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Evaluation of participants' feedback after a simulation-based training in neonatal resuscitation using a realistic delivery room

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Open Journal of Pediatrics 2012年第4期2卷 281-287页

作者： Alejandro Avila-Alvarez Iria Gonzalez-Rivera Jose L.Fernandez-Trisac Maria I.Taboada-Perianes Bruno Rodriguez-Gonzalez Alberto Centeno-Cortes Maria Diaz-Gomez Teresa Rei-Serra Rita Jacome-Feijoo unidade de Neonatoloxia Servizo de PediatriaComplexo Hospitalario Universitario A CorunaA CorunaSpain unidade de cuidados intensivos pediatricos Servizo de PediatriaComplexo Hospitalario Universitario A CorunaA CorunaSpain Servizo de Urxencias Hospital Arquitecto MarcideFerrolSpain Centro Tecnoloxico de Formacion Complexo Hospitalario Universitario de A CorunaA CorunaSpain Servizo de Xinecoloxia e Obstetricia Complexo Hospitalario Universitario de A CorunaA CorunaSpain

BACKGROUND: Low-frequency and high-risk situations, such as neonatal resuscitation, are the ideal targets for simulation-based learning. The aim of this paper is to present the structure of our internal neonatal resuscitation training program, using a realistic, simulated delivery room, and to present the participants' opinions about teamwork, emotional stress, and their subjective ability to face a resuscitation. METHODS: We administered a training course to 24 doctors and midwives. One of the simulation classrooms was modified to appear similar to a real delivery room. Four scenarios were conducted using a previously designed checklist of primary and secondary goals. Upon completion, all students participated in a debriefing session with the help of a video review. RESULTS: Students rated the achievement of their previously defined goals on a scale of 1 to 5. Grouping together the percentages of the highest ratings (Categories 4 and 5), 83.4% (20/24) of the students considered the course useful for acquiring clinical skills. For 87.5% (21/24) of the students, the scenarios simulated real clinical situations, the room properly simulated a real delivery room, and the course improved the students' ability to work in a team. For 66.6% (16/24) of the students, the course improved their stress in confronting neonatal resuscitation. Initially, only 33.3% (8/24) of the students considered themselves very capable or fully able to cope with a resuscitation. After the course, that percentage rose to 62.5% (15/24). CONCLUSIONS: The incorporation of simulation-based learning into neonatal resuscitation teaching programs, using realistic scenarios, is useful and offers the possibility of acquiring technical skills, but it also allows for the improvement of teamwork and the adoption of different roles and positive attitudes towards emotional stress.

关键词： Neonatal Resuscitation Simulation Training

Strongyloides stercoralis in an immunocompetent adult:An unexpected cause of weight lost

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Case Reports in Clinical Medicine 2013年第7期2卷 427-431页

作者： Lia Marques Andre Rodrigues Elisa Vedes Dores Marques Servico de Medicina III Hospital de Pulido ValenteCentro Hospitalar Lisboa NorteLisboa unidade de cuidados intensivos do Hospital da Luz Lisboa

Strongyloides stercoralis infects at least 100 million humans worldwide each year, but its prevalence is underestimated. It is endemic in hot and humid climates as well as resource poor countries with inadequate sanitary conditions. The rise of international travel and immigration has a positive impact in strongyloidiasis. Due to its unique auto infection life-cycle, Strongyloides may lead to chronic infections remaining undetected for decades. Strongyloidiasis is most often asymptomatic but it has a wide range of clinical presentations. The two most severe forms of strongyloidiasis are hyperinfection and disseminated syndromes. These occur most often in patients with impaired cell mediated immunity. A 42-year-old immunocompetent man presented with chronic watery diarrhea, malaise, upper abdominal pain, anorexia and weight lost. Strongyloides stercoralis was identified in stool samples and duodenal biopsy. The patient was successfully treated with albendazole. The authors report a case of strongyloidiasis hyperinfection in an immunocompetent host 20 years away from an endemic area and make a literature review.

