1
|
Beckett RS, Jagadish A, Carroll W, Gilchrist FJ. Quality improvement project assessing the feasibility of using canister weight to estimate remaining doses in a salbutamol pressurised metered-dose inhaler. Arch Dis Child 2024; 109:444-446. [PMID: 38316530 DOI: 10.1136/archdischild-2023-326678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Robert S Beckett
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Annapurna Jagadish
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Will Carroll
- Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Francis J Gilchrist
- Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| |
Collapse
|
2
|
Evans K, Battersby C, Boardman JP, Boyle E, Carroll W, Dinwiddy K, Dorling J, Gallagher K, Hardy P, Johnston E, Mactier H, Marcroft C, Webbe JWH, Gale C. National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the UK. Arch Dis Child Fetal Neonatal Ed 2023; 108:569-574. [PMID: 37094919 PMCID: PMC10646876 DOI: 10.1136/archdischild-2023-325504] [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: 02/23/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The provision of neonatal care is variable and commonly lacks adequate evidence base; strategic development of methodologically robust clinical trials is needed to improve outcomes and maximise research resources. Historically, neonatal research topics have been selected by researchers; prioritisation processes involving wider stakeholder groups have generally identified research themes rather than specific questions amenable to interventional trials. OBJECTIVE To involve stakeholders including parents, healthcare professionals and researchers to identify and prioritise research questions suitable for answering in neonatal interventional trials in the UK. DESIGN Research questions were submitted by stakeholders in population, intervention, comparison, outcome format through an online platform. Questions were reviewed by a representative steering group; duplicates and previously answered questions were removed. Eligible questions were entered into a three-round online Delphi survey for prioritisation by all stakeholder groups. PARTICIPANTS One hundred and eight respondents submitted research questions for consideration; 144 participants completed round one of the Delphi survey, 106 completed all three rounds. RESULTS Two hundred and sixty-five research questions were submitted and after steering group review, 186 entered into the Delphi survey. The top five ranked research questions related to breast milk fortification, intact cord resuscitation, timing of surgical intervention in necrotising enterocolitis, therapeutic hypothermia for mild hypoxic ischaemic encephalopathy and non-invasive respiratory support. CONCLUSIONS We have identified and prioritised research questions suitable for practice-changing interventional trials in neonatal medicine in the UK at the present time. Trials targeting these uncertainties have potential to reduce research waste and improve neonatal care.
Collapse
Affiliation(s)
- Katie Evans
- School of Public Health, Faculty of Medicine, Neonatal Medicine, Imperial College London, London, UK
| | - Cheryl Battersby
- School of Public Health, Faculty of Medicine, Neonatal Medicine, Imperial College London, London, UK
| | - James P Boardman
- Neonatal Medicine, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
| | - Elaine Boyle
- Neonatal Medicine, University of Leicester, Leicester, UK
- Neonatal Clinical Studies Group, National Institute for Health and Care Research, London, UK
| | | | - Kate Dinwiddy
- British Association of Perinatal Medicine, London, UK
| | - Jon Dorling
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Katie Gallagher
- EGA Institute for Women's Health, University College London, London, UK
| | - Pollyanna Hardy
- Policy Research Unit in Maternal Health & Care, National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Emma Johnston
- Parents and Family Engagement Lead, Thames Valley and Wessex Operational Delivery Network, Thames Valley and Wessex, UK
| | - Helen Mactier
- Neonatal Medicine, University of Glasgow, Glasgow, UK
| | - Claire Marcroft
- Neonatal Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Chris Gale
- School of Public Health, Faculty of Medicine, Neonatal Medicine, Imperial College London, London, UK
| |
Collapse
|
3
|
Davarzani S, Saucier D, Talegaonkar P, Parker E, Turner A, Middleton C, Carroll W, Ball JE, Gurbuz A, Chander H, Burch RF, Smith BK, Knight A, Freeman C. Closing the Wearable Gap: Foot-ankle kinematic modeling via deep learning models based on a smart sock wearable. Wearable Technol 2023; 4:e4. [PMID: 38487777 PMCID: PMC10936318 DOI: 10.1017/wtc.2023.3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 03/17/2024]
Abstract
The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot-ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R-squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot-ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system.
Collapse
Affiliation(s)
- Samaneh Davarzani
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, USA
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
| | - David Saucier
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
| | - Purva Talegaonkar
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, USA
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
| | - Erin Parker
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, USA
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Alana Turner
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
| | - Carver Middleton
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Will Carroll
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi State, MS, USA
| | - John E. Ball
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Ali Gurbuz
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Harish Chander
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
| | - Reuben F. Burch
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, USA
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
| | - Brian K. Smith
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, USA
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
| | - Adam Knight
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
| | - Charles Freeman
- Human Factors and Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Mississippi State, MS, USA
- School of Human Sciences, Mississippi State University, Mississippi State, MS, USA
| |
Collapse
|
4
|
Persons AK, Middleton C, Parker E, Carroll W, Turner A, Talegaonkar P, Davarzani S, Saucier D, Chander H, Ball JE, Elder SH, Simpson CL, Macias D, Burch V. RF. Comparison of the Capacitance of a Cyclically Fatigued Stretch Sensor to a Non-Fatigued Stretch Sensor When Performing Static and Dynamic Foot-Ankle Motions. Sensors (Basel) 2022; 22:s22218168. [PMID: 36365868 PMCID: PMC9661536 DOI: 10.3390/s22218168] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 05/26/2023]
Abstract
Motion capture is the current gold standard for assessing movement of the human body, but laboratory settings do not always mimic the natural terrains and movements encountered by humans. To overcome such limitations, a smart sock that is equipped with stretch sensors is being developed to record movement data outside of the laboratory. For the smart sock stretch sensors to provide valuable feedback, the sensors should have durability of both materials and signal. To test the durability of the stretch sensors, the sensors were exposed to high-cycle fatigue testing with simultaneous capture of the capacitance. Following randomization, either the fatigued sensor or an unfatigued sensor was placed in the plantarflexion position on the smart sock, and participants were asked to complete the following static movements: dorsiflexion, inversion, eversion, and plantarflexion. Participants were then asked to complete gait trials. The sensor was then exchanged for either an unfatigued or fatigued plantarflexion sensor, depending upon which sensor the trials began with, and each trial was repeated by the participant using the opposite sensor. Results of the tests show that for both the static and dynamic movements, the capacitive output of the fatigued sensor was consistently higher than that of the unfatigued sensor suggesting that an upwards drift of the capacitance was occurring in the fatigued sensors. More research is needed to determine whether stretch sensors should be pre-stretched prior to data collection, and to also determine whether the drift stabilizes once the cyclic softening of the materials comprising the sensor has stabilized.
