ࡱ> `gca+DyK $geraldine.macgibbon@pharmac.govt.nzyK nmailto:geraldine.macgibbon@pharmac.govt.nzyX;H,]ą'cDyK kyle.reid@pharmac.govt.nzyK Zmailto:kyle.reid@pharmac.govt.nzyX;H,]ą'c 25 November, 2008 Geraldine MacGibbon Therapeutic Group Manager PHARMAC PO Box 10 254 Wellington 6143 E-Mail  HYPERLINK mailto:geraldine.macgibbon@pharmac.govt.nz geraldine.macgibbon@pharmac.govt.nz Response To Pharmac Consultation On Proposal For Funding Methylphenidate And Clozapine The Paediatric Society of New Zealand welcomes the proposal by PHARMAC to fund Ritalin, Ritalin SR and Ritalin LA from July 2009. This is an important addition to the range of stimulant medications available to treat children and young people diagnosed with attention deficit hyperactivity disorder. We have no comment on the proposal relating to clozapine. We would like to take this opportunity to thank PHARMAC staff for their ongoing efforts to ensure access to appropriate medications for children. Yours sincerely, Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation /IQ_op./0]^+,-./IQ_op./0]^+,-.@ABQ[]   FK    <.@ABQ[]  $$ u+#$ $  $ !Sn# $ !Sn# $x$ $ Oh+'0p   , 8 DPX`h TAX INVOICEAX racpNVOacp Normal.dotDenised9niMicrosoft Word 8.0@H'@2s@c)u@"u  @0M(&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+*B,B.B6B8B:BB@BBBDBFBBBBBBBZY\Y~YYYYYYY$ ! $ !n# !DyK kyle.reid@pharmac.govt.nzyK Zmailto:kyle.reid@pharmac.govt.nzyX;H,]ą'cDyK kyle.reid@pharmac.govt.nzyK Zmailto:kyle.reid@pharmac.govt.nzyX;H,]ą'c՜.+,D՜.+,< hp  racpm    TAX INVOICE Title(RZ _PID_GUID _PID_HLINKSAN{792604B6-65F6-47F3-82ED-7C0FC3A40D78}AL -՜.+,D՜.+,< hp  racpmO   TAX INVOICE Title(RZ _PID_GUID _PID_HLINKSAN{792604B6-65F6-47F3-82ED-7C0FC3A40D78}AL -!mailto:kyle.reid@pharmac.govt.nzOMC:\Documents and Settings\Denise\WORK\PSNZ Docs\Letterheads and Logos\RM.JPGt Word 8.0@H'@2s@c)u@"u  @0MLNP&ȓʓ,PRt֦ئڦ fhZLNP&VXxľѕ6H*0JjU jUCJ5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH5 jUmH6CJCJH*5CJCJ0JCJ jCJUj+CJU2@@@@AA ANAPA&B(B*B.B4BBBZYYYZZZZZ[[LfPfnnpppqttttttttDuFuHuvuxuNvPvRvVv\vvvZL jCJUCJ 6mH nH  H*mH nH mH nH  jUCJ jUmH5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH59RvTvVv^v`vbvdvfvhvjvlvnvvvvvvvZ|~ދ$ ! $ !n# !D3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4=90th percentile. Growth Velocity. The entry criteria is based on GV <25th percentile for bone age. This criteria is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favorable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is _not_ linearly proportional to the change in bone age. Second, bone ages have a well known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements. All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone age for exit. The criteria are currently specify Bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criteria is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Yours sincerely,  Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz   Health of our children: Wealth of our nation x jlZLNP&VXx jl 0077P>x?z?|?CJ6H*0JjU jUCJ jUmH5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH57&(>@ȓʓ~DF,.PTVt$ H$7$8$ئڦ *Hh $ !n# ! $$ u+#$ $  $ !Sn# $ !Sn#$  $x$ x jlZLNP&VXx jl 0077P>x?z?|?JJtRxRXZZ ZCJ6H*0JjU jUCJ jUmH5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH5?