La hospitalización domiciliaria del paciente agudo: un nuevo enfoque de cuidados / Home hospitalization of the acute patient: a new approach to care

La hospitalización a domicilio (HAD) pediátrica tiene como objetivo proveer al paciente y a su familia de una alternativa a la hospitalización convencional, de forma segura y eficaz, mejorando la calidad de vida del paciente y su familia. Las patologías más frecuentes en HAD de paciente agudo pediátrico son la patología respiratoria aguda y las infecciones bacterianas que precisan antibioterapia parenteral. El éxito de un programa de hospitalización domiciliaria de paciente agudo recae en la adecuada selección de pacientes y la exhaustiva capacitación de los cuidadores, así como en una buena comunicación y coordinación entre los diferentes servicios y niveles de atención implicados.(AU)

Pediatric hospitalization at home (HAH) aims to provide the patient and his family with an alternative to conventional hospitalization, safely and effectively, improving the quality of life of the patient and his family. The most frequent pathologies in HAH in pediatric acute patients are acute respiratory pathology and bacterial infections that require parenteral antibiotic therapy. The success of an acute patient home hospitalization program relies on the proper selection of patients and exhaustive training of caregivers, as well as good communication and coordination between the different services and levels of care involved.(AU)

Alívio da dor e sofrimento psicológico em oncologias pediátricas: uma revisão sistemática / Pain relief and psychological distress in pediatric oncology: a systematic review / Alivio del dolor y malestar psicológico en oncología pediátrica: una revisión sistemática

Objetivo: identificar intervenções para reduzir dor e sofrimento psicológico nas oncologias pediátricas duranteprocedimentos com agulhas. Método: Conduziu-se uma revisão sistemática entre novembro de 2020 e maio de 2021 nas bases MEDLINE e PsyclNFO. Foram inclusos: estudos primários com intervenções comportamentais e/ou farmacológicas sem restringir idioma ou ano de publicação e exclusos: secundários e duplicatas. Resultados: Após a elegibilidade, 26 estudos formaram a síntese. O contato familiar, palhaçadas médicas, desviar o olhar, musicoterapia, realidade virtual e hipnose foram as principais técnicas psicológicas. Foram considerados eficazes os métodos farmacológicos: fentanil com etomidato, dose baixa oral ou spray nasal de midazolam e xarope de acetaminofeno. A associação de lidocaína e prilocaína com hipnose mostrou-se efetiva, assim como, midazolam associado com jogos de vídeo ou livros musicais. Conclusão: O caminho para a reduzir dor e sofrimento psicológico é um processo complexo e pode haver um sinergismo entre intervenções psicológicas e farmacológicas.(AU)

Objective: to identify interventions to reduce pain and psychological distress in pediatric oncology patients duringneedle procedures. Method: A systematic review was conducted between November 11, 2020 and May 17, 2021 in MEDLINE and PsyclNFO. We included: primary studies with behavioral and/or pharmacological interventions without restricting language or year of publication and excluded: secondary and duplicates. Results: After eligibility, 26 studies formed the synthesis. Family contact, medical clowning, looking away, music therapy, virtual reality and hypnosis were the main psychological techniques. Pharmacological methods were considered effective: fentanyl with etomidate, low dose oral or nasal spray of midazolam, and acetaminophen syrup. The combination of lidocaine and prilocaine with hypnosis was shown to be effective in reducing fear and pain, as well as midazolam associated with video games or music books. Conclusion: The way to reduce psychological pain and suffering is a complex process and there may be a synergism between psychological and pharmacological interventions.(AU)

Objetivo: Identificar intervenciones para reducir el dolor y la angustia psicológica en los pacientes de oncologíapediátrica durante los procedimientos con agujas. Método: Se realizá una revisión sistemática entre el 11 de noviembre de 2020 y el 17 de mayo de 2021 en MEDLINE y PsyclNFO. Se incluyeron: estudios primarias con intervenciones conductuales y/o farmacológicas sin restringir el idioma o el ano de publicación y se excluyeron: secundarias y duplicados. Resultados: Tras la elegibilidad, 26 estudios formaron la síntesis. EI contacto con la familia, la payasada médica, la mirada ausente, la musicoterapia, la realidad virtual y la hipnosis fueron las principales técnicas psicológicas. Se consideraron eficaces los métodos farmacológicos: fentanilo con etomidato, dosis bajas de midazolam por vía oral o nasal y jarabe de paracetamol. La unión de lidocaína y prilocaína con hipnosis resultá eficaz para reducir el miedo y el dolor, así como el midazolam asociado a videojuegos o libras musicales. Conclusión: La forma de reducir el dolor y el sufrimiento psicológico es un proceso complejo y puede haber un sinergismo entre las intervenciones psicológicas y farmacológicas(AU)