Collapse
Affiliation(s)
- Andrea Karen Persons
- The Ohio State Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, OH 43202, USA
| | - Carver Middleton
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Erin Parker
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Will Carroll
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Alana Turner
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - Purva Talegaonkar
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Samaneh Davarzani
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - David Saucier
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
| | - Harish Chander
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - John E. Ball
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Steven H. Elder
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Chartrisa LaShan Simpson
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - David Macias
- OrthoVirginia, 1920 Ballenger Ave., Alexandria, VA 22314, USA
| | - Reuben F. Burch V.
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| |
Collapse
|
5
|
Abstract
The links between bullying and asthma have not been explored in children. We wanted to determine the child/parent factors and attitudes associated with asthma-related bullying. Individual child/parent responses of children with asthma (N=943) from the Room to Breathe survey were analysed. 1 in 10 children reported asthma-related bullying/teasing (n=93). Children with well-controlled asthma were less likely to report being a victim of asthma-related bullying/teasing (OR 0.51, 95% CI 0.23 to 0.84, p=0.006). Being a victim of bullying/teasing was more common in children reporting activity restriction (OR 1.74, 95% CI 1.11 to 2.75, p=0.010), who described their asthma as 'bad' (OR 3.02, 95% CI 1.86 to 4.85, p<0.001) and those whose parents reported ongoing asthma-related health worries (OR 1.64, 95% CI 1.04 to 2.58, p=0.024). Asthma consultations should incorporate specific questions about bullying and be child-focused in order to gain a representative appreciation of asthma control and its impact on the child's life.
Collapse
Affiliation(s)
- Rebecca Charles
- Paediatric Respiratory Service, Staffordshire Children's Hospital at Royal Stoke, Stoke-on-Trent, UK
| | - Paul L P Brand
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands
| | - Francis J Gilchrist
- Paediatric Respiratory Service, Staffordshire Children's Hospital at Royal Stoke, Stoke-on-Trent, UK.,Keele University, Stoke-on-Trent, UK
| | - Johannes Wildhaber
- Paediatrics, Department of Community Health, University and Hospital Fribourg, Fribourg, Switzerland
| | - Will Carroll
- Paediatric Respiratory Service, Staffordshire Children's Hospital at Royal Stoke, Stoke-on-Trent, UK .,Keele University, Stoke-on-Trent, UK
| |
Collapse
|
6
|
Gilchrist F, Carroll W. Two systematic cochrane reviews of the prevention and treatment of distal intestinal obstruction syndrome in cystic fibrosis. Paediatr Respir Rev 2022; 41:49-50. [PMID: 35184969 DOI: 10.1016/j.prrv.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Francis Gilchrist
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, United Kingdom
| |
Collapse
|
7
|
Abstract
BACKGROUND Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention. OBJECTIVES This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 09 September 2021. We also searched online trial registries. Date of last search: 12 October 2021. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE. MAIN RESULTS There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall certainty of the evidence was found to be very low. AUTHORS' CONCLUSIONS There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.
Collapse
Affiliation(s)
- Francis J Gilchrist
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Jessica Green
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
8
|
Abstract
BACKGROUND Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions. Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small intestine. The mass may partially block the intestine (incomplete DIOS) or completely block the intestine (complete DIOS). Symptoms of DIOS can affect quality of life and other aspects of CF health, such as airway clearance, exercise, sleep and nutritional status. Treatment of constipation and prevention of complete bowel obstruction are required for gastrointestinal management in CF. However, many different strategies are used in clinical practice and there is a lack of consensus. The importance of this topic was highlighted in a recent research priority setting exercise by the James Lind Alliance. OBJECTIVES To evaluate the effectiveness and safety of laxative agents of differing types for preventing DIOS (complete and incomplete) in children and adults with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 09 September 2021. We also searched online trial registries. Date of last search: 12 October 2021. SELECTION CRITERIA Randomised and quasi-randomised controlled parallel trials comparing laxative therapy for preventing DIOS (including osmotic agents, stimulants, mucolytics and substances with more than one action) at any dose to placebo, no treatment or an alternative laxative therapy, in people of any age with pancreatic sufficient or insufficient CF and any stage of lung disease. Randomised cross-over trials were judged on an individual basis. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion, extracted outcome data and performed a risk of bias assessment for the included data. We judged the certainty of the evidence using GRADE criteria. MAIN RESULTS We included one cross-over trial (17 participants) with a duration of 12 months, in which participants were randomly allocated to either cisapride (a gastro-prokinetic agent) or placebo for six months each. The trial had an unclear risk of bias for most domains but had a high risk of reporting bias. Radiograph scores revealed no difference in occurrence of DIOS between cisapride and placebo (narrative report, no data provided). There were no adverse effects. Symptom scores were the only secondary outcome within the review that were reported. Total gastrointestinal symptom scores favoured cisapride with a statistically significant mean difference (MD) of -7.60 (95% confidence interval (CI) -14.73 to -0.47). There was no significant difference at six months between cisapride and placebo for abdominal distension, MD -0.90 (95% CI -2.39 to 0.59) or abdominal pain, MD -0.4 (95% CI -2.05 to 1.25). The global symptom scores (whether individuals felt better or worse) were reported in the paper to favour cisapride and be statistically significant (P < 0.05). We assessed the available data to be very low certainty. There was a great deal of missing data from the included trial and the investigators failed to report numerical data for many outcomes. The overall risk of bias of the trial was unclear and it had a high risk for reporting bias. There was also indirectness; the trial drug (cisapride) has since been removed from the market in several countries due to adverse effects, thus it has no current applicability for preventing DIOS. The included trial also had very few participants, which downgraded the certainty a further level for precision. AUTHORS' CONCLUSIONS There is an absence of evidence for interventions for the prevention of DIOS. As there was only one included trial, we could not perform a meta-analysis of the data. Furthermore, the included trial compared a prokinetic agent (cisapride) that is no longer licensed for use in a number of countries due to the risk of serious cardiac events, a finding that came to light after the trial was conducted. Therefore, the limited findings from the trial are not applicable in current clinical practice. Overall, a great deal more research needs to be undertaken on gastrointestinal complications in CF, as this is a very poorly studied area compared to respiratory complications in CF.
