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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Oakley E, Wilson CL, Hopper SM, Cheek JA, Hearps S, Mackay MT, Dalziel SR, Lee KJ. Facial Function in Bell Palsy in a Cohort of Children Randomized to Prednisolone or Placebo 12 Months After Diagnosis. Pediatr Neurol 2024; 153:44-47. [PMID: 38320457 DOI: 10.1016/j.pediatrneurol.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Information on the medium-term recovery of children with Bell palsy or acute idiopathic lower motor neuron facial paralysis is limited. METHODS We followed up children aged 6 months to <18 years with Bell palsy for 12 months after completion of a randomized trial on the use of prednisolone. We assessed facial function using the clinician-administered House-Brackmann scale and the modified parent-administered House-Brackmann scale. RESULTS One hundred eighty-seven children were randomized to prednisolone (n = 93) or placebo (n = 94). At six months, the proportion of patients who had recovered facial function based on the clinician-administered House-Brackmann scale was 98% (n = 78 of 80) in the prednisolone group and 93% (n = 76 of 82) in the placebo group. The proportion of patients who had recovered facial function based on the modified parent-administered House-Brackmann scale was 94% (n = 75 of 80) vs 89% (n = 72 of 81) at six months (OR 1.88; 95% CI 0.60, 5.86) and 96% (n = 75 of 78) vs 92% (n = 73 of 79) at 12 months (OR 3.12; 95% CI 0.61, 15.98). CONCLUSIONS Although the vast majority had complete recovery of facial function at six months, there were some children without full recovery of facial function at 12 months, regardless of prednisolone use.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia.
| | - David Herd
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Perth Children's Hospital, Perth, Australia; Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia
| | - Amit Kochar
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Katherine J Lee
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Hermantara R, Richmond L, Taqi AF, Chilaka S, Jeantet V, Guerrini I, West K, West A. Improving CRISPR-Cas9 directed faithful transgene integration outcomes by reducing unwanted random DNA integration. J Biomed Sci 2024; 31:32. [PMID: 38532479 DOI: 10.1186/s12929-024-01020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The field of genome editing has been revolutionized by the development of an easily programmable editing tool, the CRISPR-Cas9. Despite its promise, off-target activity of Cas9 posed a great disadvantage for genome editing purposes by causing DNA double strand breaks at off-target locations and causing unwanted editing outcomes. Furthermore, for gene integration applications, which introduce transgene sequences, integration of transgenes to off-target sites could be harmful, hard to detect, and reduce faithful genome editing efficiency. METHOD Here we report the development of a multicolour fluorescence assay for studying CRISPR-Cas9-directed gene integration at an endogenous locus in human cell lines. We examine genetic integration of reporter genes in transiently transfected cells as well as puromycin-selected stable cell lines to determine the fidelity of multiple CRISPR-Cas9 strategies. RESULT We found that there is a high occurrence of unwanted DNA integration which tarnished faithful knock-in efficiency. Integration outcomes are influenced by the type of DNA DSBs, donor design, the use of enhanced specificity Cas9 variants, with S-phase regulated Cas9 activity. Moreover, restricting Cas9 expression with a self-cleaving system greatly improves knock-in outcomes by substantially reducing the percentage of cells with unwanted DNA integration. CONCLUSION Our results highlight the need for a more stringent assessment of CRISPR-Cas9-mediated knock-in outcomes, and the importance of careful strategy design to maximise efficient and faithful transgene integration.
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Affiliation(s)
- Rio Hermantara
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
- Department of Biomedicine, School of Life Sciences, Indonesia International Institute for Life Sciences, Jakarta, Indonesia.
| | - Laura Richmond
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Aqeel Faisal Taqi
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sabari Chilaka
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Valentine Jeantet
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ileana Guerrini
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Katherine West
- School of Molecular Biosciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Adam West
- School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, Dalziel SR. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial. Arch Dis Child 2024; 109:227-232. [PMID: 38049992 DOI: 10.1136/archdischild-2023-325381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis. METHODS This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups. RESULTS Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain). CONCLUSIONS Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease. TRIAL REGISTRATION NUMBER ACTRN12615000563561.
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Affiliation(s)
- Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Herd
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Amit Kochar
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ben Lawton
- Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Andrew Davidson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T MacKay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Williams A, Eapen N, Kochar A, Lawton B, Hort J, West A, George S, Berkowitz R, Lee KJ, Dalziel SR, Hearps S, Babl FE. Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. J Child Neurol 2023; 38:44-51. [PMID: 36740927 DOI: 10.1177/08830738221144082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited evidence on the use of facial nerve function grading scales in acute facial nerve paralysis in children. OBJECTIVE To investigate the agreement between and the usability of the House-Brackmann and Sunnybrook scales in children with idiopathic facial paralysis (Bell's palsy) and to compare their ease of administration. METHODS Data from a randomized controlled trial in children aged 6 months to <18 years with Bell's palsy was used. Children were recruited within 72 hours of symptom onset and assessed using the House-Brackmann and the Sunnybrook scales at baseline and at 1, 3, and 6 months until recovered. Agreement between the scales was assessed using the intraclass correlation coefficient (ICC) at each time point and using a Bland-Altman plot. Ease of administration was assessed using an 11-point Likert scale. RESULTS Comparative data were available for 169 of the 187 children randomized. The ICC between the 2 scales across all time points was 0.92 (95% confidence interval [CI] 0.91-0.93), at baseline 0.37 (95% 0.25, 0.51), at 1 month 0.91 (95% CI 0.89-0.94), at 3 months 0.85 (95% CI 0.80-0.89), and at 6 months 0.96 (95% CI 0.95-0.97). The median score for the ease of administration for the House-Brackmann and Sunnybrook scales was 3 (interquartile range [IQR]: 1-5) and 7 (IQR: 4-8) respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS There was excellent agreement between House-Brackmann and Sunnybrook scales, with poorer agreement at baseline. Clinicians found the House-Brackmann scale easier to administer. These findings suggest that both scales can be applied in children.
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Affiliation(s)
- Amanda Williams
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Emergency Department, 4607Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, 8538The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Robert Berkowitz
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Otolaryngology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen Hearps
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Burroughs A, West A, Giles K, Guynn A, Shah S. Analysis of interventions required for children ages 1–5 with severe sepsis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Babl F, Herd D, Borland M, Kochar A, Lawton B, Hort J, West A, George S, Zhang M, Velusamy K, Dalziel S. 1396 Prednisolone for Bell’s Palsy in children: A randomised, double-blind, placebo-controlled, Multicentre Trial. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-rcem2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims, Objectives and BackgroundCorticosteroids can be used to treat idiopathic facial paralysis (Bell’s palsy) in children, but their effectiveness is uncertain.AimsTo determine if prednisolone improves recovery of children with Bell’s palsy at one month.Method and DesignDouble-blind, placebo-controlled, randomised, trial of prednisolone in children presenting to ED with Bell’s palsy.1Patients 6 months to <18 years, recruited <72 hours after symptom onset, were randomly assigned to receive 10 days of treatment with oral prednisolone (1 mg/kg) or placebo. The primary outcome: complete recovery of facial function at 1 month on the House-Brackmann scale.2Secondary outcomes: facial function, adverse events and pain to 6 months.Results and ConclusionBetween October 2015 to August 2020, 187 children were randomised (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 6 months these proportion were 99% (n=77/78) for prednisolone and 93% (n=76/82) for placebo respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0 95% CI 0.5 to 17.7) (figure 1). There were no serious adverse events and little evidence for group differences in secondary outcomes.Abstract 1396 Figure 1In children with Bell’s palsy the vast majority recover without treatment. The study does not provide evidence that early treatment with prednisolone improves complete recovery.ReferencesSullivan F, Swan I, Donna P, Morrison J, Smith B, McKinstry B,et al. Early treatment with prednisolone or acyclovir in bell’s palsy.N Eng J Med2007;357(16):1598–607.House JW, Brackmann DE. Facial nerve grading system.Otolaryngol Head Neck Surg. 1985;93(2):146–7.
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Zhang M, Velusamy K, Sullivan F, Oakley E, Davidson A, Hopper SM, Cheek JA, Berkowitz RG, Hearps S, Wilson CL, Williams A, Elborough H, Legge D, Mackay MT, Lee KJ, Dalziel SR. Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology 2022; 99:e2241-e2252. [PMID: 36008143 DOI: 10.1212/wnl.0000000000201164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. METHODS We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). RESULTS Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. DISCUSSION In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. TRIAL REGISTRATION INFORMATION Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.
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Affiliation(s)
- Franz E Babl
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand.
| | - David Herd
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Meredith L Borland
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amit Kochar
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ben Lawton
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Jason Hort
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Adam West
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Shane George
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Michael Zhang
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Karthik Velusamy
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Frank Sullivan
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ed Oakley
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Andrew Davidson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Sandy M Hopper
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - John A Cheek
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Robert G Berkowitz
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stephen Hearps
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Catherine L Wilson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amanda Williams
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Hannah Elborough
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Donna Legge
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Mark T Mackay
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Katherine J Lee
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stuart R Dalziel
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
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8
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Vulliamy P, Hancorn K, Glasgow S, West A, Davenport RA, Brohi K, Griffiths MP. Age-related injury patterns resulting from knife violence in an urban population. Sci Rep 2022; 12:15250. [PMID: 36163382 PMCID: PMC9512781 DOI: 10.1038/s41598-022-17768-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/30/2022] [Indexed: 12/01/2022] Open
Abstract
Interpersonal violence involving knives is a major public health problem. The majority of patients are young people in urban areas, but little is known about age-specific patterns of injury and recent trends in injury characteristics. We performed a retrospective cohort study of all patients presenting to an urban major trauma centre with stab injuries resulting from assault between 2012 and 2018. A total of 3583 patients were included. Young people (age under 25) were more likely to have sustained multiple stab wounds compared to older people (43% vs 35%, p < 0.001) and had significantly higher rates of stab injuries involving the lower limbs, groin and buttocks. The annual number of injuries increased steadily during the study period in patients aged under 25 (r2 = 0.82, p = 0.005) and those over 25 (r2 = 0.95, p < 0.001). Over time, limb and junctional injuries accounted for an increasing proportion of stab wounds in young people, overtaking torso injuries as most common pattern of injury by the end of the study period. These findings illustrate the influence of age on injury patterns resulting from knife violence, and support the expansion of outreach initiatives promoting bystander-delivered haemorrhage control of extremity wounds.
