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1.
J Pediatr ; 189: 105-112, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28600155

RESUMO

OBJECTIVE: To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. STUDY DESIGN: We queried the Pediatrix Clinical Data Warehouse for all inborn infants without major anomalies born between 23 and 30 weeks' gestation from 2006 to 2015 for a diagnosis of PDA, use of indomethacin or ibuprofen, history of ductal ligation, mortality, and major morbidities. RESULTS: There were 829 091 infants entered in the Clinical Data Warehouse; 61 520 infants from 280 NICUs met our inclusion criteria. The diagnosis of PDA declined from 51% to 38% (P < .001), use of indomethacin or ibuprofen decreased from 32% to 18%, and PDA ligation decreased from 8.4% to 2.9% (both P < .001). During the study period, mortality decreased with no increase in any measured morbidity. Of the 163 sites with data for both periods, 128 (79%) showed a decrease in the diagnosis of PDA, and 132 (81%) showed a decrease in the use indomethacin and/or ibuprofen when 2011-2015 was compared with 2006-2010. Of 103 sites with at least 1 PDA ligation, 85 (83%) showed a decrease in PDA ligation in a similar comparison. CONCLUSIONS: In this large population of infants <30 weeks' gestation from 280 NICUs across the US, there were significant decreases in the diagnosis and treatment of the PDA. Although there was no evidence of increased morbidities, it remains uncertain how these changes may directly affect infant outcomes.


Assuntos
Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Ligadura/métodos , Bases de Dados Factuais , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/terapia , Humanos , Ibuprofeno/uso terapêutico , Indometacina/uso terapêutico , Recém-Nascido , Recém-Nascido Prematuro , Ligadura/estatística & dados numéricos , Estados Unidos
2.
Clin Pediatr (Phila) ; 54(9): 833-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26170418

RESUMO

OBJECTIVE: To test the hypothesis that small group concept mapping of 4 core neonatal topics as part of a fourth-year allopathic medical student elective would improve critical thinking (CT) as measured by the California Critical Thinking Skills Test (CCTST). To describe any correlations between scores on the CCTST and the step 1 and step 2 Clinical Knowledge parts of the United States Medical Licensing Exam. METHODS: Twenty-seven students participated in this pilot study during a 1-month elective. A pretest CCTST, California Critical Thinking Disposition Inventory (CCTDI), and multiple choice knowledge test (MCKT) were completed immediately before the elective began. Four weekly group sessions were held with assigned reading on each of the 4 neonatal topics. Concept mapping was performed in small groups of 4 to 6 students with a group concept map collected at the end of the exercise. A posttest CCTST and MCKT was completed after the 4 group sessions. RESULTS: Pre-CCTST overall score was 83.9 ± 6, and post-CCTST overall score was 85.6 ± 6.9 (P = .57). Pearson correlation of USMLE step 1 and pre-CCTST showed r(25) = .276, P = .164. Pearson correlation of USMLE step 2 CK and pre-CCTST revealed r(25) = .214, P = .482. The precourse MCKT average was 35%, and the postcourse average 50% (P ≤ .001). CONCLUSIONS: A recent meta-analysis confirms this is the first report of a comparison between the increasingly common CCTST and the USMLE. We confirmed that concept mapping is a valid mechanism to teach content knowledge. Although the difference in the CCTST scores was not significant, this study could serve as an important start toward development of a curriculum devoted to teaching content and improving CT. The small number of students may have prevented us from defining a significant impact.


Assuntos
Formação de Conceito , Comportamento Cooperativo , Avaliação Educacional/estatística & dados numéricos , Aprendizagem , Estudantes de Medicina/estatística & dados numéricos , Currículo , Humanos , Projetos Piloto , Estados Unidos
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