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1.
Medicine (Baltimore) ; 99(31): e20912, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756081

RESUMO

INTRODUCTION: Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS: This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME: We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER: NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION: Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.


Assuntos
Unidades de Terapia Intensiva Neonatal , Erros Médicos/prevenção & controle , Neonatologia/educação , Infecções Relacionadas a Cateter/prevenção & controle , Educação Médica Continuada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Humanos , Recém-Nascido , Segurança do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32532791

RESUMO

BACKGROUND: Neonatal-perinatal medicine (NPM) fellowship programs must provide adequate delivery room (DR) experience to ensure that physicians can independently provide neonatal resuscitation to very low birth weight (VLBW) infants. The availability of learning opportunities is unknown. METHODS: The number of VLBW (≤1500 g) and extremely low birth weight (ELBW) (<1000 g) deliveries, uses of continuous positive airway pressure, intubation, chest compressions, and epinephrine over 3 years at accredited civilian NPM fellowship program delivery hospitals were determined from the Vermont Oxford Network from 2012 to 2017. Using Poisson distributions, we estimated the expected probabilities of fellows experiencing a given number of cases over 3 years at each program. RESULTS: Of the 94 NPM fellowships, 86 programs with 115 delivery hospitals and 62 699 VLBW deliveries (28 703 ELBW) were included. During a 3-year fellowship, the mean number of deliveries per fellow ranged from 14 to 214 (median: 60) for VLBWs and 7 to 107 (median: 27) for ELBWs. One-half of fellows were expected to see ≤23 ELBW deliveries and 52 VLBW deliveries, 24 instances of continuous positive airway pressure, 23 intubations, 2 instances of chest compressions, and 1 treatment with epinephrine. CONCLUSIONS: The number of opportunities available to fellows for managing VLBW and ELBW infants in the DR is highly variable among programs. Fellows' exposure to key, high-risk DR procedures such as cardiopulmonary resuscitation is low at all programs. Fellowship programs should track fellow exposure to neonatal resuscitations in the DR and integrate supplemental learning opportunities. Given the low numbers, the number of new and existing NPM programs should be considered.


Assuntos
Neonatologia/educação , Ressuscitação/educação , Pressão Positiva Contínua nas Vias Aéreas , Epinefrina/uso terapêutico , Bolsas de Estudo , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Intubação , Ressuscitação/métodos , Vermont
4.
Rev Saude Publica ; 54: 23, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049212

RESUMO

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON-Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC-Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.


Assuntos
Maternidades/organização & administração , Hospitais de Ensino/organização & administração , Programas Nacionais de Saúde/organização & administração , Neonatologia/educação , Obstetrícia/educação , Brasil , Cesárea/normas , Parto Obstétrico/normas , Feminino , Maternidades/normas , Hospitais de Ensino/normas , Humanos , Recém-Nascido , Trabalho de Parto , Nascimento Vivo , Programas Nacionais de Saúde/normas , Neonatologia/normas , Obstetrícia/normas , Período Pós-Parto , Gravidez
6.
Am J Perinatol ; 37(4): 375-377, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30722073

RESUMO

OBJECTIVE: This study aimed to quantify knowledge on neonatal topics among obstetricians and pediatricians participating in a perinatal teaching program aimed at reducing neonatal mortality in Laos. STUDY DESIGN: Obstetricians and pediatricians from Vientiane and the surrounding areas participated in a 1-week teaching program in obstetric and neonatal topics and responded to pre- and posttests questionnaires to quantify their knowledge. RESULTS: Although questions were predominantly related to neonatal topics, obstetricians performed significantly better than pediatricians during the pretest. Both groups increased their knowledge significantly as quantified by the results of the posttest. CONCLUSION: The teaching program was effective in improving knowledge on perinatal mortality related topics of the participants. These results may be related to the fact that most of the obstetricians had participated in a structured teaching program previously, whereas the pediatricians did not. We thus speculate that there is a sustained effect of even a 1-week teaching program in neonatology even several years after the initial teaching.


