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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The main goal of intensive medicine professionals is to provide appropriate and timely care to patients&#44; especially in the field of paediatrics&#44; where patients have their whole lives ahead of them&#46; To provide quality care to restore health and return the patient to a long and high-quality life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; despite significant advances in research&#8212;there are endless publications&#8212;there is a considerable gap between the evidence obtained in clinical research&#44; which demonstrates the benefits of new therapeutic interventions &#40;pharmacological treatment or life support techniques&#41; and the actual impact in patient outcomes of the implementation of these interventions in everyday clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This gap needs to be addressed&#44; and as health care professionals we must strive to translate the highest-quality evidence from clinical research to the care provided at the bedside of critically ill children and adolescents&#46; We must give this issue the importance it actually has&#44; and use any available technical and organisational resources&#44; our knowledge and the methods at our disposal to ensure the translation of the results of the highest-level clinical research to everyday practice in paediatric intensive care&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the past few years&#44; there have been important advances in paediatric intensive medicine&#44; both in diagnostic and monitoring methods and in treatment&#46; Advances in less invasive multiparametric monitoring techniques &#40;pulse oximetry&#44; bispectral index and tissue oximetry&#44; among others&#41; are particularly important for the paediatric patient&#46; The introduction of ultrasound has been a qualitative leap in terms of diagnostic speed and patient safety both in the short term &#40;effectiveness and safety in placement of vascular access devices&#41; and the long term &#40;reduced exposure to ionising radiation&#41;&#46; Mechanical ventilation is administered through ventilators that are accurate enough to adapt to the needs of the youngest patients&#44; and techniques such as continuous veno-venous haemofiltration can be used appropriately in this subpopulation thanks to the availability of suitable monitoring devices&#44; filters and catheters&#46; The widespread use of non-invasive ventilation in children made possible by the combination of the increased sophistication of ventilators&#44; on one hand&#44; and the development of suitable face masks&#44; on the other&#44; has also transformed paediatric intensive care&#46; Last of all&#44; we should highlight the opportunities and the concerns&#44; especially of an ethical nature&#44; that the use of extracorporeal life support systems&#44; such as extracorporeal membrane oxygenation&#44; bring to our everyday practice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The appropriate use of all the resources available to professionals to provide the best possible care to critical patients requires new frameworks and new roles<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> based on teamwork and effective communication and leadership&#46; Making the necessary changes in the practice of intensive medicine can be facilitated by the development of strategies that help target and align efforts made in that direction&#46; One example is the use of random real-time patient safety auditing as a tool to address and prevent errors of omission&#44; especially those that keep patients from receiving care in adherence to evidence-based recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Another contribution that has brought us one step further towards this new framework is the introduction of clinical information systems&#44; which allow the collection&#44; integration and storage of patient care data for a safer and more effective management&#46; A skilled analysis of health care records can show how well we are doing things and whether we are using specific resources when they are actually indicated&#44; and also which circumstances hinder the achievement of expected outcomes&#44; even with appropriate treatment&#46; There is hope that in upcoming years these systems will also provide a source of data for clinical research&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In short&#44; clinical information systems give us the opportunity to analyse processes and outcomes through data collected on a day-to-day basis&#44; allowing an enhancement of clinical management&#44; benchmarking and real-life studies&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We must not forget that in health care in general and in intensive care in particular&#44; resources are limited and costly&#46; It is essential that ICU beds are allocated appropriately&#44; but this is a complex and difficult to attain goal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Anticipation is a characteristic aspect of our specialty&#46; Delays in treatment have been associated with increased mortality&#44; but the association with potential sequelae or recovery time has been overlooked&#44; despite the impact they have on the child&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The recommendations for ICU admission&#44; triage and discharge published in this issue of Anales de Pediatr&#237;a<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> provide a good starting point for the development of a model that ensures the translation of scientific knowledge and the delivery of timely and appropriate care&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Under the current circumstances&#44; as we face the converging duties of providing the best possible care &#40;translation of advances in research&#41; in the most efficient possible manner &#40;at the right time and place and with the appropriate duration&#41; under relatively heterogeneous &#40;but not inequitable&#41; conditions in terms of the distribution of resources &#40;geographical distribution&#44; health care administration&#44; levels of hospital care&#41; and the actual threats to the health and wellbeing of the population &#40;emerging pandemics&#44; terrorism&#41;&#44; the publication of a consensus document for the essential criteria that must dictate admission to and discharge from the paediatric intensive care unit &#40;PICU&#41; and the selection of patients eligible for critical care is bound to become a key reference for all individuals responsible for the delivery of health care for the paediatric age group &#40;administrators&#44; managers&#44; department chiefs&#44; physicians and nurses&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors carried out the challenging task of providing a succinct schema of the &#8220;universe&#8221; of reasons that may warrant admission of a child to the PICU&#44; without failing to emphasise the importance of adapting their recommendations to local circumstances and acknowledging the role of paediatric critical care specialists&#44; 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Editorial
Seizing opportunities and breaking barriers to ensure the transfer of knowledge based on better clinical evidence
Aprovechando oportunidades y rompiendo barreras para garantizar la traslación del conocimiento basado en la mejor evidencia clínica
María Bodía,
Corresponding author
mbodi.hj23.ics@gencat.cat

Corresponding author.
