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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Abstract
The perinatal brain is well equipped to react to the environment during sleep. Several lines of research in animals and humans prior to and immediately after birth have documented the capability to respond, to process and remember patterns of stimulation. In this article, we will summarize recent findings as well as previous work documenting the memory and learning capacities of the developing brain during sleep and wake states. The role of these sleep state dependent processes may play in the ability to adapt to the postnatal environment will be discussed.
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Affiliation(s)
- Bridget Callaghan
- Department of Psychiatry, Columbia University et à la Division of Developmental Neuroscience, New York State, Psychiatric Institute, New York, New York, États-Unis
| | - William P Fifer
- Department of Psychiatry, Columbia University et à la Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, États-Unis
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4
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Gilbert R, Brown M, Faria R, Fraser C, Donohue C, Rainford N, Grosso A, Sinha AK, Dorling J, Gray J, Muller-Pebody B, Harron K, Moitt T, McGuire W, Bojke L, Gamble C, Oddie SJ. Antimicrobial-impregnated central venous catheters for preventing neonatal bloodstream infection: the PREVAIL RCT. Health Technol Assess 2020; 24:1-190. [PMID: 33174528 DOI: 10.3310/hta24570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Clinical trials show that antimicrobial-impregnated central venous catheters reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is insufficient evidence for use in newborn babies. OBJECTIVES The objectives were (1) to determine clinical effectiveness by conducting a randomised controlled trial comparing antimicrobial-impregnated peripherally inserted central venous catheters with standard peripherally inserted central venous catheters for reducing bloodstream or cerebrospinal fluid infections (referred to as bloodstream infections); (2) to conduct an economic evaluation of the costs, cost-effectiveness and value of conducting additional research; and (3) to conduct a generalisability analysis of trial findings to neonatal care in the NHS. DESIGN Three separate studies were undertaken, each addressing one of the three objectives. (1) This was a multicentre, open-label, pragmatic randomised controlled trial; (2) an analysis was undertaken of hospital care costs, lifetime cost-effectiveness and value of information from an NHS perspective; and (3) this was a retrospective cohort study of bloodstream infection rates in neonatal units in England. SETTING The randomised controlled trial was conducted in 18 neonatal intensive care units in England. PARTICIPANTS Participants were babies who required a peripherally inserted central venous catheter (of 1 French gauge in size). INTERVENTIONS The interventions were an antimicrobial-impregnated peripherally inserted central venous catheter (coated with rifampicin-miconazole) or a standard peripherally inserted central venous catheter, allocated randomly (1 : 1) using web randomisation. MAIN OUTCOME MEASURE Study 1 - time to first bloodstream infection, sampled between 24 hours after randomisation and 48 hours after peripherally inserted central venous catheter removal. Study 2 - cost-effectiveness of the antimicrobial-impregnated peripherally inserted central venous catheter compared with the standard peripherally inserted central venous catheters. Study 3 - risk-adjusted bloodstream rates in the trial compared with those in neonatal units in England. For study 3, the data used were as follows: (1) case report forms and linked death registrations; (2) case report forms and linked death registrations linked to administrative health records with 6-month follow-up; and (3) neonatal health records linked to infection surveillance data. RESULTS Study 1, clinical effectiveness - 861 babies were randomised (antimicrobial-impregnated peripherally inserted central venous catheter, n = 430; standard peripherally inserted central venous catheter, n = 431). Bloodstream infections occurred in 46 babies (10.7%) randomised to antimicrobial-impregnated peripherally inserted central venous catheters and in 44 (10.2%) babies randomised to standard peripherally inserted central venous catheters. No difference in time to bloodstream infection was detected (hazard ratio 1.11, 95% confidence interval 0.73 to 1.67; p = 0.63). Secondary outcomes of rifampicin resistance in positive blood/cerebrospinal fluid cultures, mortality, clinical outcomes at neonatal unit discharge and time to peripherally inserted central venous catheter removal were similar in both groups. Rifampicin resistance in positive peripherally inserted central venous catheter tip cultures was higher in the antimicrobial-impregnated peripherally inserted central venous catheter group (relative risk 3.51, 95% confidence interval 1.16 to 10.57; p = 0.02) than in the standard peripherally inserted central venous catheter group. Adverse events were similar in both groups. Study 2, economic evaluation - the mean cost of