3 research outputs found

    Autopercepción de la eficacia en enfermeras neonatales entrenadas en una simulación in situ de reanimación cardio pulmonar neonatal

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    Introduction. The care of the neonate in critical condition is a complex situation that requires of training and continuing education, through the incorporation of active methodologies of learning, as the clinical simulation. Objective: To describe the self-perception of efficacy of the in-situ clinical simulation. Methods: Descriptive, observational and cross-sectional study. The sample was intentional and included participants of the clinical stage of Reanimation Cardiopulmonary in the Unit of Neonatal Intermediate Cares of the Instituto Nacional de Salud del Niño San Borja, Lima – Peru. The unit of analysis was the nurses with specialty in neonatology. We applied the Tool of Efficiency of Simulation - Modified. Results. 12 nurses participated, more than 80% of them considered that the in-situ clinical simulation increases their confidence and develops a favorable learning environment in technical and non-technical skills. Conclusions. The in-situ clinical simulation generated a high percentage of satisfaction as a methodology of learning.Introducción. El cuidado del neonato en estado crítico es una situación compleja, que requiere formación y educación continua, mediante la incorporación de metodologías activas de aprendizaje, como la simulación clínica. Objetivo. Describir la autopercepción de eficacia de la simulación clínica in-situ. Métodos. Estudio descriptivo, observacional, transversal. La muestra fue intencional y conformada por los participantes del escenario clínico de Reanimación Cardiopulmonar en la Unidad de Cuidados Intermedios Neonatales del Instituto Nacional de Salud del Niño San Borja, Lima, Perú. La unidad de análisis fueron las enfermeras con especialidad en neonatología. Se aplicó la Herramienta de Eficacia de Simulación – Modificada. Resultados. 12 enfermeras participaron, más del 80% de ellas consideraron que la simulación clínica in-situ aumenta su confianza y desarrolla un entorno de aprendizaje favorable en habilidades técnicas como no técnicas. Conclusiones. La simulación clínica in-situ generó un alto porcentaje de satisfacción como metodología de aprendizaje

    Evaluación de grado estudiantes de medicina del último año mediante simulación clínica multimodal: Experiencia de una universidad peruana

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    Introduction: Medical education has been affected by social isolation due to the pandemic, and the evaluation of clinical skills in students must opt ​​for options such as clinical simulation. Objective: to describe the evaluation of the degree exam for human medicine interns with multimodal clinical simulation. Clinical evaluation: The structured activity with multimodality from the methodology and location of the participants fulfilled the objective of evaluating and graduating interns. It was carried out through the presentation of case scenarios of two of the major specialties in the intern per student, carried out in a simulation office and a high-fidelity room occupying simulated patients, high-performance simulators, nurse/assistance, function software vital and technical simulation, all of them in person in addition to the student, and the juries remotely who, through observation first and then the support of the student, were able to evaluate performance through rubrics.Introducción: La educación médica ha sido afectada por el aislamiento social por la pandemia, y la evaluación de competencias clínicas en estudiantes debe optar por opciones como la simulación clínica. Objetivo: describir la evaluación de examen de grado de internos de medicina humana con simulación clínica multimodal. Evaluación clínica La actividad estructurada con multimodalidad desde la metodología y ubicación de los participantes cumplió el objetivo de evaluar y graduar internos. Se realizó a través de la presentación de casos-escenario de 2 de las especialidades grandes en el internado por  alumno, realizadas en consultorio de simulación y sala de alta fidelidad ocupando pacientes simulados, simuladores de alta prestación, enfermera/o asistiendo, software de funciones vitales y técnico de simulación, todos ellos en presencial además del alumno, y los jurados en remoto que a través de la observación primero y luego la sustentación del alumno fueron capaces de evaluar el desempeño mediante rúbricas

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030
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