ORCID Profile
0000-0001-7910-5048
Current Organisations
Great Ormond Street Hospital For Children NHS Trust
,
Queensland University of Technology
,
Trinity College Dublin
,
The University of Edinburgh
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
Complex pain in children and young people: part I—assessment
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1093/BJAED/MKX018
Management of anaphylaxis in children undergoing oral food challenges in an adapted COVID-19 field hospital
Publisher: BMJ
Date: 25-08-2021
Correction to: Day-case pelvic osteotomy for developmental dysplasia of the hip
Publisher: SAGE Publications
Date: 06-2021
Intra‐operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery
Publisher: Wiley
Date: 07-2020
DOI: 10.1002/ANR3.12068
Abstract: A 15‐year‐old boy with cerebral palsy and epilepsy presented for a posterior spinal fusion as part of staged repair of thoracolumbar scoliosis. Total intravenous anaesthesia was induced and maintained with propofol, remifentanil and ketamine. Following prone positioning, cervical traction was applied. Polyuria developed intra‐operatively, from 4 to 18 ml.kg −1 .h −1 . There was a corresponding rise in plasma sodium concentration from 132 to 145 mmol.l −1 . Haemodynamic stability was maintained with boluses of Hartmann's solution and a noradrenaline infusion. Given the possibility of diabetes insipidus due to reduced cerebral perfusion pressure, the cervical traction was removed. This initially showed a good response with a transient reduction in polyuria to 3 ml.kg −1 .h −1 before rising to 8 ml.kg −1 .h −1 . Subsequently, a vasopressin infusion was started with normalisation of diuresis and plasma sodium concentration by the end of surgery. Diabetes insipidus is an endocrine disorder related to lack of production or insensitivity to vasopressin. In the peri‐operative period, it is mainly associated with pituitary surgery and rarely with spinal surgery. To the authors' knowledge, this is only the second report of diabetes insipidus associated with staged scoliosis surgery. Cervical traction should be considered as a potential cause of intra‐operative diabetes insipidus.
Accuracy of Identification of the Cricothyroid Membrane in Female Subjects Using Palpation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Social deprivation and paediatric chronic pain referrals in Ireland: a cross-sectional study
Publisher: Walter de Gruyter GmbH
Date: 03-06-2021
Abstract: Social deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. Our primary objective was to determine if there was a relationship between social deprivation and paediatric chronic pain referrals in Ireland. Secondary objectives included analysing for differences between deprivation groups in pain characteristics and function that are recorded at first clinic visit. Families attending the national paediatric complex pain service in Dublin, Ireland, complete questionnaires on pain characteristics, parental pain catastrophizing, and pain-related disability including sleep quality and school attendance. We retrospectively reviewed records from between February 2016 and November 2019 on 288 patients. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on data from the Irish national census. Referrals followed a normal distribution across deprivation grades. Children in the disadvantaged group had a longer duration of pain, greater use of screens at bedtime, and longer sleep onset latency. Parents in the disadvantaged group had significantly higher levels of parental pain catastrophizing. In Ireland, while paediatric chronic pain referrals were normally distributed across deprivation group, the disadvantaged group was different in several ways that may be clinically significant. Further work will be needed to determine the longitudinal relationship between these factors before and after the referral and initial review. Screening for, and targeting, potential risk factors for pain chronicity may be needed to harmonize treatment outcomes in children from socially disadvantaged families.
Central and systemic inflammatory responses to thoracotomy — Potential implications for acute and chronic postsurgical pain
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.JNEUROIM.2015.06.010
Abstract: Chronic postsurgical pain (CPSP) may affect up to 70% of patients after surgery. Glial and immune mediators have been implicated in the pathogenesis of chronic postsurgical pain. Our objective was to study cerebrospinal fluid (CSF) and serum concentrations of IL-1β, IL-6, IL-8, IL-10, IFNγ and TNFα over a 72-hour period in patients undergoing a thoracotomy and oesophagectomy. Despite adequate pain control, thoracotomy was still associated with significant central and peripheral inflammation. This must be taken into consideration in planning future strategies to prevent CPSP.
Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.IJOA.2013.07.007
Abstract: In the event of failure to secure the airway by conventional means, it may be necessary to perform invasive airway access via the cricothyroid membrane. No studies have addressed anatomy of this structure in the obstetric population. We aimed to review the anatomical variation of this structure in a population of childbearing age. We searched the radiology database for computed tomography studies of the neck performed in a 13-month period in consecutive patients aged 15-55 years. Studies on 18 females and 22 males were reviewed. Male patients were included for comparison. Data were reconstructed using a high spatial frequency algorithm to optimise spatial resolution. Five parameters were measured: distance from the skin to the membrane, maximum midline height of the membrane in the vertical plane, maximum transverse diameter of the membrane, neck diameter and cartilaginous calcification. The distance (mean range) from skin to the membrane was similar in females and males (16.2 [3-33] vs. 13.9 [3-37] mm, P = 0.42). The vertical height (9.9 [7-17] vs. 11.4 [8-15] mm, P = 0.04) and maximum width of the membrane (14.5 [10-17] mm vs. 12.5 [10-15] mm, P < 0.01) were greater in males. Cartilaginous calcification was low and did not differ between genders. The cricothyroid membrane is not necessarily a superficial structure and consequently may be difficult to palpate. The smallest dimensions of the membrane indicate that smaller than recommended cricothyroidotomy devices may be required in some patients as the external diameter of commercial trocar devices and tracheal tubes may exceed 7 mm.
ICD-11 Classification of Pediatric Chronic Pain Referrals in Ireland, with Secondary Analysis of Primary vs Secondary Pain Conditions
Publisher: Oxford University Press (OUP)
Date: 26-03-2021
DOI: 10.1093/PM/PNAB116
Abstract: To classify pediatric chronic pain referrals in Ireland according to the classification system of the 11th version of the International Classification of Diseases (ICD-11). In addition, differences between primary and secondary pain groups were assessed. Retrospective review of complex pain assessment forms completed at the time of initial attendance at pediatric chronic pain clinics in Dublin, Ireland. Patients were classified as having a chronic primary (CPP) or chronic secondary (CSP) pain condition as per ICD-11 classification. Secondary analysis of between-group and within-group differences between primary and secondary pain conditions was undertaken. Of 285 patients coded, 123 patients were designated as having a CPP condition (77% of whom were assigned an adjunct parent code) and 162 patients as having a CSP condition (61% of whom were assigned an adjunct parent code). Between-group comparisons found that the lowest reported pain scores were higher in CPP than in CSP conditions. There were stronger correlations between parental pain catastrophizing and pain intensity, school attendance, and pain interference with social activities in the CSP group than in the CPP group. The majority of children with both CPP and CSP were assigned multiple parent codes. There appears to be a gradient in the differences in biopsychosocial profile between CPP and CSP conditions. Additional field testing of the ICD-11 classification in pediatric chronic pain will be required.
Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane
Publisher: Wiley
Date: 27-05-2019
DOI: 10.1111/PAN.13658
Abstract: Emergency front of neck airway is a recommended airway rescue strategy in children over 1 year old. Surgical tracheostomy is advocated as the first-line technique, but in the absence of an ear, nose and throat surgeon cricothyroidotomy or tracheostomy is proposed. Recent research shows that clinical identification of the cricothyroid membrane is frequently inaccurate in older children and adults and has prompted investigation of ultrasound as a potential clinical tool for emergency front of neck airway. Advance knowledge of the dimensions of the pediatric cricothyroid membrane may assist clinicians in determining the feasibility of emergency front of neck airway, optimum technique, and equipment. The aim of this study was to assess the accuracy of ultrasound-assisted pediatric cricothyroid membrane localization and dimension measurement using magnetic resonance imaging as the reference standard. After structured training, two pediatric anesthesiology trainees used ultrasound to identify and measure the dimensions of the cricothyroid membrane in pediatric patients undergoing elective magnetic resonance imaging of the head and neck under general anesthesia. A pediatric radiologist reviewed the corresponding magnetic resonance imaging scans and measured the height of the cricothyroid membrane. The accuracy of the cricothyroid membrane height as measured by ultrasound was compared to that measured by magnetic resonance imaging. Twenty-two patients were included in the study. The cricothyroid membrane was accurately identified by ultrasound in all cases. The correlation coefficient for cricothyroid membrane height measured by ultrasound and that measured by magnetic resonance imaging was 0.98 (95% C.I 0.95-0.99, P < 0.0001). The bias was -0.16 mm and the precision was 0.19 mm. All differences were within the a priori limits of agreement. The 95% limits of agreement were -0.54 to 0.22 mm. Ultrasound can be used to accurately identify and measure cricothyroid membrane height in pediatric patients. This approach could have clinical and research utility.
