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Módolo NSP, Cumino DDO, Lima LC, Barros GAMD. Advancing pediatric anesthesia in Brazil: reflections on research and education. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844535. [PMID: 38936800 PMCID: PMC11295974 DOI: 10.1016/j.bjane.2024.844535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Norma Sueli Pinheiro Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
| | - Débora de Oliveira Cumino
- Sabará Hospital Infantil, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil; Hospital Municipal Menino Jesus, São Paulo, SP, Brazil
| | - Luciana Cavalcanti Lima
- Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Faculdade Pernambucana de Saúde, Recife, PE, Brazil
| | - Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil
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Wale A, Young Z, Zhang W, Hiom S, Ahmed H, Yemm R, Mantzourani E. Factors affecting the patient journey and patient care when receiving an unlicensed medicine: A systematic review. Res Social Adm Pharm 2023; 19:1025-1041. [PMID: 37121796 DOI: 10.1016/j.sapharm.2023.04.120] [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: 02/08/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine. OBJECTIVE A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends. METHODS Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers. RESULTS Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability. CONCLUSIONS This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
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Affiliation(s)
- Alesha Wale
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Zoe Young
- University Library Services, Cardiff University, Cardiff, Wales, UK
| | - Wenjuan Zhang
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Sarah Hiom
- Research and Development, St Mary's Pharmaceutical Unit, Cardiff, Wales, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | - Rowan Yemm
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
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Gabes M, Ragamin A, Baker A, Kann G, Donhauser T, Gabes D, Howells L, Thomas KS, Oosterhaven JAF, Pasmans SGMA, Schuttelaar ML, Apfelbacher C. Content validity of the Recap of atopic eczema (RECAP) instrument in Dutch, English and German to measure eczema control in young people with atopic eczema: a cognitive interview study. Br J Dermatol 2022; 187:919-926. [PMID: 35842231 DOI: 10.1111/bjd.21767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recap of atopic eczema (RECAP) is a patient-reported outcome measure assessing eczema control. This instrument has been developed and validated in the UK. There are self-reported and proxy-reported versions in English, Dutch and German. However, it is unclear whether the self-reported version shows adequate content validity when completed by young people (8-16 years) in these languages. OBJECTIVES To assess the content validity (comprehensibility, relevance and comprehensiveness) of the English, German and Dutch versions of the self-reported RECAP in young people with atopic eczema and to identify the most appropriate age cutoff for self-completion. METHODS We conducted 23 semistructured cognitive interviews with young people aged 8-16 years, using the 'think-aloud' method. In Germany and the Netherlands, participants were recruited in dermatology clinics and in the UK through social media and existing mailing lists. Interviews were audio recorded, transcribed verbatim and analysed in the three languages, using a problem-focused coding manual. Transcripts were coded by two independent reviewers in each country. Themes were translated into English and compared across the three countries. RESULTS Significant age-related comprehensibility issues with the last three items of the questionnaire occurred with young people aged 8-11 years, causing difficulties completing RECAP without help. However, older children had only minor problems and were able to complete the questionnaire by themselves. The self-reported version of RECAP has sufficient content validity for self-completion in young people aged 12 years and above. However, the German version with some translational adaptations may be appropriate for children from the age of 8 years. There may be some situations where the proxy version is needed for older children too. CONCLUSIONS The self-reported version of RECAP is appropriate for use from the age of 12 years. The proxy version can be used in children younger than 12 years. Other measurement properties should be further investigated. What is already known about this topic? Recap of atopic eczema (RECAP) is an instrument recommended by the Harmonising Outcome Measures for Eczema initiative for the core outcome domain of long-term control of atopic eczema. Content validity of RECAP for self-completion by adults and of the proxy version has been assessed. What does this study add? In this study, content validity (comprehensibility, relevance and comprehensiveness) of the self-reported version of RECAP among young people (aged 8-16 years) with atopic eczema across the UK, Germany and the Netherlands is assessed. Based on these findings, key recommendations on how to measure eczema control in young people with atopic eczema are formulated. What are the clinical implications of this work? The Dutch, English and German self-completion versions of RECAP are recommended for use in adolescents from the age of 12 years. The proxy version could be used in children younger than 12 years or where children are cognitively or physically incapable of reporting their experience of eczema control. Caregivers should be encouraged to complete RECAP together with their child where possible.
