Experiências NE: rede de cardiologia pediátrica da Paraíba

Rede de Cardiologia Pediátrica da Paraíba Experiência de 2012 a 2017

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)

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

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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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.

La formación de los residentes de Pediatría a debate: resultados de la encuesta realizada a pediatras colaboradores docentes en la Comunidad de Madrid / Debate on the training of pediatric residents: results of the survey on pediatricians, teaching collaborators in the Community of Madrid

Introducción: la junta directiva de la Asociación Madrileña de Pediatría de Atención Primaria (AMPap) decidió realizar una encuesta a los socios colaboradores en la docencia de residentes de Pediatría cuatro años y medio después de que fuera publicada la resolución conjunta de los Ministerios de Sanidad y Consumo y de Educación y Ciencia, por la que se establecían los requisitos generales para la acreditación de centros de salud vinculados a unidades docentes acreditadas para la formación de especialistas en Pediatría y sus áreas específicas. Material y métodos: en junio de 2011 enviamos a la lista de correo de nuestra sociedad una encuesta diseñada con la herramienta Google Docs® y dirigida a los socios que fueran asiduos colaboradores en la docencia de residentes de Pediatría. Contestaron a 12 preguntas relacionadas con la ubicación de su centro de trabajo, hospital de referencia, número de residentes que reciben, tiempo de rotación y distribución. Resultados: hemos obtenido 47 respuestas y hemos comprobado que menos de la mitad de los residentes de Pediatría hacen la rotación obligatoria en Atención Primaria (AP). Conclusiones: hemos comprobado cómo, a pesar de que más de la mitad de los pediatras madrileños desarrollan su labor en la AP y de que la Comisión Nacional de la Especialidad ha dado importancia a este hecho planteando una rotación obligatoria de tres meses, solo dos de cada cinco residentes de Pediatría en nuestra comunidad la cumplen. Planteamos la necesidad de que algún pediatra colaborador en la docencia o los coordinadores de pediatras de las Direcciones Asistenciales formen parte de las Comisiones de Docencia de los hospitales o de las nuevas Unidades Multiprofesionales y que la labor docente de los pediatras colaboradores sea valorada curricular y profesionalmente(AU)

Introduction: the board of directors of the Madrid Primary Care Paediatrics’ Association (AMPap) decided to conduct a survey to partner teachers of pediatric residents four and a half years after the joint resolution of the Ministries of Health and Consumer Affairs and Education and Science was published. In this resolution, the general requirements for accreditation of health centers linked to accredited training units for specialists in pediatrics were stablished. Material and methods: in June 2011 a survey designed with Google docs was sent to the mailing list of our society, and directed to partners who were regulars in the teaching of pediatric residents. They answered 12 questions related to their workplace location, reference hospital, number of residents received, distribution, and turnover time. Results: we obtained 47 answers and found that less than half of the pediatric residents do the mandatory rotation in primary care. Conclusions: we have seen that, despite the fact that more than half of Madrid’s pediatricians develop their work in primary care and that the Specialty National Commission gives importance to this fact, hence considering a mandatory rotation of three months, only two out of five pediatric residents in our community met this requirement. We arise the need that a pediatrician teaching collaborator or the Pediatricians Coordinators in care Management take part in the new Multiprofessional Units and that the pediatric teaching collaboration be valued in the curriculum and the profession(AU)

Peds PLACE: quality continuing medical education in Arkansas.

The University of Arkansas for Medical Sciences (UAMS) and Arkansas Children's Hospital (ACH) sponsor Peds PLACE (Pediatric Physician Learning and Collaborative Education), a telemedicine continuing education program. This study assessed to what extent participants were satisfied with Peds PLACE and how to improve it. It was found that 95% of the participants agreed that the presentations related to their professional needs and 98% that it increased their knowledge. In addition, 81% evaluated the presentations as some of the best they have attended and 93% agreed that the information would translate into professional practice and enhance patient care. Comments were positive and correlated with the survey data. Participants recommended several ways to improve Peds PLACE.

