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International Collaborative (international + collaborative)

Distribution by Scientific Domains
Medical Sciences100%

Terms modified by International Collaborative

  • international collaborative study
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    Selected Abstracts

    Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand

    EMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009
    Theane Theophilos
    Abstract Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0,12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed. [source]

    Paediatric emergency guidelines: Could one size fit all?

    EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2009
    Sarah Dalton
    Abstract Objectives: The development of clinical practice guidelines (CPG) is a core task in EDs and CPGs are widely used. The process of CPGs development in Australian and New Zealand ED is unknown. We aim to describe this process in paediatric EDs and examine the feasibility of developing collaborative guidelines. Methods: A piloted questionnaire regarding CPG development, dissemination, implementation and evaluation was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. Specific questions regarding feasibility of combined guidelines were included. Results: All PREDICT EDs participated in the survey. All used CPGs in EDs and 12/13 had ED-specific guidelines. EDs had an average of 77 guidelines with approximately 5 new guidelines generated annually. Staff at most sites (10/13) also accessed guidelines from external sources. Most hospitals (10/13) had a guideline committee, generally comprising of senior ED and general paediatric staff. Guidelines were usually written by committee members and 10/13 hospitals adopted modified external guidelines. An average committee met six times a year for 90 min and involved seven clinicians. Most sites did not have a project manager or dedicated secretarial support. Few hospitals included literature references (3/13) or levels of evidence (1/13) in their guidelines. Most did not consider implementation, evaluation or teaching packages. Most sites (10/13) supported the development of collaborative guidelines. Conclusions: Paediatric EDs expend significant resources to develop CPGs. Collaborative guidelines would likely decrease duplication of effort and increase the number of available, current and evidence-based CPGs. [source]

    Procedural sedation in children in the emergency department: A PREDICT study

    EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2009
    Meredith Borland
    Abstract Objective: To investigate current procedural sedation practice and compare clinical practice guidelines (CPG) for procedural sedation at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. This will determine areas for improvement and provide baseline data for future multicentre studies. Methods: A questionnaire of specialist emergency physicians regarding demographics, general procedural sedation practice and specific sedation agents given to children. CPG for general sedation and sedation agents were obtained for each site. Results: Seventy-five (71%) useable surveys returned from 105 potential respondents. Most commonly used agents were nitrous oxide (N2O) (75, 100%), ketamine (total 72, 96%; i.v. 59, 83% and i.m. 22, 31%) and midazolam (total 68, 91%; i.v. 52, 81%, oral 47, 73%, intranasal 26, 41% and i.m. 6, 9%). Sedation was used for therapeutic and diagnostic procedures. Forty-three (57%) used formal sedation records and sedation checklists and thirty-one (41%) respondents reported auditing sedations. Four sites ran staff education and competency programmes. Nine sites had general sedation CPG, eight for ketamine, nine for N2O, eight for midazolam (four parenteral, five oral and six intranasal) and three for fentanyl. No site had a guideline for propofol administration. Conclusion: Procedural sedation in this research network commonly uses N2O, ketamine and midazolam for a wide range of procedures. Areas of improvement are the lack of guidelines for certain agents, documentation, staff competency training and auditing processes. Multicentre research could close gaps in terms of age cut-offs, fasting times and optimal indications for various agents. [source]

    Review article: drug-induced liver injury in clinical practice

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010
    E. Björnsson
    Aliment Pharmacol Ther 2010; 32: 3,13 Summary Background, Drug-induced liver injury (DILI) is an important differential diagnosis in many patients in clinical hepatology. DILI is the leading cause of acute liver failure and is an important safety issue when new drugs are developed. Aims, To provide a review of the recent data on DILI with particular focus on the most common and relevant issues seen in clinical practice. Methods, A Medline search was undertaken to identify relevant literature using search terms including ,drug-induced liver injury' and ,hepatotoxicity'. Results, The true incidence of DILI remains unknown but incidence up to 14 cases per 100 000 inhabitants and year has been reported. Antibiotics, analgesics and NSAIDs are the most common drugs causing liver injury. Idiosyncratic DILI has been shown to have a dose-dependent component and drugs without significant hepatic metabolism rarely cause DILI. Chronic elevation in liver enzymes can develop after DILI but this is rarely associated with clinical morbidity or mortality. Conclusions, Drug-induced liver injury remains a diagnostic challenge. Multicentre studies and international collaborative work with well-characterized patients will increase our understanding of liver injury associated with drugs. New therapies for acute liver failure resulting from drugs are needed. [source]