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Affiliation(s)
- Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Aviël Ragamin
- Department of Pediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Arabella Baker
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, NG7 2NR, UK
| | - Gesina Kann
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,University of Regensburg, Regensburg, Germany
| | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,University of Regensburg, Regensburg, Germany
| | - Daniela Gabes
- Faculty of Human Sciences, University of Regensburg, Germany
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, NG7 2NR, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, NG7 2NR, UK
| | - Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Pediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marie L Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Bulik NB, Farcaș A, Bucșa C, Iaru I, Oniga O. Safety of Antibiotics in Hospitalized Children in Romania: A Prospective Observational Study. Pharmaceuticals (Basel) 2022; 15:ph15060713. [PMID: 35745632 PMCID: PMC9231061 DOI: 10.3390/ph15060713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 12/10/2022] Open
Abstract
Antibiotics are among the most prescribed drugs in pediatric inpatients and are frequently associated with adverse drug reactions (ADRs) in children. This study aimed to assess the frequency and type of ADRs related to the use of antibiotics in pediatric inpatients through a prospective observational study, conducted over 6 months, covering the winter and spring seasons when the incidence of infections peaks in Romania. ADRs were evaluated for causality, avoidability and severity. Among the 266 included children, 25 (9.4%) experienced 30 ADRs. ADR frequency tended to be higher in ≤2-year-olds (13 of 25, 52.0%) than in other age categories. Gastrointestinal and hematological ADRs were most frequently observed. Diarrhea was the most common ADR associated with antibiotics (8 of 30, 26.7%). Ceftriaxone (16 of 30, 53.3%), cefuroxime, ceftazidime and azithromycin (3 of 30, 10.0% each) were most commonly responsible for ADRs. After causality assessment, 2 (6.7%) ADRs were considered definite, 12 (40.0%) probable and 16 (53.3%) possible. One ADR was classified as definitely avoidable and one as possibly avoidable. Seven children required treatment for ADRs. Antibiotic treatment was discontinued in 4 children. Antibiotics frequently caused ADRs in ≤ 2-year-olds and were commonly associated with gastrointestinal symptoms. Close monitoring of antibiotic-associated ADRs remains important in the pediatric population.
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Affiliation(s)
- Noémi-Beátrix Bulik
- Department of Pharmaceutical Chemistry, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania; (N.-B.B.); (O.O.)
| | - Andreea Farcaș
- Pharmacovigilance Research Centre, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-724238587
| | - Camelia Bucșa
- Pharmacovigilance Research Centre, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Irina Iaru
- Department of Pharmacology, Physiology and Pathophysiology, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Ovidiu Oniga
- Department of Pharmaceutical Chemistry, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania; (N.-B.B.); (O.O.)
