ORCID Profile
0000-0002-5679-0932
Current Organisations
Metro South Health
,
University of Queensland
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.
Publisher: Wiley
Date: 07-06-2012
DOI: 10.1111/J.1651-2227.2012.02738.X
Abstract: Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines in idual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention.
Publisher: Wiley
Date: 17-12-2020
Abstract: To compare clinical outcomes following induction of labour (IOL) using a balloon catheter and going home, versus prostaglandin (PG) as an inpatient. Randomised controlled trial. Eight Australian maternity hospitals. Women with uncomplicated term singleton pregnancies undergoing IOL for low-risk indications including post-term, advanced maternal age and 'social' reasons. Between September 2015 and October 2018, 347 women were randomised to a balloon outpatient group and 348 to a PG inpatient group. The PG group received Dinoprostone, either 2 mg gel or 10 mg controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. The primary outcome was a composite neonatal measure comprising nursery admission, intubation/cardiac compressions, acidaemia, hypoxic ischaemic encephalopathy, seizure, infection, pulmonary hypertension, stillbirth or death. Clinical and process outcomes are reported. There were no statistically significant differences in the primary outcome comparing balloon with PG (18.6% versus 25.8% relative risk = 0.77, 95% CI 0.51-1.02 P = 0.070), cord arterial pH <7.10 (3.5% versus 9.2% P = 0.072), nursery admissions (12.6% versus 15.5% P = 0.379), neonatal antibiotic use (12.1% versus 17.6% P = 0.103), or mode of birth. Nulliparous women in the balloon group had lower rates of the primary outcome (20.4% versus 31.0% P = 0.032) Parous women were less likely to have an unassisted vaginal birth (77.6% versus 92.3% P = 0.045). Balloon catheters may be a superior method of cervical priming for nulliparous women, whereas this may not be the case for parous women. It is feasible that nulliparous women go home after commencing balloon catheter IOL, and the likelihood of adverse outcomes is low. Multicentre trial shows outpatient induction using balloon catheter is safe and feasible for nulliparous women.
Publisher: Wiley
Date: 10-12-2020
DOI: 10.1111/JPC.14712
Abstract: Extremely low birthweight infants often present with mild neurodevelopmental impairments in gross motor function and postural stability in early childhood. The aim of the study was to undertake a randomised controlled trial to determine the short- and longer-term effects of group-based physiotherapy compared to standard care on performance in extremely low birthweight children with minimal/mild impairment. Fifty children aged 4 years, born <28 weeks gestation and/or birthweight <1000 g with minimal/mild motor impairment were enrolled in a randomised controlled trial and randomly allocated to 6 weeks of group-based intervention (n = 24) or standard care (n = 26). The intervention consisted of a combination of traditional physiotherapy and task-oriented approaches of approximately 1 h in duration and varied according to each child's strengths and weaknesses. Baseline, post intervention and 1 year post baseline assessments included Movement Assessment Battery for Children-2 (MABC-2), single leg stance, lateral reach and long jump. Forty-eight (96%) children completed the study, which demonstrated no significant differences between the intervention and standard care groups on any of the assessments. Both groups improved initially from baseline to initial reassessment on the MABC-2 (P < 0.001). For both groups, however, MABC-2 manual dexterity, aiming/catching and total score declined from baseline to 1 year follow-up. However, for both groups, single leg stance and limb strength were significantly improved from baseline to 1 year follow-up. There were no differences in outcomes between groups. Both approaches may contribute to improved short-term performance and longer-term improvements on functional skills in extremely preterm children.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
DOI: 10.1111/J.1572-0241.2007.01577.X
Abstract: Antibodies to baker's yeast (mannan) have been widely used to aid in diagnosis of Crohn's disease. Recently, there has been interest in antibodies against a flagellin from Clostridium coccoides subphylum. We hypothesized that reactivity with these antigens is a surrogate marker for a generalized increased IgG response against intestinal microbiota in Crohn's disease. We compared the diagnostic utility of IgG antibodies against flagellin and mannan with two complex surface antigen preparations, one derived from B. vulgatus (Bv), the other from over 20 common mucosa-associated microbiota, a multibacterial membrane preparation (MBP). IgG antibodies were measured in sera from two age- and sex-matched populations: 120 Crohn's patients (CD) and 160 gastroenterology controls (CON) comprising 40 ulcerative colitis (UC) and 120 non-IBD patients. IgG was elevated against all antigen preparations in Crohn's but statistical analysis of receiver operator characteristic (ROC) plots showed that IgG against the complex antigen preparations MBP and Bv had better diagnostic accuracy to distinguish the two populations (CD and CON) than IgG against mannan (P < or = 0.01) or flagellin (P < or = 0.04). Concentrations of antibody reactive with distinct in idual antigens correlated weakly. The findings support our hypothesis that measurement of IgG reactivity against in idual antigens gives an indication of a generalized increased IgG response against in idual intestinal microbiota in Crohn's, rather than measuring specific immune responses important for pathogenesis. The data are consistent with either a mucosal defect that facilitates increased exposure to microbial antigens or an altered immune response, both of which could occur due to known genetic and molecular defects in Crohn's disease.
Publisher: Wiley
Date: 02-12-2013
DOI: 10.1111/JPC.12014
Abstract: To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian s le of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory -3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. High rates of disturbed eating behaviours and thoughts were seen in this Australian s le of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2015
Publisher: Wiley
Date: 20-08-2008
DOI: 10.1111/J.1365-2036.2008.03768.X
Abstract: The thiopurines, azathioprine (AZA) and mercaptopurine are extensively used in Crohn's discase (CD). Thiopurine bioactivation can be erted by either thiopurine methyltransferase (TPMT), or by xanthine oxidase/dehydrogenase (XOD) which forms 6-thiouric acid (6TU). To investigate whether chronic inflammation could influence small intestinal XOD activity using urinary excretion of 6TU as a surrogate marker of XOD activity. 6-Thiouric acid excretion was compared between 32 CD patients and nine dermatology patients (control group), on AZA. Six CD patients were interesting: five with low TPMT activity (one deficient, four intermediate), and one receiving AZA/allopurinol co-therapy. There was no statistical difference in 6TU excretion between the CD and control group. CD location, severity or surgery did not affect excretion. The TPMT-deficient patient excreted 89% of daily AZA dose as 6TU, but excretion by TPMT carriers was essentially normal. Concurrent 5-aminosalicylic acid therapy increased 6TU excretion significantly (median 32.9%), consistent with inhibiting TPMT. 6TU was undetectable in the patient on AZA/allopurinol co-therapy. The results refuted our hypothesis, but fitted a model where most of an oral thiopurine dose effectively escapes first-pass metabolism by gut XOD, but is heavily catabolized by TPMT. Bioavailability of thiopurines may be competitively inhibited by dietary purines.
Publisher: Wiley
Date: 16-10-2020
DOI: 10.1002/IJGO.12979
Abstract: To develop a model for predicting emergency cesarean for fetal distress (ECFD) at term using a combination of maternal and late pregnancy ultrasound parameters measured at more than 36 gestational weeks. A study of prospectively collected data, including ultrasound scans at 36-38 weeks, for singleton non-anomalous deliveries at Mater Mother's Hospital, Brisbane, Australia, between January 2010 and April 2017. Univariable and multivariable mixed-effects generalized linear models were generated. The final model was validated by the K-fold cross validation technique. Overall, 5439 women met the inclusion criteria of these, 230 (4.2%) underwent ECFD. There were more nulliparous women and women with induction of labor (IOL) in the ECFD cohort (both P < 0.001). ECFD neonates had lower z-scores for estimated fetal weight (EFW), cerebroplacental ratio (CPR), and middle cerebral artery pulsatility index and higher scores for umbilical artery pulsatility index. Ethnicity, nulliparity, IOL, EFW z-score, and CPR z-score were included in the final prediction model, which showed high accuracy with an area under the receiver operator characteristic curve of 0.77. The study shows that a prediction model combining the continuous standardized measures of CPR and EFW and several maternal factors was able to identify ECFD with improved accuracy.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2021
DOI: 10.1007/S00125-020-05323-0
Abstract: Gestational diabetes mellitus (GDM) is generally defined based on glycaemia during an OGTT, but aetiologically includes women with defects in insulin secretion, insulin sensitivity or a combination of both. In this observational study, we aimed to determine if underlying pathophysiological defects evaluated as continuous variables predict the risk of important obstetric and neonatal outcomes better than the previously used dichotomised or categorical approaches. Using data from blinded OGTTs at mean gestational week 28 from five Hyperglycemia and Adverse Pregnancy Outcome study centres, we estimated insulin secretion (Stumvoll first phase) and sensitivity (Matsuda index) and their product (oral disposition index [DI]) in 6337 untreated women (1090 [17.2%] with GDM as defined by the International Association of Diabetes and Pregnancy Study Groups). Rather than dichotomising these variables (i.e. GDM yes/no) or subtyping by insulin impairment, we related insulin secretion and sensitivity as continuous variables, along with other maternal characteristics, to obstetric and neonatal outcomes using multiple regression and receiver operating characteristic curve analysis. Stratifying by GDM subtype offered superior prediction to GDM yes/no only for neonatal hyperinsulinaemia and pregnancy-related hypertension. Including the DI and the Matsuda score significantly increased the area under the receiver operating characteristic curve (AUROC) and improved prediction for multiple outcomes (large for gestational age [AUROC 0.632], neonatal adiposity [AUROC 0.630], pregnancy-related hypertension [AUROC 0.669] and neonatal hyperinsulinaemia [AUROC 0.688]). Neonatal hypoglycaemia was poorly predicted by all models. Combining the DI and the Matsuda score with maternal characteristics substantially improved the predictive power of the model for large for gestational age, neonatal adiposity and pregnancy-related hypertension. Continuous measurement of insulin secretion and insulin sensitivity combined with basic clinical variables appeared to be superior to GDM (yes/no) or subtyping by insulin secretion and/or sensitivity impairment in predicting obstetric and neonatal outcomes in a multi-ethnic cohort. Graphical abstract.
Publisher: Wiley
Date: 12-2014
DOI: 10.1111/AJO.12289
Publisher: Wiley
Date: 04-11-2014
DOI: 10.1002/PD.4253
Abstract: Fetal RHD screening programs that aim to reduce unnecessary antenatal anti-D prophylaxis are being introduced into clinical practice. Strategies to manage women serologically typed as Rhesus D negative who have maternal RHD variants are needed. This study describes maternal RHD allelic variants detected in nonselected and alloimmunised Rhesus D negative obstetric populations and explores a mathematical approach to identify these variants. Fetal RHD status was defined by testing cell-free fetal DNA in maternal plasma. Women at risk of an RHD variant were identified by selection for C and E haplotypes or by recognition of low polymerase chain reaction cycle threshold on fetal RHD typing. Maternal RHD alleles were defined by SNP profiling or sequencing. The prevalence of RHD variants in nonselected and alloimmunised groups was 1% (6/603) and 5.5% (6/110), respectively (p < 0.001). An inverse association between RHD cycle threshold values and gestational age was described by a linear model (p < 0.001). Standard residual values with a Z score threshold of -3.00 would have detected all maternal variants with one (1/713) false positive. The prevalence of maternal RHD variants was significantly higher in alloimmunised cases. The causative mechanism for this needs further investigation. Mathematical modeling simplifies the detection of maternal RHD variants.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3773555
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3405600
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2023-075429
Abstract: Despite growing awareness of neurodevelopmental impairments in children with congenital heart disease (CHD), there is a lack of large, longitudinal, population-based cohorts. Little is known about the contemporary neurodevelopmental profile and the emergence of specific impairments in children with CHD entering school. The performance of standardised screening tools to predict neurodevelopmental outcomes at school age in this high-risk population remains poorly understood. The NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) trial randomised 1371 children years of age, investigating the effect of gaseous nitric oxide applied into the cardiopulmonary bypass oxygenator during heart surgery. The NITRIC follow-up study will follow this cohort annually until 5 years of age to assess outcomes related to cognition and socioemotional behaviour at school entry, identify risk factors for adverse outcomes and evaluate the performance of screening tools. Approximately 1150 children from the NITRIC trial across five sites in Australia and New Zealand will be eligible. Follow-up assessments will occur in two stages: (1) annual online screening of global neurodevelopment, socioemotional and executive functioning, health-related quality of life and parenting stress at ages 2–5 years and (2) face-to-face assessment at age 5 years assessing intellectual ability, attention, memory and processing speed fine motor skills language and communication and socioemotional outcomes. Cognitive and socioemotional outcomes and trajectories of neurodevelopment will be described and demographic, clinical, genetic and environmental predictors of these outcomes will be explored. Ethical approval has been obtained from the Children’s Health Queensland (HREC/20/QCHQ/70626) and New Zealand Health and Disability (21/NTA/83) Research Ethics Committees. The findings will inform the development of clinical decision tools and improve preventative and intervention strategies in children with CHD. Dissemination of the outcomes of the study is expected via publications in peer-reviewed journals, presentation at conferences, via social media, podcast presentations and medical education resources, and through CHD family partners. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as ‘Gene Expression to Predict Long-Term Neurodevelopmental Outcome in Infants from the NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) Study – A Multicentre Prospective Trial’. Trial registration: ACTRN12621000904875.
