Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

AIM To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis.METHODS A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation. A follow up post-test was completed 3-6 mo after the simulation. Nurses completed a survey regarding the education activity. RESULTS Pediatric and medicine-pediatric residents(n = 20) and pediatric nurses(n = 25) completed the simulation course. Graduating residents(n = 16) were used as reference group. Pretest results were similar in the control and intervention group(74% ± 10% vs 76% ± 15%, P = 0.658). After completing the intervention, participants improved in the immediate post-test in comparison to themselves and the control group(84% ± 12% post study; P < 0.05). The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results(78% ± 14%, P = 0.761). Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning.CONCLUSION Results suggest a multidisciplinary, longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs, future studies are needed to determine ways to decrease this decay.

Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest

Objective:Cardiopulmonary resuscitation(CPR)after cardiac arrest(CA)is one of the main causes of capillary leakage syndrome(CLS).This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation(CA-CPR)model in Sprague-Dawley(SD)rats.Methods:We conducted a prospective,randomized,animal model study.All adult male SD rats were randomly divided into a normal group(group N),a sham operation group(group S),and a cardiopulmonary resuscitation group(group T).The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins.In group S and group T,the endotracheal tube was intubated.In group T,CA induced by asphyxia(AACA)was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min,and the rats were resuscitated with manual chest compression and mechanical ventilation.Preresuscitation and postresuscitation measurements,including basic vital signs(BVS),blood gas analysis(BG),routine complete blood count(CBC),wet-to-dry ratio of tissues(W/D),and the HE staining results after 6 h were evaluated.Results:In group T,the success rate of the CA-CPR model was 60%(18/30),and CLS occurred in 26.6%(8/30)of the rats.There were no significant differences in the baseline characteristics,including BVS,BG,and CBC,among the three groups(P>0.05).Compared with pre-asphyxia,there were significant differences in BVS,CBC,and BG,including temperature,oxygen saturation(SpO_(2)),mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin,hematocrit,pH,pCO_(2),pO_(2),SO_(2),lactate(Lac),base excess(BE),and Na+(P<0.05)after the return of spontaneous circulation(ROSC)in group T.At 6 h after ROSC in group T and at 6 h after surgery in groups N and S,there were significant differences in temperature,heart rate(HR),respiratory rate(RR),SpO_(2),MAP,CVP,WBC,pH,pCO_(2),Na+,and K+among the three groups(P<0.05).Compared with the other two groups,the rats in group T showed a significantly increased W/D weight ratio(P<0.05).The HE-stained sections showed consistent severe lesions in the lung,small intestine,and brain tissues of the rats at 6 h after ROSC following AACA.Conclusion:The CA-CPR model in SD rats induced by asphyxia could reproduce CLS with good stability and reproducibility.

“There Are Many Cases That You Carry with You That Leave Scars”: Burnout and Secondary Trauma among Pediatric Residents in Routine and Covid Times

The current research joins previous studies in examining post-traumatic stress disorder (PTSD) and burnout among healthcare workers. The research focuses on the experiences of pediatric residents working in an emergency department both in normal times and during the Covid pandemic. Research conducted prior to and during the Covid pandemic outbreak shows negative psychological effects among healthcare workers. Most of that research was conducted within the positivistic-quantitative paradigm. The current study is qualitative and focuses on pediatric residents who provide medical services to a unique population in a peripheral region of Israel, namely the Bedouin-Arab population. The research questions are the following: What characterizes pediatric residents’ work, in general and during the pandemic? Do they show signs of burnout and secondary trauma? How do they perceive their work with the Bedouin-Arab population, especially during the pandemic? The study, conducted within the phenomenological genre, included 14 pediatric residents in a large hospital in Israel’s periphery. Semi-structured clinical interviews were employed, in addition to questionnaires that examined PTSD and burnout to enhance the reliability of the findings. The results show that all residents reported stressful incidents in which patients’ physical integrity was threatened. The residents described the special nature of the medical cases they treated in routine times and during the pandemic outbreak, which stems mostly from the specific characteristics the population of Israel’s periphery. While at the early stages of the pandemic, the residents experienced reduced work pressure, they reported substantial difficulties later in the crisis, which intensified their sense of physical and emotional stress. Most residents reported feeling inadequately prepared for dealing with traumatic events. According to the results, most residents displayed secondary trauma (12 participants in interviews and 11 in questionnaires), which can be classified into categories based on the DSM-5. In the interviews, all 14 participants reported various signs of burnout. The questionnaires indicated burnout symptoms among 10 participants. Giving a voice to pediatric residents, the study highlights the complexity of their routine work as well as their role during the Covid crisis. Based on the findings, recommendations have been made for policymakers. The study highlights the importance of raising awareness to the implications of the residents’ rough work conditions in routine and emergency times and to the need to develop social support and intervention programs that might improve their well-being during their professional work.

A Potential Role for GLUT4 in Predicting Sepsis in Critically Ill Children

Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.