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Siapkara A, Fracasso C, Egger GF, Rizzari C, Trasorras CS, Athanasiou D, Turner MA. Recommendations by the European Network of Paediatric Research at the European Medicines Agency (Enpr-EMA) Working Group on preparedness of clinical trials about paediatric medicines process. Arch Dis Child 2021; 106:1149-1154. [PMID: 33858819 PMCID: PMC8666697 DOI: 10.1136/archdischild-2020-321433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 12/01/2022]
Abstract
Conduct of clinical trials in babies, children and young people is often hindered by issues that could have been foreseen before the trial opened; that is, some clinical trials are often underprepared. In order to identify a good approach to trial preparedness, the European Network of Paediatric Research at the European Medicines Agency formed a working group. The Working Group included representation from regulators, industry, academics, paediatric clinical research networks and parents.The Working Group consulted widely about how to prepare for paediatric clinical trials. The Group's detailed recommendations have been published (https://www.ema.europa.eu/en/documents/other/preparedness-medicines-clinical-trials-paediatrics-recommendations-enpr-ema-working-group-trial_en.pdf).This paper is a summary of the key recommendations including the following: start early, preferably in parallel to designing the medicine's development plan and individual protocols; identify the rationale and clinical need; listen to the perspectives of children and families, and of patient advocacy groups; identify how many people will be eligible for the trial; identify the resources needed, such as clinical facilities (including play therapy) and out-of-pocket expenditure by participants and their families; use all available data to estimate what is possible; present information about preparedness in a structured way; deploy proportionate resources to support the preparation of trials.A well-prepared, well-designed trial is likely to require fewer changes during its course, be run in a shorter time frame and achieve expected objectives.
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Affiliation(s)
- Angeliki Siapkara
- VRNN, Medicines and Healthcare products Regulatory Agency (MHRA), London, UK
| | | | - Gunter F Egger
- Scientific Evidence Generation Department, European Medicines Agency, Amsterdam, Netherlands
| | - Carmelo Rizzari
- Department of Paediatrics, University of Milan–Bicocca, Milano, Italy
| | | | | | - Mark A Turner
- Institute if Life Course and Medical Sciences, Liverpool Health Partners, University of Liverpool, Liverpool, UK
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AlAzmi A, Alasmari Z, Yousef C, Alenazi A, AlOtaibi M, AlSaedi H, AlShaikh A, AlObathani A, Ahmed O, Goronfolah L, Alahmari M. Off-Label Drug Use in Pediatric Out-Patient Care: A Multi-Center Observational Study. Hosp Pharm 2021; 56:690-696. [PMID: 34732923 DOI: 10.1177/0018578720942226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Prescribing a drug for a child is not an easy task and requires using the best available evidence as a guide, especially when a drug is used off-label. The practice of prescribing a drug for off-label use is fairly widespread worldwide. The FDA does not regulate prescribing patterns or practices of individual practitioners and, therefore, allows off-label use. The main objective of this study is to evaluate off-label prescribing among the pediatric population in the Kingdom of Saudi Arabia (KSA). Method This is a retrospective, simple random selection observational study of children (≤15 years) who visited pediatric clinics and had at least 1 drug prescribed over a 12-month period (January to December 2018). Results A total of 865 drugs (mean 1 and SD 0.24) were prescribed to 326 children. Off-label was identified in 39.4% of the drugs with a frequency of 512 (as 1 drug may belong to more than 1 off-label category). The most common reason for off-label prescribing was related to doses that were "higher or lower than the recommended use" (48.6%), and the most frequently identified drug class prescribed for off-label use was anti-infective drugs for systemic use (39.9%). The percentage of off-label drug use was found to be higher in girls and in the age group of 1 month to 2 years (P = .001) for both variables. In addition, a significant association was found between off label drug use and the total number of drugs prescribed, P < .001. Conclusion The findings of this study showed a high incidence of off-label prescribing mainly related to dosing and indication. The results of this observational study support the need to establish a unified national pediatric dosing formulary guide to ensure safe drug use in pediatrics.