(&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+bdfhjlZ|~&(>@$ ! !bdfhjl&&''++//:7<7b8d8":$:N>P>x?z?|?$D3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4=90th percentile. Growth Velocity. The entry criteria is based on GV <25th percentile for bone age. This criteria is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favorable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is _not_ linearly proportional to the change in bone age. Second, bone ages have a well known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements. All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone agefor exit. The criteria are currently specify Bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criteria is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Yours sincerely, Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz   Health of our children: Wealth of our nation YZZ[[[[]]^]`](b*bee|m~mnndphpttttttttH$7$8$$ttttttFuHubudufuhujuxuuuuu&vPvRv $$ u+#$ $  $ !Sn# $ !Sn# $x$ $ ^`bdfhZ|~޿&(>@$ ! !(&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^xy.+,./Q[\]  JKZ%%%%Z&\&&&x'$2(299b<l<<=h@j@t@v@@Żũ 6mH nH  H*mH nH mH nH  jU5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH5 jUmHB*5B*0JCJjCJU jCJUCJ6   FGHIJKZ%\%^%`%b%%%%$ ! $ !n# !D3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4=90th percentile. Growth Velocity. The entry criteria is based on GV <25th percentile for bone age. This criteria is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favorable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is _not_ linearly proportional to the change in bone age. Second, bone ages have a well known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements. All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone agefor exit. The criteria are currently specify Bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criteria is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Yours sincerely, Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz   Health of our children: Wealth of our nation %&&&`'b'x'((6)8)..11T9V9|::<<@<h@j@l@n@p@r@t@@$H$7$8$@@@@@@A A:AA@ABAPApAAAAA(B*B $$ u+#$ $  $ !Sn# $ !Sn# $x$ $ D3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+ult for small ones in which this test is not available. Thus parents in small centres would need to travel regularly to another centre to obtain a test that is of statistical and audit value, but will not directly affect their child s management. We suggesD3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4=90th percentile. Growth Velocity: The entry criteria is based on GV <25th percentile for bone age. This criteria is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favorable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is _not_ linearly proportional to the change in bone age. Second, bone ages have a well-known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements: All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone age for exit. The criteria are currently specify Bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criteria is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Yours sincerely,  Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz   Health of our children: Wealth of our nation @ "HJ 24VZx $ !Sn# $x$ $ H$7$8$t that either a list of centres