CLAUDIO SCHVARTSMAN
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
53 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 Intoxicações agudas(2016) SCHVARTSMAN, Cláudio; SCHVARTSMAN, Samuel- Sedation and analgesia for procedures in the pediatric emergency room(2017) RAMALHO, Carlos Eduardo; BRETAS, Pedro Messeder Caldeira; SCHVARTSMAN, Claudio; REIS, Amelia GoreteObjective: Children and adolescents often require sedation and analgesia in emergency situations. With the emergence of new therapeutic options, the obsolescence of others, and recent discoveries regarding already known drugs, it became necessary to review the literature in this area. Data sources: Non-systematic review in the PubMed database of studies published up to December 2016, including original articles, review articles, systematic reviews, and meta-analyses. References from textbooks, publications from regulatory agencies, and articles cited in reviews and meta-analyses through active search were also included. Data synthesis: Based on current literature, the concepts of sedation and analgesia, the necessary care with the patient before, during, and after sedoanalgesia, and indications related to the appropriate choice of drugs according to the procedure to be performed and their safety profiles are presented. Conclusions: The use of sedoanalgesia protocols in procedures in the pediatric emergency room should guide the professional in the choice of medication, the appropriate material, and in the evaluation of discharge criteria, thus assuring quality in care. (C) 2017 Sociedade Brasileira de Pediatria.
- Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series(2020) GIORNO, Eliana Paes de Castro; PRETO-ZAMPERLINI, Marcela; WEERDENBURG, Kirstin; FERRAZ, Isabel de Siqueira; LEITE, Marcia Marques; FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Claudio
conferenceObject ALBUTEROL VIA METERED-DOSE INHALER FOR ACUTE ASTHMA IN CHILDREN: LOWER DOSES ARE SUFFICIENT AND HIGHER DOSES ARE SAFE(2015) MUCHAO, F. P.; SOUZA, J. M.; TORRES, H. C.; LALIBERA, I. B.; SCHVARTSMAN, C.; RODRIGUES, J. C.; V, L. Silva Filho- 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 Apresentação(2021) WAKSMAN, Renata Dejtiar; SCHVARTSMAN, Cláudio; TROSTER, Eduardo Juan; ABRAMOVICI, Sulim- Changing the view: impact of simulation-based mastery learning in pediatric tracheal intubation with videolaryngoscopy(2021) COUTO, Thomaz Bittencourt; REIS, Amelia G.; FARHAT, Sylvia C. L.; CARVALHO, Vitor E. L.; SCHVARTSMAN, ClaudioObjective: To determine the effect of a training program using simulation-based mastery learning on the performance of residents in pediatric intubations with videolaryngoscopy. Method: Retrospective cohort study carried out in a tertiary pediatric hospital between July 2016 and June 2018 evaluating a database that included the performance of residents before and after training, as well as the outcome of tracheal intubations. A total of 59 pediatric residents were evaluated in the pre-training with a skills' checklist in the scenario with an intubation simulator; subsequently, they were trained individually using a simulator and deliberate practice in the department itself. After training, the residents were expected to have a minimum passing grade (90/100) in a simulated scenario. The success of the first attempted intubation, use of videolaryngoscopy, and complications in patients older than 1 year of age during the study period were also recorded in clinical practice. Results: Before training, the mean grade was 77.5/100 (SD 15.2), with only 23.7% (14/59) of residents reaching the minimum passing grade of 90/100. After training, 100% of the residents reached the grade, with an average of 94.9/100 (SD 3.2), p < 0.01, with only 5.1% (3/59) needing more practice time than that initially allocated. The success rate in the first attempt at intubation in the emergency department with videolaryngoscopy was 77.8% (21/27). The rate of adverse events associated with intubations was 26% (7/27), representing a serious event. Conclusions: Simulation-based mastery learning increased residents' skills related to intubation and allowed safe tracheal intubations with video laryngoscopy. (C) 2020 Sociedade Brasileira de Pediatria.
- Mortalidade em hospital secundário pediátrico na Libéria pós-conflito em 2009(2013) COUTO, Thomaz Bittencourt; FARHAT, Sylvia Costa Lima; REID, Tony; SCHVARTSMAN, CláudioOBJECTIVE: To describe and analyze the causes of death in a pediatric secondary-care hospital (run by Médecins sans Frontières), in Monrovia, Liberia, 6 years post-civil war, to determine the quality of care and mortality in a setting with limited resources. METHODS: Data were retrospectively collected from March 2009 to October 2009. Patient charts and laboratory records were reviewed to verify cause of death. Additionally, charts of patients aged over 1 month with an infectious cause of death were analyzed for decompensated septic shock, or fluid-refractory septic shock. RESULTS: Of 8,254 admitted pediatric patients, 531 died, with a mortality rate of 6.4%. Ninety percent of deaths occurred in children <5 years old. Most deaths occurred within 24 hours of admission. The main cause of death (76%) was infectious disease. Seventy-eight (23.6%) patients >1 month old with infectious disease met the criteria for septic shock, and 28 (8.6%) for decompensated or fluid-refractory septic shock. CONCLUSION: Since the end of Liberia's devastating civil war, Island Hospital has improved care and mortality outcomes, despite operating with limited resources. Based on the available data, mortality in Island Hospital appears to be lower than that of other Liberian and African institutions and similar to other hospitals run by Médecins sans Frontières across Africa. This can be explained by the financial and logistic support of Médecins sans Frontières. The highest mortality burden is related to infectious diseases and neonatal conditions. The mortality of sepsis varied among different infections. This suggests that further mortality reduction can be obtained by tackling sepsis management and improving neonatal care.
bookPart Poluição ambiental e a saúde das crianças(2021) FARHAT, Sylvia Costa Lima; SCHVARTSMAN, Cláudio