Ruth Mari Löllgen

Background: Serious or life-threatening pediatric emergencies are rare. Patient outcomes largely depend on excellent teamwork and require regular simulation-based team training. Recommendations for pediatric simulation-based education are scarce. We aimed to develop evidence-based guidelines to inform simulation educators and healthcare stakeholders. Methods: A modified three-round Delphi technique was used. The first guideline draft was formed through expert discussion and based on consensus (n = 10 Netzwerk Kindersimulation panelists). Delphi round 1 consisted of an individual and team revision of this version by the expert panelists. Delphi round 2 comprised an in-depth review by 12 external international expert reviewers and revision by the expert panel. Delphi round 3 involved a revisit of the guidelines by the external experts. Consensus was reached after three rounds. Results: The final 23-page document was translated into English and adopted as international guidelines by the Swiss Society of Pediatrics (SGP/SSP), the German Society for Neonatology and Pediatric Intensive Care (GNPI), and the Austrian Society of Pediatrics. Conclusions: Our work constitutes comprehensive up-to-date guidelines for simulation-based team trainings and debriefings. High-quality simulation training provides standardized learning conditions for trainees. These guidelines will have a sustainable impact on standardized high-quality simulation-based education.

Background: Virtual simulation modalities have been implemented widely since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic restrictions in March 2020, as educators face persistent restrictions to face-to-face education of medical students and healthcare professionals.There is paucity of published data regarding the benefits and barriers of distance and avatar simulation training modalities.Methods: Following a 2-day virtual pediatric simulation competition facilitated by Netzwerk Kindersimulation e.V., using remote human avatars and distance simulation, we conducted a multicenter survey to explore the advantages and challenges of avatar and distance simulation among participants. We used a modified Delphi approach to draft and develop the 32-item online questionnaire with 7-point Likert-like scales (7 being the highest rating).Results: Twenty participants answered our questionnaire. Respondents indicated both a high overall satisfaction (median of 5.0 [Q25–Q75: 4.0–6.0] ) for avatar and distance simulation 6.0 (5.0–6.0), respectively, as well as a high achieved psychological safety with both simulation types (5.0 [4.0–6.0] vs. 5.0 [4.0–6.0]). The most frequently reported profits of avatar and distance simulation included the elimination of travel distances, associated lower costs, less time spent attending the education activity, and effective communication and leadership training, especially with avatar simulation. Most often named challenges were technical problems, limited reception of non-verbal cues and a spatial distance from the team/educator.Discussion: Based on the results of this pilot study, avatar and distance simulation can be employed successfully and appear to be good supplements to face-to-face simulation. Other studies are warranted to further explore the effectiveness of various types of virtual simulation compared to conventional presential simulation. We suggest using avatar-based simulation for targeted communication and leadership skills training and the application of distance simulation to bring simulation experts virtually to remote places where educator resources are lacking.

AIMS OF THE STUDY: This study set out to examine the association between current subspecialty (paediatric and hand surgery) consultation practice for children with hand and finger injuries presenting to a tertiary paediatric emergency department and length of stay in the paediatric emergency department. Also, incidence and injury pattern of hand and finger injuries in this patient group were analysed. METHODS: This was a retrospective cross-sectional study, which was undertaken as a clinical audit service. All patients under 17 years presenting to our paediatric emergency department with hand and finger injuries over a 17-month period were included in the analysis. We studied incidence and injury mechanism, current subspecialty referral practice, as well as paediatric emergency department and hospital length of stay. RESULTS: We identified 929 children for inclusion in the analysis. The most frequent reasons for presentation were hand contusions (25.5%) and fractures (20.8%). Paediatric emergency medicine physicians alone managed 845 patients (90.6%), paediatric surgery referral occurred in 50 (5.4%) and hand surgery consultation in 37 (4.0%) cases. Mean length of stay in the paediatric emergency department was 154 min and significantly longer when subspecialty review occurred. Hospital admission occurred in 87 cases (9.3%). CONCLUSIONS: Involvement of subspecialties in the care of hand and finger injuries was associated with significantly increased length of stay in the paediatric emergency department. We discuss obstacles and enablers for timely patient referral and management. We suggest the implementation of referral guidelines, tailored to the individual emergency department, to reduce unnecessary patient journey delays and to ensure higher quality repair of complex hand injuries by the appropriate surgeon, with better outcomes. Making use of the emergence of multiple surgical subspecialties for targeted treatment of paediatric finger and hand injuries might be desirable.

Jaundice should be considered as a first clinical sign preceding severe invasive bacterial infection or sepsis in patients of all ages including childhood and adolescence. Early laboratory investigations and MR imaging studies for osteomyelitis or myositis are paramount to avoid progression to life‐threatening sepsis and significant morbidity and mortality.

Scant data have been published on the oxygenation and safety measures required for the aeromedical transport of infants. Current guidelines recommend avoidance of air travel for infants younger than 1 week of age and avoidance of ascent to moderate (2500 m) to high (≥2500 m) altitude until 6 weeks of age in healthy full-term infants.^1,2 In situ flight research shows that there is an increased risk of hypoxemia in preterm infants and in those with respiratory disease, but not in healthy full-term infants who are older than 6 months of age.^3-5 We report the findings of a study examining the effect of hypobaric hypoxia during aeromedical transport in infants younger than 6 months of age.

There is a major trade-off between improvements in longevity, general health, fitness and quality of life due to regular intense physical activity on the one hand and possible cardiac risks on the other hand, whether for participants in leisure time sports activities or for highly trained athletes. Cardiac complications and sudden death in sports, even though rare, but dramatic, events, are mainly observed in those suffering from inherited, often latent diseases with a strong genetic background, unknown to the subjects. Sedentary lifestyle together with more than one risk factor may also contribute to cardiac events in persons beginning to exercise for the first time or recommencing intense physical activities after a long pause. Manifestations of inherited cardiac diseases with a typical genetic component may occur in children or adolescents, but also in adults. For many inherited cardiac diseases there is a large body of knowledge on the genetic origin, therefore, genetic testing may be a valuable tool for diagnosis and prevention of underlying diseases, especially as genetic testing has become much cheaper over the last few years. The present paper describes cardiac diseases with genetic disposition and related genetic testing and presents recommendations for genetic examinations. Testing should be of benefit for sportsmen and women but also for family members to prevent fatal cardiac events. These recommendations will consider benefits for the sports person, and ethical reflections as well.

Aplasia cutis congenita (ACC) has been observed after fetal exposure to the antithyroid drug methimazole (MMI), but not reported after propylthiouracil (PTU), the current antithyroid drug of choice during pregnancy. This occurrence has implications for patient information and causal research