U.S. attitudes and perceived practice for noninvasive ventilation in pediatric acute respiratory failure.

OBJECTIVE: Few pediatric studies exist regarding the use of noninvasive positive-pressure ventilation for acute respiratory failure; however, those that do suggest a role. This study seeks to describe attitudes and perceived practices of pediatric intensivists regarding the use of noninvasive positive-pressure ventilation in children with acute respiratory failure. DESIGN: Electronic survey. SETTING: Medical institutions. PARTICIPANTS: Of the 932 physicians approached, 353 (38%) responded to the survey. Respondents included U.S. physicians practicing pediatric critical care (90%), pediatric anesthesia critical care (4%), pediatric pulmonary critical care (4%), and other disciplines (2%). INTERVENTIONS: Survey. MEASUREMENTS AND MAIN RESULTS: The survey contained questions regarding 1) practitioner demographics, 2) patient characteristics, and 3) clinical cases designed to assess noninvasive positive-pressure ventilation use in certain patient scenarios. Noninvasive positive-pressure ventilation was used by 99% of the respondents, with 60% using noninvasive positive-pressure ventilation as initial support >10% of the time. Respondents reported use of noninvasive positive-pressure ventilation for acute respiratory failure in lower airway disease (70%), asthma (51%), acute lung injury/acute respiratory distress syndrome (43%), and upper airway obstruction (31%). In clinical scenarios, respondents reported that the factors associated with nonuse of noninvasive positive-pressure ventilation as initial support were disease process (31%), oxygenation (19%), ventilation severity (15%), expectation that the patient was likely to worsen (12%), and age or inability to cooperate (11%). CONCLUSIONS: Noninvasive positive-pressure ventilation is widely used and most frequently utilized in patients with acute lower airway disease. Factors such as severe defects in oxygenation and ventilation, disease progression, and patient tolerability decreased the likelihood of use. These findings may help direct further studies of noninvasive positive-pressure ventilation in children with acute respiratory failure.

Evaluation of a tool to teach medical students direct ophthalmoscopy.

INTRODUCTION: With declining exposure to the ophthalmologic examination in medical school, medical students and their instructors need a simple, effective method for teaching direct ophthalmoscopy. OBJECTIVE: Evaluation of canisters as direct ophthalmoscopy teaching aids for medical students. METHODS: Two ounce plastic canisters were designed to simulate an eye with 35 mm fundus photographs placed at the base and an 8mm hole drilled in the center of the cap to simulate a dilated pupil. These tools were used as an optional supplement to the instruction of ophthalmoscopy. Participants included 102 second-year medical students from the Medical College of Wisconsin and 11 residents and instructors from The Eye Institute in Milwaukee, Wis. RESULTS: Effectiveness and ease of use of the canisters were assessed by analyzing questionnaires completed by the medical students and instructors. According to 76% of students and 93% of instructors, the canisters "supplemented their learning/teaching." Most students (90%) and instructors (88%) found them "easy to use." CONCLUSION: This device is a simple and effective tool for teaching direct ophthalmoscopy to medical students.

A survey of inner city youth and their parents about participation in sports.

BACKGROUND: Several studies have explored motivating factors for sports participation for youth, but limited data is available regarding factors motivating inner-city children to participate in sports. METHODS: A consecutive sample of parents (n=100 parents) and children (n=138 children) attending a health fair in an inner-city community were surveyed regarding motivating factors for enrolling in a team sport (or enrolling their child in a team sport). Parents and children indicated the importance of 10 factors (1=not very important to 4=very important) on separate but similar written surveys. RESULTS: "Developing healthy habits" and "Becoming physically fit and healthy" received the highest mean rankings from both parents and children. "Helping my child gain or lose weight" received one of the lowest rankings from parents. CONCLUSIONS: To encourage sports participation by inner-city children, health care professionals and others should emphasize identified motivational factors for children and their parents.

The Medical College of Wisconsin Senior Mentor Program: experience of a lifetime.

The Medical College of Wisconsin (MCW) Senior Mentor Program (SMP) has been offered to a small group of first and second year medical students as a course alternative to the traditional physician mentor program. The program links students with healthy older adult mentors and includes mentor/student visits, didactic sessions, written assignments, and shadowing experiences. The goals of the course are to increase positive attitudes about aging and geriatrics and to teach basic assessment and interviewing skills in geriatric content areas. A course evaluation including questionnaires, focus groups, and content analysis found that students experienced positive attitude change about geriatric patient care, increased knowledge about geriatrics, and satisfaction with the mentor/student relationship. Students have reported gains in their knowledge of geriatric and gait assessment, ADL evaluation, and mental health screening, among other issues. Further, students report being excited, more comfortable, and less fearful caring for and interacting professionally with older adults as a result of the SMP. The SMP is an effective and meaningful method of geriatric education for preclinical students. It may be an alternative at medical schools that cannot support a large-scale multi-year senior mentor program.