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PubMed2006

The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: pediatric basic and advanced life support.

This publication contains the pediatric and neonatal sections of the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (COSTR). The consensus process that produced this document was sponsored by the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1993 and consists of representatives of resuscitation councils from all over the world. Its mission is to identify and review international science and knowledge relevant to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and to generate consensus on treatment recommendations. ECC includes all responses necessary to treat life-threatening cardiovascular and respiratory events. The COSTR document presents international consensus statements on the science of resuscitation. ILCOR member organizations are each publishing resuscitation guidelines that are consistent with the science in this consensus document, but they also take into consideration geographic, economic, and system differences in practice and the regional availability of medical devices and drugs. The American Heart Association (AHA) pediatric and the American Academy of Pediatrics/AHA neonatal sections of the resuscitation guidelines are reprinted in this issue of Pediatrics (see pages e978-e988). The 2005 evidence evaluation process began shortly after publication of the 2000 International Guidelines for CPR and ECC. The process included topic identification, expert topic review, discussion and debate at 6 international meetings, further review, and debate within ILCOR member organizations and ultimate approval by the member organizations, an Editorial Board, and peer reviewers. The complete COSTR document was published simultaneously in Circulation (International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2005;112(suppl):73-90) and Resuscitation (International Liaison Committee on Resuscitation. 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2005;67:271-291). Readers are encouraged to review the 2005 COSTR document in its entirety. It can be accessed through the CPR and ECC link at the AHA Web site: www.americanheart.org. The complete publication represents the largest evaluation of resuscitation literature ever published and contains electronic links to more detailed information about the international collaborative process. To organize the evidence evaluation, ILCOR representatives established 6 task forces: basic life support, advanced life support, acute coronary syndromes, pediatric life support, neonatal life support, and an interdisciplinary task force to consider overlapping topics such as educational issues. The AHA established additional task forces on stroke and, in collaboration with the American Red Cross, a task force on first aid. Each task force identified topics requiring evaluation and appointed international experts to review them. A detailed worksheet template was created to help the experts document their literature review, evaluate studies, determine levels of evidence, develop treatment recommendations, and disclose conflicts of interest. Two evidence evaluation experts reviewed all worksheets and assisted the worksheet reviewers to ensure that the worksheets met a consistently high standard. A total of 281 experts completed 403 worksheets on 275 topics, reviewing more than 22000 published studies. In December 2004 the evidence review and summary portions of the evidence evaluation worksheets, with worksheet author conflict of interest statements, were posted on the Internet at www.C2005.org, where readers can continue to access them. Journal advertisements and e-mails invited public comment. Two hundred forty-nine worksheet authors (141 from the United States and 108 from 17 other countries) and additional invited experts and reviewers attended the 2005 International Consensus Conference for presentation, discussion, and debate of the evidence. All 380 participants at the conference received electronic copies of the worksheets. Internet access was available to all conference participants during the conference to facilitate real-time verification of the literature. Expert reviewers presented topics in plenary, concurrent, and poster conference sessions with strict adherence to a novel and rigorous conflict of interest process. Presenters and participants then debated the evidence, conclusions, and draft summary statements. Wording of science statements and treatment recommendations was refined after further review by ILCOR member organizations and the international editorial board. This format ensured that the final document represented a truly international consensus process. The COSTR manuscript was ultimately approved by all ILCOR member organizations and by an international editorial board. The AHA Science Advisory and Coordinating Committee and the editor of Circulation obtained peer reviews of this document before it was accepted for publication. The most important changes in recommendations for pediatric resuscitation since the last ILCOR review in 2000 include: Increased emphasis on performing high quality CPR: "Push hard, push fast, minimize interruptions of chest compression; allow full chest recoil, and don't provide excessive ventilation" Recommended chest compression-ventilation ratio: For lone rescuers with victims of all ages: 30:2 For health care providers performing 2-rescuer CPR for infants and children: 15:2 (except 3:1 for neonates) Either a 2- or 1-hand technique is acceptable for chest compressions in children Use of 1 shock followed by immediate CPR is recommended for each defibrillation attempt, instead of 3 stacked shocks Biphasic shocks with an automated external defibrillator (AED) are acceptable for children 1 year of age. Attenuated shocks using child cables or activation of a key or switch are recommended in children <8 years old. Routine use of high-dose intravenous (IV) epinephrine is no longer recommended. Intravascular (IV and intraosseous) route of drug administration is preferred to the endotracheal route. Cuffed endotracheal tubes can be used in infants and children provided correct tube size and cuff inflation pressure are used. Exhaled CO2 detection is recommended for confirmation of endotracheal tube placement. Consider induced hypothermia for 12 to 24 hours in patients who remain comatose following resuscitation. Some of the most important changes in recommendations for neonatal resuscitation since the last ILCOR review in 2000 include less emphasis on using 100% oxygen when initiating resuscitation, de-emphasis of the need for routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid, proven value of occlusive wrapping of very low birth weight infants <28 weeks' gestation to reduce heat loss, preference for the IV versus the endotracheal route for epinephrine, and an increased emphasis on parental autonomy at the threshold of viability. The scientific evidence supporting these recommendations is summarized in the neonatal document (see pages e978-e988).