babies' hospital care was £83,473. Antimicrobial-impregnated peripherally inserted central venous catheters were not cost-effective. Given the increased price, compared with standard peripherally inserted central venous catheters, the minimum reduction in risk of bloodstream infection for antimicrobial-impregnated peripherally inserted central venous catheters to be cost-effective was 3% and 15% for babies born at 23-27 and 28-32 weeks' gestation, respectively. Study 3, generalisability analysis - risk-adjusted bloodstream infection rates per 1000 peripherally inserted central venous catheter days were similar among babies in the trial and in all neonatal units. Of all bloodstream infections in babies receiving intensive or high-dependency care in neonatal units, 46% occurred during peripherally inserted central venous catheter days. LIMITATIONS The trial was open label as antimicrobial-impregnated and standard peripherally inserted central venous catheters are different colours. There was insufficient power to determine differences in rifampicin resistance. CONCLUSIONS No evidence of benefit or harm was found of peripherally inserted central venous catheters impregnated with rifampicin-miconazole during neonatal care. Interventions with small effects on bloodstream infections could be cost-effective over a child's life course. Findings were generalisable to neonatal units in England. Future research should focus on other types of antimicrobial impregnation of peripherally inserted central venous catheters and alternative approaches for preventing bloodstream infections in neonatal care. TRIAL REGISTRATION Current Controlled Trials ISRCTN81931394. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK, London, UK
| | - Michaela Brown
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University IWK Health Centre, Halifax, NS, Canada
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Sam J Oddie
- Centre for Reviews and Dissemination, University of York, York, UK.,Bradford Neonatology, Bradford Royal Infirmary, Bradford, UK
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5
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Tume LN, Woolfall K, Arch B, Roper L, Deja E, Jones AP, Latten L, Pathan N, Eccleson H, Hickey H, Parslow R, Preston J, Beissel A, Andrzejewska I, Gale C, Valla FV, Dorling J. Routine gastric residual volume measurement to guide enteral feeding in mechanically ventilated infants and children: the GASTRIC feasibility study. Health Technol Assess 2020; 24:1-120. [PMID: 32458797 DOI: 10.3310/hta24230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The routine measurement of gastric residual volume to guide the initiation and delivery of enteral feeding is widespread in paediatric intensive care and neonatal units, but has little underlying evidence to support it. OBJECTIVE To answer the question: is a trial of no gastric residual volume measurement feasible in UK paediatric intensive care units and neonatal units? DESIGN A mixed-methods study involving five linked work packages in two parallel arms: neonatal units and paediatric intensive care units. Work package 1: a survey of units to establish current UK practice. Work package 2: qualitative interviews with health-care professionals and caregivers of children admitted to either setting. Work package 3: a modified two-round e-Delphi survey to investigate health-care professionals' opinions on trial design issues and to obtain consensus on outcomes. Work package 4: examination of national databases to determine the potential eligible populations. Work package 5: two consensus meetings of health-care professionals and parents to review the data and agree consensus on outcomes that had not reached consensus in the e-Delphi study. PARTICIPANTS AND SETTING Parents of children with experience of ventilation and tube feeding in both neonatal units and paediatric intensive care units, and health-care professionals working in neonatal units and paediatric intensive care units. RESULTS Baseline surveys showed that the practice of gastric residual volume measurement was very common (96% in paediatric intensive care units and 65% in neonatal units). Ninety per cent of parents from both neonatal units and paediatric intensive care units supported a future trial, while highlighting concerns around possible delays in detecting complications. Health-care professionals also indicated that a trial was feasible, with 84% of staff willing to participate in a trial. Concerns expressed by junior nurses about the intervention arm of not measuring gastric residual volumes were addressed by developing a simple flow chart and education package. The trial design survey and e-Delphi study gained consensus on 12 paediatric intensive care unit and nine neonatal unit outcome measures, and identified acceptable inclusion and exclusion criteria. Given the differences in physiology, disease processes, environments, staffing and outcomes of interest, two different trials are required in the two settings. Database analyses subsequently showed that trials were feasible in both settings in terms of patient numbers. Of 16,222 children who met the inclusion criteria in paediatric intensive care units, 12,629 stayed for > 3 days. In neonatal units, 15,375 neonates < 32 weeks of age met the inclusion criteria. Finally, the two consensus meetings demonstrated 'buy-in' from the wider UK neonatal communities and paediatric intensive care units, and enabled us to discuss and vote on the outcomes that did not achieve consensus in the e-Delphi study. CONCLUSIONS AND FUTURE WORK Two separate UK trials (one in neonatal units and one in paediatric intensive care units) are feasible to conduct, but they cannot be combined as a result of differences in outcome measures and treatment protocols, reflecting the distinctness of the two specialties. TRIAL REGISTRATION Current Controlled Trials ISRCTN42110505. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 23. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, UK
