Repeatability of PDA diameter measurements on echocardiography.

Diameter of the patent ductus arteriosus (PDA) on transthoracic echocardiography (TTE) is used as a marker of haemodynamic significance. We aimed to assess the intra- and inter-observer variability in PDA diameter in babies born at ≤ 30 weeks' gestation. TTEs for 56 infants were performed by a single neonatologist. Cineloops were stored without measurement annotations. PDAs were measured on 2-dimensional (2D) and Colour Doppler. A second, blinded neonatologist repeated measurements on the same cineloops. The scanning neonatologist repeated measurements at a later date, blinded to original measurements. Inter-observer results showed repeatability coefficients of 1.57 (2D) and 2.18 (Colour), and repeatability index of 73% (2D) and 91% (Colour). Intra-observer results showed repeatability coefficients of 0.99 (2D) and 1.32 (Colour), and repeatability index of 43% (2D) and 49% (Colour).Conclusion: There is significant inter- and intra-observer variability in measurements of PDA diameter, even on the same cineloops. We advise caution when using diameter alone as a marker of haemodynamic significance, and recommend using multiple parameters to determine haemodynamic significance of PDA. What is Known: • PDA is associated with numerous comorbidities such as bronchopulmonary dysplasia, necrotising enterocolitis, intraventricular haemorrhage and mortality. • PDA diameter is commonly measured on transthoracic echocardiography and used as a marker of haemodynamic significance. • A previous, smaller study has shown there may be poor repeatability of PDA diameter measurements in serial echocardiograms. What is New: • There is significant inter-observer variability in 2D and Colour Doppler measurements of PDA internal diameter on TTE in preterm infants. • There is moderate intra-observer correlation of repeated measurements on the same imaging in both 2D and Colour Doppler imaging.

Premature infants with patent ductus arteriosus: Postnatal growth according to type of management.

BACKGROUND: Patent Ductus Arteriosus (PDA) is a common condition, affecting nearly half of infants born before 28 weeks' of gestation, and it has been associated with poor growth. It is not known if different treatment modalities are associated with more profound growth impairment. Our aim was to compare differences in weight gain at 36 weeks' corrected gestational age (CGA) in premature infants that received medical, surgical or conservative management for PDA. METHODS: We retrospectively reviewed notes of 208 infants born under 30 weeks' gestation with a diagnosis of PDA. Gestational age (GA) at birth, birth weight z-score, CGA and weight z-score at 36 weeks' CGA were collected. In our cohort, surgical closure was performed in infants who remained symptomatic after medical or conservative management. RESULTS: Ninety-four infants had medical, 56 surgical and 58 conservative management. Surgically managed infants had a lower median (IQR) GA [24.4 (24.0-26.1) weeks'] than medically [25.4 (24.6-26.5) weeks'] or conservatively managed [26.4 (25.4-28.1) weeks', p < 0.001] infants. There was no difference in birth weight z-scores across the groups. Surgically managed infants demonstrated a greater decrease in weight z-score [-2.24 (-2.89 to -1.53)] compared to medically [-1.79 (-2.45 to -1.35)] and conservatively [-1.57 (-1.99 to -1.28), p < 0.001] managed infants between birth and 36 weeks' CGA. After adjusting for GA at birth, definitive treatment modality was significantly related to change in weight z-score from birth to 36 weeks' CGA (adjusted p = 0.022). CONCLUSION: Premature infants with PDA who were managed surgically had a greater degree of faltering growth compared to those who were treated medically or conservatively.

Simprovisation: A model for student-led simulation.

BACKGROUND: Simulation is well established in medical education, with scenarios designed by faculty members to elicit specific learning outcomes. We describe and evaluate a learner-led style of simulation-based education that puts learners in control of the day. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements. Participants are divided into two groups. They are asked to consider their learning needs and are provided with resources and faculty member support to write two simulation scenarios. Faculty members remain available to guide scenario writing and offer 'micro-teaching' on required topics. The groups then swap and participate in the scenarios written for them by the opposite group. Each scenario is followed by a structured debriefing, providing opportunities for participants to share their learning from the scenarios. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements METHODS: We delivered Simprovisation to 62 participants ranging from fourth-year medical students to junior doctors. We conducted pre- and post-course questionnaire surveys and invited participants to focus groups to discuss their experiences. RESULTS: Our feedback questionnaire shows 100% of 58 respondents found Simprovisation useful, and 95% were able to meet at least two out of three self-determined learning outcomes. Thematic analysis of focus group transcriptions showed that participants valued group-based work and setting their own learning objectives. They found writing simulation scenarios to be challenging, but a valuable source of learning, and reported being more engaged compared with previous simulation study days. CONCLUSIONS: Simprovisation is an innovative style of simulation-based education that allows learners to effectively define and address their own learning needs.