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1111/AJO.12607
Abstract: To evaluate the percentage change in total βeta-unit human chorionic gonadotropin (βhCG) levels (%ΔβhCG) in the prediction of treatment outcomes following intravaginal misoprostol for missed miscarriage before 13 weeks. A secondary analysis of a randomised controlled study of medical management of miscarriage was performed. Total βhCG levels were collected before misoprostol (baseline) and after a planned seven day interval (follow-up), when a transvaginal ultrasound (TVUS) reported a gestational sac as present or not. If no sac at TVUS, surgery was indicated on clinical criteria. %ΔβhCG ((baseline βhCG - follow-up βhCG)/baseline βhCG × 100) was evaluated in the prediction of a sac at TVUS and surgery on clinical criteria. %ΔβhCG was calculated for cases with βhCG levels within two days of misoprostol and TVUS calculation interval determined case number. The median %ΔβhCG for 24 cases with a persistent sac (6-9 day interval) was significantly lower than for 145 with no sac (58.75% (interquartile range (IQR): 37.59-76.69 maximum 86.54) vs 97.65% (IQR: 95.44-98.43) P < 0.0001). The median %ΔβhCG for eight cases needing surgery on clinical criteria (5-9 day interval) was significantly lower than for 140 cases with no sac not needing surgery (79.68% (IQR: 64.63-91.15 maximum 94.06) vs 97.68% (IQR: 95.61-98.50) P 87% predicted no sac at TVUS. %ΔβhCG > 94.5% predicted no surgery on clinical criteria. %ΔβhCG calculation over one week reliably predicted treatment outcomes after medical management of missed miscarriage.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JPAINSYMMAN.2009.11.321
Abstract: Haloperidol is used commonly for the control of nausea and vomiting (N/V) in palliative care patients, but there is very little evidence to support its use. To assess the efficacy of haloperidol as an antiemetic in patients with cancer and N/V not related to cancer treatment. Patients with an N/V score of at least 1 on a 4-point scale were prescribed either oral or subcutaneous haloperidol. N/V and toxicity were assessed daily for the duration of the study (maximum five days) by both the patient and an observer (health professional). At Day 2, 33 of 42 (79%) treated patients were assessable for response. Eight (24% 95% confidence interval [CI]: 10%-39%) patients had complete control of N/V and 12 (36% 95% CI: 20%-53%) had partial control, giving an overall response rate of 61% (95% CI: 44%-77%). At Day 5, 23 patients were assessable for response. The overall response rate was 17 of 23 (74% 95% CI: 56%-92%). If all patients are included in the response analysis, the overall response rates at Days 2 and 5 were 47% and 40%, respectively. Haloperidol has some efficacy in the treatment of N/V in this patient group. The results from this uncontrolled study provide pilot data from which to plan future controlled trials of antiemetics in the palliative care population.
Publisher: SAGE Publications
Date: 08-2015
DOI: 10.1136/ACUPMED-2015-010781
Abstract: To assess the feasibility of undertaking a high-quality randomised controlled study to determine whether EA gives better control of delayed chemotherapy-induced nausea and vomiting (CINV) than sham EA or standard antiemetic treatment alone. Patients having their first cycle of moderately or highly emetogenic chemotherapy were randomised to EA, sham EA or standard care. EA was given for 30 min on day 1 at the time of chemotherapy and on day 3 using standard acupuncture points bilaterally. Sham EA was given to points adjacent to true EA points. All patients received usual care, comprising antiemetics, according to hospital guidelines. The primary outcomes related to study feasibility, and the clinical outcome measure was the change in Functional Living Index Emesis (FLIE) score captured on days 1 and 7. 153 participants were screened between April 2009 and May 2011. Eighteen patients did not meet the inclusion criteria, 37 declined to participate and the absence of an acupuncturist or lack of consent from the treating oncologist excluded a further 38 patients 60 patients were recruited. The FLIE was completed on day 7 by 49 participants 33 of 40 patients returned on day 3 for treatment. The nausea and vomiting scores were low in all three arms. Adverse events were generally mild and infrequent. It was feasible to undertake a randomised EA trial on a busy day oncology unit. As few patients experienced nausea with their first cycle of chemotherapy, it was not possible to determine whether EA improves CINV over standard care. An enriched enrolment strategy is indicated for future studies. A simple numerical rating scale may prove a better objective nausea measure than the FLIE. ACTRN12609001054202.
Publisher: Wiley
Date: 02-12-2013
DOI: 10.1111/JPC.12021
Abstract: To describe decisions made for babies who died in the delivery room as a result of clinical practice of non-resuscitation or unsuccessful resuscitation. A retrospective study was conducted of neonatal deaths (NNDs) ≥ 400 g and/or ≥20 weeks' gestation born at Mater Mothers' Hospitals 1998-2009 who were not admitted to a neonatal nursery. Deaths were ided into not resuscitated and unsuccessful resuscitation and sub ided by cause of death as extremely preterm, congenital abnormality or 'other'. Of all 539 NNDs, 217 (40.3%) were not admitted to a neonatal nursery, comprising 174 (80.2%) not resuscitated and 41 (18.9%) unsuccessful resuscitation, while in a further two newborn infants resuscitation was not required. Only 13 of 123 (10.6%) extremely preterm infants who died in the delivery room had resuscitation attempted. Of 77 infants who died from congenital abnormalities in the delivery room 18 (23.3%) had resuscitation attempted. Fifteen babies with other diagnoses died in the delivery room five with severe intrapartum asphyxia without resuscitation and a further 10 (8 preterm) with Apgar scores of 0-1 at 1 min and ≤3 at 5 min who did not respond to extensive resuscitation. A large proportion of NNDs occurred outside the neonatal nurseries involving end-of-life decision-making. Review of the circumstances of these NNDs in the subcategories of extreme prematurity, congenital abnormalities and 'other' raises different management dilemmas with the potential for clinical practice improvement in compassionate care and transparency in decision-making.
Publisher: Wiley
Date: 30-09-2014
DOI: 10.1111/WVN.12067
Abstract: Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery. Randomized controlled trials meeting the inclusion criteria (adult patients of any ethnic background, with or without comorbidities, undergoing any mode of anesthesia for any type of cesarean section) were eligible for consideration. Active or passive warming interventions versus usual care or placebo, aiming to limit or manage core heat loss in women undergoing cesarean section were considered. The primary outcome was maternal core temperature. A comprehensive search with no language restrictions was undertaken of multiple databases from their inception until May 2012. Two independent reviewers using the standardized critical appraisal instrument for randomized controlled trials from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MASTARI) assessed retrieved papers for methodological quality and conducted data collection. Where possible, results were combined in a fixed effects meta-analysis using the Cochrane Collaboration Review Manager software. Due to heterogeneity for one outcome, random effects meta-analysis was also used. A combined total of 719 participants from 12 studies were included. Intravenous fluid warming was found to be effective at maintaining maternal temperature and preventing shivering. Warming devices, including forced air warming and under-body carbon polymer mattresses, were effective at preventing hypothermia. However, effectiveness increased if the devices were applied preoperatively. Preoperative warming devices reduced shivering and improved neonatal temperatures at birth. Intravenous fluid warming did not improve neonatal temperature, and the effectiveness of warming interventions on umbilical pH remains unclear. Intravenous fluid warming by any method improves maternal temperature and reduces shivering during and after cesarean section, as does preoperative body warming. Preoperative warming strategies should be utilized where possible. Preoperative or intraoperative warmed IV fluids should be standard practice. Warming strategies are less effective when intrathecal opioids are administered. Further research is needed to investigate interventions in emergency cesarean section surgery. Larger scale studies using standardized, clinically meaningful temperature measurement time points are required.
Publisher: Wiley
Date: 22-08-2013
DOI: 10.1111/J.1468-3083.2012.04669.X
Abstract: Quality of life (QOL) issues in patients with non-metastatic skin cancer are not satisfactorily demonstrated when using existing QOL questionnaires. To construct and validate a 10 item disease-specific QOL questionnaire, the Skin Cancer Quality of Life Impact Tool (SCQOLIT), for use in patients following treatment of non-metastatic skin cancer. The SCQOLIT was constructed and administered initially to 120 patients with non-metastatic skin cancer, 60 with malignant melanoma (MM) and 60 with non-melanoma skin cancer (NMSC) following treatment, then repeated in half this cohort at seven days, and the other half at three months. Data was collected on age, gender, skin cancer type and Breslow thickness. Statistical validation was undertaken. There were 113 valid SCQOLIT responses at initial completion (54 in the MM group, and 59 in the NMSC group). Initial SCQOLIT median scores (interquartile range [IQR], range) for the two groups were 10 (12, 0-28) MM, and 4 (5, 0-19) NMSC. Amongst the cohort readministered the SCQOLIT at three months (23 in the MM group, 25 in the NMSC group) median scores (IQR, range) were 6 (6, 0-26) MM and 3 (4, 0-20) NMSC. The SCQOLIT is a validated disease-specific QOL questionnaire for use in patients following treatment of non-metastatic skin cancer. Higher SCQOLIT scores are observed in MM patients than NMSC patients, but diminish with time in the MM group. Patients with persistently elevated SCQOLIT scores merit additional attention.
Publisher: Elsevier BV
Date: 2015
Publisher: AMPCo
Date: 09-2013
DOI: 10.5694/MJA12.11813
Abstract: To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort. Descriptive study of a cohort selected out of a randomised controlled trial. Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010. 264 women requesting medical management of missed miscarriage. Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience. 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time. The medical management of missed miscarriage on an outpatient basis is safe and effective. ACTRN12612000150842.
Publisher: JMIR Publications Inc.
Date: 24-10-2022
Abstract: xtracorporeal membrane oxygenation (ECMO) provides support for the pulmonary or cardiovascular function of children in whom the predicted mortality risk remains very high. The inevitable host inflammatory response and activation of the coagulation cascade due to the extracorporeal circuit contribute to additional morbidity and mortality in these patients. Mixing nitric oxide (NO) into the sweep gas of ECMO circuits may reduce the inflammatory and coagulation cascade activation during ECMO support. he purpose of this study is to test the feasibility and safety of mixing NO into the sweep gas of ECMO systems and assess its effect on inflammation and coagulation system activation through a pilot randomized controlled trial. he Nitric Oxide on Extracorporeal Membrane Oxygenation in Neonates and Children (NECTAR) trial is an open-label, parallel-group, pilot randomized controlled trial to be conducted at a single center. Fifty patients who require ECMO support will be randomly assigned to receive either NO mixed into the sweep gas of the ECMO system at 20 ppm for the duration of ECMO or standard care (no NO) in a 1:1 ratio, with stratification by support type (veno-venous vs veno-arterial ECMO). utcome measures will focus on feasibility (recruitment rate and consent rate, and successful inflammatory marker measurements), the safety of the intervention (oxygenation and carbon dioxide control within defined parameters and methemoglobin levels), and proxy markers of efficacy (assessment of cytokines, chemokines, and coagulation factors to assess the impact of NO on host inflammation and coagulation cascade activation, clotting of ECMO components, including computer tomography scanning of oxygenators for clot assessments), bleeding complications, as well as total blood product use. Survival without ECMO and the length of stay in the pediatric intensive care unit (PICU) are clinically relevant efficacy outcomes. Long-term outcomes include neurodevelopmental assessments (Ages and Stages Questionnaire, Strength and Difficulties Questionnaire, and others) and quality of life (Pediatric Quality of Life Inventory and others) measured at 6 and 12 months post ECMO cannulation. Analyses will be conducted on an intention-to-treat basis. he NECTAR study investigates the safety and feasibility of NO as a drug intervention during extracorporeal life support and explores its efficacy. The study will investigate whether morbidity and mortality in patients treated with ECMO can be improved with NO. The intervention targets adverse outcomes in patients who are supported by ECMO and who have high expected mortality and morbidity. The study will be one of the largest randomized controlled trials performed among pediatric patients supported by ECMO. ustralian New Zealand Clinical Trials Registry ACTRN12619001518156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376869 ERR1-10.2196/43760
Publisher: Elsevier BV
Date: 11-2023
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.WOMBI.2017.01.008
Abstract: To what extent have the characteristics and needs of pregnant women changed over time? This cross-sectional, comparative study describes some socio-demographic, mental health and lifestyle characteristics of two s les of pregnant women assessed 30 years apart. We recruited two s les of pregnant women who were attending their first clinic visit at the same large Queensland maternity hospital 30 years apart between 1981 to 1984 (S le A, N=6753) and 2011-2012 (S le B, N=2156). The women were compared using the same survey tool. Descriptive statistics are presented. Pearson's chi-square tests were undertaken (significance at <0.05) to determine how the characteristics and needs of pregnant women may be changing over time. Women, recently s led, were older, more highly-educated and were more likely to be living with, but not married to, their partners, as well as having their first baby, than were women 30 years ago. As well, recently s led, pregnant women were more likely to be non-smokers, to have higher body mass indexes and more symptoms of anxiety, but were less likely to be having an unplanned pregnancy. This study found a number of differences between the socio-demographic characteristics, lifestyles and mental health of two s les of pregnant women assessed 30 years apart. Our findings suggest the need for ongoing monitoring of pregnant women to determine changing health priorities. Being more educated, today's women may be more amenable to health education interventions. Higher body mass indexes for recently s led women, highlights an emerging problem that needs to be addressed.
