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Imti Choonara

Publications and source records attributed to Imti Choonara.

15 recordsLinked to original sources
PubMed2006

Consensus guidelines on sedation and analgesia in critically ill children.

OBJECTIVE: The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient. DESIGN: A modified Delphi technique was used to allow the Working Group to anonymously consider draft recommendations in three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences. Once consensus had been reached, a systematic review of the available literature was carried out. OUTCOME: A set of consensus guidelines was produced including 20 key recommendations, 10 relating to the provision of analgesia and 10 relating to the sedation of critically ill children. An evaluation of the existing literature supporting these recommendations is provided. CONCLUSIONS: Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.

Analgesia↗
PubMed2005

Validating the Derbyshire Children's Hospital Pain Tool in children aged 6-12 years.

The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the post-operative clinical area. It is applicable across the spectrum of age groups that present for paediatric surgery. The DPC assesses pain by utilizing three parameters: facial expression, verbal (i.e. self-report) and body movement. This exploratory study was undertaken to determine its reliability and validity in children aged 6-12 years. The research nurse assessed 60 children aged 6-12 years undergoing minor and intermediate surgery and compared the DPC against the validated Oucher Scale. Assessments were performed preoperatively and for four hours post-operatively. Any analgesia administered post-operatively was recorded, and its effects noted. This study supports construct validity and inter-rater reliability of the DPC pain assessment tool for children aged 6-12 undergoing minor and intermediate surgery.

Child↗
PubMed2004

Drug toxicity in the neonate.

The incidence of adverse drug reactions in neonates is thought to be at least 10%. The physiology of the newborn infant is different to that of both paediatric patients and adults. This therefore predisposes to certain types of drug toxicity, which are described below. Medication errors are also a significant problem in the neonatal period due to the lack of appropriate formulations designed for neonates.

Aniline Compounds↗
PubMed2004

Training in paediatric clinical pharmacology in the UK.

AIMS: To produce a training programme in paediatric clinical pharmacology. METHODS: A working group, consisting of clinical pharmacologists (paediatric and adult), general paediatricians and the pharmaceutical industry was established to produce the training programme. RESULTS: Following a two year training programme in general paediatrics, a three year training programme in clinical pharmacology has been established. This includes one year of research in clinical pharmacology (paediatric or adult). The other two years involve training in different aspects of paediatric clinical pharmacology and general paediatrics. CONCLUSION: The existence of a formal training programme should result in a significant increase in the number of paediatric clinical pharmacologists.

Child↗
PubMed2004

Unlicensed and off-label drug use in children: implications for safety.

Throughout the world, many drugs prescribed for children are used in an off-label or unlicensed manner. The incidence of unlicensed and off-label drug prescriptions appears to be greatest in critically ill neonates and children and lowest in the general population. The risk associated with unlicensed and off-label drug use appears to be greater than for prescribing in accordance with the product licence. Health professionals, however, usually have no alternative but to use unlicensed and off-label medicines. More clinical trials for medicines in children are required to provide the evidence base for safe and effective drug prescribing.

Child↗
PubMed2003

Sedation and neuromuscular blockade in paediatric intensive care: a review of current practice in the UK.

BACKGROUND: Our aim was to investigate the current practice of sedation and neuromuscular blockade in critically ill children in paediatric intensive care units (PICUs) in the UK. METHODS: A postal questionnaire was sent to all PICUs in the UK. RESULTS: The most commonly used sedative agents were midazolam in combination with morphine. Written clinical guidelines for the sedation of critically ill children were available in 45% of units. Sedation is formally assessed in 40% of units. Vecuronium is the most commonly used neuromuscular blocking agent. In the UK, 31% of critically ill children are likely to receive neuromuscular blocking agents. Depth of neuromuscular blockade is routinely assessed in 16% of patients. CONCLUSIONS: Relatively few units possess clinical guidelines for the sedation of critically ill children, and only a minority formally assess sedation levels. Where neuromuscular blocking agents are administered, sedation is frequently inadequately assessed and the depth of neuromuscular blockade is rarely estimated.

Child↗
PubMed2003

Validating the Derbyshire Children's Hospital Pain Tool: a pilot study.

BACKGROUND: The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the clinical area, and it is applicable for use in children of all ages within the postoperative setting. The pain assessment chart encompasses pain assessment by utilizing facial expression, body movement and verbal expression. An exploratory study was performed to define its reliability and validity. METHODS: The research nurse (V.P.) assessed 40 children aged 1-5 undergoing minor and intermediate surgery comparing the Toddler Preschooler Postoperative Pain Scale and the DPC. Assessments were performed preoperatively and for 4 h postoperatively. Any analgesia administered postoperatively was recorded. RESULTS: All the children scored 0 preoperatively with both pain scales, thus demonstrating known groups validity. There were 116 dual assessments by the research nurse using both pain scales. There was a strong correlation (r = 0.89) demonstrating convergent validity. There was a significant correlation between 182 joint assessments by the research nurse (V.P.) and the nursing staff using the DPC (Spearmans rank correlation, 0.81) and the Cronbach alpha coefficient ranged from 0.83 to 0.98. Construct validity was demonstrated by a fall in the mean pain scores from 1.8 to 0.1 following analgesia in 19 children. CONCLUSIONS: This exploratory study suggests the DPC holds construct, convergent and known groups validity and is a reliable pain assessment tool for children aged 1-5 years undergoing minor and intermediate surgery.

Child, Preschool↗
PubMed2003

Age and sex of drivers associated with child pedestrian injuries.

