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Pediatric simulation

Wayne W Morriss, Miodrag S Milenovic, Faye M Evans
There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program...
April 2018: Anesthesia and Analgesia
Lindsay L Juriga, David J Murray, John R Boulet, James J Fehr
BACKGROUND: Simulation is frequently used to recreate many of the crises encountered in patient care settings. Teams learn to manage these crises in an environment that maximizes their learning experiences and eliminates the potential for patient harm. By designing simulation scenarios that include conditions associated with diagnostic errors, teams can experience how their decisions can lead to errors. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error...
November 27, 2017: Diagnosis
Mary B Wire, Xiaobin Li, Jianping Zhang, William Sallas, Vassilios Aslanis, Taoufik Ouatas
Our objective was to support initial eltrombopag doses and dose titration based on modeling and simulation of plasma exposure and platelet count response in pediatric patients aged 1-17 years with previously treated chronic immune thrombocytopenia enrolled in 2 clinical studies. Data from 168 pediatric patients were used to develop a life-span population pharmacokinetic and pharmacodynamic model including 3 pharmacokinetic and 4 pharmacodynamic compartments enabling simulation of platelet counts for various starting doses and dose titration schedules...
March 14, 2018: Clinical Pharmacology and Therapeutics
Ahmad Khobrani, Nirali H Patel, Richard L George, Neil L McNinch, Rami A Ahmed
Trauma is a leading cause of morbidity and mortality in infants and children worldwide. Trauma education is one of the most commonly reported deficiencies in pediatric emergency medicine (PEM) training. In this study, we describe the creation of a pediatric trauma boot camp in which trainees' basic knowledge, level of confidence, teamwork, and communication skills are assessed. The primary goal of this pilot study was to create a simulation-based pediatric trauma curriculum for PEM fellows and emergency medicine residents utilizing Kern's curricular conceptual framework...
2018: Emergency Medicine International
Kristen M Brown, Shawna S Mudd, Elizabeth A Hunt, Julianne S Perretta, Nicole A Shilkofski, J Wesley Diddle, Gregory Yurasek, Melania Bembea, Jordan Duval-Arnould, Kristen Nelson McMillan
OBJECTIVES: Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. DESIGN: Prospective pre/post interventional pilot study. SETTING: University simulation center. SUBJECTS: Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America...
March 10, 2018: Pediatric Critical Care Medicine
Ann M Bowling, Rhonda Cooper, Ashley Kellish, Laura Kubin, Tedra Smith
INTRODUCTION: Direct patient care across the lifespan has been the standard for nursing clinical experiences over the past several years. Recently, the Ohio Board of Nursing ruled that 100% of pediatric clinical hours could be replaced with simulation. PURPOSE: Make a recommendation for the number of direct patient care clinical hours in pediatrics that are needed to meet the pediatric nursing competencies. METHOD: All fifty United States Boards of Nursing prelicensure nursing education requirements were reviewed to identify the number of required clinical hours and definitions for clinical experience...
March 2018: Journal of Pediatric Nursing
Stacy M Stellflug, Nancy K Lowe
PURPOSE: Rural health care providers (HCPs) care for millions of Americans despite challenges. Pediatric Advanced Life Support (PALS) provides rural HCPs training in assessment and interventions for critically ill/injured pediatric patients (American Heart Association, 2015). The purpose of this study was to determine the effects of integration of high fidelity simulators into PALS courses in a rural setting. DESIGN AND METHODS: Participants were randomized by course to control or experimental PALS conditions where the control group received PALS with low fidelity static manikins (LFM) and the experimental group received PALS with high-fidelity simulators (HFS)...
March 2018: Journal of Pediatric Nursing
Catherine T Recznik, Lynn M Simko
INTRODUCTION: The objective of this study was to review the currently published literature on the topic of pediatric triage education. METHOD: An integrative review of the literature was conducted using database searching and historical record review. RESULTS: A wide variety of pediatric triage educational methods exist, but studies with the highest-quality ratings most often used simulation programs or a standardized curriculum. Although there was a good deal of heterogeneity in terms of the outcomes measured, the accuracy of triage improved following educational interventions...
