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Illes J, Lawson A, McDonald PJ. Ethical Considerations for Discrete Choice Experiments with Caregivers. J Empir Res Hum Res Ethics 2022; 17:426-430. [PMID: 35849082 PMCID: PMC9398987 DOI: 10.1177/15562646221112339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We discuss research ethics challenges experienced while running a discrete choice
experiment administered to caregivers of children with treatment resistant pediatric
epilepsy. We highlight ethical considerations around the study design of the discrete
choice experimental paradigm that pertain to vulnerability of and caregiving burden on the
population, imbalance of benefit-to-load of participation, and limitations of cultural
meaningfulness and generalizability.
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Affiliation(s)
- Judy Illes
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada
| | - Ashley Lawson
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada
| | - Patrick J McDonald
- Division of Neurology, Department of Medicine, Neuroethics Canada, University of British Columbia, Vancouver, Canada.,Section of Neurosurgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Yengo-Kahn AM, Wellons JC, Hankinson TC, Hauptman JS, Jackson EM, Jensen H, Krieger MD, Kulkarni AV, Limbrick DD, McDonald PJ, Naftel RP, Pindrik JA, Pollack IF, Reeder R, Riva-Cambrin J, Rozzelle CJ, Tamber MS, Whitehead WE, Kestle JRW. Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2021; 28:93-101. [PMID: 33930865 DOI: 10.3171/2020.11.peds20806] [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] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Treating Dandy-Walker syndrome-related hydrocephalus (DWSH) involves either a CSF shunt-based or endoscopic third ventriculostomy (ETV)-based procedure. However, comparative investigations are lacking. This study aimed to compare shunt-based and ETV-based treatment strategies utilizing archival data from the Hydrocephalus Clinical Research Network (HCRN) registry. METHODS A retrospective review of prospectively collected and maintained data on children with DWSH, available from the HCRN registry (14 sites, 2008-2018), was performed. The primary outcome was revision-free survival of the initial surgical intervention. The primary exposure was either shunt-based (i.e., cystoperitoneal shunt [CPS], ventriculoperitoneal shunt [VPS], and/or dual-compartment) or ETV-based (i.e., ETV alone or with choroid plexus cauterization [CPC]) initial surgical treatment. Primary analysis included multivariable Cox proportional hazards models. RESULTS Of 8400 HCRN patients, 151 (1.8%) had DWSH. Among these, the 102 patients who underwent shunt placement (79 VPSs, 16 CPSs, 3 other, and 4 multiple proximal catheter) were younger (6.6 vs 18.8 months, p < 0.001) and more frequently had 1 or more comorbidities (37.3% vs 14.3%, p = 0.005) than the 49 ETV-treated children (28 ETV-CPC). Fifty percent of the shunt-based and 51% of the ETV-based treatments failed. Notably, 100% (4/4) of the dual-compartment shunts failed. Adjusting for age, baseline ventricular size, and comorbidities, ETV-based treatment was not significantly associated with earlier failure compared with shunt-based treatment (HR for failure 1.32, 95% CI 0.77-2.26; p = 0.321). Complication rates were low: 4.9% and 6.1% (p = 0.715) for shunt- and ETV-based procedures, respectively. There was no difference in survival between ETV-CPC- and ETV-based treatment when adjusting for age (HR for failure 0.86, 95% CI 0.29-2.55, p = 0.783). CONCLUSIONS In this North American, multicenter, prospective database review, shunt-based and ETV-based primary treatment strategies of DWSH appear similarly durable. Pediatric neurosurgeons can reasonably consider ETV-based initial treatment given the similar durability and the low complication rate. However, given the observational nature of this study, the treating surgeon might need to consider subgroups that were too small for a separate analysis. Very young children with comorbidities were more commonly treated with shunts, and older children with fewer comorbidities were offered ETV-based treatment. Future studies may determine preoperative characteristics associated with ETV treatment success in this population.
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Affiliation(s)
- Aaron M Yengo-Kahn
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - John C Wellons
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - Todd C Hankinson
- 3Department of Neurosurgery, Children's Hospital Colorado, Colorado Springs, Colorado
| | - Jason S Hauptman
- 4Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Eric M Jackson
- 5Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland
| | | | - Mark D Krieger
- 7Department of Neurosurgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Abhaya V Kulkarni
- 8Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David D Limbrick
- 9Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri
| | - Patrick J McDonald
- 10Division of Neurosurgery, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert P Naftel
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - Jonathan A Pindrik
- 11Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ian F Pollack
- 12Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
| | | | - Jay Riva-Cambrin
- 13Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Curtis J Rozzelle
- 14Division of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Alabama; and
| | - Mandeep S Tamber
- 10Division of Neurosurgery, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
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Chari A, Mallucci C, Whitelaw A, Aquilina K. Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion. Childs Nerv Syst 2021; 37:3375-3383. [PMID: 33993367 PMCID: PMC8578081 DOI: 10.1007/s00381-021-05206-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Advances in medical care have led to more premature babies surviving the neonatal period. In these babies, germinal matrix haemorrhage (GMH), intraventricular haemorrhage (IVH) and posthaemorrhagic ventricular dilatation (PHVD) are the most important determinants of long-term cognitive and developmental outcomes. In this review, we discuss current neurosurgical management of IVH and PHVD, including the importance of early diagnosis of PHVD, thresholds for intervention, options for early management through the use of temporising measures and subsequent definitive CSF diversion. We also discuss treatment options for the evolving paradigm to manage intraventricular blood and its breakdown products. We review the evidence for techniques such as drainage, irrigation, fibrinolytic therapy (DRIFT) and neuroendoscopic lavage in the context of optimising cognitive, neurodevelopmental and quality of life outcomes in these premature infants.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK ,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - Andrew Whitelaw
- Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK. .,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
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