In 2002 there were 237 road traffic collisions (RTCs) involving a child pedestrian in Derbyshire. Complete details were available for 200 RTCs. There was a significantly lower proportion of female drivers (34.5%) than expected according to the number of female drivers registered nationally (43%). Similarly, there was a greater proportion of drivers under the age of 40 years involved in RTCs with children as pedestrians (58.5%) than anticipated (42.1%). Drivers between the ages of 17-20 and 31-40 years were significantly more likely to be involved in an RTC with a child as a pedestrian. Male drivers and drivers under the age of 40 years are more likely to be involved in RTCs with children as pedestrians. Educational publicity campaigns to reduce driver speeds in urban areas need to be targeted at those drivers most likely to be involved in an RTC with a child.

Accidents, Traffic↗
PubMed2002

Further development of the Liverpool Infant Distress Scale.

The Liverpool Infant Distress Scale (LIDS) was initially designed to assess behaviours reflecting pain in neonates following surgery. This paper reports a further development of the validity and reliability of LIDS and its use as a measure of neonatal behaviour. In the first stage of validity testing the LIDS scores of infants prior to administration of analgesia were compared to LIDS scores postanalgesia. Significantly lower scores were recorded following analgesia. The second stage of validity testing compared LIDS scores of a control group of neonates with those undergoing surgery, each over 43 hours. A significantly lower score on LIDS was found for the control group of infants compared to the surgical group, providing support for validity. Internal consistency was high, providing support for reliability. By providing detailed description of neonatal behaviours LIDS may assist nurses in the identification and objective quantification of neonatal behaviour, the context of which will govern intervention. The efficacy of such interventions may also be measured using LIDS.

Female↗
PubMed2002

Unlicensed and off-label drug use in children: implications for safety.

A significant number of children receive either an unlicensed or an off-label drug during their stay in hospital. Studies throughout Europe have shown that at least one-third of children in hospital and up to 90% of neonates in a neonatal intensive care unit receive such drug prescriptions. The medicines that are most frequently used off-label include analgesics, antibiotics and bronchodilators. The purpose of licensing a drug is to ensure safety, efficacy and quality. If a drug is used in a different manner, one would expect a greater risk of toxicity. Only three studies have commented on the risk of toxicity in relation to unlicensed or off-label drug use. Only one of these three studies prospectively tried to evaluate the risk associated with off-label and unlicensed drug prescription. This study suggested that the percentage of unlicensed and off-label drug use was significantly associated with the risk of an adverse drug reaction. Two studies looking at adverse drug reactions suggest that there is a greater risk of a severe adverse drug reaction occurring in association with the off-label or unlicensed use of drugs. One study found that five out of eight severe adverse drug reactions were associated with the off-label use of a medicine. The other study found that 14 of 19 drug prescriptions associated with 17 severe adverse drug reactions were either unlicensed or off-label. The risk of prescribing off-label and unlicensed drugs in children is not clear from the limited data available.

Child↗
PubMedDate not supplied

Cuban doctors.

Explore the source record for details and available documents.

Africa, Southern↗
PubMedDate not supplied

Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial.

BACKGROUND: Rectal diazepam and buccal midazolam are used for emergency treatment of acute febrile and afebrile (epileptic) seizures in children. We aimed to compare the safety and efficacy of these drugs. METHODS: A multicentre, randomised controlled trial was undertaken to compare buccal midazolam with rectal diazepam for emergency-room treatment of children aged 6 months and older presenting to hospital with active seizures and without intravenous access. The dose varied according to age from 2.5 to 10 mg. The primary endpoint was therapeutic success: cessation of seizures within 10 min and for at least 1 hour, without respiratory depression requiring intervention. Analysis was per protocol. FINDINGS: Consent was obtained for 219 separate episodes involving 177 patients, who had a median age of 3 years (IQR 1-5) at initial episode. Therapeutic success was 56% (61 of 109) for buccal midazolam and 27% (30 of 110) for rectal diazepam (percentage difference 29%, 95% CI 16-41). Analysing only initial episodes revealed a similar result. The rate of respiratory depression did not differ between groups. When centre, age, known diagnosis of epilepsy, use of antiepileptic drugs, prior treatment, and length of seizure before treatment were adjusted for with logistic regression, buccal midazolam was more effective than rectal diazepam. INTERPRETATION: Buccal midazolam was more effective than rectal diazepam for children presenting to hospital with acute seizures and was not associated with an increased incidence of respiratory depression.

Acute Disease↗
PubMedDate not supplied

[A complete clinical trial register is already a reality in the paediatric field].

Clinical trials have a fundamental role in promoting an evidence based use of drugs in adults and in children. However, it is often difficult to identify the few paediatric studies carried out and to thus implement knowledge derived from them. Furthermore, studies that are stopped prematurely or that have insignificant or negative results often remain unpublished, leading to duplication of effort by researchers, waste of resources and concealment of potentially toxic risks. The European Community decided to support the development of a European register of clinical trials in children as part of the Fifth Framework Thematic Programme "Quality of Life" in 2002. The project DEC-net is coordinated by the Laboratory of Mother and Child Health of the Mario Negri Institute for Pharmaceutical Research in Milan and currently involves members of four countries; France, Italy, Spain and the United Kingdom. It is unique in that it is the first population oriented clinical trial register. Such a register represents a useful source for planning new studies, promoting communications and collaborations between researchers, facilitating patient access and recruitment into trials, preventing trial duplication and inappropriate funding and identifying the therapeutic needs of children that remain neglected. It will also allow for active monitoring of new or evolved knowledge of drug therapies.

Child↗