TY - JOUR T1 - Teaching pain recognition through art: the Ramsay-Caravaggio sedation scale. JF - Ital J Pediatr Y1 - 2018 A1 - Poropat, Federico A1 - Cozzi, Giorgio A1 - Magnolato, Andrea A1 - Monasta, Lorenzo A1 - Borrometi, Fabio A1 - Krauss, Baruch A1 - Ventura, Alessandro A1 - Barbi, Egidio KW - Clinical Competence KW - Conscious Sedation KW - Deep Sedation KW - Education, Medical, Graduate KW - Female KW - Hospitals, University KW - Humans KW - Internship and Residency KW - Italy KW - Male KW - Medicine in the Arts KW - Monitoring, Physiologic KW - Pain Measurement KW - Paintings KW - Pediatrics KW - Video Recording AB -

BACKGROUND: Clinical observation is a key component of medical ability, enabling immediate evaluation of the patient's emotional state and contributing to a clinical clue that leads to final decision making. In medical schools, the art of learning to look can be taught using medical humanities and especially visual arts. By presenting a Ramsay sedation score (RSS) integrated with Caravaggio's paintings during a procedural sedation conference for pediatric residents, we want to test the effectiveness of this approach to improve the quality of learning.

METHODS: In this preliminary study, we presented videos showing sedated pediatric patients in the setting of a procedural sedation lesson to two randomized groups of residents, one attending a lesson on RSS explained through the masterpieces of Caravaggio, the other without artistic support. A week later we tested their learning with ten multi-choice questions focused on theoretical questions about sedation monitoring and ten more questions focused on recognizing the appropriate RSS viewing the videos. The primary outcome was the comparison of the total number of RSS layers properly recognized in both groups. We also evaluated the appreciation of the residents of the use of works of art integrated with the lesson.

RESULTS: Eleven students were randomized to each group. Two residents in the standard lesson did not attend the test. The percentage of correct answers on the theoretical part was similar, 82% in the art group and 89% in the other (pā€‰>ā€‰0.05). No difference was found in the video recognition part of the RSS recognition test. Residents exposed to paintings shown great appreciation for the integration of the lesson with the Caravaggio's masterpieces.

CONCLUSIONS: Adding artwork to a standard medical conference does not improve the performance of student tests, although this approach has been greatly appreciated by residents.

VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29386058?dopt=Abstract ER - TY - JOUR T1 - First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. JF - Acta Paediatr Y1 - 2017 A1 - Cozzi, Giorgio A1 - Borrometi, Fabio A1 - Benini, Franca A1 - Neri, Elena A1 - Rusalen, Francesca A1 - Celentano, Loredana A1 - Zanon, Davide A1 - Schreiber, Silvana A1 - Ronfani, Luca A1 - Barbi, Egidio KW - Anesthetics, Local KW - Catheterization, Peripheral KW - Child KW - Child, Preschool KW - Female KW - Hot Temperature KW - Humans KW - Lidocaine KW - Lidocaine, Prilocaine Drug Combination KW - Male KW - Pain KW - Phlebotomy KW - Prilocaine KW - Tetracaine AB -

AIM: More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.

METHODS: We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.

RESULTS: The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups.

CONCLUSION: This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.

VL - 106 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28130888?dopt=Abstract ER -