that are agree to offer this service be appended to the proposal (Auckland, Dunedin, Christchurch and presumably Wellington), or that an exemption be added for centres where DEXA is not available at present. Height: Not al.Ll $ !n# ! $$ u+#$ $  $ !Sn# $ !Sn#l children with Prader Willi Syndrome are very short, and there is potential for treatment with GH to lead to marked tall stature in a few children. In many countries such as Australia, GH supply to patients, even those with GH deficiency, is limited by an(&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+ exit criterion once they have achieved a predefined height. We therefore wonder whether it would be reasonable to include an exit criteria somewhere in the normal range, even if it was >=90th percentile. Growth Velocity: The entry criteria is based on G [L`LNormal$*$d @CJOJQJmH nH 00 Heading 1$@&500 Heading 2$@&>* Heading 3m$$*$@& \R" b2> Y!r"B%(*-0R3"68;>bA2DGI56@CJ00 Heading 4$@&CJ44 Heading 5$@&5CJ44 Heading 6$@&5CJ88 Heading 7 $$@&5CJ44 Heading 8 $$@&5<A@<Default Paragraph Font<<Address$5OJQJhmH nH 0@0Header  !CJ0 0Footer  !CJ(U@!( Hyperlink>*B*8V18FollowedHyperlink>*B* LBBL Body Text$*$1$ p@ @hnH F>RFTitle$*$1$ p@ 5CJ0hnH .Pb. Body Text 2CJXCrXBody Text Indent$*$ 0@CJ2Q2 Body Text 3$CJ W Strong544 No Spacing CJmH nH &)& Page Number4564569%3CD89 x y X Y m n  2GHIJNOPQRSTUV@@@@@@@@@@@@@@@@@@@@ @Lxl$Up. %@*BYtRv@l "#%<=>VWXoqrK UnknownDeniseThe Walker FamilyM{Xt  &!,R$@yV7e\]{W- *@&  ( =z43 N CE%"  8  BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@V <25th percentile for bone age. This criterion is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favourable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is not linearly proportional to the change in bone age. Second, bone ages have a well known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements: All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone age for exit: The criteria are currently specify bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls`CE%"  TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`4B "H2 or >=16 y for boys. It is important to note that this criterion is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Submission prepared by Professor Alistair Jan Gunn, on behalf of the Endocrinology Special Interest Group of the Paediatric Society of New Zealand. 24  TAX INVOICEracpDenise [J`JNormal*$d @CJOJQJmH nH 00 Heading 1$@&500 Heading 2>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+ #  #$H2  # | N  3  N  3  TB  c $DjJ|( ?  D3&} [QEQEQEQEQEQEQEQEQY1topqk+fS ?3}3EVNy-m]"3}:9z}Z}P '>S֭EQEQEQEQEQEQEQEQEE412,!A,oX 4=90th percentile. Growth Velocity: The entry criteria is based on GV <25th percentile for bone age. This criteria is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favorable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is _not_ linearly proportional to the change in bone age. Second, bone ages have a well-known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements: All children at or<2 yrs should have supine measurements as recommended internationally in growth assessment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone age for exit. The criteria are currently specify Bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criteria is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Yours sincerely,  Rosemary Marks President THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz   Health of our children: Wealth of our nation "HJ  24VZx $ !Sn# $ !Sn# $x$ $ H$7$8$.Llb$ ! $ !n# ! $$ u+#$ $  $ !Sn# $ !Sn#bdfhjl&&''++//:7<7b8d8":$:N>P>x?z?