ABSTRACT
OBJECTIVE: To evaluate a training program in paediatric critical care for residents in paediatrics. METHODS: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. RESULTS: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6+/-1.2), final score (8.6+/-0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7+/-1.2) and the evaluation by the tutor (6.9+/-0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2+/-1.0) and the practical evaluation by the tutor (6.7+/-0.9). Residents considered the training program as adequate: theoretical education (8.5+/-0.8), resident handbook (9+/-0.9), practical training (8.3+/-1.0), investigation (7.6+/-2.0) and human relationship (9.2+/-0.9). CONCLUSIONS: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents.
Subject(s)
Critical Care , Internship and Residency , Pediatrics/education , Curriculum , HumansABSTRACT
Objetivo: Evaluar los resultados de un programa de formación en cuidados intensivos pediátricos para residentes de Pediatría. Métodos: Se diseñó un programa de formación en cuidados intensivos pediátricos para médicos residentes de Pediatría y se evaluaron los resultados con una prueba teórica escrita inicial y final, una evaluación por el médico responsable, una autoevaluación de los residentes y una encuesta escrita sobre la calidad del programa. Resultados: Desde abril del 1998 hasta agosto de 2009, se incluyeron a 156 residentes en el programa de formación. Los residentes mostraron mejoría entre la evaluación teórica inicial (5,6±1,2) y la final (8,6±0,7) (p<0,001). Un 14,1% contestó correctamente al menos el 70 % de las preguntas de la evaluación inicial y un 96,6 % de la final (p<0,001). La puntuación teórica final fue significativamente más alta que la autoevaluación de los residentes (6,7±1,2) y la evaluación de los tutores (6,9±0,9) (p<0,001). No hubo diferencias entre la autoevaluación práctica de los residentes (5,8±1,3) y la evaluación práctica del tutor (6,7±0,9). Los residentes consideraron adecuado el programa formativo: formación teórica (8,5±0,8), manual de residentes (9±0,9), educación práctica (8,3±1,0), investigación (7,6±2,0) y trato humano (9,2±0,9). Conclusiones: El programa descrito es un método educativo útil para la formación teórica y práctica de los residentes de Pediatría en cuidados intensivos. La evaluación del programa de entrenamiento es esencial para mejorar la formación de los residentes de Pediatría (AU)
Objective: To evaluate a training program in paediatric critical care for residents in paediatrics. Methods: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. Results: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6±1.2), final score (8.6±0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7±1.2) and the evaluation by the tutor (6.9±0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2±1.0) and the practical evaluation by the tutor (6.7±0.9). Residents considered the training program as adequate: theoretical education (8.5±0.8), resident handbook (9±0.9), practical training (8.3±1.0), investigation (7.6±2.0) and human relationship (9.2±0.9). Conclusions: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents (AU)
Subject(s)
Humans , Internship and Residency/methods , Critical Care , Education, Medical/methods , Educational Measurement , Program Evaluation , Curriculum/trendsABSTRACT
Objetivo: A partir de la necesidad de mantener el Sistema de Gestión de Calidad según la norma UNE-EN ISO 9001:2000 de 12 servicios del Hospital General Universitario Gregorio Marañón, la realización de auditorías internas con personal propio, pareció una herramienta útil en la gestión del conocimiento y la mejora continua. El Servicio de Medicina Preventiva y Gestión de Calidad desarrolló un programa de auditorías, que viene implementándose desde los últimos 3 años. Material y métodos: Se realizó un programa de formación de auditores internos, los cuales formaron parte de la bolsa de auditores del hospital. Se consolidó como grupo a los responsables de calidad de los servicios certificados. Se desarrolló un procedimiento de programación y coordinación de auditorías. Se encuestó a los auditores y auditados sobre las dificultades en la realización de las auditorías, incluyendo un apartado para sugerencias, y se redactó para la Dirección un informe global anual con los resultados de auditorías internas y externas, y con las áreas de mejora detectadas en todo el proceso. Resultados: Se han realizado 40 auditorías internas en el Hospital General Universitario Gregorio Marañón desde el año 2007 y se cuenta con 38 personas capacitadas para su realización. El sistema de gestión de calidad ha mejorado en forma de disminución de las «No conformidades» en las auditorías externas, y todos los servicios han mantenido la certificación. Conclusiones: La percepción del personal auditor y de los servicios auditados respecto a la realización de auditorías internas con personal propio es muy positiva. Se han encontrado áreas de mejora y soluciones comunes (AU)
