Pediatr Crit Care Me
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Pediatr Crit Care Me · Aug 2018
Observational StudyKnowledge Accrual Following Participation in Pediatric Fundamental Critical Care Support Course in Gaborone, Botswana.
To describe provider characteristics, knowledge acquisition, perceived relevance, and instruction quality of the Society of Critical Care Medicine's Pediatric Fundamentals of Critical Care Support course pilot implementation in Botswana. ⋯ Pediatric Fundamentals of Critical Care Support training significantly increased provider knowledge to care for hospitalized seriously ill or injured children in Botswana. Knowledge accrual is most significant among early career providers and is not limited by previous pediatric resuscitation or emergency training. Further contextualization of the course to use equipment relevant to providers work environment may increase the value of training.
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Pediatr Crit Care Me · Aug 2018
Ethical, Cultural, Social, and Individual Considerations Prior to Transition to Limitation or Withdrawal of Life-Sustaining Therapies.
As part of the invited supplement on Death and Dying in the PICU, we reviewed ethical, cultural, and social considerations for the bedside healthcare practitioner prior to engaging with children and families in decisions about limiting therapies, withholding, or withdrawing therapies in a PICU. Clarifying beliefs and values is a necessary prerequisite to approaching these conversations. Striving for medical consensus is important. ⋯ Engaging additional supportive services early can aid with understanding or resolving disagreement. There is wide variation globally in ethical permissibility, cultural, and societal influences that impact the clinician, child, and parents. Thoughtful consideration to these issues when approaching decisions about limitation or withdrawal of life-sustaining therapies will help to reduce emotional, spiritual, and ethical burdens, minimize misunderstanding for all involved, and maximize high-quality care delivery.
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Pediatr Crit Care Me · Aug 2018
Modes of Death and the Dying Process in Brazilian PICU Over the Last 30 Years: Personal Reflections.
This text is part of the chapter 7 of a special issue supplement called "Death and Dying in PICU" having Christopher S. Parshuram and Karen Dryden-Palmer as the guest editors. ⋯ The PICU mortality rate decreased significantly from over 20% to below 5% as well as the modes of death being observed that the life support limitation is far the most frequent death process in the PICU. Palliative care, in the last 10 years, increased its coverage in our country and being frequently offered as a complementary care to terminal ill patients in the PICU.
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Pediatr Crit Care Me · Aug 2018
Death and Dying 1987-2017: The Destination Is the Same, the Journey Is Different.
A personal reflection on the changing landscape with regard to case mix, care, and staffing and how mortality and expectations have evolved over the past 30 years in a multidisciplinary Pediatric Critical Care Unit in a Quaternary level academic institution in Canada. ⋯ Many of the preventable deaths have been prevented with Public Health initiatives. Death now is increasingly in complex patients with complicated treatment regimes in a society that has increasingly unrealistic expectations of what modern medicine can do. Many of these complex children do not die but are dependent on our technology and skill set-something we are often ill prepared for.
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To describe individual perspective over ~30 years in a PICU in Cape Town, South Africa. ⋯ Narrative, experiential reflection.