| | - Kerry Woolfall
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Barbara Arch
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Louise Roper
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Deja
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Lynne Latten
- Nutrition and Dietetics, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Helen Eccleson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | - Jennifer Preston
- Department of Women's and Children's Health, Institute of Translational Medicine (Child Health), Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Anne Beissel
- Neonatal Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France
| | | | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Frederic V Valla
- Paediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon-Bron, France
| | - Jon Dorling
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Carreras-Abad C, Cochet M, Hall T, Ramkhelawon L, Khalil A, Peregrine E, Vinayakarao L, Sivarajan S, Hamid R, Planche T, Sheridan E, Winchester S, Plumb J, Djennad A, Andrews N, Le Doare K, Heath P. Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study. Health Technol Assess 2019; 23:1-40. [PMID: 31855555 PMCID: PMC6936166 DOI: 10.3310/hta23670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Group B streptococcus is the leading cause of infection in infants. Currently, intrapartum antibiotic prophylaxis is the major strategy to prevent invasive group B streptococcus disease. However, intrapartum antibiotic prophylaxis does not prevent maternal sepsis, premature births, stillbirths or late-onset disease. Maternal vaccination may offer an alternative strategy. Multivalent polysaccharide protein conjugate vaccine development is under way and a serocorrelate of protection is needed to expedite vaccine licensure. OBJECTIVES The ultimate aim of this work is to determine the correlate of protection against the major group B streptococcus disease-causing serotypes in infants in the UK. The aim of this feasibility study is to test key operational aspects of the study design. DESIGN Prospective cohort study of pregnant women and their infants in a 6-month period (1 July to 31 December 2018). SETTING Five secondary and tertiary hospitals from London and South England. National iGBS disease surveillance was conducted in all trusts in England and Wales. PARTICIPANTS Pregnant women aged ≥ 18 years who were delivering at one of the selected hospitals and who provided consent during the study period. There were no exclusion criteria. INTERVENTIONS No interventions were performed. MAIN OUTCOME MEASURES (1) To test the feasibility of collecting serum at delivery from a large cohort of pregnant women. (2) To test the key operational aspects for a proposed large serocorrelates study. (3) To test the feasibility of collecting samples from those with invasive group B streptococcus. RESULTS A total of 1823 women were recruited during the study period. Overall, 85% of serum samples were collected at three sites collecting only cord blood. At the two sites collecting maternal, cord and infant blood samples, the collection rate was 60%. A total of 614 women were screened for group B streptococcus with a colonisation rate of 22% (serotype distribution: 30% III, 25% Ia, 16% II, 14% Ib, 14% V and 1% IV). A blood sample was collected from 34 infants who were born to colonised women. Maternal and infant blood and the bacterial isolates for 15 newborns who developed invasive group B streptococcal disease during the study period were collected (serotype distribution: 29% III, 29% II, 21% Ia, 7% Ib, 7% IV and 7% V). LIMITATIONS Recruitment and sample collection were dependent on the presence of research midwives rather than the whole clinical team. In addition, individualised consent limited the number of women who could be approached each day, and site set-up for the national surveillance study and the limited time period of this feasibility study limited recruitment of all eligible participants. CONCLUSIONS We have verified the feasibility of collecting and processing rectovaginal swabs and blood samples in pregnant women, as well as samples from those with invasive group B streptococcal disease. We have made recommendations for the recruitment of cases within the proposed GBS3 study and for controls both within GBS3 and as an extension of this feasibility study. FUTURE WORK A large case-control study comparing specific immunoglobulin G levels in mothers whose infants develop invasive group B streptococcal disease with those in colonised mothers whose infants do not develop invasive group B streptococcal disease is recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN49326091; IRAS project identification number 246149/REC reference number 18/WM/0147. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clara Carreras-Abad
