Exposure of parenteral nutrition (PN) to light induces hydroperoxides (HPO) formation whose toxicity, especially in pediatrics, is documented. In this context, we evaluated the efficacy of photoprotection medical devices used in our institution to protect PN from degradation after two different exposures to light. A mixed oil lipid emulsion (Smoflipid®) in standard or opaque syringes and a ternary PN mixture bags (Numetah®) with or without opaque overwrap were exposed for at least 420min to a xenon lamp. Samples of Smoflipid® in standard or opaque syringes were also exposed for 24h to conditions reproducing those of a neonatal intensive care unit. The use of opaque syringes for Smoflipid® administration or opaque overwraps for Numetah® administration reduced HPO formation by an average of 14% and 40%, respectively, compared to standard conditions after at least 420min to a xenon lamp. When Smoflipid® samples were administered with standard or opaque syringes and exposed to a phototherapy lamp, the fold-change in the HPO concentration increased, respectively, by 6.3 or 5.4 at 24h compared with syringes unexposed to phototherapy lamp. Although the observed differences were non-significant, it nonetheless appears prudent to use photoprotection of PN during administration, particularly in patients with immature or compromised antioxidant capacity.

Effective physician-patient communication is crucial to compassionate healthcare, particularly when conveying life-altering diagnoses such as those associated with congenital heart diseases. Despite its importance, medical practitioners often face challenges in communicating effectively. Because of these gaps, we aim to introduce a simulation-based training protocol to improve pediatric cardiology trainee’s communication skills. This study will be conducted in collaboration with associations supporting caregivers of children with congenital heart disease. It strives to demonstrate how specific training programs can efficiently foster humanistic, patient-centered care in standard medical practice. This multicenter, open-label randomized controlled trial will be conducted in pediatric cardiac units and simulation centers of across 10 universities in France. The study population comprises pediatric cardiologists in training (including pediatric cardiac fellows or specialist assistants). The SIMUL-CHD intervention will consist of simulation-based training with standardized patients, focusing on improving communication skills for pediatric cardiology trainees during diagnostic counselling. Patients and caregivers have been recruited from a National Patient Association named “Petit Cœur de Beurre”. The primary outcome is the quality of physicians’ communication skills. The evaluation committee, which will review video recordings of the sessions, will be blinded to which participants received simulation-based training (group of interest) and which received theory-based training (control group). Secondary outcomes are the effect of SIMUL-CHD on empathy and anxiety levels in young pediatric cardiologists. Baseline scores pre and post-intervention will be compared, and skill improvement resulting from the intervention measured. Simulation-based training has proven efficacy in teaching technical skills in various scenarios however its application to communication skills in pediatric cardiology remains unexplored. The involvement of experienced parents provides a unique perspective, incorporating their profound understanding of the emotional challenges and specific hurdles faced by families dealing with congenital heart disease. This trial is registered with the OSF registry (registered https://osf.io/ed78q ).

In this paper, we investigate the use of an encoder-decoder neural architecture for unsupervised representation learning of mixed asynchronous data, and we introduce the JMETTS (Joint Modelling of Event Traces and Time Series) model. Our aim is to perform short-term forecasts for multivariate time series contextualized by events. As a proof of concept, we focus on a real-world case related to digitally assisted training in anaesthesiology. With a maximal prediction error percentage around 5.5%, the high predictive performance of JMETTS is comparable to its only competitor published to date. The source code is publicly available.

Training novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents. This prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed. Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75

