive and/or painful surgery, develop increased (subclinical) symptoms of PTSS. In addition, about 1 in 10 children even develop a post-traumatic stress disorder (PTSS). Unfortunately, symptoms of unprocessed medical trauma are still poorly recognized. From research it is known that if elevated PTSS symptoms in children are left untreated, this can have a serious impact on their quality of life, psychosocial functioning and can result lead to long term psychiatric complaints. In the Dutch multidisciplinary guidelines for mental health institutions , trauma-focused cognitive behavioral therapy and EMDR are recommended for treating posttraumatic stress complaints. Many psychologists already use EMDR successfully in their daily clinical practice. EMDR works faster, requires less treatment sessions, is considered less stressful for the patient and therefore fits well in the psychosocial care given in a children's hospital. Remarkably, the effectiveness of EMDR in medical untreated trauma in children has not previously been systematically investigated. In the Erasmus-MC Sophia Children's Hospital, Rotterdam, a randomized controlled trial (RCT) is being conducted into the effectiveness of EMDR in children / adolescents with a medical related trauma. Design. A randomized, controlled intervention study (RCT). Method. Included are children / adolescents aged 4 to 16 who have undergone a one-time (trauma type 1) or repeated (trauma type 2) hospital admission / medical treatment up to 5 years ago. Participating children are screened for increased PTSS symptoms (partial PTSS). All children with partial PTSS are then randomly assigned to: 1) standardized EMDR or 2) care as usual (CAU = medical care only). Results. The data collection will last from July 2016 to February 2018. During the period from July 2016 to April 2017, 116 participants completed the pre-measurement. Of these, 67% were symptom-free, 28% had subclinical symptoms and 5% had PTSS. The first results of the complete screening assessment will be presented and discussed during the conference. Discussion. The vast majority of children undergoing hospitalization or surgery are not structurally screened for PTSS complaints and do not receive structurally psychological assistance. If EMDR proves effective, this will be implemented structurally in Erasmus MC Sophia. A good network between medical specialists and cognitive behavioral psychotherapists is necessary for optimal psychosocial care.
Time : 10:35 - 11:15
Dr Igor Klepikov is a retired MD PhD Professor
Treatment of acute pneumonia(АР) in recent decades focused solely on antibiotic therapy,does not include pathogenetic,specific methods of assistance and repeats the principles of treatment of other inflammatory diseases.Reducing the effectiveness of antimicrobial drugs,the emergence and the increasing number of antibiotic-resistant pathogens and a gradual increase in the frequency of purulent complications attach importance and urgency to the solution of this problem.The first step in this decision is a revision of ideas about the nature and mechanisms of АP.This work has been done and tested in a clinical setting in the years 1976-1984 in Novokuznetsk State Institute for postgraduate doctors(USSR,Russia).The basis of the new doctrine АP was based on the following scientific medical axioms,already having previous scientific justification.1. The body's response to any stimulus, including the initiation of inflammation,is highly individual and unique.2.The basis for the inflammatory transformation of the body tissue is a vascular reaction with a specific stage sequence.3.Small and big circles of blood circulation not only have a direct relationship,but an inverse relationship.4.Among the nonspecific forms of inflammation AP is the only process occurring in the system of lesser circulation.5.The same medical procedure can have different effects on inflammation in the small or big circles of blood circulation.Following private studies were additionally performed:1.Experimental model of AP(4 series of experiments, 44 animals) obtaining a model of pleural complications(certificate for invention No 1631574, A1,1 November 1990,USSR. ).2.X-ray examination 56 lung anatomical preparations with different forms of the AP,taken from the dead patients.3.Record comparative rheopulmonography before and after performing medical procedures(36 patients).4.Analysis of the observation and treatment of 994 children with AP and its various destructive and pleural complications. The revised treatment guidelines were applied in 101 patients in the initial period of aggressive forms of АP.The received results allow to speak about possibility of the guaranteed prevention of suppurative and destructive complications of the disease.
Penn State Hershey College of Medicine
Keynote: Expanding access to education opportunities for pediatricians seeing children with mental health disorders
Time : 11:15- 11:55
Dr. Petrovic-Dovat is a Director of the Child and Adolescent Anxiety Disorder Program at the Penn State Hershey College of medicine. She is the Associate Director of Pediatric Behavioral Health Collaborative Care Program and the Associate Site Director for Child Services. Dr. Petrovic’s clinical and research interests include anxiety disorders and depression. She actively collaborates with the Department of Pediatrics at the clinical and research level and is involved in the clinical care, as well as resident and medical student’s education.
