Cataract surgery outcomes in pediatric patients with systemic comorbidities

Purpose: The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Methods: Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary?care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle?corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Results: Thirty patients with a mean age of 55 months (9 months–14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary?care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down’s syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan’s syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2?year follow?up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow?up. Around 70% of the parents reported improvement in their child’s psychomotor skills. Conclusion: Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Avaliação do processo ensino-aprendizagem da técnica de ressuscitação cardiopulmonar pela equipe de enfermagem / Evaluation of the cardiopulmonary resuscitation teaching-learning by the nursing team

O estudo teve como objetivo avaliar o processo ensino-aprendizagem da técnica de ressuscitação cardiopulmonar pela equipe de Enfermagem, no pós-operatório de cirurgia cardíaca. A amostra foi composta de 37 enfermeiros, 10 técnicos, e 53 auxiliares de Enfermagem de uma Unidade de Terapia Intensiva Cirúrgica, de um Hopsital de Ensino, da rede pública do Município de São Paulo. No método do estudo foi elaborado um modelo padrão ("check-list"), para enfermeiros; e outro, para os técnicos e auxiliares de Enfermagem; que foram apreciados por um "corpo de juízes", e utilizados na avaliação da habilidade (execução) e do conhecimento (descrição) dos enfermeiros, técnicos e auxiliares, em duas etapas de coleta de dados. Os resultados foram analisados, permitindo constatar que: 1) As médias dos escores dos enfermeiros, técnicos e auxiliares de Enfermagem, na habilidade (execução) e no conhecimento (descrição), não alcançaram os escores totais estipulados pelos juízes para cada cenário, na 1ª etapa do estudo. 2) As médias dos escores dos enfermeiros, técnicos e auxiliares de Enfermagem, na habilidade (execução) e no conhecimento (descrição), não alcançaram os escores totais estipulados pelos juízes para cada cenário, na 2ª etapa do estudo. 3) Houve melhora estatisticamente significativa tanto na habilidade (execução) quanto no conhecimento (descrição) dos enfermeiros, técnicos e auxiliares de Enfemagem, nos cenários do modelo padrão, quando comparadas as duas etapas do estudo.

This study had as goal to evaluate the cardiopulmonary resuscitation teaching-learning process by the nursing team in cardiac surgery posoperative. The sample consisted of 37 nurses, 10 technicians and 53 Nursing aides of an Intensive Care Unit of a university hospital, in the public health care chain of the city São Paulo. In the study method , we established two standard models (check-list) one for nurses and another one for the technicians and Nurisng aides and they were appreciated by a judge corps and used in the evaluation of the skill (execuation) and the knowledge (description) shown by nurses, technicians and Nursing aides in two steps in the operationalization of the data collecting. The results, were analised and showed that: 1) The score level among nurses, technicians and Nursing aides on skill (execution) and on knowledge (description) didn't achieve the score stipulated by the judges for each scenery in the first step of the study. 2) The score level among nurses, technicians and Nursing aides on skill (execution) and on knowledge (description) didn't achieve the score stipulated by the judges for each scenery in the second step of the study. 3) There was a statistically significant improvement both on skill (execution) and on knowledge (description) among nurses, technicians and Nursing aides in the standard model sceneries, whem compared to the previous steps of the study.

Basic Life Support Training for Medical Students using Skillmeter ResusciTM Anne / 대한마취과학회지

Basic life support training is a part of the curricula of medical school in Anesthesiology practice. Every effort should be made to improve proper mouth-to-mouth breathing and perform correct extemal chest compression. Skillmeter Resusci(TM) Anne (Laerdal(R), Finland) is known to be an extremely valuable aid for accurate and objective training of medical students and for evaluating their performance. Fiftytwo medical students have been trained in basic life support skills and have been evaluated with Skillmeter Resusci Anne. We adopted standards by American Heart Association. As other reports, trainees' outcome was related to psychosomatic skill rather than their knowledge or clinical experience. Repeated training improves the performance capability of artificial ventilation better than external chest compression. At least 6 times of training session seemed required for over ninety percents of the students to reach the desired level of competence in these skills. In summary, a state-of-the-art resuscitaion training manikin displayed an objective individual evaluation and also aroused the interest of the students in CPR basic life support teaching.