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Snelling PJ, Jones P, Bade D, Gillespie A, Keijzers G, Ware RS. Ultrasound Secondary Signs for the Diagnosis of Pediatric Distal Forearm Fractures: A Diagnostic Study. Ultrasound Med Biol 2024; 50:898-907. [PMID: 38519361 DOI: 10.1016/j.ultrasmedbio.2024.02.015] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of ultrasound secondary signs of fractures in pediatric patients aged 5-15 y presenting to the emergency department with a clinically non-deformed distal forearm injury. METHODS This diagnostic study was conducted in South East Queensland, Australia. Emergency clinicians performed point-of-care ultrasound on eligible patients and recorded secondary signs of fractures (pronator quadratus hematoma [PQH] sign, periosteal hematoma, visible angulation) or physeal fractures (fracture-to-physis distance [FPD], physis alteration). The reference standard was the final fracture diagnosis determined by expert panel. The primary outcome was the diagnostic accuracy of secondary signs for cortical breach and physeal fractures. Diagnostic statistics were reported for each relevant secondary sign. RESULTS A total of 135 participants were enrolled. The expert panel diagnosed 48 "no" fracture, 52 "buckle" fracture and 35 "other" fracture. All "other" fractures were cortical breach fractures and included 15 Salter-Harris II fractures. The PQH sign demonstrated high sensitivity and moderate specificity to diagnose cortical breach fractures (91%, 95% Confidence Interval [CI] 78%-97% and 82%, 73%-88%). Poor sensitivity but high specificity was observed for the visible angulation and periosteal hematoma secondary signs. FPD <1cm showed perfect sensitivity and moderate specificity (100%, 80%-100% and 85%, 78%-90%) for diagnosis of Salter-Harris II fracture. Conversely, physis alteration showed poor sensitivity but excellent specificity (40%, 20%-64% and 99%, 95%-100%) for the diagnosis of Salter-Harris II fractures. CONCLUSION Ultrasound secondary signs showed good diagnostic accuracy for both cortical breach fractures and Salter-Harris II fractures. Future research should consider optimal use of secondary signs to improve diagnostic accuracy.
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Affiliation(s)
- Peter J Snelling
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
| | - Philip Jones
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Department of Emergency Medicine, Logan Hospital, Meadowbrook, Queensland, Australia
| | - David Bade
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Department of Orthopaedics, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Alan Gillespie
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia
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Luke C, Mick-Ramsamy L, Bos AF, Benfer KA, Bosanquet M, Gordon A, Williams H, Taifalos C, Smith M, Leishman S, Oakes E, Kentish M, McNamara L, Ware RS, Boyd RN. Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological examination in a developmentally vulnerable First Nations cohort. Early Hum Dev 2024; 192:106004. [PMID: 38636257 DOI: 10.1016/j.earlhumdev.2024.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
AIM To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening. METHODS A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP). RESULTS Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development. INTERPRETATION Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.
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Affiliation(s)
- Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia; Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Arend F Bos
- General Movements Trust, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, the Netherlands
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Anya Gordon
- Townsville University Hospital (TUH), Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Hailey Williams
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Chloe Taifalos
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Maria Smith
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Ellena Oakes
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Lynda McNamara
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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McCosker LK, Ware RS, Seale H, Hooshmand D, O'Leary R, Downes MJ. The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial. Vaccine 2024; 42:2578-2584. [PMID: 38485641 DOI: 10.1016/j.vaccine.2024.03.020] [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: 09/21/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable. This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured 'on-time' at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated. Eighty-six people consented to participate, and 43 were randomly allocated to each of the 'incentive' and 'no incentive' groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, -9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, -2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001). Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Dona Hooshmand
- Ashben Medical Centre, Gold Coast, Queensland, Australia.
| | - Ryan O'Leary
- Queensland Council of Social Service, Brisbane, Queensland, Australia; Gold Coast Homelessness Network, Australia.
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
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Xu HG, Corley A, Ware RS, Nghiem S, Stirling S, Wang C, Marsh N. Using a LOng peripheral intraVEnous catheter with retractable guidewire to optimize first-insertion success for patients with Difficult IntraVenous Access in the emergency department (LOVE-DIVA): a study protocol for a randomized controlled trial. Br J Nurs 2024; 33:S28-S34. [PMID: 38578937 DOI: 10.12968/bjon.2024.33.7.s28] [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] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION First-insertion success rates for peripheral vascular access devices (PVADs) in patients with difficult venous access (DIVA) are low, which negatively affects staff workload, patient experience, and organizational cost. There is mixed evidence regarding the impact of a peripheral vascular access device with retractable coiled tip guidewire (GW; AccuCath™, BD) on the first-insertion success rate. The aim of this study is to investigate whether the use of long GW-PVADs, compared with standard PVADs, reduces the risk of first-time insertion failure, in patients admitted to emergency departments (EDs). METHODS AND ANALYSIS A parallel-group, two-arm, randomized controlled trial will be carried out in two Australian EDs to compare long GW-PVADs (5.8 cm length) against standard care PVADs (short or long). Patients ≥18 years of age meeting DIVA criteria will be eligible for the trial. The sample size is 203 participants for each arm. Web-based central randomization will be used to ensure allocation concealment. Neither clinicians nor patients can be blinded to treatment allocation. Primary outcome is the first-insertion success rate. Secondary outcomes include the number of insertion attempts, time to insert PVAD, all-cause failure, dwell-time, patient-reported pain, serious adverse events, complications, subsequent vascular access devices required, patient satisfaction, staff satisfaction, and healthcare costs. Differences between the two groups will be analyzed using Cox proportional hazards regression. Cost-effectiveness analysis will also be conducted. Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION The study is approved by Metro South Ethics Committee (HREC/2022/QMS/82264) and Griffith University (2022/077). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION ACTRN12622000299707.
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Affiliation(s)
- Hui Grace Xu
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Amanda Corley
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Son Nghiem
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Scott Stirling
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Carrie Wang
- Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Takashima MD, Ezure Y, Ullman AJ, Ware RS. Methodological progress note: Choosing analytic methods for randomized trials. J Hosp Med 2024; 19:312-315. [PMID: 38402416 DOI: 10.1002/jhm.13315] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Mari D Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Yukiko Ezure
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- NHMRC Centre for Wiser Wound Care, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Wong MD, Blake TL, Zahir SF, Suresh S, Hantos Z, Grimwood K, Lambert SB, Ware RS, Sly PD. Longitudinal tracking of intrabreath respiratory impedance in preschool children. Pediatr Pulmonol 2024. [PMID: 38560779 DOI: 10.1002/ppul.26994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Longitudinal measurements of intrabreath respiratory impedance (Zrs) in preschool-aged children may be able to distinguish abnormal lung function trajectories in children with a history of wheezing compared to healthy ones. METHODS Children from a prospective, longitudinal community-based cohort performed annual intrabreath oscillometry (IB-OSC) measurements from age 3- to 7-years. IB-OSC was performed using a single 10 Hz sinusoid while clinically asymptomatic. Linear mixed-effects models were developed to explore the effects of wheezing phenotypes, growth, and sex on seven IB-OSC outcome variables over time: resistance at end-expiration (ReE), resistance at end-inspiration (ReI), the tidal change in resistance (∆R=ReE-ReI), reactance at end-expiration (XeE), reactance at end-inspiration (XeI), the tidal change in reactance (∆X=XeE-XeI), and ∆X normalized by tidal volume (∆X/VT). RESULTS Eighty-five children produced 374 acceptable IB-OSC measurements. Subjects were classified into one of three wheeze groups: never (n = 36), transient (n = 34), or persistent (n = 15). After adjusting for height, children with persistent wheezing, compared to those who never wheezed, had +0.814 hPa s L-1 ReE (95% confidence interval [CI] +0.178 to +1.451, p = 0.015), -0.792 hPa s L-1 XeE (95% CI -1.203 to -0.381, p = 0.003), -0.538 hPa s L-1 ∆X (95% CI -0.834 to -0.242, p = 0.007) and -1.672 hPa s L-2 ∆X/VT (95% CI -2.567 to -0.777, p < 0.001). Increasing height had a significant effect on all IB-OSC resistance and reactance variables when adjusted for the effect of preschool wheezing. CONCLUSIONS IB-OSC is feasible for tracking lung function growth in preschool-aged children and may allow abnormal lung function to be identified early in asymptomatic preschoolers with a history of persistent wheezing.
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Affiliation(s)
- Matthew D Wong
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Tamara L Blake
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Syeda F Zahir
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Sadasivam Suresh
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Zoltán Hantos
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Keith Grimwood
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
| | - Stephen B Lambert
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Peter D Sly
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
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Benfer KA, Whittingham K, Ware RS, Ghosh AK, Chowdhury S, Moula G, Samanta S, Khan NZ, Bell KL, Oftedal S, Bandaranayake S, Salt AT, Bhattacharya A, Maiti P, Tripathi SK, Morgan C, Novak I, Boyd RN. Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT. Pediatrics 2024; 153:e2023063854. [PMID: 38516717 DOI: 10.1542/peds.2023-063854] [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] [Accepted: 12/13/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sayak Chowdhury
- Indian Institute of Cerebral Palsy, Kolkata, India
- SSKM Postgraduate Institute of Medical Education and Research, Kolkata, India
| | | | - Sandip Samanta
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | | | | | - Pradip Maiti
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Whittingham K, Benfer K, Sakzewski L, Wotherspoon J, Burgess A, Comans T, Keramat SA, Ware RS, Boyd RN. Sleep problems in a population-based cohort of primary school age children with Cerebral Palsy. Res Dev Disabil 2024; 147:104690. [PMID: 38364615 DOI: 10.1016/j.ridd.2024.104690] [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] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
AIMS To examine sleep problems in a population-based sample of school-aged children (8-12yo) with Cerebral Palsy (CP) METHOD: Eighty-six children (mean 9 years, 5 months, SD = 1 year, 6 months; male = 60) with CP (Gross Motor Function Classification System; GMFCS I=46; II=21; III=9; IV=6; V=6) participated. Classifications/assessments included: Sleep Disturbance Scale for Children (SDSC), Gross Motor Function Measure (GMFM-66), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Strengths and Difficulties Questionnaire (SDQ) and the Cerebral Palsy- Quality of Life (CP-QOL) Pain Impact subscale. Analysis included linear and logistic regression. RESULTS 38 (44 %) children were within the clinical range for sleep problems. Sleep problems were significantly associated with epilepsy, (95 % CI) = 14.48 (7.95 to 21.01), gross motor function, -0.13 (-0.26 to -0.01), manual ability, 7.26 (0.82 to 13.69), communication, 10.01 (2.21 to 17.80), child behaviour, 1.134 (0.74 to 1.53), and pain related QOL, 0.33 (0.12 to 0.53). For the multivariable model, sleep problems remained significantly associated with epilepsy, b (95 % CI) = 11.72 (4.88 to 18.57), child behaviour, 1.03 (0.65 to 1.41) and pain-related QOL, 0.21 (0.29 to 0.38). CONCLUSIONS Sleep problems are common and associated with epilepsy, child behaviour and pain related QOL.
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Affiliation(s)
- Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia.
| | - Kath Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Jane Wotherspoon
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia; School of Psychology, The University of Queensland, Brisbane, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Australia
| | - Syed Afoz Keramat
- Centre for Health Services Research, The University of Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
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Dimanopoulos T, Chaboyer W, Campbell J, Ullman AJ, Battley C, Ware RS, Patel M, Griffin BR. Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital. J Adv Nurs 2024. [PMID: 38468151 DOI: 10.1111/jan.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. METHODS This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. RESULTS The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. CONCLUSION HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. IMPACT The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. REPORTING METHOD STROBE guidelines. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution to the conduct of this study.
