Construyendo buenas conversaciones mediante simulación: impacto percibido tras una formación sobre la comunicación de malas noticias / Building good conversations through simulation: perceived impact after training on bad news communication

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Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares / Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes

OBJETIVO: Identificar similitudes y diferencias en la empatía, en las habilidades de trabajo colaborativo interprofesional, y en las habilidades de aprendizaje médico permanente entre médicos residentes españoles y latinoamericanos que inician su formación especializada en hospitales docentes españoles. DISEÑO: Estudio observacional mediante encuesta. Emplazamiento. Cinco hospitales docentes de la provincia de Barcelona, España. PARTICIPANTES: Médicos residentes, españoles y latinoamericanos, que inician el primer año de los programas de formación médica especializada. Mediciones principales. La empatía mediante la escala Jefferson de empatía médica. La colaboración interprofesional mediante la escala Jefferson de actitud hacia el trabajo colaborativo en equipos medicina-enfermería. El aprendizaje mediante la escala Jefferson de aprendizaje médico permanente. RESULTADOS: En una muestra de 156 residentes, 110 españoles y 40 latinoamericanos, los españoles mostraron una mayor orientación empática que los latinoamericanos (p < 0,05). Por su parte, los extranjeros mostraron puntuaciones más altas en habilidades de aprendizaje médico permanente respecto a sus pares españoles (p < 0,001). En todo el grupo se observó una relación positiva entre la empatía y el trabajo colaborativo (r=+0,47; p < 0,001). Una asociación similar se observó en el grupo de latinoamericanos, entre las habilidades de aprendizaje y las de trabajo colaborativo (r=+0,34; p < 0,05). CONCLUSIONES: Los resultados confirman observaciones preliminares y ponen en evidencia la asociación positiva que existe entre la empatía y las habilidades de trabajo colaborativo interprofesional. En médicos latinoamericanos que inician su formación en hospitales españoles, el mayor desarrollo de las habilidades de aprendizaje médico permanente parece influir positivamente en el desarrollo de otras competencias de interés profesional

OBJECTIVE: To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. DESIGN: Observational study using self-administered questionnaires. Settings. Five teaching hospitals in the province of Barcelona, Spain. Participants. Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. Main measurements. Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. RESULTS: From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (p<.05). On the other hand, Latin-American physicians had the highest scores in lifelong learning abilities (p<.001). A positive relationship was found between empathy and inter-professional collaboration for the whole sample (r=+0.34; p<.05). CONCLUSIONS: These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies

[Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes]. / Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares.

OBJECTIVE: To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. DESIGN: Observational study using self-administered questionnaires. SETTINGS: Five teaching hospitals in the province of Barcelona, Spain. PARTICIPANTS: Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. MAIN MEASUREMENTS: Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. RESULTS: From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (p<.05). On the other hand, Latin-American physicians had the highest scores in lifelong learning abilities (p<.001). A positive relationship was found between empathy and inter-professional collaboration for the whole sample (r=+0.34; p<.05). CONCLUSIONS: These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies.

Grado de cumplimiento, causas de no consecución y recomendaciones para la mejora de los criterios de calidad en la atención de patologías relacionadas con la obstrucción de las vías respiratorias inferiores en servicios de urgencias pediátricos españoles / Degree of compliance with health care quality criteria in the treatment of lower airway obstruction in Spanish pediatric emergency departments, reasons for noncompliance, and recommendations for improvement

