Objective: Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.
Design: Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.
Setting: Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI).
Main Outcome Measures: Describe practice and variation in discharge advice, treatment recommendations and safety netting provision.
Results: Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) 'nearly always' assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided 'fixed' bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).
Conclusions: There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
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http://dx.doi.org/10.1136/archdischild-2023-326247 | DOI Listing |
JAC Antimicrob Resist
December 2024
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Background: The ARON study, a randomized controlled trial, assesses a behavioural intervention incorporating clinically guided C-reactive protein (CRP) point-of-care testing and a parental information booklet to reduce inappropriate antibiotic prescriptions for acutely ill children in Belgian primary care.
Objectives: To explore GP and parent views and experiences regarding the ARON trial intervention.
Methods: We conducted a qualitative embedded process evaluation in Belgian general practice.
Sensors (Basel)
November 2024
College of Science and Technology Ningbo University, Ningbo 315300, China.
In the realm of marine aquaculture, the netting of cages frequently accumulates marine fouling, which impedes water circulation and poses safety hazards. Traditional manual cleaning methods are marked by inefficiency, high labor demands, substantial costs, and considerable environmental degradation. This paper initially presents the current utilization of net-cleaning robots in the cleaning, underwater inspection, and monitoring of aquaculture cages, highlighting their benefits in enhancing operational efficiency and minimizing costs.
View Article and Find Full Text PDFBr Paramed J
December 2024
South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-5664-3329.
Introduction: UK ambulance services employ diverse models of care, resulting in 40-60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60 years and over) remain high (60-70%), despite most being mild. This research aimed to explore ambulance clinicians' perceptions, experiences and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions.
View Article and Find Full Text PDFAust J Gen Pract
December 2024
MBBS, FRACGP, Grad Cert HPE, Senior Research Fellow, Murray City Country Coast GP Training, Carlton, Vic.
Background: The management of uncertainty is a core general practice skill best learnt in clinical practice.
Objective: This article outlines strategies a general practice supervisor can implement to help registrars acquire the skills of managing and coping with uncertainty.
Discussion: The medical education literature recommends supervisors being explicit about the different paradigm operating in primary care and normalising the existence and tolerance of uncertainty.
Food Res Int
November 2024
Institute of Quality Standards and Testing Technology for Agro-Products, Chinese Academy of Agricultural Sciences, Beijing 10081, China; Key Laboratory of Agri-food Quality and Safety, Ministry of Agriculture and Rural Affairs, Beijing 10081, China. Electronic address:
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