1
|
Gibson B, McNiven C, Sebastianski M, Vandermeer B, Persad R, Robinson JL. Systematic Review of Antimicrobial Lock Solutions for Prevention of Bacteremia in Pediatric Patients With Intestinal Failure. J Pediatr Gastroenterol Nutr 2023; 76:410-417. [PMID: 36730306 DOI: 10.1097/mpg.0000000000003658] [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: 02/03/2023]
Abstract
OBJECTIVES The goal of this systematic review was to determine whether antimicrobial lock (AML) solutions prevent catheter-related bloodstream infections (CRBSI) in children with intestinal failure (IF). METHODS Electronic databases were searched: Ovid MEDLINE (1946-), Ovid Embase (1974-), Wiley Cochrane Library (inception-), and Web of Science Core Collection via Clarivate Analytics (1900-). Randomized and nonrandomized trials, case or cohort studies that studied any AML solution, and used comparator groups were included if they studied children with IF. A meta-analysis compared the rates of CRBSI with AML solutions versus controls, and a Boucher analysis was used to indirectly compare AML solutions. RESULTS Twenty-eight studies met eligibility criteria (1 open label and 27 observational studies). Quality was good (N = 13), fair (N = 9), and poor (N = 6). All but 4 studied ethanol and taurolidine. Of 15 ethanol studies, 11 reported a decrease and 3 reported a trend toward a decreased incidence of CRBSI compared to controls; 1 reported no difference. Of 9 taurolidine studies, 7 reported a decrease and 2 a trend toward decreased CRBSI rates. There was a decrease in CRBSI with ethanol versus control ( P = 0.008) and with taurolidine-citrate versus control ( P < 0.0005). Using Bucher indirect comparison of the pooled estimates from ethanol versus control to taurolidine versus control, the estimated difference was -0.99 (-4.125, 2.27; P = 0.55). CONCLUSIONS There were no randomized trials and over half of the 28 included studies were fair or poor quality. All but 1 reported at least a trend toward reduction in CRBSI. AML solutions appear to prevent CRBSI.
Collapse
Affiliation(s)
- Bridget Gibson
- From the Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Claire McNiven
- From the Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- the Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- the Alberta Centre for Health Research Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Rabin Persad
- From the Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- From the Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Chung A, Ashok D, Avinashi V, Barkey J, Bortolin K, Burnett D, Chen B, Critch J, Drouin É, Griffin J, Hulst J, Marcon M, Martinez A, Persad R, Sherlock M, Huynh H. A150 MODERATE AGREEMENT IN ENDOSCOPIC DISEASE SCORING OF PEDIATRIC EOSINOPHILIC ESOPHAGITIS AMONG PEDIATRIC GASTROENTEROLOGISTS IN CANADA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991383 DOI: 10.1093/jcag/gwac036.150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Endoscopy is an important tool in assessing the severity of gastrointestinal diseases including Eosinophilic Esophagitis (EoE). Agreement regarding endoscopy outcomes is important when using tools such as the Endoscopic Reference Score for EoE (EREFS). Purpose Our goal was to determine interrater and intrarater agreement of EREFS among Canadian pediatric gastroenterologists. Method Survey-based study of interrater and intrarater reliability amongst pediatric gastroenterologists with interest in pediatric EoE. Participants were sourced from the Canadian Pediatric EoE Network. Participants were asked how many years of training they’ve had with endoscopy for pediatric EoE and their comfort in disease scoring for pediatric EoE. Pediatric EoE cases were identified from the pediatric EoE registry at the Stollery Children’s Hospital with an endoscopic video associated with each case. Participants were asked to score each video using the EREFS questionnaire for the proximal, middle and distal segments of the esophagus. 15 endoscopic videos were evaluated, with 3 cases provided each week over a period of 5 weeks. Additional data included ratings of the video quality and endoscopy quality. Of 15 cases, 12 were unique cases, distributed evenly in severity between no active disease to severe disease. 3 cases were repeated to assess intrarater reliability. The maximum grade of the proximal, middle and distal segments of the esophagus for each component endoscopic finding (edema, rings, exudates, furrows, strictures) were used for reliability calculations. Fleiss Kappa was calculated for all EREFS items and for each component endoscopic finding. Cohen’s Kappa was calculated to assess intrarater reliability. Result(s) Fifteen participants were recruited for the study. The participants had a median of 12 years (IQR: 7, 19) of clinical experience in endoscopy for pediatric EoE. The majority of participants were “comfortable” (i.e., 4 on 5-point scale) with EREFS scoring for pediatric EoE. Fleiss Kappa for all EREFS items was 0.481. For each component endoscopic finding (edema, rings, exudates, furrows, strictures), Fleiss Kappa was 0.365, 0.293, 0.548, 0.263, 0.445 respectively. Cohen’s Kappa had a median of 0.620 (IQR: 0.593, 0.704). The majority of raters rated video quality and endoscopy quality as “good” (i.e., 4 on 5-point scale). Conclusion(s) There is moderate interrater reliability in EREFS scoring for pediatric EoE. Interrater reliability was between fair to moderate for each component endoscopic finding. Intrarater reliability was good. This study shows there is room for improvement in disease scoring for pediatric EoE. This could be in the form of additional training, expert-defined conventions, or centralized reading which have reduced variability in endoscopic reporting for adult GI disease in past studies and could be used in a follow-up study to attempt to improve agreement. Additionally, incorporating EREFS into routine clinical practice may increase agreement amongst endoscopists. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
- A Chung
- University of Alberta, Edmonton
| | - D Ashok
- University of Western Ontario, London,Canadian Pediatric EoE Network, -
| | - V Avinashi
- Canadian Pediatric EoE Network, -,BC Children's Hospital, Vancouver
| | - J Barkey
- Canadian Pediatric EoE Network, -,University of Ottawa, Ottawa
| | - K Bortolin
- Canadian Pediatric EoE Network, -,SickKids, Toronto
| | - D Burnett
- Canadian Pediatric EoE Network, -,Dalhousie University, Halifax,University of Saskatchewan, Saskatoon
| | - B Chen
- University of Alberta, Edmonton,Canadian Pediatric EoE Network, -
| | - J Critch
- Canadian Pediatric EoE Network, -,Memorial University, St. John's
| | - É Drouin
- Canadian Pediatric EoE Network, -,Université de Montréal, Montreal
| | - J Griffin
- Canadian Pediatric EoE Network, -,University of Manitoba, Winnipeg, Canada
| | - J Hulst
- Canadian Pediatric EoE Network, -,SickKids, Toronto
| | - M Marcon
- Canadian Pediatric EoE Network, -,SickKids, Toronto
| | - A Martinez
- Canadian Pediatric EoE Network, -,BC Children's Hospital, Vancouver
| | - R Persad
- University of Alberta, Edmonton,Canadian Pediatric EoE Network, -
| | - M Sherlock
- Canadian Pediatric EoE Network, -,McMaster University, Hamilton, -
| | - H Huynh
- University of Alberta, Edmonton,Canadian Pediatric EoE Network, -
| |
Collapse
|
3
|