Objetivos: Determinar el grado de cumplimiento, las causas de no consecución y recomendaciones para la mejora de los indicadores de calidad (IC) en la atención de los pacientes pediátricos con obstrucción de las vías respiratorias inferiores en los servicios de urgencias pediátricos (SUP) de hospitales españoles. Método: Para determinar el grado de cumplimiento de 5 IC se realizó un estudio descriptivo retrospectivo de una serie de casos con análisis transversal que incluyó a los pacientes menores de 14 años atendidos en 22 SUP los días 1 y 15 de cada mes durante el año 2013; para conocer las posibles causas de no consecución, un estudio tipo encuesta a los responsables de los servicios participantes; y para establecer recomendaciones para mejorar la calidad de atención y realización de los IC, un consenso de un grupo de expertos. Resultados: Se incluyeron 2.935 pacientes con una edad mediana de 2,8 (RIC 1,4-5,1) años. El porcentaje global de cumplimiento fue: valoración de la gravedad (39,8%), valoración del pico de flujo (peak flow) (0,1%), tiempo de demora en atender al paciente con disnea grave (64,4%), determinación de la saturación de oxígeno y frecuencia respiratoria (59,1%) y tratamiento con inhaladores y cámara espaciadora (34,3%). Las causas más frecuentes de no cumplimiento fueron la falta de tiempo y de material y la ausencia de recomendación en los protocolos. Se propusieron como medidas de mejora: revalorar la utilidad del peak flow en los SUP, reformular el criterio tiempo de demora en atender al paciente con disnea grave e incorporar nuevos indicadores, así como plantillas que faciliten el registro de las constantes y la puntuación de la escalas de gravedad. Conclusiones: No se alcanzan los estándares para ningún indicador de calidad siendo las causas de no cumplimiento diversas, por lo que es necesario introducir una serie de medidas para mejorar su cumplimiento (AU)

Objectives: To determine the degree of compliance with health care quality criteria in the treatment of patients with lower airway obstruction in Spanish pediatric emergency departments (PEDs), to explore the reasons for noncompliance, and to make recommendations for improvement. Methods: We carried out a retrospective, cross-sectional study of a series of patients under the age of 14 years to determine the degree of compliance with 5 quality indicators. The patients were attended in 22 PEDs on days 1 and 15 of each month in 2013. We also distributed a questionnaire to chiefs of department to discover possible reasons for noncompliance. Finally, a group of experts followed a process to produce consensus-based recommendations to improve quality of care through compliance with the indicators. Results: We included 2935 patients with a median (interquartile range) age of 2.8 (1.4-5.1) years. The overall rates of compliance were 39.8% for assessment of severity, 0.1% for measurement of peak flow, 64.4% for delay in attending a patient with severe shortness of breath, 59.1% for checking oxygen saturation and respiratory frequency, and 34.3% for treatment with inhalers and a spacer. The most common reasons for noncompliance were lack of time or material and the absence of the recommendation in protocols. The following improvement steps were recommended: reassess the usefulness of peak flow measurement in PEDs, reformulate the criteria for delay in attending patients with severe dyspnea, and adopt new indicators and templates that facilitate the recording of vital constants and scores on severity scales. Conclusions: An acceptable level of compliance was not achieved on any of the health care quality indicators for a variety of reasons. A series of steps should be taken to improve compliance (AU)

[Degree of compliance with health care quality criteria in the treatment of lower airway obstruction in Spanish pediatric emergency departments, reasons for noncompliance, and recommendations for improvement]. / Grado de cumplimiento, causas de no consecución y recomendaciones para la mejora de los criterios de calidad en la atención de patologías relacionadas con la obstrucción de las vías respiratorias inferiores en servicios de urgencias pediátricos españoles.

OBJECTIVES: To determine the degree of compliance with health care quality criteria in the treatment of patients with lower airway obstruction in Spanish pediatric emergency departments (PEDs), to explore the reasons for noncompliance, and to make recommendations for improvement. MATERIAL AND METHODS: We carried out a retrospective, cross-sectional study of a series of patients under the age of 14 years to determine the degree of compliance with 5 quality indicators. The patients were attended in 22 PEDs on days 1 and 15 of each month in 2013. We also distributed a questionnaire to chiefs of department to discover possible reasons for noncompliance. Finally, a group of experts followed a process to produce consensus-based recommendations to improve quality of care through compliance with the indicators. RESULTS: We included 2935 patients with a median (interquartile range) age of 2.8 (1.4-5.1) years. The overall rates of compliance were 39.8% for assessment of severity, 0.1% for measurement of peak flow, 64.4% for delay in attending a patient with severe shortness of breath, 59.1% for checking oxygen saturation and respiratory frequency, and 34.3% for treatment with inhalers and a spacer. The most common reasons for noncompliance were lack of time or material and the absence of the recommendation in protocols. The following improvement steps were recommended: reassess the usefulness of peak flow measurement in PEDs, reformulate the criteria for delay in attending patients with severe dyspnea, and adopt new indicators and templates that facilitate the recording of vital constants and scores on severity scales. CONCLUSION: An acceptable level of compliance was not achieved on any of the health care quality indicators for a variety of reasons. A series of steps should be taken to improve compliance.

