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Bird C, Hayward GN, Turner PJ, Wasala D, Merrick V, Lyttle MD, Mullen N, Fanshawe TR. Infections diagnosed in children and young people screened for malaria in UK emergency departments: a retrospective multi-centre study. Paediatr Int Child Health 2024; 44:1-7. [PMID: 38212934 DOI: 10.1080/20469047.2023.2299576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Data on imported infections in children and young people (CYP) are sparse. AIMS To describe imported infections in CYP arriving from malaria-endemic areas and presenting to UK emergency departments (ED) who were screened for malaria. METHODS This is a retrospective, multi-centre, observational study nested in a diagnostic accuracy study for malaria rapid diagnostic tests. Any CYP < 16 years presenting to a participating ED with a history of fever and travel to a malaria-endemic area between 1 January 2016 and 31 December 2017 and who had a malaria screen as a part of standard care were included. Geographical risk was calculated for the most common tropical infections. RESULTS Of the 1414 CYP screened for malaria, 44.0% (n = 622) arrived from South Asia and 33.3% (n = 471) from sub-Saharan Africa. Half (50.0%) had infections common in both tropical and non-tropical settings such as viral upper respiratory tract infection (URTI); 21.0% of infections were coded as tropical if gastro-enteritis is included, with a total of 4.2% (60) cases of malaria. CYP diagnosed with malaria were 7.44 times more likely to have arrived from sub-Saharan Africa than from South Asia (OR 7.44, 3.78-16.41). CONCLUSION A fifth of CYP presenting to participating UK EDs with fever and a history of travel to a malaria-endemic area and who were screened for malaria had a tropical infection if diarrhoea is included. A third of CYP had no diagnosis. CYP arriving from sub-Saharan Africa had the greatest risk of malaria.Abbreviations: CYP: children and young people; ED: emergency department; PERUKI: Paediatric Emergency Research in the UK and Ireland; RDT: rapid diagnostic test; VFR: visiting friends and relatives.
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Affiliation(s)
- Chris Bird
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Infection, Respiratory and Acute Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Desha Wasala
- Emergency Department, Bristol Royal Hospital for Children, UK
| | - Vanessa Merrick
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Niall Mullen
- Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bird C, Hayward GN, Turner PJ, Merrick V, Lyttle MD, Mullen N, Fanshawe TR. A diagnostic accuracy study to evaluate standard rapid diagnostic test (RDT) alone to safely rule out imported malaria in children presenting to UK emergency departments. J Pediatric Infect Dis Soc 2023; 12:290-297. [PMID: 37070464 DOI: 10.1093/jpids/piad024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/17/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Microscopy is the gold standard for malaria diagnosis but is dependent on trained personnel. Rapid diagnostic tests (RDT) form the mainstay of diagnosis in endemic areas without access to high quality microscopy. We aimed to evaluate whether RDT alone could rule out imported malaria in children presenting to UK Emergency Departments (EDs). METHODS UK-based, multi-centre, retrospective, diagnostic accuracy study. Included: any child <16 years presenting to ED with history of fever and travel to a malaria-endemic country, between 01/01/2016 and 31/12/2017. Diagnosis: microscopy for malarial parasites (clinical reference standard) and RDT (index test). UK Health Research Authority approval: 20/HRA/1341. RESULTS There were 47 cases of malaria out of 1,414 eligible cases (prevalence 3·3%) in a cohort of children whose median age was 4 years (IQR 2-9), of whom 43% were female. Cases of Plasmodium falciparum totalled 36 (77%, prevalence 2·5% ).The sensitivity of RDT alone to detect malaria infection due to any Plasmodium species was 93·6% (95% CI 82·5% to 98·7%), specificity 99·4% (95% CI 98·9% to 99·7%), positive predictive value 84·6% (95% CI 71·9% to 93·1%) and negative predictive value 99·8% (95% CI 99·4% to 100·0%). Sensitivity of RDT to detect P. falciparum infection was 100% (90·3% to 100%), specificity 98·8% (98·1% to 99·3%), positive predictive value 69·2% (54·9% to 81·2%, n=46/52) and negative predictive value 100% (99·7% to 100%, n=1362/1362). CONCLUSIONS RDTs were 100% sensitive in detecting P. falciparum malaria. However, lower sensitivity for other malaria species and the rise of pfhrp2 and pfhrp3 (pfhrp2/3) gene deletions in the P. falciparum parasite mandate the continued use of microscopy for diagnosing malaria.