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Affiliation(s)
- P Vulliamy
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - K Hancorn
- The Royal London Hospital Major Trauma Centre, Barts Health NHS Trust, Whitechapel, E1 1FR, UK
| | - S Glasgow
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - A West
- The Royal London Hospital Major Trauma Centre, Barts Health NHS Trust, Whitechapel, E1 1FR, UK
| | - R A Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK.,The Royal London Hospital Major Trauma Centre, Barts Health NHS Trust, Whitechapel, E1 1FR, UK
| | - K Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK.,The Royal London Hospital Major Trauma Centre, Barts Health NHS Trust, Whitechapel, E1 1FR, UK
| | - M P Griffiths
- The Royal London Hospital Major Trauma Centre, Barts Health NHS Trust, Whitechapel, E1 1FR, UK.
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9
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Brohan J, Taylor J, West A, Albert A, Chau A. Developing an institutional focused cardiac ultrasound course for obstetric anesthesiologists. Int J Obstet Anesth 2021; 49:103233. [PMID: 34810055 DOI: 10.1016/j.ijoa.2021.103233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- J Brohan
- Department of Anesthesia, BC Women's Hospital, Vancouver, B.C., Canada
| | - J Taylor
- Department of Anesthesia, BC Women's Hospital, Vancouver, B.C., Canada
| | - A West
- Department of Anesthesia, BC Women's Hospital, Vancouver, B.C., Canada
| | - A Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, B.C., Canada
| | - A Chau
- Department of Anesthesia, BC Women's Hospital, Vancouver, B.C., Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, B.C., Canada.
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10
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Bernstein D, West A, Preston E, Premakumaran P, Suleyman N, Undre S. 1473 Urology Consent Forms at a District General Hospital – a Quality Improvement Project. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Consent is a core component of interaction between patients and healthcare professionals. Prior to surgery, forms are completed to record patient consent. As well as containing risks and benefits of the procedure, the consent form, as per guidelines1,2, must be legible and suitable to a patient’s capacity. To evaluate compliance with local and national guidelines, a quality improvement project was undertaken at a district general hospital.
Method
Over a three-week period 30 urology consent forms were selected to assess adherence to local and national guidelines. The appropriateness of consent form, patient signature, legibility, acronym use and whether the patient was offered a carbon copy were assessed. After initial data collection, all urology staff consenting patients were notified of the findings and how best to improve guideline adherence. A further three-week data collection was undertaken, though the sample set was small due to Coronavirus and Christmas.
Results
The results confirmed that patients had appropriate consent forms filled out and were signed appropriately. After intervention, there was clear improvement in legibility, with no low legibility consent forms, and 100% vs 83% high or moderate legibility between data sets. Intervention also resulted in significant reduction of acronym use; 33% vs 60%. More patients were also offered to retain a carbon copy; 89% vs 40%.
Conclusions
Through this intervention of highlighting local and national guidance as compared to current practice, compliance drastically improved. As the pandemic subsides, we hope regular emails to surgical teams will improve consent form completion to better patient care.
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Affiliation(s)
- D Bernstein
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - A West
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - E Preston
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - P Premakumaran
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - N Suleyman
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - S Undre
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
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11
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Lacey B, West A, Craig S. Parents' and carers' impression of "quality" within a Paediatric Emergency Department. BMC Pediatr 2021; 21:313. [PMID: 34256736 PMCID: PMC8276454 DOI: 10.1186/s12887-021-02752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback. Methods A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”. Results One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%). Conclusion We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02752-7.
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Affiliation(s)
- Brendan Lacey
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Adam West
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Simon Craig
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Locked Bag 29, Clayton South, Victoria, Australia
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12
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West A, Gupta V, Smythe M, Staiger E, Bao Y, Brooks S. 141 Locomotion pattern analysis using digital video labeling by machine learning. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Babl FE, Kochar A, Osborn M, Borland ML, West A, Williams A, Dalziel SR. Risk of Leukemia in Children With Peripheral Facial Palsy. Ann Emerg Med 2020; 77:174-177. [PMID: 32788067 DOI: 10.1016/j.annemergmed.2020.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 01/07/2023]
Abstract
Most children with peripheral facial palsy will not have a cause identified. Although leukemia can cause facial nerve palsy, the magnitude of the risk is unknown and recommendations for investigations are variable. We are currently conducting a randomized, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children within the Paediatric Research in Emergency Departments International Collaborative emergency research network. In the course of the assessment for eligibility of the trial, from 644 acute-onset facial palsy presentations we identified 5 children with previously undiagnosed leukemia. We estimate the rate of leukemia in children with acute-onset facial palsy who present to emergency departments to be 0.6% (95% confidence interval 0.2% to 1.6%). In accordance with these cases, we suggest consideration of a screening CBC count for acute-onset peripheral facial palsy presentations in children before initiation of corticosteroid treatment.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, and Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia.
| | - Amit Kochar
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia; Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Michael Osborn
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia; Emergency Department, Perth Children's Hospital, and the Divisions of Emergency Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Adam West
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia; Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, and the Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Williams
- Emergency Department, Royal Children's Hospital, and Murdoch Children's Research Institute, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia; Emergency Department, Starship Children's Hospital, and the Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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14
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Cheek JA, Craig SS, West A, Lewena S, Hiscock H. Emergency department utilisation by vulnerable paediatric populations during the COVID-19 pandemic. Emerg Med Australas 2020; 32:870-871. [PMID: 32705775 PMCID: PMC7404865 DOI: 10.1111/1742-6723.13598] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022]
Abstract
Objective To determine if changes to community‐based services have effected paediatric ED attendances for mental health issues and neonates during the COVID‐19 pandemic. Methods Analysis of total presentations, presentations with a mental health diagnoses and presentation of neonates during the early stages of the pandemic compared with the previous year for four Victorian hospitals. Results There was a 47.2% decrease in total presentations compared with 2019, with a 35% increase in mental health diagnoses and a 2% increase in neonatal presentations. Conclusion Vulnerable paediatric patients are seeking care elsewhere during the pandemic because of the closure of community services.
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Affiliation(s)
- John A Cheek
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simon S Craig
- Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Adam West
- Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Stuart Lewena
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
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15
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Hiscock H, Connolly AS, Dunlop K, Perera P, O'Loughlin R, Brown SJ, Krieser DM, West A, Chapman P, Lawford R, Cheek JA. Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study. J Paediatr Child Health 2020; 56:1114-1120. [PMID: 32100422 DOI: 10.1111/jpc.14835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
AIM The number of children and young people presenting to emergency departments (EDs) with anxiety and depression is increasing. We aimed to determine parent perspectives on: (i) barriers to accessing non-ED mental health services; and (ii) improving access in the paediatric mental health service system. METHODS Qualitative study with parents of children and young people aged 0-19 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression. EXCLUSION CRITERIA child or young person without a parent/guardian, or presented with self-harm or suicide attempt. Eligible participants completed semi-structured phone interviews. Interviews were recorded and transcripts were coded and analysed using content analysis. RESULTS A total of 72 parents completed interviews. The average child age was 14 years (standard deviation 2.5) and two thirds identified as female (64%). A total of 57% of children and young people presented with a primary diagnosis of anxiety. Parents reported barriers in accessing care including: service shortages and inaccessibility, underresourced schools, lack of clinician mental health expertise, lack of child-clinician rapport, inconsistent care, financial constraints, lack of mental health awareness among parents, and stigma. Parents want expanded and improved access to services, more respite and support services, supportive schools, and improved mental health education for parents. CONCLUSIONS Parents of children and young people attending the ED for anxiety and depression are generally dissatisfied with services for child mental health. Solutions that enable parents to better care for their child in the community are needed to improve care.
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Affiliation(s)
- Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Ann-Siobhan Connolly
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katie Dunlop
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Prescilla Perera
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Rachel O'Loughlin
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephanie J Brown
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David M Krieser
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Department of Paediatric Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Pauline Chapman
- Department of Emergency Medicine, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Robyn Lawford
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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16
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Hiscock H, Connolly AS, Dunlop K, Perera P, O'Loughlin R, Brown SJ, Krieser DM, West A, Chapman P, Lawford R, Cheek JA. Understanding parent-reported factors that influence children and young people's anxiety and depression presentations to emergency departments: A multi-site study. Emerg Med Australas 2020; 32:724-730. [PMID: 32096307 DOI: 10.1111/1742-6723.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Victorian ED data show increased presentations for anxiety and depression in children. We aimed to determine parent-reported factors contributing to these presentations. METHODS Qualitative study with parents of children and young people aged 0-17 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression (excluding self-harm or suicide attempt). Eligible parents completed semi-structured phone interviews, which were audio-recorded and transcribed. Transcripts were coded and qualitatively analysed using thematic analysis. RESULTS Seventy parents completed interviews. The average age of children and young people was 14 years (standard deviation 2.4) and 63% (n = 44) identified as female. Thirty (43%) children received a primary diagnosis of depression, compared to 40 (57%) children who received a primary diagnosis of anxiety. The majority of respondents were mothers (n = 59; 84%). Key themes as to why families presented to EDs included: listening to trusted professionals, desperation, a feeling of no alternative, respecting their child's need to feel safe and to rule out a potentially serious medical condition. CONCLUSIONS Parents bring their children to the ED for many reasons. Policy makers, managers and clinicians should work with parents to develop alternative approaches that provide families with community-based support, particularly for younger children and after hours, in order to provide an appropriate source of care for children and young people with anxiety and depression.
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Affiliation(s)
- Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ann-Siobhan Connolly
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Dunlop
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Prescilla Perera
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel O'Loughlin
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephanie J Brown
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Department of Paediatric Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Pauline Chapman
- Department of Emergency Medicine, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Robyn Lawford
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John A Cheek
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
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17
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Ehrig S, Schamberger B, Bidan CM, West A, Jacobi C, Lam K, Kollmannsberger P, Petersen A, Tomancak P, Kommareddy K, Fischer FD, Fratzl P, Dunlop JWC. Surface tension determines tissue shape and growth kinetics. Sci Adv 2019; 5:eaav9394. [PMID: 31535019 PMCID: PMC6739108 DOI: 10.1126/sciadv.aav9394] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 08/15/2019] [Indexed: 05/23/2023]
Abstract
The collective self-organization of cells into three-dimensional structures can give rise to emergent physical properties such as fluid behavior. Here, we demonstrate that tissues growing on curved surfaces develop shapes with outer boundaries of constant mean curvature, similar to the energy minimizing forms of liquids wetting a surface. The amount of tissue formed depends on the shape of the substrate, with more tissue being deposited on highly concave surfaces, indicating a mechano-biological feedback mechanism. Inhibiting cell-contractility further revealed that active cellular forces are essential for generating sufficient surface stresses for the liquid-like behavior and growth of the tissue. This suggests that the mechanical signaling between cells and their physical environment, along with the continuous reorganization of cells and matrix is a key principle for the emergence of tissue shape.