Child↗
PubMed1999

[National quality control of serologic HLA typing].

Since 1995 the Istituto Superiore di Sanità, in collaboration with the Italian Red Cross, has been organising annually the quality control of serological HLA class I and II typing on histocompatibility laboratories which perform typing for organ and bone marrow transplantation. Improvement has been obtained every year; in fact, results of the 1997 control show that the 77% of the laboratories typed the major specificities correctly. Despite the remarkable improvement achieved during the first three years of quality controls, a new organisation has been designed for further years to ensure the participation of all the Italian laboratories (more than 100) and to promote a quality control scheme that will be acceptable at international level.

Accreditation↗
PubMed2002

Endovascular surgery: the future without limits.

The new millennium brings with it tremendous advances in technology and information sharing. Various medical, surgical, and engineering specialities are becoming more focused, thus enabling experts in these fields to gain insight and understanding previously unappreciated by those who came before us. Economic and technologic evolution will eliminate some of the drawbacks of endovascular therapy, such as persistent neck remnants. It is likely that drug delivery systems exist that would allow maximal benefit with little or no systemic adverse effects. It is likely that devices are available that could minimize various procedural complications. We as future neurosurgeons must persist in the quest to find collaborations that will promote cross-fertilization and cross-pollination among cardiologists, neurosurgeons, physicists, radiologists, neurologists, engineers, and other scientists so that the technology can be translated to reality. It is clear that, in time, transcatheter techniques will replace many operations for the treatment of cerebrovascular pathologies. Let us not allow ourselves the luxury of time.

Angioplasty↗
PubMed1993

A cross-national prevalence study of children with emotional and behavioural problems--a WHO collaborative study in the Western Pacific Region.

Emotional and behavioural problems in primary school children were investigated with Rutter's questionnaires, in Japan (N = 2638), China (N = 2432) and Korea (N = 1975). The prevalence rates of children with deviant scores on the teachers' and parents' scales were 3.9 and 12.0% in Japan, 8.3 and 7.0% in China and 14.1 and 19.1% in Korea, respectively. Deviance of the antisocial type was more frequent than the neurotic type in Japan and China. Both types were almost equally frequent in Korea. The prevalence of deviance was higher in boys, and also higher in those children with poor school achievement. In China and Korea, the prevalence was higher in children from one-parent families. Although other family background factors had major effects on deviant behaviour in these two countries, the number of siblings and birth order had only a limited effect on the deviant behaviour of children in Japan, China and Korea.

Age Factors↗
PubMedDate not supplied

A cross-national EEG study of children with emotional and behavioral problems: a WHO collaborative study in the Western Pacific Region.

Electroencephalograms (EEGs) of children from the general population, assessed by Rutter's questionnaires as having deviant behavior, were quantitatively evaluated in Japan (n = 27), China (n = 39), and Korea (n = 87). Compared with age-matched normal behavior children in Japan (n = 30), China (n = 27), and Korea (n = 26), there were no differences either in the EEG frequency pattern or other EEG variables. The EEGs of age-matched children diagnosed with attention deficit disorder with hyperactivity in psychiatric clinics in Japan (n = 21), China (n = 41), and Korea (n = 29), were significantly different from those of normal and deviant behavior groups. There were more delta and fast theta waves and fewer alpha waves in all three countries, and hypothetical EEG maturation was retarded in Japan and China. These results suggest that the deviant behavior of children in the general population had no biological background, but presumably stemmed from psychosocial disadvantages. In contrast, the symptoms of hyperactive children seemed to be related to a biological dysfunction such as brain immaturity.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Children's protective services and law enforcement: fostering partnerships in investigations of child abuse.