Collapse
Affiliation(s)
- Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, UK
| | - Jessica Green
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Francis J Gilchrist
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| |
Collapse
|
9
|
Lenzie A, Hoyle J, Yang E, Spencer S, Willey C, Bonner J, Dobelbower M, Snider J, McCammon S, Carroll W, Nabell L, Bhatia S, McDonald A. Pain, Weight Loss, and Quality of Life in a Supportive Care Trial for Patients With Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Soltan MA, Varney J, Sutton B, Melville CR, Lugg ST, Parekh D, Carroll W, Dosanjh DP, Thickett DR. COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills. BMJ Open Respir Res 2021; 8:e000951. [PMID: 34373239 PMCID: PMC8354812 DOI: 10.1136/bmjresp-2021-000951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ethnic minorities account for 34% of critically ill patients with COVID-19 despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand deterioration risk factors to inform clinical risk tool development. METHODS Multicentre cohort study of hospitalised patients with COVID-19 (n=3671) exploring determinants of health, including Index of Multiple Deprivation (IMD) subdomains, as risk factors for presentation, deterioration and mortality by ethnicity. Receiver operator characteristics were plotted for CURB65 and ISARIC4C by ethnicity and area under the curve (AUC) calculated. RESULTS Ethnic minorities were hospitalised with higher Charlson Comorbidity Scores than age, sex and deprivation matched controls and from the most deprived quintile of at least one IMD subdomain: indoor living environment (LE), outdoor LE, adult skills, wider barriers to housing and services. Admission from the most deprived quintile of these deprivation forms was associated with multilobar pneumonia on presentation and ICU admission. AUC did not exceed 0.7 for CURB65 or ISARIC4C among any ethnicity except ISARIC4C among Indian patients (0.83, 95% CI 0.73 to 0.93). Ethnic minorities presenting with pneumonia and low CURB65 (0-1) had higher mortality than White patients (22.6% vs 9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004). CONCLUSIONS Ethnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities.
Collapse
Affiliation(s)
- Marina A Soltan
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
- Health Inequalities Research Unit, England, United Kingdom, Great Britain
| | | | - Benjamin Sutton
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
- Birmingham Lung Research Unit, Birmingham, UK
| | - Colin R Melville
- The University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
| | - Dhruv Parekh
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
- Birmingham Lung Research Unit, Birmingham, UK
| | - Will Carroll
- University Hospitals North Midlands, Stoke on Trent, UK
| | - Davinder P Dosanjh
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
- Birmingham Lung Research Unit, Birmingham, UK
| | - David R Thickett
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
11
|
Mukhida K, Carroll W, Arseneault R. Does work have to be so painful? A review of the literature examining the effects of fibromyalgia on the working experience from the patient perspective. Can J Pain 2020; 4:268-286. [PMID: 33987505 PMCID: PMC7951172 DOI: 10.1080/24740527.2020.1820858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Chronic pain conditions, such as fibromyalgia, adversely affect individuals’ abilities to work. Aim The aim of this study was to examine, from the perspective of patients, the effects that fibromyalgia symptoms had on their ability to work, the challenges that they encountered in the workplace that did not foster their continued employment, and the types of modifications to their work or workplace that they thought would facilitate their productivity and ability to work. Methods A scoping review method, applying techniques of systematic review, was used to conduct a research synthesis of the literature regarding fibromyalgia and work that looked at this issue from the patient perspective. Results A variety of themes emerged from the analysis and could be broadly categorized into (1) the work experience was a challenging one with which to cope; (2) relationships were strained at work; (3) clinical symptoms had repercussions on subjects’ attitudes toward work and the relation to life outside of work; and (4) a variety of possible solutions were considered to help subjects better cope with fibromyalgia and work. Conclusions Strategies that potentially could foster continued employment of patients with fibromyalgia include those at the micro, meso, and macro levels. Health care providers can support patients’ employment goals by collaborating with patients and their employers, dispelling stigma regarding the illness, and providing practical and specific advice regarding workplace accommodations.
Collapse
Affiliation(s)
- K Mukhida
- Pain Management Unit, Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - W Carroll
- Department of Management, Sobey School of Business, Saint Mary's University, Halifax, Nova Scotia, Canada
| | - R Arseneault
- Department of Management, Sobey School of Business, Saint Mary's University, Halifax, Nova Scotia, Canada
| |
Collapse
|
12
|
Abstract
Since the detection of COVID-19 in December 2019, the rapid spread of the disease worldwide has led to a new pandemic, with the number of infected individuals and deaths rising daily. Early experience shows that it predominantly affects older age groups with children and young adults being generally more resilient to more severe disease.1, 2, 3 From a health standpoint, children and young people are less directly affected than adults and presentation of the disease has shown different characteristics. Nonetheless, COVID-19 has had severe repercussions on children and young people. These indirect, downstream implications should not be ignored. An understanding of the issues is essential for those who hope to advocate effectively for children to prevent irreversible damage to the adults of the future. This article reviews some of the evidence of harm to children that may accrue indirectly as a result of pandemics. It explores the physical and psychological effects, discusses the role of parenting and education, offering practical advice about how best to provide support as a healthcare professional.
Collapse
|
13
|
Strickler S, Yang E, Spencer S, Willey C, Bonner J, Dobelbower M, Nabell L, McCammon S, Bhatia S, Carroll W, McDonald A. Effect of Protocol-based Pain Management on Patient Reported Pain During Radiation for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Charles R, Gilchrist FJ, Carroll W. Is there an association between having asthma and being bullied? Arch Dis Child 2020; 105:903-905. [PMID: 32620568 DOI: 10.1136/archdischild-2020-319354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Rebecca Charles
- Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Francis J Gilchrist
- Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| |
Collapse
|
15
|
Chander H, Burch RF, Talegaonkar P, Saucier D, Luczak T, Ball JE, Turner A, Kodithuwakku Arachchige SNK, Carroll W, Smith BK, Knight A, Prabhu RK. Wearable Stretch Sensors for Human Movement Monitoring and Fall Detection in Ergonomics. Int J Environ Res Public Health 2020; 17:ijerph17103554. [PMID: 32438649 PMCID: PMC7277680 DOI: 10.3390/ijerph17103554] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
Wearable sensors are beneficial for continuous health monitoring, movement analysis, rehabilitation, evaluation of human performance, and for fall detection. Wearable stretch sensors are increasingly being used for human movement monitoring. Additionally, falls are one of the leading causes of both fatal and nonfatal injuries in the workplace. The use of wearable technology in the workplace could be a successful solution for human movement monitoring and fall detection, especially for high fall-risk occupations. This paper provides an in-depth review of different wearable stretch sensors and summarizes the need for wearable technology in the field of ergonomics and the current wearable devices used for fall detection. Additionally, the paper proposes the use of soft-robotic-stretch (SRS) sensors for human movement monitoring and fall detection. This paper also recapitulates the findings of a series of five published manuscripts from ongoing research that are published as Parts I to V of “Closing the Wearable Gap” journal articles that discuss the design and development of a foot and ankle wearable device using SRS sensors that can be used for fall detection. The use of SRS sensors in fall detection, its current limitations, and challenges for adoption in human factors and ergonomics are also discussed.
Collapse
Affiliation(s)
- Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA; (A.T.); (S.N.K.K.A.); (A.K.)
