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Donovan P, O'Connor P. The confidence and competence of primary school staff to administer an adrenaline auto-injector. Eur J Pediatr 2024:10.1007/s00431-024-05562-y. [PMID: 38609653 DOI: 10.1007/s00431-024-05562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
School teachers are often inadequately prepared to use an adrenaline auto-injector (AAI), resulting in potentially dangerous treatment delays. The purpose of this study was to assess the observed competence, and self-reported confidence, of primary school teachers in the Republic of Ireland (RoI) to use an AAI. An evaluation of whether there was a link between confidence and competence was also assessed. Teachers from four primary schools in the RoI completed a questionnaire to assess their prior level of experience, training, and confidence levels with AAI administration. The four steps in administrating trainer AAI to a mannequin simulator were then assessed. A total of 61 teachers participated (out of a population of 80). The mean self-reported confidence was 1.82 out of 5 (SD = 0.96). There was no significant difference in confidence between trained and untrained participants (U = 240.5, NS). Participants who had received AAI administration training performed significantly more of the steps correctly (mean = 3.85, SD = 0.95) as compared to those who had received no training (mean = 2.97, SD = 1.10; U = 180.5, p = 0.008). There was no correlation between confidence in administrating AAI and the percentage of steps in the procedure performed correctly (rho = -0.17, NS). Conclusion: Improvements in readiness to administer AAIs can be achieved through the application of more effective approaches to teaching clinical skills, changes to school policies and practices, and consideration of the design of AAIs in order to make their operation safer and simpler. It is important that teachers have the confidence and competence to safely administer an AAI. What is Known: • Poor ability in adrenaline auto-injector use seen across population groups-healthcare professionals, patients, carers, and school staff • Training in the use of adrenaline auto-injectors has positive impact on competency What is New: • Irish school teachers show poor levels of competency in adrenaline auto-injector use • No observed correlation between reported confidence and competency.
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Affiliation(s)
- P Donovan
- School of Medicine, University of Galway, Galway, Ireland
| | - P O'Connor
- School of Medicine, University of Galway, Galway, Ireland.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Eisenhofer S, Neininger MP, Bertsche A, Kiess W, Bertsche T, Kapellen TM. Assessing Parental Competence and Self-Ratings in Management of Pediatric Type 1 Diabetes and Emergency Glucagon Administration-An Exploratory Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1319. [PMID: 37628318 PMCID: PMC10453678 DOI: 10.3390/children10081319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Parents of pediatric patients with type I diabetes require competence in hypoglycemia management and skills in glucagon administration to deal with potentially life-threatening severe hypoglycemia. We aimed to compare parents' subjective self-ratings to an objective expert assessment of competences and skills in dealing with severe hypoglycemia. METHODS We interviewed 140 participants to assess their subjective self-ratings. The objective expert assessments used a standardized clinical case scenario of severe hypoglycemia and a practical demonstration of glucagon administration. RESULTS The participants self-rated their competence in hypoglycemia management as good (5) or very good (6), and their skills in administering glucagon as acceptable (3) [Scale: very poor (1) to very good (6)]. In the standardized clinical case scenario, 1.4% (2/140) of participants named all relevant steps of severe hypoglycemia management. In the practical demonstration of glucagon administration, 92.9% (130/140) of participants committed at least one drug handling error; 52.1% (73/140) committed at least one drug handling error rated with high clinical risk. CONCLUSIONS We found discrepancies regarding participants' subjective self-ratings compared to their performance in the respective objective expert assessments. These discrepancies indicate a lack of error awareness and the need for intervention studies to improve competence in hypoglycemia management and glucagon administration.
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Affiliation(s)
- Simone Eisenhofer
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany; (S.E.); (M.P.N.)
| | - Martina P. Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany; (S.E.); (M.P.N.)
| | - Astrid Bertsche
- Department of Pediatric Neurology, University Medicine Greifswald, Fleischmannstraße 6, 17489 Greifswald, Germany;
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 23, 04103 Leipzig, Germany; (W.K.); (T.M.K.)
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 23, 04103 Leipzig, Germany; (W.K.); (T.M.K.)
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany; (S.E.); (M.P.N.)
| | - Thomas M. Kapellen
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 23, 04103 Leipzig, Germany; (W.K.); (T.M.K.)