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Affiliation(s)
- S. Ehrig
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - B. Schamberger
- Paris-Lodron University of Salzburg, Department of the Chemistry and Physics of Materials, Salzburg, Austria
| | - C. M. Bidan
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
- Université Grenoble Alpes, CNRS, Laboratoire Interdisciplinaire de Physique (LIPhy), Grenoble, France
| | - A. West
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - C. Jacobi
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - K. Lam
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - P. Kollmannsberger
- Center for Computational and Theoretical Biology, University of Würzburg, Germany
| | - A. Petersen
- Berlin-Brandenburg Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - P. Tomancak
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany
| | - K. Kommareddy
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - F. D. Fischer
- Montanuniversität Leoben, Institute of Mechanics, Leoben, Austria
| | - P. Fratzl
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - John W. C. Dunlop
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
- Paris-Lodron University of Salzburg, Department of the Chemistry and Physics of Materials, Salzburg, Austria
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Craig SS, Seith RW, Cheek JA, Wilson K, Egerton-Warburton D, Paul E, West A. Lidocaine and phenylephrine versus saline placebo nasal spray for the pain and distress of nasogastric tube insertion in young children and infants: a randomised, double-blind, controlled trial. The Lancet Child & Adolescent Health 2019; 3:391-397. [DOI: 10.1016/s2352-4642(19)30058-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/24/2022]
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Walker K, Ben-Meir M, Dunlop W, Rosler R, West A, O'Connor G, Chan T, Badcock D, Putland M, Hansen K, Crock C, Liew D, Taylor D, Staples M. Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial. BMJ 2019; 364:l121. [PMID: 30700408 PMCID: PMC6353062 DOI: 10.1136/bmj.l121] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. DESIGN Randomised, multicentre clinical trial. SETTING Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. PARTICIPANTS 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. INTERVENTIONS Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. MAIN OUTCOME MEASURES Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. RESULTS Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. CONCLUSIONS Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. TRIAL REGISTRATION ACTRN12615000607572 (pilot site); ACTRN12616000618459.
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Affiliation(s)
- Katherine Walker
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Ben-Meir
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - William Dunlop
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Australian National University, Canberra, ACT, Australia
| | - Rachel Rosler
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
| | - Adam West
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
| | | | - Thomas Chan
- Emergency Department, Austin Health, Heidelberg, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Diana Badcock
- Emergency Department, Bendigo Health, Bendigo, VIC, Australia
| | - Mark Putland
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
- Emergency Department, Bendigo Health, Bendigo, VIC, Australia
- Emergency Department, Melbourne Health, Parkville, VIC, Australia
| | - Kim Hansen
- Emergency Department, Prince Charles Hospital, Chermside, QLD, Australia
- Emergency Department, St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Carmel Crock
- Emergency Department, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Taylor
- University of Melbourne, Melbourne, VIC, Australia
- Emergency Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Margaret Staples
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Biostatistics, Cabrini Institute, Malvern, VIC, Australia
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West A. Heterogeneous catalysis: No metal is an island. Nat Rev Chem 2018. [DOI: 10.1038/s41570-018-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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West A. Heterogeneous catalysis: Tuning up a hybrid catalyst. Nat Rev Chem 2018. [DOI: 10.1038/s41570-018-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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West A. Intermolecular Forces and Solvation. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/b978-0-12-801970-2.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Cheek JA, Braitberg G, Craig S, West A. Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department. J Paediatr Child Health 2017; 53:451-457. [PMID: 28195435 DOI: 10.1111/jpc.13482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. METHODS A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. RESULTS There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). CONCLUSIONS We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs.
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Affiliation(s)
- John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - George Braitberg
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Craig
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
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Abstract
Details on the 28-year treatment history of a patient with an endocrine-responsive breast cancer are provided. She was originally diagnosed as having a T1N0M0 cancer after a modified radical mastectomy at age 41. Fifteen years later, in 1998, she presented with hemoptysis and pleuritic chest pain: a 10 cm right atrial tumor and estrogen receptor (ER) positive endobronchial and adjacent lung parenchyma adenocarcinoma were documented. Epithelial markers normalized as she manifested a partial response (PR) lasting 3 years with tamoxifen treatment. From 2001 to 2007 she benefitted from exemestane treatment. Upon progression in the previous lung area and left adrenal, exemestane withdrawal led to transient decrease in markers. Six months later (in July 2008), with growth in her adrenal tumor, laparoscopic adrenalectomy was performed: in addition to ER positivity, the tumor showed Her2 overexpression and amplification. She has subsequently had some control of disease with fulvestrant, letrozole + trastuzumab, and subsequently letrozole + lapatinib. In addition to the chronicity of disease, this history illustrates the expanding range of treatments available for endocrine-responsive breast cancer commensurate to our greater understanding of tumor biology.
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Affiliation(s)
| | | | - F Muggia
- Correspondence to: F Muggia. E-mail:
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Sivakumar P, Curley D, Rahman NM, Lee YCG, Feller-Kopman D, West A, Ahmed L. P7 Clinicians’ perspectives of health related quality of life and priorities in deciding management for malignant pleural effusion. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sivakumar P, Douiri A, West A, Rao D, Warwick G, Chen T, Ahmed L. OPTIMUM: a protocol for a multicentre randomised controlled trial comparing Out Patient Talc slurry via Indwelling pleural catheter for Malignant pleural effusion vs Usual inpatient Management. BMJ Open 2016; 6:e012795. [PMID: 27798020 PMCID: PMC5073842 DOI: 10.1136/bmjopen-2016-012795] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The development of malignant pleural effusion (MPE) results in disabling breathlessness, pain and reduced physical capability with treatment a palliative strategy. Ambulatory management of MPE has the potential to improve quality of life (QoL). The OPTIMUM trial is designed to determine whether full outpatient management of MPE with an indwelling pleural catheter (IPC) and pleurodesis improves QoL compared with traditional inpatient care with a chest drain and talc pleurodesis. OPTIMUM is currently open for any centres interested in collaborating in this study. METHODS AND ANALYSIS OPTIMUM is a multicentre non-blinded randomised controlled trial. Patients with a diagnosis of MPE will be identified and screened for eligibility. Consenting participants will be randomised 1:1 either to an outpatient ambulatory pathway using IPCs and talc pleurodesis or standard inpatient treatment with chest drain and talc pleurodesis as per British Thoracic Society guidelines. The primary outcome measure is global health-related QoL at 30 days measured using the EORTC QLQ-C30 questionnaire. Secondary outcome measures include breathlessness and pain measured using a 100 mm Visual Analogue Scale and health-related QoL at 60 and 90 days. A sample size of 142 patients is needed to demonstrate a clinically significant difference of 8 points in global health status at 30 days, for an 80% power and a 5% significance level. ETHICS AND DISSEMINATION The study has been approved by the NRES Committee South East Coast-Brighton and Sussex (reference 15/LO/1018). The trial results will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBERS UKCRN19615 and ISRCTN15503522; Pre-results.
