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0023—Growth Hormone Treatment of a Child with Growth Hormone Deficiency, Type I Diabetes, and Chronic Steroid Use
INFORMATIONAL to provide an increased number of qualified care extenders in the area of pediatric endocrinology. To quantify the magnitude of this shortage and to receive input regarding the design of an appropriate educational program, we have designed a survey for those organizations with interest in pediatric endocrinology. The survey will be available online to members of these professional organizations (LWPES, AACE, and PENS) by the end of 2005. Two different survey tools have been designed to ascertain both physician and nursing perceptions and expectations of such a program. The results will be analyzed by practice setting and by current practice role. In addition, we will determine the interest in and expected outcomes for a specialty educational program for advance practice providers. Based on results, we will plan, implement, and evaluate the proposed curriculum. Careful attention will be given to the inclusion of evidence-based practice guidelines. At the same time, the use of the most current informatics tools available will be integrated into learning activities. These factors, coupled with the excellent reputation of our academic institution, will assist in the process of improving standards of current education for the advanced practice nurse.
0022 – Knowledge Deficit of Skilled Endocrine Nurses Who Perform Fasting Studies: Report of an Intensive Educational Intervention. Cheryl McLean, Laura Ann Wanner, Children’s Hospital of Philadelphia, Philadelphia, PA Performing an inpatient fasting test presents challenges to an experienced nurse. Children who present with persistent hypoglycemia must be evaluated by a fasting test. A fasting test is a series of operations requiring critical decision-making skills to ensure that a correct diagnosis is established. Examples of hypoglycemic disorders that require a fasting test for diagnosis include hyperinsulinism, growth hormone deficiency, fatty acid oxidation disorder, and glycogen storage disease. The endocrine inpatient unit at the Children’s Hospital of Philadelphia performs two to four fasting tests per week. Through practical experience, the nursing staff of the endocrine inpatient unit have become skilled in performing fasting tests. An educational intervention was implemented to further educate this trained group of nurses about the fasting test process. A written examination was obtained prior to and after the educational intervention. Thirty-eight nurses participated in the educational intervention. This group scored an average of 55% accuracy on the pretest. After the 1-hr intensive educational training, scores on the posttest rose to 83%. Surprisingly,
241 these results reveal that this experienced group of nurses demonstrated significant knowledge deficit. Further formal educational training about the fasting test process is thus necessary even for knowledgeable nurses.
0023 – Growth Hormone Treatment of a Child with Growth Hormone Deficiency, Type I Diabetes, and Chronic Steroid Use. Elizabeth Pries, Laura Garrity, Nicole Kays, Denise McDaniel, Division of Endocrinology, Children’s Memorial Hospital, Chicago, IL
P.K. is 14 years 4 months old, has had severe steroid-dependent asthma since infancy, and was diagnosed with type I diabetes at the age of 3 years. He has been hospitalized numerous times for his asthma, or diabetes, or both conditions. A review of our hospital records notes at least 35 admissions (not counting ER visits) in the past 4 years, with at least one to two intensive care unit interventions yearly. His growth has been consistently under the 5th percentile since he was 5 years old, which is attributed to his suboptimal diabetes control (glycosylated hemoglobin [HgA1C], 8.5 – 9%; normal, b5.8%) and frequent high-dose prednisone therapy administered orally. In 2000, his short stature became a major issue with P.K. and his family, and they requested a workup and possible therapy. Growth hormone (GH) testing was delayed because of numerous hospitalizations, but it was completed in 2005. He is GH-deficient and recently started GH therapy. Impacting on this plan is his chronic steroid therapy (maintenance dose of prednisone, 20 mg, every other day) and type I diabetes. There is literature noting the benefits of GH therapy in children with juvenile rheumatoid arthritis who are on chronic steroid therapy; not only has their growth velocity increased, but they also had an increase in lean body mass. It has also been documented that large pharmacological steroid doses given chronically negatively affected the release and effects of GH. His endocrinologist prescribed GH at 0.3 mg/kg/day; it is to be given on days P.K. receives more than 20 mg of prednisone due to asthma exacerbation. Few data addressing the effects of GH therapy on type I diabetes are available. Due to increased GH levels from the therapy, it is predicted that he will have increased insulin needs because of decreased insulin sensitivity and insulin resistance. His insulin needs have increased from 0.98 to 1.6U/kg, with consistent HgA1C, after the first 6 weeks of GH therapy. This case study will monitor P.K. through his first months on GH therapy, its impact on his diabetes, and his response to GH therapy.
