scholarly journals PERSPECTIVES ON NEONATAL RESUSCITATION TRAINING IN A CANADIAN PEDIATRIC RESIDENCY PROGRAM: COMMUNITY VERSUS TERTIARY CARE EXPERIENCES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e24-e25
Author(s):  
Mary Woodward ◽  
Andrea Hunter ◽  
Meghan McConnell ◽  
Connie Williams
Keyword(s):  
Qualitative Methodology ◽  
Cognitive Theory ◽  
A Priori ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Community Setting ◽  
High Volume ◽  
Resuscitation Training ◽  
Tertiary Center ◽  
Clinical Cases

Abstract BACKGROUND The competencies involved in neonatal resuscitation include a thorough knowledge of transitional neonatal physiology as well as technical expertise, the ability to lead a multidisciplinary team, and appropriate management of resources. In Canadian paediatric training programs, residents acquire neonatal resuscitation competency in both community and tertiary care settings. There is limited literature regarding experiences of training in variable settings and no literature with respect to the integration of neonatal competency acquisition across training environments. OBJECTIVES To explore residents’ and recent paediatric graduates’ perspectives on acquisition of competencies and neonatal resuscitation training in community and tertiary care centers. DESIGN/METHODS This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained. RESULTS Overall, the participants described a large ‘disconnect’ (lack of communication and congruence of curriculum) between community and tertiary training environments for neonatal resuscitation. Inherent challenges in the community included the variable skill and experience of the interdisciplinary team, availability of resources, and a lack of confidence in their own leadership. In addition, gaps in preceptor knowledge and communication were identified. Strengths of the community setting included: more autonomy for the learner, a high volume of clinical cases with particular emphasis on the ‘normal’; and opportunity for observed feedback with preceptors. In comparison, tertiary center experiences were perceived to be ‘overwhelming’ with a demanding workload and limited opportunity for direct observation and feedback from faculty. Strengths of the tertiary center experience included: variety and high volume of acute clinical cases, facilitating technical skill expertise and self-confidence; and a strong academic focus on physiology and knowledge translation. CONCLUSION Participants described both valuable opportunities and challenges for training and competency acquisition in neonatal resuscitation in tertiary and community settings. Integration of curricula or competencies across settings and across residency level of experience was lacking. This work suggests areas for collaboration within and across training centres to align opportunities in neonatal resuscitation competency training.

scholarly journals RESIDENTS’ AND RECENT GRADUATES’ PERSPECTIVES ON SIMULATION TRAINING IN NEONATAL RESUSCITATION COMPETENCY ACQUISITION

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e50-e51
Author(s):  
Mary Woodward
Keyword(s):  
Qualitative Methodology ◽  
Simulation Training ◽  
Cognitive Theory ◽  
A Priori ◽  
Neonatal Resuscitation ◽  
Clinical Exposure ◽  
Training Models ◽  
Institutional Ethics ◽  
Preparedness For Practice ◽  
Recent Graduates

Abstract BACKGROUND Simulation training has been incorporated into Canadian residency programs in order to teach both the technical and behavioral skills of resuscitation. Current literature speaks to ‘improvement’ in skills following a simulation encounter. Residents’ perspectives on competency acquisition through simulation training have not been previously reported. OBJECTIVES To explore the perspectives of residents and recent graduates on simulation as an educational modality for competency acquisition in neonatal resuscitation DESIGN/METHODS This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained. RESULTS Participants recognized the important role of simulation which allowed for a safe space to practice in order to become familiar with the algorithm and the equipment of resuscitation. Strengths associated with simulation training included: teaching geared toward the junior learner on the team, the opportunity to build and consolidate learning, and ideal preparation for examinations. In particular, given the current limited neonatal clinical exposure (constraints of reduced workload and hours), simulation was often seen as the trainee’s only opportunity for leading resuscitation. However, both groups of participants highlighted that for neonatal resuscitation the technology was less important than the scenario itself, i.e. ‘high fidelity is not the doll, it’s the stress of the situation’. They identified a lack of the ‘fear’ element in simulated scenarios, with a controlled comfortable environment, artificial ‘time component’, and ‘hypothetical resolution’ of every scenario. Finally, participants identified another potential pitfall of simulation which led to overconfidence and a false sense of expertise that cannot be translated to the ‘real baby’. CONCLUSION Participants perceived simulation to be a useful training modality for aspects of competency acquisition in neonatal resuscitation but highlighted a number of challenges and gaps toward preparedness for practice. In the development of future curricula in competency based training models, educators should consider in the design, graduated levels of simulation aimed toward transition to practice.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

scholarly journals Sociodemographic and Clinical Profile of Patients Presenting With Erectile Dysfunction: Experience From a Tertiary Care Centre of North India