March 6, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Brady S Moffett, Charissa Kam, Marianne Galati, Lindsay Schmees, Gideon A Stitt, Paula A Revell, Debra L Palazzi
BACKGROUND: Obese pediatric patients often require dose reductions when initiating gentamicin therapy. An appropriate method for calculating ideal body weight for dosing gentamicin in pediatric patients has not been validated. METHODS: A retrospective, population pharmacokinetic study was designed and included non-intensive care pediatric patients who received gentamicin and had serum gentamicin concentrations sampled. Actual body weight, adjusted body weight, and fat-free mass were used to describe the pharmacokinetic variables...
March 6, 2018: Therapeutic Drug Monitoring
Ching-Ching Yang, Pei-Chieh Yu, Jau-Ming Ruan, Yu-Cheng Chen
PURPOSE: The target detectability of cone beam computed tomography (CBCT) performed in image-guided radiation therapy (IGRT) was investigated to achieve sufficient image quality for patient positioning over a course of treatment session while maintaining radiation exposure from CBCT imaging as low as reasonably achievable (ALARA). METHODS: Body CBCT scans operated in half-fan mode were acquired with three different protocols: CBCTlowD , CBCTmidD , and CBCThighD , which resulted in weighted CT dose index (CTDIw ) of 0...
March 8, 2018: Journal of Applied Clinical Medical Physics
Andrew J Lautz, Kelly C Martin, Akira Nishisaki, Christopher P Bonafide, Roberta L Hales, Elizabeth A Hunt, Vinay M Nadkarni, Robert M Sutton, Donald L Boyer
OBJECTIVES: Miscommunication has been implicated as a leading cause of medical errors, and standardized handover programs have been associated with improved patient outcomes. However, the role of structured handovers in pediatric emergencies remains unclear. We sought to determine if training with an airway, breathing, circulation, situation, background, assessment, recommendation handover tool could improve the transmission of essential patient information during multidisciplinary simulations of critically ill children...
March 7, 2018: Hospital Pediatrics
Justin C Sowder, Mar Janna Dahl, Kaitlin R Zuspan, Kurt H Albertine, Donald M Null, Mitchell D Barneck, J Fredrik Grimmer
Objective To (1) compare physiologic changes during rigid bronchoscopy during spontaneous and mechanical ventilation and (2) evaluate the efficacy of a helium-oxygen (heliox) gas mixture as compared with room air during rigid bronchoscopy. Study Design Crossover animal study evaluating physiologic parameters during rigid bronchoscopy. Outcomes were compared with predicted computational fluid analysis. Setting Simulated ventilation via computational fluid dynamics analysis and term lambs undergoing rigid bronchoscopy...
March 1, 2018: Otolaryngology—Head and Neck Surgery
Deep Bera, Shreyas B Raghunathan, Chao Chen, Zhao Chen, Michiel A P Pertijs, Martin D Verweij, Verya Daeichin, Hendrik J Vos, Antonius F W van der Steen, Nico De Jong, Johan Hans G Bosch
Until now, no matrix transducer has been realized for 3D transesophageal echocardiography (TEE) in pediatric patients. In 3D TEE with a matrix transducer, the biggest challenges are to connect a large number of elements to a standard ultrasound system, and to achieve a high volume rate (>200 Hz). To address these issues, we have recently developed a prototype miniaturized matrix transducer for pediatric patients with micro-beamforming and a small central transmitter. In this paper we propose two multiline parallel 3D beamforming techniques (µBF25 and µBF169) using the micro-beamformed datasets from 25 and 169 transmit events to achieve volume rates of 300 Hz and 44 Hz, respectively...
