Consensus-based guideline for the supportive anthroposophic therapies to treat children with pseudocroup (stenosing laryngotracheitis).

PURPOSE: Supportive anthroposophic therapies are used to treat children with pseudocroup by pediatricians in outpatient and inpatient settings. Anthroposophic treatment comprises forms of creative therapies, external applications as well as remedies, which production is based on the knowledge of the human being, nature and substances. A scientifically based guideline for these therapies is lacking. Due to insufficient study situation, we developed a consensus-based guideline to make therapy decisions more transparent and facilitate clinical routine. METHODS: An online Delphi process with 67 anthroposophic pediatricians was conducted. Recommendations were accepted when reaching more than 75 % of expert agreement; otherwise, recommendations were revised and assessed by the experts once again. RESULTS: Recommendations for general interventions and for anthroposophic remedies (Bryonia/Spongia comp.; Larynx/Apis comp.) as well as for external applications (embrocation with lavender oil) were developed. Recommendations have a consensus of 96.4 % or more. CONCLUSION: The consensus-based guideline provides practical recommendations for the supportive anthroposophic therapies for pseudocroup. The implementation and practicability of this guideline has to be investigated.

A MYCN-driven de-differentiation profile identifies a subgroup of aggressive retinoblastoma.

Retinoblastoma are childhood eye tumors arising from retinal precursor cells. Two distinct retinoblastoma subtypes with different clinical behavior have been described based on gene expression and methylation profiling. Using consensus clustering of DNA methylation analysis from 61 retinoblastomas, we identify a MYCN-driven cluster of subtype 2 retinoblastomas characterized by DNA hypomethylation and high expression of genes involved in protein synthesis. Subtype 2 retinoblastomas outside the MYCN-driven cluster are characterized by high expression of genes from mesodermal development, including NKX2-5. Knockdown of MYCN expression in retinoblastoma cell models causes growth arrest and reactivates a subtype 1-specific photoreceptor signature. These molecular changes suggest that removing the driving force of MYCN oncogenic activity rescues molecular circuitry driving subtype 1 biology. The MYCN-RB gene signature generated from the cell models better identifies MYCN-driven retinoblastoma than MYCN amplification and can identify cases that may benefit from MYCN-targeted therapy. MYCN drives tumor progression in a molecularly defined retinoblastoma subgroup, and inhibiting MYCN activity could restore a more differentiated and less aggressive tumor biology.

Evaluation of a guideline for supportive anthroposophic therapies for hospitalised children with acute gastroenteritis - A prospective case series study.

OBJECTIVE: Even though several German children's hospitals offer integrative, anthroposophic medical therapies in addition to the standard medical care, guidelines for these anthroposophic therapies are still rare. Therefore, we investigated the feasibility of implementing a published, consensus-based guideline for the treatment of children with acute gastroenteritis (aGE) with anthroposophic therapies in the community hospital Herdecke. DESIGN: A prospective case series of paediatric patients (≤18 years) with an aGE admitted to the department of integrative paediatrics of the community hospital Herdecke was conducted. Demographic, clinical and therapeutic data was recorded at initial presentation and at follow-up visits. Physicians were surveyed with a questionnaire to evaluate feasibility of implementing the guideline. RESULTS: Sixty-two patients (0-15 years; 22 male, 40 female) were included in the case series. All patients received some form of anthroposophic therapy. The most frequently used remedies were Geum urbanum, Nux vomica and Bolus alba comp. Treating physicians showed a high adherence to the expert-based consensus guideline in their prescribed therapies. All physicians stated that they were familiar with the guideline and used the recommendation to inform their therapy decision. Suitability for daily use and effectiveness in treating the main symptoms of aGE were highly scored by the physicians. CONCLUSION: The consensus-based guideline of anthroposophic therapies for aGE in children was successfully implemented and found to be useful for physicians in clinical practice.

Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood.

BACKGROUND: Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. METHODS: 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. RESULTS: Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). CONCLUSION: The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.