Pulmonary Embolism in Pediatrics Patocka, Catherine, MDCM; Nemeth, Joe, MDCM
The Journal of emergency medicine,
2012, 2012-Jan, 2012-1-00, 20120101, Letnik:
42, Številka:
1
Journal Article
Recenzirano
Abstract Background Pulmonary embolism (PE), an uncommon diagnosis in pediatric patients, is a potentially life-threatening condition with significant morbidity and mortality. Improvements in ...pediatric care have resulted in survival of more chronically and critically ill children and thus, an increased number of pediatric patients at risk for this disease. Objectives We review the pathophysiology, risk factors, presentation, diagnosis, and initial management of PE in pediatric patients presenting to the Emergency Department. Discussion Although there is a significant lack of pediatric-specific literature pertaining to the diagnosis and management of PE, there are clear differences in the emergency approach to these patients, including specific risk factors and the inutility of clinical decision rules and D-dimer. Conclusion/Summary We outline these differences and present rational diagnostic and treatment algorithms.
Advanced life support courses have a clear educational impact; however, it is important to determine whether participation of one or more members of the resuscitation team in an accredited advanced ...life support course improves in-hospital cardiac arrest patient survival outcomes.
We searched EMBASE.com, Medline, Cochrane and CINAHL from inception to 1 November 2022. Included studies were randomised or non-randomised interventional studies assessing the impact of attendance at accredited life support courses on patient outcomes. Accredited life support courses were classified into 3 contexts: Advanced Life Support (ALS), Neonatal Resuscitation Training (NRT), and Helping Babies Breathe (HBB). Existing systematic reviews were identified for each of the contexts and an adolopment process was pursued. Appropriate risk of bias assessment tools were used across all outcomes. When meta-analysis was appropriate a random-effects model was used to produce a summary of effect sizes for each outcome.
Of 2714 citations screened, 19 studies (1 ALS; 7 NRT; 11 HBB) were eligible for inclusion. Three systematic reviews which satisfied AMSTAR-2 criteria for methodological quality, included 16 of the studies we identified in our search. Among adult patients all outcomes including return of spontaneous circulation, survival to discharge and survival to 30 days were consistently better with accredited ALS training. Among neonatal patients there were reductions in stillbirths and early neonatal mortality.
These results support the recommendation that accredited advanced life support courses, specifically Advanced Life Support, Neonatal Resuscitation Training, and Helping Babies Breathe improve patient outcomes.
Background: Competency based medical education (CBME) relies on supervisor narrative comments contained within entrustable professional activities (EPA) for programmatic assessment, but the quality ...of these supervisor comments is unassessed. There is validity evidence supporting the QuAL (Quality of Assessment for Learning) score for rating the usefulness of short narrative comments in direct observation.
Objective: We sought to establish validity evidence for the QuAL score to rate the quality of supervisor narrative comments contained within an EPA by surveying the key end-users of EPA narrative comments: residents, academic advisors, and competence committee members.
Methods: In 2020, the authors randomly selected 52 de-identified narrative comments from two emergency medicine EPA databases using purposeful sampling. Six collaborators (two residents, two academic advisors, and two competence committee members) were recruited from each of four EM Residency Programs (Saskatchewan, McMaster, Ottawa, and Calgary) to rate these comments with a utility score and the QuAL score. Correlation between utility and QuAL score were calculated using Pearson’s correlation coefficient. Sources of variance and reliability were calculated using a generalizability study.
Results: All collaborators (n = 24) completed the full study. The QuAL score had a high positive correlation with the utility score amongst the residents (r = 0.80) and academic advisors (r = 0.75) and a moderately high correlation amongst competence committee members (r = 0.68). The generalizability study found that the major source of variance was the comment indicating the tool performs well across raters.
Conclusion: The QuAL score may serve as an outcome measure for program evaluation of supervisors, and as a resource for faculty development.
Pulmonary embolism Ouellette, David W; Patocka, Catherine
Emergency medicine clinics of North America,
05/2012, Letnik:
30, Številka:
2
Journal Article
Recenzirano
Pulmonary embolism (PE) remains one of the most challenging medical diseases in the emergency department. PE is a potentially life threatening diagnosis that is seen in patients with chest pain ...and/or dyspnea but can span the clinical spectrum of medical presentations. In addition, it does not have any particular clinical feature, laboratory test, or diagnostic modality that can independently and confidently exclude its possibility. This article offers a review of PE in the emergency department. It emphasizes the appropriate determination of pretest probability, the approach to diagnosis and management, and special considerations related to pregnancy and radiation exposure.
In 2018, Canadian post-graduate Emergency Medicine (EM) programs transitioned to Competence-by-Design. Residents are now assessed using Entrustable Professional Activities (EPAs). We developed and ...implemented simulation for assessment to mitigate anticipated challenges with residents completing the required number of observations of resuscitation-based EPAs. Our survey of trainees who participated in these sessions suggests that it may be a feasible and acceptable method for EPA assessment.
Abstract Aim Healthcare providers demonstrate limited retention of knowledge and skills in the months following completion of a resuscitation course. Resuscitation courses are typically taught in a ...massed format (over 1–2 days) however studies in education psychology have suggested that spacing training may result in improved learning and retention. Our study explored the impact of spaced instruction compared to traditional massed instruction on learner knowledge and pediatric resuscitation skills. Methods Medical students completed a pediatric resuscitation course in either a spaced or massed format. Four weeks following course completion students completed a knowledge exam and blinded observers used expert-developed checklists to assess student performance of three skills (bag-valve mask ventilation (BVMV), intra-osseous insertion (IOI) and chest compressions (CC)). Results Forty-five out of 48 students completed the study protocol. Students in both groups had similar scores on the knowledge exam spaced: (37.8 ± 6.1) vs. massed (34.3 ± 7.6)( p < 0.09 ) and overall global rating scale scores for IOI, BVMV and CC; however students in the spaced group also performed critical procedural elements more frequently than those in the massed training group Conclusion Learner knowledge and performance of procedural skills in pediatric resuscitation taught in a spaced format is at least as good as learning in a massed format. Procedures learned in a spaced format may result in better retention of skills when compared to massed training.
Resuscitation courses are typically taught in a massed format despite existing evidence suggesting skill decay as soon as 3 months after training. Our study explored the impact of spaced versus ...massed instruction on acquisition and long-term retention of provider paediatric resuscitation skills.
Providers were randomized to receive a paediatric resuscitation course in either a spaced (four weekly sessions) or massed format (two sequential days). Infant and adult chest compressions CC, bag mask ventilation BMV, and intraosseous insertion IO performance was measured using global rating scales.
Forty-eight participants completed the study protocol. Skill performance improved from baseline in both groups immediately following training. 3-months post-training the infant and adult CC scores remained significantly improved from baseline testing in both the massed and spaced groups; however, the infant BMV and IO scores remained significantly improved from baseline testing in the spaced: BMV (pre, 1.8 ± 0.7 vs post-3-months, 2.2 ± 7; P = 0.005) IO (pre, 2.5 ± 1 vs post-3-months, 3.1 ± 0.5; P = 0.04) but not in the massed groups: BMV (pre, 1.6 ± 0.5 vs post-3-months, 1.8 ± 0.5; P = 0.98) IO (pre, 2.6 ± 1.1 vs post-3-months, 2.7 ± 0.2; P = 0.98).
3-month retention of CC skills are similar regardless of training format; however, retention of other resuscitation skills may be better when taught in a spaced format.
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