关键词： Strongyloides stercoralis Immunocompetent Hyperinfection

Skeletal cystic angiomatosis:A rare cause of unilateral lytic bone lesions

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Case Reports in Clinical Medicine 2013年第7期2卷 381-385页

作者： Lia Marques Elisa Vedes Miguel Toscano Rico Servico de Medicina III Hospital Pulido ValenteCentro Hospitalar Lisboa NorteLisboaPortugal unidade de cuidados intensivos Hospital da LuzLisboaPortugal Servico de Medicina Hospital de Santa MartaCentro Hospitalar Lisboa CentralLisboaPortugal

Cystic angiomatosis is a rare, benign, multifocal disorder of bone and viscera. Angiomatous deposits result in bone lysis and organ dysfunction. Bony cystic lesions occur in the axial and proximal appendicular skeleton. Lesions may cause bone pain or pathological fracture. Diagnosis is difficult, of exclusion and demands a biopsy. The prognosis varies upon whether the lesions are solely skeletal or there is visceral involvement. A 71-year-old man reports increasing symptoms of painful swelling in the right thoracic wall for over a month. The swelling was bony hard in consistency. Except for his bony swelling, the patient’s physical examination was within normal limits, as were all his laboratory studies. X-ray imagery showed multicystic expansive lytic areas involving the right ribs. Computerized tomography, magnetic resonance imagery and gallium bone scan revealed lytic lesions of multiple right ribs, and cervical, dorsal, lumbar and sacrum iliac spine. A right rib biopsy has shown a cystic formation with endothelial walls. Five years later, the patient remained stable, with no clinical, laboratory or imagilogic progression of disease and without visceral involvement. This case is presented in his rarity and differential diagnosis challenge.

关键词： Cystic Angiomatosis Bone Lytic Lesions Histiocitosis X

Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes

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Chinese Medical Journal 2022年第2期135卷 187-193页

作者： Adrian K.Bengelloun Guillermo J.Ortega Julio Ancochea Ancor Sanz-Garcia Diego A.Rodriguez-Serrano Guillermo Fernandez-Jimenez Rosa Giron Elena Avalos Joan B.Soriano J.Ignacio de Ulibarri Facultad de Medicina Universidad Autónoma de MadridMadridSpain Unidad de Análisis de Datos Instituto de Investigación Sanitaria del Hospital de la PrincesaMadridSpain Servicios de Neumología Admisión y Documentación ClínicaCuidados Intensivos y Nutrición y DietéticaHospital Universitario de La PrincesaMadridSpain Centro de Investigación en Red de Enfermedades Respiratorias(CIBERES) Instituto de Salud Carlos III(ISCIII)MadridEspañaSpain

Background:In-hospital mortality in patients with coronavirus disease 2019(COVID-19)is *** prognostic indices are needed to identify patients at high-risk of COVID-19 health *** aimed to determine the usefulness of the CONtrolling NUTritional status(CONUT)index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital ***:Our study design is of a retrospective observational study in a large cohort of COVID-19 *** addition to descriptive statistics,a Kaplan-Meier mortality analysis and a Cox regression were performed,as well as receiver operating curve(ROC).Results:From February 5,2020 to January 21,2021,there was a total of 2969 admissions for COVID-19 at our hospital,corresponding to 2844 ***,baseline(within 4 days of admission)CONUT index could be scored for 1627(57.2%)***’age was 67.3±16.5 years and 44.9%were *** CONUT severity distribution was:194(11.9%)normal(0-1);769(47.2%)light(2-4);585(35.9%)moderate(5-8);and 79(4.9%)severe(9-12).Mortality of 30 days after admission was 3.1%in patients with normal risk CONUT,9.0%light,22.7%moderate,and 40.5%in those with severe CONUT(Pdeath associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model(Pder the curve(AUC)and 95%confidence interval of 0.711(0.676-0746).Conclusion:The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patients.

