There is a great need for paediatric palliative care (PPC) services globally, but access to services is lacking in many parts of the world, particularly in resource-poor settings. Globally it is estimated that 21.6 million children need access to palliative care, with 8.2 needing specialist services. PC has been identified as important within the global health agenda e.g., within universal health coverage, and a recent Lancet commission report recognised the need for PPC. However, a variety of challenges have been identified to PPC development globally such as: access to treatment, access to medications such as oral morphine, opiophobia, a lack of trained health and social care professionals, a lack of PPC policies and a lack of awareness about PPC. These challenges can be overcome utilising a variety of strategies including advocacy and public awareness, education, access to medications, implementation and research. Examples will be discussed impacting on the provision of PPC in resource-poor settings. High-quality PPC service provision can be provided with resource-poor settings, and there is an urgent need to scale up affordable, accessible, and quality PPC services globally to ensure that all children needing palliative care can access it.
The International Children’s Palliative Care Network held its second international conference on children’s palliative care in Buenos Aires, Argentina, from the 18th–21st May 2016. The theme of the conference was ‘Children’s Palliative Care…. Now!’ emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children’s palliative care, and hidden aspects of children’s palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children’s palliative care, genetics, perinatal and neonatal palliative care, the impact of children’s palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children’s palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The ‘Big Debate’ explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children’s palliative care and participants were continually challenged to ensure that children can access palliative care NOW.
Antimicrobial resistance is a growing global health concern that warrants attention and immediate action. [1] Since their introduction, antimicrobial agents have effectively decreased morbidity and mortality caused by infectious diseases. Regrettably, their inappropriate and irrational use has led to an increased risk of adverse drug effects and the development of antimicrobial resistance, which renders some antimicrobials ineffective. [2,3] Moreover, a discrepancy in diagnostic procedures vital to correctly identifying different pathogens aggravates the situation. [2] Since healthcare settings are associated with the highest emergence and spread of antimicrobial resistance, [4] the Infectious Diseases Society of America [5] published guidelines recommending that all hospitals develop institutional programmes to enhance antimicrobial stewardship and hence curb the growing threat of antimicrobial resistance. Subsequently, policies and evidence-based interventions, such as antimicrobial stewardship programmes (ASPs), have been drafted and implemented in various healthcare institutions worldwide. [6,7] Antimicrobial stewardship (AMS) refers to a collection of strategies and tools to improve clinical outcomes and use of antimicrobials, whereby selection of the optimal regimen, dose, duration and route of administration is promoted. [8] AMS programmes are considered an important strategy in the fight against antimicrobial resistance. [8] Dyar et al. [9] define AMS as a coherent set of actions that promote using antimicrobials in a way that ensures sustainable access to effective therapy for all who need it. Establishing the impact of an implemented ASP in a healthcare facility is important to inform decisions about the future of the programme, whether it needs scaling up or not. [10] From evidence, impact evaluation studies conducted on the effectiveness of the ASP are often limited to individual impact rather than the assessment of both individual and organisational impact. [11][12][13][14] Furthermore, comprehensive impact evaluation of health interventions depends on the effectiveness of the programme/intervention, its reach in the population, and the extent to which it is properly implemented. [15] Applying the RE-AIM framework [16] makes it possible to comprehensively explore five different impact dimensions that affect the ASP: (i) reach for assessing the target population accomplished; (ii) effectiveness, i.e. measuring the patient outcomes resulting from the programme; (iii) adoption, i.e. measuring the number of target settings participating in the study and staff who are responsible for the management of the programme in the facility; (iv) implementation, i.e. consistency and cost of delivery; and (v) maintenance of the intervention's positive effects over time. [16] The RE-AIM framework is useful for determining which interventions work in real-world settings and assesses impact at individual and organisational levels. [17] Although there is evidence of the effectiveness of ASPs in the This open-access arti...
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