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Affiliation(s)
- Chris Bird
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Mark D Lyttle
- University Hospitals Bristol NHS Foundation Trust, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Niall Mullen
- South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Tyson M, Trenear R, Skellett S, Maconochie I, Mullen N. Survey About Second-Line Agents for Pediatric Convulsive Status Epilepticus. Pediatr Emerg Care 2023; 39:247-252. [PMID: 35510724 DOI: 10.1097/pec.0000000000002745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Convulsive status epilepticus (CSE) is the most common neurological emergency in children. It is a frequent cause of admission to pediatric intensive care units and is associated with significant short- and long-term morbidity. Management of CSE is a step-wise approach: first-line antiseizure agents (typically benzodiazepines) followed by a second-line agent before deeper anesthesia usually accompanied by intubation and ventilation. Current guidelines in the United Kingdom specify phenytoin as the second-line agent of choice for CSE. Two recent large international randomized controlled trials compared the efficacy of phenytoin with that of another second-line agent levetiracetam. Both studies found levetiracetam to be noninferior to phenytoin. METHODS We conducted an online survey of clinicians across 67 emergency departments that treat children and 29 pediatric intensive care units in the United Kingdom and Ireland to assess their current and preferred second-line agents for treating pediatric CSE in light of recently published evidence. The survey was distributed via the Pediatric Emergency Research in United Kingdom and Ireland network and the Pediatric Critical Care Society. RESULTS We found that although most clinicians use phenytoin, as per current guidelines, they seek greater flexibility in choice of second-line agent, with levetiracetam being the preferred alternative to phenytoin. CONCLUSIONS To facilitate use of levetiracetam for treatment of CSE in pediatrics, it should be included as a second-line agent in addition to phenytoin in the next update of the National Institute for Health and Care Excellence and other United Kingdom clinical guidelines.
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Affiliation(s)
- Marguerite Tyson
- From the Paediatric Intensive Care Unit, Great Ormond Street Hospital
| | | | - Sophie Skellett
- Paediatric Intensive Care Unit, Great Ormond Street Hospital
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London
| | - Niall Mullen
- Department of Paediatric Emergency Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
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Stokle M, Tinker RJ, Munro SP, Mullen N. Early reattenders to the paediatric emergency department: A prospective cohort study and multivariate analysis. J Paediatr Child Health 2022; 58:1616-1622. [PMID: 35726728 DOI: 10.1111/jpc.16061] [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: 02/21/2022] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
AIMS The rate of unplanned reattendances is used as an indicator of the quality of care delivered in a paediatric emergency department (PED). With early reattendance in the UK well above the national target of 1-5%, we aimed to identify the factors which predict unplanned early reattendance to the PED. METHODS This is a prospective, single-centre cohort study undertaken over 12 months. Data were collected on all patients who reattended the PED within 7 days of their initial visit as well as for a comparative cohort of patients with no visit in the preceding or subsequent 7 days. Multiple patient and departmental variables were recorded and analysed using a multivariate regression model. RESULTS There were a total of 19 420 index visits to the PED, of which 1461 patients had an unscheduled reattendance within 7 days - a rate of 7.5%. Factors associated with unplanned but related reattendance include young age and diagnosis with a respiratory or other medical illness. Interestingly, the grade of clinician appeared to be relevant with patients seen by junior members of the medical team less likely to reattend. Acuity of illness was not a significant factor. A substantial number of unplanned early reattenders (36.3%) would have been missed had a time period of 72 h been used rather than 7 days. CONCLUSIONS This study identifies the typical patient who will have an unplanned, related early reattendance to a PED. This study also supports the use of a 7-day time period when using early reattendance as a performance indicator.
