20 research outputs found
Aggressive Fluid Resuscitation in Severe Pediatric Hyperglycemic Hyperosmolar Syndrome: A Case Report
Objective. This report describes a severe case of hyperglycemic hyperosmolar syndrome
complicated by rhabdomyolysis, acute kidney injury, hyperthermia, and hypovolemic
shock, with management centred upon fluid administration.
Design. Case report.
Setting. Pediatric intensive care unit in university teaching hospital.
Patients. 12 years old adolescent female presenting with hyperglycemic hyperosmolar
syndrome with a new diagnosis of type 2 diabetes mellitus.
Intervention. Aggressive fluid resuscitation and insulin.
Main results. The patient had a good outcome, discharged home on hospital day 6.
Conclusions. Hyperglycemic hyperosmolar syndrome is associated with a number of
complications. Management strategies are undefined, given the rarity of its presentation,
and further studies are warranted
Paroxysmal Autonomic Instability with Dystonia after Pneumococcal Meningoencephalitis
Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently resulting in severe neurological impairment. A seven-month-old child presenting with Streptococcus pneumoniae meningoencephalitis developed right basal ganglia and hypothalamic infarctions. Daily episodes of agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing were observed. The diagnosis of paroxysmal autonomic instability with dystonia was established. The patient responded to clonidine, baclofen, and benzodiazepines. Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis
A new measure for multi-professional medical team communication: design and methodology for multilingual measurement development
BackgroundAs implementation science in global health continues to evolve, there is a need for valid and reliable measures that consider diverse linguistic and cultural contexts. A standardized, reproducible process for multilingual measure development may improve accessibility and validity by participants in global health settings. To address this need, we propose a rigorous methodology for multilingual measurement development. We use the example of a novel measure of multi-professional team communication quality, a determinant of implementation efforts.MethodsThe development and translation of this novel bilingual measure is comprised of seven steps. In this paper, we describe a measure developed in English and Spanish, however, this approach is not language specific. Participants are engaged throughout the process: first, an interprofessional panel of experts and second, through cognitive interviewing for measure refinement. The steps of measure development included: (1) literature review to identify previous measures of team communication; (2) development of an initial measure by the expert panel; (3) cognitive interviewing in a phased approach with the first language (English); (4): formal, forward-backward translation process with attention to colloquialisms and regional differences in languages; (5) cognitive interviewing repeated in the second language (Spanish); (6) language synthesis to refine both instruments and unify feedback; and (7) final review of the refined measure by the expert panel.ResultsA draft measure to assess quality of multi-professional team communication was developed in Spanish and English, consisting of 52 questions in 7 domains. This measure is now ready for psychometric testing.ConclusionsThis seven-step, rigorous process of multilingual measure development can be used in a variety of linguistic and resource settings. This method ensures development of valid and reliable tools to collect data from a wide range of participants, including those who have historically been excluded due to language barriers. Use of this method will increase both rigor and accessibility of measurement in implementation science and advance equity in research and practice
Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study
Background
Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported.
Objective
To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors.
Methods
A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected.
Results
Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid.
Conclusions
A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites
Case Report Paroxysmal Autonomic Instability with Dystonia after Pneumococcal Meningoencephalitis
Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently resulting in severe neurological impairment. A seven-month-old child presenting with Streptococcus pneumoniae meningoencephalitis developed right basal ganglia and hypothalamic infarctions. Daily episodes of agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing were observed. The diagnosis of paroxysmal autonomic instability with dystonia was established. The patient responded to clonidine, baclofen, and benzodiazepines. Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis
Child injuries in Lebanon: assessing mothersâ injury prevention knowledge attitude and practices
Abstract Background Childhood injury is a neglected public health problem with a sizeable burden on childrenâs well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothersâ Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothersâ supervision. Methods This cross-sectional study recruited mothers of children aged up to 10Â years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothersâ KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes. Results A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12Â months, mostly sustained by males (53.8%) and children aged 5â10Â years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5Â years (pâ<â0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (pâ=â0.001). Conclusion Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries
Cultural differences in simulation debriefing: A qualitative analysis
Context: Simulation is a social practice impacted by norms, values, and beliefs. We seek to explore the relationship between cultural factors and participant behaviour patterns as perceived by debriefers during healthcare simulation debriefings. Our research question focuses on elucidating factors that influence debreifing dynamics between and among debriefers and learners according to Hofstede's cultural dimension: the Power Distance Index. Methods and materials: The study employed inductive qualitative analysis following Braun and Clark's 6-step approach to explore debriefers' perceived barriers to discussing non-technical skills including closed-loop communication, situational awareness, and cultural aspects of healthcare simulation debriefing. This study is a complementation to previously published quantitative paper, the qualitative findings are derived from the third section of the interview guide developed by the authors which focused on aspects of the debriefing such as debriefers' perceptions of participant familiarity with non-technical skills and cultural sensitivity. Findings: The responses of 57 debriefers from 26 countries were analysed; 36 (64%) of whom practiced simulation in low power distance index (PDI) countries and 31 (36%) practiced in high PDI countries. We identified three major themes: I. Group dynamics, encompassing challenges of hierarchy, âspeaking upâ, fear of âlosing faceâ and âjudgementâ. II. Conceptual clarity about debriefing medical/technical content and the challenges of âlanguageâ and III. Institutional âskepticismâ toward simulation as a relatively new method of teaching in many parts of the world. Insights: The findings confirm the social nature of simulation debriefings, where the interactions are guided by motivations and rules, and where more variability can be found within a culture than between cultures. Acknowledging these differences could lead to cultivating new integrative perspectives for all levels of the healthcare system