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Affiliation(s)
- Aeshah AlAzmi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Princes Noorah Oncology Center, Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Zahra Alasmari
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Specialized Poly Clinic, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Consuela Yousef
- Imam Abdulrahman Bin Faisal Hospital, MNGHA, Dammam, Saudi Arabia
| | - Ahmed Alenazi
- Imam Abdulrahman Bin Faisal Hospital, MNGHA, Dammam, Saudi Arabia
| | - Mohammed AlOtaibi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Hani AlSaedi
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Adnan AlShaikh
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi Arabia
| | - Amani AlObathani
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Omaima Ahmed
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
- Princes Noorah Oncology Center, Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Loie Goronfolah
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Mousa Alahmari
- Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
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Agnihotri G, Lio PA, Lee KC. Differences in pediatric versus adult clinical trial characteristics for atopic dermatitis. Pediatr Dermatol 2021; 38:775-779. [PMID: 34173679 DOI: 10.1111/pde.14658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a growing burden in all ages. The aim of this study was to compare trial characteristics between pediatric and adult AD trials. METHODS Data were collected from ClinicalTrials.gov on AD therapeutic trials completed between 2003 and 2019. The trials were classified as pediatrics (mean or median age <18 years of the experimental group participants) or adults. The trials with and without results on ClinicalTrials.gov were searched on PubMed for further data collection. RESULTS Of 210 trials, 50 (24%) were pediatric trials [mean age: 8.2 ± 4.3 years (SD)] and 160 (76%) were adult trials [mean age 35.2 ± 5.7 years (SD)]. Pediatric and adult trials were equally likely to be randomized controlled trials; however, pediatric trials were more likely to be open-label trials (P < .001) and have no comparator (P < .001). Adult trials were more likely to be industry-funded (95% vs. 80%, P = .001). Any evaluation of drug safety was more likely present in adult trials (83% vs. 60%, P = .001). In trials examining AD severity as an outcome, the Eczema Area and Severity Index (EASI) predominated in adult trials (51% vs. 29%, P < .05) and Scoring Atopic Dermatitis (SCORAD) in pediatric trials (25% vs. 10%, P < .05). CONCLUSION The results highlight differences in trial design between pediatric and adult AD trials and show a lack of standardization in trial design.
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Affiliation(s)
- Gaurav Agnihotri
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Peter A Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, Chicago, IL, USA
| | - Kachiu C Lee
- Department of Dermatology, Temple University, Philadelphia, PA, USA
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Deja E, Peters MJ, Khan I, Mouncey PR, Agbeko R, Fenn B, Watkins J, Ramnarayan P, Tibby SM, Thorburn K, Tume LN, Rowan KM, Woolfall K. Establishing and augmenting views on the acceptability of a paediatric critical care randomised controlled trial (the FEVER trial): a mixed methods study. BMJ Open 2021; 11:e041952. [PMID: 33692177 PMCID: PMC7949453 DOI: 10.1136/bmjopen-2020-041952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore parent and staff views on the acceptability of a randomised controlled trial investigating temperature thresholds for antipyretic intervention in critically ill children with fever and infection (the FEVER trial) during a multi-phase pilot study. DESIGN Mixed methods study with data collected at three time points: (1) before, (2) during and (3) after a pilot trial. SETTING English, Paediatric Intensive Care Units (PICUs). PARTICIPANTS (1) Pre-pilot trial focus groups with pilot site staff (n=56) and interviews with parents (n=25) whose child had been admitted to PICU in the last 3 years with a fever and suspected infection, (2) Questionnaires with parents of randomised children following pilot trial recruitment (n=48 from 47 families) and (3) post-pilot trial interviews with parents (n=19), focus groups (n=50) and a survey (n=48) with site staff. Analysis drew on Sekhon et al's theoretical framework of acceptability. RESULTS There was initial support for the trial, yet some held concerns regarding the proposed temperature thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed protocol changes and training, which influenced views on trial acceptability. Staff trained by the FEVER team found the trial more acceptable than those trained by colleagues. Parents and staff found the trial acceptable. Some concerns about pain or discomfort during weaning from ventilation remained. CONCLUSIONS Pre-trial findings and pilot trial experience influenced acceptability, providing insight into how challenges may be overcome. We present an adapted theoretical framework of acceptability to inform future trial feasibility studies. TRIAL REGISTRATION NUMBERS ISRCTN16022198 and NCT03028818.
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Affiliation(s)
- Elizabeth Deja
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | - Imran Khan
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Rachel Agbeko
- Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, UK
| | - Shane M Tibby
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Kentigern Thorburn
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Kerry Woolfall
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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