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Affiliation(s)
- Tanesha Dimanopoulos
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Maharshi Patel
- School of Medicine and Dentistry, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Bronwyn R Griffin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
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10
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Schults JA, Young ER, Marsh N, Larsen E, Corley A, Ware RS, Murgo M, Alexandrou E, McGrail M, Gowardman J, Charles KR, Regli A, Yasuda H, Rickard CM. Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial. J Intensive Care 2024; 12:12. [PMID: 38459599 PMCID: PMC10924392 DOI: 10.1186/s40560-024-00719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. METHODS Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. RESULTS Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60-74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15-59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). CONCLUSIONS AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
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Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Emily R Young
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Marghie Murgo
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
| | - Evan Alexandrou
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - John Gowardman
- Intensive Care Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Karina R Charles
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, The Notre Dame University, Fremantle, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, Saitama, Japan
- Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Claire M Rickard
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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11
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Coombes BK, Sierra-Silvestre E, Bisset LM, Mielke GI, Ware RS, Coombes JS, Burton NW, Coppieters MW. Pain exacerbation following physical activity in adults with diabetic neuropathy: Ecological momentary assessment of foot symptoms. Aust J Gen Pract 2024; 53:93-98. [PMID: 38437648 DOI: 10.31128/ajgp-05-23-6821] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND AND OBJECTIVES People with diabetic peripheral neuropathy (DPN) report fluctuating foot symptoms. This study used ecological momentary assessment to: (1) compare foot symptoms between days, time points and periods with/without preceding physical activity or pain medication; and (2) determine relationships between symptoms and endogenous pain modulation. METHOD Ten low-active Australian adults with probable DPN underwent temporal summation of pain (TSP) and conditioned pain modulation (CPM) then completed mobile phone surveys five times daily for seven days, where they recorded the intensity of six foot symptoms and whether they performed physical activity or consumed pain medication in the preceding three hours. RESULTS: All foot symptoms except numbness were greater in periods following physical activity, whereas periods following pain medication showed greater shooting pain. TSP showed very large correlations with sensitivity to touch, burning pain, shooting pain and prickling/tingling. DISCUSSION: General practitioners should be aware that physical activity might exacerbate symptoms of DPN when encouraging their patients to be active.
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Affiliation(s)
- Brooke K Coombes
- BPhty (Hons), MPhty (Musc), GCertHigherEd, PhD, Lecturer, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Eva Sierra-Silvestre
- BSc Physiotherapy, MSc (MT), PhD, Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Leanne M Bisset
- PhD, MPhty (ManipPhty), MPhty (Sports), BPhty, Associate Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Gregore Iven Mielke
- BPhysEd (Hons), MPhil, PhD, The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Qld
| | - Robert S Ware
- BSc (Hons1), PhD, Professor, School of Medicine and Dentistry, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Jeff S Coombes
- BAppSci, Bed (Hons), MEd, PhD, Professor, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld
| | - Nicola W Burton
- BSc (Hons), MPsych (Clinical), GCertHigherEd, PhD, Associate Professor, School of Applied Psychology, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Research Fellow, Centre for Mental Health, Griffith University, Brisbane, Qld
| | - Michel W Coppieters
- BPT, PhD, Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Professor, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
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12
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Laporta-Hoyos O, Fiori S, Pannek K, Pagnozzi AM, Ware RS, Boyd RN. Longitudinal assessment of brain lesions in children with cerebral palsy and association with motor functioning. Eur J Paediatr Neurol 2024; 49:27-34. [PMID: 38330549 DOI: 10.1016/j.ejpn.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND The semi-quantitative scale of structural brain Magnetic Resonance Imaging (sqMRI) is a valid and reliable measure of brain lesion extent in children with cerebral palsy (CP) >3-years. This system scores lesion burden for each major brain region. The sum of the scores gives a global score ranging from 0 to 48. PURPOSE To investigate how sqMRI scores changed from infancy to school-age, and whether these were associated with lesion load, age at first assessment, and gross motor function and its changes. MATERIALS AND METHODS Twenty-eight children with CP underwent MRI and motor (Gross Motor Function Measure-66; GMFM-66) assessments when <40-months and again when 8-12-years. We investigated whether (i) toddler/preschool-age sqMRI scores (Time 1) reflected school-age sqMRI scores (Time 2); (ii) temporal changes in sqMRI scores (Time 1-Time 2 difference) were related to the child's age at Time 1 and lesion extent; (iii) early or later sqMRI scores were associated with motor functioning; (iv) sqMRI scores' longitudinal changes were associated with motor changes. RESULTS Except for the corticosubcortical (grey-matter only) layers, sqMRI scores were significantly higher ('higher lesion load') at Time 1 than at Time 2. Age at Time 1 was not associated with temporal changes in global sqMRI scores. Higher lesion load at Time 2, but not at Time 1, was associated with smaller temporal changes in the global sqMRI score. The sqMRI scores were associated with concurrent, but not future or past motor GMFM-66 scores. Longitudinal changes in sqMRI scores were not associated with longitudinal changes in motor GMFM-66 scores. CONCLUSION sqMRI scores of brain lesion extent at school-age are lower and a better indication of later-life motor functioning than very early life sqMRI scores. It may be best to interpret MRI white matter lesions with caution in very early life due to possible changes in lesion appearance and the unpredictable role of functional plasticity.
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Affiliation(s)
- Olga Laporta-Hoyos
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Departament de Psicologia Clínica i Psicobiologia & Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
| | - Simona Fiori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.
| | - Kerstin Pannek
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Alex M Pagnozzi
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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13
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Snelling PJ, Jones P, Bade D, Bindra R, Davison M, Gillespie A, McEniery J, Moore M, Keijzers G, Ware RS. Diagnostic Accuracy of Point-of-Care Ultrasound Versus Radiographic Imaging for Pediatric Distal Forearm Fractures: A Randomized Controlled Trial. Ann Emerg Med 2024; 83:198-207. [PMID: 37999655 DOI: 10.1016/j.annemergmed.2023.10.008] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Abstract
STUDY OBJECTIVE In patients aged 5 to 15 years with a clinically nondeformed distal forearm injury presenting to the emergency department (ED), we examined whether point-of-care ultrasound or radiographic imaging had better diagnostic accuracy, with the reference diagnosis determined by an expert panel review. METHODS This multicenter, open-label, diagnostic randomized controlled trial was conducted in South East Queensland, Australia. Eligible patients were randomized to receive initial imaging through point-of-care ultrasound performed by an ED clinician or radiograph. Images were defined as "no," "buckle," or "other" fracture by the treating clinician. The primary outcome was the diagnostic accuracy of the treating clinician's interpretation compared against the reference standard diagnosis, which was determined retrospectively by an expert panel consisting of an emergency physician, pediatric radiologist, and pediatric orthopedic surgeon, who reviewed all imaging and follow-up. RESULTS Two-hundred and seventy participants were enrolled, with 135 randomized to each initial imaging modality. There were 132 (97.8%) and 112 (83.0%) correctly diagnosed participants by ED clinicians in the point-of-care ultrasound and radiograph groups, respectively (absolute difference [AD]=14.8%; 95% confidence interval [CI] 8.0% to 21.6%; P<.001). Point-of-care ultrasound had better accuracy for participants with "buckle" fractures (AD=18.5%; 95% CI 7.1% to 29.8%) and "other" fractures (AD=17.1%; 95% CI 2.7% to 31.6%). No clinically important fractures were missed in either group. CONCLUSION In children and adolescents presenting to the ED with a clinically nondeformed distal forearm injury, clinician-performed (acquired and interpreted) point-of-care ultrasound more accurately identified the correct diagnosis than clinician-interpreted radiographic imaging.
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Affiliation(s)
- Peter J Snelling
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
| | - Philip Jones
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia
| | - David Bade
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia; Department of Orthopaedics, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Randy Bindra
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michelle Davison
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Alan Gillespie
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jane McEniery
- Department of Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Moore
- Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Robert S Ware
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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14
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Caynes KD, Rose TA, Ware RS, Johnston LM. Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility. Int J Speech Lang Pathol 2024:1-13. [PMID: 38379211 DOI: 10.1080/17549507.2023.2287991] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP). METHOD Twenty-one clinicians (speech-language pathologists [SLPs] n = 11; physiotherapists [PTs] n = 5; occupational therapists [OTs] n = 5) novice to the Viking Speech Scale (VSS), Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) rated eight unfamiliar children with CP (8-16 years) following classification orientation. Inter-rater agreement was examined between (a) novices, (b) novice SLPs vs. PTs and OTs, and (c) novice vs. expert (kappa statistics). Utility perceptions were scored regarding classification terminology, ease of use, assistive decision-making resources, and construct validity and were analysed using Kruskal-Wallis H-tests. RESULT Rating agreement between novices was substantial (VSS, k = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, k = 0.44, 95% CI [0.23-0.65]; CFCS, k = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, kw = 0.89, 95% CI [0.86-0.92]; FCCS, kw = 0.89, 95% CI [0.86-0.92]; CFCS, kw = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; p = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; p = 0.009), and construct validity (FCCS, CFCS, VSS; p < 0.001). CONCLUSION Novice raters achieved substantial agreement for speech classification, supporting utilisation in clinical, research, and CP register activities. Orientation to communication classification constructs, content, and instructions is recommended for novice raters.
