SYLVIA COSTA LIMA FARHAT
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- 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.
- 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.
- 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.
- 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.
- Fast, cheap and feasible: Implementation of pediatric telemedicine in a public hospital during the Covid-19 pandemic(2022) SEVERINI, Rafael da Silva Giannasi; OLIVEIRA, Pedro Carpini de; COUTO, Thomaz Bittencourt; SIMON JUNIOR, Hany; ANDRADE, Anarella Penha Meirelles de; NANBU, Danilo Yamamoto; FARHAT, Sylvia C. L.; SCHVARTSMAN, ClaudioObjective: In Brazil, telemedicine was allowed as an exception during the coronavirus disease (COVID-19) pandemic. Despite its recognized value and availability, telemedicine is not universally used, suggesting that some barriers prevent its adoption and acceptance within the community. This study aims to describe the implementation of a low-cost telemedicine service in a pediatric hospital in Brazil. Method: Retrospective descriptive study reporting the first three months (April to June 2020) of the experience of implementing a low-cost telemedicine emergency care program in a public tertiary hospital. The service was available to patients up to 18 years of age enrolled in this hospital. A tool for assessing the severity of the patient was developed, the aim of standardizing the procedure, while maintaining quality and safety. Guardian's satisfaction was assessed with a questionnaire sent after teleconsultations. Results: 255 teleconsultations were carried out with 140 different patients. Of the total consultations, 182 were from 99 patients that had performed the Real-Time Polymerase Chain Reaction (RT-PCR) test for the new coronavirus (SARS-Cov-2) or had direct contact with a person known to be positive for COVID-19. Only 26 (14%) were referred to an in-person consultation. No deaths, adverse events or delayed diagnosis were recorded. 86% of the patients who answered the satisfaction questionnaire were satisfied and 92% would use telemedicine again. Conclusion: This study presents an innovative implementation of a telemedicine program in a public and exclusively pediatric tertiary service, serving as a reference for future implementation in other public services in Brazil and developing countries. (C) 2022 Sociedade Brasileira de Pediatria.
- Point-of-care lung ultrasound imaging in pediatric COVID-19(2020) GIORNO, Eliana P. C.; PAULIS, Milena De; SAMESHIMA, Yoshino T.; WEERDENBURG, Kirstin; SAVOIA, Paulo; NANBU, Danilo Y.; COUTO, Thomaz B.; SA, Fernanda V. M.; FARHAT, Sylvia C. L.; CARVALHO, Werther B.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioBackground: There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. Objective: To describe lung US imaging findings and aeration score of 34 children with COVID-19. Methods: This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. Results: Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p=0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. Conclusion: Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.
- Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department(2020) COUTO, Thomaz Bittencourt; REIS, Amelia Gorete; FARHAT, Sylvia Costa Lima; CARVALHO, Vitor Emanoel de Lemos; SCHVARTSMAN, ClaudioThe aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation-associated events and desaturation among these patients. Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years. The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups (P < .01), respectively. There was a lower proportion of tracheal intubation-associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141];P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141];P = .06). The median number of attempts was 1 (range, 1-5) for the VL group and 2 (range, 1-8) for the DL group (P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9-10.4,P < 0.01). Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation-associated events.
bookPart Introdução(2023) SCHVARTSMAN, Claudio; FARHAT, Sylvia Costa Lima; REIS, Amélia Gorete; COUTO, Thomaz Bittencourt- High-fidelity simulation versus case-based discussion for teaching medical students in Brazil about pediatric emergencies(2015) COUTO, Thomaz Bittencourt; FARHAT, Sylvia C.L.; GEIS, Gary L.; OLSEN, Orjan; SCHVARTSMAN, ClaudioOBJECTIVE: To compare high-fidelity simulation with case-based discussion for teaching medical students about pediatric emergencies, as assessed by a knowledge post-test, a knowledge retention test and a survey of satisfaction with the method. METHODS: This was a non-randomized controlled study using a crossover design for the methods, as well as multiple-choice questionnaire tests and a satisfaction survey. Final-year medical students were allocated into two groups: group 1 participated in an anaphylaxis simulation and a discussion of a supraventricular tachycardia case, and conversely, group 2 participated in a discussion of an anaphylaxis case and a supraventricular tachycardia simulation. Students were tested on each theme at the end of their rotation (post-test) and 4-6 months later (retention test). RESULTS: Most students (108, or 66.3%) completed all of the tests. The mean scores for simulation versus case-based discussion were respectively 43.6% versus 46.6% for the anaphylaxis pre-test (p=0.42), 63.5% versus 67.8% for the post-test (p=0.13) and 61.5% versus 65.5% for the retention test (p=0.19). Additionally, the mean scores were respectively 33.9% versus 31.6% for the supraventricular tachycardia pre-test (p=0.44), 42.5% versus 47.7% for the post-test (p=0.09) and 41.5% versus 39.5% for the retention test (p=0.47). For both themes, there was improvement between the pre-test and the post-test (p<0.05), and no significant difference was observed between the post-test and the retention test (p>0.05). Moreover, the satisfaction survey revealed a preference for simulation (p<0.001). CONCLUSION: As a single intervention, simulation is not significantly different from case-based discussion in terms of acquisition and retention of knowledge but is superior in terms of student satisfaction.