|?bAdAAA$(&P . A!"#$%nF% @yV7e\]{WJFIFddC   (1#%(:3=<9387@H\N@DWE78PmQW_bghg>Mqypdx\egc N }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz? (((((((((((((((((((((((((((((((((((((((((((((((((((((]^ElQi%!#AoJ&%ot˫{u+֢R GB)QEQEQEQEQEQEQEQEQES8TO =Űn Ԛ 0* AY_/IXwX%'#*VQEQEQEQEQEQEQEQEQEYL>q!>ִ" ɥE&b( 3Fb46 M5ܒK1$ԒjQEQEQEQEW?oEAX\<(((si]D H!wX29봜n:AEQX.KỨl>E[dq/"{PYNP*$b8 _Aǻw8Z(DVTfҤ'^ kd)Y>+JEQEQEQ\i8-5f8WI^frcEQEQEOSK.N$D'ԩv)F&O.pC ߥ+ 7 m٤@A$EC0N1ߥ[Ҵb$ͼst*oaֵrWu&X࠰ <~7k94p 2IU$ھy0mje ai7rs= OH<˞34d=>gA!mZhﱳ2vb2A琠=OZ"+ $S UQwUIi v# ;[Yn%8HMgF y)U 0PFvnIEI߽]$Ȥ+=FIkR(3*)f!T xSb&de =EKE*4=PgT|j:t.$39KdzH((4JB 1\N@ sG~rw4(t(mmlq.ўԟE֊!/%w01Ȑ[@29:?&͗c1!JRMKJfylk#S2 %uؙ$wo6P"e &\Z7V֒vH<5kH.(!0cOrI?Ai:0MFӒp*#!`@8_Ċ."mWPEÃ2)P2܎0$ԓYUc\0!,u#c[\VHmޞ_SF1x--ykX5U.M.>ebq^j~ ]rڄ0$n[KeZAm(BFTwP -JX3vТ}Zy6yF3=QLeVRR0AEgaI'dhA ƚm(6r4q??/KZ))ׇ4^>?Ξc֙5Cѧjn5@?o F?.<-t㡺v@āV Eu(2AdRQETK8Dnm(u^  XG59].qg12aY 4IٰF꾛\u\ʑi0Яfc9ZZ} WH 0ij}ɫp[Al 85 ?Ju ʄP{qTƓw o^"p$X }YsO:,S\_`f?P HR% KEQP;hљzRk';z\aS J쵯EQEQEQEQEQETv^@\IJDUAJ̕ԑʗq z0e'֜\r{"S''ܞ;b=Ks%-:l,>Z((( ?J((((((((Jb:BHr(+actually attaining epiphyseal closure. Submission prepared by Professor Alistair Jan Gunn, on behalf of the Endocrinology Special Interest Group of the Paediatric Society of New Zealand.  [L`LNormal$*$d @CJOJQJmH nH 00 Heading 1$@&500 Heading 2$@&>* Heading 3m$$*$@& \R" b2> Y!r"B%(*-0R3"68;>bA2DGI56@CJ00 Heading 4$@&CJ44 Heading 5$@&5CJ44 Heading 6$@&5CJ88 Heading 7 $$@&5CJ44 Heading 8 $$@&5<A@<Default Paragraph Font<<Address$5OJQJhmH nH 0@0Header  !CJ0 0Footer  !CJ(U@!( Hyperlink>*B*8V18FollowedHyperlink>*B* LBBL Body Text$*$1$ p@ @hnH F>RFTitle$*$1$ p@ 5CJ0hnH .Pb. Body Text 2CJXCrXBody Text Indent$*$ 0@CJ2Q2 Body Text 3$CJ W Strong544 No Spacing CJmH nH &)& Page Number4564569%3CD89 x y X Y m n  2GHIJNOPQRSTUV@@@@@@@@@@@@@@@@@@@@ @Lxl$Up. %@*BYtRv@bl "#%<=>VWXoqrK UnknownDeniseThe Walker FamilyM{Xt  &!,R$@yV7e\]{W- *@&  ( =z43 N CE%"  8  BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@`CE%"  TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`4B "H2  #  #$H2  # | N  3  N  3  TB  c $DjJ|( ?  C AC:\Documents and Settings\Denise\WORK\PSNZ Docs\Letterheads and Logos\RM.JPGB S  ? y 4=^tuD$t#uDJ> @ OPR$* Z \ ~ 26OPRDeniseC:\DOCUME~1\Denise\LOCALS~1\Temp\AutoRecovery save of PSNZ Response to Pharmac Re Proposal for Strattera, Humalog, Zyprexa 10 sep.asdDenisebC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ .docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\DOCUME~1\Denise\LOCALS~1\Temp\AutoRecovery save of PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.asdDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.doc'|} D~NsrtZ*PpTVxGzfm "W 1 JRg :pKx=FP v  mkatԑ{n -  :.$@&>* Heading 3m$$*$@& \R" b2> Y!r"B%(*-0R3"68;>bA2DGI56@CJ00 Heading 4$@&CJ44 Heading 5$@&5CJ44 Heading 6$@&5CJ88 Heading 7 $$@&5CJ44 Heading 8 $$@&5<A@<Default Paragraph Font<<Address$5OJQJhmH nH 0@0Header  !CJ0 0Footer  !CJ(U@!