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Affiliation(s)
- Katy D Caynes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia and
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Matthews BG, Thomson CE, Harding MP, McKinley JC, Ware RS. Treatments for Morton's neuroma. Cochrane Database Syst Rev 2024; 2:CD014687. [PMID: 38334217 PMCID: PMC10853972 DOI: 10.1002/14651858.cd014687.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Morton's neuroma (MN) is a painful neuropathy resulting from a benign enlargement of the common plantar digital nerve that occurs commonly in the third webspace and, less often, in the second webspace of the foot. Symptoms include burning or shooting pain in the webspace that extends to the toes, or the sensation of walking on a pebble. These impact on weight-bearing activities and quality of life. OBJECTIVES To assess the benefits and harms of interventions for MN. SEARCH METHODS On 11 July 2022, we searched CENTRAL, CINAHL Plus EBSCOhost, ClinicalTrials.gov, Cochrane Neuromuscular Specialised Register, Embase Ovid, MEDLINE Ovid, and WHO ICTRP. We checked the bibliographies of identified randomised trials and systematic reviews and contacted trial authors as needed. SELECTION CRITERIA We included all randomised, parallel-group trials (RCTs) of any intervention compared with placebo, control, or another intervention for MN. We included trials where allocation occurred at the level of the individual or the foot (clustered data). We included trials that confirmed MN through symptoms, a clinical test, and an ultrasound scan (USS) or magnetic resonance imaging (MRI). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We assessed bias using Cochrane's risk of bias 2 tool (RoB 2) and assessed the certainty of the evidence using the GRADE framework. MAIN RESULTS We included six RCTs involving 373 participants with MN. We judged risk of bias as having 'some concerns' across most outcomes. No studies had a low risk of bias across all domains. Post-intervention time points reported were: three months to less than 12 months from baseline (nonsurgical outcomes), and 12 months or longer from baseline (surgical outcomes). The primary outcome was pain, and secondary outcomes were function, satisfaction or health-related quality of life (HRQoL), and adverse events (AE). Nonsurgical treatments Corticosteroid and local anaesthetic injection (CS+LA) versus local anaesthetic injection (LA) Two RCTs compared CS+LA versus LA. At three to six months: • CS+LA may result in little to no difference in pain (mean difference (MD) -6.31 mm, 95% confidence interval (CI) -14.23 to 1.61; P = 0.12, I2 = 0%; 2 studies, 157 participants; low-certainty evidence). (Assessed via a pain visual analogue scale (VAS; 0 to 100 mm); a lower score indicated less pain.) • CS+LA may result in little to no difference in function when compared with LA (standardised mean difference (SMD) -0.30, 95% CI -0.61 to 0.02; P = 0.06, I2 = 0%; 2 studies, 157 participants; low-certainty evidence). (Function was measured using: the American Orthopaedic Foot and Ankle Society Lesser Toe Metatarsophalangeal-lnterphalangeal Scale (AOFAS; 0 to 100 points) - we transformed the scale so that a lower score indicated improved function - and the Manchester Foot Pain and Disability Schedule (MFPDS; 0 to 100 points), where a lower score indicated improved function.) • CS+LA probably results in little to no difference in HRQoL when compared to LA (MD 0.07, 95% CI -0.03 to 0.17; P = 0.19; 1 study, 122 participants; moderate-certainty evidence), and CS+LA may not increase satisfaction (risk ratio (RR) 1.08, 95% CI 0.63 to 1.85; P = 0.78; 1 study, 35 participants; low-certainty evidence). (Assessed using the EuroQol five dimension instrument (EQ-5D; 0-1 point); a higher score indicated improved HRQoL.) • The evidence is very uncertain about the effects of CS+LA on AE when compared with LA (RR 9.84, 95% CI 1.28 to 75.56; P = 0.03, I2 = 0%; 2 studies, 157 participants; very low-certainty evidence). Adverse events for CS+LA included mild skin atrophy (3.9%), hypopigmentation of the skin (3.9%) and plantar fat pad atrophy (2.6%); no adverse events were observed with LA. Ultrasound-guided (UG) CS+LA versus non-ultrasound-guided (NUG) CS+LA Two RCTs compared UG CS+LA versus NUG CS+LA. At six months: • UG CS+LA probably reduces pain when compared with NUG CS+LA (MD -15.01 mm, 95% CI -27.88 to -2.14; P = 0.02, I2 = 0%; 2 studies, 116 feet; moderate-certainty evidence). (Assessed with a pain VAS.) • UG CS+LA probably increases function when compared with NUG CS+LA (SMD -0.47, 95% CI -0.84 to -0.10; P = 0.01, I2 = 0%; 2 studies, 116 feet; moderate-certainty evidence). We do not know of any established minimum clinical important difference (MCID) for the scales that assessed function, specifically, the MFPDS and the Manchester-Oxford Foot Questionnaire (MOXFQ; 0 to 100 points; a lower score indicated improved function.) • UG CS+LA may increase satisfaction compared with NUG CS+LA (risk ratio (RR) 1.71, 95% CI 1.19 to 2.44; P = 0.003, I2 = 15%; 2 studies, 114 feet; low-certainty evidence). • HRQoL was not measured. • UG CS+LA may result in little to no difference in AE when compared with NUG CS+LA (RR 0.42, 95% CI 0.12 to 1.39; P = 0.15, I2 = 0%; 2 studies, 116 feet; low-certainty evidence). AE included depigmentation or fat atrophy for UG CS+LA (4.9%) and NUG CS+LA (12.7%). Surgical treatments Plantar incision neurectomy (PN) versus dorsal incision neurectomy (DN) One study compared PN versus DN. At 34 months (mean; range 28 to 42 months), PN may result in little to no difference for satisfaction (RR 1.06, 95% CI 0.87 to 1.28; P = 0.58; 1 study, 73 participants; low-certainty evidence), or for AE (RR 0.95, 95% CI 0.32 to 2.85; P = 0.93; 1 study, 75 participants; low-certainty evidence) compared with DN. AE for PN included hypertrophic scaring (11.4%), foreign body reaction (2.9%); AE for DN included missed nerve (2.5%), artery resected (2.5%), wound infection (2.5%), postoperative dehiscence (2.5%), deep vein thrombosis (2.5%) and reoperation with plantar incision due to intolerable pain (5%). The data reported for pain and function were not suitable for analysis. HRQoL was not measured. AUTHORS' CONCLUSIONS Although there are many interventions for MN, few have been assessed in RCTs. There is low-certainty evidence that CS+LA may result in little to no difference in pain or function, and moderate-certainty evidence that UG CS+LA probably reduces pain and increases function for people with MN. Future trials should improve methodology to increase certainty of the evidence, and use optimal sample sizes to decrease imprecision.
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Affiliation(s)
- Barry G Matthews
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Colin E Thomson
- Department of Trauma & Orthopaedics, The Royal Infirmary of Edinburgh and St John's Hospital Livingston, Edinburgh, UK
| | | | - John C McKinley
- Royal Infirmary of Edinburgh and Royal Hospital for Sick Children, Edinburgh, UK
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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Lumsden EJ, Kimble RM, Ware RS, Griffin B. Tissue Pressure Changes and Implications on Dressing Selection when utilising Negative Pressure Wound Therapy on an Ex Vivo Porcine Model. Burns 2024:S0305-4179(24)00024-X. [PMID: 38378389 DOI: 10.1016/j.burns.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
Negative Pressure Wound Therapy (NPWT) is broadly used in surgical wound management and more recently burn care; however, the tissue pressure changes and best dressing application technique remains unknown. This study was done to help understand the tissue pressure changes beneath negative pressure when varying the delivered pressures, dressing thickness and distribution of dressings. This study was done in 2021 at a quaternary paediatric burns hospital. Utilising a cadaveric porcine model, an intracranial pressure monitor and transducer were used to assess pressure. The transducer was placed on the epidermis or inserted under ultrasound guidance via cannulation to the dermis, subcutaneous or muscular layer. Mepitel™, ACTICOAT™, varying layers of Kerlix™ (10, 20 or 30 layers) and NPWT were then applied either circumferentially or non-circumferentially. Each set of results is indicative of the intracranial pressure probe reading when NPWT was delivered at -40, -60, -80, -100 and -120 mmHg. The median and interquartile pressure recordings were epidermis: -42 (-42.5 - -41), -60.5 (-62.5 - -60), -80.5 (-82 - -80), - 99 (-99 - -98)mmHg (p < 0.001); dermis: 1 (0 - 2), 2 (1 - 3.5), 3 (2 - 5.5), 4 (3 - 7), 5.5 (4 - 7.5)mmHg (p < 0.001) (the increase in pressure was less when circumferential dressings (p < 0.001) or more layers of Kerlix were applied (p < 0.001)); subcutis: 1.5 (-4.5-1), -2.5 (-7.5 - 1.5), -3.5 (-11 - 1.5), -5 (-14 - 1.5) and -6 (-16 - 2)mmHg (p = 006) (the decrease in pressure was less with increased layers of Kerlix (0.047) and muscular: 0 (-0.5 - 0), 0 (-1 - 0.5), 0 (-1 - 1), 0 0 (-1 - 1), 00 (-1.5 - 1)mmHg (p = 0.55). These data suggest negative pressure paradoxically exerts a positive pressure on the dermis. Circumferential and multi-layer dressings reduce this positive pressure. This knowledge has impacted our burn negative pressure wound therapy dressing selection. The limitation of this study is the cadaveric model, a live model is suggested for future studies.
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Affiliation(s)
- Emma J Lumsden
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Department of Paediatric Surgery, Urology, Burns and Trauma; Queensland Children's Hospital, Stanley St, South Brisbane, QLD 4101, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia.
| | - Roy M Kimble
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Department of Paediatric Surgery, Urology, Burns and Trauma; Queensland Children's Hospital, Stanley St, South Brisbane, QLD 4101, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia
| | - Robert S Ware
- Griffith University, Menzies Health Institute Queensland, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia
| | - Bronwyn Griffin
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia
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Takashima MD, Grimwood K, Vilcins D, Knibbs LD, Sly PD, Lambert SB, Ware RS. Association of antenatal and early childhood air pollution and greenspace exposures with respiratory pathogen upper airway acquisitions and respiratory health outcomes. Int J Environ Health Res 2024:1-14. [PMID: 38245844 DOI: 10.1080/09603123.2023.2299225] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/20/2023] [Indexed: 01/22/2024]
Abstract
The association of air pollution and greenspace with respiratory pathogen acquisition and respiratory health was investigated in a community-based birth-cohort of 158 Australian children. Weekly nasal swabs and daily symptom-diaries were collected for 2-years, with annual reviews from ages 3-7-years. Annual exposure to fine-particulate-matter (PM2.5), nitrogen-dioxide (NO2), and normalised-difference-vegetation-index (NDVI) was estimated for pregnancy and the first 2-years-of-life. We examined rhinovirus, any respiratory virus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae detections in the first 3-months-of-life, age at initial pathogen detection, wheezing in the first 2-years, and asthma at ages 5-7-years. Our findings suggest that higher NDVI was associated with fewer viral and M. catarrhalis detections in the first 3-months, while increased PM2.5 and NO2 were linked to earlier symptomatic rhinovirus and H. influenzae detections, respectively. However, no associations were observed with wheezing or asthma. Early-life exposure to air pollution and greenspace may influence early-life respiratory pathogen acquisition and illness. .
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Affiliation(s)
- Mari D Takashima
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- Paediatric Nursing and Patient Safety, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Dwan Vilcins
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Luke D Knibbs
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney 2006, New South Wales, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Queensland, Australia
| | - Stephen B Lambert
- UQ Centre for Clinical Research, The University of Queensland, Herston, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
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Schults JA, Charles KR, Harnischfeger J, Ware RS, Royle RH, Byrnes JM, Long DA, Ullman AJ, Raman S, Waak M, Lake A, Cooke M, Irwin A, Tume L, Hall L. Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections. Aust Crit Care 2024; 37:34-42. [PMID: 38142148 DOI: 10.1016/j.aucc.2023.09.008] [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: 03/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Endotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections. OBJECTIVE The objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions. METHODS A mixed-method, pre-implementation-post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models. RESULTS Data from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use. CONCLUSIONS Implementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.
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Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Karina R Charles
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Jane Harnischfeger
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Ruth H Royle
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Joshua M Byrnes
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Australia
| | - Debbie A Long
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
| | - Amanda J Ullman
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Sainath Raman
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Michaela Waak
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Anna Lake
- The University of Queensland, Children's Health Research Centre, Australia
| | - Marie Cooke
- School of Nursing & Midwifery, Griffith University, Australia
| | - Adam Irwin
- The University of Queensland, Centre for Clinical Research, The University of Queensland, Queensland, Australia; Infection Management and Prevention Service, Queensland Children's Hospital, Queensland, Australia
| | - Lyvonne Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Lisa Hall
- Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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Murfield J, Moyle W, O'Donovan A, Ware RS. The Role of Self-Compassion, Dispositional Mindfulness, and Emotion Regulation in the Psychological Health of Family Carers of Older Adults. Clin Gerontol 2024; 47:316-328. [PMID: 33263503 DOI: 10.1080/07317115.2020.1846650] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study explored the role of compassion and dispositional mindfulness in the psychological health of family carers of older adults and tested for potential mediating effects of emotion regulation difficulties and adaptive coping strategies. METHODS A sample of 141 family carers of adults aged 65 years or older with chronic conditions completed a cross-sectional survey between July - December 2019. The survey included self-report scales that measured: self-compassion, compassion for others, compassion from others, dispositional mindfulness, depression, anxiety, stress, emotion- and problem-focused coping strategies, and difficulties in emotion regulation. RESULTS Path analyses found that increased self-compassion and increased dispositional mindfulness was associated with lower psychological distress, and that this was mediated by reduced difficulties in emotion regulation. The model had excellent fit, explaining 64.8% of the variance in psychological distress, and 52.2% of the variance in emotion regulation difficulties. CONCLUSIONS Self-compassion and dispositional mindfulness may help buffer the psychological distress of family carers of older adults, and adaptive emotion regulation is an important mechanism of change in these relationships. CLINICAL IMPLICATIONS Interventions that aim to cultivate self-compassion and mindfulness could be clinically useful in reducing psychological distress within populations of family carers of older adults by promoting adaptive emotion regulation.
