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Dudley J, Xu J. The influence of different cement spaces on the marginal gap of lithium disilicate crowns constructed by two scanner and milling unit combinations. Aust Dent J 2024. [PMID: 38469907 DOI: 10.1111/adj.13014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND This study compared the marginal gaps of CAD/CAM lithium disilicate (LDS) crowns constructed using a contemporary and older scanner/milling unit combination at three different cement spaces. METHODS Twenty-four undergraduate students prepared a Columbia model lower left first molar for an LDS crown in a simulated environment. From each crown preparation, one LDS crown was constructed using an E4D scanner/E4D milling unit (E4DS/E4DM) and TRIOS 3 scanner/Sirona inLab MC X5 milling unit (TRIO/MCX5) at cement space settings of 50, 100 and 200 μm. Each LDS crown was positioned onto the original crown preparation, and then a stereomicroscope was used to make three vertical marginal gap measurements at four locations (mid-buccal, mid-lingual, mid-mesial and mid-distal). The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface. RESULTS The MMGs of CAD/CAM LDS crowns constructed by TRIO/MCX5 were 72.31 at 50, 63.73 at 100 μm and 46.23 μm at 200 μm, which were smaller than E4DS/E4DM at each cement space. CONCLUSIONS Increasing the cement space decreased the MMG in both scanner/milling unit combinations. The smallest MMG was found using the newer scanner/milling unit at the 200 μm cement space. © 2024 Australian Dental Association.
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Affiliation(s)
- J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - J Xu
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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2
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Hayes WN, Laing E, Brown R, Silsby L, Smith L, Thomas H, Kaloyirou F, Sharma R, Griffiths J, Hume-Smith H, Marks SD, Kessaris N, Christian M, Dudley J, Shenoy M, Malina M, Muorah M, Ware N, Yadav P, Reynolds B, Bryant W, Spiridou A, Wray J, Peters MJ. A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO). Kidney Int 2024; 105:364-375. [PMID: 37914088 PMCID: PMC10804931 DOI: 10.1016/j.kint.2023.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 11/03/2023]
Abstract
Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). We then compared clinically significant electrolyte and acid-base abnormalities in the first 72 hours post-transplant. The primary outcome, acute hyponatremia, was experienced by 53% of 68 participants in the Plasma-Lyte-148 group and 58% of 69 participants in the standard fluids group (odds ratio 0·77 (0·34 - 1·75)). Five of 16 secondary outcomes differed with Plasma-Lyte-148: hypernatremia was significantly more frequent (odds ratio 3·5 (1·1 - 10·8)), significantly fewer changes to fluid prescriptions were made (rate ratio 0·52 (0·40-0·67)), and significantly fewer participants experienced hyperchloremia (odds ratio 0·17 (0·07 - 0·40)), acidosis (odds ratio 0·09 (0·04 - 0·22)) and hypomagnesemia (odds ratio 0·21 (0·08 - 0·50)). No other secondary outcomes differed between groups. Serious adverse events were reported in 9% of participants randomized to Plasma-Lyte-148 and 7% of participants randomized to standard fluids. Thus, perioperative Plasma-Lyte-148 did not change the proportion of children who experienced acute hyponatremia compared to standard fluids. However fewer fluid prescription changes were made with Plasma-Lyte-148, while hyperchloremia and acidosis were less common.
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Affiliation(s)
- Wesley N Hayes
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Emma Laing
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Rosemary Brown
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Laura Silsby
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Laura Smith
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Helen Thomas
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Fotini Kaloyirou
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Rupa Sharma
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - James Griffiths
- National Health Service Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Helen Hume-Smith
- Department of Anesthetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nicos Kessaris
- Department of Transplant Surgery, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Martin Christian
- Department of Pediatric Nephrology, Nottingham Children's Hospital, Nottingham, UK
| | - Jan Dudley
- Department of Pediatric Nephrology, Bristol Children's Hospital, Bristol, UK
| | - Mohan Shenoy
- Department of Pediatric Nephrology, Manchester Children's Hospital, Manchester, UK
| | - Michal Malina
- Department of Pediatric Nephrology, Great North Children's Hospital, Newcastle, UK
| | - Mordi Muorah
- Department of Pediatric Nephrology, Birmingham Children's Hospital, Birmingham, UK
| | - Nicholas Ware
- Department of Pediatric Nephrology, Evelina Childrens Hospital, London, UK
| | - Pallavi Yadav
- Department of Pediatric Nephrology, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Ben Reynolds
- Department of Pediatric Nephrology, Glasgow Hospital for Sick Children, Glasgow, UK
| | - William Bryant
- Department of Data Research Innovation and Virtual Environments, Great Ormond Street Hospital for Children, London, UK
| | - Anastassia Spiridou
- Department of Data Research Innovation and Virtual Environments, Great Ormond Street Hospital for Children, London, UK
| | - Jo Wray
- Department of Psychology, Great Ormond Street Hospital for Children, London, UK
| | - Mark J Peters
- University College London Great Ormond Street Institute of Child Health, London, UK; Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
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Tasic V, Edvardsson VO, Preka E, Prikhodina L, Stefanidis CJ, Topaloglu R, Shtiza D, Sarkissian A, Mueller-Sacherer T, Fataliyeva R, Kazyra I, Levtchenko E, Pokrajac D, Roussinov D, Milošević D, Elia A, Seeman T, Faerch M, Vainumae I, Kataja J, Tsimaratos M, Rtskhiladze I, Hoyer PF, Reusz G, Awan A, Lotan D, Peruzzi L, Nigmatullina N, Beishebaeva N, Jeruma E, Jankauskiene A, Niel O, Said-Conti V, Ciuntu A, Pavićević S, Oosterveld M, Bjerre A, Tkaczyk M, Teixeira A, Lungu AC, Tsygin A, Stojanović V, Podracka L, Kersnik Levart T, Espino-Hernández M, Brandström P, Sparta G, Alpay H, Ivanov D, Dudley J, Khamzaev K, Haffner D, Ehrich J. Diversity of kidney care referral pathways in national child health systems of 48 European countries. Front Pediatr 2024; 12:1327422. [PMID: 38292210 PMCID: PMC10825019 DOI: 10.3389/fped.2024.1327422] [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] [Received: 10/24/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. Methods In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. Results The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Conclusion Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.
