Browsing by Author "Ware, Robert S"
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- ItemThe effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.(2014-11-10) Armfield, Nigel R; Coulthard, Mark G; Slater, Anthony; McEniery, Julie; Elcock, Mark; Ware, Robert S; Scuffham, Paul A; Bensink, Mark E; Smith, Anthony CBackgroundIn many health systems specialist services for critically ill children are typically regionalised or centralised Studies have shown that high risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality In acute cases where distance and time impede access to specialist care clinical advice may be provided remotely by telephone Emergency retrieval services attended by medical and nursing staff may be used to transport patients to specialist centres Even with the best quality retrieval services stabilisation of the patient and transport logistics may delay evacuation to definitive care Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children However no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval Methods DesignThe study is a pragmatic multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit We aim to recruit 160 children for whom a specialist retrieval consultation is required The primary outcome measure is stabilisation time time spent on site at the referring hospital by the retrieval team adjusted for initial risk Secondary outcome measures are change in patient s physiological status repeated measure two time points scored using the Children s Emergency Warning Tool change in diagnosis repeated measure taken at three time points change in destination of retrieved patients at the tertiary hospital general ward or paediatric intensive care unit retrieval decision and length of stay in the Paediatric Intensive Care Unit for retrieved patients The trial has been approved by the Human Research Ethics Committees of Children s Health Services Queensland and The University of Queensland Australia DiscussionHealth services are adopting telemedicine however formal evidence to support its use in paediatric acute care is limited Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000156886
- ItemEfficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures: study protocol for a randomized controlled trial.(2013-01-14) Brown, Nadia J; Rodger, Sylvia; Ware, Robert S; Kimble, Roy M; Cuttle, LeilaBACKGROUND The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature Non pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia An example is virtual reality which has been used effectively to dampen pain intensity and unpleasantness Possible links or causal relationships between pain anxiety stress and burn wound healing have previously not been investigated The purpose of this study is to investigate these relationships specifically by determining if a newly developed multi modal procedural preparation and distraction device Ditto used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re epithelialization METHODS DESIGN Children 4 to 12 years with acute burn injuries presenting for their first dressing change will be randomly assigned to either the 1 Control group standard distraction or 2 Ditto intervention group receiving Ditto procedural preparation and Ditto distraction It is intended that a minimum of 29 participants will be recruited for each treatment group Repeated measures of pain intensity anxiety stress and healing will be taken at every dressing change until complete wound re epithelialization Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto intervention as well as its effect on speed of wound re epithelialization DISCUSSION Results of this study will provide data on whether the disease process can be altered by reducing stress pain and anxiety in the context of acute burn wounds TRIAL REGISTRATION ACTRN12611000913976
- ItemPlay and heal: randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns.(2014-02-10) Brown, Nadia J; Kimble, Roy M; Rodger, Sylvia; Ware, Robert S; Cuttle, LeilaThe relationships between pain stress and anxiety and their effect on burn wound re epithelialization have not been well explored to date The aim of this study was to investigate the effect of the Ditto a hand held electronic medical device providing procedural preparation and distraction intervention on re epithelialization rates in acute pediatric burns