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Affiliation(s)
- Jenny Murfield
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | | | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, Australia
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20
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Takashima MD, Grimwood K, Sly PD, Lambert SB, Ware RS. Association of rhinovirus and potentially pathogenic bacterial detections in the first 3 months of life with subsequent wheezing in childhood. Pediatr Pulmonol 2023; 58:3428-3436. [PMID: 37671813 PMCID: PMC10947429 DOI: 10.1002/ppul.26667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE Airway interactions between viruses, especially rhinoviruses, and potentially pathogenic bacteria (PPB; Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) in early infancy may increase the risk of subsequent wheezing and asthma. We evaluated the association between rhinovirus and PPB in the first 3 months of life and wheezing episodes before age 2 years and asthma at age 5-7 years. METHODS An Australian community-based birth cohort of healthy children involved parents collecting nasal swabs weekly and completing symptom diaries daily until age 2 years. In a follow-up subset, asthma diagnosis was assessed annually until age 7 years. Swabs were analyzed by real-time polymerase chain reaction assays. Children were included if they returned symptom diaries beyond age 3 months (wheeze) or were reviewed at age 5-7 years (asthma). RESULTS 1440 swabs were returned by 146 children in the first 3 months of life. Wheeze and asthma outcomes were recorded for 146 and 84 children, respectively. Each additional week of rhinovirus detection increased the incidence of wheezing before age 2 years by 1.16 times (95% confidence interval [CI]: 0.99-1.35). There were no significant associations between bacteria and wheeze. Each additional week with H. influenzae increased the odds of asthma at age 5-7 years by 135% (odds ratio: 2.35, 95% CI: 0.99-5.58). No significant interaction was observed between rhinovirus and PPB for wheezing or asthma. CONCLUSION Early life rhinovirus infection was associated with wheezing before age 2 years and H. influenzae with asthma by age 5-7 years. Microbes may play an etiologic role in wheezing and asthma, warranting further study.
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Affiliation(s)
- Mari D. Takashima
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Keith Grimwood
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Departments of Infectious Diseases and PaediatricsGold Coast HealthGold CoastQueenslandAustralia
| | - Peter D. Sly
- Children's Health and Environment Program, Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
- Australian Infectious Diseases Research CentreThe University of QueenslandSt LuciaQueenslandAustralia
| | - Stephen B. Lambert
- UQ Centre for Clinical ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable DiseasesSydneyNew South WalesAustralia
| | - Robert S. Ware
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
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21
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Kleidon TM, Gibson V, Cattanach P, Schults J, Royle RH, Ware RS, Marsh N, Pitt C, Dean A, Byrnes J, Rickard CM, Ullman AJ. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:1132-1140. [PMID: 37695594 PMCID: PMC10495929 DOI: 10.1001/jamapediatrics.2023.3526] [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] [Received: 03/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Importance Peripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs. Objective To compare device failure of MCs with PIVCs. Design, Setting, and Participants This was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer. Interventions Patients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, >5 years). One catheter was studied per patient. Main Outcomes and Measures The primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs. Results Of the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P <.001). MCs were associated with fewer insertion attempts (mean difference [MD], -0.3; 95% CI, -0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P <.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS -$151.67 [US -$101.13] per person; 95% credible interval, AUS -$171.45 to -$131.90 [US -$114.20 to -$87.95]). Conclusions and Relevance Findings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure. Trial Registration Australia New Zealand Clinical Trials Registry, ACTRN12620000724976.
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Affiliation(s)
- Tricia M. Kleidon
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Victoria Gibson
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ruth H. Royle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Colleen Pitt
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Anna Dean
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Claire M. Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amanda J. Ullman
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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22
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Coombes BK, Bisset LM, Sierra-Silvestre E, Ware RS, Coppieters MW, Coombes JS, Burton NW. Personal Activity Intelligence eHealth intervention in people with diabetic peripheral neuropathy: A feasibility study. Aust J Gen Pract 2023; 52:771-777. [PMID: 37935148 DOI: 10.31128/ajgp-04-23-6797] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND OBJECTIVES People with diabetic peripheral neuropathy (DPN) report difficulty exercising. This study tested an innovative intervention to promote physical activity self-management and its impact on foot symptoms. METHOD Ten adults with DPN not meeting exercise guidelines consented to four weekly sessions involving exercise tasters, behaviour change counselling and Physical Activity Intelligence (PAI) self-monitoring, with a goal to maintain daily PAI scores ≥100. Foot symptoms were assessed using repeated mobile phone surveys at 0 and 12 weeks. RESULTS Participants attended a mean 3.5 sessions and achieved 100 PAI on 53% and 15% of days during Weeks 2-4 and 5-12, respectively. No major adverse events and large reductions in aching (P=0.02) and burning pain (P=0.03) in the feet were recorded. DISCUSSION The PAI eHealth intervention was feasible and safe and might reduce foot symptoms. More work is needed to support self-directed exercise maintenance.
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Affiliation(s)
- Brooke K Coombes
- BPhty (Hons), MPhty (Musc), GCertHigherEd, PhD, Lecturer, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Leanne M Bisset
- PhD, MPhty (ManipPhty), MPhty (Sports), BPhty, Associate Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Eva Sierra-Silvestre
- BSc Physiotherapy, MSc (MT), PhD, Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Robert S Ware
- BSc (Hons1), PhD, Professor, School of Medicine and Dentistry, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Michel W Coppieters
- BPT, PhD, Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Adjunct Professor, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam
| | - Jeff S Coombes
- BAppSci, Bed (Hons), MEd, PhD, Professor, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld
| | - Nicola W Burton
- BSc (Hons), MPsych (Clinical), GCertHigherEd, PhD, Associate Professor, School of Applied Psychology, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Research Fellow, Centre for Mental Health, Griffith University, Brisbane, Qld
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23
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Sakzewski L, Reedman SE, Elliott C, Ziviani J, Novak I, Trost S, Majnemer A, Comans T, Shikako K, Ware RS, McNamara L, Williams S, Keramat SA, Brookes D, Boyd RN. Participate CP 2: optimising participation in physically active leisure for children with cerebral palsy - protocol for a phase III randomised controlled trial. BMJ Open 2023; 13:e075570. [PMID: 37788925 PMCID: PMC10551958 DOI: 10.1136/bmjopen-2023-075570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) participate less in physical activities and have increased sedentary behaviour compared with typically developing peers. Participate CP is a participation-focused therapy intervention for children with CP with demonstrated efficacy in a phase II randomised controlled trial (RCT) to increase perceived performance of physical activity participation goals. This study will test the effectiveness of Participate CP in a multisite phase III RCT. METHODS AND ANALYSIS One hundred children with CP, aged 8-14 years, classified Gross Motor Function Classification System levels I-IV will be randomised to either (1) receive Participate CP once/week for 1 hour for 12 weeks, or (2) waitlist control, usual care group. The waitlist group will then receive Participate CP following the 26-week retention time point. Outcomes will be assessed at baseline, 12 weeks and then 26 weeks post baseline. The primary outcomes are (1) self-reported participation goal performance on the Canadian Occupational Performance Measure at 12 weeks and (2) daily time in moderate-to-vigorous physical activity. Secondary outcomes include home and community participation frequency, involvement and environmental supportiveness, contextual barriers to participation, quality of life, intrinsic motivation for physical activities, child perception of an autonomy-supportive climate for physical activities and physical literacy at 12 and 26 weeks post study entry. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland and the New Zealand Health and Disability Ethics Committees have approved this study. Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12618000206224.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Sarah Elizabeth Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Science, The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keiko Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sian Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Syed Afroz Keramat
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Denise Brookes
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
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24
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El-Heneidy A, Grimwood K, Lambert SB, Ware RS. Interference Between Enteric Viruses and Live-Attenuated Rotavirus Vaccine Virus in a Healthy Australian Birth Cohort. J Infect Dis 2023; 228:851-856. [PMID: 37014728 PMCID: PMC10547457 DOI: 10.1093/infdis/jiad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/11/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Rotavirus vaccines have reduced effectiveness in high-mortality settings. Interference between enteric viruses and live-attenuated oral vaccine strains may be a factor. METHODS In a birth cohort of healthy Australian infants, parents collected weekly stool samples. Three hundred eighty-one paired swabs collected within 10-days of RotaTeq vaccination from 140 infants were tested for 10 enteric viruses and RotaTeq strains. RESULTS Collectively, both ribonucleic acid and deoxyribonucleic acid viruses were negatively associated with RotaTeq shedding (adjusted odds ratio = 0.29, 95% confidence interval = 0.14-0.58 and adjusted odds ratio = 0.30, 95% confidence interval = 0.11-0.78, respectively). CONCLUSIONS Enteric viruses may interfere with RotaTeq replication in the gut and thus RotaTeq stool shedding.
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Affiliation(s)
- Asmaa El-Heneidy
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Stephen B Lambert
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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25
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Spinks J, Violette R, Boyle DI, Petrie D, Fanning L, Hall KK, Kelly F, Wheeler AJ, Ware RS, Byrnes J, Chen E, Donald A, Ellis N, DelDot M, Nissen L. Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial. Med J Aust 2023; 219:325-331. [PMID: 37586750 DOI: 10.5694/mja2.52073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).
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Affiliation(s)
- Jean Spinks
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Richard Violette
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
- Griffith University, Gold Coast, QLD
| | - Douglas Ir Boyle
- HaBIC Research Information Technology Unit, the University of Melbourne, Melbourne, VIC
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, VIC
| | - Laura Fanning
- Centre for Health Economics, Monash University, Melbourne, VIC
- Box Hill Hospital, Melbourne, VIC
| | | | | | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
- The University of Auckland, Auckland, New Zealand
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD
| | - Esa Chen
- Centre for Health Economics, Monash University, Melbourne, VIC
| | | | | | - Megan DelDot
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Lisa Nissen
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
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26
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Smith GSE, Ware RS, Moyle W, Burton NW. Social Support for Physical Activity Over 9 Years in Adults Aged 60-65 Years at Baseline. J Aging Phys Act 2023; 31:776-785. [PMID: 36870349 DOI: 10.1123/japa.2021-0502] [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: 12/21/2021] [Revised: 10/08/2022] [Accepted: 12/13/2022] [Indexed: 03/06/2023]
Abstract
Physical activity is a leading determinant of health and well-being in older adults; however, participation is low. Social support can significantly influence physical activity uptake and maintenance; however, most research is cross-sectional and does not differentiate among types of support. The current study assessed four types of social support for physical activity reported over 9 years by adults aged 60-65 at baseline (n = 1,984). Data were collected using a mail survey at four time points. Data were analyzed using linear mixed models. The most common type of support was emotional, with 25% of participants reporting this often/very often. Total support for activity declined by 16% across the 9 years (p < .001). Companionship had the greatest decline among types (17%-18%, p < .001). More work is needed to understand the factors contributing to the decline in support and how to enable access to support for physical activity in older adults.
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Affiliation(s)
- Genevieve S E Smith
- School of Applied Psychology, Griffith University, Brisbane, QLD,Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD,Australia
- Centre for Mental Health, Griffith University, Brisbane, QLD,Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD,Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD,Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD,Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, QLD,Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD,Australia
- Centre for Mental Health, Griffith University, Brisbane, QLD,Australia
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27
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Wallis KA, Donald M, Horowitz M, Moncrieff J, Ware RS, Byrnes J, Thrift K, Cleetus M, Panahi I, Zwar N, Morgan M, Freeman C, Scott I. RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice. Trials 2023; 24:615. [PMID: 37770893 PMCID: PMC10537226 DOI: 10.1186/s13063-023-07646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. METHODS DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. SETTING primary care general practices in southeast Queensland, Australia. POPULATION adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. INTERVENTION RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. OUTCOME MEASURES the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. SECONDARY OUTCOMES at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. SAMPLE SIZE 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). DISCUSSION The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. TRIAL REGISTRATION ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.
