The Development of a Simulated Umbilical Line Insertion Model and Curriculum in the Neonatal Intensive Care Unit.

Background Insertion of an umbilical venous catheter (UVC) is a required skill for pediatric residents to learn and perform effectively. However, there is known variability in the ability of residents to perform this essential neonatal skill. Objective The objective of our study was to create a competency-based curriculum for umbilical vein catheter insertion using a human umbilical tissue simulated model, and to assess the feasibility of the curriculum on resident learners during their neonatology rotations. Methods We evaluated the curriculum by assessment of resident learning, reactions, and behaviours. Performance was assessed using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Results A total of 14 residents were included for analysis. The majority were 'senior' residents (postgraduate year (PGY)-3 and PGY-4 n = 10; PGY-1 n =4), and they reported a wide range of previous experience with UVC insertion prior to this curriculum implementation. The residents' reaction to the curriculum was overwhelmingly positive. All residents maintained or improved in their knowledge assessment. O-SCORE results showed improvement in UVC insertion before and after curriculum completion for both junior (2.5 +/- 0.71 to 4.5 +/- 0.41) and senior (3.55 +/- 0.42 to 4.95 +/- 0.15, p < 0.001) residents. The mean improvement in O-SCORE was greater for junior residents than senior residents. Conclusion The results of this study demonstrate the feasibility and emerging impact of a competency-based curriculum using simulation for procedural skills.

Recognizing and responding to parental mental health needs: What can we do now?

Early daily interactions in a child's life, frequent and positive, are crucial to optimal human development. The negative effects of maternal depression may include her perception of the child, the child's cognitive development and future antisocial behaviour. Emerging research investigating paternal depression is also concerning. Signs of maternal depression can be observed through either an intrusive or withdrawn maternal-infant interaction. The particular role of poverty, which affects so many Canadian families, is highlighted. Furthermore, the benefits and risks of screening for parental depression are discussed. Approaches available to the physician to address this issue using available resources are outlined.

Des interactions quotidiennes précoces fréquentes et positives dans la vie d'un enfant sont essentielles à son développement optimal. Les effets négatifs de la dépression de la mère peuvent inclure sa perception de l'enfant, le développement cognitif de l'enfant et un comportement antisocial plus tard. Des recherches émergentes sur la dépression du père sont également préoccupantes. Les signes de dépression de la mère peuvent se manifester par une interaction intrusive ou distante avec le nourrisson. Les auteurs soulignent le rôle particulier de la pauvreté, qui touche tant de familles canadiennes. Ils abordent aussi les avantages et les risques du dépistage de la dépression des parents et présentent les approches à la disposition des médecins pour sonder ce problème.

Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study.

AIMS: Plasma renin activity (PRA) has been proposed as an independent predictor of cardiovascular (CV) risk, but there are limited data from large prospective studies, particularly in patients with stable vascular disease and/or diabetes, without heart failure. METHODS AND RESULTS: We evaluated the predictive value of PRA as a marker of CV events and mortality in a large population of patients with stable chronic vascular disease and/or diabetes and one CV risk factor. Baseline PRA was measured in 2913 patients enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study. Subjects were followed for a median of 4.5 years. Compared with the referent lowest fifth, subjects in the highest fifth of the PRA distribution had a hazard ratio (HR) of 1.38 (95% confidence interval, 1.03-1.86; P = 0.03) for the composite of major vascular events, with an HR of 1.89 for CV death. These associations remained statistically significant after full adjustment for clinical characteristics, background use of ß-blockers, diuretics, allocation to ramipril, in addition to inflammatory biomarkers, high-sensitivity C-reactive protein, and N-terminal pro-brain natriuretic peptide. CONCLUSION: High PRA is an independent predictor of major vascular events and mortality in a stable population of high-risk patients with atherosclerosis and/or diabetes. Although an increase in PRA could be a marker of more intense antihypertensive therapy, our results suggest that PRA may represent a risk marker and potential target for therapy in high-risk patients with atherosclerosis and/or diabetes.