Feasibility and Efficacy of Ambulance-Based mhealth for Pediatric Emergencies (FEAMER) Trial

基于救护车的儿科紧急医疗 (FEAMER) 试验的可行性和有效性

• 批准号: 10574477
• 负责人: Junaid Abdul Razzak
• 金额: $ 18.14万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-16 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10574477
• 关键词: Accident and Emergency department; Acute; Address; Adult; Aman; Ambulances; Authorization documentation; Caring; Cessation of life; Child; Child Care; Childhood; Clinical; Clinical Trials; Cluster randomized trial; Communication; Community Consents; Conduct Clinical Trials; Consent; Consultations; Country; Data; Devices; Diarrhea; Disclosure; Educational workshop; Emergency Care; Emergency Department Physician; Emergency Situation; Emergency medical service; Equipment; Ethics; Feasibility Studies; Focus Groups; Foundations; Guidelines; Health; Health Personnel; Health Technology; Health care facility; Hospitals; Hour; Income; Injury; Intervention; Interview; Joints; Legal; Life; Link; Malaria; Measurable; Measures; Medical; Medical emergency; Meningitis; Modeling; Modernization; Outcome; Pakistan; Paramedical Personnel; Parents; Patient-Focused Outcomes; Phase; Physicians; Play; Pneumonia; Pre-hospital setting; Process; Qualitative Research; Randomized, Controlled Trials; Research; Research Design; Research Ethics; Research Project Grants; Resource-limited setting; Role; Safety; Services; System; Telemedicine; Time; Training; Transportation; Trauma patient; Triage; Universities; Work; acceptability and feasibility; acute care; authority; care systems; cluster randomized design; efficacy testing; efficacy trial; experience; improved; low and middle-income countries; mHealth; pediatric emergency; phase III trial; prospective; randomized, clinical trials; sound; stroke patient; teleconsultation; treatment arm; trial design; usability

Project Summary Of the 16000 children who die every day, 7000 die because of five acute illnesses – pneumonia, diarrhea, injuries, meningitis, and malaria – largely in in low- and middle-income countries (LMICs). Appropriate and timely acute and emergency care of these children can reduce such deaths by about half. Modern emergency care systems provide care through a “chain of survival” consisting of on-scene care, emergency medical services (EMS) for transportation, and hospital emergency departments. Care and triage decisions by healthcare providers during transportation play a critical role in the eventual outcome of patients from many acute illnesses and are, therefore, considered an essential service in most high-income countries (HICs). EMS with well-trained staff, especially in the care of an acutely ill child, is rarely found in LMICs. There is a critical need – globally, but particularly in LMICs – for solutions that address the expertise/experience gap during the most critical minutes and hours of a child's transport to a fixed emergency care facility. Such solutions can contribute to potentially saving thousands of children every year. Currently, no information exists to prove the feasibility and utility of mobile health technology to guide care during transport of acutely ill children. The purpose of the study is first to assess the feasibility of implementing an ambulance-based teleconsultation (ABT) process (R21) and, if feasible, carry out a clinical trial to confirm the efficacy of the approach on the short-term clinical outcomes (R33) in Karachi, Pakistan. Our specific aims are SA1: To assess the acceptability of ABT for the emergency care of acutely ill children. SA2: To determine the feasibility of carrying out a pilot cluster-randomized trial on the impact of ABT on the Pediatric Early Warning Score (PEWS). SA3: To determine the feasibility of carrying out a cluster- randomized trial on the impact of ABT on the Pediatric Early Warning Score (PEWS). If found feasible, we will conduct an efficacy trial with the following R33 specific aims: Specific Aim 4: To test the efficacy of ABT by measuring a change in the PEWS of acutely ill children from the scene of injury/illness to the pediatric emergency department (PEM) using a cluster-randomized design Specific Aim 5: To develop the capacity of local partners in m-health research capacity.

项目概要 每天有 16000 名儿童死亡，其中 7000 人死于五种急性疾病——肺炎、腹泻、 伤害、脑膜炎和疟疾——主要发生在低收入和中等收入国家（LMIC）。 对这些儿童进行及时的急症和紧急护理可以将此类死亡人数减少约一半。 护理系统通过由现场护理、紧急医疗服务组成的“生存链”提供护理 (EMS) 用于交通和医院急诊部门的护理和分类决策。 运输过程中的提供者对于许多急性患者的最终结果起着至关重要的作用 特快专递与 中低收入国家很少有训练有素的工作人员，尤其是在照顾重病儿童方面。 – 在全球范围内，特别是在中低收入国家 – 寻求解决最困难时期专业知识/经验差距的解决方案 此类解决方案可以在将儿童运送到固定紧急护理机构的关键时刻和小时内。 每年可能拯救数千名儿童，目前尚无信息证明这一点。 移动医疗技术指导急症儿童转运期间护理的可行性和实用性。 该研究的目的首先是评估实施基于救护车的远程会诊的可行性 （ABT）过程（R21），如果可行，进行临床试验以确认该方法对 巴基斯坦卡拉奇的短期临床结果（R33）。 我们的具体目标是 SA1：评估 ABT 对于急症紧急护理的可接受性 SA2：确定针对儿童的影响进行试点整群随机试验的可行性。 关于儿科早期预警评分 (PEWS) 的 ABT：确定开展集群的可行性。 关于 ABT 对儿科早期预警评分 (PEWS) 影响的随机试验 如果可行，我们将进行。 进行具有以下 R33 具体目标的功效试验： 具体目标 4：通过以下方式测试 ABT 的功效： 测量急症儿童从受伤/患病现场到儿科的 PEWS 变化 急诊科 (PEM) 采用整群随机设计 具体目标 5：培养以下人员的能力： 移动医疗研究能力方面的当地合作伙伴。