Desafios no atendimento à saúde da criança por médicos da Estratégia de Saúde da Família / Challenges in children's health care by physicians in the Family Health Strategy / Desafíos en la atención a la salud infantil por médicos de la Estrategia de Salud de la Familia

Introdução: O atendimento em Saúde da Criança por médicos da Estratégia de Saúde da Família (ESF) fundamenta-se em recomendações do Ministério da Saúde e da Sociedade Brasileira de Medicina de Família e Comunidade. Objetivo: Identificar as dificuldades dos médicos da ESF para ofertarem assistência em Saúde da Criança no município de Patos de Minas/MG, já que a assistência na Atenção Básica (AB) é prestada pela ESF em quase todo o território neste município. Métodos:Foi aplicado questionário estruturado aos 42 médicos que atuam na ESF, com questões específicas relacionadas ao perfil profissional e da equipe da ESF e quanto às ações em Saúde da Criança na anamnese, exame físico, exames laboratoriais e orientações. Resultados: Responderam ao questionário 32 médicos (76%). O principal motivo para estarem na ESF foi o interesse pelo trabalho na AB (78%). As dificuldades mais frequentes relacionadas à equipe foram a falta de realização dos grupos de puericultura (41%) e a ausência da puericultura compartilhada com o enfermeiro (41%). Apontaram que as habilidades clínicas e a abordagem familiar são fatores que dificultam a realização da consulta de puericultura. As dificuldades apresentadas pelos médicos foram quanto às habilidades no exame físico do recém-nascido, principalmente exame dos olhos (59%), audição (63%) e avaliação neurológica (53%). Dentre os testes oftalmológicos a dificuldade variou de 69% para acuidade visual até 94% para o teste de cobertura. Dificuldades relacionadas à estrutura física inadequada e/ou inexistência de equipamento ocorreram para a realização do Teste do Olhinho (34%) e para a aferição de pressão arterial (69%). Dificuldades devidas ao desconhecimento de recomendações do Ministério da Saúde ocorreram com o rastreamento de anemia (16%) e do perfil lipídico (41%). Quanto às orientações 16% dos médicos não abordam as curvas de Índice de Massa Corporal (IMC) com as famílias, assim como 19% não abordam violência na infância. As dificuldades identificadas nos médicos quanto às habilidades clínicas, podem estar relacionadas à qualidade de formação na graduação, assim como à ausência ou ineficácia de educação permanente durante o exercício profissional. Conclusão: A assistência à criança em Patos de Minas apresenta falhas, que estão relacionadas a fragilidades dos médicos, à estrutura física e de equipamentos e às equipes da ESF

Introduction: Child health care by physicians of the Family Health Strategy (FHS) is based on recommendations of the Ministry of Health and the Brazilian Society of Family and Community Medicine. Objective: It is necessary to identify the difficulties of the physicians of the FHS to assist in Child Health in the municipality of Patos de Minas/MG, since the assistance in Primary Care (PC) is provided by the FHS in almost all the territory of this municipality. Methods: A structured questionnaire was applied to the 42 physicians who work at the FHS, with specific questions related to the professional profile and the FHS team in which it is inserted, and regarding child health care actions in the anamnesis, physical examination, laboratory tests, orientations. Results: Answered the questionnaire 32 physicians (76%). The main reason to be in the FHS was interest in the work of PC (78%). The most frequent difficulties were the lack of fulfillment of childcare groups (41%) and the absence of childcare shared with the nurse (41%). Pointed out that clinical skills and family approach are factors that make it difficult to perform childcare appointments. The difficulties presented were related to the skills in the physical examination of the newborn, mainly eye examination (59%), hearing (63%) and neurological evaluation (53%). Among ophthalmologic tests, the difficulty ranged from 69% for visual acuity to 94% for the coverage test. Difficulties related to inadequate physical structure and/or lack of equipment occurred for the Eye Test (34%) and for the blood pressure measurement (69%). Difficulties due to ignorance of recommendations of the Ministry of Health occurred with anemia screening (16%) and lipid profile (41%). Regarding the orientations, 16% of physicians do not address Body Mass Index (BMI) curves with families, and 19% do not approach issues related of violence in childhood. The difficulties identified in physicians regarding clinical skills, may be related to the quality of undergraduate training, as well as the absence or ineffectiveness of permanent education during professional practice. Conclusions: Childcare in Patos de Minas presents flaws, which are related to the frailties of physicians, the physical structure and equipment and the teams of Family Health Strategy.

