Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2022
Justification Of Empiric Methodology to Determine Dexmedetomidine Dose for the TREX Study.
Dexmedetomidine is the sedative agent administered in combination with remifentanil and low dose of sevoflurane in the interventional arm of the ongoing TREX trial (Trial Remifentanil DExmedetomidine). The TREX pilot study (published in Paediatr Anaesth 2019;29:59-67) established infusion rates higher than those initially proposed. This could be attributed to an inappropriate target concentration for sedation or incorrect initial pharmacokinetic parameter estimates. ⋯ This current PK analysis from the Italian arm of the TREX study confirms that plasma concentration of dexmedetomidine is predictable using known covariates such as age and size. The initial target concentration (0.6 μg.L-1 ) used to sedate children cared for in the intensive care after cardiac surgery was inadequate for infants in the current TREX study. A target concentration 1 mcg.L-1 , corresponding to a loading dose of 1 mcg.kg-1 followed by an infusion of 1 mcg.kg-1 .hour-1 , provided adequate sedation.
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Paediatric anaesthesia · Nov 2022
ReviewMaking quality improvement data more accessible and understandable: analyst, designer, and storyteller.
Making data more accessible and understandable in quality improvement requires a diversity of approaches beyond formal teaching in technical skills of measurement. Improvement practitioners might co-opt the wider skillset of analyst, designer, and storyteller in tailoring the team strategy needed to make best use of the data used to inform decision-making at the point of care. Data literacy levels, negative prior experiences, or limited access to technology might influence the ability of teams to engage in measurement. ⋯ Thoughtful data visualization takes account of the inherent perceptual challenges of comprehending data and complex images. Establishing a routine of simplification-removing redundant elements and distractions-and amplifying aspects that aid understanding can bring clarity to the important concepts within a chart. Story-telling techniques can help wider audiences engage with data by carefully shaping analytical and emotional content around a central narrative-always mindful of the limitations of working memory, and the emotional momentum needed to inspire change.
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Paediatric anaesthesia · Nov 2022
ReviewPositive approaches to safety: Learning from what we do well.
Historical and current methodologies in patient safety are based on a deficit-based model, defining safety as the absence of harm. This model is aligned with the human innate negativity bias and the general philosophy of health care: to diagnose and cure illness and to relieve suffering. While this approach has underpinned measurable progress in healthcare outcomes, a common narrative in the healthcare literature indicates that this progress is stalling or slowing. ⋯ More overtly positive approaches are available, specifically focusing on success-both outstanding success and everyday success-including exnovation, appreciative inquiry, learning from excellence and positive deviance. These approaches are not mutually exclusive. The new methods described in this article are not intended as replacements of the current methods, rather they are presented as complementary tools, designed to allow the reader to take a balanced and holistic view of patient safety.
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Paediatric anaesthesia · Nov 2022
ReviewQuality Improvement and Patient Safety in India - Present and Future.
India is a vast, populous and diverse country, and this reflects in the state of health care as well. The spectrum of healthcare services ranges from world class at one end, to a dearth of resources at the other. ⋯ Training medical personnel and healthcare workers, accreditation of healthcare facilities, guidelines, and checklists, along with documentation and audit of practices will all help in improving services. This narrative review discusses the measures that have been taken, systems that have been established and the challenges involved in ensuring quality and patient safety in India.