|
1
|
Doroshow RW, Aldrich J, Dorner R, Lyons L, McCarter R. A randomized, controlled trial of an innovative, multimedia instructional program for acquiring auditory skill in identifying pediatric heart murmurs. Front Pediatr 2024; 11:1283306. [PMID: 38293663 PMCID: PMC10825047 DOI: 10.3389/fped.2023.1283306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Objective To create a brief, acceptable, innovative method for self-paced learning to enhance recognition of pediatric heart murmurs by medical students, and to demonstrate this method's effectiveness in a randomized, controlled trial. Materials and methods A curriculum of six 10-min online learning modules was designed to enable deliberate practice of pediatric cardiac auscultation, using recordings of patients' heart murmurs. Principles of andragogy and multimedia learning were applied to optimize acquisition of this skill. A pretest and posttest, given 4 weeks apart, were created using additional recordings and administered to 87 3rd-year medical students during their pediatric clerkship. They were randomized to have access to the modules after the pretest or after the posttest, and asked to use at least the first 2 of the modules. Results 47 subjects comprised the Intervention group, and 40 subjects the Control group. On our primary outcome, distinguishing innocent from pathological with at least moderate confidence, the posttest scores were significantly higher for the Intervention group (60.5%) than for the Control group (20.0%). For our secondary outcomes, the 2 groups also differed significantly in the ability to distinguish innocent from pathological murmurs, and in identifying the actual diagnosis. On all 3 outcomes, those Intervention group subjects who accessed 4-6 modules scored higher than those who accessed 0-3 modules, who in turn scored higher than the Control group. Summary Applying current principles of adult learning, we have created a teaching program for medical students to learn to recognize common pediatric murmurs. Its effectiveness was demonstrated in a randomized, controlled trial. The program results in a meaningful gain in this skill from 1 h of self-paced training with high acceptance to learners.
Collapse
Affiliation(s)
- Robin W. Doroshow
- Department of Cardiology, Children’s National Hospital and George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Julie Aldrich
- Department of Pediatrics, Children’s National Hospital and George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Rebecca Dorner
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, United States
| | - Laurie Lyons
- Department of Instructional Design and Technology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Robert McCarter
- Division of Biostatistics, Children’s National Hospital and George Washington School of Medicine and Health Sciences, Washington, DC, United States
| |
Collapse
|
|
2
|
Udine M, Donofrio MT. The Role of the Neonatologist in Fetuses Diagnosed with Congenital Heart Disease. Neoreviews 2023; 24:e553-e568. [PMID: 37653086 DOI: 10.1542/neo.24-9-e553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Prenatal diagnosis of congenital heart disease (CHD) can decrease preoperative morbidity and mortality. Delivery room planning can improve cardiac hemodynamics and time to critical catheter and surgical interventions. Care algorithms have defined lesion-specific level-of-care assignments and delivery room action plans that can facilitate team-based approaches to safe deliveries. Neonatologists play critical roles in the care of fetuses diagnosed with CHD, from the time of diagnosis through the postnatal intensive care unit (ICU) stays. Prenatally, neonatologists are members of the multidisciplinary counseling teams, with expertise to counsel expectant parents about what to expect during the ICU stay, which is especially valuable in CHD associated with extracardiac or genetic anomalies. Neonatologists' role in delivery planning includes identification of the optimal delivery location and allocation of appropriate personnel and resources. After delivery, postnatal care considerations include hemodynamic stability, optimization of end-organ function, genetics consultation, developmentally appropriate care practices to encourage caregiver bonding, and optimization of care to improve neurodevelopmental outcomes of neonates with CHD.
Collapse
Affiliation(s)
- Michelle Udine
- Division of Cardiology, Children's National Hospital, Washington, DC
| | - Mary T Donofrio
- Division of Cardiology, Children's National Hospital, Washington, DC
| |
Collapse
|
|
3
|
Sola A, Rodríguez S, Young A, Lemus Varela L, Villamayor RM, Cardetti M, Pleitez Navarrete J, Favareto MV, Lima V, Baquero H, Velandia Forero L, Venegas ME, Davila C, Dominguez Dieppa F, Germosén TM, Oviedo Barrantes AN, Alvarez Castañeda AL, Morgues M, Avila A, Fariña D, Oliva JL, Sosa E, Golombek S. CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN). Int J Neonatal Screen 2020; 6:21. [PMID: 33073018 PMCID: PMC7422978 DOI: 10.3390/ijns6010021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022] Open
Abstract
Congenital heart disease (CHD) is among the four most common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. Here, we describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN), as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve the neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we have participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges in implementing POS, significant progress has been made. We conclude that universal POS is not easy to implement in Latin America but, when executed, has not only been of significant value for babies with CHD, but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential for reducing the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns' lives in Latin America.
Collapse
Affiliation(s)
- Augusto Sola
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Susana Rodríguez
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Alejandro Young
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Lourdes Lemus Varela
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ramón Mir Villamayor
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Marcelo Cardetti
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Jorge Pleitez Navarrete
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - María Verónica Favareto
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Victoria Lima
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Hernando Baquero
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
- Dean School of Medicine, Universidad del Norte, Km. 5 Vía Puerto Colombia, Barranquilla 081007, Colombia
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - Lorena Velandia Forero
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - María Elena Venegas
- Neonatology, Medicina Alta Complejidad S.A. (MACSA), Hospital Niño Jesús Carrera 75 N° 79B-50, Barranquilla 080001, Colombia;
| | - Carmen Davila
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Fernando Dominguez Dieppa
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Taína Malena Germosén
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ada Nidia Oviedo Barrantes
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Ana Lorena Alvarez Castañeda
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Mónica Morgues
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Aldana Avila
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Diana Fariña
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Jose Luis Oliva
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| | - Erika Sosa
- Pediatric Cardiology, Children's Hospital, Hermosillo 83100, Mexico;
| | - Sergio Golombek
- Neonatology, Ibero-American Society of Neonatology (SIBEN), Wellington, FL 33414, USA; (S.R.); (A.Y.); (L.L.V.); (R.M.V.); (M.C.); (J.P.N.); (M.V.F.); (V.L.); (H.B.); (L.V.F.); (C.D.); (F.D.D.); (T.M.G.); (A.N.O.B.); (A.L.A.C.); (M.M.); (A.A.); (D.F.); (J.L.O.); (S.G.)
| |
Collapse
|