- Correspondence:
| | - Reuben F. Burch
- Department of Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems (CAVS), Mississippi State University, Mississippi State, MS 39762, USA;
| | - Purva Talegaonkar
- Department of Industrial & Systems Engineering, Mississippi State University, Mississippi State, MS 39762, USA; (P.T.); (B.K.S.)
| | - David Saucier
- Department of Electrical & Computer Engineering, Mississippi State University, Mississippi State, MS 39762, USA; (D.S.); (J.E.B.); (W.C.)
| | - Tony Luczak
- National Strategic Planning and Analysis Research Center (NSPARC), Mississippi State University, Mississippi State, MS 39762, USA;
| | - John E. Ball
- Department of Electrical & Computer Engineering, Mississippi State University, Mississippi State, MS 39762, USA; (D.S.); (J.E.B.); (W.C.)
| | - Alana Turner
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA; (A.T.); (S.N.K.K.A.); (A.K.)
| | | | - Will Carroll
- Department of Electrical & Computer Engineering, Mississippi State University, Mississippi State, MS 39762, USA; (D.S.); (J.E.B.); (W.C.)
| | - Brian K. Smith
- Department of Industrial & Systems Engineering, Mississippi State University, Mississippi State, MS 39762, USA; (P.T.); (B.K.S.)
| | - Adam Knight
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Mississippi State, MS 39762, USA; (A.T.); (S.N.K.K.A.); (A.K.)
| | - Raj K. Prabhu
- Department of Agricultural and Biomedical Engineering, Mississippi State University, Mississippi State, MS 39762, USA;
| |
Collapse
|
16
|
Bush A, Bhatt JM, Carroll W, Child F, Connett G, Doull I, Gilchrist F, Grigg J, Langton-Hewer S, Legg J, Lenney W, Paton J, Shields M, Sinha I. The ERS approach to e-cigarettes is entirely rational. Eur Respir J 2020; 55:2000413. [PMID: 32381632 DOI: 10.1183/13993003.00413-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Bush
- Imperial College, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Will Carroll
- Paediatrics, Derby Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Frances Child
- Dept of Respiratory Paediatrics, Central Manchester and Manchester Children, Manchester, UK
| | - Gary Connett
- University Hospital Southampton NHS Foundation Trust, University Hospital Southampton, Southampton, UK
| | - Iolo Doull
- Children's Hospital for Wales, Cardiff, UK
| | - Francis Gilchrist
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
| | | | - Julian Legg
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - Warren Lenney
- Academic Department of Child Health, University Hospital of North Staffordshire and Keele University, Stoke-on-Trent, UK
| | - James Paton
- Royal Hospital for Sick Children, Glasgow, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ian Sinha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
17
|
Carroll W, Clayton S, Frost S, Gupta A, Holmes S, Nagakumar P, Levy M. If it's 'only' asthma, why are children still dying? Arch Dis Child 2020; 105:494-498. [PMID: 31871041 DOI: 10.1136/archdischild-2019-318215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/11/2019] [Accepted: 12/08/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Will Carroll
- Children's Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK .,Institute of Applied Clinical Sciences, Keele University, Keele, Staffordshire, UK
| | - Sadie Clayton
- Child health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Susan Frost
- Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Atul Gupta
- Paediatric Respiratory Medicine, King's College London, London, UK
| | - Steve Holmes
- Primary Care Respiratory Society UK, Park Medical Practice, Shepton Mallet, Somerset, UK
| | - Prasad Nagakumar
- Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Mark Levy
- Clinical Lead for the UK National Review of Asthma Deaths (2011-4), London, UK.,Global Initiative on Asthma (GINA), Fontana, California, USA
| |
Collapse
|
18
|
Lavorini F, Barreto C, van Boven JFM, Carroll W, Conway J, Costello RW, Dahl BH, Dekhuijzen RPN, Holmes S, Levy M, Molimard M, Roche N, Román-Rodriguez M, Scichilone N, Scullion J, Usmani OS. Spacers and Valved Holding Chambers-The Risk of Switching to Different Chambers. J Allergy Clin Immunol Pract 2020; 8:1569-1573. [PMID: 31927099 DOI: 10.1016/j.jaip.2019.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/09/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Abstract
Spacers are pressurized metered-dose inhaler (pMDI) accessory devices developed to reduce problems of poor inhaler technique with pMDIs. Spacers that feature a 1-way inspiratory valve are termed valved holding chambers (VHCs); they act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a 2-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Both spacers and VHCs have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce corticosteroid-related side effects such as throat irritation, dysphonia, and oral candidiasis commonly seen with the use of pMDIs alone. Spacers and VHCs are not all the same, and also are not interchangeable: the performance may vary according to their size, shape, material of manufacture and propensity to become electrostatically charged, their mode of interface with the patient, and the presence or otherwise of valves and feedback devices. Thus, pairing of a pMDI plus a spacer or a VHC should be considered as a unique delivery system. In this Rostrum we discuss the risk potential for a patient getting switched to a spacer or VHC that delivers a reduced dose medication.
Collapse
Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Celeste Barreto
- Departamento de Pediatria, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Will Carroll
- Department of Paediatrics, University Hospital of North Midlands NHS Trust, Stoke-On-Trent, United Kingdom
| | - Joy Conway
- Computationally Intensive Imaging, University of Southampton, Southampton, United Kingdom
| | | | - Birthe Hellqvist Dahl
- Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stephen Holmes
- Park Medical Practice, Shepton Mallet, Somerset, United Kingdom
| | - Mark Levy
- Harrow Primary Care Trust, London, United Kingdom
| | - Mathieu Molimard
- Département de Pharmacologie, CHU de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes, Paris, France
| | - Miguel Román-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares, Mallorca, Spain
| | - Nicola Scichilone
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Jane Scullion
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Omar S Usmani
- Imperial College London & Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
19
|
Levy ML, Carroll W, Izquierdo Alonso JL, Keller C, Lavorini F, Lehtimäki L. Understanding Dry Powder Inhalers: Key Technical and Patient Preference Attributes. Adv Ther 2019; 36:2547-2557. [PMID: 31478131 PMCID: PMC6822825 DOI: 10.1007/s12325-019-01066-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 11/29/2022]
Abstract
Inhalable medications for patients with asthma and chronic obstructive pulmonary disease (COPD) can be confusing even for health care professionals because of the multitude of available devices each with different operating principles. Dry powder inhalers (DPI) are a valuable option for almost all of the patients with asthma or COPD. Based on recorded patient inspiratory profiles, the peak inspiratory flow requirement of 30 L min−1 of high-resistance devices does not usually pose any practical limitations for the patients. Suboptimal adherence and errors in device handling are common and require continuous checking and patient education in order to avoid these pitfalls of all inhalation therapy. The aim of this opinion paper is to describe the working principles of DPIs and to summarise their key properties in order to help prescribing the correct inhaler for each patient. Funding: Orion Pharma.
