Mobilization practices in critically ill children : A European point prevalence study (EU PARK-PICU)

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.BACKGROUND: Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. METHODS: A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. RESULTS: Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. CONCLUSION: Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.Peer reviewe

Effects of Feedback nn Skills During Cardiopulmonal Reanimation Training

Sudden cardiac arrest is one of the main causes of death in Europe. Early initiation and qualitative performance of cardiopulmonary resuscitation can reduce mortality. In order to perform cardio-pulmonary resuscitation of appropriate quality, theoretical and practical knowledge is needed which can be improved by clinical simulation. The aim of the study was to find out the effect of feedback on participants' skills during cardiopulmonary resuscitation training. Hypothesis - feedback improves participants' skills during cardiopulmonary resuscitation training. Research Method - randomized controlled simulation study. Research instruments - observation protocol, questionnaire. A total of 32 employees of State Emergency Medical Service (medical practitioners) participated in the study. The hypothesis was confirmed - feedback improves participants' skills during cardiopulmonary resuscitation training. The total evaluation of cardiopulmonary resuscitation in the intervention group, which performed the cardiopulmonary resuscitation scenario with the feedback function is higher (92,13%) compared to the control group (77%). Most of the participants in the intervention group fully agree that the use of feedback function during training improves the overall cardiopulmonary resuscitation skills. The results of the study indicate that the development of cardiopulmonary resuscitation training programs for medical students and practitioners requires the inclusion of practical activities with clinical simulations with feedbackpublishersversionPeer reviewe

Remote rapid cycle deliberate practice simulation training during the COVID-19 pandemic

The COVID-19 pandemic is posing new challenges for medical education and simulation practice given local social distancing requirements. This report describes the use of an online platform for rapid cycle deliberate practice simulation training that can be used and tailored to local COVID-19 pandemic restrictions as it allows for participants, facilitators and simulation equipment to be apart.publishersversionPeer reviewe

Telementoring for remote simulation instructor training and faculty development using telesimulation

Publisher Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Introduction: Simulation-based training is essential for high-quality medical care, but it requires access to equipment and expertise. Technology can facilitate connecting educators to training in simulation. We aimed to explore the use of remote simulation faculty development in Latvia using telesimulation and telementoring with an experienced debriefer located in the USA. Methods: This was a prospective, simulation-based longitudinal study. Over the course of 16 months, a remote simulation instructor (RI) from the USA and a local instructor (LI) in Latvia cofacilitated with teleconferencing. Responsibility gradually transitioned from the RI to the LI. At the end of each session, students completed the Debriefing Assessment for Simulation in Healthcare (DASH) student version form (DASH-SV) and a general feedback form, and the LI completed the instructor version of the DASH form (DASH-IV). Outcome measures were the changes in DASH scores over time. Results: A total of eight simulation sessions were cofacilitated of 16 months. As the role of the LI increased over time, the debrief quality measured with the DASH-IV did not change significantly (from 89 to 87), although the DASH-SV score decreased from a total median score of 89 (IQR 86-98) to 80 (IQR 78-85) (p=0.005). Conclusion: In this study, telementoring with telesimulations resulted in high-quality debriefing. The quality - perceived by the students - was higher with the involvement of the remote instructor and declined during the transition to the LI. This concept requires further investigation and could potentially build local simulation expertise promoting sustainability of high-quality simulation.Peer reviewe

Prospective paediatric intensive care registry in Latvia : one year outcomes

Background: In Latvia, there is a single eight-bed paediatric intensive care unit (PICU) where all critically ill children are admitted. A recent retrospective audit of the outcomes of paediatric critical care in this unit revealed a high number of unplanned extubations and excess crude mortality. In 2017, our centre joined the UK and Ireland based Paediatric Intensive Care Audit Network (PICANet) as a pilot project to investigate the feasibility of developing a paediatric critical care registry in Latvia and in the Baltic states. Methods: Riga Stradins University Ethics Committee approved the study. Anonymized data on all patients admitted to our unit from 1 June, 2017 to 31 May 2018 were prospectively entered onto the PICANet database. Results: A total of 774 PICU admissions were analysed; 45% of admissions were elective. The median age was 59 months (IQR: 14-149). The highest admission rate was on Wednesdays representing the flow of elective surgical patients. The median length of stay was 0.95 days (IQR: 0.79-1.98). Twenty-five percent required respiratory support. The expected number of deaths estimated using the Paediatric Index of Mortality 3 (PIM 3) 15.16; 15 patients (1.94%) died resulting in Standartized Mortality Ratio (SMR) of 0.99 (95% CI 0.57-1.60). The emergency readmission rate within 48 hours after PICU discharge was 0.9%. There were 1.8 unplanned extubations per 100 invasive ventilation days. Other paediatric intensive care audit networks reported similar adjusted mortality rates but lower rates of unplanned extubations. Thirty days after PICU discharge, 653 (84.36%) patients were alive and outside hospital, 98 (12.66%) were inpatients, six (0.78%) had died, two (0.26%) were lost to the follow-up. We observed a marked peak of infant emergency respiratory admissions in February. Conclusions: This project explored the possibility of prospective paediatric critical care audit in Latvia by joining an established international network. This allowed direct comparison of outcomes between the countries. Excess mortality was not observed during one-year data collection period, however a high rate of unplanned extubations was revealed. The results allowed a better planning of elective patient flow by spreading elective cases over the week to avoid "rush hours".publishersversionPeer reviewe

