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1.
BMC Infect Dis ; 22(1): 811, 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316633

RESUMO

BACKGROUND: The Meningitis/Encephalitis FilmArray® Panel (ME panel) was approved by the U.S. Food and Drug Administration in 2015 and provides rapid results when assessing patients with suspected meningitis or encephalitis. These patients are evaluated by various subspecialties including pediatric hospital medicine (PHM), pediatric emergency medicine (PEM), pediatric infectious diseases, and pediatric intensive care unit (PICU) physicians. The objective of this study was to evaluate the current use of the ME panel and describe the provider and subspecialty practice variation. METHODS: We conducted an online cross-sectional survey via the American Academy of Pediatrics Section of Hospital Medicine (AAP-SOHM) ListServe, Brown University PEM ListServe, and PICU Virtual pediatric system (VPS) Listserve. RESULTS: A total of 335 participants out of an estimated 6998 ListServe subscribers responded to the survey. 68% reported currently using the ME panel at their institutions. Among test users, most reported not having institutional guidelines on test indications (75%) or interpretation (76%). 58% of providers self-reported lack of knowledge of the test's performance characteristics. Providers from institutions that have established guidelines reported higher knowledge compared to those that did not (51% vs. 38%; p = 0.01). More PHM providers reported awareness of ME panel performance characteristics compared to PEM physicians (48% vs. 27%; p = 0.004); confidence in test interpretation was similar between both groups (72 vs. 69%; p = 0.80). CONCLUSION: Despite the widespread use of the ME panel, few providers report having institutional guidelines on test indications or interpretation. There is an opportunity to provide knowledge and guidance about the ME panel among various pediatric subspecialties.


Assuntos
Encefalite , Meningite , Médicos , Humanos , Criança , Estudos Transversais , Meningite/diagnóstico
2.
MedEdPORTAL ; 19: 11315, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37287958

RESUMO

Introduction: Over-the-counter (OTC) products are widely used by families with young children. To educate future pediatricians on OTC product counseling and support the health and safety of children under their care, modern, accessible, and engaging curricula are needed. Methods: We developed an OTC product curriculum consisting of seven videos and one facilitated group discussion using a flipped classroom pedagogy to educate students on counseling parents about OTC product use. Fourth-year medical students pursuing pediatric training from four institutions participated in the curriculum during their end-of-year transition-to-residency course. We measured effectiveness via a pre/post comparison using a student self-assessment with multiple-choice questions. A simulated parent call OSCE provided participants with an opportunity to apply their knowledge and receive directed formative feedback. Data were analyzed using descriptive and inferential statistics. Results: A total of 41 students participated in the curriculum and completed all assessments. The majority (93%) watched all the videos. All participants (100%) agreed the videos were useful. Knowledge improved significantly (pretest mean score = 70%, posttest mean score = 87%, p < .001). No significant differences were found when comparing institution, gender, prior experience, or electives. Discussion: We developed a feasible and effective video-based curriculum to teach OTC product guidance. Given the importance of discussing OTC medications with families and the need for convenient educational tools, this curriculum may have widespread application to medical students during clinical rotations as well as pediatric and family medicine trainees.


Assuntos
Avaliação Educacional , Estudantes de Medicina , Criança , Humanos , Pré-Escolar , Currículo , Estudantes de Medicina/psicologia
3.
J Pediatric Infect Dis Soc ; 11(4): 134-141, 2022 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-35020927