Publisher: BMJ
Date: 28-06-2018
DOI: 10.1136/ARCHDISCHILD-2016-312141
Abstract: To examine levels of parenting stress in mothers of preterm and term infants when the children were 2 years old to determine the trajectory of stress over three time periods and to examine the association of maternal and neonatal factors and developmental outcomes with parenting stress. It is a prospective longitudinal study to determine parenting stress in mothers of preterm and term infants with outcomes having been previously obtained at 4 and 12 months. At 2 years, 79 preterm mothers (96 babies) and 64 term mothers (77 babies) participated. The mothers completed the Parenting Stress Index-Short Form (PSI-SF), the Depression, Anxiety, Stress Scale (DASS) and the Child Behaviour Checklist (CBCL). The infants had a neurological examination and the Bayley-III scales were administered. The mean total PSI-SF at 2 years was significantly higher for the preterm group compared with the term group of mothers (p=0.007). There was a significant increase in the mean total PSI over time for the preterm mothers (p .001). For mothers at 2 years, there was an association with high levels of parenting stress and abnormal scores on the DASS (p .001) and high total T-scores on the CBCL (internalising p .001 externalising p=0.006). There was no association between parenting stress and maternal demographics, neonatal factors or Bayley-III results. Parenting stress in mothers of preterm infants continues to be high at 2 years having increased over time. Maternal mental health problems and infant behavioural issues contribute to the stress.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: Wiley
Date: 30-12-2020
DOI: 10.1111/JPC.15259
Publisher: Elsevier BV
Date: 2022
Publisher: Wiley
Date: 07-03-2014
Publisher: Wiley
Date: 09-2010
Publisher: Wiley
Date: 05-03-2008
DOI: 10.1111/J.1523-5378.2008.00587.X
Abstract: Helicobacter pylori causes peptic ulcer disease and gastric cancer, and the oral cavity is likely to serve as a reservoir for this pathogen. We investigated the binding of H. pylori to the mucins covering the mucosal surfaces in the niches along the oral to gastric infection route and during gastric disease and modeled the outcome of these interactions. A panel of seven H. pylori strains with defined binding properties was used to identify binding to human mucins from saliva, gastric juice, cardia, corpus, and antrum of healthy stomachs and of stomachs affected by gastritis at pH 7.4 and 3.0 using a microtiter-based method. H. pylori binding to mucins differed substantially with the anatomic site, mucin type, pH, gastritis status, and H. pylori strain all having effect on binding. Mucins from saliva and gastric juice displayed the most erse binding patterns, involving four modes of H. pylori adhesion and the MUC5B, MUC7, and MUC5AC mucins as well as the salivary agglutinin. Binding occurred via the blood-group antigen-binding adhesin (BabA), the sialic acid-binding adhesin (SabA), a charge/low pH-dependent mechanism, and a novel saliva-binding adhesin. In the healthy gastric mucus layer only BabA and acid/charge affect binding to the mucins, whereas in gastritis, the BabA/Le(b)-dependent binding to MUC5AC remained, and SabA and low pH binding increased. The four H. pylori adhesion modes binding to mucins are likely to play different roles during colonization of the oral to gastric niches and during long-term infection.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.WOMBI.2014.11.005
Abstract: With evidence of offspring harms and concern for younger women's drinking behaviours, this study uses a hospital cohort to trend the use and changes in women's reported alcohol consumption. To examine (i) the trend of women's reported alcohol consumption over time, (ii) whether any increases in the frequency of alcohol consumption prior to a pregnancy are accompanied by increases in the frequency of alcohol consumption in pregnancy and (iii) the characteristics of women consuming alcohol at these times. Midwives collected routine data on 19,699 women between 2001 and 2006. Data on women's alcohol use prior to pregnancy and at their pregnancy-booking visit were analysed using a non-parametric test for trend and with bivariate and multivariate tests adjusting for possible confounders. The proportion of women reporting at-least weekly alcohol use prior to pregnancy was 25.4% and 5.9% at their pregnancy-booking visit. A significant linear increase over time (p<0.001) was found in the rate of women aged 20 years and older reporting at-least weekly alcohol use prior to pregnancy. Tertiary-educated women were more likely to consume alcohol at-least weekly prior to pregnancy. Women aged less than 20 years were less likely to report at-least weekly alcohol use at both time points. Having more children and Asian ethnicity were associated with a lower risk of at-least weekly alcohol use at these times. The majority of women reduce their alcohol consumption once they learn they are pregnant, with some evidence this trend may have increased in recent years.
Publisher: Springer Science and Business Media LLC
Date: 13-08-2020
DOI: 10.1007/S10995-020-02994-4
Abstract: The customised birthweight model can be used to improve detection of babies that may be at risk of adverse outcomes associated with abnormal growth, however it is currently used in conjunction with either an intrauterine growth standard or the in idualised birthweight ratio (IBR), both of which have significant methodological flaws. Our aim was to investigate the statistical validity of the IBR and attempt to develop a new measurement to represent the appropriateness of an infant's size at birth that will support clinicians in identifying infants requiring further attention. Routinely collected hospital maternity and neonatal data on singleton, term births from a tertiary Australian hospital were extracted for the time period 1998-2009. The relationships between birthweight, customised birthweight and IBR are investigated using correlation, regression analysis and ision of births into groups of 4000 g. A new measure, the Birthweight Appropriateness Quotient (BAQ), is developed. The utility of the BAQ is compared with IBR and birthweight to identify infants with a composite neonatal morbidity outcome. Statistical flaws with the IBR due to significant correlation between birthweight and customised birthweight and a heterogenous relationship between these two measurements across the range of birthweight are present. BAQ is uncorrelated with birthweight. Comparison of BAQ and IBR as indicators of adverse neonatal outcome demonstrates that BAQ identifies babies at risk due to their small size and those babies at risk due to inappropriate size. BAQ is a customised measurement of an infant's size free of the statistical flaws experienced by the IBR with the ability to identify at-risk infants.
Publisher: Wiley
Date: 13-06-2020
DOI: 10.1111/ANAE.15117
Abstract: Children may develop changes in their behaviour following general anaesthesia. Some ex les of negative behaviour include temper tantrums and nightmares, as well as sleep and eating disorders. The aim of this study was to determine whether dexmedetomidine reduces the incidence of negative behaviour change after anaesthesia for day case surgery in children aged two to seven years. Children were randomly allocated to one of three groups: a premedication group received 2 μg.kg -1 intranasal dexmedetomidine an intra‐operative group received 1 μg.kg -1 intravenous dexmedetomidine and a control group. The primary outcome was the incidence of negative behaviour on postoperative day 3 using the Post‐Hospitalisation Behaviour Questionnaire for Ambulatory Surgery (PHBQ‐AS) and the Strength and Difficulties Questionnaire (SDQ). Secondary outcomes included: the incidence of negative behaviour on postoperative days 14 and 28 anxiety at induction emergence delirium pain length of recovery and hospital stay and any adverse events. The data for 247 patients were analysed. Negative behaviour change on postoperative day 3 was similar between all three groups when measured with the PHBQ‐AS (47%, 44% and 51% respectively adjusted p=0.99) and the SDQ (median scores 7.5, 6.0 and 8.0 respectively adjusted p=0.99). The incidence of negative behaviour in the group who received dexmedetomidine intra‐operatively was less at postoperative day 28 (15% compared with 36% in the dexmedetomidine premedication group and 41% in the control group, p .001). We conclude that dexmedetomidine does not reduce the incidence of negative behaviour on postoperative day 3 in two to seven‐year olds having day case procedures. [Correction added 15 January 2021, after first online publication: In original published version, there was a dosage error in the Summary section, which specified mg instead of μg this version corrects the error].
Publisher: Springer Science and Business Media LLC
Date: 03-03-2011
DOI: 10.1007/S00134-011-2177-5
Abstract: To describe the change in ventilatory practice in a tertiary paediatric intensive care unit (PICU) in the 5-year period after the introduction of high-flow nasal prong (HFNP) therapy in infants <24 months of age. Additionally, to identify the patient subgroups on HFNP requiring escalation of therapy to either other non-invasive or invasive ventilation, and to identify any adverse events associated with HFNP therapy. The study was a retrospective chart review of infants <24 months of age admitted to our PICU for HFNP therapy. Data was also extracted from both the local database and the Australian New Zealand paediatric intensive care (ANZPIC) registry for all infants admitted with bronchiolitis. Between January 2005 and December 2009, a total of 298 infants <24 months of age received HFNP therapy. Overall, 36 infants (12%) required escalation to invasive ventilation. In the subgroup with a primary diagnosis of viral bronchiolitis (n = 167, 56%), only 6 (4%) required escalation to invasive ventilation. The rate of intubation in infants with viral bronchiolitis reduced from 37% to 7% over the observation period corresponding with an increase in the use of HFNP therapy. No adverse events were identified with the use of HFNP therapy. HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
DOI: 10.1097/PCC.0000000000002302
Abstract: Viral infections are common in children, but there is a lack of data on severe viral infections in critically ill children. We investigated testing for viral infections in children requiring PICU admission and describe the epidemiology and outcomes. Multicenter retrospective study. Results of viral testing for nine respiratory viruses using polymerase chain reaction were collected. Children less than 16 years old nonelectively admitted to PICU over a 6-year period. Two tertiary PICUs in Queensland, Australia. None. Primary outcome was PICU length of stay. Secondary outcomes included need for and duration of intubation and mortality in PICU. Univariate and multivariate regression analyses were performed, adjusting for age, indigenous status, comorbidities, and severity of illness. Of 6,426 nonelective admissions, 2,956 (46%) were polymerase chain reaction tested for a virus of which 1,353 (46%) were virus positive. Respiratory syncytial virus was the most common pathogen identified ( n = 518, 33%), followed by rhinovirus/enterovirus and adenovirus. Across all patients who underwent polymerase chain reaction testing, identification of a respiratory virus was not significantly associated with longer overall length of stay (multivariate odds ratio, 1.08 95% CI, 0.99–1.17 p = 0.068) or longer intubation ( p = 0.181), whereas the adjusted odds for intubation and mortality were significantly lower ( p 0.01). Subgroup analyses restricted to patients with acute respiratory infections ( n = 1,241), bronchiolitis ( n = 761), pneumonia ( n = 311), confirmed bacterial infection ( n = 345), and malignancy ( n = 95) showed that patients positive for a virus on testing had significantly longer PICU length of stay (multivariate p 0.05). In children with pneumonia, identification of a respiratory virus was associated with significantly increased duration of ventilation ( p = 0.003). No association between positive test results for multiple viruses and outcomes was observed. Viral infections are common in critically ill children. Viral infections were associated with lower intubation and mortality rates compared with all children testing negative for viral infections. In several subgroups studied, identification of viral pathogens was associated with longer PICU length of stay while mortality was comparable. Prospective studies are required to determine the benefit of routine testing for respiratory viruses at the time of PICU admission.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DIABRES.2018.02.036
Abstract: To develop a risk "engine" or calculator, integrating the risks of hyperglycemia, maternal BMI and other basic demographic data commonly available at the time of the pregnancy oral glucose tolerance test (OGTT), to predict an in idual's absolute risk of specific adverse pregnancy outcomes. Data from the Brisbane HAPO cohort was analysed using logistic regression to determine the relationship between four clinical outcomes (primary CS, birth injury, large-for-gestational age, excess neonatal adiposity) with different combinations of OGTT results and maternal demographics (age, height, BMI, parity). Existing sets of international GDM diagnostic criteria were also applied to the cohort. 191 (15.3%) women were diagnosed as GDM by one or more existing criteria. All international criteria performed poorly compared to risk models utilising OGTT results only, or OGTT results in combination with maternal demographics. The risk engine's empirical performance on receiver - operator curve analysis was superior to the existing GDM diagnostic criteria tested. This concept shows promise for use in clinical practice, but further development is required.