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Affiliation(s)
- P Sivakumar
- St Thomas’ Hospital, London, UK
- King's College London, London, UK
| | - A Douiri
- King's College London, London, UK
| | - A West
- St Thomas’ Hospital, London, UK
| | - D Rao
- Princess Royal University Hospital, Orpington, UK
| | | | - T Chen
- King's College London, London, UK
| | - L Ahmed
- St Thomas’ Hospital, London, UK
- King's College London, London, UK
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West A. One register to rule them all: Emergency Medicine Events Register? Emerg Med Australas 2016; 28:760. [PMID: 27748015 DOI: 10.1111/1742-6723.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Adam West
- School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
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Elias M, Long H, Newman C, Wilson P, West A, McGill P, Wu K, Donaldson M, Reynolds N. 127 Proteomic analysis of filaggrin deficiency identifies molecular signatures characteristic of atopic eczema. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, Carmona SA, Moors I, Mokart D, Pène F, Lambert J, Meleti DE, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne L, Rabbat A, Lebert C, Perez P, Chaize M, Kafetzopoulos D, Renault A, Meert AP, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V, Azoulay E, Benoit D, Georgopoulos D, Martins-Branco D, Sousa M, Marum S, Bouw MJ, Galstyan G, Makarova P, Parovichnikova E, Kuzmina L, Troitskaya V, Drize N, Briassoulis G, Gemdzhian E, Savchenko V, Chao HC, Kılıc E, Demiriz B, Uygur ML, Sürücü M, Cınar K, Yıldırım AE, Kiss K, Suberviola B, Köves B, Csernus V, Molnár Z, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Riera J, Gaffney S, Black E, Docking R, Judge C, Drew T, Misran H, Munshi R, McGovern L, Coyle M, Dunne L, Rellan L, Deasy E, Lavin P, Fahy A, Darcy DM, Donnelly M, Ismail NH, Hall T, Wykes K, Jack J, Ngu WC, Sanchez M, Morgan P, Ruiz-Ramos J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andrés JL, Castellanos A, 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Creteur J, Funcke S, Groesdonk H, Saugel B, Wagenpfeil G, Wagenpfeil S, Reuter DA, Fernandez MM, Fernandez R, Magret M, González-Castro A, Bouza MT, Ibañez M, García C, Balerdi B, Mas A, Arauzo V, Añón JM, Ruiz F, Ferreres J, Tomás R, Alabert M, Tizón AI, Altaba S, Llamas N, Goligher EC, Fan E, Herridge M, Vorona S, Sklar M, Dres M, Rittayamai N, Lanys A, Urrea C, Tomlinson G, Reid WD, Rubenfeld GD, Kavanagh BP, Brochard LJ, Ferguson ND, Neto AS, de Abreu MG, Pelosi P, Schultz MJ, Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM, Rolland-Debord C, Bureau C, Poitou T, Clavel M, Perbet S, Terzi N, Kouatchet A, Similowski T, Demoule A, Hunfeld N, Trogrlic Z, Ladage S, Osse RJ, Koch B, Rietdijk W, Devlin J, van der Jagt M, Picetti E, Ceccarelli P, Mensi F, Malchiodi L, Risolo S, Rossi I, Antonini MV, Servadei F, Caspani ML, Roquilly A, Lasocki S, Seguin P, Geeraerts T, Perrigault PF, Dahyot-Fizelier C, Paugam-Burtz C, Cook F, Cinotti R, dit Latte DD, Mahe PJ, Fortuit C, Feuillet F, Asehnoune K, Marzorati C, Spina S, Scaravilli V, Vargiolu A, Riva M, Giussani C, Sganzerla E, Citerio G, Barbadillo S, de Molina FJG, Álvarez-Lerma F, Rodríguez A, Zakharkina T, Martin-Loeches I, Matamoros S, Povoa P, Torres A, Kastelijn J, Hofstra JJ, de Jong M, Schultz M, Sterk P, Artigas A, Bos LJ, Moreau AS, Martin-Loeches I, Povoa P, Salluh J, Rodriguez A, Nseir S, de Jong E, van Oers JA, Beishuizen A, Girbes ARJ, Nijsten MWN, de Lange DW, Bonvicini D, Labate D, Benacchio L, Olivieri A, Pizzirani E, Lopez-Delgado JC, Gonzalez-Romero M, Fuentes-Mila V, Berbel-Franco D, Romera-Peregrina I, Martinez-Pascual A, Perez-Sanchez J, Abellan-Lencina R, Ávila-Espinoza RE, Moreno-Gonzalez G, Sbraga F, Griffiths S, Grocott MPW, Creagh-Brown B, Doyle J, Wilkerson P, Soon Y, Huddart S, Dickinson M, Riga A, Zuleika A, Miyamoto K, Kawazoe Y, Morimoto T, Yamamoto T, Fuke A, Hashimoto A, Koami H, Beppu S, Katayama Y, Ito M, Ohta Y, Yamamura H, Rygård SL, Holst LB, Wetterslev J, Johansson PI, Perner A, Soliman IW, de Lange DW, van Dijk D, van Delden JJM, Cremer OL, Slooter AJC, Peelen LM, McWilliams D, Snelson C, Neves AD, Loudet CI, Busico M, Vazquez D, Villalba D, Veronesi M, Lischinsky A, López FJL, Mori LB, Plotnikow G, Díaz A, Giannasi S, Hernandez R, Krzisnik L, Cecotti C, Viola L, Lopez R, Sottile JP, Benavent G, Estenssoro E, Chen CM, Lai CC, Cheng KC, Chou W, Chan KS, Roeker LE, Horkan CM, Gibbons FK, Christopher KB, Weijs PJM, Mogensen KM, Rawn JD, Robinson MK, Christopher KB, Tang Z, Qiu C, Ouyang B, Cai C, Guan X, Regueira T, Cea L, Carlos SJ, Elisa B, Puebla C, Vargas A, Poulsen MK, Thomsen LP, Kjærgaard S, Rees SE, Karbing DS, Wollersheim T, Frank S, Müller MC, Carbon NM, Skrypnikov V, Pickerodt PA, Falk R, Mahlau A, Weber-Carstens S, Lee A, Inglis R, Morgan R, Barker G, Kamata K, Abe T, Saitoh D, Tokuda Y, Green RS, Butler MB, Erdogan M, Hwa HT, Gil LJ, Vaquero RH, Rodriguez-Ruiz E, Lago AL, Allut JLG, Gestal AE, Gonzalez MAG, Thomas-Rüddel DO, Schwarzkopf D, Fleischmann C, Reinhart K, Suwanpasu S, Sattayasomboon Y, Filho NMF, Oliveira JCA, Ballalai CS, De Lucia CV, Araponga GP, Veiga LN, Silva CS, Garrido ME, Ramos BB, Ricaldi EF, Gomes SS, Gemmell L, MacKay A, Wright C, Docking RI, Doherty P, Black E, Stenhouse P, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Yatabe T, Inoue S, Sakaguchi M, Egi M, Abdelhamid YA, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Hokka M, Egi M, Mizobuchi S, Kar P, Plummer M, Abdelhamid YA, Giersch E, Summers M, Hatzinikolas S, Heller S, Chapman M, Jones K, Horowitz M, Deane A, Schweizer R, Jacquet-Lagreze M, Portran P, Junot S, Allaouchiche B, Fellahi JL, Guerci P, Ergin B, Kapucu A, Ince C, Cioccari L, Luethi N, Crisman M, Bellomo R, Mårtensson J, Shinotsuka CR, Fagnoul D, Brasseur A, Orbegozo D, Vincent JL, Preiser JC, Preiser JC, Lheureux O, Thooft A, Brimioulle S, Vincent JL, Iwasaka H, Tahara S, Nagamine M, Ichigatani A, Cabrera AR, Zepeda EM, Granillo JF, Sánchez JSA, Montoya AAT, Montenegro AP, Blanco GAG, Robles CMC, Drolz A, Horvatits T, Roedl K, Rutter K, Kluge S, Funk GC, Schneeweiss B, Fuhrmann V, Sabetian G, Pooresmaeel F, Zand F, Ghaffaripour S, Farbod A, Tabei H, Taheri L, Anandanadesan R, Metaxa V, Teixeira C, Pereira SM, Hernández-Marrero P, Carvalho AS, Beckmann M, Hartog CS, Schwarzkopf D, Raadts A, Robertsen A, Førde R, Skaga NO, Helseth E, Honeybul S, Ho K, Lopez PM, Gonzalez MN, Ortega PN, Sola EC, Spasova T, de la Torre-Prados MV, Kopecky O, Rusinova K, Waldauf P, Cepeplikova Z, Balik M, Domínguez JP, Almudevar PM, Carmona SA, Muñoz JJR, Castañeda DP, Abellán AN, Villamizar PR, Ramos JV, Pérez LP, Lucendo AP, Ejarque MC, Estella A, Camps VL, Martín MC, Masnou N, Barbosa S, Varela A, Palma I, Cristina L, Nunes E, Pereira I, Campello G, Granja C, Pande R, Pandey M, Varghese S, Chanu M, Van Dam MJ, Ter Braak EWMT, Estella A, Gracia M, Viciana R, Recuerda M, Fontaiña LP, Tharmalingam B, Kovari F, Rose L, Mcginlay M, Amin R, Burns K, Connolly B, Hart N, Jouvet P, Katz S, Leasa D, Mawdsley C, Mcauley D, Schultz M, Blackwood B, Denham S, Worrall R, Arshad M, Isherwood P, Khadjibaev A, Sabirov D, Rosstalnaya A, Parpibaev F, Sharipova V, Blanco GAG, Guzman CIO, Sánchez JSA, Granillo JF, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Shafi M, Tomar DS, Harne R, Arora DP, Talwar N, Mazumdar S, Cha YS, Lee SJ, Tyagi N, Rajput RK, Taneja S, Singh VK, Sharma SC, Mittal S, Rao BK, Ayachi J, Fraj N, Romdhani S, Khedher A, Meddeb K, Sma N, Azouzi A, Bouneb R, Chouchene I, El Ghardallou M, Boussarsar M, Jennings R, Walter E, Ribeiro JM, Moniz I, Marçal R, Santos AC, Candeias C, e Silva ZC, Gomez SEZ, Nieto ORP, Gonzalez JAC, Cuellar AIV, Mildh H, Pettilä V, Korhonen AM, Karlsson S, Ala-Kokko T, Reinikainen M, Vaara ST, Zaleska-Kociecka M, Grabowski M, Dąbrowski M, Wozniak S, Piotrowska K, Banaszewski M, Imiela J. ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cheng DR, McCartney LE, West A, Craig SS. Effect of a pager notification system on Australasian Triage Scale category 2 patients in a paediatric emergency department. Emerg Med Australas 2016; 28:434-8. [PMID: 27197755 DOI: 10.1111/1742-6723.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/29/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Australasian EDs have introduced innovative processes to ensure safe and timely management of patients. Our ED introduced a dedicated pager system to provide rapid assessment of Australasian Triage Scale (ATS) category 2 patients in an attempt to expedite ED care. The present paper aims to evaluate the impact of this initiative on time to clinician, ED length of stay (LOS) and clinical outcomes in a tertiary paediatric ED. METHODS Retrospective structured chart review on patients presenting in a 2 month period before the intervention (August-September 2009) and the same time 1 year later. Patients were grouped into common ATS category 2 presentations and analysed in these subcategories. Clinical indicators of appropriate and timely performance were selected from best practice performance guidelines. RESULTS 779 ATS category 2 patients were seen during the two periods: 370 pre-intervention and 409 post-intervention. The overall percentage of ATS category 2 patients seen within the target time increased by 22.3%, although there was no significant change in ED LOS. The median time for patients from triage to being seen by an ED clinician improved from 10 to 6 min (P < 0.01). However, we were unable to demonstrate an impact of the pager system on various clinical quality indicators. CONCLUSIONS The rapid assessment pager system proved beneficial in reducing triage to clinician times for ATS category 2 patients but showed no improvement in overall ED LOS or disease-specific clinical quality indicators. Further research is needed to determine the influence of other components of ED functioning on clinical outcomes, as well as the overall clinical impact a pager system has on other measures of quality such as patient satisfaction and other subgroups of patients.
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Affiliation(s)
- Daryl R Cheng
- Monash Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Laura E McCartney
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Adam West
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Emergency, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Simon S Craig
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Emergency, Monash Medical Centre, Melbourne, Victoria, Australia
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Affiliation(s)
- Simon S Craig
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Patel E, Cicatiello P, Deininger L, Clench MR, Marino G, Giardina P, Langenburg G, West A, Marshall P, Sears V, Francese S. A proteomic approach for the rapid, multi-informative and reliable identification of blood. Analyst 2016; 141:191-8. [DOI: 10.1039/c5an02016f] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Blood evidence is frequently encountered at the scene of violent crimes and can provide valuable intelligence in the forensic investigation of serious offences.