OBJETIVO: Determinar el grado de cumplimiento, las causas de no consecución y recomendaciones para la mejora de los indicadores de calidad (IC) en la atención de los pacientes pediátricos con obstrucción de las vías respiratorias inferiores en los servicios de urgencias pediátricos (SUP) de hospitales españoles. METODO: Para determinar el grado de cumplimiento de 5 IC se realizó un estudio descriptivo retrospectivo de una serie de casos con análisis transversal que incluyó a los pacientes menores de 14 años atendidos en 22 SUP los días 1 y 15 de cada mes durante el año 2013; para conocer las posibles causas de no consecución, un estudio tipo encuesta a los responsables de los servicios participantes; y para establecer recomendaciones para mejorar la calidad de atención y realización de los IC, un consenso de un grupo de expertos. RESULTADOS: Se incluyeron 2.935 pacientes con una edad mediana de 2,8 (RIC 1,4-5,1) años. El porcentaje global de cumplimiento fue: valoración de la gravedad (39,8%), valoración del pico de flujo (peak flow) (0,1%), tiempo de demora en atender al paciente con disnea grave (64,4%), determinación de la saturación de oxígeno y frecuencia respiratoria (59,1%) y tratamiento con inhaladores y cámara espaciadora (34,3%). Las causas más frecuentes de no cumplimiento fueron la falta de tiempo y de material y la ausencia de recomendación en los protocolos. Se propusieron como medidas de mejora: revalorar la utilidad del peak flow en los SUP, reformular el criterio tiempo de demora en atender al paciente con disnea grave e incorporar nuevos indicadores, así como plantillas que faciliten el registro de las constantes y la puntuación de la escalas de gravedad. CONCLUSIONES: No se alcanzan los estándares para ningún indicador de calidad siendo las causas de no cumplimiento diversas, por lo que es necesario introducir una serie de medidas para mejorar su cumplimiento.

Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study.

BACKGROUND: How pediatricians manage bronchiolitis and the derived total costs (direct and indirect) in the emergency department (ED) have not been fully characterized. The aim of the present study is to calculate those costs in a European country. METHODS: A prospective and observational study, including 10 EDs of tertiary hospitals throughout Spain and during the bronchiolitis season 2010-2011, was performed. Every ED recruited children on random days of the week (3 days per week; always including one non-working day per every week). Recruitment aimed at a total sample size of 600 children. Direct (diagnostic procedures, time spent in the ED and medication) and indirect costs (work hours lost by parents, babysitting, travels, and meals) were collected. Comparisons between bronchiolitis caused by respiratory syncytial virus (RSV) and non-RSV bronchiolitis, as well as costs across severity categories were performed with the Kruskal-Wallis test. A multiple regression model was built to assess the influence of several of the studied factors on the total costs, including a RSV positive test and episode severity as independent variables; and gender, age, attending nursery school, preterm birth, low birth weight, smoker mother during pregnancy, and current smoker father as covariates. RESULTS: From the 664 recruited children, direct mean costs were €213.2 ± 91.8 and indirect ones were €35.9 ± 55.3; the total costs being €249.2 ± 122.9. Costs were significantly higher in children positive to RSV and rose with increased severity. Those associations were maintained in the multiple regression analysis. CONCLUSIONS: Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.

[Should a more interventionist approach be taken in A and E departments with atypical febrile seizures? Three years' experience in a tertiary hospital]. / Se debe ser más intervencionista en urgencias con las convulsiones febriles atípicas? Experiencia en un hospital terciario durante tres años.