( Hyperlink>*B*8V@18FollowedHyperlink>*B* LBBL Body Text$*$1$ p@ @hnH F>RFTitle$*$1$ p@ 5CJ0hnH .Pb. Body Text 2CJXCrXBody Text Indent$*$ 0@CJ2Q@2 Body Text 3$CJ W@ Strong54O4 No Spacing CJmH nH &)@& Page Number4564569%3CD,-   m n M N c d $&LMZ[\]^eu@@@@@@@@@@@@@@@@@@@@ @Lx|?$Up. %@*BYtRv@b|? "#%<=>VWXoqrK UnknownDeniseThe Walker FamilyM{Xt  &!,R$@yV7e\]{W- *@&  ( =z43 N CE%"  8  BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@`CE%"  TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`4B "H2  #  #$H2  # | N  3  N  3  TB  c $DjJ|( ?   C AC:\Documents and Settings\Denise\WORK\PSNZ Docs\Letterheads and Logos\RM.JPGB S  ? y 4=^tuD$t#uDJZ`af*1T[LRSX  ! 3 5 O Y $ $DeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\DOCUME~1\Denise\LOCALS~1\Temp\AutoRecovery save of PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.asdDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.doc'|} D~NsrtZ*PpTVxGzfm "W 1 JRg :pKx=FP v  mkatԑ{n -  :. CB|0 1j[1tԑB1 J3ѪnV 3 `l9 -J &X T] qc ai< r\4 t :u [ yW.... OJQJo( OJQJo( OJQJo( OJQJo(hh. hhOJQJo(^`.^`OJQJ- hh^h`OJQJo(0^`0o(. hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh  C AC:\Documents and Settings\Denise\WORK\PSNZ Docs\Letterheads and Logos\RM.JPGB S  ? y 4=^tuD$t#uDJ> @ OPR$* Z \ ~ 26OPRDenisebC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ .docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2008\PSNZ Reponse Re Proposal for Funding Methylphenidate and Clozapine.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\ DOCUME~1\Denise\LOCALS~1\Temp\AutoRecovery save of PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.asdDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.docDeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\2009\PSNZ Response re PHARMAC consultation Prader-Willi Syndrome widening access Growth Hormone.doc'|} D~NsrtZ*PpTVxGzfm "W 1 JRg :pKx=FP CB|0 1j[1tԑB1 J3ѪnV 3 `l9 -J &X T] qc ai< r\4 t :u [ yW.... OJQJo( OJQJo( OJQJo( OJQJo(hh. hhOJQJo(^`.^`OJQJ- hh^h`OJQJo(0^`0o(. hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.hho(. hhOJQJo( hhOJQJo( hhOJQJo( hh^h`OJQJo(hh.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH. hhOJQJo(hh.0^`0o(.?o(.hh>*o(.?o(. hhOJQJo( hhOJQJo( hhOJQJo(o(.h^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH?o(.hho(. hhOJQJo( hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH'&XP rV 3B1CB|0~}| :.mJ3"[T]qc-J 1{n -v :uKx= tl9JRg yW1[1mkaai'WW8Num1WW8Num2@ 8W?? CDMNOY`yz{|lm89?A$& w x X Y b m n ~  JOPQRSpXqZpzp|q~ppp޿qqqqq qqJqLqNqPqqpppp&p<p>q0p2pqqpqqq4qHpp q"q(pFpHqpptpq pp2q4pTqVpXppppppppphpjGzTimes New Roman5Symbol3& zArial?Bodoni BookEAGaramond BoldA& Arial Narrow?5 zCourier New;Wingdings"qhrfrfC† 7 #The Paediatric Society of New Zealand broadly supports the revised criteria, which effectively give patients with Prader-Willi Syndrome parity with those with Turners Syndrome. We would like to suggest several amendments. First, the criteria require a ba^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.hho(. hhOJQJo( hhOJQJo( hhOJQJo( hh^h`OJQJo(hh.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH. hhOJQJo(hh.0^`0o(.?o(.hh>*o(.?o(. hhOJQJo( hhOJQJo( hhOJQJo(o(.h^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH?o(.hho(. hhOJQJo( hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH'&XP rV 3B1CB|0~}| :.mJ3"[T]qc-J 1{n -v :uKx= tl9JRg yW1[1mkaai'WW8Num1WW8Num2@  8W  CJCDMNOY`yz{|35 l m M N W _ a c   # v  mkatԑ{n -  :. CB|0 1j[1tԑB1 J3ѪnV 3 `l9 -J &X T] qc ai< r\4 t :u [ yW.... OJQJo( OJQJo( OJQJo( OJQJo(hh. hhOJQJo(^`.