Educational visit to SCMC

Visit to Schneider Children's Medical Center of Israel

Main applicant
Iva Hojsak, MD, PhD

Visiting organization
Institute of Gastroenterology, Nutrition, and Liver Disease,
Schneider Children's medical center of Israel, Israel
Mentor: Professor Raanan Shamir, MD

Administering organization
Children's Hospital Zagreb, Zagreb, Croatia
Head of the hospital: Professor Goran Roić, MD, PhD
Mentor: Professor Sanja Kolaček, MD, PhD

Project supported by
1. Unity through Knowledge Fund, Ministry of Science, Education and Sports
Republic of Croatia (Programme 2A Project Grant)

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2. European Society for Pediatric Gastroenterology, Hepatology and Nutrition

Project duration
6 months (January 2010 - July 2010)

Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb is leading Croatian center for treating children with severe gastrointestinal diseases. That was accomplished by constant learning and education of the staff at leading European facilities in pediatric gastroenterology. My future work as a pediatric gastroenterologist includes parenteral and enteral nutrition, treatment of chronic diarrhea, inflammatory bowel disease and intestinal failure as a part of the Nutritional Care Team. Gaining experience and learning new therapeutical and diagnostic modalities includes the visit of the leading facilities in pediatric gastroenterology such as Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's medical center of Israel. This center is recognized as one of the leading facilities in the development of innovative approaches that improve patient care and enhance research in pediatric gastroenterology and nutrition. A unique set of patients with short bowel syndrome, dependence on total parenteral nutrition, and advanced intestinal failure is treated in this facility, which is a great opportunity to learn treatment and management of such patients especially prior and after intestinal transplantation. Institute of Gastroenterology, Nutrition, and Liver Disease at Schneider Children's medical center of Israel provides diagnosis and treatment of different gastrointestinal and nutritional disorders such as liver disease, malabsorption, intestinal disease, inflammatory bowel disease (Crohn's, ulcerative colitis), nutrition evaluation and counseling, hyperlipidemia, chronic diarrhea, liver and intestinal transplantation, GI hemorrhaging. The Institute also actively conducts research studies in the field of pediatric gastroenterology and nutrition, trains students and doctors and has been accredited for many years for fellowship training in pediatric gastroenterology and nutrition.

1. Gaining better knowledge and understanding the management of severe intestinal diseases, especially caring for patients after intestinal and multivisceral transplantation. This would include: total parenteral nutrition, selection of patients for transplantations and postoperative support.
2. Incorporation of new techniques and treatment of the most severe intestinal diseases in pediatric patients in our Center.

During my stay at Schneider Children's medical center I have participate in following:
1. Outpatient clinic - which consisted of follow up of patients with chronic intestinal and liver failure, patients with multivisceral transplantations, patients with other gastrointestinal and liver problems. During the work in outpatients clinic I have learned how to determine and change therapy of those patients, how to provide adequate follow up and how to optimize nutritional support.
2. Wards – I have participated in all rounds which included pediatric departments and Intensive care unit where the care and treatment for all patients with severe gastrointestinal and liver diseases was provided, including pretransplantational evaluation, posttransplantational care and treatment of postransplant complications.
3. Endoscopy – I have learned how to perform upper endoscopy and have participated in following procedures: colonoscopy, polypectomy, balloon esophageal dilatation and percutaneous endoscopic gastrostomy insertion.
4. Operating theaters – During my visit I have observed several different operating procedures which included patients with multivisceral and liver transplantation.
5. Radiology meetings – conducted once weekly where all complicated and interesting radiology diagnostics involving gastroenterology patients were clarified and discussed.
6. Pathology meetings - conducted once monthly with the pathologist where all histopathological findings were shown and clarified.
7. Journal club meetings – conducted once weekly included presentations of recently published papers in pediatric gastroenterology hepatology or nutrition by some of the colleagues from the Institute. I have presented our work Lactobacillus GG in the Prevention of Nosocomial Gastrointestinal and Respiratory Tract Infections, published in Pediatrics, 2010.
8. Institute meetings – conducted once weekly with aim to discuss all difficult and complicated patients treated in the Institute.
9. Conferences – during my stay in Israel I have participated in several conferences and meeting covering the field of pediatric gastroenterology and nutrition, liver and multivisceral transplantation in children and adults.

Research and publications
I have participated in several works and minor researches during my visit:
1. Nutrition in inflammatory bowel disease – Hojsak I, Shamir R. Nutritional Aspects in Inflammatory Bowel Disease. European Paediatrics, 2010. In press.
2. Alagille syndrome – Yael Mozer-Glassberg, Iva Hojsak, Noam Zevit, Rivka Shapiro, Raanan Shamir. Pruritus responsive to naltrexone in a patient with cholestatic liver disease. IMAJ, In press.
3. Vaccination of the postransplanted children – Iva Hojsak, Yaron Avitzur, Eitan Mor, Raanan Shamir, Yishay Haimi-Cohen, Zichria Zakay-Rones, Dana Wolf, Rivka Shapiro. Antibody response to influenza vaccination in pediatric liver transplant recipients. Submitted for publication.
4. Serological testing in celiac disease in children younger than 3 years of age – Iva Hojsak, Yael Mozer-Glassberg, Netta Segal, Ronit er, Corina Hartman, Raanan Shamir. Celiac disease screening assays in children younger than 3 years of age – is the IgA+IgG DGP assay helpful? Submitted for publication.
5. Spontaneous disappearance of tissue transglutaminase antibodies is common in children diagnosed with diabetes mellitus type - Orith Waisbourd-Zinman, Iva Hojsak, Yoram Rosenbach, Yael Mozer-Glassberg, Shlomit Shalitin, Moshe Phillip and Raanan Shamir. Submitted for publication.

Final remarks
I really want to thank everyone who made my visit to Schneider Children's medical center possible, including: my mentor Professor Sanja Kolaček, visiting mentor Professor Raanan Shamir and all colleagues in the Institute and my home hospital’s director Professor Goran Roić.
Special thanks to founding grants of Unity through Knowledge Fund and ESPGHAN Scholarship, without which my visit wouldn’t be possible.