- MEDIAN Kinderklinik am Nicolausholz Hospital for Children and Adolescents, Elly-Kutscher-Straße 16, 06628 Naumburg (Saale), Germany
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Santos MJL, Merrill KA, Ben-Shoshan M, Gerdts JD, Giesbrecht D, Lavine E, Prentice S, Upton J, Protudjer JLP. Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1175. [PMID: 37508672 PMCID: PMC10377763 DOI: 10.3390/children10071175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Anaphylaxis has occurred in preschools/schools yet there are no consistent food allergy (FA) management practices in early learning and childcare centres (ELCC) across jurisdictions. Presently, there are no reviews that have synthesized FA-related knowledge and management practices within ELCC. We aimed to perform a scoping review of FA management in ELCC, and report on perceived gaps or barriers. A PRISMA-ScR-guided search was conducted for North American, European and Australian articles in English/French in the OVID-MedLine, Scopus, and PsycInfo databases. Two independent reviewers screened the titles/abstracts of 2010 articles and full-text screened 77 articles; 15 of which were specifically related to ELCC. If the two reviewers could not agree to the relevance of a given study, a third reviewer provided guidance. This third reviewer also screened French articles. Thematic and descriptive reports of the studies were presented. We reported solely on pre-Coronavirus Disease pandemic ELCC studies. We included ten articles in this review, which provide evidence that ELCC staff have variable baseline knowledge, comprehension, experience, and practices in place to manage FA. ELCC staff also have limited FA-related training and experience regarding administration of epinephrine auto-injectors (EAI). Emergency Anaphylaxis Plans (EAP) were described in four studies. One study reported the parental influence on the site's food purchasing and FA management. Three studies provided educational interventions, which demonstrated increased and sustained FA-related knowledge and confidence post-intervention. Participants deemed the training beneficial and desired annual training and more FA resources to be available. Across jurisdictions, ELCC staff have provided care and administered EAI in emergencies, but training remained variable. Communication and care planning amongst ELCC staff, and parents, is crucial. Annual education, available EAI and EAPs are tools necessary for effectively managing emergencies.
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Affiliation(s)
- Mae Jhelene L Santos
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Kaitlyn A Merrill
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Biochemistry, Faculty of Science, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | | | - Don Giesbrecht
- Canadian Child Care Federation, Ottawa, ON K1G 0Y9, Canada
| | - Elana Lavine
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada
- Vaughn Pediatric Clinic, Woodbridge, Vaughan, ON L4L 8E2, Canada
| | - Susan Prentice
- Department of Sociology, Faculty of Arts, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Julia Upton
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jennifer L P Protudjer
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB R3E 0T6, Canada
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Yıldırım A, Haney MO. Effects of training on teachers' food allergy and anaphylaxis management self-efficacy levels. Allergol Immunopathol (Madr) 2023; 51:158-163. [PMID: 37422793 DOI: 10.15586/aei.v51i4.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Children are affected by food allergies more than adults, so teachers have the most significant responsibility for food allergy management in schools. OBJECTIVE To determine the effect of food allergies and anaphylaxis management training on Turkish teachers' self-efficacy. MATERIAL AND METHODS In this study, 90 teachers were selected using convenience sampling. Data were collected before and immediately after the training on School Personnel's Self-Efficacy in Managing Food Allergy and Anaphylaxis at School Scale. A training program that consisted of 60-minute sessions was conducted. Data were evaluated using the paired samples t-test. RESULTS There was a significant difference between the teachers' self-efficacy levels before (22.76±8.94) and after the training (32.81±6.09), and self-efficacy levels significantly increased (p < .05). CONCLUSIONS The training increased the teachers' self-efficacy in managing food allergies and anaphylaxis.