Introducción: La atención de la Salud Infantil por parte de los médicos de la Estrategia de Salud Familiar (ESF) se basa en las recomendaciones del Ministerio de Salud y de la Sociedad Brasileña de Medicina de Familia y Comunidad. Objetivo: Se hace necesario identificar las dificultades de los médicos de los ESF para realizar el atendimiento de la Salud Infantil en el municipio de Patos de Minas/MG, ya que la asistencia en la Atención Primaria (AP) es proporcionada por el ESF en casi todo el territorio de este municipio. Métodos: Se aplicó el cuestionario estructurado para los 42 médicos que trabajan en los ESF, con problemas específicos relacionados con el perfil profesional y de los equipos de las EFS y las acciones relacionadas con la anamnesis, examen físico, pruebas de laboratorio y orientaciones. Resultados: 32 médicos respondieron el cuestionario (76%). La razón principal para estar en el ESF fue el interés en trabajar en la AP (78%). Las dificultades más frecuentes relacionadas con el equipo fueron la falta de grupos de puericultura (41%) y la ausencia de puericultura compartido con la enfermera (41%). Señalaron que las habilidades clínicas y el enfoque familiar son factores que dificultan la consulta de puericultura. Las dificultades presentadas por los médicos fueron las habilidades en el examen relacionadas con el examen físico del recién nacido, principalmente examen ocular (59%), audición (63%) y evaluación neurológica (53%). Entre las pruebas oftalmológicas, la dificultad varió de 69% para agudeza visual hasta 94% para la prueba de cobertura. Dificultades relacionadas con una estructura física inadecuada y/o falta de equipamientos para realizar la prueba de los ojitos (34%) y medir la presión arterial (69%). Dificultades por desconocimiento de las recomendaciones del Ministerio de Salud se produjo con la detección de anemia (16%) y el perfil lipídico (41%). En cuanto a las recomendaciones, el 16% de los médicos no abordan las curvas del índice de masa corporal (IMC) en las familias, así como el 19% no aborda la violencia en la infancia. Las dificultades identificadas en los médicos con respecto a las habilidades clínicas pueden estar relacionadas con la calidad de la formación de pregrado, así como como la ausencia o ineficacia de la educación permanente durante la práctica profesional. Conclusiones: El cuidado infantil en Patos de Minas tiene fallas, que están relacionadas con debilidades de los médicos, estructura física, equipamientos, y equipos del ESF.

Webpalestra COVID-19 (Coronavírus): orientações e manejo clínico em pediatria

Experiências NE: rede de cardiologia pediátrica da Paraíba

Rede de Cardiologia Pediátrica da Paraíba Experiência de 2012 a 2017

La salut dels professionals sanitaris / No disponible

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Síndrome de Burnout en estudiantes del posgrado de pediatría / Burnout Syndrome in Pediatric Posgraduate students

Antecedentes: El síndrome de Burnout (SB) o síndrome de desgaste profesional, descrito por primera vez en 1974 por el psiquiatra america-no Herbert Freudenberger, como "estado de fatiga o frustración que se produce por la dedi-cación a una causa, forma de vida o relación que no produce el esperado refuerzo". El objeti-vo del estudio fue identi car el síndrome de Burnout en estudiantes del posgrado de pedia-tría de la Universidad Nacional Autónoma de Honduras en el Valle de Sula, que rotaban por el Hospital Nacional Mario Catarino Rivas durante el período de junio 2014 hasta agosto 2016. Pacientes y Métodos: Se realizó un estu-dio cuantitativo, descriptivo, no experimental con los médicos residentes ya descritos. Los datos se obtuvieron de un cuestionario en el cual se evaluaron características sociodemo-grá cas, laborales y propias del síndrome de Burnout además se implementó el instrumen-to Maslach Burnout Inventory (MBI) adaptado al español el cual determina; cansancio emo-cional (CE), despersonalización (DP) y realiza-ción personal (RP), que se han clasi cado en tres niveles: bajo, medio y alto Resultados: Se encuestaron 43 residentes. El 70% (30) presen-tó cansancio emocional alto, 60% (26) tenía niveles altos de despersonalización y 37% (16) presentó niveles bajos de realización personal. Se encontró que el 58% (25) tenían síndrome de Burnout Incompleto, 7% (3) presento Bur-nout completo y 35% (15) no presento el síndrome. Conclusiones: Se determinó que existe el Síndrome de Burnout en los residen-tes de pediatría. El síndrome de Burnout incompleto fue la presentación más frecuente en más de la mitad de los estudiantes...(AU)