Les recommandations françaises sur le maintien des compétences en anesthésie pédiatrique (AP) comportent un référentiel pratique et théorique et préconisent des stages pratiques. Notre but était d’explorer vécus et attendus de formation continue (FC) en AP des anesthésistes réanimateurs (AR). Une enquête a été réalisée par voie électronique entre juillet et octobre 2021 auprès des membres de l’ADARPEF et de la SFAR. L’étude a inclus 710 AR (46 [38–56] ans) avec une activité d’AP exclusive (19 %) (groupe E) ou mixte (81 %) (groupe M). Pendant leur internat, 95 % des répondeurs ont fait un stage d’AP ; 27 % ont un DIU d’AP. Seuls 25 et 24 % du groupe M ont respectivement participé à un atelier de simulation et/ou un stage pratique alors que 86 et 57 % le souhaiteraient. Les attendus étaient surtout pratiques (webinaire, simulation, stages). Un ressenti désagréable de la pratique pédiatrique était exprimé par 2 % du groupe E et 12 % du groupe M. Les principaux facteurs contributifs étaient une pratique imposée, l’inadéquation entre l’activité et le ressenti personnel des compétences et une prise en charge mensuelle inférieure à 10 enfants. Les facteurs susceptibles de majorer le plaisir de pratiquer l’AP seraient de consolider les connaissances théoriques et de bénéficier d’un soutien dans les choix d’ordre médical, technique/matériel et organisationnel. La FC en AP bénéficie d’une dynamique positive orientée vers de nouveaux formats. Cependant, l’écart important entre souhaits et formations effectives témoigne d’une importante demande non satisfaite, pour laquelle sociétés savantes et centres de références doivent se mobiliser. The French recommendations on the continuous education in paediatric anaesthesia (PA) skills include a practical and theoretical reference framework and advocate practical training sessions. Our aim was to explore the experiences and expectations of continuing medical education (CME) in PA for anaesthetists. A survey was sent online between July and October 2021 to members of the French Society of Anaesthesia and Intensive Care and the Association of French-speaking Paediatric Anaesthetists. The analysis focused on the responses of 710 anaesthetists (46 [38–56] years old) with an exclusive (E group) (19%) or mixed (M group) (71%) PA activity. During their residency, 95% of the respondents had benefited from a specific paediatric training period; 27% had obtained a post-graduate PA inter-university diploma. Only 25 and 24% of Group M respectively had participated in a simulation workshop and/or practical training, whereas 86 and 57% would like to do that. The expectations are mainly practical (webinar, simulation, practical training). The main independent factors associated with an uncomfortable activity feeling (12.5% in M group, 2% in E group) were an imposed activity, a feeling of insufficient skills and caring for < 10 children/month. The factors likely to increase their comfort would be to consolidate theoretical knowledge and to benefit from support in medical, technical/material and organisational choices. PA CME benefits from a positive dynamic oriented towards new formats. However, the large gap between expectations and actual training reflects a significant unsatisfied demand, for which academic societies and reference centres must mobilise.

Context > Before updating of the recommendations on the structural, material and functional organization of paediatric anaesthesia (PA) in France, a national survey explored the current conditions of PA practice and the application of previous guidelines.Methods > An online survey was shared during the second half of 2021 with SFAR and ADARPEF members.Results > The survey was completed by 710 anaesthetists with exclusive paediatric activity (group E) (19%) or mixed adult/child activity (group M) (81%). A medical team was dedicated to PA for 35% of the responders and the presence of an anaesthetic nurse was systematic for 65% of the responders; 38% of them managed one child at a time and 45% simultaneously one child and one adult. In group E, the median ratio (3 anaesthetists for 4 operative rooms) was higher than the desired ratio for 35% of responders. In University hospitals, 27% of responders were also involved in paediatric intensive care and 40% in continuing paediatric care. In group M, children were managed in adult consultation (88%), operating room (73%), in mixed SSPI (50%), in ambulatory (40%) or conventional (33%) adult sector without a dedicated sector. In the M group, the quality of PA activity was considered inadequate by 22% of the responders with insufficient equipment (27%), postoperative monitoring (53%), medical paediatric skills (33%), surgical skills (28%) and anaesthetic nurse skills (22%).Conclusion > Our results pointed caution regarding the organisation of PA activities, in particular the securisation of specific paediatric surgical care pathways and the availability of paediatric equipment.

Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs’ successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the “College des Ophtalmologistes Universitaires de France” in order to set up a future “licence to operate.” Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. ClinicalTrial.gov identifier: NCT05722080.