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Affiliation(s)
- Atiye Yıldırım
- Instute of Health Science, Dokuz Eylul University, Izmir, Turkey;
| | - Meryem Ozturk Haney
- Public Health Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
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Meyran D, Cassan P, Nemeth M, Singletary E, Raitt J, Djarv T, Carlson JN. The Ability of First Aid Providers to Recognize Anaphylaxis: A Scoping Review. Cureus 2023; 15:e41547. [PMID: 37554608 PMCID: PMC10404915 DOI: 10.7759/cureus.41547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
Early recognition of anaphylaxis is critical to early treatment and often occurs in the first aid setting. However, the ability of first aid providers to recognize anaphylaxis is unknown. We sought to examine the evidence regarding first aid providers' ability to recognize anaphylaxis. Our scoping review was performed as part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation processes to update the 2020 ILCOR Consensus on Science with Treatment Recommendations. We searched Medline, Embase, Cochrane, and the gray literature from 2010 to September 2022. The population included adults and children experiencing anaphylaxis with a description of any specific symptom to a first aid provider. Recognition of anaphylaxis was the primary outcome. Two investigators (DM and PC) reviewed abstracts and extracted and assessed the data. Discrepancies between the reviewers were resolved by discussion and consensus with the ILCOR First Aid Task Force. Out of 957 hits, 17 studies met inclusion criteria: one review and meta-analysis, two experimental studies, and 14 observational studies. We did not identify any studies that directly addressed our PICOST (Population, Intervention, Control, Outcomes, Study Design, and Timeframe) as none were performed in the first aid setting. Articles included individuals who may be first aid providers as patients and parents (n=5), teachers, students or school staff (n=8), caregivers and patients (n= 2) or nannies (n=1). All included studies were conducted in high-income countries. Our scoping review found that signs and symptoms of anaphylaxis were not specific and did not allow for easy identification by the first aid provider. Studies focused on education (n=10) and protocols (n=2) and found that both could have a positive impact on anaphylaxis recognition and management. While we did not identify any clinical studies that directly addressed the ability of first aid providers to identify anaphylaxis, future studies examining education methods and action plans may help improve the identification of anaphylaxis by first aid providers.
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Affiliation(s)
- Daniel Meyran
- Healthcare, French Red Cross, Paris, FRA
- Prehospital Emergency Care, Bataillon De Marins Pompiers De Marseille, Marseille, FRA
| | - Pascal Cassan
- Prehospital Emergency Care, International Federation of Red Cross and Red Crescent Societies (IFRC) Global Reference First Aid Reference Center, French Red Cross, Paris, FRA
| | - Michael Nemeth
- Prehospital Care, International Liaison Committee on Resuscitation, Toronto, CAN
| | | | - James Raitt
- Emergency Medicine, Thames Valley Air Ambulance, Oxford, GBR
| | - Therese Djarv
- Emergency Medicine, Karolinska Institute, Stockholm, SWE
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Ziyar A, Kwon J, Li A, Naderi A, Jean T. Improving epinephrine autoinjector usability and carriage frequency among patients at risk of anaphylaxis: a quality improvement initiative. BMJ Open Qual 2022; 11:bmjoq-2021-001742. [PMID: 36150740 PMCID: PMC9511578 DOI: 10.1136/bmjoq-2021-001742] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022] Open
Abstract
Although epinephrine autoinjectors (EAIs) are crucial for the management of anaphylaxis, patient carriage frequency of EAI is as low as 57% and usage of EAIs is erroneous 35%–43% of the time. Our objective was to improve patient carrying frequency of EAI and understanding of EAI usage. We implemented a quality improvement initiative using consistent closed-loop education, redesigned clinic workflow, electronic medical record reminder-based interventions, and educational materials to improve patient EAI carriage compliance and understanding of EAI indications and proper technique. The percentage of our patients who carried the EAI at all times increased from 55% to 93% in 6 months. Participants knowledge of EAI indications also improved from 22% to 91%. Patient demonstration scores of the EAI device improved from 21% to 91% as well. Our quality improvement interventions demonstrated a significant improvement>80% in EAI carriage frequency, knowledge of indications, and proper device technique.