Burnett D, Avinashi V, Hoang T, Otley A, Persad R, Sherlock M, Huynh H. A143 PEDIATRIC EOSINOPHILIC ESOPHAGITIS IN CANADA: A MULTI-CENTER COHORT WITH FOCUS ON THE STRICTURING PHENOTYPE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991379 DOI: 10.1093/jcag/gwac036.143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Eosinophilic esophagitis (EoE) is a chronic eosinophil-predominant esophageal inflammatory condition, and is now recognized as one of the most common organic causes of dysphagia in pediatrics. While fibrostenotic esophageal strictures are a common complication of adult EoE, characterization of the stricturing phenotype in pediatric EoE remains at an early stage. Purpose Describe the Canadian pediatric EoE experience, with focus on the stricturing phenotype. Method New pediatric EoE diagnoses from 2015-2018 were retrospectively identified in Vancouver (BC), Northern Alberta (AB), Hamilton (ON) and Nova Scotia (NS). Incidence rates were calculated using 2016 Federal census data. Clinical, endoscopic and histologic data were gathered for each patient’s initial clinical encounter and for any esophagogastroduodenoscopies (EGD) until the end of the follow-up period (fall 2019). Result(s) 332 new EoE cases were identified during the study period across all 4 sites. The incidence of EoE in patients less than 15 years old was 9.1 (AB), 6.5 (NS), 3.1 (BC) and 5.4 (combined) per 100,000 person-years. Incidence was not calculated for Hamilton due to risk of ascertainment bias given their catchment area overlaps with multiple other centers. Of identified cases, 40 (12.0%) had endoscopically-identified esophageal strictures at diagnosis or during the follow-up period, with a subset of 11 (3.3%) of these patients undergoing mechanical esophageal dilation. Another 11 (3.3%) patients had more subtle signs of esophageal narrowing (ex. mucosal rents), while the majority had no evidence of esophageal narrowing (281, 84.6%). The median age at diagnosis was higher in the cohort with strictures (12.4 years, IQR 8.9-14.1) than those without (10.3 years, IQR 6.1-13.6) but with wide IQR's. A similar trend was seen for the median duration of symptoms at diagnosis (1.5 years, IQR 0.5-3 versus 1.0 years, IQR 0.6-2.8). Patient reported food bolus impaction (OR 9.8, 95% CI 3.9-19.9) and dysphagia (OR 3.3, 95% CI 1.3-7.8) were associated with stricturing disease, with other symptoms less clearly linked. Trachealization was the endoscopic finding most closely associated with esophageal strictures (OR 5.7, 95% CI 2.8-11.5). Esophageal stricture(s) were noted on 72 EGDs, including 27 endoscopic esophageal dilations, but excluding 10 esophageal dilations by interventional radiology. Of the 65 EGDs done in follow-up of a known esophageal stricture (see Table), 4 of 31 had resolution of this finding post mechanical dilation, and 19 of 39 had resolution of the stricture after initiation of new medical or dietary treatments (without dilation). Conclusion(s) EoE is common in Canadian children, with esophageal strictures within a few years of diagnosis in 12% of cases. Interestingly, a large portion of strictures resolved without mechanical dilation, which seems to point away from fibrosis as the primary driver of esophageal strictures in this patient population. Please acknowledge all funding agencies by checking the applicable boxes below CAG, Other Please indicate your source of funding; Women and Children's Health Research Institute Disclosure of Interest None Declared
Collapse
Affiliation(s)
- D Burnett
- Dalhousie University, Halifax,University of Saskatchewan, Saskatoon
| | - V Avinashi
- University of British Columbia, Vancouver
| | - T Hoang
- University of British Columbia, Vancouver
| | - A Otley
- Dalhousie University, Halifax
| | | | | | - H Huynh
- University of Alberta, Edmonton
| |
Collapse
|
4
|
Aning J, Andreou A, Blaney L, Burn P, Oxley J, Mahoney S, Davies SJ, Simmons L, Trent N, Kopcke D, Persad R, Burns-Cox N. Cognitive targeted local anaesthetic transperineal biopsy alone in men with PIRADS/ LIKERT 5 on multiparametric magnetic reasonance imaging of the prostate as an initial diagnostic investigation is safe in men with a PSA density over 0.15. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00230-0] [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: 02/12/2023]
|
5
|
Parker C, Clarke N, Cook A, Catton C, Cross W, Kynaston H, Logue J, Petersen P, Neville P, Persad R, Payne H, Saad F, Stirling A, Parulekar W, Parmar M, Sydes M. LBA9 Duration of androgen deprivation therapy (ADT) with post-operative radiotherapy (RT) for prostate cancer: First results of the RADICALS-HD trial (ISRCTN40814031). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
6
|
Parker CC, Clarke NW, Catton C, Kynaston H, Cook A, Cross W, Davidson C, Goldstein C, Logue J, Maniatis C, Petersen PM, Neville P, Payne H, Persad R, Pugh C, Stirling A, Saad F, Parulekar WR, Parmar MKB, Sydes MR. RADICALS-HD: Reflections before the Results are Known. Clin Oncol (R Coll Radiol) 2022; 34:593-597. [PMID: 35810050 DOI: 10.1016/j.clon.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Affiliation(s)
- C C Parker
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - N W Clarke
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - C Catton
- Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - H Kynaston
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - W Cross
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Davidson
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - C Goldstein
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Logue
- Oncology, The Christie Hospital, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - P M Petersen
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - P Neville
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- Oncology, University College London Hospitals, London, UK
| | - R Persad
- Bristol Urological Institute, North Bristol Hospitals, Bristol, UK
| | - C Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - A Stirling
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - F Saad
- University of Montreal Hospital Center (CHUM), Montréal, Canada
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| |
Collapse
|
7
|
Burnett D, Persad R, Huynh HQ. Incidence of Pediatric Eosinophilic Esophagitis and Characterization of the Stricturing Phenotype in Alberta, Canada. JPGN Rep 2021; 2:e136. [PMID: 37206454 PMCID: PMC10191577 DOI: 10.1097/pg9.0000000000000136] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/10/2021] [Indexed: 05/21/2023]
Abstract
Limited work has been done to characterize the stricturing pediatric eosinophilic esophagitis (EoE) phenotype. We aimed to determine, in pediatric EoE: the local incidence, the frequency of esophageal stricturing, and the safety of mechanical dilations. Methods We retrospectively identified all new cases of EoE at our center from 2015 to 2018 using esophageal biopsy reports, EoE clinic lists, and a local OR database of esophageal dilatations. Electronic medical records (EMRs) were reviewed to confirm EoE diagnosis. Clinical data were captured from the outpatient EMR and gastroscopy/pathology reports. Scope adverse event data were captured from multiple sources. The 2016 census data were used to calculate incidence rates. Results One hundred eighty-five new cases of EoE were diagnosed during the study period. For patients <15 years old living in Edmonton, the incidence over the 4 years was 11.1 cases per 100,000 person years. Eight of 185 (4%) patients had endoscopically confirmed esophageal strictures, 4 of which required mechanical dilation. Eleven of 185 (5.9%) patients had more subtle signs of esophageal narrowing, but no focal strictures. No perforations or episodes of significant bleeding were reported. Pain was reported after 15% of all scopes, including 50% of the 28 scopes with focal strictures. No unexpected admissions or emergency department visits occurred within 72 hours of a gastroscope with esophageal narrowing. Conclusions Edmonton zone has one of the highest incidences of pediatric EoE reported. In this cohort, 4% had focal esophageal strictures, and 6% had more subtle narrowing. Mechanical dilation of esophageal strictures was associated with no significant adverse events.
Collapse
Affiliation(s)
- David Burnett
- From the University of Alberta
- University of Saskatchewan
| | | | | |
Collapse
|
8
|
Huysentruyt K, Brunet-Wood K, Bandsma R, Gramlich L, Fleming-Carroll B, Hotson B, Byers R, Lovelace H, Persad R, Kalnins D, Martinez A, Marchand V, Vachon M, Hulst JM. Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals. Nutrients 2021; 13:nu13082635. [PMID: 34444796 PMCID: PMC8397996 DOI: 10.3390/nu13082635] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.
Collapse
Affiliation(s)
- Koen Huysentruyt
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (R.B.); (J.M.H.)
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Correspondence:
| | - Kim Brunet-Wood
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada;
| | - Robert Bandsma
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (R.B.); (J.M.H.)