Publisher: Wiley
Date: 23-09-2011
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.EARLHUMDEV.2015.10.016
Abstract: There is a paucity of information on couple relationship quality in mothers of preterm infants during the first year of life. To determine couple relationship quality in mothers of very preterm infants in comparison to mothers of term infants and to examine maternal and infant factors associated with impaired couple relationship for the preterm mothers. At 4 and 12 months (corrected for prematurity for the preterm cohort), the mothers completed the Dyadic Adjustment Scale, the Edinburgh Postnatal Depression Scale, the Parenting Stress Index and the Short Temperament Scale. At 12 months, the infants had a neurodevelopmental assessment. 86 mothers of preterm infants and 97 term mothers participated at 4 months, with 101 mothers of the preterm infants and 98 term mothers participating at 12 months. Comparisons of the two groups revealed no differences in Dyadic Adjustment or for any of the subscales. For the preterm mothers at 4 months, the independent variables associated with poor dyadic adjustment were ethnicity and higher levels of parenting stress. At 12 months, parenting stress was also an independent variable associated with impaired couple relationship. No differences in the incidence of poor quality couple relationship was found between mothers of very preterm and term infants. For preterm mothers, impaired couple relationship was associated with parenting stress.
Publisher: Frontiers Media SA
Date: 25-10-2019
Publisher: Archives of Pathology and Laboratory Medicine
Date: 27-01-2021
DOI: 10.5858/ARPA.2020-0647-OA
Abstract: Specific reference intervals (RIs) facilitate accurate interpretation of results. Coagulation assay results may vary by demographics and also between reagents and analyzers used. Current Thromboelastograph 6s (TEG 6s) Hemostasis Analyzer RIs were generated from adult s les. To generate reagent analyzer-specific pediatric RIs for TEG 6s and coagulation parameters. A prospective, observational, single-center study of healthy children undergoing general anesthesia (January 3, 2017 to January 3, 2019). Venous blood s les were obtained for TEG 6s (Kaolin, Kaolin-Heparinase, Rapid and Functional Fibrinogen assays) and coagulation parameters (activated partial thromboplastin time, prothrombin time, thrombin clotting time, Echis time, antithrombin activity, and fibrinogen concentration using Instrumentation Laboratory ACL-TOP analyzers). Differences between activated partial thromboplastin time and prothrombin time reagents were investigated using mixed-effects regression, comparing maximum coefficients-of-variation with assay-specific allowable variation. RIs (lower/upper limits 2.5th of 97.5th percentiles) were generated using the following 2 methods: within discrete age-groups (neonates [& month], infants [1 month–1 year], young children [1–5 years], older children [6–10 years], and adolescents [11–16 years]), and modeled as functions of age and/or sex using quantile regression, including significant fractional polynomial and interaction terms. Variation between prothrombin time and activated partial thromboplastin time assays using different reagents was clinically significant. Reagent-analyzer specific pediatric RIs were generated using data from 254 children. Discrete and model-based RIs varied by age for all coagulation parameters and TEG 6s variables in all assays. We report reagent-analyzer specific pediatric RIs for TEG 6s and coagulation parameters. Observed variation reinforces recommendations for laboratory-specific RIs. These findings improve accuracy of interpretation of clinical results, provide a foundation for comparison and validation of tests in pathology, and illustrate feasibility and advantages of model-based RI approaches.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.IJNURSTU.2012.01.003
Abstract: The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives. A cross sectional study of self reported survey data. Australia, New Zealand and the United Kingdom. Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mother's age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables. 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074). Amongst the s le 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35-44 yrs aOR 1.71, 95% CI 1.41-2.08 45-55 yrs aOR 1.90, 95%CI 1.56-2.31 55-64 aOR 2.22, 95% CI 1.71-2.88), and male gender (aOR 1.46, 95% CI 1.15-1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06-1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11-1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70-0.94 and aOR 0.75, 95% CI 0.59-0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04-1.80). Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their in idual health behaviours and risks of occupational injury and chronic disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-05-2020
DOI: 10.1097/PCC.0000000000002383
Abstract: Antithrombin is a cofactor in the coagulation cascade with mild anticoagulant activity and facilitates the action of heparin as an anticoagulant. Antithrombin concentrate dosing guidelines vary but most commonly suggest that each unit of antithrombin concentrate per body weight increases the plasma antithrombin level by 1.5% to 2.2% (depending on manufacturer). We aimed to establish a dosing recommendation dependent on age and disease state. A retrospective analysis of all antithrombin concentrate doses over a period of 5 years. We calculated the increase any respective antithrombin concentrate dose achieved, indexed by body weight, and performed a multivariable analysis to establish independent factors associated with the effectiveness of antithrombin concentrate. A PICU at a university-affiliated children’s hospital. One hundred fifty-five patients treated in a PICU. None. The effect of 562 doses of antithrombin concentrate on plasma antithrombin levels administered to 155 patients, of which 414 (73.7%) antithrombin concentrate doses administered during extracorporeal life support treatment, were analyzed. For all patients, each unit of antithrombin concentrate/kg increased plasma antithrombin level by 0.86% ( sd 0.47%). Plasma antithrombin level increase was influenced by body weight (increase of 0.76% [interquartile range, 0.6–0.92%] for patients 5 kg 1.38% [interquartile range, 1.11–2.10%] for 20 kg), disease state (liver failure having the poorest antithrombin increase) and whether patients were treated with extracorporeal circulatory support (less antithrombin increase on extracorporeal life support). Heparin dose at the time of administration did not influence with amount of change in antithrombin level. Current antithrombin concentrate dosing guidelines overestimate the effect on plasma antithrombin level in critically ill children. Current recommendations result in under-dosing of antithrombin concentrate administration. Age, disease state, and extracorporeal life support should be taken into consideration when administering antithrombin concentrate.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2011
DOI: 10.1038/PR.2011.25
Abstract: This study aimed to examine the association between cannabis use before and during pregnancy and birth outcomes. Overall, 26.3% of women reported previous use of cannabis and 2.6% reported current use. Multivariate analysis, controlling for potential confounders, including tobacco smoking, alcohol consumption, and use of other illicit drugs, showed that cannabis use in pregnancy was associated with low birth weight (odds ratio (OR) = 1.7 95% confidence interval (CI): 1.3-2.2), preterm labor (OR = 1.5 95% CI: 1.1-1.9), small for gestational age (OR = 2.2 95% CI: 1.8-2.7), and admission to the neonatal intensive care unit (OR = 2.0 95% CI: 1.7-2.4). The results of this study show that the use of cannabis in pregnancy is associated with increased risk of adverse birth outcomes. Prevention programs that address cannabis use during pregnancy are needed. Data were from women birthing at the Mater Mothers' Hospital in Brisbane, Australia, over a 7-y period (2000-2006). Women were interviewed in the initial antenatal visit about their use of cannabis and other substances. Records for 24,874 women who provided information about cannabis use, and for whom birth outcomes data were available, were included in the analysis.
Publisher: Wiley
Date: 20-09-2008
DOI: 10.1111/J.1365-2036.2008.03788.X
Abstract: To investigate whether pharmacogenetic loci or metabolite concentrations explain clinical response or side effects to AZA. Patients with IBD were given 2 mg/kg of AZA without dose escalation or adjustment. Serial clinical response, thiopurine methyl transferase (TPMT) activity and thioguanine nucleotide (TGN) concentrations were measured over 6 months. All patients were genotyped for inosine triphosphatase (ITPase) and TPMT. Clinical response and side effects were compared to these variables. Two hundred and seven patients were analysed. Thirty-nine per cent withdrew due to adverse effects. Heterozygous TPMT genotype strongly predicted adverse effects (79% heterozygous vs. 35% wild-type TPMT, P A mutation was associated with withdrawal due to flu-like symptoms (P = 0.014). A baseline TPMT activity below 35 pmol/h/mg/Hb was associated with a greater chance of clinical response compared with a TPMT above 35 pmo/h/mg/Hb (81% vs. 43% respectively, P 35 pmol/h/mg/Hb). ITPase deficiency is a predictor of adverse effects and TGN concentrations above 100 correlate with clinical response.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2023
Publisher: Springer Science and Business Media LLC
Date: 31-05-2023
DOI: 10.1186/S13063-023-07330-Z
Abstract: The placement of an endotracheal tube for children with acute or critical illness is a low-frequency and high-risk procedure, associated with high rates of first-attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events, the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children. The technique known as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) uses high oxygen flow rates (approximately 2 L/kg/min) delivered through nasal cannulae during apnoea. It has been shown to at least double the amount of time available for safe intubation in healthy children undergoing elective surgery. The technique and its application in real time have not previously been studied in acutely ill or injured children presenting to the emergency department or admitted to an intensive care unit. The Kids THRIVE trial is a multicentre, international, randomised controlled trial (RCT) in children less than 16 years old undergoing emergent intubation in either the intensive care unit or emergency department of participating hospitals. Participants will be randomised to receive either the THRIVE intervention or standard care (no apnoeic oxygenation) during their intubation. The primary objective of the trial is to determine if the use of THRIVE reduces the frequency of oxygen desaturation and increases the frequency of first-attempt success without hypoxaemia in emergent intubation of children compared with standard practice. The secondary objectives of the study are to assess the impact of the use of THRIVE on the rate of adverse events, length of mechanical ventilation and length of stay in intensive care. In this paper, we describe the detailed statistical analysis plan as an update of the previously published protocol.
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJOPEN-2019-030516
Abstract: Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment. The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation %/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis. Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team. ACTRN12618000210279
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.MIDW.2012.05.001
Abstract: sterile water injections are a simple, safe, effective, non-pharmacological technique for relieving back pain in labour, however the number of injections required to achieve optimal analgesia is unknown. The objective of this trial was to evaluate the degree and duration of analgesia provided by a single injection of sterile water, compared to four injections. randomised controlled non-inferiority trial. three hundred and five women in labour at term, requesting analgesia for back pain were recruited from two metropolitan hospitals in Brisbane, Australia. participants were randomly assigned to receive either one (n=147) or four (n=158) sterile water injections. difference in self-reported pain measured using a visual analogue scale (VAS) between baseline and 30 mins post-intervention. The clinically acceptable margin of difference was defined as ≤ 1 cm on the VAS between the single injection compared to four injection technique. Secondary outcomes include VAS score on injection and 10, 60, 90 and 120 mins post-intervention, analgesia use, mode of birth and maternal satisfaction. the mean difference in the pre and post (30 mins) injection scores between two groups was -1.48 cm (95% CI -2.10, -0.86) in favour of the FI technique, however the injection pain associated with the FI was significantly greater than that of the SI technique (p<0.001). There were no significant differences between the two groups in terms of other analgesic use, mode of birth or maternal satisfaction. the four injection technique was associated with increased level of analgesia at 30 mins post-intervention compared to the single injection, but also a greater degree of injection pain.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.AJOG.2010.08.041
Abstract: This study was performed to report the neurodevelopmental outcome of survivors of twin-twin transfusion syndrome (TTTS) treated with laser surgery and to determine the risk factors for neurodevelopmental disability. A prospective study of TTTS cases treated with laser was performed. Survivors were assessed at 2 years corrected for prematurity. Neurodevelopmental disability was defined as the presence of cerebral palsy, deafness, blindness, or cognitive impairment with a developmental score >2 SDs below the mean. A total of 75 TTTS pregnancies were treated with a perinatal survival rate of 79.3%. A total of 113 survivors were assessed. The rate of cerebral palsy was 4.4% and cognitive impairment was 8%, with a neurodevelopmental disability rate of 12.4%. Quintero stage was the only independent risk factor for neurodevelopmental disability. The incidence of neurodevelopmental disability in TTTS survivors treated with laser is considerable, with Quintero stage being an independent risk factor.
