R Moral Torrero

Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain

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Publications (10)1.73 Total impact

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    ABSTRACT: Objective To evaluate the efficacy of the teaching of basic and advanced pediatric life support courses. Material and methods From February 1994 to October 1996, 23 courses on the theory and practice of pediatric life support were organized: 6 were basic courses given to 265 trainees and 17 were advanced courses given to 409 trainees. Trainees were given a multiple-choice theory evaluation before and at the end of the course. Practical evaluation of basic and advanced life support skills was also performed. Teachers and students filled in a questionnaire to evaluate their satisfaction with the course. Results In basic life support courses mean score of the initial theory evaluation was 6.6 (1.7) and the final score was 9.3 (0.9) (p < 0.001). In advanced life support courses mean score of the initial evaluation was 25.7 (5.5) out of a maximum of 40, and the final score was 36.2 (2.5) (p < 0.001). In the practical evaluation of both basic and advanced courses the mean scores for all cardiopulmonary resuscitation maneuvers were higher than the minimum required value (3 out of a maximum of 5). The evaluation of the course by teachers and pupils yielded high scores for theoretical and practical content, as well as for the methodology used. The evaluation was useful for rectifying the deficiencies encountered. Conclusions Basic and advanced pediatric life support courses are a useful method for providing training in the theory and practice of cardiopulmonary resuscitation to health personnel and the general population. Trainees and teachers were satisfied with the teaching and methodology. Evaluations of theory and practice and the questionnaire were useful in the quality control of the courses..
    Anales de Pediatría. 07/2013; 53(2):125–134.
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    ABSTRACT: To evaluate a training program in paediatric critical care for residents in paediatrics. Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6+/-1.2), final score (8.6+/-0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7+/-1.2) and the evaluation by the tutor (6.9+/-0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2+/-1.0) and the practical evaluation by the tutor (6.7+/-0.9). Residents considered the training program as adequate: theoretical education (8.5+/-0.8), resident handbook (9+/-0.9), practical training (8.3+/-1.0), investigation (7.6+/-2.0) and human relationship (9.2+/-0.9). This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents.
    Anales de Pediatría 07/2010; 73(1):5-11. · 0.87 Impact Factor
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    ABSTRACT: Objetivo Evaluar los resultados de un programa de formación en cuidados intensivos pediátricos para residentes de Pediatría. Métodos Se diseñó un programa de formación en cuidados intensivos pediátricos para médicos residentes de Pediatría y se evaluaron los resultados con una prueba teórica escrita inicial y final, una evaluación por el médico responsable, una autoevaluación de los residentes y una encuesta escrita sobre la calidad del programa. Resultados Desde abril del 1998 hasta agosto de 2009, se incluyeron a 156 residentes en el programa de formación. Los residentes mostraron mejoría entre la evaluación teórica inicial (5,6±1,2) y la final (8,6±0,7) (p<0,001). Un 14,1% contestó correctamente al menos el 70 % de las preguntas de la evaluación inicial y un 96,6 % de la final (p<0,001). La puntuación teórica final fue significativamente más alta que la autoevaluación de los residentes (6,7±1,2) y la evaluación de los tutores (6,9±0,9) (p<0,001). No hubo diferencias entre la autoevaluación práctica de los residentes (5,8±1,3) y la evaluación práctica del tutor (6,7±0,9). Los residentes consideraron adecuado el programa formativo: formación teórica (8,5±0,8), manual de residentes (9±0,9), educación práctica (8,3±1,0), investigación (7,6±2,0) y trato humano (9,2±0,9). Conclusiones El programa descrito es un método educativo útil para la formación teórica y práctica de los residentes de Pediatría en cuidados intensivos. La evaluación del programa de entrenamiento es esencial para mejorar la formación de los residentes de Pediatría. An Pediatr (Barc). 2010;73:5-11.