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Bonnie Fleming-Carroll
- SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Brenda Hotson
- Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada;
| | - Rebecca Byers
- Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada;
| | - Heather Lovelace
- Nutritional Services, BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
| | - Rabin Persad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Andrea Martinez
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada;
| | - Valerie Marchand
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada;
| | - Mélanie Vachon
- Department of Clinical Nutrition, Quebec University Hospital, Quebec, QC G1R 2J6, Canada;
| | - Jessie M. Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (R.B.); (J.M.H.)
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | |
Collapse
|
9
|
Dinneen E, Grierson J, Haider A, Allen C, Heffernan-Ho D, Clow R, Freeman A, Briggs T, Nathan S, Brew-Graves C, Mallett S, Williams N, Persad R, Aning J, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond J, Marzena R, Ben-Salha I, Kelly J, Shaw G. NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01245-8] [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: 10/20/2022]
|
10
|
Leszczynski R, Allen S, Persad R, Page T, Cross W, Craske E, Lovett H, Stalbow K. Remote consultations: Experiences of patients with prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00596-0] [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: 10/20/2022]
|
11
|
Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [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: 10/20/2022]
|
12
|
Bortolin KA, Ashok D, Avinashi V, Barkey J, Burnett D, Critch J, Drouin E, Griffin J, Huynh H, Marcon P, Martinez A, Persad R, Sherlock M, Waterhouse C, Hulst JM. A14 WIDE VARIATION IN CLINICAL MANAGEMENT OF PAEDIATRIC EOSINOPHILIC ESOPHAGITIS: A CANADIAN EXPERIENCE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Eosinophilic esophagitis (EoE) is a chronic disorder treated by food elimination diet (FED), topical steroids and/or proton-pump inhibitors (PPI). Serial endoscopies and biopsies assess response to therapy. EoE management has evolved as guidelines are updated.
Aims
To identify practice variation among Canadian paediatric gastroenterologists (PG) who care for children with EoE.
Methods
An online survey using REDCap about decision-making in children with EoE was distributed to PG in Canada in November 2020.
Results
62 PG completed the survey (response rate 69%, 62/94). The majority work in academic centres (92%). 3 centers indicated an accrual of >50 new patients per year; 9/16 centres have >100 patients in follow-up. An EoE Clinic is present in 5 centres.
Diagnosis: Familiarity with the 2018 AGREE and 2020 AGA EoE guidelines was found to be 57% and 67% respectively. Criteria required to diagnose EoE according to current guidelines were correctly indicated by 42% of PG. (Figure 1).
Endoscopy: The majority of PG (95%) adhere to guidelines in terms of required number and location of biopsies for the initial diagnosis. Ideal timing of repeat endoscopy after change in therapy in patients who are not in histological remission was 8–12 weeks by 67% of PG, timing in stable patients on maintenance therapy varied (33% only if patient is symptomatic). 25% used the EREFS Score in reporting endoscopic findings.
Therapy: Improvement of symptoms was the highest ranked goal (64%), followed by remission of histologic findings (30%). A treatment algorithm was in place in 4 centers. The majority routinely assess adherence to therapy (73%) and consult a dietitian for FED (77%). Most (87%) do not consult an allergist for initial management. Preferred choices of 1st-line therapy varied among PG (Figure 2). When FED was selected, 32% of PG started with 1 food, 32% started with 2 foods, most frequently excluding dairy, followed by wheat. 14 (26%) start with ≥6 FED. Prescription of budesonide slurry was consistent among PG with doses of 1 and 2 mg/day in children <10 and >10 years, respectively.
Conclusions
The is the first Canadian study to assess the variation in management of children with EoE by PG. Overall, PG demonstrated good adherence to the guidelines in terms of initial diagnosis, but differences in maintenance therapy choice and timing of endoscopies. The results highlight a need for standardized management algorithms to deliver uniform care to this growing group. Grounding these guidelines in evidence will warrant a significant investment in further paediatric EoE research.
Funding Agencies
None
Collapse
Affiliation(s)
- K A Bortolin
- The Hospital for Sick Children, Toronto, ON, Canada
| | - D Ashok
- Pediatrics, Western University, London, ON, Canada
| | - V Avinashi
- BC Children’s Hospital, Vancouver, BC, Canada
| | - J Barkey
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - D Burnett
- Pediatrics, Dalhousie University, Edmonton, AB, Canada
| | - J Critch
- Memorial University, St. John’s,, Canada
| | - E Drouin
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - J Griffin
- Pediatric Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - H Huynh
- Alberta Health Services, Edmonton, AB, Canada
| | - P Marcon
- The Hospital for Sick Children, Toronto, ON, Canada
| | - A Martinez
- Pediatrics, Dalhousie University, Edmonton, AB, Canada
| | - R Persad
- Alberta Health Services, Edmonton, AB, Canada
| | - M Sherlock
- McMaster Children’s Hospital, Hamilton, ON, Canada
| | | | - J M Hulst
- The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
13
|
Cyrkot S, Marcon M, Brill H, Mileski H, Dowhaniuk J, Frankish A, Carroll MW, Persad R, Turner JM, Mager DR. FODMAP intake in children with coeliac disease influences diet quality and health-related quality of life and has no impact on gastrointestinal symptoms. Int J Food Sci Nutr 2021; 72:956-967. [PMID: 33541165 DOI: 10.1080/09637486.2021.1880553] [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] [Indexed: 02/08/2023]
Abstract
Children with coeliac disease (CD) following the gluten-free diet may experience ongoing gastrointestinal symptoms despite strict adherence. The study objective was to evaluate the association between foods high in fermentable oligo/di/monosaccharides, and polyols (FODMAP) and gastrointestinal symptoms, and the potential implications to diet quality and health-related quality of life in CD children. Dietary intake was studied in age-sex matched children 5-18 years (CD, n = 46; non-coeliac mild chronic gastrointestinal complaints [GIC], n = 46; healthy controls [HC], n = 46). CD children consumed fewer foods high in FODMAPs compared to GIC and HC (p < .0001). FODMAP intake was not related to gastrointestinal symptoms in CD children (p > 0.05) but was positively associated with child health-related quality of life (p < 0.05). FODMAP intake from fruits and vegetables was positively associated with diet adequacy and total diet quality in CD children (p < 0.05). FODMAP intake may influence diet quality and health-related quality of life but has no impact on gastrointestinal symptoms in CD children.
Collapse
Affiliation(s)
- Samantha Cyrkot
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Margaret Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
| | - Herbert Brill
- Division of Gastroenterology and Nutrition, McMaster Children's Hospital, Hamilton, Canada
| | - Heather Mileski
- Division of Gastroenterology and Nutrition, McMaster Children's Hospital, Hamilton, Canada
| | - Jenna Dowhaniuk
- Division of Gastroenterology and Nutrition, McMaster Children's Hospital, Hamilton, Canada
| | - Alena Frankish
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Matthew W Carroll
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Division of Pediatric Gastroenterology and Nutrition, Stollery Children's Hospital, Edmonton, Canada
| | - Rabin Persad
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Division of Pediatric Gastroenterology and Nutrition, Stollery Children's Hospital, Edmonton, Canada
| | - Justine M Turner
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Division of Pediatric Gastroenterology and Nutrition, Stollery Children's Hospital, Edmonton, Canada
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Canada
| |
Collapse
|
14
|
Stavrinides V, Norris J, Bott S, Brown L, Burns-Cox N, Dudderidge T, El-Shater Bosaily A, Frangou E, Freeman A, Ghei M, Henderson A, Hindley R, Kaplan R, Kirkham A, Oldroyd R, Parker C, Persad R, Punwani S, Rosario D, Shergill I, Carmona L, Winkler M, Whitaker H, Ahmed H, Emberton M. MRI index lesions in the cancerous prostate: How do they differ from false positive phenotypes? Lessons from the PROMIS study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
15
|
Marra G, Gontero P, Calleris G, Oderda M, Filippini C, Sanchez-Salas R, Goonewardene S, Popert R, Cahill D, Persad R, Palou J, Joniau S, De La Taille A, Roupret M, Albisinni S, Morlacco A, Gandaglia G, Mottrie A, Smith J, Gill I, Van Der Poel H, Tilki D, Murphy D, Davis J, Karnes R. Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33404-2] [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: 10/23/2022] Open
|
16
|
Norris J, Carmona Echeverria L, Bott S, Brown L, Burns-Cox N, Dudderidge T, El-Shater Bosaily A, Frangou E, Freeman A, Ghei M, Henderson A, Hindley R, Kaplan R, Kirkham A, Oldroyd R, Parker C, Persad R, Punwani S, Rosario D, Shergill I, Stavrinides V, Winkler M, Whitaker H, Ahmed H, Emberton M. Which prostate cancers are overlooked by mpMRI? An analysis from PROMIS. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32877-9] [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: 10/23/2022] Open
|
17
|
Burnett D, Persad R, Huynh HQ. A196 INCIDENCE OF PEDIATRIC EOSINOPHILIC ESOPHAGITIS IN EDMONTON ZONE AND RISK OF STRICTURING AT DIAGNOSIS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.195] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Eosinophilic esophagitis (EoE) is a common cause of esophageal dysfunction in children. A subset of children have a more severe phenotype of EoE, complicated by esophageal stricturing. Limited work has been done to characterize this phenotype.