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Madeleine Cochet
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Tom Hall
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Laxmee Ramkhelawon
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, London, UK
| | - Latha Vinayakarao
- Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sharmila Sivarajan
- Department of Obstetrics and Gynaecology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Rosol Hamid
- Department of Obstetrics and Gynaecology, Croydon Health Services NHS Trust, Croydon, UK
| | - Tim Planche
- Microbiology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Winchester
- Microbiology Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Jane Plumb
- Group B Strep Support Group, Haywards Heath, UK
| | - Abdelmajid Djennad
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Paul Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
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7
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St James-Roberts I, Garratt R, Powell C, Bamber D, Long J, Brown J, Morris S, Dyson S, Morris T, Bhupendra Jaicim N. A support package for parents of excessively crying infants: development and feasibility study. Health Technol Assess 2019; 23:1-144. [PMID: 31597591 DOI: 10.3310/hta23560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder ('colic'), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants' outcomes and how NHS money is spent. OBJECTIVES To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS. DESIGN Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents' guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents' and NHS professionals' willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial. SETTING Primary health care. PARTICIPANTS Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs. INTERVENTIONS The support package included a website, a printed booklet and a programme of cognitive-behavioural therapy-based sessions delivered to parents by a qualified practitioner. MAIN OUTCOME MEASURES (1) Demographic data, (2) figures for parents' use of the package components and continuation in the study, (3) parents' and HVs'/SCPHNs' ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs. RESULTS Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified. LIMITATIONS No control group was included. Most of the recruited parents were white, well educated and in stable relationships. CONCLUSIONS Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable. TRIAL REGISTRATION Current Controlled Trials ISRCTN84975637. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ian St James-Roberts
- Thomas Coram Research Unit, University College London Institute of Education, University College London, London, UK
| | - Rosemary Garratt
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Charlotte Powell
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Deborah Bamber
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jaqui Long
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jayne Brown
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Sue Dyson
- School of Health and Education, Middlesex University, London, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
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FRIART J, GILLOT EP. [MODIFICATIONS OF THE SPHYGMOGRAM IN SENESCENCE]. Acta Clin Belg 2016; 19:81-97. [PMID: 14178612 DOI: 10.1080/17843286.1964.11717739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sutherland ER, Busse WW. Designing clinical trials to address the needs of childhood and adult asthma: the National Heart, Lung, and Blood Institute's AsthmaNet. J Allergy Clin Immunol 2014; 133:34-8.e1. [PMID: 24369797 DOI: 10.1016/j.jaci.2013.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Abstract
In 2008, the National Heart, Lung, and Blood Institute announced its intent to support a new asthma network known as AsthmaNet. This clinical trials consortium, now in its fifth year, has been charged with developing and executing clinical trials to address the most important asthma management questions and identify new treatment approaches in pediatric and adult patients. This review will discuss the organization of AsthmaNet and the scientific context in which the network was developed and began its work, report the results of an internal priority-setting exercise designed to guide the network's scientific strategy, and highlight the portfolio of clinical trials, proof-of-concept studies, and mechanistic studies planned for the 7-year period of the network to update the global asthma community regarding the progress and processes of the network.
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Affiliation(s)
- E Rand Sutherland
- Department of Medicine, National Jewish Health, the University of Colorado School of Medicine, Denver, Colo.