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Affiliation(s)
- Katharine A Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia.
| | - Maria Donald
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Mark Horowitz
- NHS Foundation Trust, Research and Development Department, London, Northeast London, UK
| | | | - Robert S Ware
- Griffith University, Nathan, Brisbane, QLD, Australia
| | - Joshua Byrnes
- Griffith University, Nathan, Brisbane, QLD, Australia
| | - Karen Thrift
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - MaryAnne Cleetus
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Idin Panahi
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD, Australia
| | - Chris Freeman
- The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Ian Scott
- The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
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28
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Le HHTC, Vien NT, Dang TN, Ware RS, Phung D, Thai PK, Ranganathan S, Vinh NN, Dung PHT, Thanh HN, Dung TTT, Hien TT, Sly PD, Le An P. Wearing masks as a protective measure for children against traffic-related air pollution: A comparison of perceptions between school children and their caregivers in Ho Chi Minh City, Vietnam. Trop Med Int Health 2023; 28:753-762. [PMID: 37615211 PMCID: PMC10946546 DOI: 10.1111/tmi.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Traffic-related air pollution (TRAP) problems are unlikely to be solved in the short term, making it imperative to educate children on protective measures to mitigate the negative impact on their health. Children and their caregivers may hold differing views on wearing a face mask as a safeguard against air pollution. While many studies have focused on predicting children's health-protective behaviours against air pollution, few have explored the differences in perceptions between children and their caregivers. OBJECTIVES To examine this, we conducted a study that compared the health beliefs of two generations and evaluated the factors that influence the use of masks by children to reduce air pollution exposure. METHODS The study was conducted in 24 secondary schools and involved 8420 children aged 13-14 and their caregivers. We used a Health Belief Model (HBM)-based instrument containing 17-item self-administered health beliefs questionnaires to gather data. The results were analysed using hierarchical logistic regression to determine the probability of children frequently wearing masks to protect against TRAP. RESULTS Our study showed both children and caregivers recognised that several factors could influence mask-wearing among children: discomfort or difficulty breathing while wearing a mask and forgetting to bring a mask when going outside; perceived threats of the poor quality of air and children's respiratory health problems; and cues to mask use (i.e., seeing most of their friends wearing facemasks and ease of finding masks in local stores). However, only children were significantly concerned with public perception of their appearance while wearing a mask. Females were more likely to wear masks, and caregivers with higher levels of education were more likely to encourage their children to wear masks. Children who commuted to schools by walking, biking, or motorbiking were also more accepting of mask-wearing than those who travelled by car or bus. CONCLUSIONS Children and their caregivers hold different perceptions of wearing masks to protect against air pollution. Children are more susceptible to social judgements regarding their appearance when wearing a mask.
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Affiliation(s)
- Hong H. T. C. Le
- Faculty of MedicineThe University of QueenslandBrisbane CityQueenslandAustralia
- Children's Health and Environment ProgramCentre for Children's Health ResearchBrisbane CityQueenslandAustralia
| | - Nguyen Truong Vien
- Department of Environmental and Occupational HealthPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
| | - Tran Ngoc Dang
- Faculty of Public HealthUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Robert S. Ware
- Menzies Health Institute QueenslandGriffith UniversityBrisbane CityQueenslandAustralia
| | - Dung Phung
- School of Public HealthThe University of QueenslandBrisbane CityQueenslandAustralia
| | - Phong K. Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS)The University of QueenslandBrisbane CityQueenslandAustralia
| | | | - Nguyen Nhu Vinh
- Centre for the Training of Family Medicine, Faculty of MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Phan Hoang Thuy Dung
- Grant and Innovation CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Huynh Ngoc Thanh
- Faculty of Public HealthUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Truong Thi Thuy Dung
- Faculty of Public HealthUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - To Thi Hien
- University of Science, Vietnam National UniversityHo Chi Minh CityVietnam
| | - Peter D. Sly
- Children's Health and Environment ProgramCentre for Children's Health ResearchBrisbane CityQueenslandAustralia
| | - Pham Le An
- Centre for the Training of Family Medicine, Faculty of MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- Grant and Innovation CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
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Song M, Le TTA, Denny S, Lennox NG, McPherson L, Ware RS, Harley D. Reasons for Encounters and Comorbidities in Adolescents with Intellectual Disability in General Practice: A Retrospective Analysis of Data from the Ask Study. Children (Basel) 2023; 10:1450. [PMID: 37761411 PMCID: PMC10528096 DOI: 10.3390/children10091450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners.
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Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Tran T. A. Le
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Department of Psychiatry, University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
| | - Simon Denny
- Mater Young Adult Health Centre, Mater Hospitals, Brisbane, QLD 4072, Australia;
| | - Nicholas G. Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
| | - Lyn McPherson
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - David Harley
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4006, Australia
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Snelling PJ, Keijzers G, Ware RS. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. Reply. N Engl J Med 2023; 389:673-674. [PMID: 37585644 DOI: 10.1056/nejmc2307617] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Shanley DC, Zimmer-Gembeck M, Wheeler AJ, Byrnes J, Ware RS, Liu W, Simcock G, White C, Horton S, Page M, Shelton D, Till H, Mills I, Hislop C, Harris K, Crichton A, Reid N, Reilly S, Moritz K, Walsh K, Rundle-Thiele S, Hawkins E. Diagnostic Accuracy and economic value of a Tiered Assessment for Fetal Alcohol Spectrum Disorder (DATAforFASD): Protocol. BMJ Open 2023; 13:e071004. [PMID: 37586864 PMCID: PMC10432646 DOI: 10.1136/bmjopen-2022-071004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Australian practices for diagnosing fetal alcohol spectrum disorder (FASD) are lengthy and require specialist expertise. Specialist teams are based in urban locations; they are expensive and have prolonged waitlists. Innovative, flexible solutions are needed to ensure First Nations children living in rural/remote communities have culturally appropriate and equitable access to timely diagnosis and support. This study compares the accuracy of rapid assessments (index tests) that can be administered by a range of primary healthcare practitioners to specialist standardised FASD assessments (reference tests). The cost-efficiency of index tests will be compared with reference tests. METHODS AND ANALYSIS At least 200 children aged 6-16 years at-risk of FASD will be recruited across at least seven study sites. Following standards for reporting diagnostic accuracy study (STARD) guidelines, all children will complete index and reference tests. Diagnostic accuracy statistics (including receiver operating curves, sensitivity, specificity, positive and negative predictive values and likelihood ratios) will identify whether rapid assessments can accurately identify: (1) the presence of an FASD diagnosis and (2) impairment in each neurodevelopmental domain, compared to comprehensive assessments. Direct and indirect healthcare costs for index tests compared to reference tests will be collected in primary healthcare and specialist settings. ETHICS AND DISSEMINATION OF RESULTS Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/20/QCHQ/63173); Griffith University Human Research Ethics Committee (2020/743). Results will assist in validating the use of index tests as part of a tiered neurodevelopmental assessment process that was co-designed with First Nations community and primary healthcare practitioners. Outcomes will be summarised and provided to participating practitioners and sites, and disseminated to community health services and consumers. Findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000498796.
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Affiliation(s)
- Dianne C Shanley
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Melanie Zimmer-Gembeck
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Medical & Health Sciences, The University of Auckland, Auckland, Auckland, New Zealand
| | - Joshua Byrnes
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Wei Liu
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle Simcock
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Codi White
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Horton
- Family Health, Gidgee Healing, Mt Isa, Queensland, Australia
| | - Marjad Page
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Primary Health Care, Kambu Aboriginal and Torres Strait Islander Corporation for Health, Ipswich, Queensland, Australia
| | - Doug Shelton
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Haydn Till
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Ianthe Mills
- Child and Adolescent Unit, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Carly Hislop
- Child Development Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Alison Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sheena Reilly
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Moritz
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Erinn Hawkins
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
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Lane M, Dixon R, Donald KJ, Ware RS. Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire. Health Promot J Austr 2023. [PMID: 37556927 DOI: 10.1002/hpja.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
ISSUE ADDRESSED With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme. METHODS Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data. RESULTS Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system). CONCLUSIONS Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.
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Affiliation(s)
- Margo Lane
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- UQ Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Dixon
- Faculty of Medical and Health Sciences, Nursing, University of Auckland, Auckland, New Zealand
| | - Ken J Donald
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Howard GT, Baque E, Colditz PB, Chatfield MD, Ware RS, Boyd RN, George JM. Diagnostic accuracy of the Hammersmith Neonatal Neurological Examination in predicting motor outcome at 12 months for infants born very preterm. Dev Med Child Neurol 2023; 65:1061-1072. [PMID: 36683126 PMCID: PMC10952202 DOI: 10.1111/dmcn.15512] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
AIM To evaluate the predictive validity of the Hammersmith Neonatal Neurological Examination (HNNE) performed early (at 32 weeks postmenstrual age) and at term-equivalent age (TEA) for 12-month motor outcomes in infants born very preterm. METHOD This was a diagnostic study using data from a prospective birth cohort. A total of 104 infants born preterm at less than 31 weeks gestational age (males n = 61; mean = 28 weeks 1 day [SD 1 week 6 days], range 23 weeks 1 day-30 weeks 6 days) underwent HNNE early and at TEA, which were scored by comparison with term data. Motor outcomes at 12 months corrected age were determined using the Bayley Scales of Infant and Toddler Development, Third Edition (scores ≤85). Cut-off points were determined using receiver operating characteristic curves. RESULTS Sixteen (15%) infants born preterm had motor impairment at 12 months corrected age. The HNNE total score cut-off points with the best combination of sensitivity and specificity at early and TEA assessments were 15.2 or lower (sensitivity 77%, 95% confidence interval [CI] = 46%-95%; specificity 74%, 95% CI = 63%-83%) and 23.5 or lower (sensitivity 67%, 95% CI = 38%-88%; specificity 66%, 95% CI = 54%-76%) respectively. The most predictive subscale at the early assessment was reflexes (sensitivity 86%, 95% CI = 57%-98%; specificity 62%, 95% CI = 51%-72%; cut-off point ≤3); at TEA, it was spontaneous movements (sensitivity 73%, 95% CI = 45%-92%; specificity 60%, 95% CI = 48%-70%; cut-off point ≤2). INTERPRETATION The HNNE provides moderate predictive accuracy for motor outcome at 12 months corrected age in infants born very preterm. Although modest at both time points, early assessment had stronger predictive ability for motor outcomes than TEA when scored using term data, highlighting the value of performing the HNNE earlier in the neonatal period. Performing HNNE earlier may assist risk stratification when planning follow-up services.