Aims
To determine the incidence of EoE, and the frequency of esophageal stricturing in pediatric EoE.
Methods
We retrospectively identified all new cases of EoE at the Stollery Children’s Hospital from 2015–2018 using esophageal biopsy reports for the province of Alberta (CoPath database), EoE clinic lists and an OR database for esophageal dilatation at the Stollery. Electronic medical records (EMR) were reviewed to confirm EoE diagnosis. For each confirmed case, clinical data was captured from the outpatient EMR and gastroscopy/pathology reports. A review of peri-endoscopy OR/nursing charts was performed on a subset of patients (n=75) to capture scope adverse event. Statistics Canada 2016 census data was used to calculate incidence rates.
Results
185 new cases of EoE were diagnosed at our center during the study period (see table). For patients < 15 years old living in Edmonton zone (n=73), the incidence over the 4 years was 11.1 cases per 100,000 person years {8.7 (0–4 year-old), 7.6 (5–9 year old), and 18.1 (10–14 year old)}. There was limited variation in incidence in the 4 years (9.1–12.1 per 100,000 person years). 8 of 185 (4%) patients had endoscopically confirmed esophageal strictures, 4 of which required mechanical dilation (mean 3.75 dilations per patient, range 1–6). 11/185 (5.9%) patients had more subtle signs of esophageal narrowing, but no strictures. No perforations or episodes of significant bleeding were reported in peri-endoscopy charts reviewed for 239 gastroscopes, including 16 dilations. Pain was reported after 15% of all scopes, including 50% of the 28 scopes with strictures and 63% of the 16 scopes involving dilations.
Conclusions
Edmonton zone has one of the highest incidences of EoE reported in children. In this cohort, 4% had esophageal stricture (half required dilatation) and 5.9% had more subtle narrowing. Patients with strictures were older, had more frequent food impaction and longer duration of symptoms (Table). This data will be included in an ongoing multicenter case-control study across Canada.
Funding Agencies
CAGWomen and Children’s Health Research Institute (Univ. Alberta)
Collapse
Affiliation(s)
- D Burnett
- University of Alberta, Edmonton, AB, Canada
| | - R Persad
- University of Alberta, Edmonton, AB, Canada
| | - H Q Huynh
- Pediatrics, University of alberta, Edmonton, AB, Canada
| |
Collapse
|
18
|
Sergi C, Lam J, Persad R. Clostridium ventriculi Infection in a Child with Phenylketonuria. Ann Clin Lab Sci 2020; 50:134-135. [PMID: 32161022] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Disabled individuals may be at risk for common and rare infections. We report on a 13-year-old female who had a diagnosis of phenylketonuria (PKU). The child received a percutaneous endoscopic gastrostomy (PEG) feeding tube at five years of age for the supplementation of her specialized formula. After eight years, she no longer required the gastrostomy tube for formula supplementation, and she presented for the closure of the gastrocutaneous fistula tract. The histological examination revealed acute and chronic inflammation and colonization by gram-positive bacteria with a characteristic tetrad packet arrangement known as Clostridium ventriculi (formerly Sarcina ventriculi). A review of the literature evidenced the rarity of this infection in children. This patient is the 11th case of such infection in literature, and the first patient affected with PKU. Physically and mentally disabled children are particularly vulnerable to infection because of their different feeding abilities, toilet needs, and sanitary arrangements.
Collapse
Affiliation(s)
- Consolato Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Jennifer Lam
- Department of Pediatric Surgery, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Rabin Persad
- Department of Pediatric Gastroenterology, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| |
Collapse
|
19
|
Parker C, Clarke N, Cook A, Kynaston H, Meidahl Petersen P, Cross W, Persad R, Catton C, Logue J, Payne H, Saad F, Brasso K, Lindberg H, Zarkar A, Raman R, Roder M, Heath C, Parulekar W, Parmar M, Sydes M. Timing of radiotherapy (RT) after radical prostatectomy (RP): First results from the RADICALS RT randomised controlled trial (RCT) [NCT00541047]. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
20
|
Carter LE, Shoyele G, Southon S, Farmer A, Persad R, Mazurak VC, BrunetWood MK. Screening for Pediatric Malnutrition at Hospital Admission: Which Screening Tool Is Best? Nutr Clin Pract 2019; 35:951-958. [PMID: 31286569 PMCID: PMC7539919 DOI: 10.1002/ncp.10367] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Identifying children at malnutrition risk on admission to hospital is considered best practice; however, nutrition screening in pediatric populations is not common. The aim of this study was to determine which screening tool is able to identify children with malnutrition on admission to hospital. Methods A nurse administered 2 pediatric nutrition screening tools, Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Pediatric Nutrition Screening Tool (PNST) to patients admitted to medicine and surgery units (n = 165). The Subjective Global Nutritional Assessment (SGNA) was then completed by a dietitian, blinded to the results of the screens. Sensitivity, specificity, and κ were calculated for both screening tools against the SGNA. A receiver operating characteristic (ROC) curve assessed alternate cutoffs for each tool. Length of hospital stay (LOS) was used to assess prospective validity. Results Using the recommended cutoffs, the sensitivity of STRONGkids was 89%, specificity 35%, and κ 0.483. The sensitivity of PNST was 58%, specificity 88%, and κ 0.601. Using adjusted cutoffs, PNST's sensitivity improved to 87%, specificity 71%, and κ 0.681, and STRONGkids specificity improved to 61%, sensitivity 80%, and κ 0.5. Children identified at nutrition risk had significantly longer LOS (P < 0.05). Conclusion This study showed neither tool was appropriate for clinical use based on published cutoffs. By adjusting the cutoffs using ROC curve analysis, both tools improved overall agreement with the SGNA without significantly impacting the prospective validity. PNST with adjusted cutoffs is the most appropriate for clinical use in this population.