Background: High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBabyTM, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBabyTM software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management. Methods: After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists' non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session. Results: We enrolled 128 physicians. Direct participation SQS (39 & PLUSMN; 5 HF group versus 38 & PLUSMN; 5 LC group), observation SQS (41 & PLUSMN; 4 H F group versus 39 & PLUSMN; 5 LC group), ANTS scores (38 & PLUSMN; 4 HF group versus 39 & PLUSMN; 6 LC group), T0 SQS (44 & PLUSMN; 5 HF group versus 43 & PLUSMN; 6 LC group), T3 and T6 SQS were not different between groups. Conclusion: Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management. & COPY; 2021 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

So far, models that take advantage of sequences of events to refine time series prediction have only been designed for specific applications.In this paper, we introduce the Non-Homogeneous Markov Chain AutoRegressive (NHMC-AR) model.In our model, the innovation arises from the synchronization of a multivariate Hawkes temporal point process with an autoregressive first-order hidden Markov model, through contextual variables.Experiments on anaesthesia data demonstrate that NHMC-AR has substantially better predictive performance compared to two competing methods.

Avant réactualisation des recommandations sur l’organisation structurelle, matérielle et fonctionnelle de l’anesthésie pédiatrique (AP), une enquête nationale a exploré les conditions de l’exercice de l’AP et l’impact des précédentes recommandations. Une enquête en ligne a été diffusée pendant le second semestre 2021 auprès des membres de la SFAR et de l’ADARPEF. L’enquête a été renseignée par 710 médecins anesthésistes réanimateurs (MAR) ayant une activité pédiatrique exclusive (groupe E) (19 %) ou mixte adulte/enfant (groupe M) (81 %). Une équipe médicale était dédiée à l’AP pour 35 % des MAR et la présence d’une IADE systématique pour 65 % des répondeurs ; 38 % des MAR prenaient en charge un seul enfant et 45 % un enfant et un adulte simultanément. Dans le groupe E, le ratio médian (3 AR pour 4 salles) était supérieur au ratio souhaité pour 35 % des MAR. En CHU, 27 % des AR exerçaient une activité en réanimation pédiatrique et 40 % en USC. Dans le groupe M, des enfants étaient accueillis dans des vacations de consultations (88 %) et opératoires (73 %) adulte, en SSPI mixte (50 %) et en secteur ambulatoire (40 %) ou conventionnel (33 %) adulte sans secteur dédié. L’activité d’AP était en inadéquation avec les possibilités de l’établissement pour 22 % du groupe M avec des insuffisances de matériel (27 %), de surveillance postopératoire (53 %), de compétences pédiatriques (33 %), chirurgicales (28 %) et d’IADE (22 %). Nos résultats identifient des points de vigilance sur l’organisation des activités d’AP notamment sur la sanctuarisation des filières pédiatriques et la disponibilité du matériel pédiatrique. Before updating of the recommendations on the structural, material and functional organization of paediatric anaesthesia (PA) in France, a national survey explored the current conditions of PA practice and the application of previous guidelines. An online survey was shared during the second half of 2021 with SFAR and ADARPEF members. The survey was completed by 710 anaesthetists with exclusive paediatric activity (group E) (19%) or mixed adult/child activity (group M) (81%). A medical team was dedicated to PA for 35% of the responders and the presence of an anaesthetic nurse was systematic for 65% of the responders; 38% of them managed one child at a time and 45% simultaneously one child and one adult. In group E, the median ratio (3 anaesthetists for 4 operative rooms) was higher than the desired ratio for 35% of responders. In University hospitals, 27% of responders were also involved in paediatric intensive care and 40% in continuing paediatric care. In group M, children were managed in adult consultation (88%), operating room (73%), in mixed SSPI (50%), in ambulatory (40%) or conventional (33%) adult sector without a dedicated sector. In the M group, the quality of PA activity was considered inadequate by 22% of the responders with insufficient equipment (27%), postoperative monitoring (53%), medical paediatric skills (33%), surgical skills (28%) and anaesthetic nurse skills (22%). Our results pointed caution regarding the organisation of PA activities, in particular the securisation of specific paediatric surgical care pathways and the availability of paediatric equipment.

