Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest

ObjectiveTo measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams.MethodsThirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss’ kappa coefficient (K).ResultsUnanimous agreement between professionals was present in 40% (95%CI: 28–54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55–0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57–0.77) and scientists (K = 0.62; 95%CI: 0.54–0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14–0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07–0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89–95%) of duplicate SSEPs were interpreted consistently.ConclusionDespite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age.SignificanceClinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.     

Family-centered communication: A pilot educational intervention using deliberate practice and patient feedback

ObjectiveThere are few opportunities in medical education dedicated to learning skills for effective communication in life altering patient scenarios. We therefore aimed to develop and assess a longitudinal advanced communication curriculum for pediatric residents using patient feedback and deliberate practice.MethodsPediatric residents at a large academic center were randomized into 2 groups. The intervention group received 6 educational sessions from 2019 to 2020, parent feedback of performance via the Communication Assessment Tool (CAT), and monthly communication tips. Communication skills of both groups were assessed at the end of the intervention.ResultsWe collected 937 CAT assessments on 36 first-year residents. The intervention group demonstrated statistically significant improvement in communication skills from pre to post assessment (p = 0.0063, (odds ratio (OR) 1.76, 95 % confidence interval (CI) [1.17, 2.63]) compared to the control group (p = 0.080, OR 1.41, 95 % CI [0.96, 2.05]).ConclusionsThere are patient and self-identified performance gaps in communication skills for pediatric residents, underscoring the need for formalized curricula dedicated to these skills.Practice implicationsOur study highlights the value of deliberate practice and the integration of family feedback as an educational tool in communication skills development.     

Evaluación de competencias en residentes de pediatría en el primer nivel de atención mediante la utilización del Mini-CEX

BackgroundA residency is a professional training system based on supervised clinical practice. The Mini Clinical Evaluation Exercise (Mini-CEX) is a method of assessment through direct observation that enables the design of strategies to improve professional performance.The purpose of this study is to analyze the results of implementing the Mini-CEX to assess pediatric residents during their rotation at the first level of care while exploring differences according to the training site to which they belong.MethodsWe conducted an analytical cross-sectional study that included 2nd-year pediatric residents on rotation at the first level of care in pediatric and general hospitals. Each resident underwent two Mini-CEX encounters for the assessment of 8 domains: history taking, communication skills with patients and with caregivers, physical examination, clinical judgment, clinical management, professionalism, and organization.ResultsThirty-four residents participated in the study. The total overall rating of residents from pediatric hospitals and general hospitals was 4.20 (4.07-4.34) and 4.14 (3.94-4.34), respectively. We found no statistically significant differences in the areas assessed according to the residents’ training site.ConclusionThe Mini-CEX as an assessment tool within the first level of care allowed the detection of strengths and weaknesses in residents’ training. Implementation was affected by limitations inherent to this setting. Standardization of assessors was a key element for criteria unification.     

模拟演练干预对儿科实习护生应对医院暴力能力的影响

目的 探讨模拟演练干预在儿科实习护生应对医院暴力能力中的应用效果。方法 采用随机数字表法将在儿科实习的68名护生随机分为观察组和对照组,每组34例,对照组采用常规护理教学方式,观察组在对照组基础上实施模拟演练干预。干预1个月后,采用模拟教学评价量表、实习护生工作场所暴力管理能力量表对其进行效果评价。结果 干预后观察组儿科实习护生模拟教学评价量表总分及各维度得分、实习护士工作场所暴力管理能力量表总分及各维度得分均高于对照组(P<0.001)。结论 模拟演练干预方法能够有效提高儿科实习护生应对医院暴力能力,同时也提高了儿科护理教学水平,护生满意度上升。     