Collapse
Affiliation(s)
- Laura E. Carter
- Department of Agricultural, Life, and Environmental SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Nutrition ServicesAlberta Health ServicesEdmontonAlbertaCanada
| | - Grace Shoyele
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Sarah Southon
- Department of SurgeryAlberta Health ServicesEdmontonAlbertaCanada
| | - Anna Farmer
- Department of Agricultural, Life, and Environmental SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Rabin Persad
- Alberta Health ServicesDepartment of Pediatric Gastroenterology & NutritionEdmontonAlbertaCanada
| | - Vera C. Mazurak
- Department of Agricultural, Life, and Environmental SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | | |
Collapse
|
21
|
Burn PR, Freeman SJ, Andreou A, Burns-Cox N, Persad R, Barrett T. A multicentre assessment of prostate MRI quality and compliance with UK and international standards. Clin Radiol 2019; 74:894.e19-894.e25. [PMID: 31296337 DOI: 10.1016/j.crad.2019.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
AIM To assess prostate magnetic resonance imaging (MRI) image quality and compliance with technical standards between centres in the South West region of the UK. MATERIALS AND METHODS Fifteen imaging sites in the region submitted seven consecutive anonymised MRI studies. These were assessed by two experienced radiologists in consensus. Overall, subjective image quality for T2-weighted imaging (T2W), diffusion weighted imaging (DWI), and dynamic contrast enhancement (DCE) was scored on a five-point Likert scale. Five additional quality parameters were also assessed visually, including image noise, motion, artefact, and distortion. The degree of compliance by each site with 21 published technical standards was also assessed. RESULTS Ninety-four MRI examinations were reviewed from across all sites (mean 6.3 scans per site, range 5-7). Mean compliance with technical standards was 63% (range 38-86%). Forty-seven percent of sites did not perform DCE. One site used a 3 T scanner. The percentage of patients with overall quality scores of ≥3 (diagnostically acceptable) were 68% for T2W, 81% for DWI, and 60% for both T2W and DWI. Ninety-three percent of the 45 patients who underwent DCE had diagnostically acceptable studies. By scanner age, the percentage of patients with diagnostically acceptable T2W scores was 53% for scanners ≥7 years and 80% when <7 years (p=0.006). Comparing individual sites, the mean overall quality scores were 2.9 (range 2.2-4.2) for T2W, 3.2 (1.8-4.7) for DWI, and 3.4 (2.5-4.7) for DCE. CONCLUSION There is wide variation in compliance with recognised technical standards and image quality across sites. If MRI is to replace biopsy in selected low-risk patients, improvements in image quality may be required.
Collapse
Affiliation(s)
- P R Burn
- Department of Diagnostic Imaging, Taunton and Somerset NHS Foundation Trust, Taunton, UK.
| | - S J Freeman
- Medical Imaging Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A Andreou
- Department of Radiology, Royal United Hospital Bath NHS Foundation Trust, Bath, UK
| | - N Burns-Cox
- Department of Urology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - R Persad
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - T Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
22
|
Dinneen E, Haider A, Grierson J, Briggs T, Persad R, Oakley N, Freeman A, Shaw G. Re: What is the role of NeuroSAFE in robotic radical prostatectomy? J Robot Surg 2019; 13:707-708. [PMID: 30980228 DOI: 10.1007/s11701-019-00962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TS, UK. .,Department of Urology, University College London Hospital, London, UK.
| | - A Haider
- Department of Histopathology, University College London Hospital, London, UK
| | - J Grierson
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - T Briggs
- Department of Urology, University College London Hospital, London, UK
| | - R Persad
- Department of Urology, North Bristol Hospitals Trust, Bristol, UK
| | - N Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Freeman
- Department of Histopathology, University College London Hospital, London, UK
| | - G Shaw
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TS, UK.,Department of Urology, University College London Hospital, London, UK
| |
Collapse
|
23
|
Mager DR, Liu A, Marcon M, Harms K, Brill H, Mileski H, Dowhaniuk J, Nasser R, Carroll MW, Persad R, Turner JM. Diet patterns in an ethnically diverse pediatric population with celiac disease and chronic gastrointestinal complaints. Clin Nutr ESPEN 2019; 30:73-80. [DOI: 10.1016/j.clnesp.2019.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/09/2023]
|
24
|
Gibson B, McNiven C, Sebastianski M, Featherstone R, Vandermeer B, Persad R, Robinson J. A240 ANTIMICROBIAL LOCK SOLUTIONS FOR PREVENTION OF CENTRAL VENOUS CATHETER INFECTIONS IN PEDIATRIC PATIENTS WITH INTESTINAL FAILURE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Gibson
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - C McNiven
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | | | - B Vandermeer
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - R Persad
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Robinson
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
25
|
Goonewardene SS, Gillatt D, Persad R. A systematic review of PFE pre-prostatectomy. J Robot Surg 2018; 12:397-400. [DOI: 10.1007/s11701-018-0803-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
|
26
|
Abstract
Desmoid tumours in Gardener's syndrome are a rare cause of ureteric obstruction. We report two cases of ureteric obstruction caused by desmoids, in a mother and daughter.
Collapse
Affiliation(s)
- R Batstone
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - S Sharma
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - H Bickerstaff
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - R Persad
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - P Doyle
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| |
Collapse
|
27
|
Larsen BMK, Beggs MR, Leong AY, Kang SH, Persad R, Garcia Guerra G. Can energy intake alter clinical and hospital outcomes in PICU? Clin Nutr ESPEN 2018; 24:41-46. [PMID: 29576361 DOI: 10.1016/j.clnesp.2018.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Energy is essential for the treatment and recovery of children admitted to Pediatric Intensive Care Units (PICU). There are significant immediate and long-term health consequences of both under- and over-feeding in this population. Energy requirements of critically ill children vary depending on age, nutritional status, sepsis, fever, pharmacotherapy, and duration and stage of critical illness. This study aimed to determine the incidence of over- and under-feeding and to compare hospital outcomes between these feeding categories. Secondary outcomes were collected to describe the association between feeding categories and biochemistries (serum lactate, triglycerides, C-reactive protein). METHODS An ethics approved retrospective study of children admitted to PICU was performed. All intubated patients admitted to PICU (2008-2013) were included, except those in which an IC test was not feasible. Data collection included demographics, the primary outcome variable reported as under feeding (<90%MREE), appropriate (MREE ±10%) or overfeeding (>110% MREE) determined through comparison of measured resting energy expenditure (MREE) using indirect calorimetry (IC) to actual energy intake based on predicted basal metabolic rate (PBMR) and clinical outcomes mechanical ventilation and PICU length of stay (LOS). Data were analysed with descriptive methods, ANOVA and linear regression models. RESULTS A total of 139 patients aged 10 (range 0.03-204) months were included. Sixty (43%) were female and 77 (55%) were admitted after a surgical procedure. A total of 210 IC tests were conducted showing a statistically significant difference between MREE measurements and PBMR (p = 0.019). Of the 210 measurements, only 26 measures (12.4%) demonstrated appropriate feeding, while 72 (34.3) were underfed and 112 (53.3%) were overfed. Children who were overfed had significantly longer PICU LOS (median 45.5, IQR 47.8 days) compared to those children in the appropriately fed (median 21.0, IQR 54.5 days), and underfed groups (median 16.5, IQR 21.3 days). There was a mean difference between the over and under feeding category and ventilation days after adjusting for age and PRISM score (p = 0.026), suggesting decreased mechanical ventilation days for underfed. Children who were underfed had significantly higher CRP (median 75.5, IQR 152.8 mg/L) compared to those children in the appropriately fed (median 57.8, IQR 90.9 mg/L) and overfed groups (median 22.4, IQR 56.2 mg/L). CONCLUSIONS This retrospective study confirms that estimations of energy expenditure in critically ill children are inaccurate leading to unintended under and overfeeding. Importantly under feeding seems to be associated with fewer mechanical ventilation days and PICU LOS. Further research is required to elucidate the role of optimal nutrition in altering clinical variables in this population.