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Affiliation(s)
- Velibor Tasic
- Medical School, University Children’s Hospital, Skopje, North Macedonia
| | - Vidar O. Edvardsson
- Iceland Children’s Medical Center, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Evgenia Preka
- Paediatric Nephrology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Larisa Prikhodina
- Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Diamant Shtiza
- Department of Pediatric Nephrology, University Hospital Centre “Mother Teresa”, Tirana, Albania
| | - Ashot Sarkissian
- Arabkir Joint Medical Centre, Yerevan State Medical University, Yerevan, Armenia
| | - Thomas Mueller-Sacherer
- Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Rena Fataliyeva
- Department of Pediatric Nephrology, Children’s Hospital, Baku, Azerbaijan
| | - Ina Kazyra
- 1st Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Elena Levtchenko
- Department of Pediatrics & Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Danka Pokrajac
- Department of Pediatric Nephrology, University Children’s Hospital, Sarajevo, Bosnia and Herzegovina
| | - Dimitar Roussinov
- Nephrology and Hemodialysis Clinic, University of Sofia, Sofia, Bulgaria
| | - Danko Milošević
- Pediatric Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Avraam Elia
- Department of Paediatrics, Archbishop Makarios III Hospital, Nicosia, Cyprus
| | - Tomas Seeman
- Department of Pediatrics, 2nd Medical Faculty, Charles University Prague, Prague, Czech Republic
| | - Mia Faerch
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Inga Vainumae
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Janne Kataja
- Department of Paediatrics and Adolescents Medicine, Turku University Hospital, Turku, Finland
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | | | - Peter F. Hoyer
- Department of Pediatric Nephrology, University Hospital Essen, Essen, Germany
| | - George Reusz
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Atif Awan
- Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Danny Lotan
- Division of Pediatric Nephrology, Sheba Medical Center, Edmond and Lily Children’s Hospital, Tel Hashomer, Israel
| | - Licia Peruzzi
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Children's Hospital, Turin, Italy
| | - Nazim Nigmatullina
- Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan
| | - Nasira Beishebaeva
- Department of Nephrology, National Center of Maternity and Childhood Welfare under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Edite Jeruma
- Bērnu Slimību Klīnika, Nefroloģijas Profila Virsārste, Riga, Latvia
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Olivier Niel
- Pediatric Nephrology Unit, Department of Pediatrics, Centre Hospitalier de Luxembourg, Luxembourg, Luxemburg
| | - Valerie Said-Conti
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Angela Ciuntu
- Nephrology Unit, National Institute of Health Care for Mother and Child, Chisinau, Moldova
| | - Snežana Pavićević
- Clinical Center of Montenegro, Institute for Sick Children, Podgorica, Montenegro
| | - Michiel Oosterveld
- Department of Paediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Anna Bjerre
- Department of Pediatric and Adolescent Medicine, University Hospital of Oslo, Oslo, Norway
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Ana Teixeira
- Pediatric Nephrology Division, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Adrian C. Lungu
- Pediatric Nephrology, Fundeni Clincal Institute, Bucharest, Romania
| | - Alexey Tsygin
- National Medical and Research Centre for Children's Health, Moscow, Russia
| | - Vesna Stojanović
- Pediatric Intensive Care Unit, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Ludmila Podracka
- Department of Pediatrics, Comenius University, Bratislava, Slovakia
| | - Tanja Kersnik Levart
- Pediatric Nephrology Department, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Per Brandström
- Pediatric Uro-Nephrologic Center, Department of Pediatrics Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giuseppina Sparta
- Department of Pediatric Nephrology, University Children’s Hospital, Zurich, Switzerland
| | - Harika Alpay
- Division of Pediatric Nephrology, Marmara University, Istanbul, Turkey
| | - Dmytro Ivanov
- Nephrology and RRT Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Children's Hospital, Bristol, United Kingdom
| | - Komiljon Khamzaev
- Department of Pediatric Nephrology and Hemodialysis, Tashkent Pediatric Medical Institute, National Children's Medical Center, Tashkent, Uzbekistan
| | - Dieter Haffner
- Children’s Hospital, Hannover Medical School, Hannover, Germany
| | - Jochen Ehrich
- Children’s Hospital, Hannover Medical School, Hannover, Germany
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Pickles CW, Brown C, Marks SD, Reynolds BC, Kessaris N, Dudley J. Long term outcomes following kidney transplantation in children who weighed less than 15 kg - report from the UK Transplant Registry. Pediatr Nephrol 2023; 38:3803-3810. [PMID: 37209174 DOI: 10.1007/s00467-023-06024-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/15/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Kidney transplantation is the treatment of choice in chronic kidney disease (CKD) stage 5. It is often delayed in younger children until a target weight is achieved due to technical feasibility and historic concerns about poorer outcomes. METHODS Data on all first paediatric (aged < 18 years) kidney only transplants performed in the United Kingdom between 1 January 2006 and 31 December 2016 were extracted from the UK Transplant Registry (n = 1,340). Children were categorised by weight at the time of transplant into those < 15 kg and those ≥ 15 kg. Donor, recipient and transplant characteristics were compared between groups using chi-squared or Fisher's exact test for categorical variables and Kruskal-Wallis test for continuous variables. Thirty day, one-year, five-year and ten-year patient and kidney allograft survival were compared using the Kaplan-Meier method. RESULTS There was no difference in patient survival following kidney transplantation when comparing children < 15 kg with those ≥ 15 kg. Ten-year kidney allograft survival was significantly better for children < 15 kg than children ≥ 15 kg (85.4% vs. 73.5% respectively, p = 0.002). For children < 15 kg, a greater proportion of kidney transplants were from living donors compared with children ≥ 15 kg (68.3% vs. 49.6% respectively, p < 0.001). There was no difference in immediate graft function between the groups (p = 0.54) and delayed graft function was seen in 4.8% and 6.8% of children < 15 kg and ≥ 15 kg respectively. CONCLUSIONS Our study reports significantly better ten-year kidney allograft survival in children < 15 kg and supports consideration of earlier transplantation for children with CKD stage 5. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Charles W Pickles
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Chloe Brown
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ben C Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children, 1345 Govan Road, Glasgow, UK
| | - Nicos Kessaris
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
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Kim JJ, Curtis RMK, Reynolds B, Marks S, Drage M, Kosmoliaptsis V, Dudley J, Williams A. The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients. Front Immunol 2023; 14:1207145. [PMID: 37334377 PMCID: PMC10275486 DOI: 10.3389/fimmu.2023.1207145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background The UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry. Methods We performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021. Results 319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05]. Summary Adult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.
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Affiliation(s)
- Jon Jin Kim
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Rebecca M. K. Curtis
- Statistics and Clinical Research, NHS Blood and Transplant, Bristol, United Kingdom
| | - Ben Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Martin Drage
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Children’s Hospital, Bristol, United Kingdom
| | - Alun Williams
- Department of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United Kingdom
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King C, Dudley J, Mee A, Tomlin S, Tse Y, Trivedi A, Hawcutt DB. For children admitted to hospital, what interventions improve medication safety on ward rounds? A systematic review. Arch Dis Child 2023:archdischild-2022-324772. [PMID: 36792347 DOI: 10.1136/archdischild-2022-324772] [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] [Received: 08/11/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Every year, medication errors harm children in hospitals. Ward rounds are a unique opportunity to bring information together and plan management. There is a need to understand what strategies can improve medication safety on ward rounds. We systematically reviewed published interventions to improve prescribing and safety of medicines on ward rounds. DESIGN Systematic review of randomised controlled trials and observational studies. SETTING Studies examining inpatient ward rounds. PATIENTS Children and young people aged between 0 and 18 years old. INTERVENTIONS Any intervention or combination of interventions implemented that alters how paediatric ward rounds review inpatient medications. MAIN OUTCOME MEASURE Primary outcome was improvement in medication safety on paediatric ward rounds. This included reduction in prescribing error rates, healthcare professionals' opinions on prescribing and improvement in documentation on ward rounds. RESULTS Three studies were eligible for review. One examined the use of an acrostic, one the use of a checklist, and the other a use of a specific prescribing ward round involving a clinical pharmacist and doctor. None of the papers considered weight-based errors or demonstrated reductions in clinical harm. Reductions in prescribing errors were noted by the different interventions. CONCLUSIONS There are limited data on interventions to improve medication safety in paediatric ward rounds, with all published data being small scale, either quality improvement or audits, and locally derived/delivered. Good-quality interventional or robust quality improvement studies are required to improve medication safety on ward rounds. PROSPERO REGISTRATION NUMBER CRD42022340201.
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Affiliation(s)
- Charlotte King
- Department of Women and Child's Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Abigail Mee
- Department of Pharmacy, Bristol Royal Hospital for Children, Bristol, UK
| | - Stephen Tomlin
- Department of Pharmacy, Great Ormond Street Hospital for Children, London, UK
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ashifa Trivedi
- Paediatrics, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Daniel B Hawcutt
- Department of Women and Child's Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK .,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
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Tan K, Dudley J. The marginal gaps of sequentially milled lithium disilicate crowns using two different milling units. Aust Dent J 2022; 67:239-248. [PMID: 35225358 PMCID: PMC9790678 DOI: 10.1111/adj.12909] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/13/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this study was to compare the marginal gaps of sequentially milled lithium disilicate (LDS) crowns using two different milling units. METHODS One lower left first molar typodont tooth prepared for an LDS crown by an undergraduate student in a simulation clinic was selected. The crown preparation was scanned by a TRIOS 3 scanner and twelve LDS crowns milled by an E4D (E4DM) and a Sirona inLab MC X5 (MCX5) milling unit using identical settings. The crowns were seated onto the original crown preparation and three vertical marginal gap measurements were taken at four locations (mid-buccal, mid-lingual, mid-mesial and mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each individual tooth surface and each crown. RESULTS The MMG for the E4DM (100.40 μm) was not significantly different to the MCX5 (101.08 μm) milling unit (P = 0.8809). In both units, there was a statistically significant trend of increasing MMG with sequentially milled crowns using the same burs (E4DM P = 0.0133; MCX5 P = 0.0240). CONCLUSIONS The E4DM and MCX5 milling units produced LDS crowns with similar MMG's and within a clinically acceptable range but with a trend of increasing MMG when analysed sequentially. © 2022 Australian Dental Association.