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Affiliation(s)
- Matthew Stokle
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Rory J Tinker
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Samuel P Munro
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Niall Mullen
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
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Lafferty M, Lyttle MD, Mullen N. Ingestion of metallic foreign bodies: A Paediatric Emergency Research in the United Kingdom and Ireland survey of current practice and hand-held metal detector use. J Paediatr Child Health 2021; 57:867-871. [PMID: 33719140 DOI: 10.1111/jpc.15343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use. METHODS Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics. RESULTS Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter. CONCLUSIONS There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making.
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Affiliation(s)
- Max Lafferty
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Niall Mullen
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
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Tubman L, Mullen N, Tracy DK. Fifteen-minute consultation: Recognition and management of the child or young person who has ingested a novel psychoactive substance. Arch Dis Child Educ Pract Ed 2020; 105:336-341. [PMID: 32366379 DOI: 10.1136/archdischild-2019-318390] [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: 03/23/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/03/2022]
Abstract
Intoxicated children and young people (CYP) attending the paediatric emergency department (PED) are typically under the influence of alcohol or established recreational agents such as cannabis or ecstasy. The last decade or so has seen an increase in the numbers of CYP in PED who have used novel psychoactive substances (NPS). In this review, we describe four different functional classes of NPS, their legal status, clinical effects, acute management and interventions to reduce harm.
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Affiliation(s)
- Lee Tubman
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Niall Mullen
- Paediatric Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Derek K Tracy
- Oxleas NHS Foundation Trust, London, UK.,Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Harwood R, Roland D, Patel D, Mendes F, Fitzsimmons A, Mullen N, James D, Bayreuther J, Peckham C. 382 Timing of paediatric presentation to the emergency department during the COVID-19 lockdown. J Accid Emerg Med 2020. [DOI: 10.1136/emj-2020-rcemabstracts.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims/Objectives/BackgroundPaediatric presentations to the emergency department (ED) reduced significantly during the COVID-19 lockdown. Concerns were raised that children were coming to harm as a result of delayed presentations to ED and rapid guidance was produced for parents to highlight red and amber symptoms which should prompt ED review. NHS 111 responses were also adapted for children to facilitate rapid recognition of the sick child.The aim of this rapid surveillance project was to objectively describe the proportion of children who had a delayed presentation to ED during the COVID-19 lockdown and their need for admission.Methods/DesignProspective anonymous data collection on children presenting to ED during periods between 20th April and 8th July 2020 in 7 trusts in England and Northern Ireland. Clinicians (doctors and advance care practitioners) were asked to feedback at the time of patient dispostion about whetherthe parents had reported a delay in presenting to hospitalthe parents had experienced a delay secondary to another service provider (primary care/111)there was no delay in presentationthey were uncertain as to whether there was a delay.Data was a collected via an approved website with appropriate data goverance.Abstract 382 Table 1Patient characteristics and outcomesAgeNRed SxAmber Sx111/GP inputParental delayGP/111 delayAdmission to PICU if delayedAdmission to ward if delayed0–6 weeks 67 7 (10.4%) 19 (28.4%) 23 (34.3%) 3 (4.5%) 0 (0.0%) 1 (33.3%) 1 (33.3%) 7 weeks - 3 months 51 4 (7.8%) 17 (33.3%) 50 (98.0%) 0 (0.0%) 1 (2.0%) 0 (0.0%) 0 (0.0%) 4–6 months 47 7 (14.9%) 11 (23.4%) 22 (46.8%) 4 (8.5%) 4 (8.5%) 0 (0.0%) 0 (0.0%) 7–11 months 116 10 (8.6%)22 (19.0%) 50 (43.1%) 2 (1.