Simulation in pediatric anesthesiology: current state and visions for the future.

PURPOSE OF REVIEW: Simulation is a well established practice in medicine. This review reflects upon the role of simulation in pediatric anesthesiology in three parts: training anesthesiologists to care for pediatric patients safely and effectively; evaluating and improving systems of care for children; and visions for the future. RECENT FINDINGS: Simulation continues to prove a useful modality to educate both novice and experienced clinicians in the perioperative care of infants and children. It is also a powerful tool to help analyze and improve upon how care is provided to infants and children. Advances in technology and computational power now allow for a greater than ever degree of innovation, accessibility, and focused reflection and debriefing, with an exciting outlook for promising advances in the near future. SUMMARY: Simulation plays a key role in developing and achieving peak performance in the perioperative care of infants and children. Although simulation already has a great impact, its full potential is yet to be harnessed.

The intersection of pediatric anesthesiology and social determinants of health.

PURPOSE OF REVIEW: There is increasing evidence of racial and ethnic disparities in pediatric perioperative care, which indicates a need to identify factors driving disparities. Social determinants of health (SDOH) play a fundamental role in pediatric health and are recognized as key underlying mechanisms of healthcare inequities. This article summarizes recent research exploring the influence of SDOH on pediatric perioperative outcomes. RECENT FINDINGS: Despite the scarcity of research exploring SDOH and pediatric perioperative outcomes, recent work demonstrates an association between SDOH and multiple outcomes across the perioperative care continuum. Measures of social disadvantage were associated with preoperative symptom severity, longer hospital stays, and higher rates of postoperative complications and mortality. In some studies, these adverse effects of social disadvantage persisted even when controlling for medical comorbidities and clinical severity. SUMMARY: The existing literature offers compelling evidence of the impact of SDOH on perioperative outcomes in children and reveals a critical area in pediatric anesthesia that necessitates further exploration and action. To improve outcomes and address care inequities, future efforts should prioritize the integration of SDOH assessment into pediatric perioperative research and practice.

Advances in pediatric perioperative care using artificial intelligence.

PURPOSE OF THIS REVIEW: This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS: The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY: The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.

Situación actual de la formación sanitaria especializada en pediatría y sus áreas específicas: retos y necesidades / Current situation of Specialized Health Training in pediatrics and its specific areas: challenges and needs

El desarrollo de las subespecialidades pediátricas constituye uno de los hechos más destacados de la pediatría de nuestro país desde mediados del siglo XX. La formación sanitaria especializada (FSE) en pediatría está actualmente basada en la orden SCO/3148/2006, de 20 de septiembre, por la que se aprueba y publica el programa formativo de la especialidad de pediatría y sus áreas específicas. Es un programa formativo estructurado en cuatro años que consigue formar al residente en las competencias necesarias de la pediatría, incluyendo la formación en unas competencias transversales, una formación en pediatría general y debe incluir además la formación en las diferentes áreas específicas. En 1995, el Consejo Nacional de Especialidades Médicas aprueba el concepto de área de capacitación específica (ACE). En Pediatría las ACE son necesarias para garantizar una adecuada asistencia sanitaria a la población infanto-juvenil, al mismo nivel que la medicina del adulto, asegurando mediante una formación reglada, una asistencia de calidad y uniforme. Se trata de dar un reconocimiento oficial a lo que hoy en día es una realidad asistencial en los hospitales españoles, en cualquier Comunidad Autónoma. (AU)

The development of pediatric subspecialties constitutes one of the most outstanding events in pediatrics in our country since the mid-20th century. The specialized health training (SHT) in pediatrics is currently based on order SCO/3148/2006, of September 20, which approves and publishes the training program for the specialty of pediatrics and its specific areas. It is a training program structured in 4 years that manages to train the resident in the necessary skills of pediatrics, including training in transversal skills, training in general pediatrics and must also include training in different specific areas. In 1995 was approved the specific training area (STA). In pediatrics, STAs are necessary to guarantee adequate health care for the child and adolescent population, at the same level as adult medicine, ensuring through regulated training, quality and uniform care. We want to give official recognition to what today is a healthcare reality in all the Spanish hospitals. (AU)

Incremento de la rotación del residente de pediatría por el centro de salud, ¿una opción para mitigar la crisis de la pediatría de atención primaria? / Increasing rotation of the pediatric resident in primary care is an option to mitigate the crisis in primary care pediatrics?