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Affiliation(s)
- K Tan
- Adelaide Dental SchoolThe University of AdelaideAdelaideSAAustralia
| | - J Dudley
- Adelaide Dental SchoolThe University of AdelaideAdelaideSAAustralia
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8
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McGlen SE, Stoesser N, Woodrow C, Dudley J, Newton D, Lasserson D. Tocilizumab for treatment of SARS-CoV-2 infection at home: A case report. Acute Med 2022; 21:53-55. [PMID: 35342912 DOI: 10.52964/amja.0894] [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
SARS-CoV-2 virtual wards have successfully developed to monitor and escalate patients to hospital throughout the pandemic. Here we describe the case of an 84 year old man who received his complete care for severe SARS-CoV-2 pneumonitis at home, including the administration of oxygen, dexamethasone and tocilizumab.
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Affiliation(s)
- S E McGlen
- MPharm, Oxford University Hospitals NHS Foundation Trust
| | - N Stoesser
- DPhil, Oxford University Hospitals NHS Foundation Trust and Nuffield Department of Medicine, University of Oxford
| | - C Woodrow
- MRCP, PhD, Oxford Univeristy Hospitals NHS Foundation Trust and Medical Sciences Division University of Oxford
| | - J Dudley
- RN, BSc, Oxford University Hospitals NHS Foundation Trust
| | | | - D Lasserson
- MD FRCPEdin, Oxford University Hospitals NHS Foundation Trust and Warwick Medical School, University of Warwick
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Dudley J. COVID-19 Transmission Under the Public Health Radar: High Prevalence in Young Adults for COVID-19 Pandemic Wave 1. Int J Infect Dis 2022. [PMCID: PMC8884812 DOI: 10.1016/j.ijid.2021.12.070] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Compare reported data on age specific rates of SARS-CoV-2 infections in countries from several continents to identify differences in age specific incidence of reported cases in different countries. Methods & Materials Data on age-specific case incidence of SARS-CoV-2 derived from publicly available databases from selected countries in Europe, North America, Australasia, and Asia were collected and analysed to identify and evaluate trends in reported age specific distribution of morbidity from SARS-CoV-2 in countries for which data was available. Results Data for laboratory confirmed COVID-19 cases from South Korea, Australia, New Zealand, Japan and the Netherlands exhibited essentially identical profiles, with a bimodal distribution that shows highest rate of confirmed SARS-CoV-2 infections among individuals in the 20-29 years age cohort (21%-27% of total), and a second lower peak for the 50-59 or 60-69 age cohorts (16-18% of total), while preliminary data from China, United States and Sweden exhibited a unimodal distribution with highest rate of positive individuals for the 50-59 age cohort. Conclusion There is increasing evidence that individuals < 30 years of age may be playing a highly significant role in the facilitation and amplification of COVID-19 transmission in countries worldwide. Data reported from the first wave of the COVID-19 Pandemic in at least 5 countries (South Korea, Australia, New Zealand, Japan, Netherlands) demonstrated that greater attention should be paid to the frequency and epidemiological importance of COVID-19 infections among young adults in the 20-29 year age cohort, because individuals in this age range comprise a large proportion (21%-27%) of the known laboratory confirmed COVID-19 cases in these countries, and perhaps other countries for which reliable data are not yet available. The epidemiological importance of COVID-19 infections among young adults and adolescents in amplifying and facilitating the proliferation of the COVID-19 Pandemic has been systematically underestimated in many countries, because of low rates of testing among asymptomatic individuals and low rates of severe disease or mortality among individuals <30 years of age. Clarifying and understanding the epidemiological dynamics of SARS-CoV-2 transmission among individuals in younger age cohorts will help in determining control strategies at the individual and population levels.
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Dudley J, Rajakariar K, Roberts L, Chandrasekhar J. Differences in STEMI, Door-to-Balloon Time and Mortality Between Pre-COVID and COVID Era: A Systematic Review. Heart Lung Circ 2022. [PMCID: PMC9345536 DOI: 10.1016/j.hlc.2022.06.331] [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: 12/02/2022]
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11
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Walipoor M, Dudley J. The influence of a composite resin adhesive on microleakage into the implant screw access chamber. Aust Dent J 2021; 67:39-45. [PMID: 34674276 DOI: 10.1111/adj.12879] [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] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The sealing of implant screw access chambers can influence prosthesis success, peri-implant health and patient comfort. The aim of this study was to compare the microleakage of single implant crown screw access chambers sealed with and without a composite resin adhesive. METHODS Twenty milled lithium disilicate crowns were luted to titanium-base abutments, attached to implants and randomly assigned to one of two groups. The first group had the screw access chamber sealed with polytetrafluoroethylene tape, a 10-methacryloyloxydecyl dihydrogen phosphate containing adhesive, and composite resin. The second group used the same procedure but without an adhesive. All samples were sealed at the implant-abutment interface and subjected to thermocycling then immersed in a ferrous sulphate contrast media for 48 h. Infiltration and microleakage was measured using a microcomputed tomography scanner. RESULTS All samples demonstrated high resistance to microleakage with no significant contrast media diffusion in either of the two groups. CONCLUSIONS Within the limitations of this in vitro study, the use of a composite resin adhesive for sealing the screw access chamber for single implant crowns provided no additional sealing capacity compared with composite resin alone. Composite resin restorations placed in the traditional manner without sealing provided excellent resistance to microleakage.
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Affiliation(s)
- M Walipoor
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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12
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Dudley J, Christian M, Andrews A, Andrews N, Baker J, Boyle S, Convery M, Gamston F, Garcia M, Haq S, Hegde S, Holt R, Jones H, Khan S, McCaughan J, Milford D, Pickles C, Reynolds B, Sathyanarayana V, Stojanovic J, Tse Y, Wallace D, Walsh G, Ware N, Williams A, Yadav P, Marks S. Clinical practice guidelines standardisation of immunosuppressive and anti-infective drug regimens in UK paediatric renal transplantation: the harmonisation programme. BMC Nephrol 2021; 22:312. [PMID: 34530758 PMCID: PMC8447621 DOI: 10.1186/s12882-021-02460-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/25/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jan Dudley
- Consultant Paediatric Nephrologist, Bristol, UK.
| | | | | | | | | | | | - Mairead Convery
- Consultant Paediatric Nephrologist, Belfast, Northern Ireland
| | | | - Martin Garcia
- Specialist trainee in Paediatric Nephrology, Evelina, London, UK
| | - Shuman Haq
- Consultant Paediatric Nephrologist, Southampton, UK
| | | | - Richard Holt
- Consultant Paediatric Nephrologist, Liverpool, UK
| | - Helen Jones
- Consultant Paediatric Nephrologist, Evelina, London, UK
| | | | | | | | | | | | | | | | - Yincent Tse
- Consultant Paediatric Nephrologist, Newcastle, UK
| | - Dean Wallace
- Consultant Paediatric Nephrologist, Manchester, UK
| | | | - Nick Ware
- Consultant Paediatric Nephrologist, Evelina, London, UK
| | | | | | - Stephen Marks
- Consultant Paediatric Nephrologist, Great Ormond St, London, UK
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13
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Ravanan R, Callaghan CJ, Mumford L, Ushiro-Lumb I, Thorburn D, Casey J, Friend P, Parameshwar J, Currie I, Burnapp L, Baker R, Dudley J, Oniscu GC, Berman M, Asher J, Harvey D, Manara A, Manas D, Gardiner D, Forsythe JL. SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study. Am J Transplant 2020; 20:3008-3018. [PMID: 32780493 PMCID: PMC7436919 DOI: 10.1111/ajt.16247] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [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: 06/05/2020] [Revised: 07/01/2020] [Accepted: 07/25/2020] [Indexed: 01/25/2023]
Abstract
Patients waitlisted for and recipients of solid organ transplants (SOT) are perceived to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and death; however, definitive epidemiological evidence is lacking. In a comprehensive national cohort study enabled by linkage of the UK transplant registry and Public Health England and NHS Digital Tracing services, we examined the incidence of laboratory-confirmed SARS-CoV-2 infection and subsequent mortality in patients on the active waiting list for a deceased donor SOT and recipients with a functioning SOT as of February 1, 2020 with follow-up to May 20, 2020. Univariate and multivariable techniques were used to compare differences between groups and to control for case-mix. One hundred ninety-seven (3.8%) of the 5184 waitlisted patients and 597 (1.3%) of the 46 789 SOT recipients tested positive for SARS-CoV-2. Mortality after testing positive for SARS-CoV-2 was 10.2% (20/197) for waitlisted patients and 25.8% (154/597) for SOT recipients. Increasing recipient age was the only variable independently associated with death after positive SARS-CoV-2 test. Of the 1004 transplants performed in 2020, 41 (4.1%) recipients have tested positive for SARS-CoV-2 with 8 (0.8%) deaths reported by May 20. These data provide evidence to support decisions on the risks and benefits of SOT during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Rommel Ravanan
- Chair, , Kidney Advisory Group, NHS Blood and Transplant, Bristol, UK,Correspondence Rommel Ravanan
| | - Chris J. Callaghan
- National Clinical Lead for Abdominal Organ Utilisation, NHS Blood and Transplant, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Ines Ushiro-Lumb
- Lead Clinical Microbiologist, NHS Blood and Transplant, Bristol, UK
| | - Douglas Thorburn
- Chair, Liver Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - John Casey
- Chair, Pancreas Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Peter Friend
- Chair, Multi-Visceral & Composite Tissue Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Jayan Parameshwar
- Chair, Cardiothoracic Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Ian Currie
- National Clinical Lead for Organ Retrieval, NHS Blood and Transplant, Bristol, UK
| | - Lisa Burnapp
- Clinical Lead for Living Donation, NHS Blood and Transplant, Bristol, UK
| | - Richard Baker
- Joint National Clinical Lead for Governance, NHS Blood and Transplant, Bristol, UK
| | - Jan Dudley
- Chair, Paediatric Sub-Group of the Kidney Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Gabriel C. Oniscu
- Chair, Research Innovation and Novel Technologies Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Marius Berman
- Associate National Clinical Lead for Organ Retrieval, NHS Blood and Transplant, Bristol, UK
| | - John Asher
- National Clinical Lead for Health Informatics, NHS Blood and Transplant, Bristol, UK
| | - Dan Harvey
- National Clinical Lead for Innovation & Research in Organ Donation, NHS Blood and Transplant, Bristol, UK
| | - Alex Manara
- National Quality Lead in Organ Donation, NHS Blood and Transplant, Bristol, UK
| | - Derek Manas
- Joint National Clinical Lead for Governance, NHS Blood and Transplant, Bristol, UK
| | - Dale Gardiner
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, Bristol, UK
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14
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Kwong B, Dudley J. A comparison of the marginal gaps of lithium disilicate crowns fabricated by two different intraoral scanners. Aust Dent J 2020; 65:150-157. [PMID: 32037559 DOI: 10.1111/adj.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to assess marginal gaps of CAD/CAM lithium disilicate crowns constructed using two different intraoral scanners of different generations. METHODS Twenty four Columbia model lower left molars were prepared for lithium disilicate crowns in a simulated environment by undergraduate students. The crown preparations were scanned by E4D and Trios 3 intraoral scanners and CAD/CAM lithium disilicate crowns designed and manufactured. The crowns were seated onto the original crown preparations and three vertical marginal gap measurements taken at four locations (mid-buccal, mid-lingual, mid-mesial and mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface. RESULTS The MMG was not statistically significantly different for the Trios 3 and E4D scanners (P = 0.111). There was no statistically significant effect of measurement location on the tooth on the marginal gap (P = 0.1134). CONCLUSIONS There was no difference in the MMGs of CAD/CAM lithium disilicate crowns constructed using two different intraoral scanners of different generations. Within the limitations of this study, the advances in scanning technology have produced small and insignificant improvements in the accuracy of crown margins.
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Affiliation(s)
- B Kwong
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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15
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Gabryszewski S, Dudley J, Grundmeier R, Hill D. P359 DELIVERY MODE AND FEEDING PRACTICES INFLUENCE ALLERGIC DISEASE BURDEN. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.572] [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: 10/25/2022]
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Ruffner M, Wang K, Dudley J, Cianferoni A, Grundmeier R, Spergel J, Brown-Whitehorn T, Hill D. A300 ELEVATED ALLERGIC COMORBIDITY IN PATIENTS WITH FOOD PROTEIN-INDUCED ENTEROCOLITIS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.055] [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: 11/15/2022]
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17
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Gimpel C, Bergmann C, Bockenhauer D, Breysem L, Cadnapaphornchai MA, Cetiner M, Dudley J, Emma F, Konrad M, Harris T, Harris PC, König J, Liebau MC, Marlais M, Mekahli D, Metcalfe AM, Oh J, Perrone RD, Sinha MD, Titieni A, Torra R, Weber S, Winyard PJD, Schaefer F. International consensus statement on the diagnosis and management of autosomal dominant polycystic kidney disease in children and young people. Nat Rev Nephrol 2019; 15:713-726. [PMID: 31118499 PMCID: PMC7136168 DOI: 10.1038/s41581-019-0155-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These recommendations were systematically developed on behalf of the Network for Early Onset Cystic Kidney Disease (NEOCYST) by an international group of experts in autosomal dominant polycystic kidney disease (ADPKD) from paediatric and adult nephrology, human genetics, paediatric radiology and ethics specialties together with patient representatives. They have been endorsed by the International Pediatric Nephrology Association (IPNA) and the European Society of Paediatric Nephrology (ESPN). For asymptomatic minors at risk of ADPKD, ongoing surveillance (repeated screening for treatable disease manifestations without diagnostic testing) or immediate diagnostic screening are equally valid clinical approaches. Ultrasonography is the current radiological method of choice for screening. Sonographic detection of one or more cysts in an at-risk child is highly suggestive of ADPKD, but a negative scan cannot rule out ADPKD in childhood. Genetic testing is recommended for infants with very-early-onset symptomatic disease and for children with a negative family history and progressive disease. Children with a positive family history and either confirmed or unknown disease status should be monitored for hypertension (preferably by ambulatory blood pressure monitoring) and albuminuria. Currently, vasopressin antagonists should not be offered routinely but off-label use can be considered in selected children. No consensus was reached on the use of statins, but mTOR inhibitors and somatostatin analogues are not recommended. Children with ADPKD should be strongly encouraged to achieve the low dietary salt intake that is recommended for all children.
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Affiliation(s)
- Charlotte Gimpel
- Division of Pediatric Nephrology, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Detlef Bockenhauer
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Luc Breysem
- Department of Pediatric Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Melissa A Cadnapaphornchai
- Rocky Mountain Pediatric Kidney Center, Rocky Mountain Hospital for Children at Presbyterian St Luke's Medical Center, Denver, CO, USA
| | - Metin Cetiner
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Jan Dudley
- Renal Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Tess Harris
- PKD International, Geneva, Switzerland
- PKD Charity, London, UK
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Jens König
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Max C Liebau
- Department of Pediatrics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matko Marlais
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, GPURE, KU Leuven, Leuven, Belgium
| | - Alison M Metcalfe
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Jun Oh
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Manish D Sinha
- Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Andrea Titieni
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Roser Torra
- Department of Nephrology, University of Barcelona, Barcelona, Spain
| | - Stefanie Weber
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Paul J D Winyard
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
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Dudley J, Winyard P, Marlais M, Cuthell O, Harris T, Chong J, Sayer J, Gale DP, Moore L, Turner K, Burrows S, Sandford R. Clinical practice guideline monitoring children and young people with, or at risk of developing autosomal dominant polycystic kidney disease (ADPKD). BMC Nephrol 2019; 20:148. [PMID: 31039757 PMCID: PMC6489289 DOI: 10.1186/s12882-019-1285-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/07/2019] [Indexed: 11/30/2022] Open
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is thought to affect about 1 in 1000 people in the UK. ADPKD causes a progressive decline in kidney function, with kidney failure tending to occur in middle age. Children and young people with ADPKD may not have any symptoms. However they may have high blood pressure, which may accelerate progression to later stages of chronic kidney disease.There is uncertainty and variation in how health professionals manage children and young people with confirmed or a family history of ADPKD, because of a lack of evidence. For example, health professionals may be unsure about when to test children's blood pressure and how often to monitor it in the hospital clinic or at the GP. They may have different approaches in recommending scanning or genetic testing for ADPKD in childhood, with some recommending waiting until the young person is mature enough to make this decision his or herself.This guideline is intended to help families affected by ADPKD by making sure that: health professionals with specialist knowledge in ADPKD offer you information on inheritance and potential benefits and harms of testing for ADPKD. the decision to test and the method of testing for ADPKD in children and young people is shared between you or your family and the health professionals blood pressure assessment is undertaken regularly in children and young people at risk of developing ADPKD.
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Affiliation(s)
- Jan Dudley
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul Winyard
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Matko Marlais
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Oliver Cuthell
- 0000 0001 0575 1952grid.418670.cPlymouth Hospitals NHS Trust, Plymouth, UK
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Jiehan Chong
- 0000 0004 1936 9262grid.11835.3eUniversity of Sheffield, Sheffield, UK
| | - John Sayer
- 0000 0001 0462 7212grid.1006.7Newcastle University, Newcastle, UK
| | - Daniel P. Gale
- 0000000121901201grid.83440.3bUniversity College London Medical School, London, UK
| | - Lucy Moore
- Patient Representative, c/o The Renal Association, Bristol, UK
| | - Kay Turner
- Patient Representative, c/o The Renal Association, Bristol, UK
| | - Sarah Burrows
- 0000 0001 2177 007Xgrid.415490.dQueen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Richard Sandford
- 0000 0004 0622 5016grid.120073.7Addenbrooke’s Hospital, Cambridge, UK
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Abstract
BACKGROUND The purpose of this study was to measure the marginal gaps of CAD/CAM all-ceramic crowns constructed using different cement spaces on crown preparations created by undergraduate students. METHODS Twenty-four Columbia model lower left first molars with assessed tapers and reduction volumes (RV) were recruited to receive complete coverage E.max crowns. Three E.max crowns were digitally designed and milled for each crown preparation using three different cement spaces: 50 μm (CS-50), 100 μm (CS-100), 200 μm (CS-200). Each crown was seated onto its original crown preparation and three vertical marginal gap measurements were taken at four locations (mid-buccal, mid-lingual, mid-mesial, mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface. RESULTS The MMG was statistically significantly different for each of the three cement spaces (126 μm for CS-50, 89 μm for CS-100, and 75 μm for CS-200) (P < 0.0001). A taper of between 20 and 30° produced the smallest MMG. Insufficient RV caused significantly larger MMGs. The buccal margin had significantly smaller MMGs than all other measured surfaces. CONCLUSIONS The most accurate margins of digitally designed all-ceramic crowns constructed on simulation teeth prepared by undergraduate students were observed when using a 200 μm cement space.
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Affiliation(s)
- Y Zhang
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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Affiliation(s)
- James Gilbert
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Kate Lovibond
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Andrew Mooney
- Leeds Teaching Hospitals NHS Trust and Honorary Clinical Associate Professor, University of Leeds
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Abstract
BACKGROUND This retrospective cohort study reviewed dental implant treatment completed at the Adelaide Dental Hospital over a 20-year period. METHODS The database of implant treatment completed between 1996 and 2015 was analysed for patient, implant, prosthesis and operator specifics together with known implant status. RESULTS Three hundred and twenty patients (mean age, 51.50 years) were treated with 527 implants. One hundred and eighty-four female patients received 296 implants and 136 males received 231 implants. Three hundred implants were restored with single crowns, 147 implants were restored with 63 mandibular implant overdentures, five implants were restored with two maxillary implant overdentures and 67 implants were restored with 20 full-arch fixed prostheses. The overall known implant survival rate was 87.67%. Mandibular implant overdentures had a risk of implant failure four times that of single implant-retained crowns that was statistically significant (P = 0.0100). CONCLUSIONS Implant treatment completed in this public sector clinic using finite resources and a defined system of patient and restorative selection criteria demonstrated a high known implant survival rate. Utilizing a structured and maintained patient recall protocol, it would be ideal to investigate further parameters of interest, particularly those that could improve treatment delivery and longevity.
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Affiliation(s)
- A Duong
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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22
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Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O'Brien K, Pickles T, Rumsby K, Sterne JA, Thomas-Jones E, van der Voort J, Waldron CA, Whiting P, Wootton M, Butler CC. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess 2018; 20:1-294. [PMID: 27401902 DOI: 10.3310/hta20510] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, 'clinical diagnosis' correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. 'Clinical diagnosis' correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut. CONCLUSIONS Clinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Brendan Delaney
- Department of Primary Care and Public Health Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Harriet Downing
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stevo Durbaba
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Margaret Fletcher
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.,South West Medicines for Children Local Research Network, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kim Harman
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | | | - Kathryn O'Brien
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Judith van der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff, UK
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Christopher C Butler
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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23
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Haasova M, Snowsill T, Jones-Hughes T, Crathorne L, Cooper C, Varley-Campbell J, Mujica-Mota R, Coelho H, Huxley N, Lowe J, Dudley J, Marks S, Hyde C, Bond M, Anderson R. Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation. Health Technol Assess 2018; 20:1-324. [PMID: 27557331 DOI: 10.3310/hta20610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND End-stage renal disease is a long-term irreversible decline in kidney function requiring kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation followed by induction and maintenance immunosuppressive therapy to reduce the risk of kidney rejection and prolong graft survival. OBJECTIVES To systematically review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect,(®) Novartis Pharmaceuticals) and rabbit antihuman thymocyte immunoglobulin (Thymoglobuline,(®) Sanofi) as induction therapy and immediate-release tacrolimus [Adoport(®) (Sandoz); Capexion(®) (Mylan); Modigraf(®) (Astellas Pharma); Perixis(®) (Accord Healthcare); Prograf(®) (Astellas Pharma); Tacni(®) (Teva); Vivadex(®) (Dexcel Pharma)], prolonged-release tacrolimus (Advagraf,(®) Astellas Pharma); belatacept (BEL) (Nulojix,(®) Bristol-Myers Squibb), mycophenolate mofetil (MMF) [Arzip(®) (Zentiva), CellCept(®) (Roche Products), Myfenax(®) (Teva), generic MMF is manufactured by Accord Healthcare, Actavis, Arrow Pharmaceuticals, Dr Reddy's Laboratories, Mylan, Sandoz and Wockhardt], mycophenolate sodium, sirolimus (Rapamune,(®) Pfizer) and everolimus (Certican,(®) Novartis Pharmaceuticals) as maintenance therapy in children and adolescents undergoing renal transplantation. DATA SOURCES Clinical effectiveness searches were conducted to 7 January 2015 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science [via Institute for Scientific Information (ISI)], Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (HTA) (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted to 15 January 2015 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Databases (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and EconLit (via EBSCOhost). REVIEW METHODS Titles and abstracts were screened according to predefined inclusion criteria, as were full texts of identified studies. Included studies were extracted and quality appraised. Data were meta-analysed when appropriate. A new discrete time state transition economic model (semi-Markov) was developed; graft function, and incidences of acute rejection and new-onset diabetes mellitus were used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death. RESULTS Three randomised controlled trials (RCTs) and four non-RCTs were included. The RCTs only evaluated BAS and tacrolimus (TAC). No statistically significant differences in key outcomes were found between BAS and placebo/no induction. Statistically significantly higher graft function (p < 0.01) and less biopsy-proven acute rejection (odds ratio 0.29, 95% confidence interval 0.15 to 0.57) was found between TAC and ciclosporin (CSA). Only one cost-effectiveness study was identified, which informed NICE guidance TA99. BAS [with TAC and azathioprine (AZA)] was predicted to be cost-effective at £20,000-30,000 per quality-adjusted life year (QALY) versus no induction (BAS was dominant). BAS (with CSA and MMF) was not predicted to be cost-effective at £20,000-30,000 per QALY versus no induction (BAS was dominated). TAC (with AZA) was predicted to be cost-effective at £20,000-30,000 per QALY versus CSA (TAC was dominant). A model based on adult evidence suggests that at a cost-effectiveness threshold of £20,000-30,000 per QALY, BAS and TAC are cost-effective in all considered combinations; MMF was also cost-effective with CSA but not TAC. LIMITATIONS The RCT evidence is very limited; analyses comparing all interventions need to rely on adult evidence. CONCLUSIONS TAC is likely to be cost-effective (vs. CSA, in combination with AZA) at £20,000-30,000 per QALY. Analysis based on one RCT found BAS to be dominant, but analysis based on another RCT found BAS to be dominated. BAS plus TAC and AZA was predicted to be cost-effective at £20,000-30,000 per QALY when all regimens were compared using extrapolated adult evidence. High-quality primary effectiveness research is needed. The UK Renal Registry could form the basis for a prospective primary study. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013544. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- Marcela Haasova
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Tracey Jones-Hughes
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Nicola Huxley
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jenny Lowe
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children (University Hospitals Bristol NHS Foundation Trust), Bristol, UK
| | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Mary Bond
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
| | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis & Modelling for Health Improvement, University of Exeter, Exeter, UK
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24
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Van Stralen KJ, Verrina E, Belingheri M, Dudley J, Dušek J, Grenda R, Macher MA, Puretic Z, Rubic J, Rudaitis S, Rudin C, Schaefer F, Jager KJ. Impact of graft loss among kidney diseases with a high risk of post-transplant recurrence in the paediatric population. Nephrol Dial Transplant 2018; 33:542. [DOI: 10.1093/ndt/gfx372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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25
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Ketheeswaran A, Morrisey J, Abbott J, Bennett M, Dudley J, Deans R. Intensive vaginal dilation using adjuvant treatments in women with Mayer-Rokitansky-Kuster-Hauser syndrome: retrospective cohort study. Aust N Z J Obstet Gynaecol 2017; 58:108-113. [PMID: 28960241 DOI: 10.1111/ajo.12715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/05/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023]
Abstract
AIMS To evaluate the effect of adjuvants during intensive vaginal dilator therapy for functional and anatomical neovagina creation in women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). METHODS This retrospective cohort study included 75 women with MRKH undergoing intensive vaginal dilator treatment between 2000 and 2014. One specialist nurse performed non-surgical vaginal dilation aided by adjuvants, during inpatient admissions for several dilation sessions per day. Following discharge, women continued dilation at home and were advised to attend fortnightly follow-up appointments. RESULTS Outcomes from 68 women were analysed. The median age of starting treatment was 18 years (range: 13-36). There was a mean of 3 days per admission (range 1-5) with a median of 10 dilation sessions per admission. Adjuvant treatment was used by 48/68 (71%) women: oestriol cream 29/68 (43%), 50:50 nitrous oxide and oxygen 44/68 (65%), diazepam 8/68 (12%), lidocaine ointment 26/68 (39%), paracetamol 35/68 (51%) and naproxen 2/68 (3%). There were no statistically significant differences for changes in vaginal parameters. Women receiving adjuvants had a median increase of 4.5 cm (0.5-7 cm) in neovaginal length compared with women not receiving adjuvants who had a median increase of 3.25 cm (0-7 cm) during intensive treatment. Women who received adjuvants tolerated more dilation sessions per day (10 vs 6.5 median sessions respectively) than those who did not (P < 0.001). Of those with documented length at discharge, 42/56 (75%) women had an anatomical neovagina of 7 cm or greater length. CONCLUSIONS Vaginal dilation delivered by intensive treatment and supplemented by adjuvant treatments in a multi-disciplinary centre is a rapid and effective method for creation of a neovagina in women with MRKH.
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Affiliation(s)
| | - Jennifer Morrisey
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Michael Bennett
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jan Dudley
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
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26
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Dudley J, Mughal F, Hotinski E, Mahmud M. Prosthodontic management of maxillofacial cases: a case series. Aust Dent J 2017; 63:124-128. [PMID: 28853144 DOI: 10.1111/adj.12563] [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: 08/23/2017] [Indexed: 11/29/2022]
Abstract
Maxillofacial prosthetics is an important and recognized sub-discipline of prosthodontics that forms a key component of postgraduate training programmes. General dentists have a role to play in the management of maxillofacial defect patients even though treatment usually requires a multidisciplinary approach in an institutional environment. Maxillofacial prosthetic cases frequently present with complex histories but simple patient goals. The conservatively managed implant-retained auricular prosthesis, speech aid prosthesis and orbital prosthesis cases described in this report were completed in a postgraduate clinical residency program and highlight the intrinsic complexities, challenges and ultimately satisfaction related to cases of this nature.
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Affiliation(s)
- J Dudley
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - F Mughal
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - E Hotinski
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M Mahmud
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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27
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Nelson A, Hall J, Kidd B, Imamura Kawasawa Y, Dudley J, Thiboutot D. 626 Isolation and Identification of the follicular microbiome: Implications for acne research. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.648] [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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28
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Agarwal S, Baida G, Readhead B, Dudley J, Budunova I. 707 PI3-Kinase inhibitors represent a novel class of drug repurposing candidates to prevent/alleviate glucocorticoid-induced skin atrophy. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.730] [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: 11/26/2022]
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29
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Marlais M, Cuthell O, Langan D, Dudley J, Sinha MD, Winyard PJD. Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis. Arch Dis Child 2016; 101:1142-1147. [PMID: 27288429 DOI: 10.1136/archdischild-2015-310221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 11/25/2015] [Revised: 05/05/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022]
Abstract
CONTEXT Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that can cause hypertension during childhood, but the true prevalence of hypertension during childhood is not known. OBJECTIVE We undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD. DATA SOURCES Systematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE. STUDY SELECTION Studies selected by two authors independently if reporting data on prevalence of hypertension in children and young persons aged <21 years with a diagnosis of ADPKD. Observational series were included with study populations of >15 children. Articles were excluded if inadequate diagnostic criteria for hypertension were used. Studies with selection bias were included but analysed separately. DATA EXTRACTION Data extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence. RESULTS 903 articles were retrieved from our search; 14 studies met the inclusion criteria: 1 prospective randomised controlled trial; 8 prospective observational studies; and 5 retrospective cross-sectional studies. From 928 children with clinically confirmed ADPKD, 20% (95% CI 15% to 27%) were hypertensive. The estimated prevalence of proteinuria in children with ADPKD is 20% (8 studies; 95% CI 9% to 40%) while reduced renal function occurred in 8% (5 studies; 95% CI 2% to 26%). LIMITATIONS Studies showed a high degree of methodological heterogeneity (I2=73.4%, τ2=0.3408, p<0.0001). Most studies did not use ambulatory blood pressure (BP) monitoring to diagnose hypertension. CONCLUSIONS In this meta-analysis we estimate 20% of children with ADPKD have hypertension. In the population, many children with ADPKD are not under regular follow-up and remain undiagnosed. We recommend that all children at risk of ADPKD have regular BP measurement.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, London, UK
| | - Oliver Cuthell
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dean Langan
- Institute of Child Health, University College London, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Paul J D Winyard
- Institute of Child Health, University College London, London, UK
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30
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Hay AD, Sterne JAC, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Howe R, MacGowan A, Lawton M, Busby J, Pickles T, Birnie K, O'Brien K, Waldron CA, Dudley J, Van Der Voort J, Downing H, Thomas-Jones E, Harman K, Lisles C, Rumsby K, Durbaba S, Whiting P, Butler CC. Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. Ann Fam Med 2016; 14:325-36. [PMID: 27401420 PMCID: PMC4940462 DOI: 10.1370/afm.1954] [Citation(s) in RCA: 20] [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: 11/20/2015] [Accepted: 04/07/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. METHODS We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. RESULTS Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. CONCLUSIONS A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Paul Little
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Brendan Delaney
- Guys' and St Thomas' Charity Chair in Primary Care Research, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Alasdair MacGowan
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kathryn O'Brien
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Judith Van Der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Harriet Downing
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kim Harman
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Rumsby
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Stevo Durbaba
- King's College London, Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - Penny Whiting
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, United Kingdom, and General Practitioner, Cwm Taf University Health Board, Wales, United Kingdom
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Abstract
BACKGROUND The aim of this study was to compare the crown preparation dimensions produced from two different techniques of preparation for posterior all-ceramic crowns. METHODS Twenty-four fourth year dental students undertook a course of advanced simulation training involving education in an alternative technique of preparation for a 36 all-ceramic crown. Crown preparations performed using the traditional technique were compared with an alternative technique for total occlusal convergence (TOC) and reduction difference (RD) using digital scanning and comparative software. RESULTS Groups that spent the most time performing the alternative technique produced crown preparations with significantly lower buccolingual (BL) TOC. The training resulted in crown preparations that were closer to ideal TOC and RD measurements. CONCLUSIONS The alternative technique of crown preparation for a posterior all-ceramic crown showed initial promise in creating a less buccolingually tapered and more ideally occlusally reduced crown preparation.
