High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study.

OBJECTIVE: To compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. METHODS: 70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. RESULTS: In the theory test there was an increase in scores in both methodologies (p < 0.001); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). CONCLUSION: The two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study

Abstract Objective: To compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. Methods: 70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. Results: In the theory test there was an increase in scores in both methodologies (p < 0.001 ); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). Conclusion: The two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

Endoscopic Third Ventriculostomy in the Pediatric Population: Case Series Report / Terceiro ventriculostomia endoscópica na população pediátrica: Relato de série de casos

Objective Hydrocephalus is characterized by multi- or uniloculated ventricular dilatation, and there are differences between the etiology and therapeutic response of each type. Endoscopic third ventriculostomy (ETV) is indicated for the treatment of obstructive hydrocephalus, with a reported efficacy between 50% and 76%. Reduced efficacy of the procedure has been demonstrated in communicating hydrocephalus due to multifactorial pathogenesis, and, in patients with myelomeningocele, its efficacy ranges from 15% to 20% at birth. The present study aims to compare the efficacy of ETV in the treatment of congenital obstructive hydrocephalus (COH) and acquired obstructive hydrocephalus (AOH) in the pediatric population. Methods A retrospective study of 169 endoscopic surgeries performed by the senior author in two institutions, one public (Hospital João XXIII, Belo Horizonte, Minas Gerais) and another private (Hospital Felício Rocho, Belo Horizonte, Minas Gerais), in the period from 2003 a 2020. From the selection of 169 patients, only 77 cases fit the age profile12 years of the present study. Of these, 46 were male, and the age range ranged from 10 days to 12 years. The study included multiple etiologies, which were divided into 2 groups, 34 related to COH, and 43 to AOH. Results Regarding the cases of COH, 22 were submitted to ETV as the main treatment, with 14 (63.63%) effective and 8 (36.36%) ineffective procedures. As for the cases of AOH, 13 patients underwent ETV, and 8 (61.53%) procedures were effective, and 5 (38.46%), ineffective. Conclusions Through the calculation of the p-value of 0.49, we concluded that it cannot stated that the efficacy of ETV is greater in COH than in AOH.

Objetivo A hidrocefalia é caracterizada por dilatação ventricular multi ou uniloculada, e há diferenças entre a etiologia e a resposta terapêutica de cada tipo. A terceiro ventriculostomia endoscópica (TVE) está indicada no tratamento da hidrocefalia obstrutiva, com uma eficácia relatada entre 50% e 76%. O procedimento demonstrou eficácia reduzida em hidrocefalia comunicante devido à patogênese multifatorial, sendo que, em pacientes com mielomeningocele, sua eficácia é de 15% a 20% no nascimento. Este estudo visa comparar a eficácia da TVE no tratamento da hidrocefalia obstrutiva congênita (HOC) e hidrocefalia obstrutiva adquirida (HOA) na população pediátrica. Métodos Realizou-se um estudo retrospectivo de 169 cirurgias endoscópicas realizadas pelo autor sênior em duas instituições, uma pública (Hospital João XXIII, Belo Horizonte, Minas Gerais) e outra privada (Hospital Felício Rocho, Belo Horizonte, Minas Gerais), no período de 2003 a 2020. Da seleção de 169 pacientes, apenas 77 casos se enquadraram no perfil de idade 12 anos do presente estudo. Destes, 46 eram do sexo masculino, e a faixa etária variou de 10 dias a 12 anos. O estudo contemplou múltiplas etiologias, que foram divididas em 2 grupos, sendo 34 relacionadas à HOC, e 43, à HOA. Resultados Entre os casos de HOC, 22 foram submetidos a TVE como tratamento principal, sendo que 14 (63,63%) procedimentos foram eficazes, e 8 (36,36%), ineficazes. Já entre os casos de HOA,13 pacientes foram submetidos a TVE, sendo 8 (61,53%) procedimentos eficazes, e 5 (38,46%), ineficazes. Conclusões Por meio do cálculo do valor de p de 0,49, concluiu-se que não se pode afirmar que a eficácia da TVE é maior nas HOCs do que nas HOAs.