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Affiliation(s)
- Ahdad Ziyar
- Division of Basic and Clinical Immunology, University of California Irvine, Irvine, California, USA
| | - Jimmy Kwon
- Department of Statistics, University of California Irvine, Irvine, California, USA
| | - Arthur Li
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Asal Naderi
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, University of California Irvine, Irvine, California, USA
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Vollmer RL, Girsch V, Foster JS. A Qualitative Investigation of Parent and Child Perceptions of School Food Allergy Policies in the United States. THE JOURNAL OF SCHOOL HEALTH 2022; 92:185-193. [PMID: 34806178 DOI: 10.1111/josh.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many schools implement well-intentioned food allergy policies; however, may not ease parents'/children's worry and concern. The purpose of this study was to (1) explore children's and parents' perceptions their school's food allergy policy and (2) compare these perceptions to the documented school policy. METHODS Children ages 8 to 18 with a food allergy and their parents (N = 18 pairs) across the US completed one-on-one semi-structured, audio-recorded phone interviews. School food allergy policies were collected from school websites. Content analysis was applied to the transcriptions by two investigators to identify themes among parents and children. RESULTS Parents and children described policies may impact the child's social and/or emotional well-being. Many opportunities for improvement were provided by parents and children. There is a wide variation in food allergy policies across the schools in this study, and overall, parents and children thought that policy enforcement needs to be improved. CONCLUSIONS With so much variation in food allergy policies in schools coupled with inconsistent enforcement, parents and children may feel unsafe or unsupported by the school. Schools should adopt a team- or whole-school approach to develop and enforce policies that help protect children with food allergies.
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Affiliation(s)
- Rachel L Vollmer
- Bradley University, 1501 West Bradley Avenue, Peoria, IL, 61625, USA
| | - Virginia Girsch
- Bradley University, 1501 West Bradley Avenue, Peoria, IL, 61625, USA
| | - Jaime S Foster
- Yale-Griffin Prevention Research Center, 130 Division Street, Derby, CT, 06418, USA
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10
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Park JS, Kim JK, Kwon JW. Anaphylaxis-related interventional demand and the response status of pediatric and youth educational institutions in Gangwon-do Province, South Korea: A school nurse and childcare teacher survey. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jin-Sung Park
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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11
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Raptis G, Totterdell R, Gerasimidis K, Michaelis LJ, Perez-Botella M. School allergy training promotes internal policy review and enhances staff's preparedness in managing pupils with food allergy. Clin Transl Allergy 2021; 11:e12042. [PMID: 34435756 PMCID: PMC8451729 DOI: 10.1002/clt2.12042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 01/20/2023] Open
Abstract
Background Recently non‐statutory allergy management guidance for schools has been produced in the United Kingdom; however, there has been limited progress in implementing this. The aim of this study was to evaluate the effect of face‐to‐face training on self‐reported school staff preparedness in managing the severely allergic child and whether it would stimulate schools' allergy policy review. Methods A preparedness survey was conducted prior and 2 months post‐intervention to assess the effect of training on self‐reported preparedness and perceived confidence to manage children with food allergies. Results A sample of 18 primary schools that consented to participate were selected. Of the trained schools, 89% of the head teachers felt confident in dealing with an allergy emergency compared to 39% prior training (p = 0.016). Post‐intervention all but one had arranged/were considering introducing allergy awareness sessions to help pupils manage their allergies (45% pre‐training vs. post‐training 93%, p = 0.003). Preventative measures for accidental exposure to food allergens (i.e., no food sharing policy) were adopted by all (pre‐training 61% vs. post‐training 100%, p = 0.03). Conclusion A face‐to‐face school allergy training programme enhances self‐reported staff preparedness and promotes internal allergy policy review in managing the needs of these children, hence addressing the current gap between recommendations and practice in schools.
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Affiliation(s)
- George Raptis
- Department of Paediatric Allergy and Immunology, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rebecca Totterdell
- Department of Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Konstantinos Gerasimidis
- Department of Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Louise Jane Michaelis
- Department of Immunology, Infectious Disease & Allergy, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Mercedes Perez-Botella
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Waserman S, Cruickshank H, Hildebrand KJ, Mack D, Bantock L, Bingemann T, Chu DK, Cuello-Garcia C, Ebisawa M, Fahmy D, Fleischer DM, Galloway L, Gartrell G, Greenhawt M, Hamilton N, Hourihane J, Langlois M, Loh R, Muraro A, Rosenfield L, Schoessler S, Tang MLK, Weitzner B, Wang J, Brozek JL. Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines. J Allergy Clin Immunol 2021; 147:1561-1578. [PMID: 33965093 DOI: 10.1016/j.jaci.2021.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022]
Abstract
Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.