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Affiliation(s)
- J Tran
- School of Dentistry, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Dudley
- School of Dentistry, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - L Richards
- School of Dentistry, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Douglas H, Ahlquist A, Ledger S, Prasad A, Hill L, Dudley J, Rand S. 145 5-year milestone reached in collaborative partnership between CF Unit and UK fitness provider. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30383-6] [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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Nelson A, Kidd B, Imamura Kawasawa Y, Dudley J, Thiboutot D. 481 Isolating and identifying the acne skin microbiome. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.518] [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: 11/25/2022]
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Butler CC, O'Brien K, Wootton M, Pickles T, Hood K, Howe R, Waldron CA, Thomas-Jones E, Dudley J, Van Der Voort J, Rumsby K, Little P, Downing H, Harman K, Hay AD. Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates. Fam Pract 2016; 33:127-32. [PMID: 26984993 DOI: 10.1093/fampra/cmv104] [Citation(s) in RCA: 11] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment. OBJECTIVE To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children. METHODS Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort]. RESULTS The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5-47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7-88.3%); cephalexin 95.1% (93.9-96.1%); trimethoprim 74.0% (71.7-76.2%) and nitrofurantoin 98.2% (97.4-98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8-61.4%); co-amoxiclav using the systemic BP 83.5% (73.9-90.1%); co-amoxiclav using the urinary BP 94.9% (87.7-98.4%); cephalexin 98.7% (93.2-99.8%); trimethoprim 70.9% (60.1-80.0%); nitrofurantoin 100% (95.3-100.0%) and ciprofloxacin 96.2% (89.4-98.7%). CONCLUSION Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin.
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Affiliation(s)
- Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Cwm Taf University Health Board, Abercynon,
| | - Kathryn O'Brien
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Timothy Pickles
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol
| | - Judith Van Der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Harriet Downing
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Harman
- Primary Care and Population Sciences Division, University of Southampton, Southampton and
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Ketheeswaran A, Morrisey J, Abbott J, Bennett M, Dudley J, Deans R. Vaginal Dilation in Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome. J Minim Invasive Gynecol 2015; 22:S103-S104. [DOI: 10.1016/j.jmig.2015.08.279] [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: 11/17/2022]
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McNulty CAM, Verlander NQ, Moore PCL, Larcombe J, Dudley J, Banerjee J, Jadresic L. Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures. J Med Microbiol 2015; 64:1030-1039. [PMID: 26297550 PMCID: PMC4681043 DOI: 10.1099/jmm.0.000114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/18/2022] Open
Abstract
The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all 'infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection'. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61% (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54% for general practice (GP) paediatric urines; 61% of laboratories (confidence interval 52-70%) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l(-1). Only 22% (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a quarter of laboratories were providing a service that would allow clinicians to fully comply with the first line recommendations in the 2007 NICE UTI in children guidance. Laboratory urine submission report figures suggest that the guidance has not led to an increase in diagnosis of UTI in children under 3 years old.
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Affiliation(s)
- Cliodna A M McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
| | - Neville Q Verlander
- Public Health England, Centre for Infectious Disease Surveillance and Control, Colindale, London, UK
| | - Philippa C L Moore
- Gloucestershire Hospitals NHS Foundation Trust, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
| | - James Larcombe
- Centre for Integrated Health Care Research, University of Durham Queens Campus, Stockton-on-Tees TS17 6BH, UK
| | - Jan Dudley
- Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Jaydip Banerjee
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Lyda Jadresic
- Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
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Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G, Pike K, Jadresic L. Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediatr 2015; 104:630-7. [PMID: 25690406 DOI: 10.1111/apa.12979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/09/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
Abstract
AIM To audit compliance with the 2007 National Institute of Clinical Excellence guidelines on the management of urinary tract infection in children under the age of 16 years across primary and secondary care services in England. METHODS A retrospective multisite audit of 10 general practice, 3 paediatric, 2 paediatric emergency and 2 emergency general units. Four distinct geographical areas were represented. Data were collected between 1 January 2010 and 31 December 2010. Six criteria were audited, which focused on the following: improving the rate of diagnosis, management of the very young child with UTI and selection of children for imaging. RESULTS A total of 1149 children were audited (682 from primary care and 467 from secondary care). Overall compliance was as follows: criterion 1: 28%; criterion 2: 68%; criterion 3: 89%; criterion 4: 43%; criterion 5 (comprising 12 subcriteria): 13% and for criterion 6: 45%. CONCLUSION The results indicate significant shortcomings in the implementation of NICE guidance on childhood UTI in England. The guidance is complex and this makes its implementation challenging. It was difficult to identify children presenting with nonspecific fever from clinical data systems. Adequate IT systems throughout the NHS are a key step to improving implementation of this and other NICE guidance.
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Affiliation(s)
| | - James Larcombe
- Centre for Integrated Healthcare Research; University of Durham; Durham UK
| | - Jan Dudley
- Department of Paediatric Nephrology; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Cliodna McNulty
- Head, Public Health England; Primary Care Unit, Microbiology Department; Gloucestershire Royal Hospital; Gloucester UK
| | - Jaydip Banerjee
- Department of Emergency Medicine; Leicester Royal Infirmary; Leicester UK
| | - Gita Gyoffry
- Department of Paediatrics; Musgrove Park Hospital; Taunton UK
| | - Katie Pike
- Department of Medical Statistics; University of Bristol; Bristol UK
| | - Lyda Jadresic
- Department of Paediatrics; Gloucestershire Hospitals NHS Foundation Trust; Gloucestershire Royal Hospital; Gloucester UK
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Abstract
Clinical guidelines that are rigorously developed play a fundamental role in improving healthcare and reducing unnecessary variations in practice. National guidelines are increasingly used by healthcare professionals, patients and commissioners; however, national bodies are unable to meet the demand for guidance on all topics. There are fewer resources available for guidance produced locally or by specialty groups, and it is necessary to achieve a balance between pragmatism and rigour while conforming to the widely accepted norms of what constitutes a good guideline. This paper introduces the key concepts around this topic with suggestions for those interested in developing their own guideline. An example of challenges encountered in generating high-quality clinical guidance is given in box 1. Box 1 Challenges in guideline development Professor Johnson runs a local developmental paediatrics service with eight other colleagues. All have different ways of managing children with PAVING syndrome. This was difficult for patients and staff and has led to disagreements on how certain patients should be managed. As a result, Professor Johnson developed a Guideline Development Group to look at the management of PAVING syndrome. The group identified 12 clinical questions (including diagnosis, exclusion of comorbidities, treatment modalities), searched the PubMed database and found some useful evidence that they used to formulate key recommendations. For one question about behavioural therapy, PubMed did not suggest any evidence so they informally arrived at a consensus among themselves and wrote up their guideline. On the back of this success, they applied for the guideline to be endorsed or supported by the Royal College of Paediatrics and Child Health (RCPCH). To their frustration, it was turned down on methodological grounds. Professor Johnson wrote to the RCPCH saying that he was "pretty peeved that the PAVING syndrome guideline had been rejected" for the College endorsement given all the work that had gone into writing it and "would the College mind being a bit more explicit in their guidance," to anyone who might consider doing this in the future?
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Affiliation(s)
- Munib Haroon
- Children's Services, Leicester Partnership Trust, Leicester, UK
| | - Rita Ranmal
- Royal College of Paediatrics and Child Health, London, UK
| | - Helen McElroy
- Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
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Abstract
The use of data to challenge and improve healthcare has a long and distinguished history but has often failed to bring about expected improvements. It has never become fully embedded in clinical practice, probably because data alone are insufficient to drive change. There is now a greater appreciation that changing and improving healthcare requires changing behaviours. Clinical audit remains one of the important tools that can be used to facilitate such change.