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Affiliation(s)
- E. Patel
- Biomolecular Research Centre
- Sheffield Hallam University
- Sheffield
- UK
| | - P. Cicatiello
- Dipartimento di Scienze Chimiche
- Universita’ di Napoli Federico II
- via Cinthia I-80126 Naples
- Italy
| | - L. Deininger
- Biomolecular Research Centre
- Sheffield Hallam University
- Sheffield
- UK
| | - M. R. Clench
- Biomolecular Research Centre
- Sheffield Hallam University
- Sheffield
- UK
| | - G. Marino
- Dipartimento di Scienze Chimiche
- Universita’ di Napoli Federico II
- via Cinthia I-80126 Naples
- Italy
| | - P. Giardina
- Dipartimento di Scienze Chimiche
- Universita’ di Napoli Federico II
- via Cinthia I-80126 Naples
- Italy
| | | | | | | | - V. Sears
- Centre for Applied Science and Technology
- St Albans
- UK
| | - S. Francese
- Biomolecular Research Centre
- Sheffield Hallam University
- Sheffield
- UK
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Malmberg LE, Lewis S, West A, Murray E, Sylva K, Stein A. The influence of mothers' and fathers' sensitivity in the first year of life on children's cognitive outcomes at 18 and 36 months. Child Care Health Dev 2016; 42:1-7. [PMID: 26538379 DOI: 10.1111/cch.12294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 08/21/2015] [Accepted: 09/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been increasing interest in the relative effects of mothers' and fathers' interactions with their infants on later development. However to date there has been little work on children's cognitive outcomes. METHODS We examined the relative influence of fathers' and mothers' sensitivity during interactions with their children at the end of the child's first year (10-12 months, n = 97), on child general cognitive development at 18 months and language at 36 months. RESULTS Both parents' sensitivity was associated with cognitive and language outcomes in univariate analyses. Mothers' sensitivity, however, appeared to be associated with family socio-demographic factors to a greater extent that fathers' sensitivity. Using path modelling the effect of paternal sensitivity on general cognitive development at 18 months and language at 36 months was significantly greater than the effect of maternal sensitivity, when controlling for socio-demographic background. In relation to language at 36 months, there was some evidence that sensitivity of one parent buffered the effect of lower sensitivity of the other parent. CONCLUSIONS These findings suggest that parental sensitivity can play an important role in children's cognitive and language development, and that higher sensitivity of one parent can compensate for the lower sensitivity of the other parent. Replication of these findings, however, is required in larger samples.
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Affiliation(s)
- L-E Malmberg
- Department of Education, University of Oxford, Oxford, UK
| | - S Lewis
- Simmons House Adolescent Unit, Whittington Health NHS, London, UK
| | - A West
- Berkshire Healthcare NHS Trust, Reading, UK
| | - E Murray
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - K Sylva
- Department of Education, University of Oxford, Oxford, UK
| | - A Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
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Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, West A, Hettiarachchi G, Mukherjee D, Samuel J, Bentley A, Dowson L, Miles J, Ryan F, Yoneda K, Chauhan A, Corcoran J, Psallidas I, Wrightson JM, Hallifax R, Davies HE, Lee YCG, Hedley EL, Seaton D, Russell N, Chapman M, McFadyen BM, Shaw RA, Davies RJO, Maskell NA, Nunn AJ, Miller RF. S20 Primary Result of the 1st Therapeutic Interventions in Malignant Effusion (TIME1) Trial: A 2 × 2 factorial, randomised trial of chest tube size and analgesic strategy for pleurodesis in malignant pleural effusion. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Samuel M, Sivakumar P, West A. P178 Ambulatory care of primary spontaneous pneumothorax with a Pneumostat device – cost effective and safe. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Craig SS, Cheek JA, Seith RW, West A, Goldie N. Re: Accuracy and interrater reliability of paediatric emergency department triage. Emerg Med Australas 2015; 27:620-621. [PMID: 26567014 DOI: 10.1111/1742-6723.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Simon S Craig
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - John A Cheek
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Robert W Seith
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Neil Goldie
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Emergency Department, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
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Cheek JA, Craig SS, Seith RW, West A. Urine collection in young children. Emerg Med Australas 2015; 27:348-50. [PMID: 26114831 DOI: 10.1111/1742-6723.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- John A Cheek
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Simon S Craig
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Robert W Seith
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Craig SS, Seith RW, Cheek JA, West A, Wilson K, Egerton-Warburton D. Lignocaine/phenylephrine nasal spray vs. placebo for the pain and distress of nasogastric tube insertion in children: a study protocol for a randomized controlled trial. Trials 2015; 16:30. [PMID: 25622681 PMCID: PMC4318482 DOI: 10.1186/s13063-015-0547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/31/2014] [Indexed: 12/01/2022] Open
Abstract
Background Patients and clinicians consistently rate insertion of a nasogastric tube (NGT) as one of the most painful and distressing emergency department procedures. Despite this, surveys of emergency clinicians suggest that provision of adequate procedural analgesia is often inconsistent and suboptimal. While many studies have demonstrated the effectiveness of various interventions to reduce pain and distress in adults, there have been few studies in the pediatric population. There are currently no studies comparing the effectiveness of a local anesthetic nasal spray for the prevention of the pain and distress associated with NGT insertion in children. This study aims to compare the analgesic efficacy of a proprietary preparation of lignocaine/phenylephrine nasal spray and placebo for this indication. Methods/Design This is a prospective, randomized, controlled, double-blind superiority trial of 100 children aged 6 months to 5 years weighing at least 6 kg in whom a nasogastric tube is planned to be inserted. These children will be randomized to either intranasal lignocaine/phenylephrine or placebo. Pain severity is the primary outcome measure and will be measured utilizing the Face, Legs, Arms, Cry and Consolability (FLACC) pain severity rating scale. An independent staff member not involved in inserting the NGT and the child’s parents or carer will also record pain and distress on a visual analog scale (VAS). FLACC scores and VAS scores will be presented as median and interquartile range (IQR). Non-normally distributed scores will be compared using a Wilcoxon rank-sum test. Categorical data will be analyzed using Fisher’s exact test. Adverse events will be described as type and incidence. Discussion Previous studies on NGT insertion have not focused on the pediatric population. This study aims to establish the effectiveness of a simple intranasal spray of lignocaine/phenylephrine in children undergoing NGT insertion. A positive result of this study would provide evidence of an effective intervention in a procedure considered by many to be very painful and distressing. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12614000092695, registered on 23 January 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0547-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon S Craig
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. .,Murdoch Children's Research Institute, Parkville, Australia.
| | - Robert W Seith
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - John A Cheek
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. .,Murdoch Children's Research Institute, Parkville, Australia. .,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Australia.
| | - Adam West
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - Kathryn Wilson
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - Diana Egerton-Warburton
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
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Andrews SL, Lewena S, Oberender F, Babl FE, West A, Hopper SM. Management of retrieval service patients within a paediatric emergency department. Emerg Med Australas 2014; 26:596-601. [PMID: 25330909 DOI: 10.1111/1742-6723.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Victorian Paediatric Emergency Transport Service (PETS) transports critically unwell children to tertiary paediatric hospitals. Children not directly admitted to ICU go to a tertiary ED. These patients might require prolonged and high-level care. In light of the National Emergency Access Target, we describe this cohort, clinical care needs and process measures. METHODS A retrospective chart review of patients retrieved by PETS to the Royal Children's Hospital (Melbourne, Australia) ED in 2012. Demographics, illness parameters and process measures were extracted. The ED length of stay (LOS) and time to ward suitability (time at which physiological parameters stabilised and high acuity treatments ceased) were related to patient and illness characteristics. Data are presented descriptively and analysed using spss. RESULTS In 2012, 120 patients were transported to the ED. Conditions included lower respiratory (44), neurological (28), upper respiratory (16) and trauma (14). The median ED LOS was 4.8 h (interquartile range 2.9, 7.7). On arrival, 73 (60.8%) were ward-suitable, but 51 (43%) had LOS less than 4 h. Twenty-five (20.8%) patients stayed longer than 8 h. Administrative delay (principally bed block) is responsible for the bulk of the LOS; however, 25 (20.8%) had markedly abnormal vital signs after 4 h of ED care, mainly patients with lower respiratory tract disease. CONCLUSION Most patients retrieved to the ED ultimately go to a ward rather than ICU and most have an ED stay in excess of National Emergency Access Target. Several retrieval associated care issues, such as timely and appropriate ward disposition, can be addressed by administrative changes.
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Affiliation(s)
- Sarah L Andrews
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Mayland CR, Lees C, West A, Cox T, Mason SR, Ellershaw JE. SUPPORTING PATIENTS AND THEIR FAMILIES WHO WISH TO DIE AT HOME - BEREAVED RELATIVES' VIEWS ABOUT THE CARE AND SUPPORT RECEIVED. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bowley DM, Gillingham S, Mercer S, Schrager JJ, West A. Pneumoperitoneum without visceral trauma: an under-recognised phenomenon after blast injury? J ROY ARMY MED CORPS 2013; 159:312-3. [PMID: 24277924 DOI: 10.1136/jramc-2013-000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The management of patients who have sustained blast injuries poses an important challenge for military healthcare professionals. Current military operations are generating large numbers of casualties and modern military healthcare facilities are increasingly using CT scanning to facilitate their management. This small case series serves to draw attention to a rare (or possibly under-reported) phenomenon after blast injury. METHODS AND RESULTS We report two patients exposed to blast who had pneumoperitoneum identified by CT scan but who did not have abdominal visceral injury or ballistic peritoneal violation. DISCUSSION The use of cross-sectional imaging is leading to the recognition of otherwise occult injury. Military practitioners should be aware of this injury pattern when using CT to help select patients for conservative management after abdominal blast injury.
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Yu KMK, Tong W, West A, Cheung K, Li T, Smith G, Guo Y, Tsang SCE. Non-syngas direct steam reforming of methanol to hydrogen and carbon dioxide at low temperature. Nat Commun 2013. [PMID: 23187630 DOI: 10.1038/ncomms2242] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A non-syngas direct steam reforming route is investigated for the conversion of methanol to hydrogen and carbon dioxide over a CuZnGaO(x) catalyst at 150-200 °C. This route is in marked contrast with the conventional complex route involving steam reformation to syngas (CO/H2) at high temperature, followed by water gas shift and CO cleanup stages for hydrogen production. Here we report that high quality hydrogen and carbon dioxide can be produced in a single-step reaction over the catalyst, with no detectable CO (below detection limit of 1 ppm). This can be used to supply proton exchange membrane fuel cells for mobile applications without invoking any CO shift and cleanup stages. The working catalyst contains, on average, 3-4 nm copper particles, alongside extremely small size of copper clusters stabilized on a defective ZnGa2O4 spinel oxide surface, providing hydrogen productivity of 393.6 ml g(-1)-cat h(-1) at 150 °C.