0022 – Knowledge Deficit of Skilled Endocrine Nurses Who Perform Fasting Studies: Report of an Intensive Educational Intervention. Cheryl McLean, Laura Ann Wanner, Children’s Hospital of Philadelphia, Philadelphia, PA Performing an inpatient fasting test presents challenges to an experienced nurse. Children who present with persistent hypoglycemia must be evaluated by a fasting test. A fasting test is a series of operations requiring critical decision-making skills to ensure that a correct diagnosis is established. Examples of hypoglycemic disorders that require a fasting test for diagnosis include hyperinsulinism, growth hormone deficiency, fatty acid oxidation disorder, and glycogen storage disease. The endocrine inpatient unit at the Children’s Hospital of Philadelphia performs two to four fasting tests per week. Through practical experience, the nursing staff of the endocrine inpatient unit have become skilled in performing fasting tests. An educational intervention was implemented to further educate this trained group of nurses about the fasting test process. A written examination was obtained prior to and after the educational intervention. Thirty-eight nurses participated in the educational intervention. This group scored an average of 55% accuracy on the pretest. After the 1-hr intensive educational training, scores on the posttest rose to 83%. Surprisingly,
241 these results reveal that this experienced group of nurses demonstrated significant knowledge deficit. Further formal educational training about the fasting test process is thus necessary even for knowledgeable nurses.
0023 – Growth Hormone Treatment of a Child with Growth Hormone Deficiency, Type I Diabetes, and Chronic Steroid Use. Elizabeth Pries, Laura Garrity, Nicole Kays, Denise McDaniel, Division of Endocrinology, Children’s Memorial Hospital, Chicago, IL
P.K. is 14 years 4 months old, has had severe steroid-dependent asthma since infancy, and was diagnosed with type I diabetes at the age of 3 years. He has been hospitalized numerous times for his asthma, or diabetes, or both conditions. A review of our hospital records notes at least 35 admissions (not counting ER visits) in the past 4 years, with at least one to two intensive care unit interventions yearly. His growth has been consistently under the 5th percentile since he was 5 years old, which is attributed to his suboptimal diabetes control (glycosylated hemoglobin [HgA1C], 8.5 – 9%; normal, b5.8%) and frequent high-dose prednisone therapy administered orally. In 2000, his short stature became a major issue with P.K. and his family, and they requested a workup and possible therapy. Growth hormone (GH) testing was delayed because of numerous hospitalizations, but it was completed in 2005. He is GH-deficient and recently started GH therapy. Impacting on this plan is his chronic steroid therapy (maintenance dose of prednisone, 20 mg, every other day) and type I diabetes. There is literature noting the benefits of GH therapy in children with juvenile rheumatoid arthritis who are on chronic steroid therapy; not only has their growth velocity increased, but they also had an increase in lean body mass. It has also been documented that large pharmacological steroid doses given chronically negatively affected the release and effects of GH. His endocrinologist prescribed GH at 0.3 mg/kg/day; it is to be given on days P.K. receives more than 20 mg of prednisone due to asthma exacerbation. Few data addressing the effects of GH therapy on type I diabetes are available. Due to increased GH levels from the therapy, it is predicted that he will have increased insulin needs because of decreased insulin sensitivity and insulin resistance. His insulin needs have increased from 0.98 to 1.6U/kg, with consistent HgA1C, after the first 6 weeks of GH therapy. This case study will monitor P.K. through his first months on GH therapy, its impact on his diabetes, and his response to GH therapy.