In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. The TRansfusion and TReatment of severe Anaemia in African Children: (TRACT ISRCTN84086586) is a 3x2x2 factorial controlled trial involving 3954 children (aged 2m to 12y) with severe anaemia (haemoglobin <6g/dl). The trial has been designed to address the poor outcomes following SA in children in sub-Saharan Africa, which is associated with high rates of in-hospital mortality (9-10%), 6-month case fatality (12%) and relapse or re-hospitalisation (6%) indicating that the current recommendations and/or management strategies are not working in practice. Hospitalised children will be enrolled at 4 centres in 2 countries (Malawi, Uganda) and followed for 6 months. TRACT trial is designed to answer 4 simple questions. Q1 and 2: which children should receive a transfusion (since current guidelines recommend transfusions only in children with a Hb <4g/dl (or <6g/dl if accompanied by complications)); and how volume to transfuse in each transfusion event?. Q3 and 4: Since the major factors related to poor longer term outcome are micronutrient deficiencies and sepsis would post-discharge multi-vitamin multi-mineral supplementation versus routine care (folate and iron) for 3 months and/or cotrimoxazole prophylaxis for 3 months versus no prophylaxis improve outcome and prevent relapse. Primary outcome is cumulative mortality to 4 weeks for the transfusion strategy comparisons, and to 6 months for the nutritional support/antibiotic prophylaxis comparisons. If confirmed by the trial, a cheap and widely available ‘bundle’ of effective interventions could lead to, if widely implemented, substantial reductions in mortality in African children hospitalised with severe anaemia every year. The trial started in Sept 2014 and currently 2700 children have been enrolled. We expect the trial results to be available in 2017.
Should we Transfuse the Sick Child in Africa?
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Why we need palliative care everywhere
Ka, , 2016, The Talks smaccDUB 2016, emergency medicine, End of life, Palliative Care, palliative medicine, quality of life, 0
Exploring dogma and myths about knowledge, skills and training of the 'resuscitationist'.
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It is time to throw away the hard cervical collar – PRO: Darren Braude, CON: Karim Brohi
Phoebe Adams, , 2016, The Talks smaccDUB 2016, Cervical spine immobilization, controversy, debate, SMACCDub, spinal motion restriciton, spinal protection, Trauma, 0
Darren Braude and Karim Brohi battle it out in the #SMACCDub Cage Match ‘It is time to throw away...
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Hospital Handover of Major Trauma – Make them Listen
Phoebe Adams, , 2016, The Talks smaccDUB 2016, Ambulance, emergency, Handover, Paramedic, Patient handover, SMACCDub, Trauma, 0
Describing the importance of patient handover and the critical time when the pre-hospital practitioner will give this information to...
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Does the Early Bird Catch the Worm?: How to be truly “awake” during a shift
Phoebe Adams, , 2016, The Talks smaccDUB 2016, Fatigue, shift work, SMACCDub, warm up, 0
Is there a specific time during our shift when we are too fatigued to safety practice? That was the...
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Geriatric EM: Our new USP?
Ka, , 2015, 2016, The Talks smaccChicago 2015, The Talks smaccDUB 2016, elderly emergency care, elderly falls, emergency care, frailty, Geriatrics, 0
This talk will outline the importance and significance for the specialty in getting to grips with managing elderly patients...
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Kettlebells for the Brain
Ka, , 2016, The Talks smaccDUB 2016, brain, Meditation, scott weingart, 1
My opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation.
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How Resuscitation Works
Ka, , 2016, The Talks smaccDUB 2016, chest compression, Resuscitation theory, 0
This talk uses a case study approach to discuss the need for technical accuracy in resuscitation practice.
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1984. Dystopian Literature and Emergency Medicine
Ka, , The Talks smaccDUB 2016, Bureaucracy, Climate change, Dystopia, Futurism, literature, 0
The role of physical and chemical restraints, neuroleptics, benzodiazepines, and ketamine, and the diagnostic and therapeutic priorities for the...