Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.</p

Lessons learned from 1-to-1 laptop initiatives: reflections on critical components

More and more jurisdictions are exploring and implementing ubiquitous learning environments. The Ubiquitous Computing Evaluation Consortium identifies at least 14 large-scale learning with laptop and 16 district initiatives. Other jurisdictions are implementing handheld initiatives. MIT has announced a $100 laptop intended to bring technology to the world's poor countries, but will be piloted in Massachusetts. Such initiatives have enormous implications for both inservice and preservice teacher education. This panel will bring together panelists representing five learning with laptop initiatives, including Irving (TX) Independent School District, the Maine Learning Technology Initiative, the New Bedford Global Learning Charter School (MA), and various handheld initiatives. The panel presentations will conclude with a long-term view of 1-to-1 initiatives, including comparisons and contrasts between Australia and the USA

Nationwide collaborative development of learning outcomes and exemplar standards for Australian pharmacy programmes

Objectives Internationally, the preparation of pharmacy graduates for professional practice has evolved from educating for capacities for practice, to a focus on competencies, and most recently, on assuring graduate outcomes. Consequently, there is an increasing emphasis on the specification of and accountability around student learning outcomes. This, in turn, has implications for teaching and assessment. The aim of the study was to harmonise the various expectations and regulatory requirements for Australian pharmacy education programmes through the development of learning outcomes and exemplar standards for all entry-level pharmacy graduates. Methods Learning outcomes and exemplar standards were developed through a participatory action research framework which involved academic staff representatives from pharmacy schools in Australia, pharmacy student representatives, and the Australian Pharmacy Council (APC, the accreditation body for Australian pharmacy programs) involving an iterative process of dissemination and seeking of feedback. Key findings The key result from the project was the formulation of national pharmacy learning outcomes and exemplar standards (PhLOS) for all students graduating from entry-level pharmacy programmes. These have been endorsed by both students and academics. Conclusions Learning outcomes have been developed through a collaborative process for pharmacy programmes across Australia through harmonisation of the various expectations and regulatory requirements for pharmacy education programmes. Application of these learning outcomes and exemplar standards will ensure that all graduates of all entry-level pharmacy programmes will have achieved at least the same threshold, regardless of the university from which they graduate prior to entering their internship year

Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis

Background Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures. Methods and Findings Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions—Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients <5 y and 5–14 y (relative risk [RR] = 3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50–64 y and ≥65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the ≥65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be a risk factor for ICU admission and fatal outcome (RR = 36.3). Conclusions Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes