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Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.
Study Objectives:
The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.
Methods:
This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).
Results:
There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
Conclusion:
Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.
This chapter summarizes the most commonly performed bariatric operations. It reviews the impact of pre-pregnancy bariatric surgery on the female reproductive functions and the relevant pregnancy outcome parameters. The chapter formulates recommendations for clinical care of these patients for both the postoperative as well as the prenatal period. Mixing the different types of bariatric surgery might lead to unreliable conclusions since a different outcome can be expected after the restrictive type than after the malabsorptive types. Women experiencing pregnancy after bariatric surgery have important reproductive health care needs. The specific needs of these high-risk pregnancies are best addressed by a multidisciplinary team including obstetricians, surgeons, endocrinologists, pediatricians, psychiatrists, and nutritionists. Some aspects of prenatal care in women with a history of bariatric surgery require specific attention. Pregnancy after surgery improves many pregnancy outcomes but adds new risks related to nutritional deficiencies and surgical complications, thus requiring a specialized multidisciplinary approach.