The Emergency Medicine Education and Research by Global Experts (EMERGE) Network: Challenges and Lessons Learned.

INTRODUCTION: The Emergency Medicine Education and Research by Global Experts (EMERGE) network was formed to generate and translate evidence to improve global emergency care. We share the challenges faced and lessons learned in establishing a global research network. METHODS: We describe the challenges encountered when EMERGE proposed the development of a global emergency department (ED) visit registry. The proposed registry was to be a six-month, retrospective, deidentified, minimal dataset of routinely collected variables, such as patient demographics, diagnosis, and disposition. RESULTS: Obtaining reliable, accurate, and pertinent data from participating EDs is challenging in a global context. Barriers experienced ranged from variable taxonomies, need for language translation, varying site processes for curation and transfer of deidentified data, navigating institution- and country-specific data protection regulations, and substantial variation in each participating institution's research infrastructure including training in research-related activities. We have overcome many of these challenges by creating detailed data-sharing agreements with bilateral regulatory oversight agreements between EMERGE and participating EDs, developing relationships with and training health informaticians at each site to ensure secure transfer of deidentified data, and formalizing an electronic transfer process ensuring data privacy. CONCLUSION: We believe that networks like EMERGE are integral to providing the necessary platforms for education, training, and research collaborations for emergency care. We identified substantial challenges in data sharing and variation in local sites' research infrastructure and propose potential approaches to address these challenges.

Acute severe paediatric asthma: study protocol for the development of a core outcome set, a Pediatric Emergency Reserarch Networks (PERN) study.

BACKGROUND: Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency condition. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct clinical trials, so that valid comparisons can be made between future studies. We have formed an international working group comprising paediatricians and emergency physicians from North America, Europe, Asia, the Middle East, Africa, South America, Central America, Australasia and the United Kingdom. METHODS/DESIGN: A 5-stage approach will be used: (1) a comprehensive list of outcomes relevant to stakeholders will be compiled through systematic reviews and qualitative interviews with patients, families, and clinicians; (2) Delphi methodology will be applied to reduce the comprehensive list to a core outcome set; (3) we will review current clinical practice guidelines, existing clinical trials, and literature on bedside assessment of asthma severity. We will then identify practice differences in tne clinical assessment of asthma severity, and determine whether further prospective work is needed to achieve agreement on inclusion criteria for clinical trials in acute paediatric asthma in the emergency department (ED) setting; (4) a retrospective chart review in Australia and New Zealand will identify the incidence of serious clinical complications such as intubation, ICU admission, and death in children hospitalized with acute severe asthma. Understanding the incidence of such outcomes will allow us to understand how common (and therefore how feasible) particular outcomes are in asthma in the ED setting; and finally (5) a meeting of the Pediatric Emergency Research Networks (PERN) asthma working group will be held, with invitation of other clinicians interested in acute asthma research, and patients/families. The group will be asked to achieve consensus on a core set of outcomes and to make recommendations for the conduct of clinical trials in acute severe asthma. If this is not possible, the group will agree on a series of prioritized steps to achieve this aim. DISCUSSION: The development of an international consensus on core outcomes is an important first step towards the development of consensus guidelines and standardised protocols for randomized controlled trials (RCTs) in this population. This will enable us to better interpret and compare future studies, reduce risks of study heterogeneity and outcome reporting bias, and improve the evidence base for the management of this important condition.

Principales motivos de consulta en niños de 0 a6 años del área del Rincón de Salas y Puente de Piedra de Grecia en el año del 2003 / Main reasons for consultation in children of 0 to 6 years of the area of the Rincón de Salas and Puente de Piedra of Grecia in 2003

Objetivo: En el año 2003 en el periodo de enero a diciembre, en el EBAIS (Equipo Básico de Atención Integral de Salud) de Puente de Piedra y Rincón de Salas de Grecia, las IVRS (Infecciones Vías Respiratorias Superiores) de origen viral fueron la primera causa de consulta. La mayoría de estas infecciones son causadas por virus y los niños pueden mejorar sin necesidad de utilizar los servicios médicos. Los padres de familia tienen conceptos erróneos acerca de sus causas, factores de riesgo y tratamiento, lo cual produce consultas médicas inncesarias. El objetivo de este estudio es determinar los principales motivos de consulta en niños de 0-6 años y conocer los conceptos que tienen los padres de familia acerca la IVRS. Metodología: Se trata de un estudio de tipo descriptivo donde se evaluaron los conocimientos de los padrs de familia acerca de las IVRS de origen viral. Se determinaron además los principales motivos de consulta de niños de 0-6 años y los factores que inciden en el aumento de la frecuencia de estas enfermedades. En el área de atracción de los EBAIS de Puente Piedra y Rincón de Salas habitan aproximadamente 391 niños entre los 0-6 años. Se seleccionó una muestra significativa aleatorizada de aproximadamente el 40 por ciento de esta población correspondiente a 170 niños. Sus familias contestaron en forma individualizada un cuestionario cuyos resultados fueron posteriormente analizadas con el programa informático Epi-Info 6. Resultados: De los 170 pacientes del estudio, 93 eran niños y 77 niñas, cuyas edades oscilaron entre el mes de nacido hasta los seis años de edad. La nacionalidad de la mayoría de los niños es costarricense y el 8.2 por ciento nicaragüense. Consultaron en 461 ocasiones al EBAIS. El primer motivo de consulta fue la gripe con 186 consultas, faringitis estreptocococcica en segundo lugar con 88 visitas y en tercer lugar el asma con 61. Los padres de familia afirman que las cuasas de la gripe son el clima (109), los virus (91) y las bacterias (25). El 78 por ciento consideraron necesario siempre o a veces el uso de los antibióticos para el tratamiento de la gripe. El 50 por ciento afirmó que las infecciones virales deben tratarse con antibióticos. Conclusiones: Los principales motivos de consulta fueron la gripe, la faringitis y el asma. Además el estudio reveló que los padres de familia conocen acerca de las causas de la gripe; sin embargo, tienen una idea equivocada sobre su tratamiento...