Introducción y recuerdo histórico del Hospital Materno Infantil Gregorio Marañón / Introduction and historical memory of the Hospital Materno Infantil Gregorio Marañón

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Pediatric Residents' Perspective on Family-Clinician Discordance in Primary Care: A Qualitative Study.

The engagement of families in health maintenance is associated with better child health outcomes, but demographic discordance between families and clinicians may be a barrier to family engagement. Using a longitudinal qualitative study design, we conducted 15 semi-structured interviews with five pediatric residents who elected to facilitate group well child care (GWCC). Four themes describing residents' perceptions of the role of discordance in family-clinician engagement include: 1) discordance was not a barrier; 2) discordance leads to a lack of engagement and trust; 3) residents transcended discordance in GWCC because either GWCC led residents to change their communication techniques or because, with GWCC, parents have concordant adults in the room; and 4) the education residents obtained in GWCC allowed them to empathize with the families' health-related decisions. Finding ways in which pediatric providers can improve skills in family engagement may be an important step in decreasing health inequities.

Papel de los padres en las urgencias pediátricas: ¿tradición, conflicto o mejoría? / Role of parents in paediatric emergencies: Tradition, conflict or improvement

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¿Ha aumentado la presencia de los padres durante los procedimientos invasivos en urgencias en los últimos años? / Has the presence of parents during invasive procedures in the emergency department increased in the last few years?

INTRODUCCIÓN: En los últimos años los padres están adquiriendo un protagonismo cada vez mayor en los servicios de urgencias pediátricos (SUP), manifestando su deseo de presenciar los procedimientos invasivos (PI) realizados a sus hijos. OBJETIVOS: 1) Comparar la presencia de los padres durante los PI en SUP españoles entre 2008 y 2012; 2) comparar los argumentos para restringir la presencia y los problemas derivados; y. 3) conocer si ha cambiado la opinión del personal sanitario. METODOLOGÍA: Estudio descriptivo multicéntrico comparativo. En 2008 y 2012 se envían 42 encuestas vía correo electrónico a los responsables de SUP españoles, incluyéndose en el estudio los que responden en ambos periodos. RESULTADOS: Veintidós hospitales participan en el estudio. La presencia de los padres en los SUP espa˜noles aumenta entre 2008 y 2012 para todos los PI, significativamente en la analítica sanguínea y en el sondaje vesical. En 2012 los responsables argumentan menos frecuentemente el nerviosismo de los niños, la ansiedad de los padres y el temor del personal a un peor rendimiento para restringir la presencia. En ambos periodos los problemas son ocasionales, disminuyendo el peor comportamiento de los niños. Según los responsables el acuerdo del personal sanitario no ha cambiado en estos años. CONCLUSIONES: La presencia de los padres durante los PI en los SUP ha aumentado en los últimos 4 a˜nos, aunque es aún escasa durante los procedimientos más invasivos. Los responsables argumentan menos problemas conductuales, aunque el grado de acuerdo del personal no ha cambiado, siendo necesario continuar trabajando en el tema

INTRODUCTION: In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed. OBJECTIVES: 1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject. METHODOLOGY: A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study. RESULTS: A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years. CONCLUSIONS: The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue

Factores desencadenantes de insatisfacción e ira en padres de niños atendidos en servicios de urgencias / actors related to dissatisfaction and anger in parents of children treated at paediatric emergency services