Although collaboration in child abuse investigations has been emphasized since 1974, barriers, including role conflicts and organizational differences, have often been reported. This study describes the process of collaboration based on the perceptions of investigators working with a Child Advocacy Center. Telephone interviews were conducted with 290 child protective service workers and law enforcement officers from 28 child advocacy centers in 20 different states. Respondents identified barriers to the process of collaboration such as conflicts over case control and facilitators including co-housing and cross-training. Conditions that should contribute to successful collaboration are discussed.

Adult↗
PubMed2005

Interprofessional learning and higher education structural barriers.

Structural changes need to be made within universities such that interprofessional education for patient-centred collaborative practice becomes a responsibility that crosses faculty jurisdictions and is accepted as the responsibility of all associated health and human service programs. In communities, the patient or client is the centre of professional attention requiring care that goes beyond the skill and scope of any one profession. Notions about collaboration inform and drive interprofessional education and should lead to sustainable system changes within centres of advanced education that ensure a permanent place for interprofessional education in all health and human service programs. This chapter explores the many barriers to achieving this goal, and offers insights into their removal from one university's experience.

British Columbia↗
PubMed2000

Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. The DCLHb Cardiac Surgery Trial Collaborative Group.

BACKGROUND: Risks associated with transfusion of allogeneic blood have prompted development of methods to avoid or reduce blood transfusions. New oxygen-carrying compounds such as diaspirin cross-linked hemoglobin (DCLHb) could enable more patients to avoid allogeneic blood transfusion. METHODS: The efficacy, safety, hemodynamic effects, and plasma persistence of DCLHb were investigated in a randomized, active-control, single-blind, multicenter study in post-cardiac bypass surgery patients. Of 1,956 screened patients, 209 were determined to require a blood transfusion and met the inclusion criteria during the 24-h post-cardiac bypass period. These patients were randomized to receive up to three 250-ml infusions of DCLHb (n = 104) or three units of packed erythrocytes (pRBCs; n = 105). Further transfusions of pRBCs or whole blood were permitted, if indicated. Primary efficacy end points were the avoidance of blood transfusion through hospital discharge or 7 days postsurgery, whichever came first, and a reduction in the number of units of pRBCs transfused during this same time period. Various laboratory, physiologic, and hemodynamic parameters were monitored to define the safety and pharmacologic effect of DCLHb in this patient population. RESULTS: During the period from the end of cardiopulmonary bypass surgery through postoperative day 7 or hospital discharge, 20 of 104 (19%) DCLHb recipients did not receive a transfusion of pRBCs compared with 100% of control patients (P < 0.05). The overall number of pRBCs administered during the 7-day postoperative period was not significantly different. Mortality was similar between the DCLHb (6 of 104 patients) and the control (8 of 105 patients) groups. Hypertension, jaundice/hyperbilirubinemia, increased serum glutamic oxalo-acetic transaminase, abnormal urine, and hematuria were reported more frequently in the DCLHb group, and there was one case of renal failure in each group. The hemodynamic effects of DCLHb included a consistent and slightly greater increase in systemic and pulmonary vascular resistance with associated increases in systemic and pulmonary arterial pressures compared with pRBC. Cardiac output values decreased more in the DCLHb group patients after the first administration than the control group patients. At 24 h postinfusion, the plasma hemoglobin level was less than one half the maximal level for any amount of DCLHb infused. CONCLUSIONS: Administration of DCLHb allowed a significant number (19%) of cardiac surgery patients to avoid exposure to erythrocytes postoperatively.

Aged↗
PubMed1993

Developing and evaluating cross-cultural instruments from minimum requirements to optimal models.