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Affiliation(s)
- Kai Man Kerry Yu
- Wolfson Catalysis Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, UK
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Tong W, West A, Cheung K, Yu KM, Tsang SCE. Dramatic Effects of Gallium Promotion on Methanol Steam Reforming Cu–ZnO Catalyst for Hydrogen Production: Formation of 5 Å Copper Clusters from Cu–ZnGaOx. ACS Catal 2013. [DOI: 10.1021/cs400011m] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Weiyi Tong
- Wolfson Catalysis
Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, United Kingdom
- Lab for Advanced Materials, Research Institute of Industrial Catalysis, East China University of Science & Technology, Meilong Road 130, Shanghai 200237, China
| | - Adam West
- Wolfson Catalysis
Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, United Kingdom
| | - Kevin Cheung
- Wolfson Catalysis
Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, United Kingdom
| | - Kai-Man Yu
- Wolfson Catalysis
Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, United Kingdom
| | - Shik Chi Edman Tsang
- Wolfson Catalysis
Centre, Department of Chemistry, University of Oxford, South Parks Road, Oxford, OX1 3QR, United Kingdom
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West A, Dupré SM, Yu L, Paton IR, Miedzinska K, McNeilly AS, Davis JRE, Burt DW, Loudon ASI. Npas4 is activated by melatonin, and drives the clock gene Cry1 in the ovine pars tuberalis. Mol Endocrinol 2013; 27:979-89. [PMID: 23598442 PMCID: PMC3689899 DOI: 10.1210/me.2012-1366] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Seasonal mammals integrate changes in the duration of nocturnal melatonin secretion to drive annual physiologic cycles. Melatonin receptors within the proximal pituitary region, the pars tuberalis (PT), are essential in regulating seasonal neuroendocrine responses. In the ovine PT, melatonin is known to influence acute changes in transcriptional dynamics coupled to the onset (dusk) and offset (dawn) of melatonin secretion, leading to a potential interval-timing mechanism capable of decoding changes in day length (photoperiod). Melatonin offset at dawn is linked to cAMP accumulation, which directly induces transcription of the clock gene Per1. The rise of melatonin at dusk induces a separate and distinct cohort, including the clock-regulated genes Cry1 and Nampt, but little is known of the up-stream mechanisms involved. Here, we used next-generation sequencing of the ovine PT transcriptome at melatonin onset and identified Npas4 as a rapidly induced basic helix-loop-helix Per-Arnt-Sim domain transcription factor. In vivo we show nuclear localization of NPAS4 protein in presumptive melatonin target cells of the PT (α-glycoprotein hormone-expressing cells), whereas in situ hybridization studies identified acute and transient expression in the PT of Npas4 in response to melatonin. In vitro, NPAS4 forms functional dimers with basic helix loop helix-PAS domain cofactors aryl hydrocarbon receptor nuclear translocator (ARNT), ARNT2, and ARNTL, transactivating both Cry1 and Nampt ovine promoter reporters. Using a combination of 5′-deletions and site-directed mutagenesis, we show NPAS4-ARNT transactivation to be codependent upon two conserved central midline elements within the Cry1 promoter. Our data thus reveal NPAS4 as a candidate immediate early-response gene in the ovine PT, driving molecular responses to melatonin.
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Affiliation(s)
- A West
- University of Manchester, Manchester M13 9PT, UK
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McGhee DJM, Royle PL, Counsell CE, Abbas A, Sethi P, Manku L, Narayan A, Clegg K, Bardai A, Brown SHM, Hafeez U, Abdelhafiz AH, McGovern A, Breckenridge A, Seenan P, Samani A, Das S, Khan S, Puffett AJ, Morgan J, Ross G, Cantlay A, Khan N, Bhalla A, Sweeting M, Nimmo CAMD, Fleet J, Igbedioh C, Harari D, Downey CL, Handforth C, Stothard C, Cracknell A, Barnes C, Shaw L, Bainbridge L, Crabtree L, Clark T, Root S, Aitken E, Haroon K, Sudlow M, Hanley K, Welsh S, Hill E, Falconer A, Miller H, Martin B, Tidy E, Pendlebury S, Thompson S, Burnett E, Taylor H, Lonan J, Adler B, McCallion J, Sykes E, Bancroft R, Tullo ES, Young TJ, Clift E, Flavin B, Roberts HC, Sayer AA, Belludi G, Aithal S, Verma A, Singh I, Barne M, Wilkinson I, Sakoane R, Singh N, Wilkinson I, Cottee M, Irani TS, Martinovic O, Abdulla AJJ, Irani TS, Abdulla AJJ, Riglin J, Husk J, Lowe D, Treml J, Vasilakis JN, Buttery A, Reid J, Healy P, Grant-Casey J, Pendry K, Richards J, Singh A, Jarrett D, Hewitt J, Slevin J, Barwell G, Youde J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Robinson D, O'Connell J, Topp JD, Topp JD, Warburton K, Simpson L, Bryce K, Suntharalingam S, Grosser K, D'Silva A, Southern L, Bielawski C, Cook L, Sutton GM, Flanagan L, Storr A, Charlton L, Kerr S, Robinson L, Shaw F, Finch LK, Weerasuriya N, Walker M, Sahota O, Logan P, Brown F, Rossiter F, Baxter M, Mucci E, Brown A, Jackson SHD, de Savary N, Hasan S, Jones H, Birrell J, Hockley J, Hensey N, Meiring R, Athavale N, Simms J, Brown S, West A, Diem P, Simms J, Brown S, West A, Diem P, Davies R, Kings R, Coleman H, Stevens D, Campbell C, Hope S, Morris A, Ong T, Harwood R, Dasgupta D, Mitchell S, Dimmock V, Collin F, Wood E, Green V, Hendrickse-Welsh N, Singh N, Cracknell A, Eccles J, Beezer J, Garside M, Baxter J. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hoit G, Hinkewich C, Tiao J, Porgo V, Moore L, Moore L, Tiao J, Wang C, Moffatt B, Wheeler S, Gillman L, Bartens K, Lysecki P, Pallister I, Patel S, Bradford P, Bradford P, Kidane B, Holmes A, Trajano A, March J, Lyons R, Kao R, Rezende-Neto J, Leblanc Y, Rezende-Neto J, Vogt K, Alzaid S, Jansz G, Andrusiek D, Andrusiek D, Bailey K, Livingston M, Calthorpe S, Hsu J, Lubbert P, Boitano M, Leeper W, Williamson O, Reid S, Alonazi N, Lee C, Rezende-Neto J, Aleassa E, Jennings P, Jennings P, Mador B, Hoffman K, Riley J, Vu E, Alburakan A, Alburakan A, Alburakan A, Mckee J, Bobrovitz N, Gabbe B, Gabbe B, Hodgkinson J, Hodgkinson J, Ali J, Ali J, Grant M, Roberts D, Holodinsky J, Cooper C, Santana M, Kruger K, Hodgkinson J, Waggott M, Da Luz L, Banfield J, Santana M, Dorigatti A, Birn K, Bobrovitz N, Zakirova R, Davies D, Das D, Gamme G, Pervaiz F, Almarhabi Y, Brainard A, Brown R, Bell N, Bell N, Jowett H, Jowett H, Bressan S, Hogan A, Watson I, Woodford S, Hogan A, Boulay R, Watson I, Howlett M, Atkinson P, Chesters A, Hamadani F, Atkinson P, Azzam M, Fraser J, Doucet J, Atkinson P, Muakkassa F, Sathivel N, Chadi S, Joseph B, Takeuchi L, Bradley N, Al Bader B, Kidane B, Harrington A, Nixon K, Veigas P, Joseph B, O’Keeffe T, Bracco D, Rezende-Neto J, Azzam M, Lin Y, Bailey K, Bracco D, Nash N, Alhabboubi M, Slobogean G, Spicer J, Heidary B, Joos E, Berg R, Berg R, Sankarankutty A, Zakrison T, Babul S, Lockhart S, Faux S, Jackson A, Lee T, Bailey K, Pemberton J, Green R, Tallon J, Moore L, Turgeon A, Boutin A, Moore L, Reinartz D, Lapointe G, Turgeon A, Stelfox H, Turgeon A, Nathens A, Neveu X, Stelfox H, Turgeon A, Nathens A, Neveu X, Moore L, Turgeon A, Bratu I, Gladwin C, Voaklander D, Lewis M, Vogt K, Eckert K, Williamson J, Stewart TC, Parry N, Gray D, L’Heureux R, Ziesmann M, Kortbeek J, Brindley P, Hicks C, Fata P, Engels P, Ball C, Paton-Gay D, Widder S, Vogt K, Hernandez-Alejandro R, Gray D, Vanderbeek L, Forrokhyar F, Anatharajah R, Howatt N, Lamb S, Sne N, Kahnamoui K, Lyons R, Walters A, Brooks C, Pinder L, Rahman S, Walters A, Kidane B, Parry N, Donnelly E, Lewell M, Mellow R, Hedges C, Morassutti P, Bulatovic R, Morassutti P, Galbraith E, McKenzie S, Bradford D, Lewell M, Peddle M, Dukelow A, Eby D, McLeod S, Bradford P, Stewart TC, Parry N, Williamson O, Fraga G, Pereira B, Sareen J, Doupe M, Gawaziuk J, Chateau D, Logsetty S, Pallister I, Lewis J, O’Doherty D, Hopkins S, Griffiths S, Palmer S, Gabbe B, Xu X, Martin C, Xenocostas A, Parry N, Mele T, Rui T, Abreu E, Andrade M, Cruz F, Pires R, Carreiro P, Andrade T, Lampron J, Balaa F, Fortuna R, Issa H, Dias P, Marques M, Fernandes T, Sousa T, Inaba K, Smith J, Okoye O, Joos E, Shulman I, Nelson J, Parry N, Rhee P, Demetriades D, Ostrofsky R, Butler-Laporte G, Chughtai T, Khwaja K, Fata P, Mulder D, Razek T, Deckelbaum D, Bailey K, Pemberton J, Evans D, Anton H, Wei J, Randall E, Sobolev B, Scott BB, van Heest R, Frankfurter C, Pemberton J, McKerracher S, Stewart TC, Merritt N, Barber L, Kimmel L, Hodgson C, Webb M, Holland A, Gruen R, Harrison K, Hwang M, Hsee L, Civil I, Muizelaar A, Baillie F, Leeper T, Stewart TC, Gray D, Parry N, Sutherland A, Hart M, Gabbe B, Tuma F, Coates A, Farrokhyar F, Faidi S, Gastaldo F, Paskar D, Reid S, Faidi S, Petrisor B, Bhandari M, Loh WL, Ho C, Chong C, Rodrigues G, Gissoni M, Martins M, Andrade M, Cunha-Melo J, Rizoli S, Abu-Zidan F, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K, Gabbe B, Simpson P, Smith K, Cox S, Cameron P, Evans D, West A, Barratt L, Rozmovits L, Livingstone B, Vu M, Griesdale D, Schlamp R, Wand R, Alhabboubi M, Alrowaili A, Alghamdi H, Fata P, Essbaiheen F, Alhabboubi M, Fata P, Essbaiheen F, Chankowsky J, Razek T, Stephens M, Vis C, Belton K, Kortbeek J, Bratu I, Dufresne B, Guilfoyle J, Ibbotson G, Martin K, Matheson D, Parks P, Thomas L, Kirkpatrick A, Santana M, Kline T, Kortbeek J, Stelfox H, Lyons R, Macey S, Fitzgerald M, Judson R, Cameron P, Sutherland A, Hart M, Morgan M, McLellan S, Wilson K, Cameron P, Sorvari A, Chaudhry Z, Khawaja K, Ali A, Akhtar J, Zubair M, Nickow J, Sorvari A, Holodinsky J, Jaeschke R, Ball C, Blaser AR, Starkopf J, Zygun D, Kirkpatrick A, Roberts D, Ball C, Blaser AR, Starkopf J, Zygun D, Jaeschke R, Kirkpatrick A, Santana M, Stelfox H, Stelfox H, Rizoli S, Tanenbaum B, Stelfox H, Redondano BR, Jimenez LS, Zago T, de Carvalho RB, Calderan TA, Fraga G, Campbell S, Widder S, Paton-Gay D, Engels P, Ferri M, Santana M, Kline T, Kortbeek J, Stelfox H, Nathens A, Lashoher A, McFarlan A, Ahmed N, Booy J, McDowell D, Nasr A, Wales P, Roberts D, Mercado M, Vis C, Kortbeek J, Kirkpatrick A, Lall R, Stelfox H, Ball C, Niven D, Dixon E, Stelfox H, Kirkpatrick A, Kaplan G, Hameed M, Ball C, Qadura M, Sne N, Reid S, Coates A, Faidi S, Veenstra J, Hennecke P, Gardner R, Appleton L, Sobolev B, Simons R, van Heest R, Hameed M, Sobolev B, Simons R, van Heest R, Hameed M, Palmer C, Bevan