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 year 198 15 (7.6%) 43 (21.7%) 58 (29.3%) 4 (2.0%) 3 (1.5%) 0 (0.0%) 1 (14.3%) 2–5 years 471 14 (3.0%) 98 (20.8%) 107 (22.7%) 11 (2.3%) 1 (0.2%) 1 (8.3%) 1 (8.3%) 6–10 years 388 22 (5.7%) 112 (28.9%) 105 (27.1%) 17 (4.4%) 4 (1.0%) 0 (0.0%) 3 (14.3%) 11–15 years 299 22 (7.4%) 64 (21.4%) 64 (21.4%) 12 (4.0%) 2 (0.7%) 0 (0.0%) 3 (21.4%) Total 1637 101 (6.2%) 386 (23.6%) 449 (27.4%) 53 (3.2%) 15 (0.9%) 2 (2.9%) 9 (13.2%) Sx: Signs (as per RCPCH guidance)PICU: Paediatric Intensive Care UnitResults/Conclusions1637 patients patient entries were recorded, the majority in May 2020 (86%). Patient characteristics and outcomes are shown in table 1.Diagnosis of 11 patients with delayed presentation requiring admission: sepsis, abdominal pain of unclear cause, abscess, bronchiolitis, headache, GORD, DKA, testicular torsion and viral induced wheeze.1 in 24 children were reported to have delayed presentation during lockdown and a small number of these children required PICU admission.Overall the data are reassuring that the majority of children are brought to ED appropriately. Ongoing messaging for parents regarding red and amber symptoms continues to be important, particularly in the event of any further lockdowns.
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Chacko J, King C, Harkness D, Messahel S, Grice J, Roe J, Mullen N, Sinha IP, Hawcutt DB. Pediatric acute asthma scoring systems: a systematic review and survey of UK practice. J Am Coll Emerg Physicians Open 2020; 1:1000-1008. [PMID: 33145551 PMCID: PMC7593416 DOI: 10.1002/emp2.12083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/06/2019] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute exacerbations of asthma are common in children. Multiple asthma severity scores exist, but current emergency department (ED) use of severity scores is not known. METHODS A systematic review was undertaken to identify the parameters collected in pediatric asthma severity scores. A survey of Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI) sites was undertaken to ascertain routinely collected asthma data and information about severity scores. Included studies examined severity of asthma exacerbation in children 5-18 years of age with extractable severity parameters. RESULTS Sixteen articles were eligible, containing 17 asthma severity scores. The severity scores assessed combinations of 15 different parameters (median, 6; range, 2-8). The most common parameters considered were expiratory wheeze (15/17), inspiratory wheeze (13/17), respiratory rate (10/17), and general accessory muscle use (9/17). Fifty-nine PERUKI centers responded to the questionnaire. Twenty centers (33.1%) currently assess severity, but few use a published score. The most commonly recorded routine data required for severity scores were oxygen saturations (59/59, 100%), heart rate, and respiratory rate (58/59, 98.3% for both). Among well-validated scores like the Pulmonary Index Score (PIS), Pediatric Asthma Severity Score (PASS), Childhood Asthma Score (CAS), and the Pediatric Respiratory Assessment Measure (PRAM), only 6/59 (10.2%), 3/59 (5.1%), 1/59 (1.7%), and 0 (0%) of units respectively routinely collect the data required to calculate them. CONCLUSION Standardized published pediatric asthma severity scores are infrequently used. Improved routine data collection focusing on the key parameters common to multiple scores could improve this, facilitating research and audit of pediatric acute asthma.