Publisher: AMPCo
Date: 04-2010
DOI: 10.5694/J.1326-5377.2010.TB03557.X
Abstract: To examine the prevalence of perianal Crohn's disease (PCD) and the eligibility of PCD patients to access anti-tumour necrosis factor-alpha (anti-TNFalpha) treatment under current Australian Pharmaceutical Benefits Scheme (PBS) guidelines. A retrospective study of patients with Crohn's disease (CD) and PCD attending four large adult inflammatory bowel disease (IBD) centres in Australia between January 2004 and May 2008. Patients for whom anti-TNFalpha therapy was clinically indicated were assessed to determine whether they satisfied PBS criteria for subsidised medication. Prevalence of CD and PCD in patients attending different IBD centres eligibility of PCD patients for PBS-subsidised anti-TNFalpha medication. Data were available on 3589 patients, representing about 6% of all patients with IBD in Australia. Of the 1815 patients with CD, 310 (17%) had PCD. Anti-TNFalpha therapy was deemed clinically indicated for 166 patients with PCD (54%), of whom 49 (30%) did not qualify for PBS-funded therapy. Thirty per cent of patients with clinically significant PCD currently do not have access to PBS-subsidised optimal medical treatment. We believe that PBS criteria should be extended to include this subgroup of IBD patients.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.EARLHUMDEV.2015.02.007
Abstract: The aim of the study was to screen very preterm infants for autism spectrum disorder (ASD) with comparisons to a group of term controls. The study also aimed to identify maternal and neonatal risk factors, development and behaviour associated with a positive screen in the preterm group. Preterm infants born ≤ 30 weeks gestation and term infants were recruited at two years of age. The mothers were posted the questionnaires and completed the Modified Checklist for Autism in Toddlers (M-CHAT), the Child Behaviour Checklist (CBCL) and the Depression, Anxiety and Stress Scales (DASS). Previously collected data from the mothers at 12 months--the Edinburgh Postnatal Depression Scales (EPDS) were analysed. The children had neurodevelopmental assessment including the Bayley-III. Infants positive on M-CHAT screen had an M-CHAT follow-up interview by phone and then were assessed by a developmental paediatrician as indicated with a diagnosis of autism being made on clinical judgement. 13 (13.4%) of the 97 preterm infants screened positive on the M-CHAT compared to three (3.9%) of the 77 term infants (p = 0.036). On follow-up interview, three of the preterm infants remained positive (one was diagnosed with autism) compared to none of the term infants. The preterm infants who screened positive were born to younger, non-Caucasian mothers and were of lower birth weight and had a higher incidence of being small for gestational age (SGA). The infants had lower composite scores on Bayley-III and had more internalising and externalising behaviours on the CBCL. The mothers had more emotional problems on the DASS and higher scores on the EPDS. On multivariate analysis, SGA, greater internalising behaviours and higher EPDS scores remained statistically significant. A positive screen on the M-CHAT occurs more commonly in very preterm infants than those born at term. Internalising behaviours and maternal mental health are associated with a positive screen in the preterm cohort.
Publisher: Research Square Platform LLC
Date: 08-04-2021
DOI: 10.21203/RS.3.RS-390577/V1
Abstract: Background : Intravenous fluid therapy represents the most common intervention critically ill patients are exposed to. Hyperchloremia and metabolic acidosis associated with 0.9% sodium chloride have been observed to lead to worse outcomes, including mortality. Balanced solutions, such as PlasmaLyte-148 and Compound Sodium Lactate, represent potential alternatives but the evidence on optimal fluid choices in critically ill children remains scarce. The aim of this study is to demonstrate whether balanced solutions, when used as the intravenous fluid therapy, are able to reduce the incidence of a rise in serum chloride level compared to 0.9% sodium chloride in critically ill children. Methods : This is a single centre, open label randomised controlled trial with parallel 1:1:1 assignment into three groups: 0.9% sodium chloride, Plasma-Lyte 148, and Compound Sodium Lactate solutions for intravenous fluid therapy. The intervention includes both maintenance and bolus fluid therapy. Children age years admitted to intensive care and receiving intravenous fluid therapy during the first four hours of admission are eligible. The primary outcome measure is a ³5mmol/L increase in serum chloride level within 48 hours post randomisation. The enrolment target is 480 patients. The main analyses will be intention-to-treat. Discussion : This study tests three types of intravenous fluid therapy in order to compare the risk of hyperchloremia associated with normal saline versus balanced solutions. The pragmatic study is thereby assessing the most common intervention in paediatric critical care. This is a single centre open label study with no blinding at the level of delivery of intervention. Certain Paediatric Intensive Care Unit (PICU) patient groups such as patients admitted with a cardiac condition or following traumatic brain injury are excluded from this study. Trial registration : The study has received ethical approval (HREC/19/QCHQ/53177: 06/06/2019). It is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001244190) from 9 th September 2019. Recruitment commenced on 12 th November 2019. The primary results manuscript will be published in a peer reviewed journal.
Publisher: Elsevier BV
Date: 06-2021
DOI: 10.51893/2021.2.OA6
Abstract: OBJECTIVE: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. DESIGN: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. SETTING: Paediatric intensive care units in Australia and New Zealand. PARTICIPANTS: Medical and nursing staff working in intensive care. MAIN OUTCOME MEASUREMENTS: Self-reported priorities for research. RESULTS: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. CONCLUSIONS: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.
Publisher: Wiley
Date: 19-10-2017
Abstract: To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices. Retrospective cohort study. A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or from public models of care - predominantly midwife-led care or care shared between midwives, general practitioners, and obstetricians. A total of 131 436 births during 1998-2013: 69 037 public and 62 399 private. Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in the use of assisted reproductive technologies, plurality, major congenital anomalies, birth method, and gestational age. Stillbirth, and neonatal and perinatal mortality rates. After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than in the private cohort (adjusted odds ratio, aOR 1.53 95% confidence interval, 95% CI 1.29-1.80 stillbirth aOR 1.56, 95% CI 1.26-1.94 neonatal death aOR 1.48, 95% CI 1.15-1.89). These disparities reduced by 15.7, 20.5, and 19.6%, respectively, after adjusting for major congenital anomalies, birth method, and gestational age. Perinatal mortality occurred more often among public than private births, and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. Private obstetrician-led care: more obstetric intervention and earlier births reduce perinatal mortality. Background Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine whether this pattern is a result of public-private differences in care or merely linked with differences in the characteristics of the two groups. In Australian private hospitals, a private obstetrician almost always provides continuing care to each woman during pregnancy and birth. Public hospitals provide a number of care options, which usually involve midwives and/or a family doctor. Method The study population included 131 436 births (52.5% public 47.5% private) from 1998-2013 at a single metropolitan centre with co-located public and private facilities. To isolate the effect of differences in care, we used a statistical technique called propensity score matching to select a public group and a private group with similar characteristics and equal size. This enabled us to compare 'apples with apples' when comparing public versus private perinatal death rates. Perinatal deaths include stillbirths and babies that die within 28 days of birth. Main findings After matching and after accounting for different patterns in the use of fertility treatments and multiple-birth pregnancies (such as twins), babies born in the public sector were approximately 1.5 times more likely to die than babies born in the private sector. This difference was reduced to 1.3 times more likely to die than babies born in the private sector after taking into account other factors that could skew the data, such as major congenital anomalies, birth method, and duration of pregnancy. Limitations This was a single-centre study, so the results may not apply to all settings. Despite our efforts to create highly similar public and private cohorts, some differences between the groups are likely to have remained and this may have affected the results. Implications Our findings suggest that private obstetrician-led care has a beneficial impact on perinatal deaths, despite, or possibly because of, higher obstetric intervention rates and earlier births in the private hospital. Further research is required.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Wiley
Date: 05-08-2010
Publisher: Wiley
Date: 09-2017
DOI: 10.1002/PDI.2126
Publisher: Research Square Platform LLC
Date: 17-10-2022
DOI: 10.21203/RS.3.RS-2032168/V1
Abstract: The placement of an endotracheal tube for children with acute or critical illness is a low frequency and high-risk procedure, associated with high rates of first attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children. The technique known as Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) uses high oxygen flow rates (approximately 2L/kg/min) delivered through nasal cannulae during apnoea. It has been shown to at least double the amount of time available for safe intubation in healthy children undergoing elective surgery. The technique and its application in real time has not previously been studied in acutely ill or injured children presenting to the emergency department or admitted to an intensive care unit. The Kids THRIVE trial is a multicentre, international, randomised controlled trial (RCT) in children less than 16 years old undergoing emergent intubation in either the intensive care unit or emergency department of participating hospitals. Participants will be randomised to receive either the THRIVE intervention or standard care (no apnoeic oxygenation) during their intubation. The primary objective of the trial is to determine if the use of THRIVE reduces the frequency of oxygen desaturation and increases frequency of first attempt success without hypoxaemia in emergent intubation of children compared with standard practice. The secondary objectives of the study are to assess the impact of the use of THRIVE on the rate of adverse events, length of mechanical ventilation and length of stay in intensive care. In this paper we describe the detailed statistical analysis plan as an update the previously published protocol.
Publisher: Informa UK Limited
Date: 09-09-2016
DOI: 10.1080/01443615.2016.1174824
Abstract: Induction for "post-dates" is a very common procedure and in Queensland, Australia, accounts for 35.5% of all inductions. Systematic reviews all conclude that induction of labour does not increase the risk of caesarean section (CS). However, these reviews have generally included a mixed population and have not stratified for parity. We report in a retrospective cohort study involving only nulliparous women with uncomplicated singleton pregnancy at 40° to 41
Publisher: Elsevier BV
Date: 04-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-06-2020
DOI: 10.1097/PCC.0000000000002411
Abstract: Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury. Single-center retrospective observational study. Thirty-six–bed surgical/medical tertiary PICU. Children from birth to less than or equal to 16 years old admitted between 2015 and 2018. None. Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as “high risk of acute kidney injury.” Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3–5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5–9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6–4.2) and 3.1 (95% CI, 2.4–3.8), respectively. The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.
Publisher: American Medical Association (AMA)
Date: 17-01-2023
Abstract: Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown. To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure. A multicenter, randomized clinical trial was conducted at 14 metropolitan and tertiary hospitals in Australia and New Zealand, including 1567 children aged 1 to 4 years (randomized between December 18, 2017, and March 18, 2020) requiring hospital admission for acute hypoxemic respiratory failure. The last participant follow-up was completed on March 22, 2020. Enrolled children were randomly allocated 1:1 to high-flow oxygen therapy (n = 753) or standard oxygen therapy (n = 764). The type of oxygen therapy could not be masked, but the investigators remained blinded until the outcome data were locked. The primary outcome was length of hospital stay with the hypothesis that high-flow oxygen therapy reduces length of stay. There were 9 secondary outcomes, including length of oxygen therapy and admission to the intensive care unit. Children were analyzed according to their randomization group. Of the 1567 children who were randomized, 1517 (97%) were included in the primary analysis (median age, 1.9 years [IQR, 1.4-3.0 years] 732 [46.7%] were female) and all children completed the trial. The length of hospital stay was significantly longer in the high-flow oxygen group with a median of 1.77 days (IQR, 1.03-2.80 days) vs 1.50 days (IQR, 0.85-2.44 days) in the standard oxygen group (adjusted hazard ratio, 0.83 [95% CI, 0.75-0.92] P & .001). Of the 9 prespecified secondary outcomes, 4 showed no significant difference. The median length of oxygen therapy was 1.07 days (IQR, 0.50-2.06 days) in the high-flow oxygen group vs 0.75 days (IQR, 0.35-1.61 days) in the standard oxygen therapy group (adjusted hazard ratio, 0.78 [95% CI, 0.70-0.86]). In the high-flow oxygen group, there were 94 admissions (12.5%) to the intensive care unit compared with 53 admissions (6.9%) in the standard oxygen group (adjusted odds ratio, 1.93 [95% CI, 1.35-2.75]). There was only 1 death and it occurred in the high-flow oxygen group. Nasal high-flow oxygen used as the initial primary therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not significantly reduce the length of hospital stay compared with standard oxygen therapy. anzctr.org.au Identifier: ACTRN12618000210279
Publisher: Wiley
Date: 28-07-2018
DOI: 10.1111/CCH.12495
Abstract: Extreme prematurity or extremely low birth weight (ELBW) can adversely affect behaviour. Nondisabled ELBW children are at risk of behavioural problems, which may become a particular concern after commencement of formal education. This study explored the frequency of behavioural and emotional problems amongst nondisabled ELBW children at 4 to 5 years of age and whether intervention had a positive influence on behaviour. The relationship between behaviour, gender, and other areas of performance at 5 years was explored. Fifty 4-year-old children (born <28 weeks gestation or birth weight <1,000 g) with minimal/mild motor impairment were randomly allocated to intervention (n = 24) or standard care (n = 26). Intervention was 6 group-based physiotherapy weekly sessions and home programme. Standard care was best practice advice. The Child Behavior Checklist (CBCL) for preschool children was completed at baseline and at 1-year post-baseline. Other measures at follow-up included Movement Assessment Battery for Children Second Edition, Beery Visual-Motor Integration Test 5th Edition, and Peabody Picture Vocabulary Test 4th Edition. The whole cohort improved on CBCL total problems score between baseline (mean 50.0, SD 11.1) and 1-year follow-up (mean 45.2, SD 10.3), p = .004. There were no significant differences between groups over time on CBCL internalizing, externalizing, or total problems scores. The intervention group showed a mean difference in total problems score of -3.8 (CI [1.5, 9.1]) between times, with standard care group values being -4.4 (CI [1.6, 7.1]). Males had higher total problems scores than females (p = .026), although still performed within the "normal" range. CBCL scores did not correlate with other scores. The behaviour of nondisabled ELBW children was within the "normal" range at 4 to 5 years, and both intervention and standard care may have contributed to improved behavioural outcomes. Behaviour was not related to performance in other developmental domains.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.JPAINSYMMAN.2014.09.017
Abstract: The therapeutic efficacy of a transdermal system (TDS) is directly related to the adhesion of TDS, with partial adhesion resulting in lower plasma concentration. Currently there is no TDS adhesion scoring tool available for use in the clinical setting. To validate a U.S. Food and Drug Administration (FDA) scoring system for the adhesion of the fentanyl TDS in cancer patients. A library of images was created from photographs of fentanyl lacebo TDS placed on patients/volunteers. Thirty photographs, reflecting varying degrees of adhesion, were selected for each of series A and B, with 10 photographs common to both series. Each series was shown to 30 health professionals asked to score the photographs using the FDA scoring system. Validity was assessed using Spearman's rank correlation and reliability by Cohen's kappa (k). Photo editing software was used to assign control scores to each photograph. Validity was high for both series (≥ 0.954). Inter-reliability (k) ranged from 0.327 to 0.858 (average, 0.547) and 0.433-0.910 (average, 0.620) in series A and B, respectively. The combined agreement across both series was 0.585. Intra-rater agreement (k) of the 10 common images was 0.605. No significant difference was observed between the scoring patterns for those with more than 10 years of working experience. Overall, the TDS adhesion score determined by the participants visually in this study corresponded well to those generated by photo editing software, thus rendering the scoring system highly valid. The FDA scoring system is an adequate tool for assessing fentanyl TDS adhesion in clinical practice.
