Research Offers Hope for Better Treatments of Pediatric Brain Tumors and Brain Cancer

Pediatric brain tumors and brain cancer, while rare, are considered to be the deadliest of all childhood cancers. While the incidence rate may be relatively low, with approximately 3,400 new cases diagnosed annually in the United States, the mortality rate of children with these types of cancers is significantly higher than other childhood cancers and diseases. Roughly one-third of these kids will not survive beyond five years.

However, it is encouraging to note that, as a result of advancements in research and treatment methods, there have been noticeable decreases in overall cancer death rates since the early 1990s, with an estimated 25,000 survivors currently living in the U.S. Although “survivorship” for these kids comes with its own lingering effects, such as cognitive damage, physical challenges and social isolation, the research that is taking place today will hopefully, someday help to minimize these effects, and allow these survivors to live longer, healthier lives.

Hope for the children and families who face this dreadful disease comes from the tireless efforts of many non-profit organizations, research foundations, hospitals and other pediatric medical institutions who are dedicated to finding the cause, and ultimately, the cure for this deadly invader of children. A few of the more notable milestones of late include:

• The creation of a tissue bank consortium, a collaborative initiative involving the Children’s Brain Tumor Foundation and a group of researchers at several leading pediatric oncology hospitals nationwide. The bank will enable researchers to obtain samples of brain tumor tissue that can be characterized, analyzed and used to evaluate treatments. The results can then be documented in a database that can be shared with pediatric cancer facilities across the country.

• The publishing of a landmark study of medulloblastoma*, a type of brain tumor typically found in children. The study team found that the number of mutations in pediatric medulloblastoma tumors is five to ten times fewer than in adult medulloblastoma tumors, which suggests that, compared to adult tumors, pediatric tumors may respond better to drugs that target the genes and pathways altered by mutations that drive cancer progression.

Pediatric brain and spinal cord tumors are difficult to diagnose because their signs and symptoms may mimic those of other disorders, and vary according to the exact location of the tumor. Once a diagnosis is made, successful treatment is also difficult because there are so many different kinds of brain tumors and cancers, and their precise causes are unknown.

Research holds the key to quicker, more accurate diagnoses and subsequently, better treatments. While progress is being made on a number of research platforms, it continues to be challenging for several reasons:

• There are many different kinds of children’s brain and spinal cord tumors, which has stymied research as investigators face the challenges of collecting and analyzing tissue, as well as the ethical issues posed in treating children.

• Because the disease is rare and tissue samples of tumors are small, it takes time to test and validate new treatment options, and there is currently not an adequate database for recording and sharing this information.

• Doctors and researchers are dealing with a growing child’s brain and body, so they must first ensure they avoid harming the child.

• Funds for research and treatment options are limited, due to the relatively low rate of incidence, compared to other childhood cancers and diseases.

As any research investigator would attest, much work has been done, much progress has been made, but it is not enough. It is never enough. The efforts will continue, and the unshakable commitment of so many will stand strong until the statistics dwindle from 3,400 to 0.

10 Hot Tips for Passing the AHA PALS Exam the First Time

Here is a guide to help you improve your chances of passing the AHA – American Heart Association certification exam for PALS – Pediatric Advanced Life Support. If you take the advice given here seriously, you will do very well on the exam. But you must allow yourself plenty of time to learn all of this material – especially if you are new to this.

1. Study and memorize the Zombie Notes study guides

The Zombie notes focus on information from the literature, test questions and the real life everyday situations – information you need to provide safe care during a pediatric emergency. As you read the study guide, try to memorize the medications and their doses. You must memorize and understand the algorithms; the arrhythmias and in which situations the medications and treatments may be required. Memorizing the algorithms and drug doses is the most difficult part. Repeating the information over and over, and even saying it out loud really helps with the memorization. Once the hard part is memorized, you can start using critical thinking in adjusting treatments based on patient symptoms. The Zombie notes helps you study the ‘need to knows’ and it is easy to take with you to study in your spare time.

2. Read and study the AHA-PALS Certification Manual

The American Heart Association (AHA) PALS Certification Manual may be distributed by the instructor. The AHA provider manual comes with a DVD and cards to assist the learner learn and apply their knowledge and skills. The textbook is filled with information of topics around assessing and treatment of critical situations, shock states, airway management, treatments and pharmacological modalities.

3. Understand basic EKGs

Any critically ill patient of any age may have their heart rate and rhythm affected. Trauma, medications, dehydration, and heredity all play a part in a patient’s arrhythmia. It is the practitioner’s role to recognize potential cardiac changes and treat appropriately. Knowing the difference in synchronized and unsynchronized cardioversion (shock) is important. YOU MUST be able to recognize the lethal arrhythmias in the pediatric patient: bradycardia – 4 heart-blocks; ventricular fibrillation; ventricular tachycardia; pulseless electrical activity (PEA); asystole. Other important rhythms to know are: sinus tachycardia; supraventricular tachycardia (SVT).

4. Watch YouTube videos on EKG and other PALS/ACLS topics

The YouTube videos can teach you and remind you of the topics you are studying and clarify any questions you may have had. You can always contact Michele if you have any questions.

5. Take practice tests over and over until you get them all correct

Practice tests can reinforce what you know and help you find the areas you need to focus your studies.

6. Take a BCLS course and be sure you can perform high-quality-CPR at the class

The prerequisite to any American Heart Association Certification Course is the ability to perform BCLS skills. The instructor may ask you for your valid AHA certification card. During the PALS course you will have to perform in practice and testing sessions. Some of the BCLS skills will include: Chest compressions for neonates, infants, small children and large children (including the two-thumb technique); ventilations using a bag-mask-valve (Ambu bag); the AED and appropriate age-group pads.

