High-fidelity simulation versus video-based learning in the management of pediatric septic shock: a pilot study.

High-fidelity simulation (HFS) and video-based learning (VBL) promote competence in acute care in a realistic and safe environment. These two modalities have not been compared in pediatric emergency situations. Interns rotating in the pediatric department were randomized for the two educational methods. The delivered learning subject was septic shock in children. The level of knowledge was measured before intervention, immediately after intervention (post-test 1) and 1 week later (post-test 2). Knowledge test scores improved significantly following intervention in both VBL study group and HFS study group (71.5 ± 13.2 [39.0-88.0], p < 0.001 and 80.1 ± 10.3 [57.4-94.5], p < 0.001, respectively). The improvement was significantly higher in HFS study group (p = 0.04). There was a non-significant drop in the retention score evaluated by the post-test 2 in the two groups compared to the post-test 1 score (66.9 ± 15.4 [31.5-86.1], p = 0.17 and 78.8 ± 12.4 [56.0-100.0], p = 0.72 in the VBL and HFS study groups, respectively). The retention score was significantly higher in the HFS group (p = 0.04).Conclusion: High-fidelity simulation and video-based training are both effective educational methods in teaching pediatric emergencies for interns. HFS appears to be superior in enhancing short-term retention. What is Known: • High-fidelity simulation is an effective educational tool to improve learners' knowledge and skills. • Video-based learning is an effective teaching tool in terms of short-term knowledge acquisition. What is New: • High-fidelity simulation is more effective in terms of short-term knowledge and generated more satisfaction than educational video learning.

Adrenal insufficiency in severe West Nile Virus infection.

OBJECTIVE: To explore adrenal function in severe West Nile virus (WNV) infection. DESIGN AND SETTING: Prospective interventional cohort study in a medical ICU of a teaching hospital. PATIENTS: Ten consecutive patients (seven men, mean age 64+/-12years, mean SAPS II 26+/-6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39+/-1 degrees C) and altered mental status (mean Glasgow Coma Score 11+/-2). Mean SOFA score was 9+/-2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation. INTERVENTIONS: A short corticotropin test was performed in each patient to assess the adrenal function. MEASUREMENTS AND RESULTS: Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 microg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 microg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 microg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived. CONCLUSION: Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.