Publisher: Research Square Platform LLC
Date: 27-01-2020
Abstract: Background Pulse oximetry (SpO 2 ) is used to monitor oxygen saturation levels to avoid hypoxaemia in children. Sensor manufacturers claim high sensitivity, specificity and accuracy. Few studies have evaluated accuracy and precision of SpO 2 in children. Methods This prospective, observational study was conducted in a 36-bed mixed medical/surgical paediatric intensive care unit. All children years old with an arterial line were eligible. Paired SpO 2 readings obtained with a Masimo and a Nellcor sensor were prospectively matched and validated to the arterial haemoglobin oxygen saturation (SaO 2 ). Bias between SpO 2 and SaO 2 (SpO 2 -SaO 2 ), accuracy root mean square (A rms ), sensitivity, specificity and kappa agreement were calculated for sensors. Multivariable regression analysis was conducted to determine the relationship between clinical variables and bias in paired sensor readings. Findings There were 929 participants with 16,839 readings (9,382 simultaneous Masimo and Nellcor). Nineteen percent of paired values had SaO 2 %. Bias increased with decreasing SaO 2 . Both sensors failed to achieve FDA’s A rms requirement in all ranges. Of the 15.5% patients with ‘true hypoxaemia’ (SaO 2 %), 28.6% (n=1165) were not correctly identified by pulse oximetry. Variables associated with higher odds of bias included sepsis, respiratory distress and post-cardiac arrest increasing lactate vasoconstrictor use lower SaO 2 and low admission weight. Interpretation Both tested sensors, with current algorithms, are not precise enough for a PICU setting. Sensor readings in patients with respiratory disease, sepsis and cardiac arrest should be used with caution.
Publisher: Mary Ann Liebert Inc
Date: 11-2017
Abstract: Pharmacotherapy for problematic aggressive and violent behavior disorders in male children and adolescents is associated with significant adverse events. Treatments with more acceptable risk-benefit ratios are critically needed. Micronutrient intervention will be investigated as an alternative to bridge the therapeutic gap in the management of these behaviors. Males aged 4-14 who displayed ongoing violent and aggressive behaviors received micronutrient intervention containing alpha-tocopherol (vitamin E), ascorbic acid (vitamin C), biotin, chromium, pyridoxal-5-phosphate (P5P), pyridoxine (vitamins B6), selenium, and zinc, in a 16-week open-label trial. Plasma zinc, plasma copper, copper/zinc ratio, and urinary hydroxyhemopyrroline-2-one (HPL) tests were conducted at baseline and endpoint. Participants were examined for changes in aggressive and violent behaviors measured using the Children's Aggression Scale (CAS) and the Modified Overt Aggression Scale (MOAS), improvements in family functioning measured using the Family Functioning Style Scale, improvements in health-related quality of life (HRQoL) measured using the Pediatric Quality of Life Inventory (PedsQL) at baseline, 8 weeks, endpoint, and at 4-6-month follow-up. Thirty-two male children and adolescents met inclusion criteria. Thirty-one (mean 8.35 ± standard deviation 2.93 years) completed the study, with one participant lost to follow-up. Micronutrient therapy significantly improved parent-reported aggressive and violent behaviors measured using the CAS for all domains except the use of weapons (p < 0.001 to p = 0.02) with medium to large effect size (Cohen's d = 0.72-1.43) and the MOAS (p < 0.001) with large effect size (Cohen's d = 1.26). Parent-reported HRQoL (p < 0.001 Cohen's d = -1.69) and family functioning (p = 0.03 Cohen's d = -0.41) also significantly improved. Micronutrient therapy appeared well tolerated, with a favorable side effect profile. It appeared effective in the reduction of parent-reported aggressive and violent behaviors, and showed improvement in family functioning and HRQoL in male youth after 16 weeks. Further research in the form of a double-blinded, randomized controlled trial is required to verify these initial positive observations.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2017
DOI: 10.1007/S00520-016-3472-Z
Abstract: The purpose of this study is to assess the efficacy of oral Vitamin C as an opioid-sparing agent when used in conjunction with opioids and standard adjuvant therapy in the management of chronic cancer pain. An open-label pilot study of patients ≥18 years of age with chronic pain secondary to cancer and/or its treatment and a Brief Pain Inventory average pain score of ≥3/10. In addition to opioid analgesia, patients received 1 g of vitamin C twice daily over 3 days (total daily dose of 2 g). Patients' usual medications, including breakthrough medications, were continued throughout the study period. The primary endpoint was total daily opioid use during vitamin C administration compared with that immediately prior to study. Thirty-four patients were enrolled in the study. Seven failed to complete the trial. Across the 17 evaluable patients, the median daily opioid consumption was 360 mg oral morphine equivalents (OME) on the days prior to vitamin C and 390 mg when administered with vitamin C. This study failed to demonstrate any clinically significant benefit from vitamin C in conjunction with opioids in cancer-related pain and does not provide support for embarking on a larger randomised trial to determine efficacy.
Publisher: Frontiers Media SA
Date: 21-11-2022
Abstract: This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events. The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed. We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion. Screening, risk of bias, quality of evidence and data extraction was performed by two independent reviewers, with conflicts resolved by a third reviewer where consensus could not be reached. From 362 screened studies, fourteen studies ( N = 2442) met the eligibility criteria. Randomised controlled trials ( N = 482) and studies performed in the operating theatre ( N = 835) favoured the use of apnoeic oxygenation with a reduced incidence of hypoxaemia (RR: 0.34, 95% CI: 0.24 to 0.47, p & 0.001, I 2 = 0% and RR: 0.27, 95% CI: 0.11 to 0.68, p = 0.005, I 2 = 68% respectively). Studies in the ED and PICU were of lower methodological quality, displaying heterogeneity in their results and were unsuitable for meta-analysis. Among the studies reporting first attempt intubation success, there were inconsistent effects reported and data were not suitable for meta-analysis. There is a growing body of evidence to support the use of apnoeic oxygenation during the intubation of children. Further research is required to determine optimal flow rates and delivery technique. The use of humidified high-flow oxygen shows promise as an effective technique based on data in the operating theatre, however its efficacy has not been shown to be superior to low flow oxygen in either the elective anesthetic or emergency intubation situations Systematic Review Registration: This review was prospectively registered in the PROSPERO international register of systematic reviews (Reference: CRD42020170884, registered April 28, 2020).
Publisher: Wiley
Date: 05-03-2012
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.WOMBI.2011.11.001
Abstract: Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth. A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5% p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07 95% CI 0.92-1.24 p=0.397), birth assisted by instrument (aOR 1.02 95% CI 0.86-1.21 p=0.852) or emergency caesarean section (aOR 0.89 95% CI 0.74-1.06 p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29 95% CI 1.06-1.58 p=0.013). Women in MGP care are no more or less likely to have an unassisted vaginal birth.
Publisher: Wiley
Date: 04-2017
DOI: 10.1111/IMJ.13375
Abstract: Routine psychosocial screening and management of people with diabetes is recommended. To profile demographic, medical and psychosocial characteristics of young people with diabetes, and to develop a screening tool and care pathway for routine use. Indices of diabetes control and recorded diabetes complications were complimented by psychosocial screening tools assessing psychological, diabetes specific and perceived stress (Kessler 10, Problem Area in Diabetes, Perceived Stress Scale), well-being (World Health Organization Well Being Index-5), disordered eating (Eating Disorder Risk Inventory-3 Risk Composite), compensatory behaviour questionnaire, social support (Multidimensional Scale of Perceived Social Support), resilience (Connor Davidson Resilience Scale - 2 item) and financial concerns. Service provision and demographic data were also collected. Diabetes and mental health clinicians then identified a subset of measures to use for routine screening along with care pathways. Psychosocial screening was well accepted. Participants (151) had suboptimal glycaemic control (glycated haemoglobin 8.0 interquartile range 1.8%/64 interquartile range 22 mmol/mol). Severe diabetes-related distress (Problem Area in Diabetes ≥40) was found in 19.4% and 26.0% reported difficulties managing healthcare costs. A mental health disorder was likely in 9.7%, whilst 23.4% had high Kessler 10 scores. Low World Health Organization Well Being Index-5 scores (≤13) were seen in 29.0%. Risk for an eating disorder (Eating Disorder Risk Inventory-3 Risk Composite) was 12.7%, whereas approximately 36.0% had disturbed eating behaviours. Psychosocial screening of young adults with diabetes identified complex needs. A brief psychosocial screening tool and associated care pathways were developed for routine use in a young adult tertiary referral diabetes clinic. The tool assesses constructs, such as diabetes distress, depression, anxiety, well-being, hypoglycaemia-unawareness, fear of hypoglycaemia, social support, weight, shape and eating concerns and financial concerns. This will provide a longitudinal data source for further research to inform clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2013
DOI: 10.1007/S00384-012-1561-0
Abstract: Health-related quality of life (HRQL) is not well studied in proctocolectomy patients with pediatric onset of ulcerative colitis (UC). We aimed to (1) compare the HRQL of proctocolectomy patients with those treated with conventional therapy and (2) determine factors that influence HRQL in UC patients < 18 years. Chart review was done on patients diagnosed with pediatric onset of UC (<18) at the Stollery Children's Hospital. HRQL was evaluated in 88 patients using disease- and age-specific questionnaires IMPACT III ( 143 points) were most likely to be in remission (p = 0.05), they were less likely to be on medication (p < 0.05), have parent/guardian with postsecondary education (p = 0.01), did not suffer from fatigue (p < 0.01), and did not report depression (p < 0.02). The IMPACT correlation with PUCAI (adjusted r (2) = 0.33) and EQ-VAS (adjusted r (2) = 0.45) was strong. Surgical patients reported to have a HRQL comparable to or better than the nonsurgical patients. Depression, fatigue, parent/guardian education, and drugs influence HRQL.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.IJNURSTU.2019.01.001
Abstract: The objective of this review is to explore, review and synthesize the empirical literature that reports on the concept of woman centred care. Integrative review of the empirical literature on the concept of woman centred care. A comprehensive search strategy was conducted using the phrase 'woman-centred care' 'women-centred care' (and all associated spelling variants) in the relevant databases including PubMed, Cumulative Index to Nursing and Allied Health, Intermid, Scopus, Informit and Web of Science. A concurrent search using the phrase 'patient-centred care' (and associated spelling variants) was also conducted, to ensure all studies about care of a woman in pregnancy, labour and postpartum were captured. A comprehensive five stage integrative review methodology was used to review primary studies which addressed woman-centred care as either an intervention or an outcome. The quality of included studies was assessed using the appropriate Critical Appraisal Skills Programme tool. Initial searching located 1205 papers. Seventeen studies met the inclusion criteria (qualitative n=12 and quantitative n=5). The studies were conducted in Australia (n=5), Ireland (n=1), Japan (n=2), Netherlands (n=2), New Zealand (n=1), South Africa (n=1), Sweden (n=1), Switzerland (n=1), United Kingdom (n=1), and the United States of America (n=2). The quality of the studies varied. NVivo software was employed to abstract and synthesize the data. Analysis revealed 10 subthemes synthesized under three pre-determined main themes of clinical practice (choice and control, empowerment, protecting normal birth, relationships and the in idual midwife), maternity service (model of care, continuity of care and maternity care systems) and education (registered practitioners and student midwives). This review integrates the empirical literature to illuminate the concept of woman-centred care as it currently applies to clinical practice, maternity service, and education. The concept of woman- centred care is intertwined in the themes and subthemes identified in the studies. There is wide variation in how woman-centred care is interpreted and this contributes to the confusion and tokenism with which it is discussed in health policy documents and frameworks. Further research is also warranted in the development of a universal definition of woman-centred care and in how woman-centred care behaviours are developed in practitioners.
