Altered Folate Homeostasis in Children with Down Syndrome: A Potential Basis for Enhanced Methotrexate Toxicity.

Methotrexate is used to treat autoimmune and oncologic diseases in children with Down syndrome. However, increased methotrexate-related toxicity is reported in this population. We evaluated differences in the concentrations and distribution of erythrocyte folates in children with Down syndrome as a potential basis for this enhanced toxicity.

Estimating Weight in Children With Down Syndrome.

Objective. Significant attention has been paid to weight estimation in settings where scales are impractical or unavailable; however, no studies have evaluated the performance of published weight estimation methods in children with Down syndrome. This study was designed to evaluate the predictive performance of various methods in this population with well-established differences in height and weight for age. Methods. This was a prospective study of children aged 0 to 18 years with Down syndrome. Anthropometric measurements including height, weight, humeral length, and mid-upper arm circumference were collected and applied to 4 distinct weight estimation strategies based on age (APLS), length (Broselow), habitus (Cattermole), and length plus habitus (Mercy). Predictive performance was evaluated by examining residual error (RE), percentage error (PE), root mean square error (RMSE), limits of agreement, and intraclass correlation coefficients. Results. A total of 318 children distributed across age, gender, and body mass index percentile were enrolled. APLS and Mercy showed the smallest degree of bias (PE = 7.8 ± 24.5% and -3.9 ± 12.4%, respectively). Broselow suffered the most extreme underestimation (-63%), whereas the APLS suffered the greatest degree of overestimation (107%). Mercy demonstrated the highest intraclass correlation coefficient (0.987 vs 0.867-0.885) and predicted weight within 20% of actual in the largest proportion of participants (88% vs 40% to 76%). All methods were less robust in children with Down syndrome than reported for unaffected children. Conclusions. Mercy offered the best option for weight estimation in children with Down syndrome. Additional anthropometric data collected in this special population would allow investigators to refine existing weight estimation strategies specifically for these children.

Teaching patient communication skills to medical students: a review of randomized controlled trials.

Tools to examine the effects of teaching interventions across a variety of studies are needed. The authors perform a meta-analysis of 24 randomized controlled trials evaluating the effects of teaching on medical students' patient communication skills. Study quality is rated using a modified Jadad score, and standardized mean difference effect size (d) measures are calculated. Fifteen of 24 studies have sufficient data for analysis. Students' ability to establish rapport improves after teaching. The effects are large when the teaching intervention was small group discussion (n = 5) or giving structured feedback on a student-patient interview (n = 6). A similar effect of teaching is seen on student data gathering skills (n = 5). Teaching medical students patient communication skills using small group discussion or providing feedback on a student-patient interview results in improvement in student performance.