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Affiliation(s)
- Jerry Chacko
- School of MedicineUniversity of LiverpoolLiverpoolUK
- Department of Women's and Children's HealthUniversity of LiverpoolLiverpoolUK
| | - Charlotte King
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK
| | - David Harkness
- National Institute for Health Research Alder Hey Clinical Research FacilityAlder Hey Children's HospitalLiverpoolUK
| | - Shrouk Messahel
- Emergency DepartmentAlder Hey Children's HospitalLiverpoolUK
| | - Julie Grice
- Emergency DepartmentAlder Hey Children's HospitalLiverpoolUK
| | - John Roe
- Darwin Emergency DepartmentDarwinNorthern TerritoryAustralia
| | - Niall Mullen
- Paediatric Emergency MedicineSunderland Royal HospitalSunderlandUK
| | - Ian P. Sinha
- Department of Respiratory MedicineAlder Hey Children's HospitalLiverpoolUK
| | - Daniel B. Hawcutt
- Department of Women's and Children's HealthUniversity of LiverpoolLiverpoolUK
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Stinchcombe A, Maxwell H, Mullen N, Weaver B, Tuokko H, Naglie G, Marshall S, Bedard M. CHANGES IN DRIVERS’ READINESS FOR MOBILITY TRANSITION, SELF-RESTRICTION, AND HEALTH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A. Stinchcombe
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada,
| | - H. Maxwell
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada,
- Centre for Applied Health Research, St. Joseph’s Care Group, Thunder Bay, Ontario, Canada,
| | - N. Mullen
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada,
| | - B. Weaver
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada,
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - H.A. Tuokko
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada,
| | - G. Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada,
- Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada,
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
| | - S. Marshall
- University of Ottawa, Ottawa, Ontario, Canada,
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,
| | - M. Bedard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada,
- Centre for Applied Health Research, St. Joseph’s Care Group, Thunder Bay, Ontario, Canada,
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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10
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Van de Voorde P, Emerson B, Gomez B, Willems J, Yildizdas D, Iglowstein I, Kerkhof E, Mullen N, Pinto CR, Detaille T, Qureshi N, Naud J, De Dooy J, Van Lancker R, Dupont A, Boelsma N, Mor M, Walker D, Sabbe M, Hachimi-Idrissi S, Da Dalt L, Waisman H, Biarent D, Maconochie I, Moll H, Benito J. Paediatric community-acquired septic shock: results from the REPEM network study. Eur J Pediatr 2013; 172:667-74. [PMID: 23354787 PMCID: PMC3631515 DOI: 10.1007/s00431-013-1930-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/04/2013] [Accepted: 01/06/2013] [Indexed: 11/30/2022]
Abstract
UNLABELLED INTRODUCTION AND PURPOSE OF THE STUDY: With this study we aimed to describe a "true world" picture of severe paediatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included. RESULTS A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ≥2 in POPC) was significantly related (p < 0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept). CONCLUSION The outcome in our sample was very good. Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.
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Affiliation(s)
- P. Van de Voorde
- Paediatric Intensive care and Emergency Medicine, 1K12IC, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - B. Emerson
- Paediatric Emergency Medicine, Yale-New Haven Children’s Hospital, New Haven, CT USA
| | - B. Gomez
- Paediatric Emergency Medicine, University Hospital Cruces, Barakaldo, Bilbao Spain
| | - J. Willems
- Paediatric Intensive care and Emergency Medicine, 1K12IC, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - D. Yildizdas
- Paediatric Intensive Care Medicine, Çukurova University Hospital, Adana, Turkey
| | - I. Iglowstein
- Paediatric Emergency Medicine, Ostschweizer Children’s hospital, St Gallen, Switzerland
| | - E. Kerkhof
- Paediatric Emergency Medicine, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - N. Mullen
- Paediatric Emergency Medicine, St Mary’s Hospital, London, UK
| | - C. R. Pinto
- Paediatric Intensive Care Medicine, Coimbra Children’s Hospital CHUC, Coimbra, Portugal
| | - T. Detaille
- Paediatric Intensive Care and Emergency Medicine, University Hospital Louvain UCL, Brussels, Belgium
| | - N. Qureshi
- Paediatric Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - J. Naud
- Paediatric Emergency Medicine–SMUR, University Hospital Pellegrin, Bordeaux, France
| | - J. De Dooy
- Paediatric Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - R. Van Lancker
- Emergency Medicine, University Hospital, Leuven, Belgium
| | - A. Dupont
- Paediatric Intensive Care and Emergency Medicine, University Hospital Queen Fabiola HUDERF, Brussels, Belgium
| | - N. Boelsma
- Paediatric Intensive Care Medicine, University Hospital Brussels, Brussels, Belgium
| | - M. Mor
- Paediatric Emergency Medicine, Schneider Children’s Medical Center of Israel, Petah Tikva, Tel Aviv Israel
| | - D. Walker
- Paediatric Emergency Medicine, Yale-New Haven Children’s Hospital, New Haven, CT USA
| | - M. Sabbe
- Emergency Medicine, University Hospital, Leuven, Belgium
| | - S. Hachimi-Idrissi