Publisher: American Medical Association (AMA)
Date: 05-07-2022
Publisher: Wiley
Date: 09-06-2023
DOI: 10.1111/NICC.12938
Abstract: Globally, sepsis has been identified as one of the leading causes of preventable childhood mortality and morbidity. Previous studies on intensive care patients estimated that approximately 30% of children with sepsis experience some form of disability at discharge. Development of care has seen growing numbers of children treated for sepsis not requiring a PICU admission however, outcomes in this population are yet to be understood. Further focus is required to understand sepsis survivorship across the wider population to address knowledge gaps and morbidity burden in the broader surviving population. To assess the cognitive, physical, emotional and social health of children surviving sepsis 2 years after hospital discharge. A prospective, observational cohort study. Two hundred and thirty‐two children will be screened, 2 years after their hospital admission, and approached for participation in this study. Children who are years of age at follow‐up, treated for sepsis‐related organ dysfunction or septic shock in Queensland between October 2018 and December 2019, will be included. Children who are deceased at follow‐up, under care of the state, or require English interpreters will be excluded from participation. Data will be collected through an online follow‐up survey comprising validated caregiver‐reported questionnaires covering the four Post Intensive Care Syndrome‐paediatrics (PICS‐p) domains (cognitive, physical, emotional and social health Manning et al. Pediatr Crit Care Med, 2018, 19, 298–300). The primary outcome is an adaptive behaviour of the participants assessed using the Vinelands‐3 tool. Secondary outcomes will include neurodevelopment, quality of life, child distress, overall function, executive function, caregiver's distress and caregiver's stress. Analysis of variance (ANOVA), Kruskal‐Wallis and Fisher's exact test/chi‐squared tests will be used for statistical analyses. No adjustments will be made for multiple comparisons but it is acknowledged that comparisons made in this study are exploratory. With more children surviving sepsis, there is a need for a more comprehensive assessment of patient and family outcomes to allow support structures for families leaving the hospital after sepsis. This study is expected to inform clinicians and stakeholders of patient and family well‐being after sepsis survivorship.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2022
DOI: 10.1038/S41598-022-14226-6
Abstract: We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (− 20.8 h [− 36.1, − 8.0]) but not intensive care (–9.4 h [− 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [− 5.0%, 11.4%]), non-intensive (− 4.5 h [− 19.0, 9.8]) and intensive (+ 7.7 h, [− 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [− $857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs.
Publisher: Wiley
Date: 03-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2010
DOI: 10.1038/AJG.2010.281
Abstract: Mucosa-associated bacteria are increased in inflammatory bowel disease (IBD), which suggests the possibility of an increased source of digestible endogenous mucus substrate. We hypothesized that mucolytic bacteria are increased in IBD, providing increased substrate to sustain nonmucolytic mucosa-associated bacteria. Mucolytic bacteria were characterized by the ability to degrade human secretory mucin (MUC2) in pure and mixed anaerobic cultures. Real-time PCR was used to enumerate mucosa-associated mucolytic bacteria in 46 IBD and 20 control patients. Bacterial mucolytic activity was tested in vitro using purified human MUC2. We confirm increased total mucosa-associated bacteria 16S rRNA gene in macroscopically and histologically normal intestinal epithelium of both Crohn's disease (CD) (mean 1.9-fold) and ulcerative colitis (UC) (mean 1.3-fold). We found a disproportionate increase in some mucolytic bacteria. Mean Ruminococcus gnavus were increased >4-fold and Ruminococcus torques ∼100-fold in macroscopically and histologically normal intestinal epithelium of both CD and UC. The most abundantly detected mucolytic bacterium in controls, Akkermansia muciniphila, was reduced many fold in CD and in UC. Coculture of A. muciniphila with MUC2 as the sole carbon source led to reduction in its abundance while it augmented growth of other bacteria. Mucolytic bacteria are present in healthy humans, where they are an integral part of the mucosa-associated bacterial consortium. The disproportionate increase in R. gnavus and R. torques could explain increased total mucosa-associated bacteria in IBD.
Publisher: Wiley
Date: 11-08-2009
DOI: 10.1002/PPUL.21000
Abstract: In adults, ventilation is preferentially distributed towards the dependent lung. A reversal of the adult pattern has been observed in infants using radionuclide ventilation scanning. But these results have been obtained in infants and children with lung disease. In this study we investigate whether healthy infants have a similar reverse pattern of ventilation distribution. Measurement of regional ventilation distribution in healthy newborn infants during non-REM sleep in comparison to adults. Twenty-four healthy newborns and 13 adults were investigated with electrical impedance tomography (EIT) in supine and prone position. Regional ventilation distribution was assessed with profiles of relative impedance change. The phase lag between dependent and non-dependent ventilation was calculated as a measure of asynchronous ventilation. In newborns and adults the geometric center of ventilation was centrally located in the lung at 52.2 +/- 6.2% from anterior to posterior and at 50.5 +/- 14.7%, respectively. Using impedance profiles, ventilation was equally distributed to the dependent and non-dependent lung regions in newborns. Ventilation distribution in adults was similar. Phase lag characteristics of the impedance signal showed that infants had slower emptying of the dependent lung than adults. The speculated reverse pattern of regional ventilation distribution in healthy infants compared to adults could not be demonstrated. Gravity had little effect on ventilation distribution in both infants and adults measured in supine and prone position.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2013
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.AUCC.2021.06.004
Abstract: Clinically significant post-traumatic stress symptoms (PTSS) have been reported in up to a quarter of paediatric intensive care unit (PICU) survivors. Ongoing PTSS negatively impacts children's psychological development and physical recovery. However, few data regarding associations between potentially modifiable PICU treatment factors, such as analgosedatives and invasive procedures, and children's PTSS have been reported. We sought to investigate the medical treatment factors associated with children's PTSS after PICU discharge. A prospective longitudinal cohort study was conducted in two Australian tertiary referral PICUs. Children aged 2-16 y admitted to the PICU between June 2008 and January 2011 for >8 h and <28 d were eligible for participation. Biometric and clinical data were obtained from medical records. Parents reported their child's PTSS using the Trauma Symptom Checklist for Young Children at 1, 3, 6, and 12 months after discharge. Logistic regression was used to assess potential associations between medical treatment and PTSS. A total of 265 children and their parents participated in the study. In the 12-month period following PICU discharge, 24% of children exhibited clinically elevated PTSS. Median risk of death (Paediatric Index of Mortality 2 [PIM2]) score was significantly higher in the PTSS group (0.31 [IQR 0.14-1.09] v 0.67 [IQR 0.20-1.18] p = 0.014). Intubation and PICU and hospital length of stay were also significantly associated with PTSS at 1 month, as were midazolam, propofol, and morphine. After controlling for gender, reason for admission, and PIM2 score, only midazolam was significantly and independently associated with PTSS and only at 1 month (adjusted odds ration (aOR) 3.63, 95% CI 1.18, 11.12, p = 0.024). No significant relationship was observed between the use of medications and PTSS after 1 month. Elevated PTSS were evident in one quarter (24%) of children during the 12 months after PICU discharge. One month after discharge, elevated PTSS were most likely to occur in children who had received midazolam therapy.
Publisher: JMIR Publications Inc.
Date: 15-03-2023
DOI: 10.2196/43760
Abstract: Extracorporeal membrane oxygenation (ECMO) provides support for the pulmonary or cardiovascular function of children in whom the predicted mortality risk remains very high. The inevitable host inflammatory response and activation of the coagulation cascade due to the extracorporeal circuit contribute to additional morbidity and mortality in these patients. Mixing nitric oxide (NO) into the sweep gas of ECMO circuits may reduce the inflammatory and coagulation cascade activation during ECMO support. The purpose of this study is to test the feasibility and safety of mixing NO into the sweep gas of ECMO systems and assess its effect on inflammation and coagulation system activation through a pilot randomized controlled trial. The Nitric Oxide on Extracorporeal Membrane Oxygenation in Neonates and Children (NECTAR) trial is an open-label, parallel-group, pilot randomized controlled trial to be conducted at a single center. Fifty patients who require ECMO support will be randomly assigned to receive either NO mixed into the sweep gas of the ECMO system at 20 ppm for the duration of ECMO or standard care (no NO) in a 1:1 ratio, with stratification by support type (veno-venous vs veno-arterial ECMO). Outcome measures will focus on feasibility (recruitment rate and consent rate, and successful inflammatory marker measurements), the safety of the intervention (oxygenation and carbon dioxide control within defined parameters and methemoglobin levels), and proxy markers of efficacy (assessment of cytokines, chemokines, and coagulation factors to assess the impact of NO on host inflammation and coagulation cascade activation, clotting of ECMO components, including computer tomography scanning of oxygenators for clot assessments), bleeding complications, as well as total blood product use. Survival without ECMO and the length of stay in the pediatric intensive care unit (PICU) are clinically relevant efficacy outcomes. Long-term outcomes include neurodevelopmental assessments (Ages and Stages Questionnaire, Strength and Difficulties Questionnaire, and others) and quality of life (Pediatric Quality of Life Inventory and others) measured at 6 and 12 months post ECMO cannulation. Analyses will be conducted on an intention-to-treat basis. The NECTAR study investigates the safety and feasibility of NO as a drug intervention during extracorporeal life support and explores its efficacy. The study will investigate whether morbidity and mortality in patients treated with ECMO can be improved with NO. The intervention targets adverse outcomes in patients who are supported by ECMO and who have high expected mortality and morbidity. The study will be one of the largest randomized controlled trials performed among pediatric patients supported by ECMO. Australian New Zealand Clinical Trials Registry ACTRN12619001518156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376869 DERR1-10.2196/43760
Publisher: Wiley
Date: 09-2012
DOI: 10.1111/J.1440-1754.2012.02534.X
Abstract: Growth charts are the mainstay of monitoring growth in babies who were born small or preterm. A variety of different charts are available, each with specific limitations. Most birthweight centile charts underestimate growth restriction in preterm babies and there are few good charts for monitoring longitudinal growth in preterm babies it is important to be aware of the limitations of using cross-sectional data for monitoring longitudinal growth. Customised centile charts of fetal growth are used increasingly for antenatal monitoring for small-for-gestational age fetuses despite a lack of robust evidence. It is also unclear whether customised centile charts should be used for assessing birthweight, particularly in babies born at term. Faltering post-natal growth in preterm babies is very common but need not be universal with close attention to nutrition. Monitoring of growth trajectories through infancy following either fetal growth restriction or post-natal faltering growth is important to ensure proportional growth, particularly during periods of accelerated growth. This review will discuss these issues in the context of current practice in Australia and New Zealand.