In the age of increased international collaboration in medical research, the necessity of having at hand cross-culturally applicable instruments for the assessment of health-related quality of life (HRQL) in clinical trials has been voiced. Several important theoretical bases leading to cultural bias in HRQL measurement include differences in definitions of HRQL across national and cultural contexts, levels of observation relied upon to indicate HRQL states, and the significance or weight placed upon the various HRQL states or dimensions measured. Despite a growing literature on the development and evaluation of existing HRQL measures in other cultures, comprehensive sets of procedures or requirements for the international part of development and evaluation are lacking. This paper reviews major approaches to developing international HRQL measures, and discusses various methods and criteria that have been recommended for evaluating measurement equivalence in comparisons of research across national and cultural contexts. A summary of recent trends and advances in international HRQL assessment is presented.

Bias↗
PubMed2002

Cross-boundary cooperation in a watershed context: the sentiments of private forest landowners.

Ecosystem management and sustainable forestry on mixed ownership landscapes will require some level of cross-boundary coordination or management. Oregon's experiment with local, voluntary, collaborative forums, called watershed councils, is one mechanism to foster cross-boundary management. Fifty qualitative, in-depth interviews in three study areas were conducted with nonindustrial private forest (NIPF) landowners, watershed council members, and agency employees to learn how and why landowners participate (or not) on watershed councils. Study areas were located in three different areas of the state to reflect different ecological and organizational settings. Our case study identified three themes-stewardship ethic, property rights amid uncertainty, and action orientation-that were most salient among landowners when deciding to participate in their local watershed council. Other factors related to competing opportunities were also identified. Our results relate to the social psychological antecedents to cooperation of perceived consensus, group identity, and legitimacy of authority as well as to applied situations where cross-boundary coordination and management are goals.

Conservation of Natural Resources↗
PubMed2004

BlueWorks aims to improve performance throughout Blues' system.

Last October, the Chicago-based Blue Cross and Blue Shield System, in collaboration with researchers at Harvard Medical School in Boston, embarked on a unique collaboration to identify and promote the most promising programs developed by Blues companies to maintain health care affordability while encouraging the adoption of effective clinical practices. Those efforts are beginning to bear fruit, with the first six winning initiatives revealed in the first BlueWorks Quarterly Report.

Blue Cross Blue Shield Insurance Plans↗
PubMed2003

A cross-national meta-analysis of alcohol and injury: data from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP).

AIMS: To examine the relationship of acute alcohol consumption with an injury compared to a non-injury event in the emergency room across ERs in five countries. DESIGN: Meta-analysis was used to evaluate the consistency and magnitude of the association of a positive blood alcohol concentration (BAC) at the time of arrival in the ER and self-reported consumption within 6 hours prior to the event with admission to the ER for an injury compared to a non-injury, and the extent to which contextual (socio-cultural and organizational) variables explain effect sizes. FINDINGS: When controlling for age, gender and drinking five or more drinks on an occasion at least monthly, pooled effect size was significant and of a similar magnitude for both BAC and self-reported consumption, with those positive on either measure over half as likely again to be admitted to the ER with an injury compared to a medical problem. Effect sizes were found to be homogeneous across ERs for BAC, but not for self-report. Trauma center status and legal level of intoxication were positively predictive of self-reported consumption effect size on injury. CONCLUSIONS: These data suggest a moderate, but robust association of a positive BAC and self-report with admission to the ER with an injury, and that contextual variables also appear to play a role in the alcohol-injury nexus.

Alcohol Drinking↗
PubMed2006

Collaboration of Werner syndrome protein and BRCA1 in cellular responses to DNA interstrand cross-links.

Cells deficient in the Werner syndrome protein (WRN) or BRCA1 are hypersensitive to DNA interstrand cross-links (ICLs), whose repair requires nucleotide excision repair (NER) and homologous recombination (HR). However, the roles of WRN and BRCA1 in the repair of DNA ICLs are not understood and the molecular mechanisms of ICL repair at the processing stage have not yet been established. This study demonstrates that WRN helicase activity, but not exonuclease activity, is required to process DNA ICLs in cells and that WRN cooperates with BRCA1 in the cellular response to DNA ICLs. BRCA1 interacts directly with WRN and stimulates WRN helicase and exonuclease activities in vitro. The interaction between WRN and BRCA1 increases in cells treated with DNA cross-linking agents. WRN binding to BRCA1 was mapped to BRCA1 452-1079 amino acids. The BRCA1/BARD1 complex also associates with WRN in vivo and stimulates WRN helicase activity on forked and Holliday junction substrates. These findings suggest that WRN and BRCA1 act in a coordinated manner to facilitate repair of DNA ICLs.