C, Crameri J, Palmer C, Hogan D, Grealy L, Bevan C, Palmer C, Jowett H, Boulay R, Chisholm A, Beairsto E, Goulette E, Martin M, Benjamin S, Boulay R, Watson I, Boulay R, Watson I, Watson I, Savoie J, Benjamin S, Martin M, Hogan A, Woodford S, Benjamin S, Chisholm A, Ondiveeran H, Martin M, Atkinson P, Doody K, Fraser J, Leblanc-Duchin D, Strack B, Naveed A, vanRensburg L, Madan R, Atkinson P, Boulva K, Deckelbaum D, Khwaja K, Fata P, Razek T, Fraser J, Verheul G, Parks A, Milne J, Nemeth J, Fata P, Correa J, Deckelbaum D, Bernardin B, Al Bader B, Khwaja K, Razek T, Atkinson P, Benjamin S, Sproul E, Mehta A, Galarneau M, Mahadevan P, Bansal V, Dye J, Hollingsworth-Fridlund P, Stout P, Potenza B, Coimbra R, Madan R, Marley R, Salvator A, Pisciotta D, Bridge J, Lin S, Ovens H, Nathens A, Abdo H, Dencev-Bihari R, Parry N, Lawendy A, Ibrahim-Zada I, Pandit V, Tang A, O’Keeffe T, Wynne J, Gries L, Friese R, Rhee P, Hameed M, Simons R, Taulu T, Wong H, Saleem A, Azzam M, Boulva K, Razek T, Khwaja K, Mulder D, Deckelbaum D, Fata P, Plourde M, Chadi S, Forbes T, Parry N, Martin G, Gaunt K, Bandiera G, Bawazeer M, MacKinnon D, Ahmed N, Spence J, Sankarankutty A, Nascimento B, Rizoli S, Ibrahim-Zada I, Aziz H, Tang A, Friese R, Wynne J, O’keeffe T, Vercruysse G, Kulvatunyou N, Rhee P, Sakles J, Mosier J, Wynne J, Kulvatunyou N, Tang A, Joseph B, Rhee P, Khwaja K, Fata P, Deckelbaum D, Razek T, Dias P, Issa H, Fortuna R, Sousa T, Abreu E, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Norman D, Li J, Pemberton J, Al-Oweis J, Khwaja K, Fata P, Deckelbaum D, Razek T, Albuz O, Karamanos E, Vogt K, Okoye O, Talving P, Inaba K, Demetriades D, Elhusseini M, Sudarshan M, Deckelbaum D, Fata P, Razek T, Khwaja K, MacPherson C, Sun T, Pelletier M, Hameed M, Khalil MA, Azzam M, Valenti D, Fata P, Deckelbaum D, Razek T, Brown R, Simons R, Evans D, Hameed M, Inaba K, Vogt K, Okoye O, Gelbard R, Moe D, Grabo D, Demetriades D, Inaba K, Karamanos E, Okoye O, Talving P, Demetriades D, Inaba K, Karamanos E, Pasley J, Teixeira P, Talving P, Demetriades D, Fung S, Alababtain I, Brnjac E, Luz L, Nascimento B, Rizoli S, Parikh P, Proctor K, Murtha M, Schulman C, Namias N, Goldman R, Pike I, Korn P, Flett C, Jackson T, Keith J, Joseph T, Giddins E, Ouellet J, Cook M, Schreiber M, Kortbeek J. Trauma Association of Canada (TAC) Annual Scientific Meeting. The Westin Whistler Resort & Spa, Whistler, BC, Thursday, Apr. 11 to Saturday, Apr. 13, 2013Testing the reliability of tools for pediatric trauma teamwork evaluation in a North American high-resource simulation settingThe association of etomidate with mortality in trauma patientsDefinition of isolated hip fractures as an exclusion criterion in trauma centre performance evaluations: a systematic reviewEstimation of acute care hospitalization costs for trauma hospital performance evaluation: a systematic reviewHospital length of stay following admission for traumatic injury in Canada: a multicentre cohort studyPredictors of hospital length of stay following traumatic injury: a multicentre cohort studyInfluence of the heterogeneity in definitions of an isolated hip fracture used as an exclusion criterion in trauma centre performance evaluations: a multicentre cohort studyPediatric trauma, advocacy skills and medical studentsCompliance with the prescribed packed red blood cell, fresh frozen plasma and platelet ratio for the trauma transfusion pathway at a level 1 trauma centreEarly fixed-wing aircraft activation for major trauma in remote areasDevelopment of a national, multi-disciplinary trauma crisis resource management curriculum: results from the pilot courseThe management of blunt hepatic trauma in the age of angioembolization: a single centre experienceEarly predictors of in-hospital mortality in adult trauma patientsThe impact of open tibial fracture on health service utilization in the year preceding and following injuryA systematic review and meta-analysis of the efficacy of red blood cell transfusion in the trauma populationSources of support for paramedics managing work-related stress in a Canadian EMS service responding to multisystem trauma patientsAnalysis of prehospital treatment of pain in the multisystem trauma patient at a community level 2 trauma centreIncreased mortality associated with placement of central lines during trauma resuscitationChronic pain after serious injury — identifying high risk patientsEpidemiology of in-hospital trauma deaths in a Brazilian university teaching hospitalIncreased suicidality following major trauma: a population-based studyDevelopment of a population-wide record linkage system to support trauma researchInduction of hmgb1 by increased gut permeability mediates acute lung injury in a hemorrhagic shock and resuscitation mouse modelPatients who sustain gunshot pelvic fractures are at increased risk for deep abscess formation: aggravated by rectal injuryAre we transfusing more with conservative management of isolated blunt splenic injury? A retrospective studyMotorcycle clothesline injury prevention: Experimental test of a protective deviceA prospective analysis of compliance with a massive transfusion protocol - activation alone is not enoughAn evaluation of diagnostic modalities in penetrating injuries to the cardiac box: Is there a role for routine echocardiography in the setting of negative pericardial FAST?Achievement of pediatric national quality indicators — an institutional report cardProcess mapping trauma care in 2 regional health authorities in British Columbia: a tool to assist trauma sys tem design and evaluationPatient safety checklist for emergency intubation: a systematic reviewA standardized flow sheet improves pediatric trauma documentationMassive transfusion in pediatric trauma: a 5-year retrospective reviewIs more better: Does a more intensive physiotherapy program result in accelerated recovery for trauma patients?Trauma care: not just for surgeons. Initial impact of implementing a dedicated multidisciplinary trauma team on severely injured patientsThe role of postmortem autopsy in modern trauma care: Do we still need them?Prototype cervical spine traction device for reduction stabilization and transport of nondistraction type cervical spine injuriesGoing beyond organ preservation: a 12-year review of the beneficial effects of a nonoperative management algorithm for splenic traumaAssessing the construct validity of a global disability measure in adult trauma registry patientsThe mactrauma TTL assessment tool: developing a novel tool for assessing performance of trauma traineesA quality improvement approach to developing a standardized reporting format of ct findings in blunt splenic injuriesOutcomes in geriatric trauma: what really mattersFresh whole blood is not better than component therapy (FFP:RBC) in hemorrhagic shock: a thromboelastometric study in a small animal modelFactors affecting mortality of chest trauma patients: a prospective studyLong-term pain prevalence and health related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomized controlled trialDescribing pain following trauma: predictors of persistent pain and pain prevalenceManagement strategies for hemorrhage due to pelvic trauma: a survey of Canadian general surgeonsMajor trauma follow-up clinic: Patient perception of recovery following severe traumaLost opportunities to enhance trauma practice: culture of interprofessional education and sharing among emergency staffPrehospital airway management in major trauma and traumatic brain injury by critical care paramedicsImproving patient selection for angiography and identifying risk of rebleeding after angioembolization in the nonoperative management of high grade splenic injuriesFactors predicting the need for angioembolization in solid organ injuryProthrombin complex concentrates use in traumatic brain injury patients on oral anticoagulants is effective despite underutilizationThe right treatment at the right time in the right place: early results and associations from the introduction of an all-inclusive provincial trauma care systemA multicentre study of patient experiences with acute and postacute injury carePopulation burden of major trauma: Has introduction of an organized trauma system made a difference?Long-term functional and return to work outcomes following blunt major trauma in Victoria, AustraliaSurgical dilemma in major burns victim: heterotopic ossification of the tempromandibular jointWhich radiological modality to choose in a unique penetrating neck injury: a differing opinionThe Advanced Trauma Life Support (ATLS) program in CanadaThe Rural Trauma Team Development Course (RTTDC) in Pakistan: Is there a role?Novel deployment of BC mobile medical unit for coverage of BMX world cup sporting eventIncidence and prevalence of intra-abdominal hypertension and abdominal compartment syndrome in critically ill adults: a systematic review and meta-analysisRisk factors for intra-abdominal hypertension and abdominal compartment syndrome in critically ill or injured adults: a systematic review and meta-analysisA comparison of quality improvement practices at adult and pediatric trauma centresInternational trauma centre survey to evaluate content validity, usability and feasibility of quality indicatorsLong-term functional recovery following decompressive craniectomy for severe traumatic brain injuryMorbidity and mortality associated with free falls from a height among teenage patients: a 5-year review from a level 1 trauma centreA comparison of adverse events between trauma patients and general surgery patients in a level 1 trauma centreProcoagulation, anticoagulation and fibrinolysis in severely bleeding trauma patients: a laboratorial characterization of the early trauma coagulopathyThe use of mobile technology to facilitate surveillance and improve injury outcome in sport and physical activityIntegrated knowledge translation for injury quality improvement: a partnership between researchers and knowledge usersThe impact of a prevention project in trauma with young and their learningIntraosseus vascular access in adult trauma patients: a systematic reviewThematic analysis of patient reported experiences with acute and post-acute injury careAn evaluation of a world health organization trauma care checklist quality improvement pilot programProspective validation of the modified pediatric trauma triage