7. Review all the PALS medications and their doses (oxygen, epinephrine, amiodarone, adenosine, atropine, and procainamide, etc.)

These medications are used throughout the PALS program. Oxygen, fluids, epinephrine and amiodarone are used the most. Infusions that one needs to be familiar with are dopamine, levophed, magnesium, and dobutamine.

8. Read about different diagnosis (dehydration, epiglottitis, croup, septic and cardiogenic shock, trauma, etc.)

Knowing the common diagnosis and the common treatments will ready you for the practice scenarios and testing mega codes.

9. Be prepared to work in a team setting and be able to participate verbally with hands on participation

You may be assigned to a different role in the mega code. You may be practicing skills that your scope of practice does not allow in the work place. The skills allowed in the classroom, allows you to see how we can help each other in an emergency situation. Feel free to speak up when the instructor allows teamwork. Also be prepared to run a mega code as the team leader as well.

10. Participate in class, and ask and answer lots of questions

Speaking up and asking many questions helps you understand and will facilitate your classrooms ask more detailed questions as well.

What Happens During A Routine Physical For Children?

Taking your child for regular routine physicals is crucial, especially during those first few years. These routine physicals, also known as well-child visits, allow your child’s pediatrician to ensure that your child’s growth and development are happening as expected and that there is no cause for concern.

So many times parents worry that their kids do not start walking or talking at around the same time as most other children. Sometimes, this is really no cause for concern as every child starts walking and talking at different times. Sometimes, however, this developmental delay could be due to other factors. If you are worried, you can voice your fears at your child’s next visit to the clinic and the pediatrician may conduct a few additional tests to eliminate any possible problems.

Another reason why routine physicals are so important is that symptoms of some health conditions are not immediately noticeable and may go undiagnosed and untreated for too long. Because a younger child’s organs are not yet fully developed they are particularly vulnerable. At a well-child visit, the pediatrician will be able to identify the early symptoms and start treatment immediately so that the disease does not progress any further.

Here’s what the doctor will do at your child’s next pediatric routine physical.

Measure Vital Signs

The first thing that the pediatrician will do is to check that all vital organs are functioning normally and that there are no aberrations. They will check the pulse rate and blood pressure to detect whether there are no abnormalities related to the heart and the circulatory system.

They will also check the height and weight to determine whether your child is developing normally. Accordingly they may make some recommendations for making a few nutritional changes.

In addition, other checks will be done to ascertain the condition of the lungs.

Palpation

This involves physical touching different body parts to establish the location of the lymph nodes and determine whether they are larger or smaller than they should be. If anything unusual is noticed, they may make a note so they can continue to monitor this aspect during the next visit.

Check Your Child’s Eyes, Nose And Ears

Eye, nose and ear exams are conducted at every visit as they reveal a lot to the doctor. The condition of the eyes can indicate an infection or it may indicate some other type of visual problem. In checking the nose, the pediatrician will look for sign of upper respiratory distress and also for the development of sinuses. An ear exam is done to test the hearing abilities and also to check if there is any discharge from the ear.

Lastly, the doctor will do a complete physical check to ascertain if there are any general health issues.

Some Things to Know About the United States Medical Licensing Examination

Medical students who would like to practice in the U.S. will need to ensure that they are able to pass the United States Medical Licensing Examination (USMLE Step 1 and 2). This examination is sponsored by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) and it can be written on various pre-determined dates during the year.

What it is

All sections of the United States Medical Licensing Examination have been designed to assess a physician’s ability to demonstrate his or her patient-centered skills and to apply all of the concepts, knowledge and principles that form a crucial part of effective and safe patient care. Step 1 and Step 2 of this examination have to be passed in order for the relevant medical examining and licensing authorities to determine whether a student is competent and ready to deal with actual patients and real-life medical scenarios or not.

How Students are evaluated for Step 1

Students will be evaluated by means of a multiple choice question exam that is computer-based. Each section will consist of content pertaining to pathology, physiology, microbiology, pharmacology, anatomy, biochemistry and behavioral sciences. Interdisciplinary areas such as immunology, genetics, nutrition, aging and molecular and cell biology are included in this exam as well. Students will be expected to perform other tasks as well such as identify microscopic pathologic and normal specimens, interpret graphs and tables and/or apply basic scientific knowledge to various clinical problems. The 8 hour exam consists of 322 questions divided into 7 blocks of 46 questions per block.

Evaluation for USMLE Step 2

The USMLE Step 2 consists of 2 parts, namely Clinical Knowledge (CK) and the Clinical Skills (CS). USMLE Step 2 CK assesses a student’s clinical knowledge by means of a 9 hour multiple choice exam. The exam consists of 8 blocks, each with 44 questions and an hour is given for students to complete each block. Subjects covered here include pediatrics, medicine, surgery, psychiatry and obstetrics and gynecology. The CS section assesses a student’s clinical skills by means of simulated interactions with 12 different patients. Students have 15 minutes to perform clinical examination and take notes from each patient, and 10 minutes to note findings and provide diagnoses for each case.

Preparing for these Exams

It is essential for students to get as much study time in as possible when preparing, as this will help ensure that they are ready to pass the exams the first time round. One of the best ways that preparation can be done is by making use of online question banks, as these simulate the actual examinations that will eventually be written. It is normally recommended that students use these question banks for a minimum of 3 to 6 months, so that they can completely familiarize themselves with the type of questions they can expect to encounter during their actual exams.

Once students have achieved a passing mark for each of these examinations, they can look forward to being able to apply their knowledge in real-life medical situations at various hospitals, clinics and other health care facilities around the country.