Collapse
Affiliation(s)
- Mark L Levy
- Sessional General Practitioner, Kenton Bridge Medical Centre, London, UK.
| | - Will Carroll
- Department of Paediatrics, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - Claus Keller
- Practice for Pneumology, Allergology and Work Medicine, Frankfurt, Germany
| | - Federico Lavorini
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Allergy Centre, Tampere University Hospital, Tampere University, Tampere, Finland
| |
Collapse
|
20
|
Wijeratne T, Dodick D, Grisold W, Carroll W. World Brain Day 2019; migraine – the painful truth. Eur J Neurol 2019; 26:e92-e93. [DOI: 10.1111/ene.14045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- T. Wijeratne
- Department of Neurology Sunshine Hospital, Western Health Footscray VICAustralia
- School of Psychology and Public Health Department of Psychology and Counselling La Trobe University Bundoora VICAustralia
- Department of Medicine AIMSSMelbourne Medical School – WHCRE, University of Melbourne, Sunshine Hospital St Albans VIC Australia
| | - D. Dodick
- Department of Neurology Mayo Clinic Phenix AZ USA
| | - W. Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology ViennaAustria
| | - W. Carroll
- Department of Neurology Sir Charles Gairdner Hospital Nedlands WA Australia
| |
Collapse
|
21
|
Saglani S, Bush A, Carroll W, Cunningham S, Fleming L, Gaillard E, Gupta A, Murray C, Nagakumar P, Paton J, Roberts G, Seddon P, Sinha I. Biologics for paediatric severe asthma: trick or TREAT? Lancet Respir Med 2019; 7:294-296. [PMID: 30824361 DOI: 10.1016/s2213-2600(19)30045-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sejal Saglani
- National Heart & Lung Institute, Imperial College London, London SW7 2AZ, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
| | - Andrew Bush
- National Heart & Lung Institute, Imperial College London, London SW7 2AZ, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Will Carroll
- Department of Paediatrics, University Hospital of North Midlands NHS Trust, Stoke-On-Trent, UK
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Louise Fleming
- National Heart & Lung Institute, Imperial College London, London SW7 2AZ, UK; Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Erol Gaillard
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital, London, UK
| | - Clare Murray
- Department of Respiratory Paediatrics, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Prasad Nagakumar
- Department of Respiratory Paediatrics, Birmingham Women's & Children's Hospital, University of Birmingham, Birmingham, UK
| | - James Paton
- Department of Child Health, University of Glasgow, Glasgow, UK
| | - Graham Roberts
- Paediatric Allergy and Respiratory Medicine, University of Southampton, Southampton, UK
| | - Paul Seddon
- Children's and Adolescent Services, Brighton & Sussex University Hospital NHS Trust, Brighton, UK
| | - Ian Sinha
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
22
|
Abstract
BACKGROUND Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention. OBJECTIVES This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 24 July 2018.We also searched the following trials registries and other resources: ClinicalTrials.gov; International Standard Randomised Controlled Trial Number (ISRCTN) Registry; the WHO International Clinical Trials Registry; and Open Grey.Date of last searches: 10 June 2018. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE. MAIN RESULTS There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall quality of the evidence was found to be very low. AUTHORS' CONCLUSIONS There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.
Collapse
Affiliation(s)
- Jessica Green
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Will Carroll
- University Hospitals of the North MidlandsDepartment of Paediatric Respiratory MedicineNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | | |
Collapse
|
23
|
Abstract
BACKGROUND Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions. Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small intestine. The mass may partially block the intestine (incomplete DIOS) or completely block the intestine (complete DIOS). Symptoms of DIOS can affect quality of life and other aspects of CF health, such as airway clearance, exercise, sleep and nutritional status. Treatment of constipation and prevention of complete bowel obstruction are required for gastrointestinal management in CF. However, many different strategies are used in clinical practice and there is a lack of consensus. The importance of this topic was highlighted in a recent research priority setting exercise by the James Lind Alliance. OBJECTIVES To evaluate the effectiveness and safety of laxative agents of differing types for preventing DIOS (complete and incomplete) in children and adults with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 22 May 2018.We also searched online trial registries. Date of last search: 10 June 2018. SELECTION CRITERIA Randomised and quasi-randomised controlled parallel trials comparing laxative therapy for preventing DIOS (including osmotic agents, stimulants, mucolytics and substances with more than one action) at any dose to placebo, no treatment or an alternative laxative therapy, in people of any age with pancreatic sufficient or insufficient CF and any stage of lung disease. Randomised cross-over trials were judged on an individual basis. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion, extracted outcome data and performed a risk of bias assessment for the included data. We judged the quality of the evidence using GRADE criteria. MAIN RESULTS We included one cross-over trial (17 participants) with a duration of 12 months, in which participants were randomly allocated to either cisapride (a gastro-prokinetic agent) or placebo for six months each. The trial had an unclear risk of bias for most domains but had a high risk of reporting bias.Radiograph scores revealed no difference in occurrence of DIOS between cisapride and placebo (narrative report, no data provided). There were no adverse effects. Symptom scores were the only secondary outcome within the review that were reported. Total gastrointestinal symptom scores favoured cisapride with a statistically significant mean difference (MD) of -7.60 (95% confidence interval (CI) -14.73 to -0.47). There was no significant difference at six months between cisapride and placebo for abdominal distension, MD -0.90 (95% CI -2.39 to 0.59) or abdominal pain, MD -0.4 (95% CI -2.05 to 1.25). The global symptom scores (whether individuals felt better or worse) were reported in the paper to favour cisapride and be statistically significant (P < 0.05).We assessed the available data to be very low quality. There was a great deal of missing data from the included trial and the investigators failed to report numerical data for many outcomes. The overall risk of bias of the trial was unclear and it had a high risk for reporting bias. There was also indirectness; the trial drug (cisapride) has since been removed from the market in several countries due to adverse effects, thus it has no current applicability for preventing DIOS. The included trial also had very few participants, which downgraded the quality a further level for precision. AUTHORS' CONCLUSIONS There is an absence of evidence for interventions for the prevention of DIOS. As there was only one included trial, we could not perform a meta-analysis of the data. Furthermore, the included trial compared a prokinetic agent (cisapride) that is no longer licensed for use in a number of countries due to the risk of serious cardiac events, a finding that came to light after the trial was conducted. Therefore, the limited findings from the trial are not applicable in current clinical practice.Overall, a great deal more research needs to be undertaken on gastrointestinal complications in CF, as this is a very poorly studied area compared to respiratory complications in CF.
