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Marino LV, Fandinga C, Barratt J, Brady I, Denton SA, Fitzgerald K, Mills T, Palframan K, Phillips S, Rees L, Scanlan N, Ashton JJ, Beattie RM. Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool. Clin Nutr 2023; 42:1701-1710. [PMID: 37531806 DOI: 10.1016/j.clnu.2023.07.018] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND & AIMS The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share). METHODS A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool. RESULTS Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001). CONCLUSION A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.
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Affiliation(s)
- L V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Health Science, University of Southampton, Southampton, UK.
| | - C Fandinga
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Barratt
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I Brady
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Denton
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Fitzgerald
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Mills
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Palframan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Phillips
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Rees
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N Scanlan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R M Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
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Oyebanji T, Aun N, Maniarasu V, Beattie R. EP06.01-004 Lung Cancer Resection During the Covid-19 Pandemic: A Single Centre Study. J Thorac Oncol 2022. [PMCID: PMC9452029 DOI: 10.1016/j.jtho.2022.07.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bishop H, Evans J, Eze JI, Webster C, Humphry RW, Beattie R, White J, Couper J, Allison L, Brown D, Tongue SC. Bacteriological Survey of Fresh Minced Beef on Sale at Retail Outlets in Scotland in 2019: Three Foodborne Pathogens, Hygiene Process Indicators, and Phenotypic Antimicrobial Resistance. J Food Prot 2022; 85:1370-1379. [PMID: 35653627 DOI: 10.4315/jfp-22-051] [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: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT The health and economic burden of foodborne illness is high, with approximately 2.4 million cases occurring annually in the United Kingdom. A survey to understand the baseline microbial quality and prevalence of food-related hazards of fresh beef mince on retail sale could inform risk assessment, management, and communication to ensure the safety of this commodity. In such a survey, a two-stage sampling design was used to reflect variations in population density and the market share of five categories of retail outlets in Scotland. From January to December 2019, 1,009 fresh minced beef samples were collected from 15 geographic areas. The microbial quality of each sample was assessed using aerobic colony count and Escherichia coli count. Samples were cultured for Campylobacter and Salmonella, and PCR was used to detect target genes (stx1 all variants, stx2 a to g, and rfbO157) for Shiga toxin-producing E. coli (STEC). The presence of viable E. coli O157 and STEC in samples with a positive PCR signal was confirmed via culture and isolation. Phenotypic antimicrobial sensitivity patterns of cultured pathogens and 100 E. coli isolates were determined, mostly via disk diffusion. The median aerobic colony count and E. coli counts were 6.4 × 105 (interquartile range, 6.9 × 104 to 9.6 × 106) and <10 CFU/g (interquartile range, <10 to 10) of minced beef, respectively. The prevalence was 0.1% (95% confidence interval [CI], 0 to 0.7%) for Campylobacter, 0.3% (95% CI, 0 to 1%) for Salmonella, 22% (95% CI, 20 to 25%) for PCR-positive STEC, and 4% (95% CI, 2 to 5%) for culture-positive STEC. The evidence for phenotypic antimicrobial resistance detected did not give cause for concern, mainly occurring in a few E. coli isolates as single nonsusceptibilities to first-line active substances. The low prevalence of pathogens and phenotypic antimicrobial resistance is encouraging, but ongoing consumer food safety education is necessary to mitigate the residual public health risk. HIGHLIGHTS
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Affiliation(s)
- H Bishop
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK
| | - J Evans
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK
| | - J I Eze
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK.,Biomathematics & Statistics Scotland, JCMB, The King's Buildings, Edinburgh EH9 3FD, UK
| | - C Webster
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK
| | - R W Humphry
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK
| | - R Beattie
- Scientific Services Laboratories of Edinburgh, Glasgow and Tayside Councils, 6 James Lindsay Place, Dundee, DD1 5JJ, 4 Marine Esplanade, Edinburgh EH6 7LU, and Colston Laboratories 64 Everard Drive, Glasgow G21 1XG, UK
| | - J White
- Scientific Services Laboratories of Edinburgh, Glasgow and Tayside Councils, 6 James Lindsay Place, Dundee, DD1 5JJ, 4 Marine Esplanade, Edinburgh EH6 7LU, and Colston Laboratories 64 Everard Drive, Glasgow G21 1XG, UK
| | - J Couper
- Scientific Services Laboratories of Edinburgh, Glasgow and Tayside Councils, 6 James Lindsay Place, Dundee, DD1 5JJ, 4 Marine Esplanade, Edinburgh EH6 7LU, and Colston Laboratories 64 Everard Drive, Glasgow G21 1XG, UK
| | - L Allison
- Scottish Microbiological Reference Laboratories (SMiRL) (Edinburgh and Glasgow), Scottish E. coli O157/STEC Reference Laboratory (SERL), Department of Laboratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, and Level 5, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow G21 3ER, UK
| | - D Brown
- Scottish Microbiological Reference Laboratories (SMiRL) (Edinburgh and Glasgow), Scottish E. coli O157/STEC Reference Laboratory (SERL), Department of Laboratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, and Level 5, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow G21 3ER, UK
| | - S C Tongue
- Scotland's Rural College, An Lochran, 10 Inverness Campus, Inverness IV2 5NA, UK
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Reid R, Alakhras Aljanadi F, Beattie R, Graham A. 1150 A Painless Anterior Chest Wall Mass Post Coronary Artery Bypass Grafting Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.361] [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: 11/13/2022]
Abstract
Abstract
Aim
We aim to present here a case of a painless anterior chest wall mass which was first noted during routine follow up post coronary artery bypass graft surgery
Case presentation
An 80-year-old male developed an asymptomatic slow growing pronounced swelling over the right anterior chest wall post CABG. His other past medical history includes chronic obstructive pulmonary disease, pulmonary fibrosis, ischaemic heart disease, an AICD for complete heart block, hypertension, hyperlipidaemia and osteoarthritis. A CT scan demonstrated a 10 x 12 x 6.5 cm subcutaneous lesion at the mid-line of the lower chest wall adjacent to the xiphisternum and the previous sternotomy site. On clinical examination there was a large non-tender cystic swelling with peripheral calcifications, but overlying skin was normal. Fluid was aspirated from the lesion and cytology showed a paucicellular specimen with features in keeping with seroma. Due to the progressive increase in size patient underwent surgical resection. A gelatinous bloody fluid was aspirated from the lesion and it was then resected enbloc. The tumour base appeared to arise from 6/7th costal cartilage and tumour was shaved away. The mass was confirmed histologically to be chondrosarcoma.