Investigating changes in incidence and severity of pediatric appendicitis during the COVID-19 pandemic in Canada:an interrupted time series analysis

At the onset of the coronavirus disease 2019(COVID-19)pandemic,pediatric emergency department(ED)visits decreased worldwide by an estimated 30%-89%[1].In Canada,there was a 58%reduction in pediatric ED visits in March and April 2020 relative to the same months in previous years[2].These reductions have been attributed to a decrease in non-severe acute respiratory syndrome corona-virus 2(SARS-CoV-2)infections in children resulting from confinement and public health measures,as well as a shift toward virtual care[3,4].

Response to"Incidence and severity of pediatric appendicitis during the COVID-19 pandemic"

We would like to thank Quaglietta et al.[1]for their interest in our study and making their data available to allow compar-ison with our article[2]on the impact of the coronavirus dis-ease 2019(COVID-19)pandemic on pediatric appendicitis.We welcome new Canadian data on the impact of the pandemic on pediatric appendicitis.We agree with the authors that our article could not reflect the experience of all hospitals and provinces in Canada.

Personal experience in pediatric emergency medicine training in Canada and China

Currently, pediatric emergency medicine （PEM） as practiced in many developed countries is different from ours in China. Chinese pediatric emergency medicine is just children＇s internal medicine and does not include general surgery, ear-nose-throat, etc. If children have an emergency condition that require specialized treatments they need to go to different departments. However in Canada, the pediatric emergency physicians will first treat the patients whatever the condition, then, if it is a complicated sub specialty problem, they will consult the specialist or let the patient see the specialist later. In addition, resuscitation is done in the pediatric intensive care unit （PICU） in China, but it is done in the emergency room in Canada. This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

Brainstem folding in an influenza child with Dandy-Walker variant

BACKGROUND Influenza in children is a major cause of morbidity and mortality worldwide.Nervous system diseases are a factor relating to increased mortality rate.However, reports of how these underlying diseases contribute to the death of children with influenza are rare.CASE SUMMARY A 4-year-old-girl developed type A influenza-related encephalopathy(IAE) with seizures, acute disorder of consciousness, and intracranial hypertension(cerebrospinal fluid pressure: 250 mm H2O), and the Dandy-Walker variant was found by her first magnetic resonance imaging(MRI) when admission. Three days later, she suddenly presented anisocoria, acute pulmonary edema, and coma, and the later MRI found that she had compressed brainstem, oblongata "Zlike folding", and swelling bilateral basal ganglia. After admission, the patient were tested for routine and special biomarkers and underwent neuroimaging and neuroelectrophysiology examinations as well as Oseltamivir and intravenous immunogloblin treatments. When predicting that unstable intracranial structures detected by MRI might have disastrous consequences in the progression of IAE,she was transferred into the pediatric intensive care unit and underwent continuous assessment of clinical condition while she did not have instability of basic vital signs;at the same time, her parents were fully informed about the risk and prognosis. Although she was ultimately dead from brain stem failure, the parents expressed understanding and did not trigger a doctor-patient conflict.CONCLUSION In case of finding an unstable intracranial structure, intensive care should be given to IAE patient and their clinical condition should be monitored continuously.

低龄儿童接受导尿术前床边膀胱超声检查的实用性

Background. Urethral catheterization is the method of choice for obtaining samples for urine culture and urine analysis in infants. Before the procedure, there is little certainty of the presence or amount of urine in the bladder. Consequently, this relatively invasive and uncomfortable procedure often needs to be repeated. The newly available technology of portable ultrasound may be useful in reducing the number of unsuccessful procedures. Objective. To investigate the utility of bedside ultrasound of the bladder performed by pediatric emergency medicine physicians before catheterization in reducing the number of unsuccessful attempts. Methods. A prospective, 2-phase study was performed in the setting of an urban pediatric emergency department from August 2003 to February 2004. Children who were between the ages of 0 and 24 months were enrolled. During the observation phase, the amount of urine obtained during the first catheterization was recorded for each patient. During the intervention period, a rapid bedside ultrasound of the bladder was performed by a pediatric emergency medicine physician immediately before urethral catheterization. When a sufficient amount of urine was seen, catheterization was conducted as usual. Otherwise, catheterization was deferred and repeated ultrasound was performed at 30-minute intervals until sufficient urine was identified. The amount of urine obtained was recorded. Results. During the observation phase, 136 infants underwent urethral catheterization. Overall, the rate of success during the first attempt,defined as obtaining > 2 mL of urine, sufficient for culture and other routine studies, was 72%(95%confidence interval: 66%-78%). A total of 112 subjects were enrolled during the intervention phase. Sufficient urine was identified on the first ultrasound in 76%(n = 85) of the patients. Among these, 98%(n = 83)-underwent successful urethral catheterization during the first attempt. Among those in whom insufficient urine was identified initially (n = 27; 24%), subsequent ultrasound revealed sufficient amount in all patients within 90 minutes. Among these, 93%(n = 25) underwent successful urethral catheterization during the first attempt. Overall rate of success of initial urethral catheterization during the intervention phase was 96%(95%confidence interval: 93%-99%). Compared with the success rate during the observation phase, the differences were statistically significant. The results were consistent after being adjusted for gender. Conclusion. A rapid bedside ultrasound of the bladder performed by pediatric emergency physicians led to an increased success rate of urethral catheterization in children who were younger than 2 years. We were able to avoid repeated invasive testing with a simple noninvasive procedure.