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.

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil.

BACKGROUND: In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day. METHODS: This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6-18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day. RESULTS: At baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8-13.6 years). In the sample as a whole, there were significant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF25-75%), when calculated as percentages of the predicted values. However, the z-score for FEF25-75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV1% (p = 0.004). CONCLUSIONS: The fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25-75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

Asthma and allergic rhinitis co-morbidity: a cross-sectional questionnaire study on adolescents aged 13-14 years.

AIMS: There is scarce epidemiological population-based data on the prevalence of asthma and allergic rhinitis (AR) co-morbidity in adolescents. The aim was to verify asthma and AR prevalence rates in order to emphasise asthma/AR co-morbidity. METHODS: Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in adolescents aged 13-14 years, chosen randomly from public schools in Belo Horizonte, Brazil. RESULTS: A total of 3262 students were identified, 3083 (47.3% males) of whom completed the questionnaire (response rate 94.7%). The prevalence of symptoms related to asthma and AR co-morbidity was 8.4% (95% CI, 8.09-10.25). Among asthmatic adolescents, symptoms of AR were reported in 46.5% (95% CI, 42.60-52.08%). CONCLUSIONS: There is a high prevalence of adolescent asthma and AR co-morbidity in this area of Brazil. This co-morbidity is an important health issue that requires strategic application of primary health care facilities to achieve adequate control of both asthma and allergic rhinitis.