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Iro MA, Sadarangani M, Absoud M, Chong WK, Clark CA, Easton A, Gray V, Kneen R, Lim M, Pike M, Solomon T, Vincent A, Willis L, Yu LM, Pollard AJ. ImmunoglobuliN in the Treatment of Encephalitis (IgNiTE): protocol for a multicentre randomised controlled trial. BMJ Open 2016; 6:e012356. [PMID: 27810972 PMCID: PMC5129051 DOI: 10.1136/bmjopen-2016-012356] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Infectious and immune-mediated encephalitides are important but under-recognised causes of morbidity and mortality in childhood, with a 7% death rate and up to 50% morbidity after prolonged follow-up. There is a theoretical basis for ameliorating the immune response with intravenous immunoglobulin (IVIG), which is supported by empirical evidence of a beneficial response following its use in the treatment of viral and autoimmune encephalitis. In immune-mediated encephalitis, IVIG is often used after a delay (by weeks in some cases), while diagnosis is confirmed. Wider use of IVIG in infectious encephalitis and earlier use in immune-mediated encephalitis could improve outcomes for these conditions. We describe the protocol for the first ever randomised control trial of IVIG treatment for children with all-cause encephalitis. METHODS AND ANALYSIS 308 children (6 months to 16 years) with a diagnosis of acute/subacute encephalitis will be recruited in ∼30 UK hospitals and randomised to receive 2 doses (1 g/kg/dose) of either IVIG or matching placebo, in addition to standard treatment. Recruitment will be over a 42-month period and follow-up of each participant will be for 12 months post randomisation. The primary outcome is 'good recovery' (score of 2 or lower on the Glasgow Outcome Score Extended-paediatric version), at 12 months after randomisation. Additional secondary neurological measures will be collected at 4-6 weeks after discharge from acute care and at 6 and 12 months after randomisation. Safety, radiological, other autoimmune and tertiary outcomes will also be assessed. ETHICS AND DISSEMINATION This trial has been approved by the UK National Research Ethics committee (South Central-Oxford A; REC 14/SC/1416). Current protocol: V4.0 (10/03/2016). The findings will be presented at national and international meetings and conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBERS NCT02308982, EudraCT201400299735 and ISRCTN15791925; Pre-results.
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Affiliation(s)
- M A Iro
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver BC, Canada
| | - M Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas’ NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - W K Chong
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - C A Clark
- Institute of Child Health, University College London, London, UK
| | - A Easton
- The Encephalitis Society, Malton, North Yorkshire, UK
| | - V Gray
- Psychological services (Paediatrics), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Kneen
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Littlewoods Neuroscience Foundation, Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Lim
- Department of Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas’ NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - M Pike
- Department of Paediatric Neurology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - T Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A Vincent
- Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - L Willis
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L-M Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Niesten IJM, Nentjes L, Merckelbach H, Bernstein DP. Antisocial features and "faking bad": A critical note. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 41:34-42. [PMID: 25843907 DOI: 10.1016/j.ijlp.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We critically review the literature on antisocial personality features and symptom fabrication (i.e., faking bad; e.g., malingering). A widespread assumption is that these constructs are intimately related. Some studies have, indeed, found that antisocial individuals score higher on instruments detecting faking bad, but others have been unable to replicate this pattern. In addition, studies exploring whether antisocial individuals are especially talented in faking bad have generally come up with null results. The notion of an intrinsic link between antisocial features and faking bad is difficult to test and research in this domain is sensitive to selection bias. We argue that research on faking bad would profit from further theoretical articulation. One topic that deserves scrutiny is how antisocial features affect the cognitive dissonance typically induced by faking bad. We illustrate our points with preliminary data and discuss their implications.
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Affiliation(s)
| | - Lieke Nentjes
- Forensic Psychology Section, Maastricht University, The Netherlands; Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | | | - David P Bernstein
- Forensic Psychology Section, Maastricht University, The Netherlands; Forensic Psychiatric Center 'de Rooyse Wissel', The Netherlands
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