- Paediatric Intensive care and Emergency Medicine, 1K12IC, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium ,Paediatric Intensive Care Medicine, University Hospital Brussels, Brussels, Belgium
| | - L. Da Dalt
- Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - H. Waisman
- Paediatric Emergency Medicine, Schneider Children’s Medical Center of Israel, Petah Tikva, Tel Aviv Israel
| | - D. Biarent
- Paediatric Intensive Care and Emergency Medicine, University Hospital Queen Fabiola HUDERF, Brussels, Belgium
| | - I. Maconochie
- Paediatric Emergency Medicine, St Mary’s Hospital, London, UK
| | - H. Moll
- Paediatric Emergency Medicine, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - J. Benito
- Paediatric Emergency Medicine, University Hospital Cruces, Barakaldo, Bilbao Spain
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11
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Hastings CE, Fisher CA, McCabe MA, Allison J, Brassil D, Offenhartz M, Browning S, DeCandia E, Medina R, Duer-Hefele J, McClary K, Mullen N, Ottosen M, Britt S, Sanchez T, Turbini V. Clinical research nursing: a critical resource in the national research enterprise. Nurs Outlook 2011; 60:149-156.e1-3. [PMID: 22172370 DOI: 10.1016/j.outlook.2011.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/03/2011] [Accepted: 10/13/2011] [Indexed: 12/31/2022]
Abstract
Translational clinical research has emerged as an important priority for the national research enterprise, with a clearly stated mandate to more quickly deliver prevention strategies, treatments and cures based on scientific innovations to the public. Within this national effort, a lack of consensus persists concerning the need for clinical nurses with expertise and specialized training in study implementation and the delivery of care to research participants. This paper reviews efforts to define and document the role of practicing nurses in implementing studies and coordinating clinical research in a variety of clinical settings, and differentiates this clinical role from the role of nurses as scientists and principal investigators. We propose an agenda for building evidence that having nurses provide and coordinate study treatments and procedures can potentially improve research efficiency, participant safety, and the quality of research data. We also provide recommendations for the development of the emerging specialty of clinical research nursing.
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Affiliation(s)
- Clare E Hastings
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA.
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12
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Collichio F, Ollila D, Huck K, Mullen N, Shearer H, Turner E, Kelly H, Zeger E, Socinski M, Hensing T. A phase II trial of weekly 1-hour paclitaxel in stage IV melanoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. Collichio
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - D. Ollila
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - K. Huck
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - N. Mullen
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - H. Shearer
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - E. Turner
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - H. Kelly
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - E. Zeger
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - M. Socinski
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
| | - T. Hensing
- UNC Chapel Hill, Chapel Hill, NC; Evanston Northwestern Healthcare, Evanston, IL
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13
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Torpy DJ, Chen CC, Mullen N, Doppman JL, Carrasquillo JA, Chrousos GP, Nieman LK. Lack of utility of (111)In-pentetreotide scintigraphy in localizing ectopic ACTH producing tumors: follow-up of 18 patients. J Clin Endocrinol Metab 1999; 84:1186-92. [PMID: 10199751 DOI: 10.1210/jcem.84.4.5576] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Octreotide scintigraphy has been advocated as the principal imaging modality for localizing ectopic ACTH-secreting tumors in Cushing's syndrome. To assess its usefulness we reviewed the course of 18 consecutive patients with ectopic ACTH-producing tumor. Imaging included (111)In-pentetreotide scintigraphy, computed tomography (CT), and/or magnetic resonance imaging (MRI). Tumor was detected initially in 7/18 patients, and in 3/18 during follow-up. No ACTH-secreting tumor was detected by octreotide scintigraphy when CT/ MRI were negative. Seventeen of forty octreotide scintigrams were abnormal. CT and/or MRI confirmed tumors in 10, but demonstrated nonendocrine lesions in association with 6 false positive octreotide scintigrams. Hepatic venous sampling for ACTH refuted one lesion detected by octreotide and CT scans. Twenty-three of forty octreotide scintigrams were normal. Of these, 8 were false negative, as CT and/or MRI detected tumor; 10 agreed with negative CT and MRI, and 5 correctly refuted false positive CT and/or MRI scans. Repeated CT/ MR, but not octreotide scintigraphy, led to tumor resection in 2 patients. We conclude that octreotide scintigraphy does not offer greater sensitivity than CT/MRI and that false positive scans are common. Although octreotide scintigraphy may be helpful in selected cases, it is not a significant advance over conventional imaging for ectopic ACTH-secreting tumors.