Conclusions
Given the uncommon prevalence of malignant primary chest wall tumours this case highlights the importance of high clinical suspicion even after developing post CABG.
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Affiliation(s)
- R Reid
- Royal Victoria Hospital, Belfast, United Kingdom
| | | | - R Beattie
- Royal Victoria Hospital, Belfast, United Kingdom
| | - A Graham
- Royal Victoria Hospital, Belfast, United Kingdom
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Marino LV, Valla FV, Beattie RM, Verbruggen SCAT. Micronutrient status during paediatric critical illness: A scoping review. Clin Nutr 2020; 39:3571-3593. [PMID: 32371094 PMCID: PMC7735376 DOI: 10.1016/j.clnu.2020.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023]
Abstract
Background No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion. Objectives The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission. Design Scoping review. Eligibility criteria Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness. Sources of evidence NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted. Results 711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients. Conclusion During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the ‘absence of evidence should not imply evidence of absence’, and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
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Affiliation(s)
- L V Marino
- Department of Dietetics/Speech & Language Therapy, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton, UK.
| | - F V Valla
- Paediatric Intensive Care Unit, Hôpital Femme Mère Enfant, CarMEN INSERM UMR 1060 Hospices Civils de Lyon, Lyon-Bron, France
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
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Batra A, Beattie RM. Recognising malnutrition in children with neurodisability. Clin Nutr 2020; 39:327-330. [PMID: 31472988 DOI: 10.1016/j.clnu.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- A Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, United Kingdom.
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Affiliation(s)
- R M Beattie
- Paediatric Gastroenterology Unit, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - A Batra
- Paediatric Gastroenterology Unit, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - L V Marino
- Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - M J Johnson
- NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Soppa G, Theodoropoulos P, Bilkhu R, Harrison DA, Alam R, Beattie R, Bleetman D, Hussain A, Jones S, Kenny L, Khorsandi M, Lea A, Mensah K, Hici TN, Pinho-Gomes AC, Rogers L, Sepehripour A, Singh S, Steele D, Weaver H, Klein A, Fletcher N, Jahangiri M. Variation between hospitals in outcomes following cardiac surgery in the UK. Ann R Coll Surg Engl 2019; 101:333-341. [PMID: 30854865 PMCID: PMC6513373 DOI: 10.1308/rcsann.2019.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We examine the influence of variations in provision of cardiac surgery in the UK at hospital level on patient outcomes and also to assess whether there is an inequality of access and delivery of healthcare. Cardiothoracic surgery has pioneered the reporting of surgeon-specific outcomes, which other specialties have followed. We set out to identify factors other than the individual surgeon, which can affect outcomes and enable other surgical specialties to adopt a similar model. MATERIALS AND METHODS A retrospective analysis of prospectively collected data of patient and hospital level factors between 2013 and 2016 from 16 cardiac surgical units in the UK were analysed through the Society for Cardiothoracic Surgery of Great Britain and Ireland and the Royal College of Surgeons Research Collaborative. Patient demographic data, risks factors, postoperative complications and in-hospital mortality, as well as hospital-level factors such as number of beds and operating theatres, were collected. Correlation between outcome measures was assessed using Pearson's correlation coefficient. Associations between hospital-level factors and outcomes were assessed using univariable and multivariable regression models. RESULTS Of 50,871 patients (60.5% of UK caseload), 25% were older than 75 years and 29% were female. There was considerable variation between units in patient comorbidities, bed distribution and staffing. All hospitals had dedicated cardiothoracic intensive care beds and consultants. Median survival was 97.9% (range 96.3-98.6%). Postoperative complications included re-sternotomy for bleeding (median 4.8%; range 3.5-6.9%) and mediastinitis (0.4%; 0.1-1.0%), transient ischaemic attack/cerebrovascular accident (1.7%; range 0.3-3.0%), haemofiltration (3.7%; range 0.8-6.8%), intra-aortic balloon pump use (3.3%; range 0.4-7.4%), tracheostomy (1.6%; range 1.3-2.6%) and laparotomy (0.3%; range 0.2-0.6%). There was variation in outcomes between hospitals. Univariable analysis showed a small number of positive associations between hospital-level factors and outcomes but none remained significant in multivariable models. CONCLUSIONS Variations among hospital level factors exists in both delivery of, and outcomes, following cardiac surgery in the UK. However, there was no clear association between these factors and patient outcomes. This negative finding could be explained by differences in outcome definition, differences in risk factors between centres that are not captured by standard risk stratification scores or individual surgeon/team performance.
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Affiliation(s)
- G Soppa
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - P Theodoropoulos
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Bilkhu
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - DA Harrison
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Alam
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Beattie
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - D Bleetman
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Hussain
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - S Jones
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - L Kenny
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - M Khorsandi
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Lea
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - Ka Mensah
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - TN Hici
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - AC Pinho-Gomes
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Sepehripour
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - S Singh
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - D Steele
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - H Weaver
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Klein
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - N Fletcher
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - M Jahangiri
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
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Marino LV, Kidd CS, Davies NJ, Thomas PC, Williams SW, Beattie RM. Survey of healthcare professional and parental experience in accessing support for breastfeeding during an acute hospital admission. Acta Paediatr 2019; 108:175-177. [PMID: 30160801 DOI: 10.1111/apa.14561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- L V Marino
- Department of Dietetics/SLT Faculty of Medicine University Hospital Southampton NHS Foundation Trust Southampton University Southampton UK
- NIHR Biomedical Research Centre Southampton University Hospital Southampton NHS Foundation Trust and University of Southampton Southampton UK
| | - C S Kidd
- Department of Dietetics/SLT Faculty of Medicine University Hospital Southampton NHS Foundation Trust Southampton University Southampton UK
| | - N J Davies
- Department of Dietetics/SLT Faculty of Medicine University Hospital Southampton NHS Foundation Trust Southampton University Southampton UK
| | - P C Thomas
- Paediatric Gastroenterology Faculty of Medicine Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton University Southampton UK
| | - S W Williams
- General Paediatrics Faculty of Medicine Southampton University Southampton UK
- Faculty of Medicine University of Southampton Southampton UK
| | - R M Beattie
- NIHR Biomedical Research Centre Southampton University Hospital Southampton NHS Foundation Trust and University of Southampton Southampton UK
- Paediatric Gastroenterology Faculty of Medicine Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton University Southampton UK
- Faculty of Medicine University of Southampton Southampton UK
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Gavin J, Marino LV, Ashton JJ, Beattie RM. Patient, parent and professional perception of the use of maintenance enteral nutrition in Paediatric Crohn's Disease. Acta Paediatr 2018; 107:2199-2206. [PMID: 30192409 DOI: 10.1111/apa.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/08/2018] [Revised: 06/29/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022]
Abstract
AIM Maintenance enteral nutrition (MEN) is routinely used in Paediatric Crohn's Disease (CD) to prolong remission although there is limited evidence for efficacy and a lack of formal guidelines. This study surveyed patients', parents' and professional experience with MEN. METHODS Two questionnaires were developed to survey the experience of MEN; (i) Patients/Parents (children >10 years of age aimed to complete independently) and (ii) Dietitians. Questionnaires were sent to families prescribed MEN after exclusive enteral nutrition (EEN) between 2015-17 (n = 77) and dietitians working in paediatric regional centres in UK (n = 23). RESULTS Response rate to the questionnaires was 53% patients, 62% parents and 83% dietitians. Patients/parents reported medical/dietetic advice to be the primary factor affecting compliance, 30% patients reported side effects. Fifty-six per cent of patients/58% parents stated a preference for dietary advice rather than MEN. Dietetic responses indicated 79% used MEN after EEN as standard procedure and 79% did not have exit criteria for MEN. Sixty-eight per cent perceived the taste was the primary factor affecting patient compliance. CONCLUSION Patients' perception of the usefulness of MEN differs to professionals. This study highlights the extensive practice of MEN after EEN in clinical remission, which may not be nutritionally indicated. Patient preference is for dietary advice rather than MEN.
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Affiliation(s)
- J Gavin
- Department of Dietetics/SLT; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - L V Marino
- Department of Dietetics/SLT; University Hospital Southampton Foundation NHS Trust; Southampton UK
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
| | - J J Ashton
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
- Department of Paediatric Gastroenterology; Southampton Children's Hospital University Hospitals Southampton; Southampton UK
| | - R M Beattie
- Department of Paediatric Gastroenterology; Southampton Children's Hospital University Hospitals Southampton; Southampton UK
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Gavin J, Ashton JJ, Heather N, Marino LV, Beattie RM. Nutritional support in paediatric Crohn's disease: outcome at 12 months. Acta Paediatr 2018; 107:156-162. [PMID: 28901585 DOI: 10.1111/apa.14075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/04/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022]
Abstract
AIM Paediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission. METHODS Newly diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagnosis. Data are presented as medians. RESULTS A total of 102 patients were identified (age = 13 years, 76% male), 58 (57%) completed exclusive enteral nutrition (EEN) as induction therapy, and 77 (75%) entered clinical remission. Following induction, 58 (57%) of all patients continued MEN and 44 (43%) consumed normal diet (ND). BMI Z-score increased (diagnosis-12 months) for EEN (-1.41 to -0.21 (p = <0.0001)) and steroid groups (-0.97 to -0.11 (p = 0.001)). BMI Z-score increased (post induction - 12 months) for MEN (-0.62 to -0.44 (p = 0.04)) but not ND (-0.33 to -0.4 (p = 0.79)). Height Z-score did not increase for any treatment group over 12 months. MEN and ND group relapse rates were similar at six months, MEN = 21/58 (36%); ND = 21/44 (48%) (p = 0.24) and 12 months, MEN = 24/58 (41%); ND = 13/44 (30%) (p = 0.22). Fewer patients treated with EEN then MEN relapsed less than six months, 14 of 43 (33%), compared to patients treated with steroids then ND 16/29 (55%) (p = 0.09). CONCLUSION BMI Z-score increased but height Z-score remained unchanged over 12 months for the MEN group. Use of MEN was not associated with prolonged time to relapse. Prospective studies are required to examine the utility of MEN.
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Affiliation(s)
- J Gavin
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - JJ Ashton
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
| | - N Heather
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - LV Marino
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - RM Beattie
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
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12
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Mossotto E, Ashton JJ, Coelho T, Beattie RM, MacArthur BD, Ennis S. Classification of Paediatric Inflammatory Bowel Disease using Machine Learning. Sci Rep 2017; 7:2427. [PMID: 28546534 PMCID: PMC5445076 DOI: 10.1038/s41598-017-02606-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023] Open
Abstract
Paediatric inflammatory bowel disease (PIBD), comprising Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) is a complex and multifactorial condition with increasing incidence. An accurate diagnosis of PIBD is necessary for a prompt and effective treatment. This study utilises machine learning (ML) to classify disease using endoscopic and histological data for 287 children diagnosed with PIBD. Data were used to develop, train, test and validate a ML model to classify disease subtype. Unsupervised models revealed overlap of CD/UC with broad clustering but no clear subtype delineation, whereas hierarchical clustering identified four novel subgroups characterised by differing colonic involvement. Three supervised ML models were developed utilising endoscopic data only, histological only and combined endoscopic/histological data yielding classification accuracy of 71.0%, 76.9% and 82.7% respectively. The optimal combined model was tested on a statistically independent cohort of 48 PIBD patients from the same clinic, accurately classifying 83.3% of patients. This study employs mathematical modelling of endoscopic and histological data to aid diagnostic accuracy. While unsupervised modelling categorises patients into four subgroups, supervised approaches confirm the need of both endoscopic and histological evidence for an accurate diagnosis. Overall, this paper provides a blueprint for ML use with clinical data.
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Affiliation(s)
- E Mossotto
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - J J Ashton
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - T Coelho
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - B D MacArthur
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S Ennis
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.
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Thomas PC, Marino LV, Williams SA, Beattie RM. Outcome of nutritional screening in the acute paediatric setting. Arch Dis Child 2016; 101:1119-1124. [PMID: 27609019 DOI: 10.1136/archdischild-2016-310484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 01/17/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions. METHODS Prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool. RESULTS The percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs. CONCLUSION These results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk.
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Affiliation(s)
- P C Thomas
- Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L V Marino
- Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Williams
- Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R M Beattie
- Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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14
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Abstract
Functional abdominal pain (FAP) is common in childhood, but is not often caused by disease. It is often the impact of the pain rather than the pain itself that results in referral to the clinician. In this review, we will summarise the currently available evidence and discuss the functional dimensions of the presentation, within the framework of commonly expressed parental questions. Using the Rome III criteria, we discuss how to classify the functional symptoms, investigate appropriately, provide reassurance regarding parental worries of chronic disease. We outline how to explain the functional symptoms to parents and an individualised strategy to help restore function.
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Affiliation(s)
- L K Brown
- Department of Paediatric, Poole Hospital NHS Trust, Poole, Dorset, UK
| | - R M Beattie
- Department of Child Health, University Hospital Southampton, Southampton, UK
| | - M P Tighe
- Department of Paediatric, Poole Hospital NHS Trust, Poole, Dorset, UK
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15
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Booth K, Beattie R, McBride M, Manoharan G, Spence M, Jones JM. High Risk Aortic Valve Replacement - The Challenges of Multiple Treatment Strategies with an Evolving Technology. Ulster Med J 2016; 85:18-22. [PMID: 27158160 PMCID: PMC4847840] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Deciding on the optimal treatment strategy for high risk aortic valve replacement is challenging. Transcatheter Aortic Valve implantation (TAVI) has been available in our centre as an alternative treatment modality for patients since 2008. We present our early experience of TAVI and SAVR (surgical Aortic Valve Replacement) in high risk patients who required SAVR because TAVI could not be performed. METHODS The database for Surgical aortic valve and Transcatheter aortic valve replacement referrals was interrogated to identify relevant patients. RESULTS Survival to hospital discharge was 95.5% in the forty five patients who had SAVR when TAVI was deemed technically unsuitable. One year survival was 86%. CONCLUSION Defining who is appropriate for TAVI or high risk SAVR is challenging and multidisciplinary team discussion has never been more prudent in this field of evolving technology with ever decreasing risks of surgery. The introduction of TAVI at our institution has seen a rise in our surgical caseload by approximately by 25%. Overall, the option of aortic valve intervention is being offered to more patients in general which is a substantial benefit in the treatment of aortic valve disease.
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Affiliation(s)
- K Booth
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
| | - R Beattie
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
| | - M McBride
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
| | - G Manoharan
- Department of Cardiology, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
| | - M Spence
- Department of Cardiology, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
| | - J M Jones
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA
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16
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17
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McGuigan A, Beattie R, Graham A. 26 Coronary artery bypass grafting without an lad graft – is it worth it? Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Ashton JJ, Coelho T, Ennis S, Batra A, Afzal NA, Beattie RM. Presenting phenotype of paediatric inflammatory bowel disease in Wessex, Southern England 2010-2013. Acta Paediatr 2015; 104:831-7. [PMID: 25847524 DOI: 10.1111/apa.13017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/12/2015] [Revised: 03/12/2015] [Accepted: 03/27/2015] [Indexed: 12/17/2022]
Abstract
AIM There has been at least a twofold increase in the incidence of paediatric inflammatory bowel disease (PIBD) over the last 20 years; we report the presenting features from 2010 to 2013 and compare with previous data. METHODS All patients diagnosed with PIBD at University Hospitals Southampton from 2010 to 2013 were identified from an in-house database. Data were obtained from paper and electronic notes. Height, weight and BMI SDS are presented as median values (95% CI). RESULTS One hundred and seventy-two patients were included (median age at diagnosis 13.5, 115 male); Crohn's disease (CD) - 107, UC - 50, inflammatory bowel disease unclassified (IBDU) - 15. The most common presenting features of CD were abdominal pain (86%), diarrhoea (78.5%) and weight loss (56.1%); 42.1% of patients had all three. In UC blood in stool (92%), diarrhoea (92%) and abdominal pain (88%) were the most common; all three in 76% of patients. CD presented with ileocolonic disease in 52.5%. UC presented with pancolitis in 64%. There was growth delay in CD: height -0.37 (-0.60 to -0.14); weight -1.09 (-1.35 to -0.83). Growth was maintained in UC: height 0.53 (0.19 to 0.87); weight 0.14 (-0.20 to 0.48). CONCLUSION Paediatric inflammatory bowel disease phenotype remains as extensive despite increasing incidence. Although the classical phenotype is common, a reasonable proportion present with atypical features, normal growth and normal blood markers.
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Affiliation(s)
- JJ Ashton
- Department of Paediatric Gastroenterology; University Hospital Southampton; Southampton UK
| | - T Coelho
- Department of Paediatric Gastroenterology; University Hospital Southampton; Southampton UK
| | - S Ennis
- Human Genetics and Genomic Medicine; University of Southampton; Duthie Building; University Hospital Southampton; Southampton UK
| | - A Batra
- Department of Paediatric Gastroenterology; University Hospital Southampton; Southampton UK
| | - NA Afzal
- Department of Paediatric Gastroenterology; University Hospital Southampton; Southampton UK
| | - RM Beattie
- Department of Paediatric Gastroenterology; University Hospital Southampton; Southampton UK
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19
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Affiliation(s)
- R M Beattie
- Archives of Disease in Childhood, BMA House, London, UK
| | - N J Brown
- Archives of Disease in Childhood, BMA House, London, UK
| | - H Cass
- Royal College of Paediatrics and Child Health, London, UK
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20
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Ashton JJ, Blackburn S, Burge D, Beattie RM. An unlikely cause of severe malnutrition in a 3-year-old girl with previous gastroschisis. BMJ Case Rep 2014; 2014:bcr-2014-204530. [PMID: 25183805 DOI: 10.1136/bcr-2014-204530] [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: 11/04/2022] Open
Abstract
A 3-year-old girl with previous gastroschisis associated with jejunal and colonic atresia presented with severe oedema, abdominal pain and diarrhoea. Clinically she was malnourished. Serum albumin and concentrations of micronutrients were low. A barium meal examination showed jejunal dilation. A stricture was suspected and the patient was taken to theatre where an 8 cm length of bowel was resected including a jejunal stricture at the point of previous atresia repair. Inside the proximal dilated jejunum was a large trichobezoar (hairball), thought to be acting as a ball valve inside the bowel. This girl made a rapid recovery after surgery. Her nutritional state improved, symptoms resolved and serum biochemistry normalised. She remains well at follow-up with normal blood results, normal albumin and no diarrhoea.
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Affiliation(s)
- J J Ashton
- Department of Paediatric Gastroenterology, University Hospital Southampton, Southampton, UK
| | - S Blackburn
- Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK
| | - D Burge
- Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK
| | - R M Beattie
- Department of Paediatric Gastroenterology, University Hospital Southampton, Southampton, UK
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21
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Beattie R, Johnston P, Jeganathan R. Gigantic left atrium - can surgery reverse the downward spiral of cardiac cachexia? Ulster Med J 2014; 83:180-181. [PMID: 25571610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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22
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Abstract
BACKGROUND There has been a significant increase in the incidence of paediatric inflammatory bowel disease (PIBD) over the last 25 years although there is no recent data from England. We aimed to analyse changes in incidence within a defined English population over the last decade and compare this to recent and historical incidence data from comparable studies. METHODS The new diagnosis incidence of PIBD (age less than or equal to 16 years) was recorded from a prospective database for a geographically defined area within Southern England (2002-2012). Data were analysed for two separate time periods (cohort 1:2002-2006 and cohort 2:2008-2012) and compared to data from the British Paediatric Surveillance Unit (BPSU) survey in 1998/1999. Data were analysed by age, sex and disease type. RESULTS There has been an increase in incidence of PIBD from 6.39/100,000/year during cohort 1 to 9.37/100,000/year during cohort 2 (p=0.0002). This compares with the BPSU incidence data in England (1998-1999) of 5.2/100,000/year. There was no statistically significant difference in median age of diagnosis between cohorts (p=0.46). The incidence of Crohn's disease (CD) was 3.8/100,000/year in cohort 1 rising to 5.85/100,000/year in cohort 2 (p=0.001). The incidence of ulcerative colitis (UC) was 2.01/100,000/year in cohort 1 rising to 2.62/100,000/year in cohort 2 (p=0.1458). Overall PIBD incidence is higher in males in cohort 1 (male-to-female ratio 1.35:1) and cohort 2 (male-to-female ratio 1.5:1). CONCLUSIONS The incidence of PIBD continues to increase with a rise of almost 50% in the last decade in Southern England. The reasons for this increase remain unclear.
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23
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Blackburn SC, Wiskin AE, Barnes C, Dick K, Afzal NA, Griffiths DM, Beattie RM, Stanton MP. Surgery for children with Crohn's disease: indications, complications and outcome. Arch Dis Child 2014; 99:420-6. [PMID: 24395646 DOI: 10.1136/archdischild-2013-305214] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcome data for surgery in paediatric Crohn's disease are limited. We report 10 years' experience at a regional paediatric gastroenterology centre. METHODS Children undergoing surgery for Crohn's disease (January 2002-December 2012) were identified from an onsite patient register. Patients were followed until transition to adult services. Data were obtained from medical records and are expressed as median (range). RESULTS Sixty-nine children, aged 13.8 years (6.3-17.0) at diagnosis, were included. 42 were male (61%). Follow-up was 1.8 years (27 days-6 years). Surgery followed diagnosis by 9 months (0 days-7 years). 52 children (75%) received thiopurines and 5 (7%) anti-TNF (tumour necrosis factor) therapy preoperatively. 58 (84%) underwent intra-abdominal surgery (40 right hemicolectomy, 8 stoma formation, 2 subtotal colectomy, 2 small bowel resection, 6 other) and 10 (14%) underwent surgery for perianal disease. The commonest indications for intra-abdominal surgery were stricturing disease 35 (60%) and unresponsive luminal disease 13 (22%). There were 13 (22%) early, and 5 (8.6%) late, complications following intra-abdominal surgery. Nine children had disease relapse, five required further surgery. Height SD scores (SDS) did not increase between diagnosis; -0.5 (-3.4-2.1) and most recent follow up; -0.4 (-3.0-1.1). Body Mass Index (BMI) SDS increased from -1.0 (-6.3-1.5) to -0.3 (-3.3-2.0) (p<0.05). CONCLUSIONS Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS.
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Affiliation(s)
- S C Blackburn
- Department of Paediatric Surgery, Southampton University Hospital NHS Trust, , Southampton, UK
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24
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Goulet O, Olieman J, Ksiazyk J, Spolidoro J, Tibboe D, Köhler H, Yagci RV, Falconer J, Grimble G, Beattie RM. Neonatal short bowel syndrome as a model of intestinal failure: physiological background for enteral feeding. Clin Nutr 2012; 32:162-71. [PMID: 23159212 DOI: 10.1016/j.clnu.2012.09.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [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: 02/26/2012] [Revised: 08/26/2012] [Accepted: 09/12/2012] [Indexed: 01/17/2023]
Abstract
Intestinal failure (IF) is a well identified clinical condition, which is characterised by the reduction of functional gut capacity below the minimum needed for adequate digestion and absorption of nutrients for normal growth in children. Short bowel syndrome (SBS) is the leading cause of IF in neonates, infants and young children usually as a result of extensive intestinal resection during the neonatal period. Simultaneously maintaining optimal nutritional status and achieving intestinal adaptation is a clinical challenge in short bowel patients. Both growth and development of the child as well as gut adaptation should be considered synergistically as primary outcome parameters. Enteral nutrition (EN) can be introduced orally and/or by tube feeding (TF). Several controversies over nutritional treatment of children with SBS related intestinal failure remain. As reported from different centres around the world, most practices are more "experienced based" rather than "evidence based". This is partly due to the small number of patients with this condition. This review (based on a consensus) discusses the physiological principles and nutritional management, including the type of diet and route of delivery. Perspectives in optimizing intestinal adaptation and reducing the consequences of small intestinal bacterial overgrowth are also discussed.
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Affiliation(s)
- O Goulet
- Department of Pediatric Gastroenterology-Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Descartes, France.
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25
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Wiskin AE, Owens DR, Cornelius VR, Wootton SA, Beattie RM. Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet 2012; 25:319-22. [PMID: 22591201 DOI: 10.1111/j.1365-277x.2012.01254.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND There has been increasing interest in the use of nutrition risk assessment tools in paediatrics to identify those who need nutrition support. Four non-disease specific screening tools have been developed, although there is a paucity of data on their application in clinical practice and the degree of inter-tool agreement. METHODS The concurrent validity of four nutrition screening tools [Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Simple Paediatric Nutrition Risk Score (PNRS)] was examined in 46 children with inflammatory bowel disease. Degree of malnutrition was determined by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria. RESULTS There was good agreement between STAMP, STRONGkids and PNRS (kappa > 0.6) but there was only modest agreement between PYMS and the other scores (kappa = 0.3). No children scored low risk with STAMP, STRONGkids or PNRS; however, 23 children scored low risk with PYMS. There was no agreement between the risk tools and the degree of malnutrition based on anthropometric data (kappa < 0.1). Three children had anthropometry consistent with malnutrition and these were all scored high risk. Four children had body mass index SD scores < -2, one of which was scored at low nutrition risk. CONCLUSIONS The relevance of nutrition screening tools for children with chronic disease is unclear. In addition, there is the potential to under recognise nutritional impairment (and therefore nutritional risk) in children with inflammatory bowel disease.
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Affiliation(s)
- A E Wiskin
- NIHR Biomedical Research Unit (Nutrition, Diet & Lifestyle), Southampton, UK
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26
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Affiliation(s)
- H R Jenkins
- Department of Child Health, University Hospital of Wales, Cardiff, UK.