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Affiliation(s)
- James Y Paton
- Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Glasgow, UK
| | - Rita Ranmal
- Royal College of Paediatrics and Child Health, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
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Affiliation(s)
- J Dudley
- School of Dentistry; The University of Adelaide; South Australia Australia
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41
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Affiliation(s)
- Peter Lachman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jane Runnacles
- Department of Paediatrics, Royal Free Hospital, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
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George EM, Reichardt CL, Aird KA, Benson BA, Bleem LE, Carlstrom JE, Chang CL, Cho HM, Crawford TM, Crites AT, de Haan T, Dobbs MA, Dudley J, Halverson NW, Harrington NL, Holder GP, Holzapfel WL, Hou Z, Hrubes JD, Keisler R, Knox L, Lee AT, Leitch EM, Lueker M, Luong-Van D, McMahon JJ, Mehl J, Meyer SS, Millea M, Mocanu LM, Mohr JJ, Montroy TE, Padin S, Plagge T, Pryke C, Ruhl JE, Schaffer KK, Shaw L, Shirokoff E, Spieler HG, Staniszewski Z, Stark AA, Story KT, van Engelen A, Vanderlinde K, Vieira JD, Williamson R, Zahn O. A MEASUREMENT OF SECONDARY COSMIC MICROWAVE BACKGROUND ANISOTROPIES FROM THE 2500 SQUARE-DEGREE SPT-SZ SURVEY. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/799/2/177] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jukna V, Milián C, Xie C, Itina T, Dudley J, Courvoisier F, Couairon A. Filamentation with nonlinear Bessel vortices. Opt Express 2014; 22:25410-25425. [PMID: 25401574 DOI: 10.1364/oe.22.025410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present a new type of ring-shaped filaments featured by stationary nonlinear high-order Bessel solutions to the laser beam propagation equation. Two different regimes are identified by direct numerical simulations of the nonlinear propagation of axicon focused Gaussian beams carrying helicity in a Kerr medium with multiphoton absorption: the stable nonlinear propagation regime corresponds to a slow beam reshaping into one of the stationary nonlinear high-order Bessel solutions, called nonlinear Bessel vortices. The region of existence of nonlinear Bessel vortices is found semi-analytically. The influence of the Kerr nonlinearity and nonlinear losses on the beam shape is presented. Direct numerical simulations highlight the role of attractors played by nonlinear Bessel vortices in the stable propagation regime. Large input powers or small cone angles lead to the unstable propagation regime where nonlinear Bessel vortices break up into an helical multiple filament pattern or a more irregular structure. Nonlinear Bessel vortices are shown to be sufficiently intense to generate a ring-shaped filamentary ionized channel in the medium which is foreseen as opening the way to novel applications in laser material processing of transparent dielectrics.
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Aagaard K, Miller R, Chen J, Stodgell C, Dudley J, Schadt E. Novel insights on the molecular targets of environmental exposures during pregnancy using placental multi'omics data integration in the National Children's Study (NCS). Neurotoxicol Teratol 2014. [DOI: 10.1016/j.ntt.2014.04.012] [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: 10/25/2022]
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Abstract
Parenteral nutrition (PN) can be described as the "Intravenous administration of nutrients necessary to sustain life in those who would otherwise have died or suffered serious disease". PN is indicated in children who cannot be fully fed by the oral or intestinal route, usually as a result of intestinal failure. Intradialytic parenteral nutrition (IDPN) is rarely indicated in children on dialysis and does not confer a benefit over enteral supplements in the compliant patient with adequate intestinal function. Renal and metabolic consequences of PN are potentially life-threatening and include disorders of glucose homeostasis, acid-base and fluid and electrolyte disturbances, nephrolithiasis, impaired renal function and metabolic bone disease. Many of these complications are avoidable. Adequate clinical and biochemical assessment and monitoring of children receiving PN by a multidisciplinary nutrition support team is recommended to mitigate against the risks of these complications.
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Affiliation(s)
- Jan Dudley
- Bristol Royal Hospital for Children, Bristol, BS355RT, United Kingdom,
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Abstract
We present the case of a young boy with Dent's disease, identified as having a mutation in the kidney-specific chloride-proton antitransporter CLCN5 during investigation for nephrotic-range proteinuria. He went on to develop growth hormone deficiency and was treated with recombinant growth hormone. He later presented acutely with hepatorenal failure and thrombotic occlusion of the middle and right hepatic veins consistent with a diagnosis of Budd-Chiari syndrome, which required a prolonged period of intensive care. The diagnosis of Dent's disease should be considered early in boys with nephrotic-range proteinuria in the absence of clinical oedema and hypoalbuminaemia to allow for the timely introduction of strategies, such as a high-citrate diet, to preserve renal function. The measurement of urinary β-2 microglobulin has been shown by this case to be a more reliable and specific marker of tubular dysfunction than the urinary retinol-binding protein.
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Affiliation(s)
- Caroline Platt
- Department of Paediatrics, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK
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47
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Affiliation(s)
- J Dudley
- School of Dentistry; Faculty of Health Sciences; The University of Adelaide; South Australia
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Dodd A, Dudley J, Twigg S. Plasma Exchange in Haemolytic-Uraemic Syndrome Secondary to E. Coli. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400414] [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: 11/16/2022] Open
Abstract
A 12-year-old previously healthy girl presented with seizures, bloody diarrhoea and abdominal pain. A diagnosis of haemolytic-uraemic syndrome was made on the basis of the presence of haemolysis, thrombocytopenia and acute renal failure. This case report reviews clinical aspects of the syndrome. Plasma exchange has been used to treat cerebral symptoms in these patients and the dilemma surrounding its use is presented.
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Affiliation(s)
- Amy Dodd
- CT2 Anaesthesia, Gloucestershire Royal Hospital
| | - Jan Dudley
- Consultant Paediatric Nephrologist, Bristol Royal Hospital for Children
| | - Steven Twigg
- Consultant in Anaesthesia and Intensive Care Medicine, Gloucestershire Royal Hospital
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Dudley J, Smith G, Llewelyn-Edwards A, Bayliss K, Pike K, Tizard J. Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch-Schonlein Purpura (HSP). Arch Dis Child 2013; 98:756-63. [PMID: 23845696 DOI: 10.1136/archdischild-2013-303642] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [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: 11/03/2022]
Abstract
BACKGROUND The long-term prognosis of Henoch-Schönlein Purpura (HSP) is predominantly determined by the extent of renal involvement. There is no consensus as to whether treatment with prednisolone at presentation can prevent or ameliorate the progression of nephropathy in HSP. METHODS Children under 18 years of age with new-onset HSP were randomly assigned to receive prednisolone or placebo for 14 days. The primary outcomes were (a) the presence of proteinuria at 12 months (defined as urine protein : creatinine ratio (UP : UC) >20 mg/mmol) and (b) the need for additional treatment (defined as the presence of hypertension requiring treatment or renal biopsy anomalies or the need for treatment of renal disease) during the 12 month study period. RESULTS 352 children were randomised. Of those patients with laboratory UP : UC results available at 12 months, 18/123 (15%) patients on prednisolone and 13/124 (10%) patients on placebo had UP : UC >20 mg/mmol. There was no significant difference in the proportion of patients with UP : UC >20 mg/mmol at 12 months between the treatment groups (OR (prednisolone/placebo)=1.46, 95% CI 0.68 to 3.14, n=247), even after adjusting for baseline proteinuria and medications known to affect proteinuria (adjusted OR=1.29, 95% CI 0.58 to 2.82, n=247). Similarly, there was no significant difference in the time needed for additional treatment between the two groups (hazard ratio (HR) (prednisolone/placebo)=0.53, 95% CI 0.18 to 1.59, n=323). CONCLUSIONS This is the largest trial of the role of steroids in children with HSP. We found no evidence to suggest that early treatment with prednisolone reduces the prevalence of proteinuria 12 months after disease onset in children with HSP. TRIAL REGISTRATION NUMBER ISRCTN71445600.
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Affiliation(s)
- Jan Dudley
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, , Bristol, UK
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Martins S, Gilliam M, Dudley J, Yan S, Holl J. Development of an iPAD waiting room app for contraceptive counseling in Title X clinics. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.122] [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: 11/25/2022]
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