关键词： Admission Clinical risk CONUT COVID-19 Prognosis Score

A Case Report of Hypothyroidism and Pericardial Effusion

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Case Reports in Clinical Medicine 2020年第12期9卷 408-420页

作者： Cacelín Garza José Ramón Cacelín Miranda Rafael Sebastián Cacelín Miranda Ariadna Rosalba Meléndez Ordo&ntilde ez Jesús Alberto Servicio de Medicina Interna Hospital General de Nativitas Tlax Mexico departamento de Medicina Interna Unidad de Cuidados Intensivos Hospital General de Zona No. 1 Instituto Mexicano del Seguro Social Tlax Mexico Facultad de Medicina Universidad Popular Autónoma del Estado de Puebla Puebla México Residente de la Especialidad de Anestesiología Hospital Juárez de México Ciudad de México México

The pericardial sac is made of two layers: the visceral and parietal pericardium. Located between these two layers, the pericardial cavity is found. It contains around 15 to 50 mL of a liquid secreted by mesothelial cells. Pericardial effusion is described as the accumulation of liquid within the pericardial cavity, exceeding the previous mentioned quantity. It has multiple causes, such as malignancy, infectious origins, inflammation, and others, such as hypothyroidism. One of the multiple clinical manifestations associated with hypothyroidism is pericardial effusion. It is related to the severity and duration of the disease, being more frequent in congenital hypothyroidism or cases of a long history of hypothyroidism, as well as clinical hypothyroidism. It can present a clinical challenge mainly due to the discordance between the total volume of the effusion and the clinical symptoms shown by the patient. The main objective of this work is to present a case of a forty-two-year-old male with hypothyroidism-associated pericardial effusion which resolved satisfactorily with hormone replacement therapy.

关键词： Hypothyroidism Pericardial Effusion Echocardiogram Levothyroxin

Community-Acquired Severe Sepsis:A Prospective Cohort Study

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Open Journal of Internal Medicine 2015年第3期5卷 37-49页

作者： Cristiana Sousa Mariana Brandao Orquídea Ribeiro Teresa Cardoso Service of Medicine Centro Hospitalar de Trás-os-Montes e Alto DouroChaves UnitChavesPortugal Service of Medicine Hospital de Santo AntónioOporto Hospital CenterUniversity of OportoPortoPortugal Statistician at department of Health Information and decision Sciences Center for Research in Health Technologies and Information Systems(CINTESIS)Department of Biostatistics and Medical InformaticsCINTESISFaculty of MedicineUniversity of OportoPortoPortugal Intensive Care Unit(UCIP) Hospital de Santo AntónioOporto Hospital CenterUniversity of OportoPortoPortugal

Severe sepsis (SS) is one of the principal causes of admission in intensive care units (ICU), with an associated high morbidity and mortality. This study intends to characterize epidemiology of community-acquired SS (CASS) with special emphasis in the prevalence of multidrug resistant organisms and independent prognostic factors associated with ICU mortality. Methods: A prospective cohort study was conducted over 3.5 years, including all consecutive adult patients with CASS admitted to a mixed ICU, in a 600-bed university-affiliated hospital. Results: 1221 patients were admitted into the ICU, 25% with CASS. The mean age was 59 years and the mean SAPS (simplified acute physiological score) was II 48. Most had septic shock (67%). Respiratory (57%), intra-abdominal (22%) and urinary tract (8%) infections were the main sources of infection. The overall isolation rate was 56%. The most common identified microorganisms were Streptococcus pneumoniae (27%), Escherichia coli (22%), Staphylococcus aureus methicillin sensitive (8%) and Haemophilus influenzae (7%). The median ICU and hospital length of stay were 8 and 16 days, respectively. The ICU mortality rate was 33. Independent risk factors associated with higher mortality were older age, higher SAPS II, septic shock and chronic hepatic disease. Female gender was independently associated with lower mortality. The type of microorganism was not significantly associated with prognosis. Conclusion: CASS was highly prevalent among ICU admissions. Independent risk factors associated with ICU mortality included older age and previous comorbidities, but mainly severity of acute illness reinforcing the need for early recognition and treatment. Multidrug resistant organisms were implicated in considerable proportion of community-acquired sepsis.

关键词： Community-Acquired Sepsis Severe Sepsis Septic Shock ESKAPE Organisms ICU Mortality