Collapse
Affiliation(s)
- Jessica Green
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Will Carroll
- University Hospitals of the North MidlandsDepartment of Paediatric Respiratory MedicineNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | | |
Collapse
|
24
|
Affiliation(s)
- Naomi Ditchfield
- University Hospitals of the North Midlands; Department of Respiratory Paediatrics; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Simon J Davies
- University Hospital of North Staffordshire; Department of Nephrology; Princes Rd Hartshill Stoke-on-Trent UK ST4 7LN
| | - Will Carroll
- University Hospitals of the North Midlands; Department of Paediatric Respiratory Medicine; Newcastle Road Stoke-on-Trent UK ST4 6QG
| |
Collapse
|
25
|
Kermode A, Hart P, Lucas R, Booth D, Carroll W, Nolan D, Cole J, Jones A, Trend S. Narrowband UVB phototherapy for clinically isolated syndrome: Delivering the benefits of all UVB-induced molecules. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Carroll W. Therapeutic overview of MS - emerging goals. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
27
|
Green J, Gilchrist FJ, Carroll W. Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jessica Green
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Will Carroll
- University Hospitals of the North Midlands; Department of Paediatric Respiratory Medicine; Newcastle Road Stoke-on-Trent UK ST4 6QG
| |
Collapse
|
28
|
Green J, Carroll W, Gilchrist FJ. Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica Green
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Will Carroll
- University Hospitals of the North Midlands; Department of Paediatric Respiratory Medicine; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| |
Collapse
|
29
|
Moriarty C, Carroll W. Paracetamol: pharmacology, prescribing and controversies. Arch Dis Child Educ Pract Ed 2016; 101:331-334. [PMID: 27206455 DOI: 10.1136/archdischild-2014-307287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/25/2016] [Accepted: 04/20/2016] [Indexed: 11/03/2022]
Affiliation(s)
| | - Will Carroll
- Academic Department of Paediatric, Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
30
|
Moriarty C, Carroll W. Ibuprofen in paediatrics: pharmacology, prescribing and controversies. Arch Dis Child Educ Pract Ed 2016; 101:327-330. [PMID: 27458064 DOI: 10.1136/archdischild-2014-307288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 11/04/2022]
Abstract
Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice.
Collapse
Affiliation(s)
- Camilla Moriarty
- Department of Paediatric, Chelsea and Westminster Hospital, London, UK
| | - Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
31
|
Ponnampalam A, de Sousa P, Carroll W. Recognising early meningitis: a missed opportunity to diagnose meningitis. BMJ Case Rep 2016; 2016:bcr-2016-214636. [PMID: 27516108 DOI: 10.1136/bcr-2016-214636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There are ∼250 cases of neonatal bacterial meningitis each year in the UK. Clinical evaluation of signs and symptoms of meningitis is challenging, particularly, during the neonatal period. Although uncommon, it is recognised that bacterial meningitis can be present in a child with an apparently normal cerebrospinal fluid (CSF) initially.We report the case of a newborn baby girl who was admitted with concerns regarding 2 dusky episodes. She underwent blood tests, a lumbar puncture and was started on intravenous antibiotics. With negative cultures, normal blood results and following a significant clinical improvement, antibiotics were discontinued after 48 hours and the baby was discharged home. She re-presented to the children's emergency department 7 hours later with a history of an apnoeic episode. A second CSF sample was suggestive of bacterial meningitis. We will discuss the published literature and the potential drawbacks of lumbar punctures and ways to diagnose meningitis early.
Collapse
Affiliation(s)
- Anusha Ponnampalam
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Paula de Sousa
- Department of Paediatrics, Conquest Hospital, Saint Leonards on Sea, UK
| | - Will Carroll
- Department of Paediatrics, Royal Stoke University Hospital, Stoke-on-Trent, UK
| |
Collapse
|
32
|
Abstract
Salbutamol has become a key drug in respiratory medicine since it was first developed by Sir David Jack et al in 1968, 5000 years after the β agonist ephedrine was first used in its raw form, as the Ma Huang herb in Chinese medicine to treat asthma. It is one of the most commonly encountered medicines in paediatric practice and the authors have found that an understanding of its pharmacology in clinical practice is incredibly helpful. In this article, we discuss its pharmacology and pharmacodynamics, practical prescribing points and some unresolved issues surrounding its use, which should serve to provide an essential working knowledge for the busy paediatrician.
Collapse
Affiliation(s)
- Paul Andrzejowski
- Sheffield Hand Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Will Carroll
- Department of Respiratory Paediatrics, University Hospitals of North Midlands, Staffordshire, UK
| |
Collapse
|
33
|
Patterson K, Goddard P, Desai M, Carroll W, Preece M, Gilchrist F. ePS01.1 A 7-year review of CF newborn screening results from a UK regional laboratory. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
34
|
Abstract
Codeine is a drug that until recently was widely used in children. It was endorsed by the WHO as the second step on the analgesic ladder for cancer pain and has been used routinely for postoperative and breakthrough pain. Recently, its safety and efficacy have been called into question, following deaths after adenotonsillectomy was associated with its use. This has led to regulation by the US Food and Drug Administration, European Medicines Agency and the UK Medicines and Healthcare products Regulatory Agency to place significant restrictions on its use, and some centres have stopped using it altogether.In this article, we discuss the developmental pharmacology underpinning its action, reviewing what is known about the pharmacokinetics, pharmacodynamics and pharmacogenetics in children, how this relates to prescribing, as well as the practical issues and the recent regulatory framework surrounding its use.
Collapse
Affiliation(s)
- Paul Andrzejowski
- Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Will Carroll
- Department of Respiratory Paediatrics, University Hospitals of North Midlands, Stoke-on-Trent, Staffordshire, UK
| |
Collapse
|
35
|
Carroll W. Education, education, education. Paediatr Respir Rev 2016; 17:30-1. [PMID: 26547509 DOI: 10.1016/j.prrv.2015.08.014] [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: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022]
Abstract
Patient outcomes can be influenced by one of three main mechanisms: the delivery of optimal clinical care, the conduct of high quality research and through teaching and mentorship of other health care professionals. Measurable educational outcomes include the mentorship of others, the publication of guidelines and the authorship of journal articles. There is good evidence to support an optimal profile for medical educators and evidence that optimal teaching can improve outcomes for children with asthma. The evidence for the value of clinical guidelines and even the publication of research is limited.