The need to comprehend and predict the dynamics of complex systems has spurred developments of time series forecasting methods across several disciplines. Nowadays, time series are collected with event logs for an ever increasing number of systems. Event logs can contain prominent information about the system dynamics. This paper addresses joint modelling of time series and event traces, to enhance time series forecasting. We introduce the Non-Homogeneous Markov Chain AutoRegressive model, to best apprehend the combined influence of past events belonging to several event categories, on a system's dynamics. The originality of our proposal stems from the synchronization of a Hawkes temporal point process with the classical first-order hidden Markov model, through contextual variables. We also instantiate a basic version whose contextual variables only take into account events' latest occurrences. Our proof-of-concept experiments address a real-world case related to digitally assisted training in anaesthesiology. We demonstrate that the advanced instantiation outperforms the basic instantiation (maximal prediction error percentage: 5.6% versus 13.5%). Finally, we validate the suitability of the advanced instantiation for the desired simulation, by applying real sequences of medical actions to digital patients. We show that we obtain highly realistic simulations.

Context > The French recommendations on the continuous education in paediatric anaesthesia (PA) skills include a practical and theoretical reference framework and advocate practical training sessions. Our aim was to explore the experiences and expectations of continuing medical education (CME) in PA for anaesthetists. Methods > A survey was sent online between July and October 2021 to members of the French Society of Anaesthesia and Intensive Care and the Association of French-speaking Paediatric Anaesthetists. Results > The analysis focused on the responses of 710 anaesthetists (46 [38-56] years old) with an exclusive (E group) (19%) or mixed (M group) (71%) PA activity. During their residency, 95% of the respondents had benefited from a specific paediatric training period; 27% had obtained a post -graduate PA inter -university diploma. Only 25 and 24% of Group M respectively had participated in a simulation workshop and/or practical training, whereas 86 and 57% would like to do that. The expectations are mainly practical (webinar, simulation, practical training). The main independent factors associated with an uncomfortable activity feeling (12.5% in M group, 2% in E group) were an imposed activity, a feeling of insufficient skills and caring for < 10 children/month. The factors likely to increase their comfort would be to consolidate theoretical knowledge and to benefit from support in medical, technical/material and organisational choices. Conclusion > PA CME benefits from a positive dynamic oriented towards new formats. However, the large gap between expectations and actual training reflects a significant unsatisfied demand, for which academic societies and reference centres must mobilise.

More than half a million surgeries with anaesthesia are performed every day worldwide, making the safety and quality of intraoperative care a major health issue. We present SVP-OR (Simulation of Virtual Patient at the Operating Room), a novel approach designed for computer-assisted anaesthesia training. For this purpose, we simulate the evolution of the physiological state of a virtual patient, depending on the actions of the simulator user (anaesthetist in training) and the other medical agents. We present the problem as a case-based reasoning approach. When a new medical action is initiated, we first identify real patients whose anaesthetic profiles show a region most similar to the recent history of the virtual patient; then we predict the near future of the virtual patient (a multivariate time series) from the time series of these real patients. Our contribution is fourfold. First, we have designed a contextualized multidimensional pattern recognition approach focused on temporal data. Second, using the concept of contextualized multidimensional pattern, we have developed a generic framework for predicting the evolution of a virtual patient’s state in the operating room. Thirdly, the choice of a relevant dissimilarity measure for real-time comparison of many short time series is crucial for our simulation problem. We have designed an experimental protocol to achieve the comparative analysis of 8 candidates. Fourthly, we have evaluated the realism of the SVP-OR simulations. We have examined how the prediction ability varies along the phases of the surgery studied.

Abstract In pediatric patients, pain remains the most common complaint after surgery. This French multicenter epidemiological study (AlgoDARPEF) aimed to evaluate the use of a smartphone application (App) to assess the duration and severity of pain experienced by children undergoing outpatient surgery. Children younger than 18 years scheduled for an elective outpatient procedure in one of the participating centers were eligible. Parents were invited to provide daily information for 10 days regarding their child's pain and comfort through a smartphone App using the Parents' Postoperative Pain Measure-Short-Form (PPPM-SF). Children older than 6 years could also provide self-assessments of pain using a numerical rating scale (NRS)-11. Data regarding pain medication, preoperative anxiety, postoperative nausea and vomiting, and parent satisfaction were also analyzed. Repeated-measures analyses of variances (ANOVAs) were used to compare the self-assessments and hetero-assessments of pain. Eleven centers participated in the study, and 1573 patients were recruited. Forty-nine percentage of parents (n = 772) actually used the App at least once. In all surgeries, the average pain rating on the PPPM-SF scale did not exceed 3/10 throughout the follow-up period, as well as for 4 main surgical specialties. Age, visceral surgery, and preoperative anxiety ≥ 4/10 were identified as independent risk factors for experiencing at least 1 episode of pain ≥4/10 during the first 48 postoperative hours. Although these findings indicated that postoperative pain management seems to be satisfactory in the families who used the App, some improvements in anxiety management are suggested. This study shows that inviting parents to use a smartphone App to assess and report the quality of postoperative management in pediatric patients provides useful information. A continuous report regarding pain and adverse events over a 10-day postoperative period by a self-reporting or parent's contribution is possible. Future studies should investigate the ability of live data collection using an App to ensure fast, efficient interactions between patients and physicians.