Incidence and outcomes of patients with functionally univentricular heart born in Latvia, 2007 to 2015

Funding Information: This study was approved by the Ethics Committee of the Children’s Clinical University Hospital (Decision No. 5-2016; 12 September 2016); given the retrospective nature and absence of any patient identification, the requirement for individual patient or parent consent was waived. Publisher Copyright: © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: A functionally univentricular heart is the term used to describe congenital heart defects where it is impossible to restore two pumping chambers. These lesions are associated with high mortality, morbidity, and medical resource utilization. The aim of this study was to review incidence and outcomes of patients with a functionally univentricular heart at the only pediatric cardiac surgery center in Latvia. Methods: We performed a retrospective review of medical records of (i) all children with a functionally univentricular heart treated at the Clinic of Pediatric Cardiology and Cardiac Surgery, and (ii) all prenatally diagnosed cases of univentricular heart at Children’s Clinical University Hospital in Latvia. We reviewed data regarding children born from January 1, 2007, to December 31, 2015. The children’s cardiac anatomy and interventions were categorized in accordance with the International Pediatric and Congenital Cardiac Code (v3.3). Results: During the study period, 49 patients with a functionally univentricular heart were admitted to Children’s Clinical University Hospital with a corrected incidence of 0.69 per 1000 live births per year. There were 26 patients that had a hypoplastic left ventricle, and 22 patients that had a hypoplastic right ventricle, while one patient had an indeterminate ventricle. Thirty (61.2%) patients had died by the end of data collection. Twenty-one of the 30 deaths occurred before or immediately after stage I surgical palliation. Cumulative neonatal and 5-year survival of patients with a hypoplastic right ventricle was 81.8% and 63.6%, respectively; for patients with hypoplastic left ventricle—46.2% and 17.3%, respectively. Discussion: This is the first mid-term outcome study of patients with a univentricular heart in Latvia. The high mortality reflects the challenges of a small-volume, developing congenital cardiac surgery center. Data from this study will be used as a baseline for quality improvement.publishersversionPeer reviewe

Assessment of ADAMTS-13 Level in Hospitalized Children with Serious Bacterial Infections as a Possible Prognostic Marker

Background and objectives: In children, acute infection is the most common cause of visits in the primary care or emergency department. In 2002, criteria for diagnostics of pediatric sepsis were published, and then revised in 2016 as life-threatening organ dysfunction due to a dysregulated host response to infection. In the pathophysiology of sepsis endothelial dysfunction plays a very important role. Deficient proteolysis of von Willebrand factor, due to reduced ADAMTS-13 activity, results in disseminated platelet-rich thrombi in the microcirculation. ADAMTS-13 deficiency has been detected in systemic inflammation. The clinical relevance of ADAMTS-13 during sepsis is still unclear. We aimed to investigate the possible use of ADAMTS-13 as a prognostic marker in children with serious bacterial infection (SBI). Materials and Methods: Inclusion criteria were hospitalized children with SBI, aged from 1 month to 17 years. SBI was defined based on available clinical, imaging, and later also on microbiological data. Sepsis was diagnosed using criteria by The International Consensus Conference. In all the patients, the levels of ADAMTS-13 were measured at the time of inclusion. Results: Data from 71 patients were analyzed. A total of 47.9% (34) had sepsis, 21.1% (15) were admitted to the ICU, 8.5% (6) had mechanical ventilator support, and 4.2% (3) patients had a positive blood culture. The median level of ADAMTS-13 in this study population was 689.43 ng/mL. Patients with sepsis, patients admitted to the Intensive Care Unit, and patients in need of mechanical ventilator support had significantly lower levels of ADAMTS-13. None of the patients had ADAMTS-13 deficiency. In patients with SBI, the area under the curve (AUC) to predict sepsis was 0.67. A cut-off ADAMTS-13 level of <= 730.49 had 82% sensitivity and 60% specificity for sepsis in patients with SBI. Conclusions: ADATMS-13 levels were lower in patients with SBI and sepsis, but AUC and sensitivity were too low to accept it as a prognostic markerPeer reviewe