Collapse
Affiliation(s)
- Will Carroll
- Consultant Paediatrician, Derbyshire Children's Hospital, Uttoxeter Road, Derby, DE22 3NE.
| |
Collapse
|
36
|
Pulsipher MA, Langholz B, Wall DA, Schultz KR, Bunin N, Carroll W, Raetz E, Gardner S, Goyal RK, Gastier-Foster J, Borowitz M, Teachey D, Grupp SA. Risk factors and timing of relapse after allogeneic transplantation in pediatric ALL: for whom and when should interventions be tested? Bone Marrow Transplant 2015; 50:1173-9. [PMID: 25961775 DOI: 10.1038/bmt.2015.103] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/17/2015] [Accepted: 03/11/2015] [Indexed: 11/09/2022]
Abstract
We previously showed that minimal residual disease (MRD) detection pre-hematopoietic cell transplant (HCT) and acute GvHD (aGvHD) independently predicted risk of relapse in pediatric ALL. In this study we further define risk by assessing timing of relapse and the effects of leukemia risk category and post-HCT MRD. By multivariate analysis, pre-HCT MRD <0.1% and aGvHD by day +55 were associated with decreased relapse and improved event-free survival (EFS). Intermediate leukemia risk status predicted decreased relapse, and improved EFS and overall survival (OS). Patients with pre-HCT MRD ⩾0.1% who did not develop aGvHD compared with those with MRD <0.1% who did develop aGvHD had much worse survival (2 years EFS 18% vs 71%; P=0.001, 2 years OS 46 vs 74%; P=0.04). Patients with pre-HCT MRD <0.1% who did not experience aGvHD had higher rates of relapse than those who did develop aGvHD (40% vs 13%; P= 0.008). Post-HCT MRD led to a substantial increase in relapse risk (HR=4.5, P<0.01). Patients at high risk of relapse can be defined after transplant using leukemia risk category, presence of MRD pre or post HCT, and occurrence of aGvHD. An optimal window to initiate intervention to prevent relapse occurs between day +55 and +200 after HCT.
Collapse
Affiliation(s)
- M A Pulsipher
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute/University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA
| | - B Langholz
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - D A Wall
- Manitoba Blood and Marrow Transplant Program, Winnepeg, Manitoba, Canada
| | - K R Schultz
- Department of Pediatrics University of BC, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - N Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - W Carroll
- NYU Department of Pediatrics and Cancer Institute, NYU Langone Medical Center, New York, NY, USA
| | - E Raetz
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute/University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA
| | - S Gardner
- NYU Department of Pediatrics and Cancer Institute, NYU Langone Medical Center, New York, NY, USA
| | - R K Goyal
- Division of Blood and Marrow Transplantation and Cellular Therapies, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - M Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - D Teachey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
37
|
Snowise NG, Carroll W. What's in a grunt? A user's guide to RDS. J Paediatr Child Health 2014; 50:425-6. [PMID: 24548112 DOI: 10.1111/jpc.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2013] [Indexed: 11/28/2022]
|
38
|
|
39
|
Strautins K, Tschochner M, James I, Choo L, Dunn DS, Pedrini M, Kermode A, Carroll W, Nolan D. Combining HLA-DR risk alleles and anti-Epstein-Barr virus antibody profiles to stratify multiple sclerosis risk. Mult Scler 2013; 20:286-94. [DOI: 10.1177/1352458513498829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Risk factors for multiple sclerosis (MS) include human leukocyte antigen (HLA)-DR and Epstein-Barr virus (EBV)-specific antibody responses, including an epitope within EBV nuclear antigen 1 (EBNA-1) that is of recent interest. Objective: The objective of this paper is to assess case-control associations between MS risk and anti-EBV antibody levels as well as HLA-DR profiles, gender and age in a population-based cohort. Methods: Serological responses to EBV were measured in 426 MS patients and 186 healthy controls. HLA-DR typing was performed using sequence-based methods. Results: MS patients had significantly higher levels of antibodies against epitope-specific and polyspecific EBNA-1 and viral capsid antigen (VCA), compared with controls (all p < 10−15). In regression analyses, anti-EBNA-1 and anti-VCA antibody levels, protective HLA-DR*04/07/09 alleles and gender (all p < 0.003) contributed independently to a model that classified cases and controls with an odds ratio > 20 (sensitivity 92%, specificity 64%). Notably, the strong influence of high-risk HLA-DR alleles was abrogated after inclusion of EBV serology results. Conclusions: The ability to discriminate MS cases and controls can be substantially enhanced by including anti-EBV serology as well as HLA-DR risk profiles. These findings support the relevance of EBV-specific immunity in MS pathogenesis, and implicate both HLA-dependent and HLA-independent immune responses against EBNA-1 as prominent disease risk factors.
Collapse
Affiliation(s)
- K Strautins
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
- School of Veterinary and Life Sciences, Murdoch University, Australia
| | - M Tschochner
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
| | - I James
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
| | - L Choo
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
| | - DS Dunn
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
| | - M Pedrini
- Centre for Neuromuscular and Neurological Disorders, Australian Neuromuscular Research Institute, Sir Charles Gairdner Hospital, University of WA, Australia
| | - A Kermode
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Australia
- Centre for Neuromuscular and Neurological Disorders, Australian Neuromuscular Research Institute, Sir Charles Gairdner Hospital, University of WA, Australia
| | - W Carroll
- Department of Neurology, Sir Charles Gairdner Hospital, Australia
- Centre for Neuromuscular and Neurological Disorders, Australian Neuromuscular Research Institute, Sir Charles Gairdner Hospital, University of WA, Australia
| | - D Nolan
- Institute for Immunology & Infectious Diseases, Murdoch University, Australia
- Department of Clinical Immunology, Royal Perth Hospital, Australia
| |
Collapse
|
40
|
Nolan D, Castley A, Tschochner M, James I, Qiu W, Sayer D, Christiansen FT, Witt C, Mastaglia F, Carroll W, Kermode A. Contributions of vitamin D response elements and HLA promoters to multiple sclerosis risk. Neurology 2012; 79:538-46. [DOI: 10.1212/wnl.0b013e318263c407] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
41
|
Spencer S, Carroll W, Nabell L, Meredith R, Desmond R, Magnuson J, Rosenthal E. Phase II postoperative adjuvant radiotherapy and erlotinib in patients with stage III cutaneous squamous cell carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Karpova E, Emes R, Carroll W, Fryer A, Ismail K, Farrell W. O407 Folate supplementation in pregnancy can affect gene specific DNA methylation. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Affiliation(s)
- Rianna Burrill
- Department of Paediatrics, Northampton General Hospital, Northampton, UK.