    Anales españoles de pediatría: Publicación oficial de la Asociación Española de Pediatría (AEP), ISSN 1695-4033, Vol. 73, Nº. 1, 2010, pags. 5-11. 01/2010;
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    ABSTRACT: To analyze response to heliox therapy in critically ill infants and children with upper and/or lower airway respiratory insufficiency. Sixty-five patients, aged between 12 days and 8 years old, treated with heliox through facial mask, nasal prongs or non-invasive ventilation were studied. Diagnoses were bronchiolitis (25), upper postextubation respiratory insufficiency (19), respiratory insufficiency after airway surgery (14), and croup-laryngotracheomalacia (7). Response to heliox treatment was measured by the change in clinical scores, respiratory rate, heart rate, pulse oximetry, blood gas analysis, and the need for non-invasive and invasive mechanical ventilation. Fifty-four patients (83.1 %) improved after heliox therapy, with statistically significant differences in clinical score (from 8.7 to 5.5), respiratory rate (from 51.4 to 38.8 rpm), and heart rate (from 161.6 to 145.6 bpm). No changes were observed in saturation or blood gas analysis. After heliox therapy, 29.8 % of patients required non-invasive ventilation and 26.5 % required intubation. Patients with bronchiolitis and those aged less than 1 year had a lesser response to heliox therapy and more frequently required non-invasive ventilation. No significant differences were found in intubation requirements. No adverse effects were observed. Heliox therapy improved clinical scores in infants and children with upper and lower airway respiratory insufficiency, but a significant percentage of patients needed non-invasive or invasive mechanical ventilation.
    Anales de Pediatría 04/2007; 66(3):240-7. · 0.87 Impact Factor
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    ABSTRACT: Objective To analyze response to heliox therapy in critically ill infants and children with upper and/or lower airway respiratory insufficiency. Patients and methods Sixty-five patients, aged between 12 days and 8 years old, treated with heliox through facial mask, nasal prongs or non-invasive ventilation were studied. Diagnoses were bronchiolitis (25), upper postextubation respiratory insufficiency (19), respiratory insufficiency after airway surgery (14), and croup-laryngotracheomalacia (7). Response to heliox treatment was measured by the change in clinical scores, respiratory rate, heart rate, pulse oximetry, blood gas analysis, and the need for non-invasive and invasive mechanical ventilation. Results Fifty-four patients (83.1%) improved after heliox therapy, with statistically significant differences in clinical score (from 8.7 to 5.5), respiratory rate (from 51.4 to 38.8 rpm), and heart rate (from 161.6 to 145.6 bpm). No changes were observed in saturation or blood gas analysis. After heliox therapy, 29.8% of patients required non-invasive ventilation and 26.5% required intubation. Patients with bronchiolitis and those aged less than 1 year had a lesser response to heliox therapy and more frequently required non-invasive ventilation. No significant differences were found in intubation requirements. No adverse effects were observed. Conclusions Heliox therapy improved clinical scores in infants and children with upper and lower airway respiratory insufficiency, but a significant percentage of patients needed non-invasive or invasive mechanical ventilation.
    Anales De Pediatria - AN PEDIATR. 01/2007; 66(3):240-247.
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    ABSTRACT: To evaluate the efficacy of the teaching of basic and advanced pediatric life support courses. From February 1994 to October 1996, 23 courses on the theory and practice of pediatric life support were organized: 6 were basic courses given to 265 trainees and 17 were advanced courses given to 409 trainees. Trainees were given a multiple-choice theory evaluation before and at the end of the course. Practical evaluation of basic and advanced life support skills was also performed. Teachers and students filled in a questionnaire to evaluate their satisfaction with the course. In basic life support courses mean score of the initial theory evaluation was 6.6 (1.7) and the final score was 9.3 (0.9) (p < 0.001). In advanced life support courses mean score of the initial evaluation was 25.7 (5.5) out of a maximum of 40, and the final score was 36.2 (2.5) (p < 0.001). In the practical evaluation of both basic and advanced courses the mean scores for all cardiopulmonary resuscitation maneuvers were higher than the minimum required value (3 out of a maximum of 5). The evaluation of the course by teachers and pupils yielded high scores for theoretical and practical content, as well as for the methodology used. The evaluation was useful for rectifying the deficiencies encountered. Basic and advanced pediatric life support courses are a useful method for providing training in the theory and practice of cardiopulmonary resuscitation to health personnel and the general population. Trainees and teachers were satisfied with the teaching and methodology. Evaluations of theory and practice and the questionnaire were useful in the quality control of the courses.
    Anales espanoles de pediatria 08/2000; 53(2):125-34.