Introduction: The need to maintain a Quality Management System based on the UNE-EN-ISO 9001:2000 standards in 12 Departments of the "Hospital General Universitario Gregorio Marañón" (HGUGM), led us to make the decision to establish an internal audit program using our own personnel as a useful tool for knowledge management and continuous improvement. The Department of "Medicina Preventiva y Gestión de Calidad" developed an Audit Program, which has been implemented in our Hospital during the last three years. Materials and methods: We conducted a training program for internal auditors, who then became part of the hospital audit staff. Quality Managers of the accredited departments were consolidated as a group. A procedure for scheduling and coordination of audits was developed. The auditors and those audited were surveyed on the difficulties in conducting audits, including a section for suggestions, and an annual report was drafted with the results of internal and external audits, as well as the improvement areas identified in the whole process. Results: A total of 40 internal audits have been performed in HGUGM since 2007, and 38 people were trained. The Quality Management System improved in terms of the decreasing number of non-conformances (NC) in external audits, and all services have maintained the certification. Conclusions: The perception of auditors and those audited regarding the performing of internal audits by our own personnel is very positive. There were identified improvement areas and common solutions (AU)
Subject(s)
Humans , 51706 , Clinical Audit/methods , 34002 , /standards , Hospital Units/standards , Knowledge Management for Health Research , Sanitary SupervisionABSTRACT
Este artículo es un claro ejemplo de un Hospital del siglo XXI, donde la prioridad al crear un nuevo Hospital Materno-Infantil era generar, tras la implantación definitiva de las TIC, un Hospital sin papeles sin placa y sin cables; acercándose además al concepto del Hospital sin paredes, orientando a facilitar la asistencia en el domicilio y el acceso a la información desde fuera del hospital por profesionales de otros ámbitos e incluso por pacientes (AU)
This article is a clear example of a Hospital of the 21st Century, where the priority of creating a new Mother-and-Child Hospital was to generate, after the definitive introduction of ICTs, a Hospital without papers, without plates and without cables, also approaching the concept of a Hospital without walls, oriented towards favouring home nursing and the access to information outside the hospital for professionals of other areas and even for patients (AU)
Subject(s)
Humans , Hospitals, Public/organization & administration , Information Technology/methods , Technological Development , Information Services/trends , Home Care Services, Hospital-BasedABSTRACT
Hypernatremia is an electrolyte disturbance most frequently caused by excess water loss and less frequently by increased sodium intake. The few reported cases of severe hypernatremia (> 190 mEq/l) had an adverse outcome with high mortality and/or severe neurologic sequelae. The first case was a 7-year-old girl with renal failure undergoing continuous venovenous hemodiafiltration therapy who presented hypernatremia (216 mEq/l) after incorrect preparation of dialysis fluid. The patient was treated with hemodiafiltration and hypernatremia was resolved in 48 hours. She had a convulsive crisis without subsequent neurologic impairment. The second patient, a 3-year-old girl with pseudohypoaldosteronism type I and encephalopathy, had hypernatremia (203 mEq/l) due to erroneous sodium administration, which was corrected in 36 hours with intravenous fluid therapy. Her neurologic status was unchanged by treatment. We conclude that children with extreme hypernatremia survive without neurologic sequelae if treatment achieves a progressive decrease of natremia.