OBJETIVOS: La ira en pacientes y familiares durante su estancia en servicios de urgencias ha merecido la atención de investigadores desde hace tiempo. El objetivo del presente estudio es explorar la ira de los padres durante la atención a sus hijos en servicios de urgencias pediátricas, sondeando dimensiones específicas de insatisfacción que pueden predecir la aparición de ira. MATERIAL Y MÉTODOS: Se trata de un estudio descriptivo transversal mediante autoinforme en 711 progenitores de ni˜nos atendidos en servicios de urgencias de pediatría. Los instrumentos utilizados fueron el Inventario de Expresión de Ira Estado-Rasgo -2 (STAXI-2) y la Escala de Satisfacción con los Servicios Sanitarios. Los análisis estadísticos incluyeron análisis descriptivos, correlaciónales, de varianza y de regresión lineal múltiple. RESULTADOS: Un total de 53 progenitores (7,5%) mostraron niveles de ira altos o medios. La puntuación media en satisfacción fue 37.12 (SD = 7.33). Se encontró que mayores niveles de satisfacción global se asociaron significativamente a menores niveles de ira (r = -.29, p = .00). Entre las variables estudiadas, una menor satisfacción con el acceso al servicio (B = -.172, p = .00) y con el personal sanitario (B = -.121, p = .01) y una mayor gravedad percibida del estado de salud del menor (B = .157, p = .00), predijeron mayores niveles de ira. CONCLUSIONES: Es importante continuar trabajando para mejorar el acceso de los pacientes y sus familiares a los servicios de urgencias, los procesos de información y la comunicación con el personal sanitario, entre otras iniciativas

AIM: Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents. MATERIALS AND METHODS: A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models. RESULTS: A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD = 7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r = −.29, p = .00). Among the variables studied, dissatisfaction with access to the service (ˇ = −.172, p = .00), with the healthcare staff (ˇ = −.121, p = .01), and perceived severity of the child's health status ( = .157, p = .00) predicted higher levels of anger. CONCLUSIONS: On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives

Early extracorporeal life support experiences in 2 tertiary pediatric intensive care units in Turkey.

BACKGROUND/AIM: Extracorporeal membrane oxygenation (ECMO) is a unique life-support modality offered to patients unresponsive to optimal medical therapy. The aim of this study was to evaluate early experiences with ECMO support in 2 tertiary Turkish pediatric intensive care units (PICUs). MATERIALS AND METHODS: We retrospectively evaluated a total of 10 ECMO-supported patients between March 2012 and March 2013 in Marmara and Ege University Hospital PICUs. We reported data regarding demographics, laboratory and diagnostic information, and the clinical course of the patients. RESULTS: The study consisted of 6 males and 4 females from 5 months to 14 years of age (mean age: 0.5 ± 5.01 years) supported with ECMO. Out of the 10 patients, 8 were on venovenous ECMO for respiratory failure and 2 received venoarterial ECMO for cardiac failure. Mean ECMO and intensive care duration was 11.1 ± 7.3 days and 23.5 ± 17.8 days, respectively. Bleeding was the most common complication (60%). Forty percent of the patients were weaned from ECMO, among which 50% were discharged in good health without sequelae. CONCLUSION: Initial experiences build the learning curve of institutions, and our early results are encouraging. Giving time to heal to the right patient at the right time is the key to success.

Educación para la salud en pediatría a través de una aplicación para teléfonos móviles / Health education through a pediatric mobile phone application

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Ultrasound-assisted lumbar puncture in pediatric emergency medicine.

BACKGROUND: Ultrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting. OBJECTIVE: To assess whether ultrasound increases provider confidence in identifying an insertion point for lumbar puncture. METHODS: A feasibility study was conducted using a convenience sample of pediatric emergency patients requiring lumbar puncture. Provider confidence in selecting a needle insertion site for lumbar puncture using ultrasound assistance was compared to provider confidence using traditional landmarks alone. A simple technique using a linear probe is described. RESULTS: Nineteen patients were included in the study, with the primary end point the mean confidence score (based on a five-point Likert scale) in identifying a needle insertion site prior to and after using ultrasound. Using the Wilcoxon signed-rank test, the mean confidence score was 2.89 with the landmark procedure alone, and 4.79 with ultrasound assistance, yielding an average score difference of 1.90 (95% confidence interval 1.23-2.56; Wilcoxon p < 0.001, paired t-test p < 0.001). Thus, compared to the landmark procedure, the use of ultrasound was associated with a significantly higher average confidence score. CONCLUSION: The use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.