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    ABSTRACT: The aim of this study was to analyze the effectiveness of pediatric cardiopulmonary resuscitation training of medical students in pediatric basic life support (PBLS) courses. Between 1995 and 1998, four theoretical and practical PBLS courses were given to 304 fifth and sixth-year medical students. The theoretical classes provided conceptual information about cardiorespiratory arrest and prevention, basic cardiopulmonary resuscitation maneuvers and practice sessions in basic cardiopulmonary resuscitation of infants and older children to groups of 6 to 8 students. At the beginning of the course, students took a theoretical test that consisted of 10 or 20 multiple-choice questions. At the end of the course, the theoretical test was repeated and a practical test of basic cardiopulmonary resuscitation skills for infants and children was given. Students evaluated the course by completion of an anonymous written questionnaire. The mean initial score (out of a maximum of 10) was 6.4 and the mean score on the final theoretical test was 9.6 (p < 0.001). The practical evaluation showed that 95% of the students mastered the skills of the basic pediatric cardiopulmonary resuscitation maneuvers. The student evaluation of the course yielded scores (on a scale of 5 points) of 4.4 for the theoretical classes, 4.4 for presentation, 4.7 for practical classes and 4.8 for professors' teaching skills. The pediatric basic life support courses were a useful method for providing theoretical-practical training to students of medicine and should be an essential part of the pediatric curricula in medical studies.
    Anales espanoles de pediatria 06/1999; 50(6):571-5.
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    ABSTRACT: The objective of this study was to analyze the efficacy of continuous veno-venous renal replacement therapies in neonates and children. We analyzed 10 episodes of acute renal failure in 9 patients, between 7 days and 2 years of age and weighing between 2.9 and 13 kg, treated with continuous veno-venous renal replacement therapies (hemofiltration or hemodiafiltration) by using a BSM-32-IC (Hospal) monitor and two types of hemofilters, Miniflow of 0.04 m2 (Hospal) and FH22 of 0.2 m2 (Gambro). We used a blood flow between 15 and 40 ml/min and obtained an ultrafiltration rate of 190 +/- 61 ml/hour. The mean life of the hemofilters was 16 +/- 14 hours, with the duration of the technique between 5 and 58 hours. In three episodes the technique was ended because of normalization of renal function. All patients tolerated continuous renal replacement therapies without important secondary effects (one patient had moderate ischemia of the leg because of erroneous arterial catheterization, 3 patients had electrolyte alterations. 1 patient had hypothermia and 5 patients needed platelet transfusions). Seven patients died because of shock and multiple organ failure which was not related to the technique. Continuous veno-venous renal replacement therapies are useful in the treatment of critically ill children. Veno-venous techniques can be used in term neonate and infants.
    Anales espanoles de pediatria 08/1998; 49(1):39-45.
  • Anales espanoles de pediatria 07/1998; 48(6):653-6.
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    ABSTRACT: The objective of this study was to analyze the therapeutic response to inhaled nitric oxide (NO) in children with acute respiratory distress syndrome (ARDS) and/or pulmonary hypertension (PHT). We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT, four of which had secondary ARDS. All patients presented hypoxemia and/or PHT refractory to conventional therapy. We analyzed the PaO2/FiO2 ratio, oxygenation index and mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP) before and after treatment with inhaled nitric oxide. Patients were treated with inhaled NO at 1.5 to 45 ppm between 45 minutes to 47 days. NO improved oxygenation, increasing by greater than 15% the PaO2/FiO2 ratio in 84% of the patients. In those patients which improved, PaO2 increased from 87.4 +/- 57.7 mmHg to 133.6 +/- 60.1 mmHg (p < 0.001), the PaO2/FiO2 ratio from 95.4 +/- 60.9 to 157.5 +/- 86.8 (p < 0.0001) and the oxygenation index diminished from 25.6 +/- 15.6 to 17 +/- 12.4. The PAP/SAP ratio diminished by greater than 15% in 66% of the patients, decreasing from 59.9 +/- 24.5% to 42.6 +/- 14.1% (p = 0.01). Inhaled NO improved oxygenation and decreased pulmonary hypertension in an important number of children with ARDS and/or PHT.
    Anales espanoles de pediatria 06/1997; 46(6):581-6.