Paediatric HERMES: European accreditation of training centres in paediatric respiratory medicine

HERMES: European accreditation of training centres in paediatric respiratory medicine http://ow.ly/ZBmUg

Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada

In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients.Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients

Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation

Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of ‘what good looks like’. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language framework—For Us—that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units

The emerging role of AMPK in the regulation of breathing and oxygen supply

Regulation of breathing is critical to our capacity to accommodate deficits in oxygen availability and demand during, for example, sleep and ascent to altitude. It is generally accepted that a fall in arterial oxygen increases afferent discharge from the carotid bodies to the brainstem and thus delivers increased ventilatory drive, which restores oxygen supply and protects against hypoventilation and apnoea. However, the precise molecular mechanisms involved remain unclear. We recently identified as critical to this process the AMP-activated protein kinase (AMPK), which is key to the cell-autonomous regulation of metabolic homoeostasis. This observation is significant for many reasons, not least because recent studies suggest that the gene for the AMPK-α1 catalytic subunit has been subjected to natural selection in high-altitude populations. It would appear, therefore, that evolutionary pressures have led to AMPK being utilized to regulate oxygen delivery and thus energy supply to the body in the short, medium and longer term. Contrary to current consensus, however, our findings suggest that AMPK regulates ventilation at the level of the caudal brainstem, even when afferent input responses from the carotid body are normal. We therefore hypothesize that AMPK integrates local hypoxic stress at defined loci within the brainstem respiratory network with an index of peripheral hypoxic status, namely afferent chemosensory inputs. Allied to this, AMPK is critical to the control of hypoxic pulmonary vasoconstriction and thus ventilation–perfusion matching at the lungs and may also determine oxygen supply to the foetus by, for example, modulating utero-placental blood flow

The Grameen Bank approach to community engagement

Muhammad Yunus, founder of the micro-credit Grameen Bank made two observations fundamental to the mindset required for non-tokenistic approaches to community development and community engagement. He noted (1997, p. 3): “First, our knowledge base about people and their interactions is still very inadequate; second, each individual person is very important. Each person has tremendous potential. S/he alone can influence the lives of others within communities, nations, within and beyond his/her own time.” The capacity for micro-interventions, focussed on supporting community aspirations and community identified training needs, to be effective in generating “the essential worth of individuals, fundamental to any sustainable change process” (Paton 2003, p. 5) is examined. This paper explores the perspective that, contrary to popular rhetoric, the much misunderstood process of capacity building is only one of the elements required to generate effective community engagement. In fact creating an enabling environment is an equally vital element necessary to allow individuals and communities to reach their potential. It further argues that community engagement can only occur when people not only posses the skills essential to adequately address their own issues but also feel confident enough of their own ability and worth to participate. They must also be treated as respected equals by all others involved in the process. To what degree socially focused micro–interventions can contribute to pro-active community engagement is discussed in the practice context of the delivery of short flexible training programs designed to meet the specific needs of rural and regional areas of Queensland

Meeting the needs of rural families in times of crisis

In 2003 qualitative research investigated the role of Rural Family Support Worker (RFSW) within Central Queensland. Catalyst for the study was the perception that Departmental funding criteria were not keeping abreast of community needs and expectations. The findings from this project offer an ideal opportunity to review the funder/ purchaser/provider model in practice in Australia. Key issues arising are: the appropriateness of this model for service delivery in rural communities and its effectiveness in meeting the expectations of all the stakeholders connected to the Rural Family Support (RFS) system. This paper examines views espoused in the literature and perspectives put forward by a range of Human Service Sector Professionals, Departmental staff, clients of the RFSWs and the RFSWs themselves. It identifies areas where a more proactive and collaborative approach between contractual partners will ensure the RFS program can better meet the needs of rural families in times of crisis

Evaluating business retention and expansion as a tool for regional development

Australia’s economic and political policy settings have changed to align with a global market economy. These changes have impacted heavily on the businesses sector and in particular on Australia’s regional business and regional economies. In order to assist regional commercial sectors operate more effectively in this environment, a program called Business Retention and Expansion was developed. The Business Retention and Expansion (BR&E) program was specifically designed to assist the commercial sector of regional communities to work more effectively together through improved connectivity, alliances and partnerships. The outcome is to develop a business operating environment at a regional scale that is more competitive in this new global environment.This paper outlines the findings of a pilot study evaluating the effectiveness of the BR&E program conducted in the Innisfail region of Queensland, Australia. The Innisfail BR&E Program was designed to investigate the impact of using an action learning approach to develop ownership and leadership within this Queensland community. The project focussed on strong local knowledge and involvement and community interaction, underpinned by expertise from the University Sector and the Queensland Government