Assuntos
Competência Clínica , Educação Médica Continuada , Neonatologia/educação , Obstetrícia , Pediatras/educação , Avaliação Educacional , Humanos , Lactente , Mortalidade Infantil , Laos/epidemiologia , Obstetrícia/educação , Serviços Urbanos de Saúde
7.
Am J Perinatol ; 37(5): 511-518, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30895576

RESUMO

OBJECTIVE: This study aimed to report on Neonatal-Perinatal Medicine (NPM) fellows' views of self-preparedness upon starting postresidency training. STUDY DESIGN: We conducted a national survey of first-year NPM fellows in the United States. The validated survey had five major areas: professionalism, psychomotor ability, independence/graduated responsibility, clinical evaluation, and academia. Survey responses were analyzed using descriptive statistics, and the free-text answers were categorized. RESULTS: Of 228 potential first-year NPM fellows, 140 (61%) initially responded to the survey. Overall, the fellows perceived themselves positively in professionalism and independence/graduated responsibility domains. Marked variability was observed in perceived preparedness in psychomotor ability, with confidence in neonatal intubation and arterial line placement of 86 and 49%, respectively. Lack of confidence in performing neonatal intubation procedures correlates with lack of attempts. The majority (75%) of fellows reported being interested in academia, but less than half felt capable of writing an article. CONCLUSION: First-year NPM fellows identified deficiencies in the domains of psychomotor ability and academia. Residency and fellowship programs should partner to address these deficiencies.


Assuntos
Competência Clínica , Internato e Residência , Neonatologia/educação , Perinatologia/educação , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Feminino , Humanos , Masculino , Inquéritos e Questionários , Estados Unidos
8.
BMC Pediatr ; 19(1): 434, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722685

RESUMO

BACKGROUND: Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children. METHODS: This will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods. DISCUSSION: This study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.


Assuntos
Intubação Intratraqueal , Pescoço/diagnóstico por imagem , Recursos Humanos em Hospital/educação , Sistemas Automatizados de Assistência Junto ao Leito , Treinamento por Simulação , Ultrassonografia , Avaliação Educacional , Humanos , Recém-Nascido , Capacitação em Serviço , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Erros Médicos , Neonatologia/educação , Paquistão , Projetos de Pesquisa
9.
J Perinat Neonatal Nurs ; 33(4): 350-360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31651629

RESUMO

More than 80 000 babies are admitted to specialist neonatal units in the United Kingdom every year, with approximately 2109 neonatal deaths a year; 98% in hospital. A common element in guidance and pathways to facilitate the provision of palliative care to infants and their families is the importance of good education and training to develop high-quality staff and services. This article presents a mixed-methods, sequential, explanatory design evaluation of 1 day palliative care education workshops delivered using a network-wide approach to multidisciplinary professionals. Workshops were delivered by healthcare professionals and bereaved parents and evaluated using questionnaires, adapted for neonatal staff from standardized measures, and follow-up interviews. The workshop content and shared learning approach resulted in significant improvements in participant's knowledge, attitude, self-beliefs and confidence in neonatal palliative care, enhanced awareness of services, and improved links between professionals. Participants cascaded their learning to their teams and provided examples of changes in their clinical practice following the workshop. Parent stories were identified as a very powerful component of the training, with lasting impact on participants. Formal, integrated palliative care education programs for perinatal and neonatal staff and longitudinal research into the impact on practice and the experience received by families are needed.


Assuntos
Educação a Distância/métodos , Capacitação em Serviço , Neonatologia/educação , Cuidados Paliativos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos
10.
Neonatology ; 116(4): 305-314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658465