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Impacto de la gamificación en el aprendizaje sobre administración de fármacos en pediatría en estudiantes del grado en enfermería / Impact of gamification on learning of the administration of pediatric medication by nursing degree students

Introducción: La motivación con la que afronta el aprendizaje el alumnado es un aspecto clave que todo docente universitario debe tener en consideración.Objetivos: Analizar la eficacia de un seminario estructurado mediante metodología de gamificación en estudiantes del grado de enfermería durante su formación clínica en unidades hospitalarias pediátricas y determinar el grado de satisfacción con la actividad llevado a cabo.Métodos: Participaron un total de 244 estudiantes de 4º curso del Grado en Enfermería y 50 enfermeras tutoras clínicas de un centro hospitalario. Se llevó a cabo un test pre y post seminario. El caso constó de tres fases: una relacionada con las actividades al ingreso en una Unidad de Cuidados Intensivos, la segunda con el cálculo de medicación pediátrica y la tercera con los cuidados de enfermería a aplicar. Para valorar la eficacia en relación a la práctica clínica se elaboraron dos encuestas ad hoc, una dirigida a los estudiantes y otra a enfermeras asociadas docentes y/o tutoras clínicas. También se administró una encuesta de satisfacción.Resultados: La puntuación media obtenida en el pre test teórico fue de 9,1 puntos sobre 10 y, en el post test, de 9,73. Las tres preguntas relacionadas con el nivel de conocimientos, autoconfianza y seguridad del alumnado obtuvieron las siguientes puntuaciones: 4,09, 4,83 y 3,99 puntos sobre 10 pre seminario versus los 7,71, 7,75 y 7,21 puntos post seminario, observándose significación estadística (p<0.001). Se obtuvo significación estadística en las preguntas que relacionaban la “consecución de objetivos docentes en áreas asistenciales” (enfermero/a) y la de “adquisición de competencias clínicas específicas” (alumnado), p=0.04. El grado de satisfacción global fue de 8,66±1,43 puntos.Conclusiones: La gamificación es una metodología docente eficaz muy bien valorada por parte de las estudiantes, considerándola de gran utilidad. (AU)

Background: The motivation of students in their approach to learning should be a matter of concern to all university instructors.Aims: To analyze the effectiveness of a structured seminar using gamification methodology with nursing degree students during their clinical training in pediatric hospital units, and to determine their level of satisfaction with the activity as carried out.Methods: A total of 244 fourth-year nursing degree students participated, along with 50 nurse clinical tutors from a hospital. A pretest and a post-test were administered. The case had three stages: one related to activities at the time of patient admission to the pediatric intensive care unit, a second involving the calculation of pediatric medication dosages, and a third involving the nursing care to be given. Two ad hoc surveys were used to assess the effectiveness of the seminar, one directed at the students and the other at the nursing instructors and/or clinical tutors. A satisfaction survey was also given.Results: The average score for the theoretical pretest was 9.1 over 10; on the post-test it was 9.73. The three questions addressing the level of knowledge, self-confidence, and self-assuredness of the students yielded the following scores: 4.09, 4.83, and 3.99 over 10 pre- seminar vs 7.71, 7.75, and 7.21 post-seminar; this difference was statistically significant (p<0.001). There was statistical significance in the responses to the questions related to “achieving pedagogical aims in areas of care” (nurses) and “acquisition of specific clinical skills” (students), p=0.04. The overall level of satisfaction was 8.66±1.43 points.Conclusions: Gamification is an effective teaching methodology that is well-received by the students and seen by them as useful. (AU)

El final de vida en pacientes atendidos por equipos de cuidados paliativos pediátricos. Estudio observacional multicéntrico / End of life in patients under the care of paediatric palliative care teams. Multicentre observational study