Predicting the Risk of Mortality in Children using a Fuzzy-Probabilistic Hybrid Model

Publisher Copyright: © 2022 Corsino Rey et al.Introduction. The mortality risk in children admitted to Pediatric Intensive Care Units (PICU) is usually estimated by means of validated scales, which only include objective data among their items. Human perceptions may also add relevant information to prognosticate the risk of death, and the tool to use this subjective data is fuzzy logic. The objective of our study was to develop a mathematical model to predict mortality risk based on the subjective perception of PICU staff and to evaluate its accuracy compared to validated scales. Methods. A prospective observational study in two PICUs (one in Spain and another in Latvia) was performed. Children were consecutively included regardless of the cause of admission along a two-year period. A fuzzy set program was developed for the PICU staff to record the subjective assessment of the patients' mortality risk expressed through a short range and a long range, both between 0% and 100%. Pediatric Index of Mortality 2 (PIM2) and Therapeutic Intervention Scoring System 28 (TISS28) were also prospectively calculated for each patient. Subjective and objective predictions were compared using the logistic regression analysis. To assess the prognostication ability of the models a stratified B-random K-fold cross-validation was performed. Results. Five hundred ninety-nine patients were included, 308 in Spain (293 survivors, 15 nonsurvivors) and 291 in Latvia (282 survivors, 9 nonsurvivors). The best logistic classification model for subjective information was the one based on MID (midpoint of the short range), whereas objective information was the one based on PIM2. Mortality estimation performance was 86.3% for PIM2, 92.6% for MID, and the combination of MID and PIM2 reached 96.4%. Conclusions. Subjective assessment was as useful as validated scales to estimate the risk of mortality. A hybrid model including fuzzy information and probabilistic scales (PIM2) seems to increase the accuracy of prognosticating mortality in PICU.publishersversionPeer reviewe

Human Respiratory Syncytial Virus Caused Lower Respiratory Tract Infection: Clinical and Molecular Characterization in Hospitalized Children in Latvia. Summary of the Doctoral Thesis

Promocijas darbs izstrādāts: Rīgas Stradiņa universitātes Pediatrijas katedrā Latvijas Biomedicīnas pētījumu un studiju centrā. Aizstāvēšana: 2014. gada 11. martā plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Dzirciema ielā 16, Hipokrāta auditorijā.Cilvēka respiratorais sincitiālais vīruss (HRSV) ir īpašs izaicinājums bērnu infekciju slimībās. Pirmkārt, tas ir visbiežākais dziļāko elpceļu infekciju izraisītājs agrīna vecuma bērniem, kas šajā grupā ir vadošais mirstības un hospitalizācijas iemesls. Otrkārt, tam nav pieejama efektīva specifiskā ārstēšana. Treškārt, lai arī efektīva un droša vakcīna ir globāla prioritāte, tās izstrāde kavējas I fāzes klīniskajos pētījumos. Viens no tās izveides apgrūtinājumiem – ātrā vīrusa mainība – tika analizēts šajā pētījumā. Trīs secīgu sezonu laikā pētījumā tika prospektīvi iekļauti 207 stacionēti bērni ar dziļāko elpceļu infekciju. Lai diagnosticētu HRSV un izšķirtu tā galvenās grupas, HRSV-A un B, šī pētījuma nolūkiem tika izstrādāta uz polimerāzes ķēdes reakciju balstīta metode, ar kuru 88 (42,5%) pētījuma pacientiem tika detektēta HRSV infekcija. HRSV epidemioloģiskās aktivitātes periods ilga no 51. līdz 19. gada nedēļai. Ikgadējo uzliesmojumu laikā HRSV izraisīja vairāk kā 90% bronhiolītu un 50% pneimoniju. Ar HRSV inficētie pacienti bija ievērojami jaunāki, un to vecums pārsvarā bija zem 6 mēnešiem. Ar molekulāro analīzi tika konstatēts, ka abu grupu vīrusi cirkulē paralēli, tomēr HRSV-A dominēja pirmajās divās sezonās, kurām sekoja HRSV-B dominanta sezona. Grupu ietvaros prevalēja viens genotips, NA1 (HRSV-A) un BA-IV (HRSV-B), kuri šajā laikā bija plaši izplatīti arī pasaulē. Statistiski ticamas klīniskās atšķirības starp dažādu grupu un genotipu izraisītajām infekcijām netika atrastas. 2012. gadā Latvijā tika konstatēts nesen atklātais HRSV-A genotips ON1, kuram raksturīgā 72 nukleotīdu duplikācija G gēnā tika izmantota, lai rekonstruētu tā globālo izplatību un populācijas dinamiku. Šis ir pirmais HRSV molekulārās epidemioloģijas pētījums Latvijā un tam ir gan lokāla, gan globāla zinātniskā novitāte. Tas aktualizē precīzu HRSV sezonalitātes datu nepieciešamību Latvijā. Tika atklāti vairāki jauni HRSV celmi, kuru sekvences ir deponētas GenBank datu bāzē. Šis pētījums ir pirmais, kas izvirza genotipa ON1 migrēšanas hipotēzi un populācijas dinamikas aplēses. Iegūtie dati var tikt izmantoti optimālākai imūnprofilakses pielietošanai riska grupas zīdaiņiem Latvijā un globālo sabiedrības veselības stratēģiju plānošanā.Promocijas darbs izstrādāts ar ESF līdzfinansēta projekta „Atbalsts doktorantiem studiju programmas apguvei un zinātniskā grāda ieguvei Rīgas Stradiņa universitātē”, vienošanās Nr. 2009/0147/1DP/1.1.2.1.2/09/IPIA/VIAA/009, atbalstu