BRCA1 Protein↗
PubMedDate not supplied

The causes of children's institutionalization in Romania. The Children's Health Care Collaborative Study Group.

A country-wide, cross-sectional survey was conducted to determine the causes of institutionalization of Romanian children aged 0-3 years. A total of 628 children were sampled at random. Interview were conducted with directors of institutions and records of each sampled child were reviewed. Each sampled child was given a brief medical and developmental evaluation. The children in Romanian institutions have one or more chronic health conditions. Their families have multiple, complex social problems. The referral to institutions usually involved a paediatrician (76% of children). Fifty-four per cent of children were referred primarily from paediatric and maternity hospitals. The majority of children currently interned are likely to remain in institutional care. Implications for policy and re-organization of health and social services are discussed.

Child, Institutionalized↗
PubMed1994

Promoting interdisciplinary collaboration in health research in developing countries: lessons from the Triangle Programme in Sri Lanka.

The Triangle Programme (1989-1992) aimed at strengthening the institutional capacity for health social science research and intervention in Sri Lanka through the promotion of appropriate international and national partnerships. First, it involved an international partnership (Triangle 1) among two universities in the developed world, i.c. University of Antwerp in Belgium and the University of Connecticut in the USA, and one university in the developing world, i.c. the University of Peradeniya, Sri Lanka. This partnership facilitated the transfer of knowledge, experience, skills across national boundaries and the North/South divide. Second, it developed a national/local partnership (Triangle 2) among the Faculties of Arts, Agriculture and Medicine at the University of Peradeniya by involving them in a joint programme of health social science research and training covering the entire range of activities from proposal development to dissemination of research results. Focusing on the latter aspect (Triangle 2) this paper reviews the results of the programme from the angle of cross-fertilization of disciplines through their collaboration in applied health research in a developing country setting.

Belgium↗
PubMed2004

Prevalence of diabetic eye disease in Tayside, Scotland (P-DETS) study: methodology.

AIMS: To describe the use of a validated diabetes register for sampling frame generation and assessment of the representative nature of participants in a fieldwork study of diabetic eye disease. METHODS: We performed an observational, cross-sectional fieldwork study of diabetic retinal disease using reference standard eye examination. We sampled the entire diabetic population using the Diabetes Audit and Research in Tayside Study (DARTS) diabetes register. RESULTS: The study population comprised 4825 diabetic patients aged over 16 years registered with one of 166 general practitioners (GPs) in 41 practices in Tayside in October 1999. This represented 61.1% of the Tayside diabetic population (7903). A total of 586 (66%; 95% confidence interval 63, 70) patients were examined from a sampling frame of 882 living patients registered with a Tayside GP. Demographic and disease parameters recorded on the DARTS patient register allowed comparison between participants and non-participants. CONCLUSIONS: This study shows the clear benefit of using a complete diabetic population as a sampling frame. This allows potential selection bias and external validity to be evaluated using routine data sources. Studies performed and reported in this way will aid the critical appraisal process.

Adult↗
PubMed1990

Guidelines for neuropsychological research in multiple sclerosis.

Acquisition of scientific information regarding the neuropsychological aspects of multiple sclerosis has been hampered by studies using small, inadequately described patient and control samples and a wide array of cognitive test procedures that hinder multicenter data pooling. Based on a review of key issues of clinical need and experimental interest, research guidelines are proposed for investigations in this burgeoning research area. The guidelines include suggestions for sampling methods, population characterization, and control groups as well as a recommended core battery of neuropsychological tests for use in this population. It is hoped that these guidelines will advance knowledge about the neuropsychology of multiple sclerosis by helping to promote sound experimental design, facilitate cross-study comparison, and encourage multicenter collaborative efforts.

Cognition Disorders↗