, Joan Balcellsb
a Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, Spain
b Servicio de Medicina Intensiva Pediátrica, Hospital Valle de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The main goal of intensive medicine professionals is to provide appropriate and timely care to patients&#44; especially in the field of paediatrics&#44; where patients have their whole lives ahead of them&#46; To provide quality care to restore health and return the patient to a long and high-quality life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; despite significant advances in research&#8212;there are endless publications&#8212;there is a considerable gap between the evidence obtained in clinical research&#44; which demonstrates the benefits of new therapeutic interventions &#40;pharmacological treatment or life support techniques&#41; and the actual impact in patient outcomes of the implementation of these interventions in everyday clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This gap needs to be addressed&#44; and as health care professionals we must strive to translate the highest-quality evidence from clinical research to the care provided at the bedside of critically ill children and adolescents&#46; We must give this issue the importance it actually has&#44; and use any available technical and organisational resources&#44; our knowledge and the methods at our disposal to ensure the translation of the results of the highest-level clinical research to everyday practice in paediatric intensive care&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the past few years&#44; there have been important advances in paediatric intensive medicine&#44; both in diagnostic and monitoring methods and in treatment&#46; Advances in less invasive multiparametric monitoring techniques &#40;pulse oximetry&#44; bispectral index and tissue oximetry&#44; among others&#41; are particularly important for the paediatric patient&#46; The introduction of ultrasound has been a qualitative leap in terms of diagnostic speed and patient safety both in the short term &#40;effectiveness and safety in placement of vascular access devices&#41; and the long term &#40;reduced exposure to ionising radiation&#41;&#46; Mechanical ventilation is administered through ventilators that are accurate enough to adapt to the needs of the youngest patients&#44; and techniques such as continuous veno-venous haemofiltration can be used appropriately in this subpopulation thanks to the availability of suitable monitoring devices&#44; filters and catheters&#46; The widespread use of non-invasive ventilation in children made possible by the combination of the increased sophistication of ventilators&#44; on one hand&#44; and the development of suitable face masks&#44; on the other&#44; has also transformed paediatric intensive care&#46; Last of all&#44; we should highlight the opportunities and the concerns&#44; especially of an ethical nature&#44; that the use of extracorporeal life support systems&#44; such as extracorporeal membrane oxygenation&#44; bring to our everyday practice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The appropriate use of all the resources available to professionals to provide the best possible care to critical patients requires new frameworks and new roles<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> based on teamwork and effective communication and leadership&#46; Making the necessary changes in the practice of intensive medicine can be facilitated by the development of strategies that help target and align efforts made in that direction&#46; One example is the use of random real-time patient safety auditing as a tool to address and prevent errors of omission&#44; especially those that keep patients from receiving care in adherence to evidence-based recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Another contribution that has brought us one step further towards this new framework is the introduction of clinical information systems&#44; which allow the collection&#44; integration and storage of patient care data for a safer and more effective management&#46; A skilled analysis of health care records can show how well we are doing things and whether we are using specific resources when they are actually indicated&#44; and also which circumstances hinder the achievement of expected outcomes&#44; even with appropriate treatment&#46; There is hope that in upcoming years these systems will also provide a source of data for clinical research&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In short&#44; clinical information systems give us the opportunity to analyse processes and outcomes through data collected on a day-to-day basis&#44; allowing an enhancement of clinical management&#44; benchmarking and real-life studies&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We must not forget that in health care in general and in intensive care in particular&#44; resources are limited and costly&#46; It is essential that ICU beds are allocated appropriately&#44; but this is a complex and difficult to attain goal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Anticipation is a characteristic aspect of our specialty&#46; Delays in treatment have been associated with increased mortality&#44; but the association with potential sequelae or recovery time has been overlooked&#44; despite the impact they have on the child&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The recommendations for ICU admission&#44; triage and discharge published in this issue of Anales de Pediatr&#237;a<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> provide a good starting point for the development of a model that ensures the translation of scientific knowledge and the delivery of timely and appropriate care&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Under the current circumstances&#44; as we face the converging duties of providing the best possible care &#40;translation of advances in research&#41; in the most efficient possible manner &#40;at the right time and place and with the appropriate duration&#41; under relatively heterogeneous &#40;but not inequitable&#41; conditions in terms of the distribution of resources &#40;geographical distribution&#44; health care administration&#44; levels of hospital care&#41; and the actual threats to the health and wellbeing of the population &#40;emerging pandemics&#44; terrorism&#41;&#44; the publication of a consensus document for the essential criteria that must dictate admission to and discharge from the paediatric intensive care unit &#40;PICU&#41; and the selection of patients eligible for critical care is bound to become a key reference for all individuals responsible for the delivery of health care for the paediatric age group &#40;administrators&#44; managers&#44; department chiefs&#44; physicians and nurses&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors carried out the challenging task of providing a succinct schema of the &#8220;universe&#8221; of reasons that may warrant admission of a child to the PICU&#44; without failing to emphasise the importance of adapting their recommendations to local circumstances and acknowledging the role of paediatric critical care specialists&#44; 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ISSN: 23412879
Original language: English
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