Objectives: The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. Methods: A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. Results: Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. Conclusion: PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators. RÉ SUMÉObjectifs: L'é tude avait pour objectifs d'é valuer les pratiques actuelles concernant les ré unions-bilan aprè s ré animation (RBAR) dans les services d'urgences (SU) pé diatriques au Canada, et de cerner les domaines susceptibles d'amélioration. Mé thode: Nous avons mené une enquê te sur l'é valuation nationale des besoins afin de recueillir des renseignements sur les pratiques actuelles concernant les RBAR et les points de vue sur la tenue de ces ré unions dans les SU pé diatriques. Un questionnaire a é té envoyé à des infirmiè res et infirmiers travaillant dans des SU, à des stagiaires et à des mé decins traitants, dans 10 hô pitaux pé diatriques, de soins tertiaires, partout au Canada. Des statistiques sommaires ont é té noté es. Ré sultats: Ont fait l'objet d'analyse les donné es de 183 participants (taux de ré ponse: 48.7%). Bien que 88.8% d'entre eux considè rent que les ré unions-bilan sont un processus important, 52.5% ont indiqué que ce genre de ré union aprè s des ré animations ré elles se tenaient dans moins de 25% des cas, et 68.3% ont indiqué qu'ils n'avaient pas d'attentes à l'é gard des RBAR dans leur é tablissement. De plus, 83.7% des ré pondants estimaient que les animateurs devraient avoir des compé tences particuliè res, acquises dans le cadre de sé ances de formation structuré e, mais 63.4% des animateurs n'avaient pas de formation en matiè re de ré union-bilan. Par ailleurs, 72% des participants é taient d'avis que l...
Background: Information about the prevalence of obesity in children with type 1 diabetes mellitus (DM1) is inconsistent and limited. The burden of the concurrent problems of obesity and DM1 can have notable medical, psychological, and social implications for both patients and their families. Aims: To determine prevalences of overweight and obesity in children with DM1 compared to a control population. Methods: In a cross-sectional study, we compared the prevalence of overweight/obesity in 390 children with DM1 (males 54%) and 565 controls (CONT; males 60%) aged 6 to 16 years. Overweight and obesity were defined as body mass indices between the 85 th and 95 th percentiles, and greater than the 95 th percentile for age, respectively. Results: Overall, 29.5% DM1 and 18.1% CONT (p <0.001) were either obese or overweight. The prevalence of obesity alone did not differ (DM1 5.4% vs CONT 8.2%), but a greater rate of overweight was seen in the DM1 group (DM 24.1% vs CONT 10.0%, ρ <0.001). RateS of overweight were higher in the DM1 than CONT across all age groups and in both genders (males: DM1 20.1% vs CONT 8.9%, ρ <0.001; females: DM1 28.7% vs CONT 11.5%, ρ <0.001). Only females showed an increase in overall overweight/obesity rate (DM1 34.8% vs CONT 16.4%, ρ <0.001) and this was most evident in older girls. Conclusions: Children with DM1 are more overweight, but not more obese, than their nondiabetic counterparts. Additional research is warranted to evaluate the characteristics of DM1 and its management that may influence weight gain. KEY WORDStype 1 diabetes mellitus, obesity, overweight, body mass index, children
Background: Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Methods: Retrospective descriptive analysis of patients admitted to a level 1 trauma centre with self-inflicted injuries, 2008-2013. Results: Over a 5-year period, 268 patients with SIT presented to our hospital, 177 (66%) male, average age 39.4 years (SD 16). The most common mechanism of injury was stabbing, (47%), followed by jumping (26.86%). Jumpers had higher ISS (22 v. 9). Seasonal variation showed summer with highest incidence (34%), winter having the lowest (17%). Patients from rural areas accounted for 28%, these were younger (30 v. 42 years, p = 0.002), had lower ISS (9 v. 14, p = 0.007), presented with more firearm injuries (18.6% vs. 2.3%). Overall, 63 (23%) patients had pre-existing psychiatric disease; these patients had longer LOS (20 v. 7 days, p = 0.002), and had jumping from height as predominant mechanism (p = 0.01). Mortality was 13.8%. Patients that died were older (42 v. 30 years, p = 0.002), had higher ISS (14 v. 9, p = 0.007), longer LOS (13.5 v. 6 days, p = 0.004), with fall being the predominant mechanism associated with mortality (p < 0.0001). Conclusion:Our study defines and characterizes the population at risk for SIT in an attempt to implement appropriate prevention strategies and improve the existing post-injury care pathway.Abdominal compartment syndrome in the child. Gilgamesh Eamer,* Ioana Bratu.
Background: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED. Methods: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group. Results: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score −5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants. Conclusions/Application to Practice: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.
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