2021 ◽  
pp. 263183182110311
Author(s):  
Adarsh Tripathi ◽  
Dhirendra Kumar ◽  
Sujita Kumar Kar ◽  
PK Dalal ◽  
Anil Nischal
Keyword(s):  
Erectile Dysfunction ◽  
Rating Scale ◽  
Nuclear Family ◽  
Sexual Experience ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Sexual Disorders ◽  
Care Hospital ◽  
Tertiary Center ◽  
Hamilton Rating Scale

Background: Erectile dysfunction (ED) is one of the most common psychosexual disorders in clinical practice, and it results in significant distress, interpersonal impairments, poor quality of life, and marital disharmony. However, there is limited research on ED in India. Therefore, this study aimed to assess the sociodemographic and clinical profile of patients presenting with ED. Method: Cross-sectional evaluation of patients with ED presenting to the psychosexual outpatient department (OPD) of psychiatry department in a tertiary care hospital was done on structured clinical pro forma, Mini-International Neuropsychiatric Interview, International Index of Erectile Function-5, Arizona Sexual Experience, Hamilton rating scale for depression, and Hamilton rating scale for anxiety. Results: The sample included 102 patients. The mean age was 33.38 years. The majority of the patients were married (81.4%), Hindu (82.4%), residing in a rural area (60.8%), and belonging to a nuclear family (62.7%). The majority of the patients had a moderate level of ED (50%) followed by mild-to-moderate ED (26.5%) and severe ED (23.5%). Premature ejaculation (46.1%) and depression (28.4%) were the most common sexual and psychiatric comorbidities. Obesity was common (62.7%), and only a minority had other metabolic dysfunction, namely dyslipidemia (7.8%), diabetes (5.9%), and hypertension (4.9%). Tobacco dependence and alcohol dependence were present in 37.3% and 6.9% cases, respectively. Conclusion: Young adults with moderate-to-severe ED were present for treatment at a tertiary center. Comorbidities of other sexual disorders, psychiatric disorders, and substance use are commonly encountered in such patients. Promotion of early help-seeking should be encouraged. Clinicians should thoroughly assess even the young patients for other sexual, psychiatric, and medical comorbidities.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

2020 ◽  
Author(s):  
Catherine M. Groden ◽  
Erwin T. Cabacungan ◽  
Ruby Gupta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Code Blue ◽  
Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

scholarly journals The Effect of the COVID-19 Pandemic on Pediatric Tympanostomy Tube Placement

2021 ◽  
pp. 019459982110089
Author(s):  
Gillian R. Diercks ◽  
Michael S. Cohen
Keyword(s):  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Community Setting ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Care Providers ◽  
Billing Data ◽  
Patient Age ◽  
Patient Âgé ◽  
Tympanostomy Tubes

Objective To evaluate how the coronavirus disease 2019 (COVID-19) pandemic has affected tympanostomy tube placement and practice patterns. Study Design A retrospective review of billing data. Setting A large-volume practice with both community and tertiary care providers. Methods As part of a quality initiative, billing data were queried to identify children <18 years of age who underwent tympanostomy tube placement between January 2019 and December 2020. Patient age, practice location, and case numbers were gathered. Results The study included data from 2652 patients. Prior to state-mandated clinic and operating room restrictions, there were no significant differences in the number of tympanostomy tubes placed ( P = .64), including month-to-month comparisons, the distribution of patients being cared for at community vs tertiary care sites ( P = .63), or patient age at the time of surgery ( P = .97) between 2019 and 2020. After resumption of outpatient clinical and elective surgical activities, the number of tympanostomy tubes placed decreased significantly between 2019 and 2020 (831 vs 303 cases, P = .003), with a persistent month-to-month difference. In addition, patients undergoing tube placement were older (4.5 vs 3.2 years, P < .001). The distribution of cases performed in the community setting decreased during this time period as well ( P < .001). Conclusion During the COVID-19 pandemic, the rate of pediatric tympanostomy tube placement has significantly decreased. The age of patients undergoing surgery has increased, and more children are being cared for in a tertiary setting. These findings may reflect changes in the prevalence of acute and chronic otitis media as the result of the pandemic.