Collapse
Affiliation(s)
- Bodil M K Larsen
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Megan R Beggs
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada; Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Y Leong
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sung Hyun Kang
- Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Rabin Persad
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Gonzalo Garcia Guerra
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
28
|
Marra G, Gontero P, Alessio P, Oderda M, Palazzetti A, Pisano F, Battaglia A, Munegato S, Calleris G, Frea B, Munoz F, Filippini C, Linares E, Sanchez-Salas R, Goonewardene S, Dasgupta P, Cahill D, Challacombe B, Popert R, Gillatt D, Persad R, Palou J, Joniau S, Smelzo S, Piechaud T, De La Taille A, Roupret M, Albisinni S, Van Velthoven R, Morlacco A, Vidit S, Gandaglia G, Mottrie A, Smith J, Joshi S, Fiscus G, Berger A, Aron M, Van Der Poel H, Tilki D, Murphy D, Lawrentschuk N, Davis J, Gordon L, Karnes R. Is it worth to perform radical prostatectomy in a salvage setting? Results of a contemporary multicentre series of 395 cases. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31234-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
29
|
Huber P, Afzal N, Arya M, Boxler S, Charman S, Cornaby A, Dudderidge T, Emberton M, Guillaumier S, Hindley R, Leemann L, Lewi H, Mc Cartan N, Moore C, Nigam R, Ogden C, Persad R, Shah K, Thalmann G, Virdi J, Winkler M, Ahmed H. Focal HIFU: Higher recurrence rate in treatment of anterior compared to posterior lesions in prostate cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Svystun O, Johannsen W, Persad R, Turner JM, Majaesic C, El-Hakim H. Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre. Int J Pediatr Otorhinolaryngol 2017; 99:54-59. [PMID: 28688566 DOI: 10.1016/j.ijporl.2017.05.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 04/26/2017] [Accepted: 05/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. METHODS We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. RESULTS From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. CONCLUSION a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.
Collapse
Affiliation(s)
- Orysya Svystun
- Pediatric Otolaryngology, Divisions of Otolaryngology - Head & Neck Surgery, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Wendy Johannsen
- Outpatient Feeding & Swallowing Service, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Rabin Persad
- Pediatric Gastroenterology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Justine M Turner
- Pediatric Gastroenterology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carina Majaesic
- Pediatric Pulmonology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Pediatric Otolaryngology, Divisions of Otolaryngology - Head & Neck Surgery, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada.
| |
Collapse
|
31
|
Goonewardene SS, Persad R, Gillatt D. Robotic radical cystectomy - revision and resection: An evolution in operative technique and platforms. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28657209 DOI: 10.1111/ecc.12578] [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: 11/27/2022]
Affiliation(s)
| | - R Persad
- North Bristol NHS Trust, Bristol, UK
| | - D Gillatt
- McQuarrie University, Sydney, NSW, Australia
| |
Collapse
|
32
|
Veeratterapillay R, Goonewardene SS, Barclay J, Persad R, Bach C. Radical prostatectomy for locally advanced and metastatic prostate cancer. Ann R Coll Surg Engl 2017; 99:259-264. [PMID: 28349755 DOI: 10.1308/rcsann.2017.0031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The management of advanced prostate cancer remains challenging. Traditionally, radical prostatectomy was discouraged in patients with locally advanced or node positive disease owing to the increased complication rate and treatment related morbidity. However, technical advances and refinements in surgical techniques have enabled the outcomes for patients with high risk prostate cancer to be improved. More recently, the concept of cytoreductive prostatectomy has been described where surgery (often Combined with an extended lymph node dissection) is performed in the setting of metastatic disease. Indirect evidence suggests an advantage using the cytoreductive approach. Hypothetical explanations for this observed benefit include decreased tumour burden, immune modulation, improved response to secondary treatment and avoidance of secondary complications attributable to local tumour growth. Nevertheless, prospective trials are required to investigate this further.
Collapse
Affiliation(s)
| | | | - J Barclay
- Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
| | | | - C Bach
- Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
| |
Collapse
|
33
|
Tombal B, Cornel E, Matveev V, Tammela T, Schraml J, Warnack W, Persad R, Stari A, Veiga F, Schulman C. Clinical outcomes and testosterone levels following continuous androgen deprivation (CAD) in patients with relapsing or locally advanced prostate cancer (PC): A post hoc analysis of the ICELAND study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
34
|
Rubin T, Clayton J, Adams D, Persad R, Vohra S. Systematic review of outcome measures in pediatric eosinophilic esophagitis treatment trials. Allergy Asthma Clin Immunol 2016; 12:45. [PMID: 27582776 PMCID: PMC5006498 DOI: 10.1186/s13223-016-0144-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/19/2016] [Indexed: 01/07/2023] Open
Abstract
Background Heterogeneity has been noted in the selection and reporting of disease-specific, pediatric outcomes in randomized controlled trials (RCTs). The consequence is invalid results or difficulty comparing results across trials. The primary objective of this systematic review was to assess primary outcome and outcome measure selection and reporting, in pediatric eosinophilic esophagitis (EoE) treatment trials. As secondary objectives, we compared trial disease definition to established concensus guidelines, and the efficacy of current EoE treatments. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL since 2001. We also searched clinical trial registries (portal.nihr.ac.uk; clinicaltrials.gov; isrctn.com; and anzctr.org.au) and references of included studies. We included RCTs of EoE treatment in patients 0–18 years. Two authors independently assessed articles. Results Eleven studies met inclusion criteria. All identified primary outcomes, however, of 9 unique primary outcomes, only 2 were used in more than one study. In total, 25 unique primary and secondary outcome measures were employed for pediatric EoE treatment trials. Measurement properties and rationale for their selection was rarely provided. Uptake of consensus-based diagnostic criteria was 25 % in trials initiated after 2011. Due to the small number and heterogeneity of studies obtained, no meta-analysis of treatment efficacy could be undertaken. This SR was limited to exclusively pediatric RCTs. Conclusions The results of this study confirm the need for a standardized set of core outcomes that are universally reported in pediatric EoE trials. Consistent disease definition and standardized outcome reporting will facilitate meta-analyses across similar trials and inform future clinical decision-making. Systematic review registration number CRD42013003798
Collapse
Affiliation(s)
- Tamar Rubin
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada
| | - Jacqueline Clayton
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada
| | - Denise Adams
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada ; CARE Program, University of Alberta, Suite #1702, College Plaza, 8215 112 St NW, Edmonton, AB T6G 2C8 Canada
| | - Rabin Persad
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada ; Department of Pediatric Gastroenterology and Nutrition, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada
| | - Sunita Vohra
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, 3rd Floor, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada ; CARE Program, University of Alberta, Suite #1702, College Plaza, 8215 112 St NW, Edmonton, AB T6G 2C8 Canada ; Department of Public Health Sciences, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| |
Collapse
|
35
|
Goonewardene SS, Persad R, Gillatt D. Erectile function post robotic radical prostatectomy: technical tips to improve outcomes? J Robot Surg 2016; 10:267-9. [PMID: 27272758 DOI: 10.1007/s11701-016-0578-8] [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] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Abstract
Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations.