^`OJQJ- hh^h`OJQJo(0^`0o(. hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.hho(. hhOJQJo( hhOJQJo( hhOJQJo( hh^h`OJQJo(hh.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH. hhOJQJo(hh.0^`0o(.?o(.hh>*o(.?o(. hhOJQJo( hhOJQJo( hhOJQJo(o(.h^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH?o(.hho(. hhOJQJo( hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH'&XP rV 3B1CB|0~}| :.mJ3"[T]qc-J 1{n -v :uKx= tl9JRg yW1[1mkaai'WW8Num1WW8Num2@8W""CDMNOY`yz{|lm89?A$& w x X Y b m n ~  JOPQRSpXqZpzp|q~pppqqqqq qqJqLqNqPqqpppp&p<p>q0p2pqqpqqq4qHpp q"q(pFpHqpptp q p p2q4pTqVpXppppppppphpjGzTimes New Roman5Symbol3& zArial?Bodoni BookEAGaramond BoldA& Arial Narrow?5 zCourier New;Wingdings"qhrfrfC† 7 #24  TAX INVOICEracpDeniseseline DEXA scan plus annual testing. This will be easy for large centres but difficult for small ones in which this test is not available. Thus parents in small centres would need to travel regularly to another centre to obtain a test that is of statistical and audit value, but will not directly affect their child s management. We suggest that either a list of centres that are agree to offer this service be appended to the proposal (Auckland, Dunedin, Christchurch and presumably Wellington), or that an exemption be added for centres where DEXA is not available at present. Height: Not all children with Prader Willi Syndrome are very short, and there is potential for treatment with GH to lead to marked tall stature in a few children. In many countries such as Australia, GH supply to patients, even those with GH deficiency, is limited by an exit criterion once they have achieved a predefined height. We therefore wonder whether it would be reasonable to include an exit criteria somewhere in the normal range, eSummaryInformation(DocumentSummaryInformation8DCompObjj0TableIven if it was >=90th percentile. Growth Velocity: The entry criteria is based on GV <25th percentile for bone age. This criterion is clearly intended to reflect the complex changes in GV of children in puberty. In particular, this will avoid recruitment of children in advanced puberty, whose absolute growth velocity is naturally falling and is much less than that of children of the same chronological age, even though it is appropriate for pubertal stage. However, the disadvantages are first, that GV for bone age is overly favourable for children with markedly delayed bone ages; these children show very complex changes in GV relative to their predicted final height, which is not linearly proportional to the change in bone age. Second, bone ages have a well-known high inter- and intra-observer variability. This makes evaluating GV in young children much more complex and error prone than it needs to be. We therefore suggest a small compromise, revising the entry criteria to read something like: GV for age for children whose bone age is <10 y and who are prepubertal, or GV for bone age for children with bone age >=10y or who are in puberty Supine measurements: All children at or<2 yrs should have supine measurements as recommended internationally in growth ass$@XAZ@z@|A~@@@AAAAA AAJALANAPAA@@@@&AX%@&@'A+@+A/A/A/@87@:7@`8@b8A8A8@8@":A$:A6:AF:@J:@N>@2A4@TAV@Z@j@@@x?