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Affiliation(s)
- D J Torpy
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
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14
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Davis RL, Mullen N, Makela M, Taylor JA, Cohen W, Rivara FP. Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Ann Emerg Med 1994; 24:640-5. [PMID: 8092590 DOI: 10.1016/s0196-0644(94)70273-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. DESIGN Retrospective case series of children aged 2 to 17 years with documented loss of consciousness after head injury from January 1, 1988, to July 31, 1992. All had a GCS score of 15 on initial ED evaluation and were further categorized according to physical examination findings, neurologic status, and whether the head injury was isolated or nonisolated. Recursive partitioning was used to identify variables predictive of the presence and absence of intracranial hemorrhage. SETTING ED in two settings: a regional tertiary care trauma center and a community children's hospital. RESULTS Of the 185 patients who met study criteria, 17 had evidence of depressed or basilar skull fractures on physical examination or had a ventriculoperitoneal shunt in place before head injury. In the remaining 168 patients, recursive partitioning identified two variables (neurologic status and head injury type) associated with intracranial hemorrhage. Overall, 12 of 168 patients (7%) had intracranial bleeding. However, none of the 49 neurologically normal children with isolated head injury had intracranial hemorrhage (95% confidence interval, 0.0 to 6.0). CONCLUSION The prevalence of intracranial hemorrhage in children with mild closed-head injury appears to vary with the presence of neurologic abnormalities and other noncranial injuries. After isolated head injury with loss of consciousness, children older than 2 years who are neurologically normal and without signs of depressed or basilar skull fracture may be discharged home from the ED without a cranial CT scan after careful physical examination alone.
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Affiliation(s)
- R L Davis
- Department of Pediatrics, University of Washington, Seattle
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15
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Abstract
Using a double-blind, placebo-controlled protocol, we evaluated the efficacy of nebulized albuterol in the treatment of infants aged 0 to 24 months who presented to the emergency department with wheezing. Twenty-five infants were randomly assigned to receive two identical treatments of either nebulized albuterol (0.15 mg/kg) or placebo (saline). Assessment after each treatment included a wheeze and retraction score, respiratory and heart rates, and pulse oximetry. After two treatments, there was a significant improvement in the wheeze scores (P less than 0.05) and total scores (P less than 0.05) of the albuterol group compared with the placebo group. After one treatment, there was an initial decrease in oxygen saturation in the albuterol group, which improved after the second treatment. There were no significant differences between the two groups in heart rate or respiratory rate. This study supports the use of nebulized albuterol in the treatment of wheezing infants in the emergency department.
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Affiliation(s)
- P J Schweich
- Department of Emergency Medicine, Mary Bridge Children's Hospital, Tacoma, WA 98405-0987
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16
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Mullen N. An irritable infant in respiratory distress. Hosp Pract (Off Ed) 1984; 19:241-2, 245. [PMID: 6420325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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