toolThe 16-year evolution of a Canadian level 1 trauma centre: growing up, growing out, and the impact of a booming economyA 20-year review of trauma related literature: What have we done and where are we going?Management of traumatic flail chest: a systematic review of the literatureOperative versus nonoperative management of flail chestEmergency department performance of a clinically indicated and technically successful emergency department thoracotomy and pericardiotomy with minimal equipment in a New Zealand institution without specialized surgical backupBritish Columbia’s mobile medical unit — an emergency health care support resourceRoutine versus ad hoc screening for acute stress: Who would benefit and what are the opportunities for trauma care?A geographical analysis of the Early Development Instrument (EDI) and childhood injuryDevelopment of a pediatric spinal cord injury nursing course“Kids die in driveways” — an injury prevention campaignEpidemiology of traumatic spine injuries in childrenA collaborative approach to reducing injuries in New Brunswick: acute care and injury preventionImpact of changes to a provincial field trauma triage tool in New BrunswickEnsuring quality of field trauma triage in New BrunswickBenefits of a provincial trauma transfer referral system: beyond the numbersThe field trauma triage landscape in New BrunswickImpact of the Rural Trauma Team Development Course (RTTDC) on trauma transfer intervals in a provincial, inclusive trauma systemTrauma and stress: a critical dynamics study of burnout in trauma centre healthcare professionalsUltrasound-guided pediatric forearm fracture reduction with sedation in the emergency departmentBlock first, opiates later? The use of the fascia iliaca block for patients with hip fractures in the emergency department: a systematic reviewRural trauma systems — demographic and survival analysis of remote traumas transferred from northern QuebecSimulation in trauma ultrasound trainingIncidence of clinically significant intra-abdominal injuries in stable blunt trauma patientsWake up: head injury management around the clockDamage control laparotomy for combat casualties in forward surgical facilitiesDetection of soft tissue foreign bodies by nurse practitioner performed ultrasoundAntihypertensive medications and walking devices are associated with falls from standingThe transfer process: perspectives of transferring physiciansDevelopment of a rodent model for the study of abdominal compartment syndromeClinical efficacy of routine repeat head computed tomography in pediatric traumatic brain injuryEarly warning scores (EWS) in trauma: assessing the “effectiveness” of interventions by a rural ground transport service in the interior of British ColumbiaAccuracy of trauma patient transfer documentation in BCPostoperative echocardiogram after penetrating cardiac injuries: a retrospective studyLoss to follow-up in trauma studies comparing operative methods: a systematic reviewWhat matters where and to whom: a survey of experts on the Canadian pediatric trauma systemA quality initiative to enhance pain management for trauma patients: baseline attitudes of practitionersComparison of rotational thromboelastometry (ROTEM) values in massive and nonmassive transfusion patientsMild traumatic brain injury defined by GCS: Is it really mild?The CMAC videolaryngosocpe is superior to the glidescope for the intubation of trauma patients: a prospective analysisInjury patterns and outcome of urban versus suburban major traumaA cost-effective, readily accessible technique for progressive abdominal closureEvolution and impact of the use of pan-CT scan in a tertiary urban trauma centre: a 4-year auditAdditional and repeated CT scan in interfacilities trauma transfers: room for standardizationPediatric trauma in situ simulation facilitates identification and resolution of system issuesHospital code orange plan: there’s an app for thatDiaphragmatic rupture from blunt trauma: an NTDB studyEarly closure of open abdomen using component separation techniqueSurgical fixation versus nonoperative management of flail chest: a meta-analysisIntegration of intraoperative angiography as part of damage control surgery in major traumaMass casualty preparedness of regional trauma systems: recommendations for an evaluative frameworkDiagnostic peritoneal aspirate: An obsolete diagnostic modality?Blunt hollow viscus injury: the frequency and consequences of delayed diagnosis in the era of selective nonoperative managementEnding “double jeopardy:” the diagnostic impact of cardiac ultrasound and chest radiography on operative sequencing in penetrating thoracoabdominal traumaAre trauma patients with hyperfibrinolysis diagnosed by rotem salvageable?The risk of cardiac injury after penetrating thoracic trauma: Which is the better predictor, hemodynamic status or pericardial window?The online Concussion Awareness Training Toolkit for health practitioners (CATT): a new resource for recognizing, treating, and managing concussionThe prevention of concussion and brain injury in child and youth team sportsRandomized controlled trial of an early rehabilitation intervention to improve return to work Rates following road traumaPhone call follow-upPericardiocentesis in trauma: a systematic review. Can J Surg 2013. [DOI: 10.1503/cjs.005813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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O'Reilly D, Mahendran K, West A, Shirley P, Walsh M, Tai N. Opportunities for improvement in the management of patients who die from haemorrhage after trauma. Br J Surg 2013; 100:749-55. [PMID: 23483534 DOI: 10.1002/bjs.9096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvement (OPIs) identified in patients who died from bleeding and were considered by the quality improvement system of a major trauma centre. METHODS All trauma deaths in 2006-2010 were discussed at the trauma morbidity and mortality meeting. Deaths from haemorrhage were identified and subjected to qualitative and quantitative evaluation. OPIs were identified and remedial action was taken. RESULTS During the study interval there were 7511 trauma team activations; 423 patients died. Haemorrhage was the second most common cause of death, in 112 patients, and made a substantial contribution to death in a further 15. For 84 of these 127 patients, a total of 150 OPIs were identified. Most arose in the emergency department, but involved personnel from many departments. Problems with decision-making were more common than errors in technical skill. OPIs frequently involved the decision between surgery, radiology and further investigation. Delayed and inappropriate surgery occurred even when investigation and diagnosis were appropriate. The mortality rate among patients presenting in shock fell significantly over the study interval (P < 0·026). CONCLUSION Problems with judgement are more common than those of skill. Death from traumatic haemorrhage is associated with identifiable, remediable failures in care. The implementation of a systematic trauma quality improvement system was associated with a fall in the mortality rate among patients presenting in shock.
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Affiliation(s)
- D O'Reilly
- Trauma Clinical Academic Unit, Barts Health NHS Trust, London, UK.
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Tong W, Cheung K, West A, Yu KM, Tsang SCE. Direct methanol steam reforming to hydrogen over CuZnGaOx catalysts without CO post-treatment: mechanistic considerations. Phys Chem Chem Phys 2013; 15:7240-8. [DOI: 10.1039/c3cp51073e] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cole EM, West A, Davenport R, Naganathar S, Kanzara T, Carey M, Brohi K. Can residents be effective trauma team leaders in a major trauma centre? Injury 2013; 44:18-22. [PMID: 21999937 DOI: 10.1016/j.injury.2011.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/25/2011] [Accepted: 09/19/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The overall objective of this study was to compare senior Emergency Department (ED) trainees (residents) with consultant trauma team leaders, assessing their influence on trauma team performance and patient outcomes. We aimed to identify the effect of seniority of leader on time-based performance measures and clinical outcomes. METHODS This retrospective study of prospectively collected data was conducted in an urban Major Trauma Centre which has a well-established trauma team. For the period covered by this study the trauma team was led by either an ED consultant or specialist registrar having completed a local trauma team leader development programme. Data from all adult trauma team activations for seriously injured trauma patients (ISS - Injury Severity Score >15) presenting between 1st January 2008 and 31st October 2009 were included. Performance measures included time to FAST, time to CT scan and time to haemorrhage control. Patient outcomes were mortality, critical care and hospital length of stay. RESULTS There were 579 patients seriously injured in the study period. Trainees led 126 (22%) of the trauma teams. Significant differences in times to diagnostics or haemorrhage control between trainees and consultants were only seen in patients presenting with shock. Compared with trainees, consultant team leaders were significantly more likely to achieve targets for diagnostic imaging (FAST <15 min: consultants 97% vs. 33% trainees, p<0.01; CT scan <60 min: 76% vs. 50%, p<0.01) and haemorrhage control (surgery or angiography <60 min: 82% vs. 54%, p<0.001). There was no significant difference in overall mortality between consultants and trainees (consultants 25% vs. trainees 27%, p 1.00). Critical care length of stay was also the same for both (consultants median 5 days vs. trainees median 5 days). CONCLUSIONS Consultant team leaders improve team performance, resulting in shorter times to diagnostic imaging, and faster transfer to haemorrhage control. The greatest benefit seems to be for bleeding patients. Clinical outcomes were similar for trainees and consultants in our major trauma centre.
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Affiliation(s)
- E M Cole
- Trauma Outcomes Core, Centre for Neuroscience and Trauma Science, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
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