ORCID Profile
0000-0001-8135-1520
Current Organisation
University of Queensland
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Publisher: Springer Science and Business Media LLC
Date: 13-03-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-05-2023
Publisher: Springer Science and Business Media LLC
Date: 24-06-2023
Publisher: SAGE Publications
Date: 19-01-2021
Abstract: Developmental surveillance tools are used to closely monitor the early development of infants and young children. This study provides a novel implementation of a multidimensional item response model, using Bayesian hierarchical priors, to construct developmental profiles for a small s le of children ( N = 115) with sparse data collected through an online developmental surveillance tool. The surveillance tool records 348 developmental milestones measured from birth to three years of age, within six functional domains: auditory, hands, movement, speech, tactile, and vision. The profiles were constructed in three steps: (1) the multidimensional item response model, embedded in the Bayesian hierarchical framework, was implemented in order to measure both the latent abilities of the children and attributes of the milestones, while retaining the correlation structure among the latent developmental domains (2) subsequent hierarchical clustering of the multidimensional ability estimates enabled identification of subgroups of children and (3) information from the posterior distributions of the item response model parameters and the results of the clustering were used to construct a personalized profile of development for each child. These in idual profiles support early identification of, and personalized early interventions for, children with developmental delay.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-061431
Abstract: The Surviving Sepsis C aign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool. Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds. Twelve emergency departments (EDs) in Queensland, Australia. 3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis. A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination. Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED. The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results. A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.
Publisher: American Academy of Pediatrics (AAP)
Date: 25-05-2022
Abstract: Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world. This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale. There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of “sepsis.” The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction. Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2021
DOI: 10.1186/S12913-021-07128-2
Abstract: Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis C aign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs. This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses’ perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables. In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% ( IQR = 46.7–66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score. Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.
Publisher: Public Library of Science (PLoS)
Date: 02-06-2020
Publisher: Frontiers Media SA
Date: 17-04-2023
DOI: 10.3389/FPED.2023.1140121
Abstract: The Surviving Sepsis C aign recommends systematic screening for sepsis. Although many sepsis screening tools include parent or healthcare professional concern, there remains a lack of evidence to support this practice. We aimed to test the diagnostic accuracy of parent and healthcare professional concern in relation to illness severity, to diagnose sepsis in children. This prospective multicenter study measured the level of concern for illness severity as perceived by the parent, treating nurse and doctor using a cross-sectional survey. The primary outcome was sepsis, defined as a pSOFA score & . The unadjusted area under receiver-operating characteristic curves (AUC) and adjusted Odds Ratios (aOR) were calculated. Two specialised pediatric Emergency Departments in Queensland Children aged 30 days to 18 years old that were evaluated for sepsis None 492 children were included in the study, of which 118 (23.9%) had sepsis. Parent concern was not associated with sepsis (AUC 0.53, 95% CI: 0.46–0.61, aOR: 1.18 0.89–1.58) but was for PICU admission (OR: 1.88, 95% CI: 1.17–3.19) and bacterial infection (aOR: 1.47, 95% CI: 1.14–1.92). Healthcare professional concern was associated with sepsis in both unadjusted and adjusted models (nurses: AUC 0.57, 95% CI-0.50, 0.63, aOR: 1.29, 95% CI: 1.02–1.63 doctors: AUC 0.63, 95% CI: 0.55, 0.70, aOR: 1.61, 95% CI: 1.14–2.19). While our study does not support the broad use of parent or healthcare professional concern in isolation as a pediatric sepsis screening tool, measures of concern may be valuable as an adjunct in combination with other clinical data to support sepsis recognition. ACTRN12620001340921.
No related grants have been discovered for Patricia Gilholm.