Pediatric prehospital assistance conducted by the Mobile Emergency Care Service (SAMU) / Assistência pré-hospitalar pediátrica realizada pelo Serviço de Atendimento Móvel de Urgência (SAMU) / Asistencia prehospitalaria pediátrica realizada por el Servicio de Atención Móvil De Urgencia (SAMU)

Objetivo: Descrever o atendimento pré-hospitalar pediátrico realizado pelo Serviço de Atendimento Móvel de Urgência (Samu) no município de Feira de Santana-BA, em 2009. Método: Trata-se de pesquisa quantitativa, retrospectiva e descritiva, baseada nos registros dos atendimentos pediátricos realizados pelo Samu no município de Feira de Santana. Resultados: Foram identificados 372 atendimentos; 43,5% a crianças de 5 a 10 anos; 57,1% das ocorrências foram no domicílio; quedas (28,7%) e atropelamentos (22,9%) foram as causas externas mais comuns; as causas clínicas mais prevalentes foram agravos respiratórios (40,0%) e crises convulsivas (27,9%). Conclusão: O estudo permitiu conhecer a realidade da assistência pré-hospitalar à criança no município, podendo contribuir com políticas públicas voltadas a essa clientela; além disso, colabora com a produção científica relacionada ao atendimento pré-hospitalar infantil, tema pouco explorado nessa população.

Objective: Describe the prehospital pediatric assistance conducted by the Mobile Emergency Care Service (SAMU) in the town of Feira de Santana, Bahia, Brazil, in 2009. Method: This is a quantitative, retrospective, and descriptive research, based on the records of pediatric treatments conducted by SAMU in the town of Feira de Santana. Results: One identified 372 treatments; 43.5% for children from 5 to 10 years; 57.1% of occurrences took place at home; falls (28.7%) and running over cases (22.9%) were the most usual external causes; the most prevalent clinical causes were respiratory problems (40.0%) and convulsive crises (27.9%). Conclusion: The study allowed knowing the reality of pre-hospital assistance for children in the town, and it can contribute to public policies aimed at this clientele; besides, it collaborates to the scientific production related to the prehospital child assistance, a theme poorly explored among this population.

Objetivo: Describir el atendimiento pre-hospitalario pediátrico realizado por el Servicio de Atención Móvil de Urgencia (Samu) en el municipio de Feira de Santana, Bahia, Brasil, en 2009. Método: Esta es una investigación cuantitativa, retrospectiva y descriptiva, basada en los registros de los atendimientos pediátricos realizados por el Samu en el municipio de Feira de Santana. Resultados: Fueron identificados 372 atendimientos; 43,5% a niños de 5 a 10 años; 57,1% de las ocurrencias fueron en el domicilio; caídas (28,7%) y atropellos (22,9%) fueron las causas externas más comunes; las causas clínicas más prevalentes fueron problemas respiratorios (40,0%) y crisis convulsivas (27,9%). Conclusión: El estudio permitió conocer la realidad de la asistencia pre-hospitalaria al niño en el municipio, pudiendo contribuir con políticas públicas dirigidas a esa clientela; además, colabora con la producción científica relacionada con el atendimiento prehospitalario infantil, tema poco explorado en esa población.

Low fidelity, high quality: a model for e-learning.

BACKGROUND: E-learning continues to proliferate as a method to deliver continuing medical education. The effectiveness of e-learning has been widely studied, showing that it is as effective as traditional forms of education. However, most reports focus on whether the e-learning is effective, rather than discussing innovations to allow clinical educators to ask 'how' and 'why' it is effective, and to facilitate local reproduction. CONTEXT: Previous work has set out a number of barriers to the introduction of e-learning interventions. Cost, the time to produce interventions, and the training requirements for educators and trainees have all been identified as barriers. We set out to design an e-learning intervention on paediatric prescribing that could address these issues using a low-fidelity approach, and report our methods so as to allow interested readers to use a similar approach. INNOVATION: Using low-cost, readily accessible tools and applying appropriate educational theory, the intervention was produced in a short period of time. As part of a randomised controlled trial, long-term retention of prescribing skills was demonstrated, with significantly higher prescribing skill scores in the e-learning group at 4 and 12 weeks (p < 0.0001). Feedback was universally positive, with Likert responses suggesting that it was useful, convenient and easy to use. IMPLICATIONS: A low-fidelity approach to designing can successfully overcome many of the barriers to the introduction of e-learning. The design model described is simple and can be used by clinical teachers to support local development. Further research could investigate the experiences of these clinicians using this method of instructional design.