RESUMO

BACKGROUND: The use of intraosseous (IO) access during resuscitation is widely accepted and promoted in paediatric medicine but features less prominently in neonatal training. Whilst umbilical venous catheterization (UVC) is a reliable method of delivering emergency drugs and fluids, it is not always achievable in a timely manner. IO access warrants exploration as an alternative. AIM: Conduct a systematic review of existing literature to examine the evidence for efficacy and safety of IO devices in neonatal patients, from birth to discharge. METHOD: A search of PubMed, Ovid, Medline, and Embase was carried out. Abstracts were screened for relevance to focus on neonatal-specific literature and studies which carried out separate analyses for neonates (infants <28 days of age or resident on a neonatal unit). RESULTS: One case series and 12 case reports describe IO device insertion into 41 neonates, delivering a variety of drugs, including adrenaline (epinephrine) and volume resuscitation. Complications range from none to severe. Cadaveric studies show that despite a small margin for error, IO devices can be correctly sited in neonates. Simulation studies suggest that IO devices may be faster and easier to site than UVC, even in experienced hands. CONCLUSION: IO access should be available on neonatal units and considered for early use in neonates where other access routes have failed. Appropriate training should be available to staff in addition to existing life support and UVC training. Further studies are required to assess the optimal device, position, and whether medication can be delivered IO as effectively as by UVC. If IO devices provide a faster method of delivering adrenaline effectively than UVC, this may lead to changes in neonatal resuscitation practice.


Assuntos
Infusões Intraósseas/métodos , Neonatologia/métodos , Ressuscitação/métodos , Epinefrina/administração & dosagem , Humanos , Recém-Nascido , Infusões Intraósseas/efeitos adversos , Infusões Intraósseas/instrumentação , Agulhas/efeitos adversos , Neonatologia/educação , Ressuscitação/educação
11.
Semin Perinatol ; 43(8): 151178, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31500845

RESUMO

Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.


Assuntos
Assistência à Saúde/métodos , Neonatologia/educação , Segurança do Paciente , Perinatologia/educação , Competência Clínica , Humanos , Recém-Nascido , Equipe de Assistência ao Paciente , Ressuscitação/educação , Ressuscitação/métodos , Treinamento por Simulação
12.
Semin Perinatol ; 43(8): 151179, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31493857

RESUMO

Neonatal resuscitation is an event that can cause high stress among healthcare professionals (HCPs) and is frequently associated with medical errors. Improving patient safety and reducing errors requires a concerted effort with a plan for improvement. Video can be used as a component of the improvement process at several points including standardizing educational information, assessing learner knowledge and skills during simulation, and assessing individual and team performance during actual neonatal resuscitations.


Assuntos
Neonatologia/educação , Segurança do Paciente , Ressuscitação/educação , Ressuscitação/métodos , Gravação em Vídeo , Competência Clínica , Humanos , Recém-Nascido , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Equipe de Assistência ao Paciente , Treinamento por Simulação
13.
J Perinatol ; 39(10): 1392-1398, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31371832

RESUMO

OBJECTIVE: To determine whether the use of family members as educators in a structured educational intervention would increase neonatology fellows' confidence in performing core communication skills targeted to guide family decision-making. STUDY DESIGN: Neonatology fellows at two centers participated in simulation-based training utilizing formally trained family members of former patients. Fellows completed self-assessment surveys before participating, immediately following participation, and 1-month following the training. Family members also evaluated fellow communication. RESULTS: For each core competency assessed, there was a statistically significant increase in self-perceived preparedness from pre-course to post-course assessments. Fellows additionally endorsed using skills learned in the curriculum in daily clinical practice. Family educators rated fellow communication highest in empathetic listening and nonverbal communication. CONCLUSIONS: Participation in a communication skills curriculum utilizing formally trained family members as educators for medical trainees successfully increased fellows' self-perceived preparedness in selected core competencies in communication. Family educators provided useful, generalizable feedback.


Assuntos
Comunicação , Tomada de Decisão Compartilhada , Educação de Pós-Graduação em Medicina/métodos , Neonatologia/educação , Relações Profissional-Família , Treinamento por Simulação , Currículo , Família , Bolsas de Estudo , Humanos , Recém-Nascido , Competência Profissional , Autoavaliação
16.
Pediatr Int ; 61(7): 664-671, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31145817