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27
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Abstract
Fundamental to appropriate nutritional prescription is an understanding of the conditions necessary for growth that include the requirements for energy in health and illness. Energy requirements need to be met by the dietary intake to prevent weight loss. A positive energy balance will result in weight gain. Energy requirement includes several components; the largest is the basal metabolic rate, although physical activity level and the energy needs of growth are important components. All aspects of energy metabolism are likely to be influenced by illness and impact on energy balance. Changes in dietary intake and physical activity are observed clinically but poorly described in most childhood illnesses. Changes in metabolic rate are poorly described in part owing to methodological problems. This review explores changes in energy expenditure associated with health and disease, highlights the lack of evidence underpinning this aspect of practical nutritional support and provides the clinician with a guide to the factors involved in estimating energy requirements, emphasising the importance of measuring the child's response to nutritional support.
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Affiliation(s)
- A E Wiskin
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton, UK.
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28
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Affiliation(s)
- M P Tighe
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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29
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Grogan E, Beattie R, Campbell C, George R, Harlow T, MacGregor B, Oliver D, Thorns A, Noble B. End-of-life decisions in the United Kingdom involving medical practitioners and legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes. Palliat Med 2009; 23:569. [PMID: 19460833 DOI: 10.1177/0269216309106458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E Grogan
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields; On behalf of the Ethics Committee of the Association of Palliative Medicine
| | - R Beattie
- Palliative Medicine, St John’s Hospice, Lancaster, UK
| | | | - R George
- Guy’s & St Thomas’ Hospital, London, UK; Biomedical Ethics, UCL
| | | | - B MacGregor
- Specialist Registrar Palliative Medicine, Myton Hamlet Hospice, Warwick, UK
| | - D Oliver
- Consultant and Honorary Senior Lecturer Palliative Medicine, Wisdom Hospice, Rochester, Kent, UK
| | - A Thorns
- Consultant and Honorary Senior Lecturer Palliative Medicine, Pilgrims Hospice and East Kent NHS Trust, Margate, Kent, UK
| | - B Noble
- Macmillan Senior Lecturer in Palliative Medicine, Sykes House, Sheffield Sykes House, Sheffield
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30
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Affiliation(s)
- M P Tighe
- Paediatric Medical Unit, Southampton General Hospital, Southampton, UK
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31
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Affiliation(s)
- M P Tighe
- Child Health, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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32
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Abstract
AIM Ulcerative Colitis (UC) has an incidence of 1.4 per 100,000 in childhood. There is a paucity of data regarding outcome particularly with the increased use of early immunosuppression. This study reviews outcome at 2 years in a cohort with UC referred to a single centre. METHOD Patients were recruited on the basis of a diagnosis made between 2000 and 2003 as a consecutive cohort. All had UC according to standard clinicopathological criteria. Children with indeterminate colitis were excluded. Follow-up data was collected at 2 years by case notes review. RESULTS Thirty-two children are reported. The median age at diagnosis was 11 years (range 2-16). All were treated with corticosteroids and 5-ASA derivatives at diagnosis. The majority of patients (94%, 30/32) received more than one course of steroids. By 2 years azathioprine use was high with 75% (24/32) of patients on treatment for steroid-dependent disease. There were 6 extra-intestinal manifestations and 8 disease related complications occurring in 12 patients (38%). The colectomy rate was 9% (3/32) for unresponsive disease. CONCLUSION There is a high need for Azathioprine in childhood UC. Colectomy rate at 2 years was around 10%. Extra-intestinal manifestations and disease related complications are common.
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Affiliation(s)
- L J Howarth
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, United Kingdom
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33
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34
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Abstract
Perspective on the paper by Ravikumara et al (see page 969)
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Affiliation(s)
- R M Beattie
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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35
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Abstract
Twenty five per cent of inflammatory bowel disease presents in childhood. Growth and nutrition are key issues in the management with the aim of treatment being to induce and then maintain disease remission with minimal side effects. Only 25% of Crohn's disease presents with the classic triad of abdominal pain, weight loss, and diarrhoea. Most children with ulcerative colitis have blood in the stool at presentation. Inflammatory markers are usually although not invariably raised at presentation (particularly in Crohn's disease). Full investigation includes upper gastrointestinal endoscopy and ileocolonoscopy. Treatment requires multidisciplinary input as part of a clinical network led by a paediatrician with special expertise in the management of the condition.
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Affiliation(s)
- R M Beattie
- Paediatric Medical Unit, Southampton General Hospital, Southampton, UK.
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36
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Abstract
BACKGROUND Enteral nutrition (EN) is widely used and is effective in the treatment of children with Crohn's disease given as an exclusive feed for 6-8 weeks. Current dietetic practice during EN is to recommend an energy intake based on estimated average requirement (EAR) for energy for age. AIMS To examine factors affecting energy intake and weight gain during EN in relation to disease site and nutritional status. METHODS A retrospective cohort study examining energy intake and weight gain during the exclusive EN feeding period in 40 patients newly diagnosed with Crohn's in relation to EAR, nutritional status, disease site. RESULTS All patients improved clinically and gained weight during EN with improvement in the CRP as a marker of the systemic inflammatory response. Energy intake was higher than EAR in 82% (33/40 patients), with the median 117.5% of EAR. Weight gain correlated with body mass index standard deviation score (P = 0.001) at start of treatment, but not energy intake or CRP. CONCLUSION Estimated average requirement underestimates energy intakes in most children with newly diagnosed Crohn's disease. During EN, an energy intake in the range of 100-149% (median 117.5%) EAR for energy for age may be required. Energy balance studies in children with active disease are required.
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Affiliation(s)
- J Gavin
- Department of Nutrition and Dietetics, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK.
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37
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Hart JW, Bremner AR, Wootton SA, Beattie RM. Measured versus predicted energy expenditure in children with inactive Crohn's disease. Clin Nutr 2005; 24:1047-55. [PMID: 16198449 DOI: 10.1016/j.clnu.2005.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 06/11/2005] [Accepted: 08/11/2005] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of the study was to assess if the estimated average requirements for energy for normal children (EAR) and the Schofield equation could reliably predict energy requirements in children with inactive Crohn's disease (CD). METHODS Twenty-three children with inactive CD were studied, median age 14.3 years (range 7.8-16.9). Resting energy expenditure (REE) was measured by indirect calorimetry and compared with that predicted using the Schofield equation (BMR). Total energy expenditure (TEE) was measured using REE and a 3-day activity diary and compared with EAR. RESULTS REE ranged from 79% to 136% of BMR. Mean REE was not significantly greater than mean BMR (P=0.25 2-tailed t-test). TEE ranged from 72% to 163% of estimated average requirements for energy for children of that weight (EARw). EARw tended to underestimate TEE in large children and overestimate TEE in small children (Bland-Altman plot R=0.5, P=0.002). EARw was a poor predictor of TEE (R=0.35, P=0.1). EAR underestimated energy requirements by >500 kcal/day in 40% of the children. CONCLUSIONS The Schofield equation and EAR are unreliable methods of predicting total energy requirements in children with inactive CD with a significant potential to underestimate energy needs. When energy requirements were greater than EAR it was due to physical activity and body habitus rather than raised REE.
