Standardisation of care: towards a common goal
In addition to training, the management of specific conditions is also being standardised throughout Europe and across the world. The need for standardisation of management was illustrated by a paper published in 1998, which compared the management of a common respiratory infection in infancy (bronchiolitis) in many European countries and in the USA. The main factor linked to the length of stay in hospital was not severity of illness but the country in which the infant lived. A 2010 study of cystic fibrosis across Europe identified fewer individuals surviving to adulthood in non-EU compared with EU countries, and suggested that up to 50% of all cases of cystic fibrosis in non-EU countries were not being diagnosed (and by implication, not receiving appropriate treatment). The considerable variation between countries, and the desire to standardise PRM training, has driven the standardisation of treatment and investigation. Table 3 lists some of the areas in which guidelines have been established.
The investigation and management of several conditions has now been standardised. However, it is important to note that for most conditions, no internationally agreed guideline exists, and many of the guidelines that do exist are based on consensus (i.e. what is currently being done) and rarely on an evidence base (i.e. clinical trials). To take drug dose as an example, most antibiotic doses are based on studies performed in adults with the assumption that children are small adults; however, this is often not the case and generally children receive inadequate doses of medication. There is a pressing need for clinical trials in PRM and this has been recognised by the 2006 EU Clinical Trials Directive, which obliges the pharmaceutical industry to test new medications in children as well as adults.
|Respiratory symptoms and signs|
|Pulmonary function testing|
|Acute and chronic lung infection|
|Epidemiology and environmental health|
|Management and leadership|
|Rigid and interventional endoscopy|
|Post lung transplant management|
|Additional diagnostic tests|
Table 2 - Modules of the Paediatric HERMES syllabus. HERMES: Harmonised Education in Respiratory Medicine for European Specialists.