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Affiliation(s)
- Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kyla J Hildebrand
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Mack
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Bantock
- Department of Primary Medical Services, Sun Peaks Community Health Centre, Sun Peaks, British Columbia, Canada
| | - Theresa Bingemann
- Department of Allergy and Immunology, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, University of Rochester, Rochester, NY
| | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Cuello-Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Quality in Health Care Residency Program, Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - David Fahmy
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David M Fleischer
- Department of Pediatrics-Allergy/Immunology, University of Colorado School of Medicine, Aurora, Colo; Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Lisa Galloway
- School District No. 73, Kamloops, British Columbia, Canada
| | - Greg Gartrell
- School District No. 73, Kamloops, British Columbia, Canada
| | - Matthew Greenhawt
- Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Nicola Hamilton
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Langlois
- District School Board of Niagara, St Catharines, Ontario, Canada
| | - Richard Loh
- Department of Immunology, Princess Margaret Hospital for Children, Subiaco, Australia
| | | | - Lana Rosenfield
- Section of Allergy and Clinical Immunology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mimi L K Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Brenda Weitzner
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Wang
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jan L Brozek
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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13
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Emerging Therapies in Anaphylaxis: Alternatives to Intramuscular Administration of Epinephrine. Curr Allergy Asthma Rep 2021; 21:18. [PMID: 33666759 DOI: 10.1007/s11882-021-00994-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Anaphylaxis is a severe, life-threatening, systemic allergic reaction that should be recognized and treated promptly. Intramuscular (IM) epinephrine is the first-line treatment for anaphylaxis and there are no absolute contraindications to its use. Despite its established track record of efficacy and safety, physicians and patients face barriers in the recognition and treatment of anaphylaxis, including the maintenance and appropriate use of epinephrine auto-injectors. This has led to investigation into potential alternatives to IM epinephrine administration in anaphylaxis. RECENT FINDINGS This review investigates the current standard of care in the treatment of anaphylaxis, barriers to IM epinephrine use, and alternative therapies under investigation for administration in anaphylaxis. Alternative routes under investigation include intranasal, sublingual, inhaled, and needle-free intramuscular administration of epinephrine. There are currently numerous investigational alternatives to IM epinephrine therapy which could hold promise as future effective treatments in the emergent management of anaphylaxis.
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Miles LM, Ratnarajah K, Gabrielli S, Abrams EM, Protudjer JLP, Bégin P, Chan ES, Upton J, Waserman S, Watson W, Gerdts J, Ben-Shoshan M. Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2321-2333. [PMID: 33549844 DOI: 10.1016/j.jaip.2021.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. OBJECTIVES A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis. METHODS Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis. RESULTS Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P = .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine. CONCLUSION The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.
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Affiliation(s)
- Laura May Miles
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
| | - Kayadri Ratnarajah
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Philippe Bégin
- Division of Clinical Immunology and Allergy, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Wade Watson
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, ON, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
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15
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Kadivec S, Košnik M. The Ability to Use Epinephrine Autoinjector in Patients Who Receive Prescription Immediately after Anaphylaxis. Int Arch Allergy Immunol 2021; 182:625-630. [PMID: 33486490 DOI: 10.1159/000513421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epinephrine autoinjector (EAI) is prescribed to prevent a fatal outcome in the case of a repeated anaphylactic reactions. We wanted to determine how adult patients who received their first prescription as part of an urgent treatment of an anaphylactic reaction or at their family physician were instructed on the use of EAI. METHODS Nurses assessing patients' knowledge asked the patient to demonstrate how to use the EAI training device. Patients who performed the critical steps correctly in 1 min were labelled as competent. RESULTS Forty-one patients (24% women, 46 ± 5 years) came for the allergy examination 116 ± 145 days after receiving a prescription for EAI. When prescribing, the doctor or nurse explained the instructions for the use of EAI to 63.4% patients, and 31.7 patients practiced the use of EAI using a training device. At the pharmacy, 22% received explanation and 7% also practiced using a training device. Fifty-four percent of patients were able to effectively administer EAI adrenaline within 1 min. Higher education level was associated with sufficient knowledge about the use of EAI (p = 0.026). At the time of the visit to the allergy specialist clinic, 61% of patients had EAI with them. The shelf life of EAI was known to 63% of patients. CONCLUSIONS The activities to increase the prescription rate of EAI immediately after treatment of anaphylactic episode are not sufficient to prevent severe outcome after the repeated episodes of anaphylaxis as nearly a half of patients are not able to use EAI correctly.