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Affiliation(s)
- Grace T. Howard
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneAustralia
| | - Emmah Baque
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneAustralia
| | - Paul B. Colditz
- University of Queensland Centre for Clinical ResearchThe University of QueenslandBrisbaneAustralia
- Perinatal Research CentreRoyal Brisbane and Women's HospitalBrisbaneAustralia
| | - Mark D. Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Robert S. Ware
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
- Australasian Cerebral Palsy Clinical Trials Network CREThe University of QueenslandBrisbaneAustralia
| | - Joanne M. George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
- Physiotherapy DepartmentQueensland Children's Hospital, Children's Health Queensland Hospital and Health ServiceBrisbaneAustralia
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Bell SFE, Ware RS, Lewis DA, Lahra MM, Whiley DM. Antimicrobial susceptibility assays for Neisseria gonorrhoeae: a proof-of-principle population-based retrospective analysis. Lancet Microbe 2023; 4:e544-e551. [PMID: 37336225 DOI: 10.1016/s2666-5247(23)00071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/09/2022] [Accepted: 02/17/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Neisseria gonorrhoeae treatment guided by molecular antimicrobial susceptibility assays could improve treatment options and antimicrobial stewardship; however, few commercial assays are available. We aimed to investigate antimicrobial susceptibility of N gonorrhoeae isolates in New South Wales, Australia, and estimate the potential usefulness of hypothetical combinations of rapid molecular antimicrobial susceptibility assays. METHODS In this proof-of-principle, population-based, retrospective analysis, we assessed N gonorrhoeae susceptibility data for ceftriaxone, azithromycin, ciprofloxacin, and penicillin. Isolates were previously collected as part of the Australian Gonococcal Surveillance Programme between Jan 1, 2008, and Dec 31, 2019. All cultured N gonorrhoeae isolates with susceptibility data to all four antimicrobials were included. However, only one isolate was included if several isolates originated from the same individual within 13 days of the previous isolate originating from that individual, and there were less than two standard double-dilution minimum inhibitory concentrations between the isolates. We assessed the use of different combinations of hypothetical antimicrobial susceptibility assays and treatment combinations in terms of their ability to minimise overall ceftriaxone use, and use specifically in isolates with decreased susceptibility to ceftriaxone, compared with standard non-assay-guided empirical ceftriaxone treatment. FINDINGS We included 23 089 N gonorrhoeae isolates. The prevalence of antimicrobial sensitivity fluctuated significantly during the study. Isolates with decreased susceptibility to ceftriaxone were more likely to be resistant to one or more antimicrobials than isolates without decreased susceptibility (782 [98·6%] of 793 vs 10 661 [47·8%] of 22 296), particularly ciprofloxacin (p<0·0001) and penicillin (p<0·0001). Compared with empirical ceftriaxone treatment, we estimated that strategies based on the use of hypothetical antimicrobial susceptibility would reduce ceftriaxone use (p<0·0001). However, because of co-resistance, most assay-directed treatment strategies, including those involving use of assays for two antibiotics, would result in only moderate reductions in ceftriaxone use among isolates with decreased susceptibility to ceftriaxone. INTERPRETATION Individualised treatment guided by molecular antimicrobial susceptibility diagnostics could help to reduce overall ceftriaxone use in gonorrhoea. However, the use of these assays needs to be informed by the non-random nature of co-resistance among circulating N gonorrhoeae strains. FUNDING Australian Government and Queensland Government.
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Affiliation(s)
- Sara F E Bell
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Robert S Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia; Westmead Clinical School, Faculty of Medicine and Health and Sydney Institute for Infectious Diseases, University of Sydney, Westmead, NSW, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for STI and AMR, NSW Health Pathology Microbiology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - David M Whiley
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
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Caparrós-Martín JA, Saladie M, Agudelo-Romero SP, Reen FJ, Ware RS, Sly PD, Stick SM, O'Gara F. Detection of bile acids in bronchoalveolar lavage fluid defines the inflammatory and microbial landscape of the lower airways in infants with cystic fibrosis. Microbiome 2023; 11:132. [PMID: 37312128 DOI: 10.1186/s40168-023-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) is a genetic condition characterized by neutrophilic inflammation and recurrent infection of the airways. How these processes are initiated and perpetuated in CF remains largely unknown. We have demonstrated a link between the intestinal microbiota-related metabolites bile acids (BA) and inflammation in the bronchoalveolar lavage fluid (BALF) from children with stable CF lung disease. To establish if BA indicate early pathological processes in CF lung disease, we combined targeted mass spectrometry and amplicon sequencing-based microbial characterization of 121 BALF specimens collected from 12-month old infants with CF enrolled in the COMBAT-CF study, a multicentre randomized placebo-controlled clinical trial comparing azithromycin versus placebo. We evaluated whether detection of BA in BALF is associated with the establishment of the inflammatory and microbial landscape of early CF lung disease, and whether azithromycin, a motilin agonist that has been demonstrated to reduce aspiration of gastric contents, alters the odds of detecting BA in BALF. We also explored how different prophylactic antibiotics regimens impact the early life BALF microbiota. RESULTS Detection of BA in BALF was strongly associated with biomarkers of airway inflammation, more exacerbation episodes during the first year of life, increased use of oral antibiotics with prolonged treatment periods, a higher degree of structural lung damage, and distinct microbial profiles. Treatment with azithromycin, a motilin agonist, which has been reported to reduce aspiration of gastric contents, did not reduce the odds of detecting BA in BALF. Culture and molecular methods showed that azithromycin does not alter bacterial load or diversity in BALF. Conversely, penicillin-type prophylaxis reduced the odds of detecting BAs in BALF, which was associated with elevated levels of circulating biomarkers of cholestasis. We also observed that environmental factors such as penicillin-type prophylaxis or BAs detection were linked to distinct early microbial communities of the CF airways, which were associated with different inflammatory landscapes but not with structural lung damage. CONCLUSIONS Detection of BA in BALF portend early pathological events in CF lung disease. Benefits early in life associated with azithromycin are not linked to its antimicrobial properties. Video Abstract.
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Affiliation(s)
- Jose A Caparrós-Martín
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
| | - Montserrat Saladie
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
- Present Address: Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira I Virgili-EURECAT, Reus, Spain
| | - S Patricia Agudelo-Romero
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - F Jerry Reen
- School of Microbiology, University College Cork, Cork, Ireland
- Synthesis and Solid State Pharmaceutical Centre, University College Cork, Cork, Ireland
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stephen M Stick
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Fergal O'Gara
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia.
- BIOMERIT Research Centre, School of Microbiology, University College Cork, Cork, T12 K8AF, Ireland.
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Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, Young E, Hall L, Keijzers G, Cullen L, Calleja P, McTaggart S, Peters N, Watkins S, Corley A, Brown C, Lin Z, Williamson F, Burgess L, Macfarlane F, Cooke M, Battley C, Rickard CM. Improving difficult peripheral intravenous access requires thought, training and technology (DART 3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23:587. [PMID: 37286977 DOI: 10.1186/s12913-023-09499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities. METHODS A stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie's Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention. DISCUSSION Study findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities. TRIAL REGISTRATION Prospectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).
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Affiliation(s)
- Jessica A Schults
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia.
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia.
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Nicole Marsh
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tricia M Kleidon
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Emily Young
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Pauline Calleja
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Australia
| | - Steven McTaggart
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nathan Peters
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
| | - Amanda Corley
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Christine Brown
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Zhen Lin
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Luke Burgess
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fiona Macfarlane
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
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Snelling PJ, Jones P, Bade D, Bindra R, Byrnes J, Davison M, George S, Moore M, Keijzers G, Ware RS. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med 2023; 388:2049-2057. [PMID: 37256975 DOI: 10.1056/nejmoa2213883] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Data on whether ultrasonography for the initial diagnostic imaging of forearm fractures in children and adolescents is noninferior to radiography for subsequent physical function of the arm are limited. METHODS In this open-label, multicenter, noninferiority, randomized trial in Australia, we recruited participants 5 to 15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated. Participants were randomly assigned to initially undergo point-of-care ultrasonography or radiography, and were then followed for 8 weeks. The primary outcome was physical function of the affected arm at 4 weeks as assessed with the use of the validated Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score (range, 8 to 40, with higher scores indicating better function); the noninferiority margin was 5 points. RESULTS A total of 270 participants were enrolled, with outcomes for 262 participants (97%) available at 4 weeks (with a window of ±3 days) as prespecified. PROMIS scores at 4 weeks in the ultrasonography group were noninferior to those in the radiography group (mean, 36.4 and 36.3 points, respectively; mean difference, 0.1 point; 95% confidence interval [CI], -1.3 to 1.4). Intention-to-treat analyses (in 266 participants with primary outcome data recorded at any time) produced similar results (mean difference, 0.1 point; 95% CI, -1.3 to 1.4). No clinically important fractures were missed, and there were no between-group differences in the occurrence of adverse events. CONCLUSIONS In children and adolescents with a distal forearm injury, the use of ultrasonography as the initial diagnostic imaging method was noninferior to radiography with regard to the outcome of physical function of the arm at 4 weeks. (Funded by the Emergency Medicine Foundation and others; BUCKLED Australian New Zealand Clinical Trials Registry number, ACTRN12620000637943).
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Affiliation(s)
- Peter J Snelling
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Philip Jones
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - David Bade
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Randy Bindra
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Joshua Byrnes
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Michelle Davison
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Shane George
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Mark Moore
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Gerben Keijzers
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Robert S Ware
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
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Lumsden E, Kimble R, McMillan C, Storey K, Ware RS, Griffin B. The feasibility of negative pressure wound therapy versus standard dressings in paediatric hand and foot burns protocol: a pilot, single-centre, randomised control trial. Pilot Feasibility Stud 2023; 9:90. [PMID: 37237316 DOI: 10.1186/s40814-023-01308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The goal of paediatric hand and foot burn management is hypertrophic scar and/or contracture prevention. The risk of scar formation may be minimised by integrating negative pressure wound therapy (NPWT) as an acute care adjunct as it decreases the time to re-epithelialisation. NPWT has known associated therapeutic burden; however, this burden is hypothesised to be outweighed by an increased likelihood of hypertrophic scar prevention. This study will assess the feasibility, acceptability and safety of NPWT in paediatric hand and foot burns with secondary outcomes of time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This is a single-site, pilot randomised control trial. Participants must be aged ≤ 16 years, otherwise well and managed within 24 h of sustaining either a hand or foot burn. Thirty participants will be randomised to either standard care (Mepitel®-a silicone wound interface contact dressing-and ACTICOAT™-a nanocrystalline silver-impregnated dressing) or standard care plus NPWT. Patients will be reviewed until 3 months post-burn wound re-epithelialisation, with measurements taken at dressing changes to assess primary and secondary outcomes. Surveys, randomisation and data storage will be done via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be performed using the Stata statistical software. ETHICS AND DISSEMINATION Queensland Health and Griffith University Human Research ethics approval including a site-specific assessment was obtained. The findings of this study will be disseminated through clinical meetings, conference presentations and peer reviewed journals. TRIAL REGISTRATION Registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622000044729, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381890&isReview=true , registered 17/01/2022).
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Affiliation(s)
- Emma Lumsden
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia.
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia.
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Roy Kimble
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Catherine McMillan
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Kristen Storey
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
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Burgess A, Oftedal S, Boyd RN, Reedman S, Trost SG, Ware RS, Sakzewski L. Construct Validity of the Both Hands Assessment Using Wrist-Worn Accelerometers. Phys Occup Ther Pediatr 2023; 44:42-55. [PMID: 37183420 DOI: 10.1080/01942638.2023.2207635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
AIM The aim of this study was to evaluate the construct validity of the Both Hands Assessment (BoHA) using activity of the upper limbs as detected by accelerometry in children with bilateral cerebral palsy (CP). METHODS Observational study of children with CP (n = 44, n = 27 boys, aged 9.1 ± 1.6 years; Manual Ability Classification Scale I: n = 15, II: n = 22, III: n = 7) completing a BoHA assessment while wearing a triaxial accelerometer on each wrist. BoHA Each-Hand sub-scores, BoHA percentage difference between hands, BoHA Units, mean activity for each hand, mean activity asymmetry index and total mean activity were calculated. Linear regressions were used to analyze associations between measures. RESULTS There were significant, positive associations between BoHA Units and total mean activity (B = 0.86, 95%CI: 0.32, 1.40), BoHA Percentage difference between hands and mean activity asymmetry index (B = 0.95, 95%CI: 0.75,1.15), and BoHA Each-Hand sub-score and mean activity for the non-dominant hand (B = 1.71, 95%CI: 1.16, 2.28), but not the dominant hand (B = 0.50, 95%CI: -0.45, 1.45). CONCLUSIONS This study provides further evidence for the construct validity of the BoHA as a measure of upper limb performance. Wearable wrist sensors such as accelerometers capture and quantify gross upper limb movement in children with CP but cannot measure fine finger movements captured by the BoHA. CLINICAL TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616001488493 and ACTRN12618000164291).