RESUMO

BACKGROUND: This study of umbilical catheterization deliberate practice training compared skill and knowledge outcomes of umbilical catheterization using a tissue-hybrid simulator (REAL) versus a synthetic simulated umbilical cord task trainer (ART). METHODS: This was a prospective randomized control study. Pediatric residents were randomized to REAL or ART umbilical catheterization deliberate practice training. Pre-post-training changes in skill performance and knowledge scores for REAL and ART groups were compared. Fidelity of REAL and ART were compared by neonatologists. RESULTS: Twenty-seven pediatric residents completed training. Post-training mean skill scores were improved compared to pre-test scores (REAL, P < 0.001; ART, P < 0.0001). Post-training skill, knowledge, and self-efficacy scores were not different between the REAL and ART groups. Fidelity of REAL was higher than ART for neonatologists (P < 0.01). CONCLUSIONS: The face validity of REAL was superior to ART, but resident umbilical cord deliberate practice training demonstrated no difference in skill, knowledge, and self-efficacy improvements between REAL and ART. Further studies on real patients are needed to evaluate the impact of using real or simulated umbilical cords for umbilical venous catheter/umbilical arterial catheter training.


Assuntos
Cateterismo , Internato e Residência , Pediatria/educação , Treinamento por Simulação/métodos , Cordão Umbilical , Cateterismo/instrumentação , Cateterismo/métodos , Competência Clínica , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Japão , Masculino , Neonatologia/educação , Estudos Prospectivos , Autoeficácia
17.
J Ultrasound ; 22(2): 201-206, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31073871

RESUMO

OBJECTIVES: Despite increased evidence that point-of-care ultrasound (POCUS) has the potential to improve patient care in many clinical areas, the extent of use and training in POCUS in Canadian neonatal intensive care units (NICUs) has not been described in the literature. In this study, we aimed to explore the extent to which POCUS is being used and the need for a formal curriculum with defined POCUS competencies in the field of Neonatal-Perinatal Medicine (NPM). METHODS: We sent a cross-sectional electronic survey to all NPM program directors and fellows in Canada. All 13 Canadian NPM programs were invited to participate. Data were analyzed using descriptive statistics and qualitative content analysis. RESULTS: The response rate was 69% (n = 9) from program directors (PDs) and 29% (n = 25) from NPM fellows. Most respondents indicated regular use of POCUS in clinical practice and ready access to a portable ultrasound machine. The most common use for POCUS was targeted assessment of patent ductus arteriosus (PDA) and persistent pulmonary hypertension (PPHN). Only six PDs reported that POCUS skills are taught to trainees in their centers and only two PDs reported that a structured program existed. Barriers to POCUS structured training include a lack of trained personnel as well as insufficient time in the busy NPM curriculum. CONCLUSION: POCUS is widely used in Canadian NICUs. However, a formal curriculum and assessment of competencies in this area of neonatal clinical care are lacking.


Assuntos
Unidades de Terapia Intensiva Neonatal , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Atitude do Pessoal de Saúde , Canadá , Competência Clínica , Estudos Transversais , Currículo , Humanos , Recém-Nascido , Neonatologistas/educação , Neonatologia/educação
18.
J Perinatol ; 39(10): 1417-1427, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31092886

RESUMO

OBJECTIVE: Excessive hypothermia is common in infants that receive passive cooling for hypoxic ischemic encephalopathy (HIE). Our goal was to reduce the number of infants with admission temperature <33 °C from 33% to less than 10% by December 2017. METHODS: Outcome measures included the number of infants with admission temperature <33 °C and number of infants with temperature within therapeutic range. Interventions included implementation of passive cooling guidelines and outreach education to birth hospitals and transport team. We used statistical process control chart to compare outcomes over a 3 year period. RESULTS: The number of infants with admission temperature <33 °C decreased from 33.3% to 5.5% (p = 0.013). The number of infants with admission temperature within target range for hypothermia therapy increased from 61.1% to 77.7% (p = 0.014). Balancing measures and complications remained unchanged. CONCLUSION: Implementation of passive cooling guidelines and outreach education led to significant decrease in excessive hypothermia in infants with HIE.