scholarly journals Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

2015 ◽  
Vol 16 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Cuneyt Eftal Taner ◽  
Atalay Ekin ◽  
Ulas Solmaz ◽  
Cenk Gezer ◽  
Birgul Cetin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Tertiary Care Center

scholarly journals Challenging management of severe chronic disorders in acute pandemic situation: Chronic liver disease under COVID-19 pandemic as the proof-of-principle model to orchestrate the measures in 3PM context

2021 ◽  
Vol 12 (1) ◽  
pp. 1-14
Author(s):  
Lubomir Skladany ◽  
Tomas Koller ◽  
Svetlana Adamcova Selcanova ◽  
Janka Vnencakova ◽  
Daniela Jancekova ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Tertiary Care ◽  
Chronic Liver ◽  
Active Management ◽  
Comprehensive Treatment ◽  
List Type ◽  
Individualized Care ◽  
Chronic Disorder ◽  
Tertiary Center

AbstractChronic liver disease management is a comprehensive approach requiring multi-professional expertise and well-orchestrated healthcare measures thoroughly organized by responsible medical units. Contextually, the corresponding multi-faceted chain of healthcare events is likely to be severely disturbed or even temporarily broken under the force majeure conditions such as global pandemics. Consequently, the chronic liver disease is highly representative for the management of any severe chronic disorder under lasting pandemics with unprecedented numbers of acutely diseased persons who, together with the chronically sick patient cohorts, have to be treated using the given capacity of healthcare systems with their limited resources. Current study aimed at exploring potentially negative impacts of the SARS CoV-2 outbreak on the quality of the advanced chronic liver disease (ACLD) management considering two well-classified parameters, namely, (1) the continuity of the patient registrations and (2) the level of mortality rates, comparing pre-COVID-19 statistics with these under the current pandemic in Slovak Republic. Altogether 1091 registrations to cirrhosis registry (with 60.8% versus 39.2% males to females ratio) were included with a median age of 57 years for patients under consideration. Already within the very first 3 months of the pandemic outbreak in Slovakia (lockdown declared from March 16, 2020, until May 20, 2020), the continuity of the patient registrations has been broken followed by significantly increased ACLD-related death rates. During this period of time, the total number of new registrations decreased by about 60% (15 registrations in 2020 versus 38 in 2018 and 38 in 2019). Corresponding mortality increased by about 52% (23 deaths in 2020 versus 10 in 2018 and 12 in 2019). Based on these results and in line with the framework of 3PM guidelines, the pandemic priority pathways (PPP) are strongly recommended for maintaining tertiary care uninterrupted. For the evidence-based implementation of PPP, creation of predictive algorithms and individualized care strategy tailored to the patient is essential. Resulting classification of measures is summarized as follows: The Green PPP Line is reserved for prioritized (urgent and comprehensive) treatment of patients at highest risk to die from ACLD (tertiary care) as compared to the risk from possible COVID-19 infection. The Orange PPP Line considers patients at middle risk of adverse outcomes from ACLD with re-addressing them to the secondary care. As further deterioration of ACLD is still probable, pro-active management is ascertained with tertiary center serving as the 24/7 telemedicine consultation hub for a secondary facility (on a physician-physician level). The Red PPP Line is related to the patients at low risk to die from ACLD, re-addressing them to the primary care. Since patients with stable chronic liver diseases without advanced fibrosis are at trivial inherent risk, they should be kept out of the healthcare setting as far as possible by the telemedical (patient-nurse or patient- physician) measurements. The assigned priority has to be monitored and re-evaluated individually—in intervals based on the baseline prognostic score such as MELD. The approach is conform with principles of predictive, preventive and personalized medicine (PPPM / 3PM) and demonstrates a potential of great clinical utility for an optimal management of any severe chronic disorder (cardiovascular, neurological and cancer) under lasting pandemics.

Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

1999 ◽  
Vol 20 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Murray A. Abramson ◽  
Daniel J. Sexton
Keyword(s):  
Hospital Stay ◽  
Medical Center ◽  
A Priori ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Tertiary Care Medical Center ◽  
Matching Criteria ◽  
Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

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