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Affiliation(s)
- Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Lumsden EJ, Kimble RM, McMillan C, Storey K, Ware RS, Griffin B. Protocol for a feasibility, acceptability and safety study of the PICO device (negative pressure wound therapy) in acute paediatric burns. BMJ Open 2023; 13:e068499. [PMID: 37137557 PMCID: PMC10163492 DOI: 10.1136/bmjopen-2022-068499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Negative pressure wound therapy (NPWT) in acute burn care may decrease the time to re-epithelialisation by more than 20%. Despite this, the perceived burden of use; including therapeutic, physical and financial, have limited the use of NPWT in acute burn care. This might be minimised by using the small, ultraportable, single-use NPWT device PICO as opposed to larger devices, which to date has never been studied in acute burn care. This research will; therefore, primarily assess the feasibility, acceptability and safety of PICO in paediatric burns. Secondary outcomes include time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This protocol details a clinical trial methodology and is pre-results. This single site, prospective, pilot randomised controlled trial will be conducted in an Australian quaternary paediatric burns centre. Participants must be aged ≤16 years, otherwise well and managed within 24 hours of sustaining a burn that fits beneath a PICO dressing. Thirty participants will be randomised to one of three groups: group A: Mepitel and ACTICOAT, group B: Mepitel, ACTICOAT and PICO and group C: Mepitel, ACTICOAT Flex and PICO. Patient outcomes will be recorded at each dressing change to assess efficacy and safety outcomes until 3 months postburn wound re-epithelialisation. Surveys, randomisation and data storage will be undertaken via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be done by using StataSE 17.0 statistical software. ETHICS AND DISSEMINATION Ethics has been obtained from Queensland Health and Griffith Human Research Ethics committees including a site-specific approval. These data will be disseminated via clinical meetings, conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000009718.
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Affiliation(s)
- Emma Joan Lumsden
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Catherine McMillan
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristen Storey
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Bradfield Strydom M, Khan S, Walpola RL, Ware RS, Tiralongo E. Interplay of the microbiome and antifungal therapy in recurrent vulvovaginal candidiasis (RVVC): A narrative review. J Med Microbiol 2023; 72. [PMID: 37171871 DOI: 10.1099/jmm.0.001705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a well-established antifungal drug commonly utilized for acute and long-term RVVC treatment. This insight review provides an overview of known vaginal and gastrointestinal microbiota characteristics in RVVC, presents the potential impacts of fluconazole therapy on multi-microbiome relationships and discusses implications for future research and clinical practice. Next-generation sequencing (NGS) and molecular methods to accurately define vaginal microbiota trends in RVVC are not comprehensively available, limiting understanding of microbiota roles in RVVC. Inconsistencies and variances in Lactobacillus profiles in RVVC women suggest poorly understood disease implications on the bacterial and fungal microbiomes. Investigations of environmental conditions like vaginal pH, drug therapy's impact, especially fluconazole maintenance therapy, and the elucidation of multi-microbiome relationships in RVVC are required to further investigate disease pathogenesis and responsible antimicrobial prescribing.
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Affiliation(s)
| | - Sohil Khan
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Ramesh L Walpola
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Evelin Tiralongo
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
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Cox AJ, Ramsey R, Ware RS, Besseling-van der Vaart I, Cripps AW, West NP. Assessment of a Multispecies Probiotic Supplement for Relief of Seasonal Allergic Rhinitis: A Randomized Double-Blind Placebo-Controlled Trial. J Integr Complement Med 2023; 29:313-320. [PMID: 37196163 DOI: 10.1089/jicm.2022.0734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Background: Early phase clinical research provided initial support for the use of a multispecies probiotic supplement to improve quality of life (QoL) in adults with seasonal allergic rhinitis (AR) and reduce the use of AR symptom relieving medication. This study aimed to confirm these early phase findings in a double-blind randomized placebo-controlled trial. Methods: Individuals, aged 18-65 years, with a minimum 2-year history of AR, moderate-to-severe AR symptoms, and a positive radio-allergosorbent test to Bermuda (Couch) Grass were randomized to receive either a multispecies probiotic supplement (total colony-forming units 4 × 109/day) or placebo twice daily for 8 weeks. A mini-rhinoconjunctivitis quality of life questionnaire (mRQLQ) scale was administered at screening, days 0, 28, and 56. The proportion of participants with a >0.7 improvement in mRQLQ was the primary outcome. Participants also completed a daily symptom and medication diary during the supplementation period. Results: There were 165 participants randomized, with 142 included in the primary outcome analysis. The percentage of participants meeting the threshold for a clinically meaningful reduction in the mRQLQ from days 0 to 56 was not significantly different between groups (61% vs. 62%, p = 0.90). However, 76 participants had a clinically meaningful improvement in QoL (decrease in mRQLQ >0.7) prior to the start of supplementation (screening to day 0). Conclusion: Changes in self-reported QoL and other disease severity metrics between screening and the start of supplementation limited the ability to discern an effect of supplementation and highlight the need for adaptive clinical trial designs in allergy research. Clinical Trial Registration: The trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12619001319167).
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Affiliation(s)
- Amanda J Cox
- Menzies Health Institute QLD, School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Rebecca Ramsey
- Menzies Health Institute QLD, School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute QLD, School Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | | | - Allan W Cripps
- Menzies Health Institute QLD, School Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Nicholas P West
- Menzies Health Institute QLD, School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
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Burgess A, Sakzewski L, Whittingham K, Wotherspoon J, Chatfield MD, Ware RS, Boyd RN. Development of social functioning in children with cerebral palsy: A longitudinal study. Dev Med Child Neurol 2023; 65:674-682. [PMID: 36282970 PMCID: PMC10953437 DOI: 10.1111/dmcn.15439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe the development of social function in children with cerebral palsy (CP) classified in all levels of the Communication Function Classification System (CFCS). METHOD This prospective, longitudinal population-based cohort study recruited children with CP born in Queensland, Australia. Social functioning was measured using the Pediatric Evaluation of Disability Inventory (PEDI) social function domain at 2 years, 2 years 6 months, 3 years, 4 years, and 5 years, and the PEDI Computer Adaptive Test (PEDI-CAT) social/cognitive domain at 8 to 12 years. RESULTS Seventy-four children provided 356 observations. PEDI-CAT social/cognitive scaled scores at 8 to 12 years were (mean [SD] n) CFCS level I, 68.6 (2.7) 45; CFCS level II, 64.0 (3.4) 10; CFCS level III, 63.5 (3.7) 4; CFCS level IV, 56.8 (5.0) 9; CFCS level V, 47.2 (5.8) 6. Scores within expected range for age (not less than 2 SD below mean) at 8 to 12 years were achieved by 35 (78%) children in CFCS level I and four (14%) in CFCS levels II to V. Forty-nine per cent of children scored at least two standard deviations below the population mean on a proxy measure of fluid intelligence. Intellectual impairment was associated with lower PEDI-CAT social/cognitive scaled scores in univariable analysis (β = -8.3, 95% confidence interval - 10.91 to -5.63; p < 0.001) but had a smaller effect when modelled together with CFCS. INTERPRETATION Social function attained by 8 to 12 years of age was strongly related to level of communication function (CFCS). The small number of children classified in CFCS levels II to V necessitates caution when viewing these individual CFCS level trajectories. WHAT THIS PAPER ADDS There is a strong relation between social functioning and Communication Function Classification System (CFCS) levels. At 8 to 12 years, 35 out of 45 children in CFCS level I met social functioning age expectations. Twenty-five out of 29 in CFCS levels II to V had social functioning below that expected for age. CFCS and age were more strongly associated with development of social functioning than Gross Motor Function Classification System or Manual Ability Classification System and age.
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Affiliation(s)
- Andrea Burgess
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
| | - Leanne Sakzewski
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
| | - Koa Whittingham
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
| | - Jane Wotherspoon
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
| | - Mark D. Chatfield
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
| | - Robert S. Ware
- Griffith University, Menzies Health Institute QueenslandBrisbaneAustralia
| | - Roslyn N. Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research CentreFaculty of MedicineBrisbaneAustralia
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Sakzewski L, Pool D, Armstrong E, Reedman SE, Boyd RN, Elliott C, Novak I, Trost S, Ware RS, Comans T, Toovey R, Peterson MD, Kentish M, Horan S, Valentine J, Williams S. ACTIVE STRIDES-CP: protocol for a randomised trial of intensive rehabilitation (combined intensive gait and cycling training) for children with moderate-to-severe bilateral cerebral palsy. BMJ Open 2023; 13:e068774. [PMID: 36990490 PMCID: PMC10069600 DOI: 10.1136/bmjopen-2022-068774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION For children with cerebral palsy (CP), who are marginally ambulant, gross motor capacity peaks between 6 and 7 years of age with a subsequent clinical decline, impacting their ability to engage in physical activity. Active Strides-CP is a novel package of physiotherapy targeting body functions, activity and participation outcomes for children with bilateral CP. This study will compare Active Strides-CP to usual care in a multisite randomised waitlist-controlled trial. METHODS AND ANALYSIS 150 children with bilateral CP (5-15 years), classified in Gross Motor Function Classification System (GMFCS) levels III and IV will be stratified (GMFCS III vs IV, age 5-10 years; 11-15 years and trial site) and randomised to receive either (1) 8 weeks of Active Strides-CP two times/week for 1.5 hours in clinic and one time/week for 1 hour alternating home visits and telehealth (total dose=32 hours) or (2) usual care. Active Strides-CP comprises functional electrical stimulation cycling, partial body weight support treadmill training, overground walking, adapted community cycling and goal-directed training. Outcomes will be measured at baseline, immediately post-intervention at 9 weeks primary endpoint and at 26 weeks post-baseline for retention. The primary outcome is the Gross Motor Function Measure-66. Secondary outcomes include habitual physical activity, cardiorespiratory fitness, walking speed and distance, frequency/involvement of community participation, mobility, goal attainment and quality of life. Analyses will follow standard principles for randomised controlled trials using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. A within-trial cost utility analysis will be performed. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland, The University of Melbourne and Curtin University Human Research Ethics Committees have approved this study. Results will be disseminated as conference abstracts and presentations, peer-reviewed articles in scientific journals, and institution newsletters and media releases. TRIAL REGISTRATION NUMBER ACTRN12621001133820.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Dayna Pool
- School of Allied Health, Curtin University, Carlisle, Western Australia, Australia
| | - Ellen Armstrong
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Sarah Elizabeth Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Toovey
- The University of Melbourne Melbourne School of Health Sciences, Melbourne, Victoria, Australia
| | - Mark D Peterson
- Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Sean Horan
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Valentine
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Sian Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- The University of Auckland Liggins Institute, Auckland, New Zealand
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El-Heneidy A, Ware RS, Lambert SB, Grimwood K. Sapovirus Infections in an Australian Community-Based Healthy Birth Cohort During the First 2 Years of Life. Clin Infect Dis 2023; 76:1043-1049. [PMID: 36310530 PMCID: PMC10029984 DOI: 10.1093/cid/ciac861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sapovirus is an important cause of acute gastroenteritis (AGE) in young children. However, knowledge gaps remain in community settings. We investigated the epidemiology, disease characteristics, and healthcare use associated with sapovirus infections in Australian children during their first 2 years of life. METHODS Children in the Brisbane-based Observational Research in Childhood Infectious Diseases birth cohort provided daily gastrointestinal symptoms (vomiting/loose stools), weekly stool swabs, and healthcare data until age 2 years. Swabs were batch-tested for sapovirus using real-time polymerase chain reaction assays. Incidence rates and estimates of associations were calculated. RESULTS Overall, 158 children returned 11 124 swabs. There were 192 sapovirus infection episodes. The incidence rate in the first 2 years of life was 0.89 infections per child-year (95% confidence interval [CI], .76-1.05), and the symptomatic incidence rate was 0.26 episodes per child-year (95% CI, .17-.37). Age ≥6 months, the fall season, and childcare attendance increased disease incidence significantly. Fifty-four of the 180 (30%) infections with linked symptom diaries were symptomatic, with 72% recording vomiting and 48% diarrhea. Prior infection reduced risk of further infections (adjusted hazard ratio, 0.70 [95% CI, .54-.81]) in the study period. Viral loads were higher and viral shedding duration was longer in symptomatic than asymptomatic children. Twenty-three (43%) symptomatic episodes required healthcare, including 6 emergency department presentations and 2 hospitalizations. CONCLUSIONS Sapovirus infections are common in Australian children aged 6-23 months. Efforts to reduce childhood AGE after the global rollout of rotavirus vaccines should include sapovirus where estimates of its incidence in communities will be crucial.