Introducción:Cada año fallecen en España alrededor de 2000 niños y adolescentes; sin embargo, conocemos poco las particularidades que envuelven a la muerte en pediatría. El objetivo de este estudio es documentar las características de los pacientes que fallecen a cargo de los equipos de cuidados paliativos pediátricos en España. Pacientes y métodos:Estudio retrospectivo, descriptivo y multicéntrico. Participaron 14 equipos de todo el territorio nacional.Resultados:Se obtuvieron datos de 164 pacientes. En la mayoría la enfermedad de base eran procesos oncológicos, neurológicos y neuromusculares. La mediana de edad al fallecimiento fue de 6,9 años (RIC: 11,2). La mediana de tiempo de seguimiento por el equipo fue de 0,3 años (RIC: 0,8 años). Los síntomas más frecuentes en la última semana de vida fueron disnea, dolor, aumento de secreciones y trastornos del sueño. El número de fármacos que se administraban a cada paciente una semana previa al fallecimiento tuvo una mediana de 6 (RIC: 4). El lugar de fallecimiento de 95 de los pacientes (57,9%) fue el hospital y de 67 (40,9%) fue su domicilio.Conclusiones:Los pacientes presentaban un amplio rango de edad y una exposición sustancial a la polifarmacia. El tiempo de seguimiento nos muestra el acceso tardío a los programas de cuidados paliativos, deberíamos hacer un esfuerzo para la introducción temprana de estos cuidados y que no quede relegada al final de vida. En España existe una distribución desigual de recursos, sin que todos los equipos tengan la posibilidad de atención domiciliaria, por lo que el lugar de fallecimiento debemos interpretarlo con cautela. (AU)

Introduction:Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain.Patients and methods:Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated.Results:Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home.Conclusions:There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution. (AU)

The Practice of Pediatric Cardiac Anesthesiology in the United States.

BACKGROUND: With advances in surgical and catheter-based interventions and technologies in patients with congenital heart disease (CHD), the practice of pediatric cardiac anesthesiology has evolved in parallel with pediatric cardiac surgery and pediatric cardiology as a distinct subspecialty over the past 80 years. To date, there has not been an analysis of the distribution of pediatric cardiac anesthesiologists relative to cardiac and noncardiac procedures in the pediatric population. The primary aim is to report the results of a survey and its subsequent analysis to describe the distribution of pediatric cardiac anesthesiologists relative to pediatric cardiac procedures that include surgical interventions, cardiac catheterization procedures, imaging studies (echocardiography, magnetic resonance, computed tomography, positron emission tomography), and noncardiac procedures. METHODS: A survey developed in Research Electronic Data Capture (REDcap) was sent to the identifiable division chiefs/cardiac directors of 113 pediatric cardiac anesthesia programs in the United States. Data regarding cardiac surgical patients and procedures were collected from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHD). RESULTS: This analysis reveals that only 38% (117 of 307) of pediatric cardiac anesthesiologists caring for patients with CHD pursued additional training in pediatric cardiac anesthesiology, while 44% (136 of 307) have gained experience during their clinical practice. Other providers have pursued different training pathways such as adult cardiac anesthesiology or pediatric critical care. Based on this survey, pediatric cardiac anesthesiologists devote 35% (interquartile range [IQR], 20%-50%) of clinical time to the care of patients in the cardiac operating room, 25% (20%-35%) of time to the care of patients in the cardiac catheterization laboratory, 10% (5%-10%) to patient care in imaging locations, and 15% covering general pediatric, adult, or cardiac patients undergoing noncardiac procedures. Attempts to actively recruit pediatric cardiac anesthesiologists were reported by 49.2% (29 of 59) of the institutions surveyed. Impending retirement of staff was anticipated in 17% (10 of 59) of the institutions, while loss of staff to relocation was anticipated in 3.4% (2 of 59) of institutions. Thirty-seven percent of institutions reported that they anticipated no immediate changes in current staffing levels. CONCLUSIONS: The majority of currently practicing pediatric cardiac anesthesiologists have not completed a fellowship training in the subspecialty. There is, and will continue to be, a need for subspecialty training to meet increasing demand for services especially with increase survival of this patient population and to replace retiring members of the workforce.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics.

In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.