DANIELLE SAAD NEMER BOU GHOSN
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
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- Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress(2023) GIORNO, Eliana P. C.; FORONDA, Flavia K.; PAULIS, Milena De; GHOSN, Danielle S. N. Bou; COUTO, Thomaz B.; SA, Fernanda V. M.; FRAGA, Andrea M. A.; FARHAT, Sylvia C. L.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioPurpose: Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early rec-ognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. Methods: This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ul-trasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. Results: A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneu-monia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). Conclusion: An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
bookPart Laboratório na emergência(2023) RODRIGUES, Katharina Reichmann; GHOSN, Danielle Saad Nemer Bou- Teaching medical students to choose wisely through simulation(2022) MORATO, Thayza Marcelly Rodrigues; MENDES, Pedro Henrique Magalhaes; GHOSN, Danielle Saad Nemer Bou; COUTO, Thomaz Bittencourt; MAI, Paulo Victor Ferreira; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio; CAVALCANTI, Nara VasconcelosThe Choosing Wisely (CW) campaign aims to encourage dialog among physicians and patients about the costs and benefits of medical care. The purpose of the present study was to describe the implementation of the CW campaign among medical students in the pediatrics clerkship using different teaching strategies and to evaluate the students' perception and performance. A prospective, interventionist, open study with a control group was conducted. All sixth-year undergraduate medical students that were on their pediatric clerkship at the Emergency Department during the study period were invited to participate. The study consisted of two strategies: a remote video class about the CW initiative and in situ simulation training. By the end of the rotation, all participants were evaluated through an Objective Structured Clinical Examination (OSCE). A total of 50 students were included, of which 24 watched only the online video (control group) and 26 were exposed to both the online video and the simulation scenarios (intervention group). Students in the intervention group had a significantly higher total score in the OSCE compared to students in the control group (median 90 vs 90; range 78-100 vs 50-100; p: 0.047). Median scores of behavioral items of the OSCE grouped together were significantly higher in the intervention group compared to the control group (median 60 vs 50; range 40-60 vs 20-60; p: 0.002). Conclusion: Simulation training about principles of the CW campaign had a greater impact on behavioral aspects of undergraduate students. This learning strategy was well accepted by participants.
bookPart Complicações agudas do paciente portador de doença reumática(2018) GHOSN, Danielle Saad Nemer Bou; SILVA, Clovis Artur Almeida da- How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency(2023) SEVERINI, Rafael da Silva Giannasi; MARCOVICI, Michelle; FARHAT, Sylvia Costa Lima; BIVANCO-LIMA, Danielle; COUTO, Thomaz Bittencourt; AMARANTE, Ana Carolina; RODRIGUES, Katharina Reichmann; GHOSN, Danielle Saad Nemer Bou; SCHVARTSMAN, ClaudioIntroduction:The exponential growth of telehealth services during the COVID-19 pandemic led to the implementa-tion of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a train-ing aimed at remote care within the pediatric emergency rotation program.Objective: To describe the implementation of a telemedicine training for pediatric residents and present the pre-liminary results.Methods: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception ques-tionnaire at the end of the training.Results: There was a significant difference in the resident's perception of experience and safety after initial train-ing. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experi-ence contributed to their learning on the subject.Conclusion: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.
- Point-of-care lung ultrasound is more reliable than chest X-ray for ruling out acute chest syndrome in sickle cell pediatric patients: A prospective study(2022) PRETO-ZAMPERLINI, Marcela; GIORNO, Eliana P. C.; GHOSN, Danielle S. N. Bou; SA, Fernanda V. M.; SUZUKI, Adriana S.; SUZUKI, Lisa; FARHAT, Sylvia C.; WEERDENBURG, Kirstin; SCHVARTSMAN, ClaudioBackground Acute chest syndrome (ACS) is a leading cause of morbidity and mortality in sickle cell patients, and it is often challenging to establish its diagnosis. Procedure This was a prospective observational study conducted in a pediatric emergency (PEM) department. We aimed to investigate the performance characteristics of point-of-care lung ultrasound (LUS) for diagnosing ACS in sickle cell children. LUS by trained PEM physicians was performed and interpreted as either positive or negative for consolidation. LUS results were compared to chest X-ray (CXR) and discharge diagnosis as reference standards. Results Four PEM physicians performed the LUS studies in 79 suspected ACS cases. The median age was 8 years (range 1-17 years). Fourteen cases (18%) received a diagnosis of ACS based on CXR and 21 (26.5%) had ACS discharge diagnosis. Comparing to CXR interpretation as the reference standard, LUS had a sensitivity of 100% (95% CI: 77%-100%), specificity of 68% (95% CI: 56%-79%), positive predictive value of 40% (95% CI: 24%-56%), and negative predictive value of 100% (95% CI: 92%-100%). Overall LUS accuracy was 73.42% (95% CI: 62%-83%). Using discharge diagnosis as the endpoint for both CXR and LUS, LUS had significantly higher sensitivity (100% vs. 62%, p = .0047) and lower specificity (76% vs.100%, p = .0002). LUS also had lower positive (60% vs.100%, p < .0001) and higher negative (100% vs.77%, p = .0025) predictive values. The overall accuracy was similar for both tests (82% vs. 88%, p = .2593). Conclusion The high negative predictive value, with narrow CIs, makes LUS an excellent ruling-out tool for ACS.
- Computerized cardiotocography in pregnancies complicated by maternal asthma(2012) NEMER, Danielle S.; NOMURA, Roseli M. Y.; ORTIGOSA, Cristiane; LIAO, Adolfo W.; ZUGAIB, MarceloObjective: The aim of the present study was to investigate the FHR parameters in term pregnancies complicated by asthma. Study design: prospective cross-sectional study performed between July 2008 and November 2009. Twenty-one singleton pregnancy between 36 and 40 weeks gestation with diagnosis of maternal asthma and no current use of oral corticosteroids were compared with 30 pregnancies without morbidities at the same gestational age. The computerized cardiotocography (System 8002, Sonicaid) was performed and 30 min analysis was studied. Statistical analysis included Student's t-test or Mann-Whitney U test for comparisons between groups. Categorical data were compared using the chi(2)-test or Fisher's exact test. Results: There were no significant differences in FHR parameters analyzed by computerized cardiotocography: basal FHR (p = 0.80), number of accelerations >10 bpm (p = 0.08) or >15 bpm (p = 0.20), duration of high episodes (p = 0.70), duration of low episodes (p = 0.46) and STV (p = 0.66). Asthmatic mothers presented mean number of fetal movement per hour significantly lower than control group (34.6 +/- 28.2 vs. 60.6 +/- 43.1, p = 0.02). Conclusion: Computerized cardiotocography demonstrates no association between the abnormal parameters of FHR and maternal asthma in term pregnancies. Maternal asthma was associated with less fetal movements per hour, suggesting further studies on the counting of fetal movements in pregnant women with asthma.
bookPart Fluidoterapia de manutenção(2018) GHOSN, Danielle Saad Nemer Bou; COUTO, Thomaz BittencourtbookPart Complicações agudas do paciente portador de doença reumática(2023) GHOSN, Danielle Saad Nemer Bou; SILVA, Clovis Artur Almeida dabookPart Fluidoterapia de manutenção(2023) GHOSN, Danielle Saad Nemer Bou; SILVA, Rafael Yanes Rodrigues da