INTRODUCTION: Atypical febrile seizures (AFS) have been related with a higher incidence of severe pathologies of the central nervous system (CNS). Recent studies show a reduction in the prevalence of some of these diseases, a fact that could affect their management. AIMS. To determine the prevalence of severe pathologies of the CNS in patients treated for AFS in A and E departments and to detect any differences between these and patients suffering from AFS that is not associated to any severe pathology. PATIENTS AND METHODS: A retrospective study was conducted by reviewing the medical records of patients diagnosed with AFS between November 2008 and November 2011. RESULTS: Altogether, the sample consisted of 231 episodes of AFS (223 patients), with an average age of 1.7 years (p25-75=1.2-2.3 years), 133 (57.6%) of whom were males. Twelve patients (5.2%; 95% CI=2.7-8.9) were diagnosed with a severe pathology of the CNS. In patients with a severe pathology of the CNS, AFS is on most occasions the first episode (91.7% versus 63%; p=0.036) and more than one diagnostic criterion is present (50% versus 15.1%; p=0.007). Moreover, focal seizures (50% versus 12.8%; p=0.003) or epileptic status (25% versus 5.9%; p=0.041) are more common, and patients present altered levels of awareness that persist after the episode (66.7% versus 31.5%; p=0.002). CONCLUSIONS: Given the fact that the prevalence of severe pathology of the CNS in patients with AFS is low, carrying out complementary tests or admission to hospital on a routine basis are not recommended. Certain characteristics of the episode increase the likelihood of AFS being the manifestation of a severe pathology of the CNS (being a first episode, presenting more than one diagnostic criterion for AFS and being a focal seizure or epileptic status), and should therefore be taken into account in the management of the patient.

Impact of human immunodeficiency virus coinfection on the progression of mother-to-child transmitted hepatitis C virus infection.

Data on mother-to-child transmitted human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection are scarce. A prospective observational study with a cohort of 70 HCV-infected children (13 of whom were HIV/HCV-coinfected; mean follow-up: 7.3 years) is presented. In our series, surrogate markers of disease progression (HCV viremia, maximum alanine aminotransferase values, and spontaneous HCV infection clearance) suggest that the evolution of liver disease in HIV/HCV-coinfected pediatric patients is more aggressive than it is in HCV-only infected children.

Severe head injury among children: computed tomography evaluation as a prognostic factor.

BACKGROUND: The value of neuroimaging in predicting unfavorable events in the outcome of pediatric patients has not been established. Our objectives were to determine clinical characteristics and outcome of severely head-injured children admitted to the pediatric intensive care unit (PICU) of a pediatric third-level university hospital and to evaluate the use of neuroimaging as a prognostic factor of morbimortality in these patients. METHODS: We performed a 9-year retrospective review. We included all patients with severe head injury admitted to the pediatric intensive care unit of our hospital from January 1995 to December 2003 requiring invasive intracranial pressure monitoring. Clinical summaries and imaging studies were reviewed. RESULTS: Data for 156 pediatric patients, aged 1 to 18 years, were collected. We reclassified neuroimaging patterns into 2 groups: those with few imaging findings and those with important lesions. These 2 groups were significantly correlated with initial Glasgow Coma Scale (P < .05). We classified patients into favorable evolution, moderate disability, and unfavorable evolution. Poorer evolution correlated with poorer initial neuroimaging patterns, and these differences were statistically significant (P < .05). CONCLUSIONS: In our group of patients, initial Glasgow Coma Scale was related with the initial neuroimaging pattern, and this relation was statistically significant. Findings in the first and second neuroimaging were useful as prognostic factors in our series.

Intracranial pressure and cerebral perfusion pressure as risk factors in children with traumatic brain injuries.

OBJECT: The authors evaluated the initial intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as prognostic factors in severe head injury in children and tried to determine the optimal CPP range. METHODS: The authors performed a 9-year retrospective review of all patients with severe traumatic brain injuries (TBIs) who required invasive ICP monitoring and were admitted to the pediatric intensive care unit at their institution between January 1995 and December 2003. These patients had Glasgow Coma Scale scores lower than 8 and/or required ICP monitoring due to worsening neurological status or neuroimaging results suggestive of cerebral hypertension. Clinical summaries and imaging studies were reviewed. Data for 156 pediatric patients who ranged in age from 1 to 18 years were obtained. Half of these patients presented with normal initial ICPs (< 20 mm Hg), and a good outcome was achieved in 80% of these children. An unfavorable outcome was observed in more than 60% of patients with an initial CPP lower than 40 mm Hg. The proportion of patients with an unfavorable outcome decreased to 10% with initial CPPs higher than 60 mm Hg, but patients with initial CPPs higher than 70 mm Hg did not improve. CONCLUSIONS: Initial ICP and CPP measurements were useful as prognostic factors in pediatric patients with severe TBIs: patients with initial CPPs between 40 and 70 mm Hg were found to have a better neurological prognosis than those with CPPs either higher or lower than that range.