@@@@@h@jGzTimes New Roman5Symbol3& zArial?Bodoni BookEAGaramond BoldA& Arial Narrow?5 zCourier New;Wingdings"qhrfrfC†  #24Q TAX INVOICEracpDeniseG lKbjbjَ @$7]GINN1P1P1PEPUUU8V$;VEP #W9W9W9W9Waaa$T)1Pai`"`|aa)wbNN9W9W0 VHwbwbwbaN89W-O9WEPEPNNNNawbLwbpFOOJ9WV phɔuEPU bjpRoot Entry FMuphɔu/Data 1TableKWordDocument*@  &  '()+ 01/9:g   FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,< hp  racpmQ   TAX INVOICE Title(RZ _PID_GUID _PID_HLINKSAN{792604B6-65F6-47F3-82ED-7C0FC3A40D78}AL -!mailto:kyle.reid@pharmac.govt.nzOMC:\Documents and Settings\Denise\WORK\PSNZ Docs\LetOh+'0p   , 8 DPX`h TAX INVOICEAX racpNVOacp Normal.dotDenised8niMicrosoft Word 8.0@d@2s@c)u@d_xu  terheads and Logos\RM.JPGS T Ui0N !"#$%&'()*+,-.1M45678p<=>?@ABCDEFGHIJKL3OPQR VWXYZ[\]^_`abcdefhojklmn;qrstuvwxyz{|}~essment.This is important to avoid confounding due to changes in supine vs standing measurements. Bone age for exit: The criteria are currently specify bone age of >14years (female) or >16 years (male) and the growth velocity <2cm/yr as calculated over six months. We would like to suggest that thisshould be bone age >= 14 yfor girls or >=16 y for boys. It is important to note that this criterion is only used in combination with a low GV. Given this, and that bone ages are not precise, >14 or >16 respectively could lead to legal difficulty stopping GH therapy in some children who are actually attaining epiphyseal closure. Submission prepared by Professor Alistair Jan Gunn, on behalf of the Endocrinology Special Interest Group of the Paediatric Society of New Zealand. 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PLP^P`LhH.hho(. hhOJQJo( hhOJQJo( hhOJQJo( hh^h`OJQJo(hh.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH. hhOJQJo(hh.0^`0o(.?o(.hh>*o(.?o(. hhOJQJo( hhOJQJo( hhOJQJo(o(.h^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH?o(.hho(. hhOJQJo( hhOJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH'&XP rV 3B1CB|0~}| :.mJ3"[T]qc-J 1{n -v :uKx= tl9JRg yW1[1mkaai'WW8Num1WW8Num2@ 8W>> CJCDMNOY`yz{|`a35 k l K L U ] _ a  !"@XAZ@z@|A~@@@AAAAA AAJALANAPAA@@@@&A@A@A@@`A@AAF@FAbJAdJAfJAOAP@Q@Q@S@SA0S@4S@TATATAT@T@X@2A4@TAV@Z@j@@@Z@@@@@h@jGzTimes New Roman5Symbol3& zArial?Bodoni BookEAGaramond BoldA& Arial Narrow?5 zCourier New;Wingdings"qhrfrfC†  #24O TAX INVOICEracpDeniseG |Kbjbjَ ^"7] 8 $ F  BBBBBBB$HJTC*"L|C0 0 H000:8  BB0|0&Fl?JB ޼u .|BpRoot Entry FMu޼udData 1TableKWordDocument^^  &!"#$%3'()45679:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]_befSummaryInformation(DocumentSummaryInformation8DCompObjj0Table8XJ29g  FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,< hp  racpmO   TAX INVOICE Title(RZ _PID_GUID _PID_HLINKSAN{792604B6-65F6-47F3-82ED-7C0FC3A40D78}AL -!mailto:kyle.reid@pharmac.govt.nzOMC:\Documents and Settings\Denise\WORK\PSNZ Docs\LetOh+'0p   , 8 DPX`h TAX INVOICEAX racpNVOacp Normal.dotDenised9niMicrosoft Word 8.0@H'@2s@c)u@"u  terheads and Logos\RM.JPGS T Ui0N !"#$%&'()*+,-.1M45678p<=>?@ABCDEFGHIJKL3OPQR VWXYZ[\]^_`abcdefhojklmn;qrstuvwxyz{|}~ Paediatric Society of New Zealand: Submissions
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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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