Social deprivation and profile of referrals and disability in paediatric chronic pain: a cross-sectional study
Publisher: Cold Spring Harbor Laboratory
Date: 27-02-2020
DOI: 10.1101/2020.02.24.20027037
Abstract: Social deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. This study is a retrospective, cross-sectional analysis of referrals to the National Paediatric Complex Pain Service in Ireland to assess if there is any link between social deprivation and pattern of referrals. Secondary objectives included determining any additional differences between deprivation categories and pain characteristics, parental pain catastrophizing, and pain-related disability, including sleep quality and school attendance. We recorded data on 289 children referred to the NPCPS between February 2016 and November 2019. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on Irish national census data. The results of the primary analysis showed referrals have a normal distribution across the deprivation index, although the disadvantaged group had a longer duration of pain at time of first clinic review (p=0.01). Secondary analyses showed deprivation is associated with higher levels of parental pain catastrophizing (p=0.0016), most significantly for helplessness (p=0.0009), and higher use of screens at bedtime (p=0.002) with longer sleep onset latency (p=0.04). However, there were similar rates of sleep disturbance, school attendance, social interference across the deprivation groups. These findings may indicate inequities in access or differences in service utilization for children from socially disadvantaged families. The differences in sleep hygiene and parental pain catastrophizing may indicate the need to screen for these potential mediators of treatment outcome, which may require targeted intervention when present, in order to harmonise treatment responses across deprivation grades. Social deprivation is associated with an increased risk of chronic pain in childhood, however children from deprived areas may be under-represented in specialist paediatric pain centres. This is be due to inequities in access to services and also differences in healthcare utilisation, possibly due the cognitive burden of poverty. This study found that while referrals were normally distributed across social deprivation grades, children from the disadvantaged group had pain for longer prior to their first clinic review. This may indicate differences in healthcare utilisation by disadvantaged families. Additionally, we found differences in sleep hygiene and parental pain catastrophizing, which are both of these are known mediators of pain chronicity. Due to potential differences in healthcare utilisation across deprivation grades, clinical pathways might need adaptation for disadvantaged families for greater efficacy. Targeted interventions that address sleep hygiene and parental catastrophizing might also be considered early in a treatment pathway for disadvantaged families, perhaps with more scheduled follow-up, to harmonise treatment responses across deprivation grades.
“Why Isn’t It Going Away?”: A Qualitative Exploration of Worry and Pain Experiences in Adolescents with Chronic Pain
Publisher: Oxford University Press (OUP)
Date: 10-2020
DOI: 10.1093/PM/PNAA245
Abstract: The role of cognition is central to the fear avoidance (FA) model of chronic pain (CP), which emphasizes the importance of catastrophic pain interpretations and has been shown to be applicable to pediatric CP populations. However, while we know that pain catastrophizing plays a distinct role in influencing outcomes for children with CP, we know little about the specifics of how young people with CP experience catastrophizing and worry, as well as their general pain beliefs. To qualitatively explore beliefs about and experiences of worry and pain among a purposeful s le of adolescents with CP. In idual semistructured interviews with 12 adolescents (aged 12–17) with varying forms of CP attending an outpatient pain clinic in a general children’s hospital. Relevant psychometric measures were administered orally to further inform the data. Data were analyzed using critical realist thematic analysis. Three themes and one subtheme were identified. Themes were 1) the worry ripple: mind, body, and behavior (subtheme: worry content: personal competence and health) 2) the pain mystery: living in a “scribble of black” and 3) the resist or avoid conundrum. The findings highlight the need for psychological interventions targeting acceptance of uncertainty and also informing education on mind/body connections in adolescents with CP.
Complex pain in children and young people; part 2: management
Publisher: Elsevier BV
Date: 03-2018
Trickle-down healthcare in paediatric chronic pain
Publisher: Elsevier BV
Date: 08-2019
Cerebrospinal fluid levels of glial cell-derived neurotrophic factor correlate with spinal cord stimulation frequency in patients with neuropathic pain: a preliminary report
Publisher: Springer Science and Business Media LLC
Date: 08-2014
DOI: 10.1038/SC.2014.81
Abstract: Case series. To evaluate relationships between spinal cord stimulation (SCS) parameters and levels of glial cell-derived neurotrophic factor (GDNF). Ambulatory pain clinic of St James's Hospital, Dublin, Ireland. Nine patients with an implanted SCS and Failed Back Surgery Syndrome (FBSS) were administered the Brief Pain Inventory and Short Form (36) Health Survey. Following a lumbar puncture, levels of GDNF in cerebrospinal fluid (CSF) were assayed and correlated with stimulation parameters. Controls were patients with arthritic back pain who were matched for age, gender and SF-36 score. Concentrations of GDNF in CSF are higher in patients with FBSS than controls (P=0.002) and correlate with SCS frequency (P=0.029). Concentrations of GDNF in CSF are higher in neuropathic pain and appear to be related to stimulation frequency. Further work is needed to evaluate this potential relationship, both in neuropathic pain and in other contexts such as locomotor dysfunction.
Cerebrospinal Fluid Levels of Vascular Endothelial Growth Factor Correlate With Reported Pain and Are Reduced by Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome
Publisher: Elsevier BV
Date: 11-2013
Back to the future: lifelong changes in pain processing in ‘ageing of prematurity’
Publisher: Elsevier BV
Date: 09-2018
Related Organisations
Great Ormond Street Hospital For Children NHS Trust
Location: United Kingdom of Great Britain and Northern Ireland
The University Of Edinburgh
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Kevin McCarthy.