| | | |
Collapse
|
44
|
Nabell LM, Peters G, Meredith R, Carroll W, Bonner J, Ove R, Spencer S. UAB 0210: A phase I/II trial of induction chemotherapy followed by concomitant docetaxel/radiotherapy with subcutaneous amifostine for advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6061 Background: Attempts to improve the outcome of locally advanced SCCHN have generally added chemotherapy to radiation, though the optimal manner of integration has been controversial. To impact distant and local control, we utilized neoadjuvant chemotherapy followed by concomitant boost radiation (CBR) with docetaxel as a radiosensitizer. To improve cytoprotection, subcutaneous amifostine was added during radiotherapy. Methods: From April 2003-March 2007 46 patients with stage III or IV newly diagnosed SCCHN were enrolled (30 Caucasian, 16 African-American). Treatment consisted of 3 cycles of neoadjuvant chemotherapy with cisplatin 75 mg/m2 and docetaxel 75 mg/m2 intravenously at 21 day intervals followed by CBR and concurrent dose-escalated weekly docetaxel starting at 20 mg/m2. Standard 2D radiotherapy was used in the majority of patients. Subcutaneous amifostine was administered at 500 mg during each day of radiation. Results: 39 patients were evaluable. The neoadjuvant chemotherapy was well tolerated by the majority of patients and appeared effective; no patient had progressive disease while on therapy. Three patients required a change to carboplatin due to toxicity. Weekly docetaxel during all weeks of CBR was not tolerable due to severe mucositis and the phase I component defined the MTD of concurrent docetaxel as 20 mg/m2 for 4 cycles during CBR. 4 patients (10%) had persistent disease at completion of treatment. Amifostine administration was well tolerated though 4 patients required discontinuation of the drug. The majority of recurrences have been localized at the primary site (6 patients). 3 patients developed isolated pulmonary metastasis. Only 2 patients remain PEG dependent with median follow-up of 24 months. Conclusions: Induction chemotherapy using cisplatin and docetaxel is feasible and easy to administer in the outpatient setting; those patients who had a major radiographic and clinical response did particularly well in follow-up. Weekly docetaxel can be safely and effectively administered during CBR with good local control. Amifostine can be safely administered via the subcutaneous route; the benefit in locally advanced patients is difficult to assess. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- L. M. Nabell
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - G. Peters
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - R. Meredith
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - W. Carroll
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - J. Bonner
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - R. Ove
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| | - S. Spencer
- UAB, Birmingham, AL; The Brody School of Medicine, East Carolina University, NC; University of Alabama, Birmingham, AL
| |
Collapse
|
45
|
Enderby B, Smith D, Carroll W, Lenney W. Hydrogen cyanide as a biomarker for Pseudomonas aeruginosa in the breath of children with cystic fibrosis. Pediatr Pulmonol 2009; 44:142-7. [PMID: 19148935 DOI: 10.1002/ppul.20963] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
HYPOTHESIS Hydrogen cyanide (HCN) is emitted by Pseudomonas aeruginosa (PA) in vitro. We hypothesized that exhaled HCN could be measured using Selected Ion Flow Tube Mass Spectrometry (SIFT-MS) and that concentrations would be higher in children with cystic fibrosis (CF) and PA infection than in children with asthma. METHODS Children aged 7-17 years with CF (n = 16) or asthma (n = 21) attending outpatient clinics provided breath samples between July and December 2007. HCN was measured using the SIFT-MS Profile 3 instrument. FeNO was measured with a Sievers NOA 280i analyzer. Baseline inter-group differences between HCN and FeNO concentrations were compared using the Mann-Whitney U test. Children were invited to re-attend fortnightly. Breath samples, spirometry, growth and clinical status were measured at each visit. RESULTS There were significant baseline differences in exhaled HCN and FeNO concentrations between the two groups. Children with CF had higher median HCN concentrations than those with asthma: 13.5 parts per billion (ppb) (IQR 8.1-16.5) versus 2.0 ppb (IQR 0.0-4.8) (P < 0.001). Children with CF had lower median FeNO levels compared to children with asthma: 13.4 ppb (IQR 8.9-17.6) versus 57.9 ppb (IQR 34.0-85.7) (P < 0.001). Intra-subject variability was high and significant changes in HCN concentrations were not observed related to changes in lung function or clinical status. CONCLUSION This study provides proof of principle that HCN is detectable in the breath of children with CF and is elevated compared to children with asthma. Further studies are required to capture data from acutely unwell children and more accurately delineate responses to treatment.
Collapse
Affiliation(s)
- Beth Enderby
- Academic Department of Paediatrics, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | | | | | | |
Collapse
|
46
|
Affiliation(s)
- J Antel
- McGill University, Montreal, Canada
| | - W Carroll
- Sir Charles Gairdner Hospital, Nedlands, Australia
| | | |
Collapse
|
47
|
Antel J, Carroll W, Thompson A. Differential diagnosis of initial isolated clinical presentations. Mult Scler 2008; 14:1153. [PMID: 18952829 DOI: 10.1177/1352458508098093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
48
|
|
49
|
Affiliation(s)
- Will Carroll
- Derby Children's Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
| | | |
Collapse
|
50
|
Morrison D, Moskowitz N, Bhojwani D, Lee H, Patel B, Horton T, Raetz E, Carroll W. Endogenous knock-down of survival genes improves chemotherapeutic response in a T-ALL cell line. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9522 Background: New targets for more effective, less toxic therapeutic approaches to childhood acute lymphoblastic leukemia (ALL) can be developed by discovering pathways unique to the blast. Using microarray technology, we identified potential target genes that are up-regulated at relapse compared to diagnosis (Blood 2006;108:711–7). Two genes, survivin and securin, were selected for analysis because they are involved in cell cycle regulation, apoptosis and cellular transformation. We hypothesized that decreasing endogenous expression of these genes would increase apoptosis and sensitize cells to chemotherapy. Methods: Short hairpin RNA constructs (shRNA) targeting both transcripts and a control shRNA were engineered. LSN2181295 (sodium salt of LY2181308), an antisense molecule targeting survivin developed by Eli Lilly and its mismatch control (LSN2293329) were also tested. The T- ALL cell line Molt4 was transiently transfected with shRNA constructs or antisense oligos. Western blot and qRT-PCR were performed to determine the time course of target knock-down while apoptosis was assessed by annexin-V labeling. Following transfection, cells were also treated with varying doses of etoposide and doxorubicin for 24 hrs prior to FACS analysis. Results: The survivin and securin shRNAs blocked endogenous gene expression by 80–90%, with maximal effect achieved at 48 hrs. Transfection of Molt4 cells with survivin and securin shRNAs induced ∼13% and 35% apoptosis, respectively, as compared to a control shRNA. When used in combination with chemotherapeutic agents, the shRNA constructs potentiated the effect of both doxorubicin and etoposide at low dosages (≤100 nM and ≤0.4 uM respectively, p values <0.01). The antisense survivin drug had a similar effect as the survivin shRNA and also potentiated the effect of vincristine. Conclusion: Targeting levels of survivin and securin in conjunction with standard chemotherapy maximizes leukemia cell kill and effectively lowers the amount of chemotherapy needed to achieve cell death. Such an approach may improve overall survival for patients at relapse and could also lead to the delivery of effective chemotherapy at less toxic doses. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- D. Morrison
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - N. Moskowitz
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - D. Bhojwani
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - H. Lee
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - B. Patel
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - T. Horton
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - E. Raetz
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| | - W. Carroll
- New York University School of Medicine, New York, NY; Eli Lilly and Company, Indianapolis, IN; Baylor College of Medicine, Houston, TX
| |
Collapse
|