Collapse
Affiliation(s)
| | - R Persad
- North Bristol NHS Trust, Bristol, UK
| | - D Gillatt
- McQuarrie University, Sydney, Australia
| |
Collapse
|
36
|
Goonewardene SS, Persad R, Gillatt D. Robotic radical cystectomy and enhanced recovery: a new pathway. World J Urol 2016; 34:1599-1600. [PMID: 27010207 DOI: 10.1007/s00345-016-1810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - R Persad
- North Bristol NHS Trust, Bristol, UK
| | - D Gillatt
- Mcquarrie University, Sydney, Australia
| |
Collapse
|
37
|
McNiven C, Switzer N, Wood M, Persad R, Hancock M, Forgie S, Dicken BJ. Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients. J Pediatr Surg 2016; 51:395-7. [PMID: 26362005 DOI: 10.1016/j.jpedsurg.2015.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/31/2015] [Accepted: 08/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The intestinal failure (IF) population is dependent upon central venous catheters (CVC) to maintain minimal energy requirements for growth. Central venous catheter infections (CVCI) are frequent and an independent predictor of intestinal failure associated liver disease. A common complication in children with long-term CVC is the risk of line breakage. Given the often-limited usable vascular access sites in this population, it has been the standard of practice to perform repair of the broken line. Although widely practiced, it is unknown if this practice is associated with increased line colonization rates and subsequent line loss. METHODS A retrospective review of our institutional IF population over the past 8years (2006-2014) was performed. Utilizing a prospectively constructed database, all pediatric patients (n=13, ages 0-17 years) with CVC dependency enrolled in the Children's Intestinal Rehabilitation Program with IF were included who underwent a repair and/or replacement procedure of their line. The control replacement group was CVCs that were replaced without being repaired (36), the experimental repair group was CVCs that were repaired (8). The primary outcome of interest was the mean number of days in each group from the intervention (replacement or repair) to line infection/colonization. Mann-Whitney tests for significance were performed with p-values <0.05 being the threshold value for significance. RESULTS There were no catheter repair associated CVCI. The mean number of days from the replacement or repair of a CVC to its removal owing to infection/colonization was 210.0 and 162.8days respectively. There was no statistically significant difference between these groups in time to removal owing to line infection (p=0.55). CONCLUSION Repair of central venous catheters in the pediatric population with intestinal failure does not lead to an increased rate of central venous catheter infection and should be performed when possible.
Collapse
Affiliation(s)
- Claire McNiven
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Noah Switzer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Melisssa Wood
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Rabin Persad
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric Gastroenterology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Marie Hancock
- Alberta Health Services, Home TPN Program University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Forgie
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric Infectious Disease, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Bryan J Dicken
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric General Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| |
Collapse
|
38
|
Goonewardene SS, Persad R, Gillatt D. Penile rehabilitation for robotic radical prostatectomy: a new game. J Robot Surg 2015; 10:379-380. [PMID: 26705112 DOI: 10.1007/s11701-015-0548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - R Persad
- North Bristol NHS Trust, Bristol, UK
| | - D Gillatt
- Mcquarrie University, Sydney, Australia
| |
Collapse
|
39
|
Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, Mager D. Assessing Nutritional Quality and Adherence to the Gluten-free Diet in Children and Adolescents with Celiac Disease. CAN J DIET PRACT RES 2015; 76:56-63. [PMID: 26067413 DOI: 10.3148/cjdpr-2014-040] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Little is known regarding nutritional adequacy of the gluten free diet (GFD) in children and adolescents with celiac disease (CD). The study aim was to examine macro- and micronutrient intake in children with CD. METHODS A cross-sectional study was conducted in children and adolescents (4-18 years of age) with CD (n = 32) and healthy controls (n = 32). Macro- and micronutrient intake, and glycemic index (GI) and glycemic load (GL) intake was assessed using validated measures. Diet quality was assessed using the Canadian Healthy Eating Index (HEI-C) and the Alberta Nutrition Guidelines. Values are shown as mean ± SE. RESULTS Age (10.4 ± 0.7 years vs 8.7 ± 0.7 years; P = 0.06), weight-for-age z score (P = 0.27), and height-for-age z score (P = 0.23) were not different between groups. CD children consumed more fibre (15.9 ± 1.2 g per day(CD) vs 10.8 ± 0.8 g per day (controls); P < 0.001), had higher GI (CD: 54 ± 2 vs 48 ± 1; P < 0.01) and GL (CD: 118 ± 8 vs 93 ± 7; P = 0.02), and lower folate (146.7 ± 15.3 (CD) vs 245.4 ± 21.8 µg per day (controls); P < 0.001) than controls. No differences in HEI-C scores (≤ and > 80) were observed between groups (P > 0.05). CONCLUSION Children with CD had high intakes of fibre, GI, and GL and lower intakes of folate. This has implications for dietary counselling in this population.
Collapse
Affiliation(s)
- Abeer S Alzaben
- a Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB
| | - Justine Turner
- b Department of Pediatrics, University of Alberta, Edmonton, AB.,c Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
| | - Leanne Shirton
- b Department of Pediatrics, University of Alberta, Edmonton, AB.,c Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
| | - Tarah M Samuel
- b Department of Pediatrics, University of Alberta, Edmonton, AB.,c Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
| | - Rabin Persad
- b Department of Pediatrics, University of Alberta, Edmonton, AB.,c Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB
| | - Diana Mager
- a Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB.,b Department of Pediatrics, University of Alberta, Edmonton, AB
| |
Collapse
|
40
|
Leung AJT, Persad S, Slae M, Abdelradi A, Kluthe C, Shirton L, Danchuk R, Persad R, Meddings J, Huynh HQ. Intestinal and gastric permeability in children with eosinophilic esophagitis and reflux esophagitis. J Pediatr Gastroenterol Nutr 2015; 60:236-9. [PMID: 25304889 DOI: 10.1097/mpg.0000000000000590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Eosinophilic esophagitis (EoE) is an allergic and immune-mediated entity that leads to a characteristic inflammation of esophageal mucosa. Patients complain of dysphagia and reflux-like symptoms. As many as 80% of patients with EoE may also have a history of atopy, and patients with asthma and eczema have previously been shown to have increased intestinal permeability. This study was designed to assess small intestinal and gastric permeability in patients with EoE and to see whether it differed from healthy individuals and patients with reflux esophagitis (RE). METHODS Gastric and small intestinal permeability was measured using sugar probe tests containing lactulose, mannitol, and sucrose. Lactulose-to-mannitol (L/M) ratios in the patient's urine were a measure for intestinal permeability, and total sucrose was a measure for gastric permeability. RESULTS We analyzed samples from 23 patients with EoE, 20 RE, 14 normal upper endoscopy with gastrointestinal symptoms, and 26 healthy controls. All of the 4 groups had L/M ratios less than the upper limit of normal (<0.025). There was no statistically significant difference in gastric permeability between the 4 groups (L/M P = 0.26, sucrose P = 0.46). CONCLUSIONS Our data suggest that an alteration in gastric and intestinal permeability does not play a role in EoE or RE pathogenesis.
Collapse
Affiliation(s)
- Aldrich J T Leung
- *Division of Pediatric GI Nutrition, University of Alberta †Women and Children's Health Research Institute ‡Department of Pediatrics, University of Alberta, Edmonton §Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
King AJL, Evans M, Moore THM, Paterson C, Sharp D, Persad R, Huntley AL. Prostate cancer and supportive care: a systematic review and qualitative synthesis of men's experiences and unmet needs. Eur J Cancer Care (Engl) 2015; 24:618-34. [PMID: 25630851 PMCID: PMC5024073 DOI: 10.1111/ecc.12286] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/02/2022]
Abstract
Prostate cancer is the second most common cancer in men worldwide, accounting for an estimated 1.1 million new cases diagnosed in 2012 (www.globocan.iarc.fr). Currently, there is a lack of specific guidance on supportive care for men with prostate cancer. This article describes a qualitative systematic review and synthesis examining men's experience of and need for supportive care. Seven databases were searched; 20 journal articles were identified and critically appraised. A thematic synthesis was conducted in which descriptive themes were drawn out of the data. These were peer support, support from partner, online support, cancer specialist nurse support, self‐care, communication with health professionals, unmet needs (emotional support, information needs, support for treatment‐induced side effects of incontinence and erectile dysfunction) and men's suggestions for improved delivery of supportive care. This was followed by the development of overarching analytic themes which were: uncertainty, reframing, and the timing of receiving treatment, information and support. Our results show that the most valued form of support men experienced following diagnosis was one‐to‐one peer support and support from partners. This review highlights the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects.