Universidades, hospitales y necesidad de pediatras, ¿hay soluciones? / Universities, Hospitals and paediatric needs. Are there solutions?

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Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children.

STUDY OBJECTIVE: We compare the mean tidal volumes per weight and peak pressures generated by the 1- and 2-person techniques of bag-valve-mask ventilation in a pediatric model. METHODS: This was a prospective, descriptive study in which postgraduate year 1, postgraduate year 2, and postgraduate year 3 pediatric residents, postgraduate year 2 emergency medicine residents, pediatric emergency department nurses, transport personnel, and paramedics were asked to perform 1- and 2-person bag-valve-mask ventilation on infant and child manikins. Participants were randomly assigned a partner and performed both techniques. Tidal volume and peak pressure were recorded every 15 seconds for 3 minutes by a blinded assistant. RESULTS: Seventy participants, 10 in each group, completed the study. Overall, for the infant- and child-manikin groups, the 2-person technique generated higher mean tidal volume per weight than the 1-person technique (infant: 7.2 versus 5.9; child: 8.8 versus 6.1). Overall, the 2-person technique generated higher mean peak pressures than the 1-person technique (infant: 27.4 versus 22.0; child: 27.2 versus 21.8). Similar results were found among all provider groups. Paramedics were the only providers able to generate a recommended median tidal volume per weight of 10 mL/kg in the child manikin group when using either technique and were the only providers, when using the 2-person technique, to generate a mean tidal volume per weight of 10 mL/kg in the infant group. CONCLUSION: Two-person bag-valve-mask ventilation provided greater mean tidal volumes per weight and peak pressures in the infant- and child-manikin model compared with the 1-person technique.

La consulta de pediatria i l’adopció / No disponible

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La coordinación entre niveles asistenciales: futuro de la relación entre pediatras / Coordination between levels of assistance: the future of relationship between pediatricians

La coordinación entre pediatras de atención especializada y de atención primaria, es fundamental para alcanzar la satisfacción de médicos y pacientes. Deberán favorecerse las relaciones asistenciales, personales y profesionales, tanto docentes como de investigación (AU)

The pediatric practice of the child health associate.

Child health associates are individuals who have completed the three-year Child Health Associate Program at the University of Colorado School of Medicine and are certified by the Colorado State Board of Medical Examiners to practice pediatrics under physician supervision. To our knowledge, this study is the first to describe the practice profile of child health associates. We found them able to provide health care services without direct physician assistance to 91.4% (2,160 of 2,363) of pediatric patients in ambulatory settings. They saw the same variety of patients as primary physicians and identified a broad range of common pediatric problems. Each supervising physician spent an average time of 5.9 minutes with the child health associate in evaluating the 8.6% of patients who required consultation. The child health associate is fully able to serve as a primary health care practitioner for children.

Evaluation of a child health associate program.

The staff of the University of Colorado Child Health Associate Program critically reviewed the effectiveness of the program's structure and content during an intensive two-day seminar. The review was conducted through workshops involving participants representing students, graduates, faculty, employers, funding agencies, university administrators, and educational consultants. The agenda for the evaluation included workshops on specific topics such as basic and clinical sciences, psychosocial skills, and proficiency testing. Information obtained provided extremely valuable data which were used to improve the program.

Interviewing skills: a comprehensive approach to teaching and evaluation.

Evaluation procedures utilizing standardized interviews scored by means of a formal objective rating system which make it possible to measure the interviewing skills of health professional students have been developed in recent years. These procedures have been used in the Child Health Associate Program at the University of Colorado Medical School to evaluate the ability of a group of students to achieve the objectives of a practice-oriented interviewing course. Results from the standardized interviews indicate that students taking the course gathered an average of 76 percent of all available data and used 86 percent of the process skills defined as necessary for positive interview interaction. A previous group of child health associate students who did not take the course gathered an average of 47 percent of all available data and used an average of 62 percent of the necessary process skills.