March 6, 2018: Physics in Medicine and Biology
Dmitry Telyshev, Maxim Denisov, Alexander Pugovkin, Sergey Selishchev, Igor Nesterenko
In this work, the study results of an implantable pediatric rotary blood pump (PRBP) are presented. They show the results of the numerical simulation of fluid flow rates in the pump. The determination method of the backflows and stagnation regions is represented. The operating points corresponding to fluid flow rates of 1, 3, and 5 L/min for 75-80 mm Hg pressure head are investigated. The study results have shown that use of the pump in the 1 L/min operating point can potentially lead to the appearance of backflows and stagnation regions...
March 6, 2018: Artificial Organs
Andrew Williams, Morgan McWilliam, James Ahlin, Jacob Davidson, Mackenzie A Quantz, Andreana Bütter
BACKGROUND: Hypertrophic pyloric stenosis (HPS) is a common neonatal condition treated with open or laparoscopic pyloromyotomy. 3D-printed organs offer realistic simulations to practice surgical techniques. The purpose of this study was to validate a 3D HPS stomach model and assess model reliability and surgical realism. METHODS: Medical students, general surgery residents, and adult and pediatric general surgeons were recruited from a single center. Participants were videotaped three times performing a laparoscopic pyloromyotomy using box trainers and 3D-printed stomachs...
February 8, 2018: Journal of Pediatric Surgery
Einav Nachman, Peter Clemensen, Katheryn Santos, Alexis R Cole, Brian D Polizzotti, Grace Hofmann, Kristen T Leeman, Sarah J van den Bosch, John N Kheir
BACKGROUND: The accurate measurement of oxygen consumption (VO2) and energy expenditure (EE) may be helpful to optimize the treatment of critically ill patients. However, current techniques are limited in their ability to accurately quantify these end points in infants due to a low VO2, low tidal volume, and rapid respiratory rate. This study describes and validates a new device intended to perform in this size range. METHODS: We created a customized device that quantifies inspiratory volume using a pneumotachometer and concentrations of oxygen and carbon dioxide gas in the inspiratory and expiratory limbs...
March 1, 2018: Anesthesia and Analgesia
Nikhat Saba, Alpana Seal
Vinca alkaloids are chemotherapeutic agents used in the treatment of both pediatric and adult cancer patients. Cytochrome P450 3A5 (CYP3A5) is 9- to 14-fold more efficient at clearing vincristine than cytochrome P450 3A4 (CYP3A4) is. However, patients who express an inactive form of the polymorphic CYP3A5 enzyme suffer from severe neurotoxicity during vincristine treatment, resulting in chemotherapy failure. Previous studies have found that the addition of new features to the parent drug can enhance its binding affinity to tubulin manyfold and could therefore yield novel anticancer drugs...
March 4, 2018: Journal of Molecular Modeling
Xiangxiang Shi, Jun Zheng, Tingting Yan
Human respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children. Here, the RSV fusion (F) glycoprotein epitope FFL was redesigned based on its complex crystal structure with motavizumab, an mAb drug in development for the prevention of RSV infections, aiming to obtain therapeutic peptide vaccines with high affinity to induce RSV-specific neutralizing antibodies. Computational modeling and analysis found that only a small region covering the helix-turn-helix (HTH) motif of FFL can directly interact with motavizumab and confer stability and specificity to the complex system, while the rest of the epitope primarily serves as a structural scaffold that stabilizes the HTH conformation of motavizumab-binding site...
March 2, 2018: Journal of Molecular Modeling
Thomas J Gniadek, Martina Richtsfeld, Shelley Pulkrabek, Kayla R Hansen, Susan L Barnett, Nitasha Joyner, Stephanie Kinney, Nicole D Zantek, Anthony Azakie, Claudia S Cohn
BACKGROUND: Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serologic investigations were unremarkable. Mechanical hemolysis was considered. STUDY DESIGN AND METHODS: Simulated syringe transfusions were performed. Measurements included hematocrit (Hct), free hemoglobin, and visual hemolysis index...
March 1, 2018: Transfusion
Erin Hulfish, Maria Carmen G Diaz, Megan Feick, Catherine Messina, Glenn Stryjewski
BACKGROUND: Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further. METHODS: A series of 131 simulated trauma resuscitations were performed...
February 28, 2018: Pediatric Emergency Care
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