| | - William W Busse
- Department of Medicine, University of Wisconsin, Madison, Wis
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Rowntree G. Accidents among children under two years of age in Great Britain: [Some findings of a National Questionnaire inquiry carried out by a Joint Committee of the Royal College of Obstetricians and Gynaecologists, the Population Investigation Committee and the Institute of Child Health (University of London) with the aid of a grant from the Nuffield Foundation]. J Hyg (Lond) 1950; 48:323-37. [PMID: 20475816 DOI: 10.1017/s0022172400015096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
1. In the spring of 1948 the health visitors of 422 authorities in Britain obtained information from 4683 mothers on accidental injuries sustained by their young children during the first 2 years of life. This study formed part of a questionnaire inquiry into the health and development of these young children, who had all been born in one week, 3–9 March 1946.2. The mothers seem to have remembered accurately the more serious accidents which received professional treatment during the 2 years under review. It is possible that some of the minor injuries which had not been treated were not recalled or entered on the questionnaires.3. The rate for all serious injuries which received professional care was 79·6 per 1000 children in the sample. Treated cuts were almost as frequent as treated burns or scalds, each being sustained by about 37 per 1000 children. There were only 7·5 fractures per 1000 children. The sum of the rates for each type of injury (81·3 per 1000) slightly exceeds the combined rate for all children injured (79·6 per 1000). This is due to the fact that in calculating the former rates eight children who were each involved in two serious accidents of different types were counted twice, i.e. once under each type of injury sustained.4. In 1946–8 treatment of young children for burns or scalds and for serious cuts was most frequently given by general practitioners. Children under 2 years of age were admitted to accident wards of hospitals chiefly for the treatment of serious burns or scalds. Fractures were usually treated at out-patients’ departments.5. Although almost all accidents occurred at home, variations in housing conditions, as measured by crowding and the domestic facilities available, had little effect on the incidence of accidents among children under 2 years of age. Accidents happened most frequently when the children were beginning to walk and becoming inquisitive, and most injuries occurred either because they were not steady on their feet or because they had not developed ‘heat-sense’.6. Since domestic help was rare, most children had to play in the kitchen or living room while their mothers were doing the housework, cooking and laundry. In these circumstances, they were often exposed to the risk of injury.
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FILLING S, JOHNSEN S. AUDIOLOGICAL EXAMINATIONS OF PATIENTS IN A DANISH HOSPITAL. Acta Otolaryngol 2009; 188:SUPPL 188:347+. [PMID: 14146696 DOI: 10.3109/00016486409134587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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CALCAGNO PL, HUSSON GS, RUBIN MI. Measurement of "extracellular fluid space" in infants by equilibration technic using inulin and sodium ferrocyanide. Exp Biol Med (Maywood) 2004; 77:309-11. [PMID: 14854031 DOI: 10.3181/00379727-77-18761] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
1. Congenital pseudarthrosis of the clavicle is described. 2. The distinction from cranio-cleido-dysostosis and from birth fracture is stressed. 3. Details are given of two patients reported in the literature and a further nine patients are described. 4. The embryology, natural history and treatment of the condition are discussed.
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FIELD JB, EPSTEIN S, EGAN T. STUDIES IN GLYCOGEN STORAGE DISEASES. I. INTESTINAL GLUCOSE-6-PHOSPHATASE ACTIVITY IN PATIENTS WITH VON GIERKE'S DISEASE AND THEIR PARENTS. J Clin Invest 1996; 44:1240-7. [PMID: 14328400 PMCID: PMC292598 DOI: 10.1172/jci105230] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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RUTTENBERG HD, JUE KL, ELLIOTT LP, ANDERSON RC, EDWARDS JE. CARDIAC MYOPATHY, PROBABLY OF CONGENITAL ORIGIN. A CASE SIMULATING ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY TRUNK. Circulation 1996; 29:768-76. [PMID: 14153948 DOI: 10.1161/01.cir.29.5.768] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical and pathologic findings are presented in a 1-year-old child with an unusual cardiac myopathy of the left ventricle. [see figure in the PDF file] [see figure in the PDF file] The clinical findings suggested the diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk. These features included insidious onset of cardiac failure in the first year of life, massive cardiomegaly with nearly normal pulmonary vasculature, absence of cyanosis and of a cardiac murmur, and electrocardiographic and vectorcardiographic findings of left ventricular hypertrophy with severe myocardial ischemia or infarction.
[see figure in the PDF file]
Angiocardiograph studies, which did not support this diagnosis, revealed an aneurysmally dilated left ventricle with unusual internal septations and loculations.
The necropsy showed concentric semicircular muscular ridges and grooves in the apical portion of the left ventricle and a peculiar fibrous endocardial network of the same chamber. It is suggested that this process may be congenital in origin.
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