RESUMO

BACKGROUND: The FilmArray Meningitis/Encephalitis panel (MEP) has an 11% false-positive and 2.2% false-negative rate compared with conventional testing. We describe clinical characteristics, treatment decisions, and outcomes in children with discordant results between MEP and conventional testing. METHODS: We conducted a multisite review of patients ≤ 18 years with suspected central nervous system infection and positive results by MEP or conventional testing (cerebrospinal fluid [CSF] culture, herpes simplex virus [HSV] polymerase chain reaction (PCR), and enterovirus [EV] PCR). Descriptive results are provided for patients with discordant results. Comparison between group 1 (MEP and CSF culture positive) and group 2 (MEP positive, CSF culture negative, or showing a different pathogen) was made by Mann-Whitney test for continuous and Fisher's test for categorical variables. RESULTS: A total of 355 patients had at least one pathogen identified. More than half of patients with bacterial pathogens identified that are included in the MEP had discordant results (30/52; 58%). There were 28 samples with bacterial pathogen identified on MEP only, 1 with different bacterial pathogens on MEP and culture, and 1 with Escherichia coli identified on CSF culture only. Patients in group 1 were more likely to have CSF pleocytosis, elevated CSF protein, and decreased CSF glucose than group 2 (P < .05). Two patients were HSV positive by MEP while HSV negative by PCR. Ten patients had discordant results between MEP and EV PCR. CONCLUSIONS: Discordant results between MEP and conventional testing are common. Treatment decisions based on a positive MEP should be made in the appropriate clinical context.


Assuntos
Encefalite , Infecções por Enterovirus , Enterovirus , Meningite , Vírus , Bactérias , Criança , Encefalite/diagnóstico , Enterovirus/genética , Escherichia coli , Humanos , Meningite/diagnóstico , Reação em Cadeia da Polimerase Multiplex/métodos , Estudos Retrospectivos
4.
MedEdPORTAL ; 17: 11087, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33598533

RESUMO

Introduction: Planning for and responding to happenstance is an important but rarely discussed part of the professional development of medical students. We noted this gap while conducting a study of career inflection points of 24 physicians who frequently mentioned how luck had shaped their unfolding careers. A review of the career counseling literature led us to a body of work known as Planned Happenstance Learning Theory (PHLT). PHLT focuses on the attitudes and skills to make happenstance a positive force in one's life. We found no reference to this work in the medical education literature and resolved to address this gap. Methods: We created resources for an interactive, 90-minute faculty development workshop. In the workshop, the facilitator used a PowerPoint presentation, vignettes of happenstance, a student testimonial, and a reflection worksheet. We presented and formally evaluated the workshop at three national meetings for health science educators. Results: Workshop participants, mostly faculty (N = 45), consistently expressed positive regard for the workshop content, organization, and instructional methods, especially the opportunity for guided reflection. A retrospective pre/postevaluation revealed a meaningful increase in knowledge about PHLT attitudes and skills, as well as a commitment to use these skills in promoting professional development. Discussion: The skills and attitudes of PHLT are relevant to students' career development. A workshop designed to introduce PHLT skills and attitudes to faculty advisors and mentors can help prepare faculty to promote students' awareness and use of these attitudes and skills.


Assuntos
Educação Médica , Estudantes de Medicina , Docentes , Humanos , Mentores , Estudos Retrospectivos
5.
Hosp Pediatr ; 9(10): 763-769, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31511395

RESUMO

OBJECTIVES: To determine the association of the use of the multiplex assay meningitis/encephalitis panel with clinical management of suspected meningitis. METHODS: A cross-sectional study was conducted with children 0 to 18 years of age who received a lumbar puncture within 48 hours of admission for an infectious workup. Patient demographic and presenting information, laboratory studies, and medication administration were collected. The primary measure was length of stay (LOS) with secondary measures: time on antibiotics, time to narrowing antibiotics, and acyclovir doses. LOS and antibiotic times were stratified for outcomes occurring before 36 hours. Logistic regression analysis was used to account for potential confounding factors associated with both the primary and secondary outcomes. A value of P < .05 was considered statistically significant. RESULTS: Meningitis panel use was associated with a higher likelihood of a patient LOS <36 hours (P = .04; odds ratio = 1.7; 95% confidence interval [CI]: 1.03-2.87), a time to narrowing antibiotics <36 hours (P = .008; odds ratio = 1.89; 95% CI: 1.18-2.87), and doses of acyclovir (P < .001; incidence rate ratio = 0.37; 95% CI: 0.26-0.53). When controlling for potential confounding factors, these associations persisted. CONCLUSIONS: Use of the meningitis panel was associated with a decreased LOS, time to narrowing of antibiotics, and fewer acyclovir doses. This likely is a result of the rapid turnaround time as compared with cerebrospinal fluid cultures. Additional studies to examine the outcomes related to this change in management are warranted.