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Affiliation(s)
- Saša Kadivec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia, .,Medical Faculty Ljubljana, Ljubljana, Slovenia,
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16
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Rodríguez Ferran L, Gómez Tornero N, Cortés Álvarez N, Thorndike Piedra F. Anaphylaxis at school. Are we prepared? Could we improve? Allergol Immunopathol (Madr) 2020; 48:384-389. [PMID: 32061426 DOI: 10.1016/j.aller.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Food allergy is a highly prevalent disorder. Anaphylaxis is the most serious consequence, and reactions often occur in schools. In the event of anaphylactic reaction prompt treatment is key and should be initiated by school personnel. The aim of this study was to assess the level of knowledge of the management of anaphylaxis, and to determine if it improves after a training session among school staff. MATERIALS AND METHODS Descriptive study carried out by means of a pre-and post-training questionnaire completed by participants before and after a training session held at the school. Data from the same participants before and after the educational session were compared using McNemar's test. RESULTS Three schools were enrolled (with a total of 38 children with food allergy) and 53 participants (85% teachers, 15% canteen staff) were trained. In the pre-training surveys, 83% said they had a Student's Allergic Reaction Management Plan, 56% had met with parents, 83% recognised some symptoms of allergic reaction but only 41% recognised anaphylaxis, 16% knew when to use adrenaline, 15% knew how to use it and 19% knew how to act after administering it. In the post-training questionnaires, 100% were satisfied and believed they had improved their knowledge, 93% recognised anaphylaxis and 95% the treatment of choice. CONCLUSIONS Prior to the intervention their knowledge was insufficient, but it improved considerably after simple training. It also increased the confidence of the staff, which will be decisive when responding to an anaphylactic reaction. We believe that a compulsory training programme should be implemented universally in all schools.
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Nieto-Eugenio I, Ventura-Puertos PE, Rich-Ruiz M. S.O.S! My Child is at School: A Hermeneutic of the Experience of Living a Chronic Disease in the School Environment. J Pediatr Nurs 2020; 53:e171-e178. [PMID: 32334897 DOI: 10.1016/j.pedn.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of the present study is to understand the experience of living a chronic disease in the school, from the perspective of the parents. DESIGN AND METHODS A Grounded Theory study was proposed with a sample of 14 affected families with children between three and eleven years old, all of them from the west and south of Spain. Information was collected using semi-structured surveys and the constant comparative method was used for the analysis. RESULTS Results are divided into three main themes: SOS! My child is at school, The Systems (don't) Answer and Families Answer. Parents live school enrolment in a state of constant alertness, characterized by distrust, worry, fear, anguish, and indignation. The responses to the problem given by the education and health systems are insufficient, uncoordinated and inefficient. Therefore, parents end up not expecting anything, they transmit the information, organize training sessions, and solve any occurring incident by themselves, often at the expense of quitting their jobs. CONCLUSION The presence of a school nurse would mean for these parents the integration between the education and health systems. PRACTICE IMPLICATIONS As findings highlight, more collaboration and sensitivity between the healthcare and educational system is needed, and the school nurse has been indicated as a crucial figure in this matter.
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Affiliation(s)
- Irene Nieto-Eugenio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain..
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain
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18
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Muraro A, Mendoza Hernandez DA. Managing food allergy and anaphylaxis: A new model for an integrated approach. Allergol Int 2020; 69:19-27. [PMID: 31759890 DOI: 10.1016/j.alit.2019.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022] Open
Abstract
There is an increasing public concern on food allergy and related anaphylactic reactions that occur mainly at the community level. The perception of the disease is huge among parents who believe that 1 out of 20 children suffers from severe food allergy. The discrepancy between this self-reported prevalence and the real one when a food challenge is performed, points out the gap in the implementation of guidelines for clinical practice. Health professionals as well show scarce adherence to the guidelines both at the Emergency Departments and at the primary care level. Anaphylactic reaction are not recognized, adrenaline is under-used and self-injectable devices are not prescribed. Although education and training are limited to local, spontaneous initiatives from patient's organization and few allergists, the data so far available demonstrate that improvement in knowledge and attitudes can be achieved further to a structured program. There is the need to establish good evidence -based practices for educational intervention that should be adopted in the context of public health policies for food allergy. This would imply a change in legislation in many countries to prevent prosecution for liability of lay people administering adrenaline when properly trained. In parallel an integrated clinical care pathway should be developed by multidisciplinary and multi-professional teams in the context of national Centres of Excellence -CoE. These CoE could drive the progression to digital health create, creating networks of CoE for best practices of care and for clinical trials.