Only about 25 % of children with mental illness are seen by a child psychiatrist. Pediatricians are often the first line of care for the majority of children with mental and behavioral health issues. However few primary care providers report confidence in their ability to successfully manage mental illness. Additional educational support is needed to help primary care providers in treating children with the mental health issues. Our group administered survey in 2014 to pediatricians to identify if there is interest in additional education opportunities that can fit the busy pediatrician’s schedule. Primary care providers were administered the investigator-designed online survey that was hosted by the secure web application REDCap (Research Electronic Data Capture). Participation was anonymous and voluntary. Of the Total N = 83 providers sent a survey, n = 28 (33%) responded. The topic the majority primary providers wanted to address in lectures were case management and medication treatment. Most providers reported having difficulties in coordinating services and expressed interest in lectures. We attempted to address these topic in the live lectures at the clinical site. However, after implementation of the initial round of live short lectures on selected topics at the clinical site, it became apparent that busy pediatrician’s schedule was resulting in low lecture attendance. Penn State Hershey Division of the Child and Adolescent Psychiatry decided to develop education web series, addressing symptoms, diagnosis of the most common mental health disorder, including the warning signs for self-harm. Our group has experience with this type of educational activity on the smaller scale. We have participated as the speakers in a Webinar on the mental health topic targeting school nurses across the Commonwealth of Pennsylvania that was the part of the Penn State Hershey PRO Wellness Center and the Highmark Foundation webinars. It was well received. The first challenges was to identify: the level of interest, topics, and possible modes of delivery for this supplemental professional development. The new “needs analysis” survey was conducted in 2017 .This time survey was sent to pediatricians who worked at our pilot site and 60.53% responded. Participation was anonymous and voluntary and the responses demonstrated a significant level of interest in the idea for lecture type mode of delivery. This time, 87 % responded that they are interested in the lecture delivered online as a webcast training, with a majority expressing a wish for online lectures to be no longer than 30 minutes, which should target specific topics and case studies, and which they could access at their own time and as needed. The Division of the Child and adolescent Psychiatry at our institution made a decision to design, record and offer Open Educational Resources in a format of web series, addressing symptoms diagnosis of the most common mental health disorder, Depression, Anxiety, Autism Spectrum Disorder, Behavior Problems, School Psychiatry and Attention Deficit Hyperactivity Disorder. Speaker with expertise in each area agreed to record lectures. Initial lecture on the topic of Depression and Suicide prevention is available as no-cost, pre-recorded Webcast psycho educational opportunity for pediatricians at our institution on the website dedicated to pediatricians and also child advocate website available to the public. Within few weeks public link had over 500 visits and we will continue to monitor the interest. This education opportunity might also benefit providers and families who live in areas with a shortage of behavioral health specialists by providing no cost short lecture series through school or other organization.
Jordan University of Science and Technology
Time : 11:55- 12:35
Eyad Altamimi is an Associate Professor of Pediatrics at the Faculty of Medicine at Jordan University of Science and Technology. He had his pediatric gastroenterology training at McMaster University, Hamilton, Canada. Dr. Altamimi published many papers on gastrointestinal issues in Jordanian children. His research focused on epidemiology of pediatric gastrointestinal and nutritional disorders in Jordan
Obesity defined as abnormal or excessive fat accumulation in the body exhibiting health risk. It represents the most serious public health challenge facing health authorities worldwide. Children are not spared; on the contrary, childhood obesity is on the rise. Direct body fat percentage estimation is very difficult. Body Mass Index (BMI) is an acceptable marker, where the ratio of the weight to the height is measured. Although BMI can indicate weight problem, it does not differentiate between fat or lean mass. Coupling BMI with other adiposity assessment tool in children like skinfold thickness might improve the precision of BMI. Obesity is a chronic disorder. Obese children are at increased risk of being obese adults. Obesity can adversely affect almost every organ in the body. Liver and gallbladder involvement are the main gastrointestinal diseases. Obesity represents the greatest risk factor for pediatric Non-Alcoholic Fatty Liver Disease (NAFLD). It is already demonstrated that positive correlation exists between abdominal fat and NAFLD. NAFLD is the most common cause of elevated liver enzymes in children. It might progress into liver cirrhosis and even hepatocellular carcinoma. Prevention of obesity and early intervention through gradual and sustained weight loss are the main strategies to prevent such deleterious complications.