Collapse
Affiliation(s)
- A J L King
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M Evans
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - T H M Moore
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Paterson
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Sharp
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Persad
- Urology, Bristol Urological Institute Southmead Hospital, Bristol, UK
| | - A L Huntley
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
42
|
Goonewardene S, Bahl A, Persad R. Re: Defining the Potential of Neoadjuvant Chemotherapy Use as a Quality Indicator for Bladder Cancer Care. J Urol 2015; 193:370-1. [DOI: 10.1016/j.juro.2014.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - A. Bahl
- Southmead Hospital, Bristol, United Kingdom
| | - R. Persad
- Southmead Hospital, Bristol, United Kingdom
| |
Collapse
|
43
|
Goonewardene SS, Nanton V, Young A, Persad R, Makar A. Prostate cancer survivorship: a new path for uro-oncology. World J Urol 2015; 33:151-3. [DOI: 10.1007/s00345-014-1373-7] [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] [Received: 05/12/2014] [Accepted: 07/27/2014] [Indexed: 12/01/2022] Open
|
44
|
Rubin T, Clayton J, Adams D, Persad R, Vohra S. Systematic review of outcome measures in randomised controlled trials of pediatric eosinophilic esophagitis (EoE) treatment. Allergy Asthma Clin Immunol 2014. [PMCID: PMC4126056 DOI: 10.1186/1710-1492-10-s1-a70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
45
|
Hultin S, Hotston M, Day A, Taylor A, Goodall R, Thomas P, Bahl A, Persad R, Gjini A. Audit of PSA requesting practices in primary care compared to guidelines established by the Prostate Cancer Risk Management programme in the Avon region of the South West of England. Journal of Clinical Urology 2014. [DOI: 10.1177/2051415813485945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Abstract
Background There is considerable challenge in transmitting the complicated information contained in the Prostate Cancer Risk Management (PCRM) programme in the primary care setting. 1 The practices surrounding requesting of PSA should be clearly understood by both GP and patient before requesting this investigation, and in order to further understand the needs and requirements of primary care practitioners in this regard we undertook an audit comparing practices in the Avon region of the Southwest of England compared to the guidelines of the PCRM programme. 1 Methods Our study identified a consistent year-on-year increase in PSA requests over the study period across all age categories and regions of the southwest of England. Results Questionnaire review of practices surrounding the PCRM programme revealed overall good practice but with space for improvement surrounding advice regarding the limitations of prostate biopsy and the relevance of testing in the elderly. Conclusions Despite requesting practices generally conforming to NICE guidelines, nearly half of all abnormal primary-care PSA tests are repeated. Requests in some cases may fall short of best practice.
Collapse
Affiliation(s)
- S Hultin
- General Medicine, Bristol Royal Infirmary, UK
| | - M Hotston
- Department of Urology, Royal Cornwall Hospital, UK
| | - A Day
- Department of Clinical Biochemistry, Weston Area Health NHS Trust, UK
| | - A Taylor
- Department of Clinical Biochemistry, Royal University Hospitals Bath, UK
| | - R Goodall
- Department of Clinical Biochemistry, North Bristol NHS Trust, UK
| | - P Thomas
- Department of Clinical Biochemistry, University Hospital Bristol NHS Trust, UK
| | - A Bahl
- Department of Urology, University Hospital Bristol NHS Trust, UK
| | - R Persad
- Department of Urology, University Hospital Bristol NHS Trust, UK
| | - A Gjini
- Department of Public Health, Bristol Public Health, UK
| |
Collapse
|
46
|
Soo J, Malik BA, Turner JM, Persad R, Wine E, Siminoski K, Huynh HQ. Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn's disease. Dig Dis Sci 2013; 58:3584-91. [PMID: 24026403 DOI: 10.1007/s10620-013-2855-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/20/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn's disease (CD) is reported to be equivalent to that of corticosteroids (CS). AIMS Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD). METHODS Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children's hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn's disease activity index. RESULTS To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9% in the EEN group versus 91.3% in the CS group (p=0.73) at 3 months) and relapse (40.6 vs. 28.6%, respectively (p=0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p=0.28). CONCLUSIONS EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.
Collapse
Affiliation(s)
- Jason Soo
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, T6G 2J3, Canada
| | | | | | | | | | | | | |
Collapse
|
47
|
Saginur M, AlRefaee FAM, Spady DW, Girgis SAM, Huynh HQ, Prosser CI, Persad R, Turner JM. Antitissue transglutaminase antibody determination versus upper endoscopic biopsy diagnosis of paediatric celiac disease. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.5.246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
48
|
Cooper T, Kuruvilla G, Persad R, El-Hakim H. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg 2012; 147:209-14. [PMID: 22588730 DOI: 10.1177/0194599812447758] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report on airway endoscopic findings and gastrointestinal and atopic conditions in a large consecutive series of atypical croup. STUDY DESIGN Case series with chart review. SETTING Tertiary pediatric referral center. SUBJECTS AND METHODS A surgical database was searched for all children who underwent full airway endoscopy to investigate atypical croup. The primary outcome measure was the prevalence of large airway lesions in patients with atypical croup undergoing endoscopy. Demographics, secondary diagnoses, and rate of positive findings were documented. Age and atopy were correlated using Spearman's correlation coefficient, and multivariate analysis identified predictors of large airway lesions. RESULTS Eighty patients were identified over a period of 8 years (58 boys; mean [SD] age 4.8 [3.8] years; range, 46 days to 13.7 years). Of the 80 children, 31 had positive airway findings, with 33 large airway lesions demonstrated, including 10 subglottic stenosis, 7 laryngeal clefts, 6 subglottic hemangiomas, 4 tracheomalacia, and 3 laryngomalacia. Esophagitis was diagnosed in 36 children, 5 of whom had eosinophilic esophagitis. Thirty-five children had an atopic condition including asthma, allergic rhinitis, eosinophilic esophagitis, and food allergies. Age correlated with associated atopy (coefficient 0.4, P < .0001) and predicted the presence of any airway lesion (coefficient -0.0625, P < .001) and subglottic stenosis in particular (coefficient -0.0362, P = .001). Prior intubation predicted subglottic stenosis (coefficient 0.267, P = .011). CONCLUSION Thirty-nine percent of airway endoscopies demonstrated large airway lesions. When eosinophilic esophagitis was sought, it was confirmed in over 1:10 patients. The findings bolster the case for airway endoscopy coupled with allergy and gastrointestinal investigations.
Collapse
Affiliation(s)
- Timothy Cooper
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|
49
|
Abstract
Prostate cancer is diagnosed in 37 000 new patients a year, and causes 10 000 deaths each year in the UK (Cancer Research UK, 2011). Diagnoses are increasingly the result of screening using measurement of prostate- specific antigen levels. The natural history of early disease is unclear. Autopsy studies before prostate-specific antigen screening showed an actual latent prevalence (not diagnosed during life) of around 30% at the age of 50 years and 75% at the age of 80 years, and many of these demonstrated local invasion (Franks, 1954). One of the main current challenges in urology is distinguishing indolent prostate cancers from potentially lethal ones. The specificity of the prostate-specific antigen test for clinically significant disease remains disappointingly low and population screening is not encouraged (Ilic et al, 2011). However, prostate-specific antigen testing is often done in good faith, but pre-test counselling is essential. Thus, prostate-specific antigen testing should only be undertaken by the patient's GP or on the advice of a urologist.
Collapse
Affiliation(s)
- M F Eylert
- Urology ST3 in the Department of Urology, Morriston Hospital, Swansea SA6 6NL.
| | | |
Collapse
|
50
|
Eylert M, Persad R, Hounsome L, Verne J, Jefferies E, Bahl A, Mostafid H. MP-04.11 Trends in Bladder Cancer Incidence and Mortality in England 1990-2006. Urology 2011. [DOI: 10.1016/j.urology.2011.07.085] [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: 10/15/2022]
|