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Affiliation(s)
- J W Hart
- Department Child Health, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, and Institute Human Nutrition, Southampton University, UK.
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38
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Wang CY, Pan Q, Xue M, Miao KR, Fei XM, Zhou XY, Zhao X, Kukuruga D, Osowski L, Poore B, Beattie R, Shi WX, Zhang H. Identification of an HLA-B*07 allele variant (B*0740) in the Chinese Han population. ACTA ACUST UNITED AC 2005; 66:148-50. [PMID: 16029438 DOI: 10.1111/j.1399-0039.2005.00438.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A novel HLA-B*07 allele, B*0740, has been identified by sequence-based typing (SBT) in the Chinese Han population. This new allele is identical to B*0705 and B*0706 for exons 2, 3, and 4, except for a single nucleotide at position 605 of codon 202 in exon 3 (AAG-->ATG) leading to an amino acid change from lysine to methionine. SBT was performed following allele separation using the Haploprep method. The serological equivalence of B*0740 to the B7 antigen did not change.
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Affiliation(s)
- C Y Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiang Su Province, P.R. China
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39
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Affiliation(s)
- A Plunkett
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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40
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Affiliation(s)
- A Plunkett
- Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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41
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Abstract
AIM Bowel wall thickening on transabdominal ultrasound scanning (USS) correlates well with Crohn's disease (CD) activity. However, the role of USS in the assessment of CD has not been fully defined. This study compared USS and barium follow-through (BaFT) in the assessment of CD. METHODS A retrospective case series was undertaken of 24 children with CD who underwent USS and BaFT during the same period of clinical disease activity. RESULTS For terminal ileum abnormality, all 13 cases with abnormal USS had abnormality on BaFT. USS did not detect five cases with affected terminal ileum and two cases with isolated proximal small-bowel CD. CONCLUSION BaFT is a more sensitive indicator of small-bowel CD than USS. USS has good positive predictive value of distal small-bowel CD, but BaFT should be performed in the presence of a normal USS where there is strong clinical evidence of CD.
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Affiliation(s)
- A R Bremner
- Division of Infection, Inflammation and Repair, Southampton University School of Medicine, Southampton, UK
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42
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Affiliation(s)
- A Chakraborty
- Paediatric Medical Unit, Southampton General Hospital, Southampton SO16 6YD
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43
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Trebble TM, Wootton SA, May A, Erlewyn-Lajeunesse MDS, Chakraborty A, Mullee MA, Stroud MA, Beattie RM. Essential fatty acid status in paediatric Crohn's disease: relationship with disease activity and nutritional status. Aliment Pharmacol Ther 2003; 18:433-42. [PMID: 12940929 DOI: 10.1046/j.1365-2036.2003.01707.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Active paediatric Crohn's disease is associated with nutritional deficiencies and altered nutrient intake. The availability of essential fatty acids (linoleic and alpha-linolenic acids) or their derivatives (arachidonic and eicosapentaenoic acids) may alter in plasma and cell membrane phospholipid in protein-energy malnutrition in children and in Crohn's disease in adults. AIM To investigate the relationship of fatty acid phospholipid profiles with disease activity and nutritional status in paediatric Crohn's disease. METHODS The fatty acid (proportionate) composition of plasma and erythrocyte phosphatidylcholine was determined in 30 patients (10.3-17.0 years) stratified into active and quiescent Crohn's disease (paediatric Crohn's disease activity index) and high and low body mass (body mass index centile). RESULTS In plasma phosphatidylcholine, active disease activity was associated with a lower level of alpha-linolenic acid compared with that in quiescent disease (P < 0.05). A body mass index below the 50th centile was associated with active Crohn's disease, low linoleic and alpha-linolenic acids and high arachidonic acid (P < 0.05) in plasma phosphatidylcholine, and low alpha-linolenic acid in erythrocyte phosphatidylcholine. These findings could not be explained through differences in habitual dietary fat intake. CONCLUSION In paediatric Crohn's disease, a low body mass index centile and high disease activity are associated with altered profiles of essential fatty acids and their derivatives, which may reflect altered metabolic demand.
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Affiliation(s)
- T M Trebble
- Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton, UK.
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Lal MK, McClelland J, Phillips J, Taub NA, Beattie RM. Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture. Acta Paediatr 2001; 90:154-9. [PMID: 11236044 DOI: 10.1080/080352501300049307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive-behavioural interventions, such as distraction by breathing and blowing exercises, have been used and found to be helpful as alternative coping strategies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before and during venepuncture, and in these children evaluated the need for EMLA using a prospective, randomized, double-blind, placebo-controlled clinical trial. Twenty-eight children attending for venepuncture were recruited, median age 6 y (range 4-8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one investigator. A modified paediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: median age of 6 and 7 y (range 4-8), median baseline and post-procedure heart rate and oxygen saturation. The median (interquartile range) for total pain score in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 to 2.3). There was no significant difference in pain score between the two groups (Mann-Whitney test, p = 0.7). The 95% confidence interval for the difference in pain score was -1.0 to +3.0. CONCLUSIONS The low pain score in both groups suggests the effectiveness of distraction therapy, although factors such as skill of the operator and previous experience of the patient group are of relevance. There was no significant difference in the pain score between the EMLA and placebo groups, suggesting that in this age group if carefully selected children receive distraction during venepuncture EMLA may not be necessary.
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Affiliation(s)
- M K Lal
- Department of Paediatrics, Peterborough District Hospital, UK
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45
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Abstract
Crohn's disease in childhood is a chronic relapsing condition with a high morbidity. Growth failure is common. The aim of therapy is to induce and then maintain disease remission and thereby promote well-being and normal growth and development. Enteral nutrition (either polymeric or elemental) is effective and used as initial therapy. This is employed as sole therapy over a 6- to 8-week period followed by a period of controlled food reintroduction. The relapse rate is high and further courses of enteral nutrition or alternative therapies are frequently required. Corticosteroids are also effective as initial therapy and are required in difficult cases but there are problems with their long term use, particularly their adverse effects on growth. Many patients develop either corticosteroid-dependent or corticosteroid-resistant disease. In this instance, additional immunosuppression, such as azathioprine, can be used. Surgery is required for those patients with disease resistant to medical therapy and this will result in remission; however, the relapse rate with surgery is high. There are many areas for future research. Very little is known about why enteral nutrition works, how long it should be given or its role as maintenance therapy. Newer immunosuppressive strategies based on cytokine modulation may be helpful in children once more experience is gained from their use in adults.