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Cho H, Kim SH, Lee JH, Kim BS, Lee J, Kim JK, Park JS, Kwon JW. Awareness of anaphylaxis among community and emergency responders in Korea. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.3.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyunseok Cho
- Department of Hospital Medicine, Kangwon University Hospital, Chuncheon, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin-Sung Park
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Raptis G, Perez-Botella M, Totterdell R, Gerasimidis K, Michaelis LJ. A survey of school's preparedness for managing anaphylaxis in pupils with food allergy. Eur J Pediatr 2020; 179:1537-1545. [PMID: 32249360 PMCID: PMC7479013 DOI: 10.1007/s00431-020-03645-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022]
Abstract
Allergic diseases are on the increase and can affect the child's well-being. The aim of this survey was to assess regional schools' preparedness in dealing with anaphylaxis following the publication of national and international guidelines for schools in 2014. The survey was developed in 2015 and distributed to schools in Cumbria, North West England, UK between 2015 and 2016. Only 47% of the respondents (95% CI, 39-57%) felt confident to manage anaphylaxis. Schools without allergic pupils were significantly less likely to have a standard management protocol in place for emergencies compared to those with allergic pupils (p < 0.001). The majority of the schools indicated that further training was needed (81% (95% CI, 74-88%).Conclusion: At the time of the survey, schools' preparedness in the region, did not meet safety standards recommended by national and international organisations. Although schools have shown eagerness in accessing training in the management of anaphylaxis, tailored training for schools is not yet widely available. There is now an urgent need to design feasible training strategies that create a safe environment for allergic pupils across all UK schools. What is Known: • One quarter of the severe allergic reactions take place for the first time while at school with some of them being fatal. • School staff is ill-prepared in the management of anaphylaxis. Access to formal training is not widely available. What is New: • School staff remains unconfident in managing the severe allergic child. Training in the management of anaphylaxis is scarce, and when available, it does not offer the required depth to cover the holistic needs of allergic pupils. • Schools would welcome generic adrenaline autoinjectors and a national policy with central funding which would describe step by step the necessary measures for the management of anaphylaxis.
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Affiliation(s)
- George Raptis
- Department of Infectious Diseases, Immunology & Allergy, Royal Hospital for Children, Queen Elizabeth Hospital, Glasgow, UK.
| | | | - Rebecca Totterdell
- grid.8756.c0000 0001 2193 314XSchool of Medicine, Dentistry & Nursing, Human Nutrition, University of Glasgow, Glasgow, UK
| | - Konstantinos Gerasimidis
- grid.8756.c0000 0001 2193 314XSchool of Medicine, Dentistry & Nursing, Human Nutrition, University of Glasgow, Glasgow, UK
| | - Louise J. Michaelis
- grid.459561.a0000 0004 4904 7256Department of Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle, UK
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Ozturk Haney M, Ozbıcakcı S, Karadağ G. Turkish teachers' self-efficacy to manage food allergy and anaphylaxis: A psychometric testing study. Allergol Immunopathol (Madr) 2019; 47:558-563. [PMID: 31174852 DOI: 10.1016/j.aller.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Food allergy in school children ranges between 5.7 and 6.4% in Turkey. Studies emphasize the importance of improving school personnel's self-efficacy in managing food allergy and anaphylaxis. However, a brief and valid measurement tool for school personnel is not available in Turkey. The aim of this study was to determine the validity and reliability of the Turkish version of the School Personnel's Self-efficacy in Managing Food Allergy and Anaphylaxis (SPSMFAA-T) scale with teachers. PATIENTS OR MATERIALS AND METHODS This methodological study was conducted by 282 primary school teachers. Data were collected with a demographic characteristics form and SPSMFAA-T. The psychometric properties of the SPSMFAA-T were evaluated by content, discriminant, construct validity and internal consistency. RESULTS Cronbach's alpha for the scale was 0.91 and item-total correlations were between 0.50 and 0.82 (p<0.001). The discriminant validity suggested that the scale successfully discriminated the teachers who had training on food allergy and anaphylaxis from the teachers who did not. The model fit indices of scale were determined to be the root mean square error of approximation (RMSEA) at 0.08, goodness of fit index (GFI) at 0.96, comparative fit index (CFI) at 0.99. CONCLUSIONS The results supported that the SPSMFAA-T was a valid and reliable measurement tool to assess Turkish teachers' self-efficacy levels to manage food allergy and anaphylaxis in school setting. The scale can be used in education programs to improve school personnel's skills to manage food allergy and anaphylaxis.