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Affiliation(s)
- Asmaa El-Heneidy
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen B Lambert
- UQ Centre for Clinical Research, The University of Queensland, Herston, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Gold Coast, Queensland, Australia
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Benfer K, Boyd RN, Roe Y, Fagan R, Luke C, Mick-Ramsamy L, Whittingham K, Novak I, Bosanquet M, McNamara L, Khandaker G, Fogarty L, Cadet-James Y, Ruben A, Comans T, Smith A, Ware RS. Study protocol: peer delivered early intervention (Learning through Everyday Activities with Parents for Infants at risk of Cerebral Palsy: LEAP-CP) for First Nation Australian infants at high risk of cerebral palsy - an RCT study. BMJ Open 2023; 13:e059531. [PMID: 36914182 PMCID: PMC10016288 DOI: 10.1136/bmjopen-2021-059531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). METHODS AND ANALYSIS This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP ('absent fidgety' on General Movements Assessment, and/or 'suboptimal score' on the Hammersmith Infant Neurological Examination) aged 12-52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. SAMPLE SIZE total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition). ETHICS AND DISSEMINATION Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167p.
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Affiliation(s)
- Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Yvette Roe
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Ruth Fagan
- Research, Gurriny Yealamucka Health Service, Yarrabah, Queensland, Australia
| | - Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Gulam Khandaker
- Public Health Unit, Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Queensland, Australia
| | - Lucy Fogarty
- Department of Physiotherapy, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Research, Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Alan Ruben
- Child, Youth, and Family Health, Cape and Torres Strait Hospital and Health Service, Cairns, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Caesar RA, Boyd RN, Cioni G, Ware RS, Doherty J, Jackson MP, Salthouse KL, Colditz PB. Early detection of developmental delay in infants born very preterm or with very low birthweight. Dev Med Child Neurol 2023; 65:346-357. [PMID: 37017185 PMCID: PMC10952560 DOI: 10.1111/dmcn.15381] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/19/2022]
Abstract
AIM This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight. METHOD A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA). RESULTS One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy (Bayley-III motor: sensitivity 100% [95% confidence interval {CI} 3-100], specificity 75% [95% CI 63-84], area under the curve [AUC] 0.87); Bayley-III cognitive: sensitivity 100% [95% CI 3-100], specificity 75% [95% CI 64-84], AUC 0.88); NSMDA motor: sensitivity 100% [95% CI 40-100], specificity 81% [95% CI 70-90], AUC 0.91 [95% CI 0.86-0.95]). GMA trajectories that combined abnormal writhing general movements at 4 to 5 weeks corrected age with suboptimal quality of fidgety movement at 16 weeks corrected age were strongly predictive of developmental delay, superior to all other clinical tools, and perinatal and demographic variables investigated (p = 0.01, Akaike information criterion method 18.79 [score corrected for small sample size], accounting for 93% of the cumulative weight). INTERPRETATION Only the GMA had sufficient predictive validity to act as a biomarker for both conditions: typical outcome and developmental delay (motor or cognitive). GMA trajectories that assessed both writhing general movements at 4 to 5 weeks corrected age and quality of fidgety movement at 16 weeks corrected age predicted adverse neurodevelopmental outcome, accurately differentiating between infants with typical outcomes and those at increased risk for motor or cognitive delay.
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Affiliation(s)
- Rebecca A. Caesar
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Giovanni Cioni
- Department of Developmental NeuroscienceIRCCS Fondazione Stella MarisPisaItaly
| | - Robert S. Ware
- Griffith University, Menzies Health Institute QueenslandGold CoastAustralia
| | - Julie Doherty
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Maxine P. Jackson
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Kaye L. Salthouse
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Paul B. Colditz
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
- The University of Queensland Centre for Clinical Research, Faculty of MedicineThe University of Queensland, Royal Brisbane and Women's HospitalBrisbaneAustralia
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48
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Le HHTC, Le An P, Vinh NN, Ware RS, Phung D, Thai PK, Ranganathan S, Dang TN, Dung PHT, Thuong DTH, Phung H, Hien TT, Sly PD. Burden of asthma-like symptoms and a lack of recognition of asthma in Vietnamese children. J Asthma 2023; 60:516-524. [PMID: 35427209 DOI: 10.1080/02770903.2022.2066002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Lack of recognition of asthma in childhood results in unmet asthma treatment needs and leads to the risk of sub-optimal respiratory health. The present study assessed the prevalence of asthmatic under-recognition in middle school children in Vietnam. METHODS We conducted a school-based survey among 15,112 Vietnamese children. Most of them are aged from 13 to 14. Schools and students were recruited using multi-stage sampling. Respiratory symptoms were collected via self-report using a standardized tool from the International Study of Asthma and Allergies in Childhood. Under-recognition of asthma was defined as a presence of at least one asthma-like symptom but a negative response to having ever asthma. Associations were investigated using logistic regression. RESULTS Prevalence of asthma-like symptoms was 27.3% and prevalence of physician-diagnosed asthma was 8.5%. Over 80% of symptomatic children were not diagnosed with asthma. Under-recognition of asthma was found more in girls (adjusted odds ratio; aOR = 1.75; 95%CI: 1.54 to 1.98). CONCLUSIONS Asthma is significantly under-recognized in Vietnamese middle-school children. Urgent action is required to improve the recognition of asthma in Vietnam.
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Affiliation(s)
- Hong H T C Le
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.,Children's Health and Environment Program, Centre for Children's Health Research, Brisbane, QLD, Australia
| | - Pham Le An
- Centre for the Training of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Nhu Vinh
- Centre for the Training of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Dung Phung
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, St Lucia, QLD, Australia
| | | | - Tran Ngoc Dang
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phan Hoang Thuy Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Do Thi Hoai Thuong
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hai Phung
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - To Thi Hien
- University of Science, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Peter D Sly
- Children's Health and Environment Program, Centre for Children's Health Research, Brisbane, QLD, Australia
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49
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Boyd RN, Novak I, Morgan C, Bora S, Sakzewski L, Ware RS, Comans T, Fahey MC, Whittingham K, Trost S, Pannek K, Pagnozzi A, Mcintyre S, Badawi N, Smithers Sheedy H, Palmer KR, Burgess A, Keramat A, Bell K, Hines A, Benfer K, Gascoigne-Pees L, Leishman S, Oftedal S. School readiness of children at high risk of cerebral palsy randomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials. BMJ Open 2023; 13:e068675. [PMID: 36849209 PMCID: PMC9972445 DOI: 10.1136/bmjopen-2022-068675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION School readiness includes cognitive, socio-emotional, language and physical growth and development domains which share strong associations with life-course opportunities. Children with cerebral palsy (CP) are at increased risk of poor school readiness compared with their typically developing peers. Recently, earlier diagnosis of CP has allowed interventions to commence sooner, harnessing neuroplasticity. First, we hypothesise that early referral to intervention for children at-risk of CP will lead to improved school readiness at 4-6 years relative to placebo or care as usual. Second, we hypothesise that receipt of early diagnosis and early intervention will lead to cost-savings in the form of reduced healthcare utilisation. METHODS AND ANALYSIS Infants identified as at-risk of CP ≤6 months corrected age (n=425) recruited to four randomised trials of neuroprotectants (n=1), early neurorehabilitation (n=2) or early parenting support (n=1) will be re-recruited to one overarching follow-up study at age 4-6 years 3 months. A comprehensive battery of standardised assessments and questionnaires will be administered to assess all domains of school readiness and associated risk factors. Participants will be compared with a historical control group of children (n=245) who were diagnosed with CP in their second year of life. Mixed-effects regression models will be used to compare school readiness outcomes between those referred for early intervention versus placebo/care-as-usual. We will also compare health-resource use associated with early diagnosis and intervention versus later diagnosis and intervention. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland, University of Sydney, Monash University and Curtin University Human Research Ethics Committees have approved this study. Informed consent will be sought from the parent or legal guardian of every child invited to participate. Results will be disseminated in peer-reviewed journals, scientific conferences and professional organisations, and to people with lived experience of CP and their families. TRIAL REGISTRATION NUMBER ACTRN12621001253897.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samudragupta Bora
- Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Faculty of Medicine, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Collingwood Fahey
- Paediatric Neurology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Alex Pagnozzi
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Rebecca Palmer
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Afroz Keramat
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Laura Gascoigne-Pees
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
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Snelling PJ, Jones P, Gillespie A, Bade D, Keijzers G, Ware RS. Point-of-Care Ultrasound Fracture-Physis Distance Association with Salter-Harris II Fractures of the Distal Radius in Children: The "POCUS 1-cm Rule". Ultrasound Med Biol 2023; 49:520-526. [PMID: 36333153 DOI: 10.1016/j.ultrasmedbio.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Salter-Harris II fractures of the distal radius can result in serious complications. The aim of this study was to measure the fracture-physis distance using point-of-care ultrasound (POCUS) to determine whether a certain distance is associated with Salter-Harris II fractures, compared with other fracture types, in a cohort of children with X-ray-identified distal radius fractures. Participants were from a parent diagnostic study conducted in an Australian tertiary pediatric emergency department, which prospectively evaluated the diagnosis of pediatric distal forearm fractures using POCUS compared against X-ray. Nurse practitioners, who underwent 2 h of training, administered a six-view POCUS protocol in clinically non-angulated pediatric forearm injuries prior to X-ray. This was a secondary analysis of data from the parent study. The 122 participants with X-ray-identified distal radius fractures from the parent study had their POCUS images interpreted by two emergency physician sonologists, who measured the fracture-physis distance. The median and maximum fracture-physis distances for Salter-Harris II fractures (n = 19) were 8.00 and 9.85 mm, whereas minimum and median distances for incomplete fractures (n = 22) were 10.20 and 15.98 mm, and those for complete fractures (n = 9) were 10.85 and 12.85 mm. Buckle fracture (n = 72) distances ranged from 4.35 to 26.55 mm, with a median of 13.65 mm. In children diagnosed with a distal radius fracture on X-ray, a fracture-physis distance cutoff of 1 cm differentiated Salter-Harris II fractures from other cortical breach fracture types, but not buckle fractures. Although this exploratory study suggests the "POCUS 1-cm rule" could be used as a secondary sign to augment the diagnosis of Salter-Harris II distal radius fractures using POCUS, further research is required to validate this measurement prospectively.
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Affiliation(s)
- Peter J Snelling
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia; Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Philip Jones
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alan Gillespie
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Bade
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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