Assuntos
Hipotermia Induzida/métodos , Hipotermia/prevenção & controle , Hipóxia-Isquemia Encefálica/terapia , Transporte de Pacientes , Hospitais Pediátricos , Humanos , Hipotermia Induzida/efeitos adversos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Kentucky , Neonatologia/educação
19.
Pediatr Int ; 61(7): 634-640, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119808

RESUMO

In July 2007, the Neonatal Cardiopulmonary Resuscitation (NCPR) program in Japan was launched to ensure that all staff involved in perinatal and neonatal medicine can learn and practice NCPR based on the Consensus on Science with Treatment Recommendations developed by the International Liaison Committee on Resuscitation. In 1978 in North America, a working group on pediatric resuscitation was formed by the American Heart Association Emergency Cardiac Care Committee and concluded that the resuscitation of newborns required a different strategy than the resuscitation of adults. The original first edition of the Neonatal Resuscitation Program textbook was published in 1987. The NCPR program consists of three courses for health-care providers and two courses for instructors. A course and B course are for newly certified health-care providers and course S is for health-care providers who are renewing their certification. As of 31 March 2019, 3,227 advanced instructors (I instructor) and 1,877 basic instructors (J instructor) were trained to teach A, B, and S courses to health-care providers on the basis of their license. In total 7,075 A courses and 4,012 B courses were held; 131 651 people attended A course or B course of the NCPR program, and 77 367 were certified. A total of 1,865 S courses, which were developed in 2015, were held and 12 875 people attended this course. Here, we introduce the background, purpose, history, and content of the development of the NCPR program in Japan.


Assuntos
Reanimação Cardiopulmonar/educação , Educação Médica Continuada/métodos , Educação Continuada em Enfermagem/métodos , Auxiliares de Emergência/educação , Tocologia/educação , Neonatologia/educação , Educação Médica Continuada/organização & administração , Educação Médica Continuada/estatística & dados numéricos , Educação Continuada em Enfermagem/organização & administração , Educação Continuada em Enfermagem/estatística & dados numéricos , Humanos , Recém-Nascido , Japão , América do Norte , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
20.
Pediatr Crit Care Med ; 20(6): e251-e257, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30985607

RESUMO

OBJECTIVES: Primary objectives were to discover current practices of informed consent for bedside procedures in the PICU and neonatal ICU and how trainees learn to obtain consent. We also attempted to gauge if program directors felt that one method of consent was subjectively superior to another in the way it fulfilled established ethical criteria for informed consent. DESIGN: An online anonymous survey. Participants were asked about how and by whom informed consent is currently obtained, training practices for fellows, and attitudes about how different consent methods fulfill ethical criteria. SETTING: All U.S. fellowship programs for neonatology (n = 98) and pediatric critical care (n = 66) in the fall of 2017. SUBJECTS: Neonatal and pediatric critical care fellowship program directors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The overall response rate was 50% (82 of 164). The most common method for obtaining consent in both ICU types was via a written, separate (procedure-specific) consent (63% neonatal ICUs, 83% PICUs); least common was verbal consent (8% neonatal ICUs and 6% PICUs). Fellows were reported as obtaining consent most often (91%), followed by mid-level practitioners (71%) and residents (66%). Residents were one-fifth as likely to obtain consent in the PICU as compared with the neonatal ICU. Sixty-three percent of fellowship directors rated their programs as "strong" or "very strong" in preparing trainees to obtain informed consent. Twenty-eight percent of fellowship directors reported no formal training on how to obtain informed consent. CONCLUSIONS: Most respondents' ICUs use separate procedure-specific written consents for common bedside procedures, although considerable variability exists. Trainees reportedly most often obtain informed consent for procedures. Although most fellowship directors report their program as strong in preparing trainees to obtain consent, this study reveals areas warranting improvement.


Assuntos
Cuidados Críticos/organização & administração , Bolsas de Estudo/organização & administração , Consentimento Livre e Esclarecido , Unidades de Terapia Intensiva Pediátrica/organização & administração , Atitude do Pessoal de Saúde , Cuidados Críticos/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva Neonatal/organização & administração , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Neonatologia/educação , Sistemas Automatizados de Assistência Junto ao Leito , Estados Unidos
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