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Alsuhaibani MA, Alharbi S, Alonazy S, Almozeri M, Almutairi M, Alaqeel A. Saudi teachers' confidence and attitude about their role in anaphylaxis management. J Family Med Prim Care 2019; 8:2975-2982. [PMID: 31681678 PMCID: PMC6820410 DOI: 10.4103/jfmpc.jfmpc_562_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background and Aims Anaphylaxis is a common emergency and life-threatening hypersensitivity reaction defined as a rapid generalized allergic reaction. Prior international studies have shown that school personnel is often not familiar with the signs of hypersensitivity or with appropriate management strategies that should be initiated at school for children with an anaphylactic reaction. Moreover, no studies have evaluated the awareness of anaphylaxis by school teachers in Saudi Arabia. The aim of this study was to determine teachers' knowledge, attitudes, and practices toward anaphylaxis in Al-Qassim, Saudi Arabia. Methods This was a cross-sectional study conducted at a public school in Al-Qassim, Saudi Arabia via a validated fourteen items questionnaire aimed to survey teacher knowledge, attitudes, and practices toward anaphylaxis. The questionnaires were disseminated using a multistage random sampling technique to Saudi national's teachers from different regions in Al-Qassim. Results Most teachers had a low level of knowledge (85.3%) of anaphylaxis and positive attitudes (72.9%), and the level of practice was reported as low (48.9%) to moderate (47.5%). The most common sources of information regarding anaphylaxis were the internet and social media. When considering significant factors associated with knowledge, attitudes, and practices (KAP), we found that sex, years of experience in teaching and witnessing students suffering from anaphylaxis were all positively associated with KAP. Conclusion The overall knowledge and practices of teachers regarding anaphylactic reactions were poor, although teachers' attitudes toward learning this information were positive. Thus, teachers need further education regarding the management of allergic reaction.
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Affiliation(s)
| | - Salman Alharbi
- Medical Intern, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Salman Alonazy
- Medical Intern, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Marwa Almozeri
- Medical Intern, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Malak Almutairi
- Medical Intern, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Aqeel Alaqeel
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
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Abstract
PURPOSE OF REVIEW The aim of this review is to describe effective management strategies in nursery or school based upon research findings. RECENT FINDINGS The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. SUMMARY A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families.
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Vale S, Netting MJ, Ford LS, Tyquin B, McWilliam V, Campbell DE. Anaphylaxis management in Australian schools: Review of guidelines and adrenaline autoinjector use. J Paediatr Child Health 2019; 55:143-151. [PMID: 30523652 DOI: 10.1111/jpc.14307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022]
Abstract
Food allergy and anaphylaxis is increasing in Australian children, and anaphylaxis is relatively common in Australian schools. This review aims to provide an overview of current policies and practices for anaphylaxis management in Australian schools, including approaches to risk mitigation and anaphylaxis training. We reviewed literature related to anaphylaxis training in the school setting published between 2010 and 2018. Current anaphylaxis policies/guidelines were obtained from Australian education and health departments, and reports of suspected anaphylaxis and adrenaline autoinjector (AAI) use for 2016-2017 were obtained from education departments where available. Our review of policies/guidelines across Australian jurisdictions indicates inconsistent approaches to anaphylaxis management training. Almost half of Australian school anaphylaxis events required a general-use AAI, administered to students not identified as at risk of anaphylaxis. Development of clear, evidence-based, consistent guidelines related to anaphylaxis management and training in the school setting is imperative to minimise risk.
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Affiliation(s)
- Sandra Vale
- National Allergy Strategy, Sydney, New South Wales, Australia.,Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Merryn J Netting
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia.,Healthy Mothers Babies and Children's Theme, South Australian Health Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Nutrition Department, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Lara S Ford
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia.,Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Briony Tyquin
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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