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Affiliation(s)
- R M Beattie
- Paediatric Medical Unit, Southampton General Hospital, England.
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Fragale A, Aguanno S, Kemp M, Reeves M, Price K, Beattie R, Craig P, Volsen S, Sher E, D'Agostino A. Identification and cellular localisation of voltage-operated calcium channels in immature rat testis. Mol Cell Endocrinol 2000; 162:25-33. [PMID: 10854695 DOI: 10.1016/s0303-7207(00)00213-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sertoli cells regulate the spermatogenic process mainly through the secretion of a complex fluid into the lumen of the seminiferous tubules behind the blood-testis barrier, containing many of the essential proteins necessary for maintenance and maturation of male germ cells. Thus, the study of Sertoli cell secretory processes is strictly correlated with the understanding of the regulatory mechanisms of spermatogenesis. In this work the authors have explored the voltage-sensitive calcium channel variety in the immature rat testis, their localisation and distribution within the seminiferous epithelium and peritubular and interstitial tissues as well as the possible role in the control of Sertoli cell secretion. The results reported in this paper, obtained by in situ hybridisation, immunohistology of rat testicular sections and Western blot analysis of Sertoli cell plasma membranes, show that mammalian Sertoli cells express mRNA encoding for several voltage-operated calcium channel subunits and express such proteins on their surface. Experiments performed on Sertoli cell monolayers cultured in the presence of specific toxins indicate that both N and P/Q-type Ca(2+) channels are involved in the regulation of protein secretion.
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Affiliation(s)
- A Fragale
- Department of Histology and Medical Embryology, University 'La Sapienza', Rome, Italy
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Fell JM, Paintin M, Arnaud-Battandier F, Beattie RM, Hollis A, Kitching P, Donnet-Hughes A, MacDonald TT, Walker-Smith JA. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 2000; 14:281-9. [PMID: 10735920 DOI: 10.1046/j.1365-2036.2000.00707.x] [Citation(s) in RCA: 267] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although enteral nutrition is a recognized form of treatment for intestinal Crohn's disease, there are persisting problems with feed palatability and only limited data as to its mode of action. AIM To assess the effects of a specific oral polymeric diet (CT3211; Nestle, Vevey, Switzerland), which is rich in transforming growth factor beta2, on the mucosal inflammatory process. METHODS Twenty-nine consecutive children with active intestinal Crohn's disease were treated with CT3211 as the sole source of nutrition for 8 weeks. Patients were assessed clinically, and endoscopically, whilst cytokine mRNA was measured in mucosal biopsies before and after treatment by quantitative reverse transcriptase polymerase chain reaction. RESULTS After 8 weeks 79% of children were in complete clinical remission. Macroscopic and histological healing in the terminal ileum and colon was associated with a decline in ileal and colonic interleukin-1beta mRNA (pre-treatment to post-treatment ratio 0.008 and 0.06: P < 0.001, P = 0.006). In the ileum there was also a fall in interferon gamma mRNA (ratio 0.15, P < 0.001) with a rise in transforming growth factor beta1 mRNA (ratio 10, P = 0.04), whilst in the colon interleukin-8 mRNA fell with treatment (ratio 0.06, P < 0.05). CONCLUSIONS The clinical response to oral polymeric diet CT3211 is associated with mucosal healing and a down regulation of mucosal pro-inflammatory cytokine mRNA in both the terminal ileum and colon. In the ileum there was also an increase in transforming growth factor beta1 mRNA.
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Affiliation(s)
- J M Fell
- Chelsea and Westminster Hospital, London, UK.
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Abstract
OBJECTIVES To assess the clinical features, investigations and outcome of 69 children (40 males, 29 females) with gastro-oesophageal reflux (GOER) referred to a tertiary referral centre in paediatric gastroenterology. METHODS A study of all patients with significant GOER seen at the Paediatric Gastroenterology Unit, Queen Elizabeth Hospital for Children, Hackney Road, London, between December 1994 and August 1995. RESULTS The median age at referral was 16 months. Presenting symptoms were recurrent vomiting (72%), epigastric and abdominal pain (36%), feeding difficulties (29%), failure to thrive (28%) and irritability (19%). Continuous 24-h lower oesophageal pH studies performed in 57 children showed 20 (35%) had a reflux index of between 10% to 20%, 14 (25%) had a index > 20%, and six (11%) had a postprandial reflux index > 10%. Reflux was shown in 38 (62%) of 62 children who underwent barium studies. None had significant anatomical abnormalities, but in the 22 children who had a negative barium studies, six had severe reflux (reflux index > 20%). Upper gastrointestinal endoscopy performed in 47 children showed reflux oesophagitis in 29 (62%), oesophageal ulceration in three, and Barrett's oesophagus in one. All of the children were treated with standard medical therapy. Sixty-six per cent were able to discontinue medication within 12 months and remained well. Four children (6%) required Nissen's fundoplication for failure to respond to medical therapy. CONCLUSIONS Most infants with GOER have an uncomplicated course. False negative results were noted in both pH monitoring and barium meal. Up to 80% of children, with therapy, will improve within 12 months.
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Affiliation(s)
- W S Lee
- Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Volsen SG, Lambert RC, Maulet Y, De Waard M, Gillard S, Craig PJ, Beattie R, Feltz A. Application of antisense techniques to characterize neuronal ion channels in vitro. Methods Enzymol 1999; 314:290-310. [PMID: 10565021 DOI: 10.1016/s0076-6879(99)14111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- S G Volsen
- Lilly Research Centre, Eli Lilly and Company Limited, Windlesham, Surrey, United Kingdom
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50
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Abstract
Abnormal linear growth is frequent in children and adolescents with Crohn's disease. The typical pattern is of growth retardation associated with delayed skeletal maturation. Puberty is also frequently delayed. Over 50% of patients may have a subnormal height velocity, and approximately 25% will have short stature. The endocrine status is characterized by normal growth hormone secretion and a slightly subnormal serum level of insulin-like growth factor I, which is related to nutritional status. Principal therapeutic options are intestinal resection for localized disease, and enteral nutrition--using a polymeric diet--for more widespread disease, particularly involving the small intestine. Growth responses to both modalities are often excellent and produce considerable psychological benefit. Optimum therapy is achieved by close collaboration between gastroenterologists and endocrinologists, and by the use of auxological methods to document pre- and post-therapeutic management.
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Affiliation(s)
- M O Savage
- Paediatric Endocrinology Section, St Bartholomew's Hospital, London, UK
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