Objective: The stress level of participants in high-fidelity simulation stems from various factors but may result in anticipatory anxiety causing sleep disturbances during the night prior to simulation. The objective of this survey was to determine the change in sleep quality of residents during the night prior to the simulation. Methods: The survey was proposed for 1 year to all residents at the beginning of the simulation, in 10 simulation centres. The questionnaire combined demographics and the Leeds Sleep Evaluation Questionnaire using visual analogue scales divided into 4 sleep qualitative domains. The primary outcome was the prevalence of sleep disturbance (> 10 mm on 1 domain). Secondary outcomes were the prevalence of severe sleep disturbance (> 25 mm), as well as qualitatively and quantitatively reported explanatory sleep parameters. Results: Among respondents, 66% [95% CI: 63 to 69] of residents had more than 10 mm and 27% [95% CI: 24 to 30] had more than 25 mm of sleep disturbance. Residents with a sleep disturbance of more than 10 mm had fewer hours of sleep (6.4 [standard deviation = 1.8] vs 7.3 [standard deviation = 1.3], difference: -0.9 [95% CI: -1.1 to -0.7]; P < .0001), with a higher number of night-time awakenings (1.3 [standard deviation = 1.5] vs 0.7 [standard deviation = 0.9], difference: 0.6 [95% CI: 0.4 to 0.8]; P < .0001). Conclusion: Among residents participating in the simulation, a high prevalence of change in sleep quality during the night before the simulation was noted. Strategies to help residents achieve better sleep prior to simulation should be explored.

Half a million surgeries are performed every day around the world, which places safety and quality at the heart of global health issues. In this context, we introduce a novel approach, SVP-OR (Simulation of Virtual Patient at the Operating Room), designed for digital training support. For this purpose, we must evolve the physiological parameters of a virtual patient submitted to the actions of a user (trainee), and of a virtual medical team. We formulate the problem as a case-based reasoning approach in which (i) we identify real patients whose anaesthetic profiles show a region similar to the recent history of the virtual patient and (ii) we predict the near future of the virtual patient (a multivariate time series) from the multivariate time series of the most similar real patients. The first contribution in this paper consists in the design of a contextualized multidimensional pattern recognition approach. Our second contribution is the development of a generic framework based on the concept of contextualized multidimensional pattern, to predict the evolution of the virtual patient. In a third contribution, we instantiate our framework, and we evaluate and compare the realism of two predictive strategies.

OSA has become the main cause of tonsillectomy in children. The most common aetiology of OSA between 3 and 6 years of age is tonsil hypertrophy. Obesity is an important contributing factor in school-age children. Because its pathophysiology is multifactorial, OSA is present in a large number of syndromes or pathologies involving craniofacial and genetic abnormalities and muscular disease. The gold standard for the diagnosis and severity of a child's OSA is sleep polysomnography, but this investigation is not widely available and is reserved for specific situations. Children with OSA have an increased perioperative risk of desaturations, upper airway obstruction and laryngospasm. The incidence of immediate postoperative respiratory complications is correlated with the severity of OSA. The specificity of the McGill oxymetry score (MOS) for detecting severe OSA is high, but the number of false negatives is significant. The Severity Hierarchy Score is certainly the most effective of the questionnaires proposed for grading the severity of OSA. Opioid requirements are reduced in case of severe OSA. Tonsillectomy does not immediately reverse the pathophysiological alterations associated with OSA and anaesthesia may in fact exacerbate them. Severe OSA is a contraindication to outpatient tonsillectomy. Association with comorbidities and/or an age less than 3 years require a closed continuous postoperative monitoring.