Assuntos
Encefalite por Herpes Simples/diagnóstico , Infecções por Enterovirus/diagnóstico , Meningites Bacterianas/diagnóstico , Meningite Pneumocócica/diagnóstico , Meningite Viral/diagnóstico , Infecções por Roseolovirus/diagnóstico , Aciclovir/uso terapêutico , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Estudos Transversais , Encefalite por Herpes Simples/líquido cefalorraquidiano , Encefalite por Herpes Simples/tratamento farmacológico , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/tratamento farmacológico , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/tratamento farmacológico , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Infecções por Roseolovirus/líquido cefalorraquidiano , Infecções por Roseolovirus/tratamento farmacológico , Punção Espinal
6.
Arch Dis Child Fetal Neonatal Ed ; 102(1): F12-F16, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27638112

RESUMO

BACKGROUND: Some pregnant patients with complex fetal anomalies meet with paediatric palliative care subspecialists prior to delivery, but referral to antenatal palliative care consultation (APCC) is not standard. Little is known about its role in perinatal decision-making. METHODS: A single-centre retrospective cohort study was undertaken for patients referred for outpatient antenatal counselling by a neonatologist over a two-and-half-year period. Patients also receiving APCC were compared with infants with similar prognoses who did not. Outcomes assessed included antenatal decision-making, obstetric and neonatal outcomes. RESULTS: 24 (17%) of the 144 referred fetuses received APCC; nearly all had been given the prognoses of 'non-survivable' or 'uncertain, likely poor'. Fetal or neonatal outcome included: fetal demise 5 (21%), in-hospital death 16 (67%) and survival to discharge (DC) 3(12%). 24 fetuses with similarly poor prognoses were not referred, but had similar outcomes: fetal demise 5 (21%), in-hospital death 16 (67%) and survival to DC 3 (12%). Those with APCC were more likely to choose comfort care than those without (67% vs 17%, p<0.01) and those who died in hospital had a shorter time to death than those who did not receive APCC. Less racial diversity was noted in the group receiving APCC. Infants with identified/suspected genetic syndromes were more likely to receive consultation despite similar mortality to the remaining cohort. CONCLUSIONS: Long-term outcomes with and without APCC were similar for infants with poor prognoses, though non-survivors with APCC were more likely to have a comfort care plan and shorter time to in-hospital death.


Assuntos
Tomada de Decisões , Cuidados Paliativos/métodos , Cuidado Pré-Natal/métodos , Encaminhamento e Consulta/organização & administração , Adulto , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem
7.
J Grad Med Educ ; 9(5): 616-621, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29075383

RESUMO

BACKGROUND: Although there is some consensus about the competencies needed to enter residency, the actual skills of graduating medical students may not meet expectations. In addition, little is known about the association between undergraduate medical education and clinical performance at entry into and during residency. OBJECTIVE: We explored the association between medical school of origin and clinical performance using a multi-station objective structured clinical examination for incoming residents at the University of Michigan Health System. METHODS: Prior to assuming clinical duties, all first-year residents at the University of Michigan Health System participate in the Postgraduate Orientation Assessment (POA). This assesses competencies needed during the first months of residency. Performance data for 1795 residents were collected between 2002 and 2012. We estimated POA variance by medical school using linear mixed models. RESULTS: Medical school predicted the following amounts of variance in performance-data gathering scores: 1.67% (95% confidence interval [CI] 0.36-2.93); assessment scores: 4.93% (95% CI 1.84-6.00); teamwork scores: 0.80% (95% CI 0.00-1.82); communication scores: 2.37% (95% CI 0.66-3.83); and overall POA scores: 4.19% (95% CI 1.59-5.35). CONCLUSIONS: The results show that residents' medical school of origin is weakly associated with clinical competency, highlighting a potential source of variability in undergraduate medical education. The practical significance of these findings needs further evaluation.


Assuntos
Competência Clínica , Educação de Graduação em Medicina/normas , Avaliação Educacional/métodos , Internato e Residência , Faculdades de Medicina , Adulto , Feminino , Humanos , Masculino , Michigan
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