Subject(s)
Hypernatremia/therapy , Child , Child, Preschool , Female , Humans , Hypernatremia/complications , Hypernatremia/etiology , Treatment OutcomeABSTRACT
La hipernatremia es una alteración hidroelectrolítica debida principalmente a pérdidas aumentadas de agua o aumento de aporte de sodio. Los pocos casos publicados de hipernatremia grave (> 190 mEq/l) presentan elevada mortalidad y/o secuelas neurológicas importantes. El primer caso es una niña de 7 años con insuficiencia renal aguda en tratamiento con hemodiafiltración venovenosa continua que presentó hipernatremia de 216 mEq/l por preparación incorrecta del líquido de diálisis. Fue tratada con hemodiafiltración que se corrigió en 48 h. Presentó una crisis convulsiva aislada sin alteraciones neurológicas posteriores. La segunda paciente, una niña de 3 años con seudohipoaldosteronismo tipo I y encefalopatía, presentó hipernatremia de 203 mEq/l debida a administración errónea de sodio, que se corrigió en 36 h con fluidoterapia intravenosa. Tras el tratamiento presenta un estado neurológico similar al previo. Concluimos que los niños con hipernatremia grave pueden sobrevivir sin secuelas neurológicas, con un tratamiento que consiga un descenso progresivo de la natremia (AU)
Subject(s)
Child, Preschool , Child , Infant, Newborn , Female , Humans , Respiration, Artificial , Treatment Outcome , Respiratory Insufficiency , Algorithms , HypernatremiaABSTRACT
Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.
Subject(s)
Critical Care , Resuscitation Orders , Decision Making , Humans , Intensive Care Units , Life Support Care , Terminal CareABSTRACT
OBJECTIVE: The purpose of this study was to analyze the clinical evolution, acute toxicity and factors which influence the response to nitric oxide treatment in children. PATIENTS AND METHODS: We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT. All patients presented hypoxemia and/or PHT refractory to conventional therapy and were treated with inhaled NO (1.5 to 45 ppm) between 45 minutes to 47 days. We studied the secondary effects, morbidity and mortality, and analyzed the relationship between NO effects and age, sex, diagnosis, infection, previous PaO2/FiO2 ratio, previous oxygenation index and previous mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP). RESULTS: The effect of NO was maintained during the time of administration without tachyphylaxis. There were no secondary effects of NO administration. NO2 was always < 2 ppm and metahemoglobinemia was below 3.5%. There was no relationship between the effect of NO and the rest of the factors analyzed. Twelve patients (48%) survived, 9 of the children with ARDS (53%) and 3 of the children with PHT (38%). Eleven of the 21 patients who improved with NO treatment survived (52%), as did 1 of the 4 patients who did not improve (25%). CONCLUSIONS: Prolonged administration of inhaled NO at low concentrations maintains the improvement of oxygenation and pulmonary hypertension without acute secondary effects. We have not found factors that could predict the clinical response to NO.
Subject(s)
Nitric Oxide/therapeutic use , Respiratory Distress Syndrome, Newborn/drug therapy , Acute Disease , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Respiratory Distress Syndrome, Newborn/mortality , Survival RateSubject(s)
Heart Septal Defects/surgery , Hypertension, Pulmonary/drug therapy , Nitric Oxide/administration & dosage , Postoperative Complications/drug therapy , Vasodilator Agents/administration & dosage , Administration, Inhalation , Combined Modality Therapy , Heart Septal Defects/complications , Humans , Infant , Male , Time FactorsABSTRACT
The intraosseous infusion is an easy technique to learn. The chosen places for infusion are: proximal tibia, distal tibia and distal femur. We have used this technique on thirteen occasions in emergency situations. In all cases, access was achieved in less than one minute. Saline, glucose and Ringer's solutions, sodium bicarbonate, blood, calcium chloride, epinephrine, atropine, succinylcholine, dopamine, dobutamine, isoproterenol, lidocaine and anticonvulsants may be infused. The doses are the same as those used in parenteral access and its efficacy is similar to that of a central venous line. Complications are rare. The most frequent is subcutaneous, and occasionally subperiosteal infiltration. Osteomyelitis appeared in 0.6% of the cases. The intraosseous infusion provides rapid, easy and safe vascular access in emergency situations. Therefore, we believe that this technique should be chosen in pediatric patients.