Cilvēka respiratorā sincitiālā vīrusa izraisīto dziļāko elpceļu infekciju klīniskais un molekulārais raksturojums hospitalizētiem bērniem Latvijā. Promocijas darba kopsavilkums

The study was conducted at: Department of Pediatrics, Rīga Stradiņš University Latvian Biomedical Research and Study Centre. Defence: on 11th of March, 2014 at 15.00 during Rīga Stradiņš University Medical Degree Committee open meeting in Lecture theatre Hippocrates, Rīga Stradiņš University, 16 Dzirciema Street, Riga.Human respiratory syncytial virus (HRSV) represents a particular challenge in pediatric infectious diseases. First, it is the most common etiologic agent of lower respiratory tract infections in infants and young children, which is the leading cause of hospitalization and mortality in this age group. Second, there is no effective specific treatment available. Third, although effective and safe vaccine is a global priority, its research is still in phase I clinical trials. One of the challenges in vaccine development, the high variability of the virus, was addressed in this study. A total of 207 hospitalized children with lower respiratory tract infections were prospectively enrolled in the study over three consecutive seasons. For HRSV diagnosis and group, HRSV-A and B, differentiation a polymerase chain reaction based method was developed that tested positive 88 (42.5%) of the patients. The seasonal activity lasted from weeks 51 to 19. During the annual outbreaks, HRSV caused more than 90% of bronchiolitis and 50% of pneumonia. Children with HRSV lower respiratory tract infection were significantly younger than those with non-HRSV and were mostly less than 6-month-old. Molecular analysis revealed that the strains of both groups co-circulated, however HRSV-A viruses predominated for the first two consecutive seasons followed by an HRSV-B dominant season. Within the groups, viruses belonged to the worldwide dominant genotypes NA1 (HRSV-A) and BA-IV (HRSV-B). Clinical characteristics of infections caused by the different groups or genotypes were not statistically significant. In 2012, recently described HRSV-A genotype ON1 emerged in Latvia. Its characteristic 72-nucleotide duplication in the G gene was exploited to reconstruct the global spread and population dynamics of this genotype. This is the first molecular epidemiologic study of HRSV in Latvia and it has several important findings. It emphasizes the need for precise HRSV seasonality data. In this study several new HRSV strains were detected and deposited in GenBank database. This is also the first study suggesting a hypothesis of the global dissemination and population dynamics of the novel genotype ON1. The data presented here can be used to optimize timing of immunoprophylaxis in the high-risk infants in Latvia and to develop global public health interventions.The thesis was co-funded by the ESF project “Support for Doctoral Students in Mastering the Study Programme and Acquisition of a Scientific Degree in Rīga Stradiņš University”, agreement No. 2009/0147/1DP/1.1.2.1.2/09/IPIA/VIAA/009