儿童闭塞性细支气管炎的核素肺灌注/通气显像研究

目的 了解闭塞性细支气管炎(BO)患儿的核素肺V/Q显像表现及该项检查在BO患儿临床诊断、病情评估、预后判断方面的价值.方法 前瞻性分析2005年2月至2011年4月在首都医科大学附属北京儿童医院呼吸感染中心确诊的30例BO患儿(男18例,女12例,年龄7个月～ 14岁)的核素肺V/Q显像资料,对不同病情和不同预后的BO患儿分别加以分析,比较其各自累及的肺段数.结果 30例BO患儿肺灌注显像异常25例(83.3％),肺通气显像异常27例(90.0％).异常肺V/Q匹配者13例(48.1％),不匹配者1例(3.7％),反向不匹配者13例(48.1％).3例轻度病情患儿中,1例肺V/Q显像正常,另2例仅1个肺段受累.10例中度病情患儿肺灌注显像异常平均累及3.7个肺段,肺通气显像异常平均累及5.6个肺段.17例严重病情患儿平均6.0个肺段肺灌注显像异常,平均8.2个肺段肺通气显像异常.30例患儿出院后随访到24例,其中8例病情加重患儿肺灌注显像异常累及肺段数量及受损程度明显高于16例复查好转患儿.结论 BO患儿的肺V/Q显像呈现肺段性、多发性肺灌注和(或)通气稀疏或缺损.该显像方法对BO患儿的临床诊断、病情评估及预后判断有重要意义.     

Lengthier cryoablation and a bonus cryoapplication is associated with improved efficacy for cryothermal catheter ablation of supraventricular tachycardias in children

Introduction Cryoablation is an effective treatment for children with supraventricular tachycardias (SVT). The present study documents the effect of two different cryoablation protocols on acute and chronic success rates. Methods and results Fifty-three consecutive patients (age range, 5–20 years) were treated; patients 1 to 17 were treated by a standard ablation protocol and patients 18 to 53 were treated by a modified ablation protocol that required lengthier cryoablations plus delivery of a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention. Electrophysiological study (EPS) was performed with diagnostic catheters and cryoablations were performed with a 7FR 4 mm tip catheter (CryoCath Technologies). Acute endpoints for non-inducibility of atrioventricular nodal re-entrant tachycardia (AVNRT) by programmed atrial stimulation at baseline or during isoproterenol performed 30 min post procedure, as well as non-inducibility and conduction block over the accessory pathway (AP). The chronic endpoint was arrhythmia recurrence post intervention. No permanent cryo-related complications or adverse outcomes were reported. Acute success rates for patients 1 to 17 and 18 to 53 were 88 and 100%, respectively. The cumulative percentage of patients without arrhythmia recurrence at 12 month follow-up was significantly different at 73 and 90%, respectively. Conclusions Lengthier cryoablation delivery, approximating 7 min per cryoablation, increases the acute success rate at intervention. Moreover, these lengthier cryoablation deliveries plus a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention may also significantly improve the chronic success rate, while also maintaining an excellent safety profile for cryoablation treatment of children with SVT such as AVNRT and AP located near the AV junction.     

Blunted muscle responsiveness to insulin in the neonatal rat

Peripheral muscle responsiveness to insulin was studied in neonatal rats in vivo by measuring net incorporation of radiolabeled glucose to glycogen in diaphragm. D(U-¹⁴C) glucose, 0.03 μCi/g rat pup weight, was injected i.p. with or without (control) insulin 5000 μU/g rat pup weight into pups from 86 litters of Sprague-Dawley rats as well as into 16 adult rats by the technique of Rafaelson. Diaphragms were excised after a 30-min in vivo exposure at birth, 24, 48, 72, or 168 hr of age and in the adult rats. Insulin increased net incorporation of radiolabeled glucose into diaphragm glycogen in comparison to age-matched controls (p < 0.025). The percent stimulation by insulin of labeled glucose into diaphragm glycogen was low at birth (250%) and at 24 hr (200%), but increased with advancing age and approached adult levels by 168 hr (1270%). At birth and at 24 hr, a 5-log insulin dose-response curve showed significant net incorporation only at 5000 μU insulin/g rat pup weight; by 72 hr a significant increase was noted at 50 μU insulin/g rat pup weight. Muscle glycogen concentration was high at birth ($\text{1.22 mg}\text{100 mg tissue}$), fell to 50% of the birth value from 24 through 168 hr, and could not account for the decreased insulin response noted. Decreased uptake of deoxyglucose into diaphragm in vivo paralleled the reduced net incorporation of radiolabeled glucose into diaphragm glycogen during the time period studied. The data are interpreted to indicate a blunted responsiveness of skeletal muscle to insulin during the first 48 hr in rats, which is related to decreased sensitivity of hexose transport to insulin.