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Adverse drug reaction active surveillance: developing a national network in Canada's children's hospitals.

https://arctichealth.org/en/permalink/ahliterature150480
Source
Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):713-21
Publication Type
Article
Date
Aug-2009
Author
Bc Carleton
Rl Poole
Ma Smith
Js Leeder
R. Ghannadan
Cjd Ross
Ms Phillips
Mr Hayden
Author Affiliation
Pharmaceutical Outcomes Programme, Children's and Women's Health Centre of British Columbia, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. bcarleton@popi.ubc.ca
Source
Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):713-21
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems - organization & administration
Analgesics, Opioid - poisoning
Anthracyclines - adverse effects
Antibiotics, Antineoplastic - adverse effects
Breast Feeding
Canada - epidemiology
Case-Control Studies
Child
Child Health Services - organization & administration
Child, Preschool
Cisplatin - adverse effects
Codeine - poisoning
Drug Overdose - genetics - mortality
Female
Genetic markers
Hearing Loss - chemically induced
Heart Diseases - chemically induced
Hospitals, Pediatric - organization & administration
Humans
Infant
Infant, Newborn
National health programs - organization & administration
Pharmacogenetics
Program Development
Time Factors
Abstract
Adverse drug reactions (ADRs) rank as the fifth leading cause of death in the western world. The nature and scope of these ADRs in children are not predictable based on post market surveillance reports that rely heavily on adult drug experience. The genotype-specific approaches to therapy in childhood (GATC) national ADR network was established to identify specific ADRs and to improve drug safety through identification of predictive genomic biomarkers of drug risk.
GATC set out to establish a national network of trained surveillance clinicians in pediatric hospitals across Canada. Surveillance clinicians identified, enrolled, and collected clinical data and biological samples from ADR cases and controls. Surveillance was targeted to three ADRs: anthracycline-induced cardiotoxicity, cisplatin-induced hearing impairment, and codeine-induced mortality in breastfed infants.
The initial surveillance site was established in September 2005, with 10 sites fully operational by 2008. In 3 years, GATC enrolled 1836 ADR cases and 13188 controls. Target numbers were achieved for anthracycline-induced cardiotoxicity. Modified target numbers were nearly attained for cisplatin-induced hearing impairment. Codeine-induced infant mortality in a breastfed infant was discovered by GATC investigators. A case-control study was subsequently conducted.
GATC has demonstrated a model of active and targeted surveillance that builds an important step toward the goal of personalized medicine for children. Effective communication, site-specific solutions and long-term sustainability across the network are critical to maintain participation and productivity. GATC may provide a framework of ADR surveillance that can be adapted by other countries and healthcare systems.
PubMed ID
19507171 View in PubMed
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An implementation strategy for a multicenter pediatric rapid response system in Ontario.

https://arctichealth.org/en/permalink/ahliterature142720
Source
Jt Comm J Qual Patient Saf. 2010 Jun;36(6):271-80, 241
Publication Type
Article
Date
Jun-2010
Author
Anna-Theresa Lobos
Jonathan Costello
Jonathan Gilleland
Rose Gaiteiro
Afrothite Kotsakis
Author Affiliation
Children's Hospital of Eastern Ontario, Department of Pediatrics, Division of Critical Care Medicine. alobos@cheo.on.ca
Source
Jt Comm J Qual Patient Saf. 2010 Jun;36(6):271-80, 241
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Child
Critical Care - methods - organization & administration
Hospital Rapid Response Team - organization & administration
Hospital Shared Services - organization & administration
Hospitals, Pediatric - organization & administration
Humans
Interdisciplinary Communication
Ontario
Program Development - methods
Safety Management - organization & administration - standards
Social Marketing
Abstract
A rapid response system using a medical emergency team was implemented across four pediatric hospitals in Ontario, Canada, in a social marketing approach.
Notes
Comment In: Jt Comm J Qual Patient Saf. 2010 Jun;36(6):263-5, 24120564887
PubMed ID
20564889 View in PubMed
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Assessment of variation in the Alberta Context Tool: the contribution of unit level contextual factors and specialty in Canadian pediatric acute care settings.

https://arctichealth.org/en/permalink/ahliterature130754
Source
BMC Health Serv Res. 2011;11:251
Publication Type
Article
Date
2011
Author
Carole A Estabrooks
Janet E Squires
Alison M Hutchinson
Shannon Scott
Greta G Cummings
Sung Hyun Kang
William K Midodzi
Bonnie Stevens
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Canada. carole.estabrooks@ualberta.ca
Source
BMC Health Serv Res. 2011;11:251
Date
2011
Language
English
Publication Type
Article
Keywords
Alberta
Canada
Clinical Competence
Cross-Sectional Studies
Diffusion of Innovation
Female
Hospitals, Pediatric - organization & administration
Humans
Male
Nursing Assessment - organization & administration
Organizational Culture
Pediatrics - instrumentation - organization & administration
Quality Control
Reproducibility of Results
Risk factors
Abstract
There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify variables that significantly contribute to between-unit variation for each of the 10 concepts.
859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT's ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1). In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care) to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3).
The null model (unadjusted baseline HLM model) established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units). When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the contribution of specialty to between-unit variation enabled us to explain more variance (1.19% to 16.73%) in 6 of the 10 ACT concepts. Finally, when we assessed the unique contribution of the unit level variables available to us, we were able to explain additional variance (15.91% to 73.25%) in 7 of the 10 ACT concepts.
The findings reported here represent the third published argument for validity of the ACT and adds to the evidence supporting its use to discriminate patient care units by all 10 contextual factors. We found evidence of relationships between a variety of individual and unit-level variables that explained much of this between-unit variation for each of the 10 ACT concepts. Future research will include examination of the relationships between the ACT's contextual factors and research utilization by nurses and ultimately the relationships between context, research utilization, and outcomes for patients.
Notes
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PubMed ID
21970404 View in PubMed
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102 records – page 1 of 11.