Publisher: Wiley
Date: 10-11-2021
DOI: 10.1111/PAN.14321
Abstract: A contemporary, well‐validated instrument for the measurement of behavior change in children after general anesthesia is lacking. The Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS) has been developed as an updated version of the original Post Hospitalization Behavior Questionnaire (PHBQ) to better reflect the current patient population and modern anesthetic practices. To assess the reliability of the PHBQ‐AS and determine concurrent validity with another measure of child behavior, the Strength and Difficulties Questionnaire (SDQ). We compared the PHBQ‐AS with the SDQ in 248 children presenting for day‐case surgery. A baseline SDQ measurement was taken prior to surgery, and then, both scales were administered on days 3, 14, and 28 postsurgery. The PHBQ‐AS demonstrated good reliability in terms of internal consistency with a Cronbach's alpha of 0.79 and split‐half correlation with Spearman Brown adjustment of 0.85. There was weak correlation with the SDQ on day 3 postoperatively (Pearson's r = 0.201), moderate correlation on day 14 (Pearson's r = 0.421), and weak‐to‐moderate correlation on day 28 (Pearson's r = 0.340). A cut‐off score of 3.2 on the PHBQ‐AS for the diagnosis of negative behavior demonstrated equivalence with the SDQ results however, the SDQ results remained relatively constant throughout the study period and reflected the expected rate of increased risk of problem behavior in children. The PHBQ‐AS showed good reliability but only had weak‐to‐moderate correlation with another measure of child behavior, the SDQ. Further validation is required before the PHBQ‐AS is used for the routine measurement of behavior change in children after anesthesia, or alternatively, a new instrument needs to be developed in order for research to advance in this area.
Publisher: AMPCo
Date: 02-2012
DOI: 10.5694/MJA11.11120
Abstract: To document temporal trends in maternal overweight and obesity in Australian women and to examine associations with pregnancy outcomes. Retrospective 12-year cohort study of 75 432 women with singleton pregnancies who had pre-pregnancy height and weight data available and who gave birth in a tertiary referral maternity hospital in Brisbane between January 1998 and December 2009. Maternal body mass index (BMI) prevalence of overweight and obesity, and pregnancy complications including hypertension, gestational diabetes, caesarean delivery, and perinatal morbidity and mortality. From 1998 to 2009, class III and class II obesity increased significantly (from 1.2% to 2.0%, and 2.5% to 3.2%, respectively), while the proportions of underweight women and those with class I obesity fell slightly (from 7.9% to 7.4%, and 7.7% to 7.5%, respectively). Increasing maternal BMI was associated with many adverse pregnancy outcomes, including hypertension in pregnancy, gestational diabetes, caesarean delivery, perinatal mortality (stillbirth and neonatal death), babies who were large for gestational age, and neonatal morbidities including hypoglycaemia, jaundice, respiratory distress and the need for neonatal intensive care (P < 0.001 for all). Most associations remained significant after adjusting for maternal age, parity, insurance status, smoking status, ethnicity and year of the birth. The frequency of congenital anomalies was not associated with maternal BMI (P = 0.71). Maternal overweight and obesity are endemic challenges for Australian obstetric care and are associated with serious maternal and neonatal complications, including perinatal mortality.
Publisher: Wiley
Date: 22-09-2016
DOI: 10.1111/AJO.12404
Abstract: There is a paucity of published clinical data to guide obstetric decision-making regarding mode of birth at extreme prematurity. To evaluate whether neonatal survival or maternal outcomes were affected by the decision to perform a caesarean section (CS) between 23 + 0 and 26 + 6 weeks' gestation. A single-centre retrospective cohort study of all liveborn infants born with a plan for active resuscitation at 23-26 weeks' gestation was performed. Descriptive and multivariate logistic regression analyses compared outcomes after vaginal birth and CS. Subgroup analyses of nonfootling breech presentations, multiple pregnancies and singleton pregnancies in spontaneous preterm labour were performed. Outcomes for 625 neonates delivered by 540 mothers were analysed. A total of 300 (48%) neonates were born vaginally and 325 (52%) by CS. Mode of birth was not associated independently with survival for any multivariate analysis gestational age at birth was an independent predictor across all analyses. Adverse maternal outcomes were documented in 112 (21%) pregnancies the rate of severe maternal complications was low. Maternal morbidity was not affected by mode of birth. Mode of birth did not affect neonatal survival or the rate of maternal morbidity for deliveries at 23-26 completed weeks' gestation.
Publisher: Wiley
Date: 04-02-2013
DOI: 10.1111/PPE.12041
Abstract: The objective of this study was to determine whether the physiological effects on birthweight as described by customised birthweight models (CBMs) from various populations and locations are consistent when applied to a single s le. The predicted birthweight was calculated for 52 826 White-European singleton term births between 1997 and 2008 from a large Australian hospital using the same set of variables from 12 published CBMs. The accuracy of prediction was tested against both the actual birthweight and a reference model. Intraclass correlation coefficients (ICCs) along with 95% confidence intervals of the measurements, paired differences (predicted-actual birthweight) and absolute values of the paired differences are reported. The average difference in predicted and actual birthweight was <200 g for all CBMs, with ICCs for all but one model indicating fair agreement (between 0.3 and 0.5). When compared with the reference model, eight of the 11 models had a difference in predicted birthweight of <220 g, and the ICCs indicated that the majority of models had strong agreement. All published CBMs demonstrated ability to predict birthweight with reasonable accuracy. The effects of maternal and fetal characteristics on birthweight appear to be consistent across birthweight models. This finding is a further step in validating the CBM, and provides greater evidence for the creation of a global model.
Publisher: Springer Science and Business Media LLC
Date: 02-06-2021
DOI: 10.1007/S40620-021-01071-5
Abstract: Acute kidney injury (AKI) is a major cause of morbidity and mortality in critically ill children. The aim of this paper was to describe the prevalence and course of AKI in critically ill children and to compare different AKI classification criteria. We conducted a retrospective observational study in our multi-disciplinary Pediatric Intensive Care Unit (ICU) from January 2015 to December 2018. All patients from birth to 16 years of age who were admitted to the pediatric ICU were included. The Kidney Disease Improving Global Outcomes (KDIGO) definition was considered as the reference standard. We compared the incidence data assessed by KDIGO, pediatric risk, injury, failure, loss of kidney function and end- stage renal disease (pRIFLE) and pediatric reference change value optimised for AKI (pROCK). Out of 7505 patients, 9.2% developed AKI by KDIGO criteria. The majority (59.8%) presented with stage 1 AKI. Recovery from AKI was observed in 70.4% of patients within 7 days from diagnosis. Both pRIFLE and pROCK were less sensitive compared to KDIGO criteria for the classification of AKI. Patients who met all three-KDIGO, pRIFLE and pROCK criteria had a high mortality rate (35.0%). Close to one in ten patients admitted to the pediatric ICU met AKI criteria according to KDIGO. In about 30% of patients, AKI persisted beyond 7 days. Follow-up of patients with persistent kidney function reduction at hospital discharge is needed to reveal the long-term morbidity due to AKI in the pediatric ICU.
Publisher: Wiley
Date: 29-10-2013
DOI: 10.1111/AJO.12009
Abstract: The optimal dose of misoprostol to be used in the medical management of miscarriage before 13 weeks has not been resolved. To evaluate the effectiveness and side effect profile of two different dosages of misoprostol. A randomised controlled, equivalence study comparing 400 vs 800 μg misoprostol per vaginum (PV) on an outpatient basis. The allocated dose was repeated the next day if clinically the products of conception had not been passed. Complete miscarriage was evaluated using two methods: ultrasound criteria on Day 7 and the need for surgical management (clinical criteria). Equivalence was demonstrated if the 95% confidence interval [CI] of the observed risk difference between the two doses for complete miscarriage lay between -15.0 and 15.0%. Differences in side effects and patient satisfaction were evaluated using patient-completed questionnaires. One hundred and fifty-eight women were allocated to receive 400 μg and 152 women to 800 μg misoprostol for the management of missed (91.3%) or incomplete (8.7%) miscarriage. The rate of induced complete miscarriage was equivalent using both ultrasound criteria (observed risk difference (ORD) -4.6%, 95% CI -12.8 to 3.7% P = 0.313) and clinical criteria (ORD -5.6%, 95% CI -14.8 to 3.6% P = 0.273). Following the 400 μg dose, the reported rate of fever/rigors was lower (ORD -15.6%, 95% CI -28.1 to -3.0% P = 0.015), and more women reported their decision to undergo medical management as a good decision (ORD 15.2%, 95% CI 2.8 to 27.7% P = 0.018). Four hundred-microgram misoprostol PV can be recommended for the medical management of miscarriage on an outpatient basis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Frontiers Media SA
Date: 30-04-2021
Abstract: Introduction: Septic shock remains amongst the leading causes of childhood mortality. Therapeutic options to support children with septic shock refractory to initial resuscitation with fluids and inotropes are limited. Recently, the combination of intravenous hydrocortisone with high dose ascorbic acid and thiamine (HAT therapy), postulated to reduce sepsis-related organ dysfunction, has been proposed as a safe approach with potential for mortality benefit, but randomized trials in paediatric patients are lacking. We hypothesize that protocolised early use of HAT therapy (“metabolic resuscitation”) in children with septic shock is feasible and will lead to earlier resolution of organ dysfunction. Here, we describe the protocol of the Res uscitation in P aediatric Sepsis Using Metab o lic Resuscitation–A Ra nd omized Controlled Pilot Study in the P aediatric I ntensive C are U nit (RESPOND PICU). Methods and Analysis: The RESPOND PICU study is an open label randomized-controlled, two-sided multicentre pilot study conducted in paediatric intensive care units (PICUs) in Australia and New Zealand. Sixty children aged between 28 days and 18 years treated with inotropes for presumed septic shock will be randomized in a 1:1 ratio to either metabolic resuscitation (1 mg/kg hydrocortisone q6h, 30 mg/kg ascorbic acid q6h, 4 mg/kg thiamine q12h) or standard septic shock management. Main outcomes include feasibility of the study protocol and survival free of organ dysfunction censored at 28 days. The study cohort will be followed up at 28-days and 6-months post enrolment to assess neurodevelopment, quality of life and functional status. Biobanking will allow ancillary studies on sepsis biomarkers. Ethics and Dissemination: The study received ethical clearance from Children's Health Queensland Human Research Ethics Committee (HREC/18/QCHQ/49168) and commenced enrolment on June 12th, 2019. The primary study findings will be submitted for publication in a peer-reviewed journal. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12619000829112). Protocol Version : V1.8 22/7/20.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.AUCC.2019.08.002
Abstract: The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59 95% confidence interval [CI]: 0.37-0.95 p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23 95% CI: 1.99-5.40 p < 0.001) and the occurrence of an AE (aOR: 2.76 95% CI: 1.74-4.37 p < 0.001). Presuction increases in fraction of inspired oxygen (FiO ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.51893/2022.3.OA8
Abstract: OBJECTIVES: To investigate the prevalence and features of self-reported burnout among intensivists working in Australia and New Zealand, and evaluate potentially modifiable workplace stressors associated with increased risk of self-reported burnout. METHODS: We performed an electronic survey among registered intensivists in Australia and New Zealand. Burnout and professional quality of life were measured using the Professional Quality of Life Scale version 5 (ProQOL-5). Socio-organisational factors were defined a priori and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors. RESULTS: 261 of 921 estimated intensivists responded (response rate, 28.3%). Overall, few participants (0.8%) demonstrated high scores ( 75th centile) for burnout, and 70.9% of participants scored in the average range for burnout. Of note, 98.1% of participants scored in the average to high range for compassion satisfaction. No association was found between sex, age, or years of practice with the level of burnout or compassion satisfaction. Seven themes emerged regarding intensivists' most stressful aspects of work: interpersonal interactions and workplace relationships (25.5%), workload and its impact (24.9%), resources and capacity (22.6%), health systems leadership and bureaucracy (16.1%), end-of-life issues and moral distress (8.4%), clinical management (4.9%), and job security and future uncertainty (1.3%). CONCLUSION: Fewer Australian and New Zealand intensivists experienced burnout than previously reported. Many self-reported work stressors do not relate to clinical work and are due to interpersonal interactions with other colleges and hospital administrators. Such factors are potentially modifiable and could be the focus of future interventions.
Publisher: Springer Science and Business Media LLC
Date: 13-05-2022
DOI: 10.1186/S12887-022-03232-2
Abstract: As admissions to paediatric intensive care units (PICU) rise and mortality rates decline, the focus is shifting from survival to quality of survivorship. There is paucity of internationally accepted guidelines to manage complications like over-sedation, delirium, and immobility in the paediatric setting. These have a strong adverse impact on PICU recovery including healthcare costs and long-term functional disability. The A2F bundle (ABCDEF), or ICU Liberation, was developed to operationalise the multiple evidence-based guidelines addressing ICU-related complications and has been shown to improve clinical outcomes and health-care related costs in adult studies. However, there is little data on the effect of ICU Liberation bundle implementation in PICU. PICU-STARS will be a single centre before-and-after after trial and implementation study. It is designed to evaluate if the multidimensional, nurse-led ICU Liberation model of care can be applied to the PICU and if it is successful in minimising PICU-related problems in a mixed quaternary PICU. In a prospective baseline measurement, the present practises of care in the PICU will be assessed in order to inform the adaptation and implementation of the PICU Liberation bundle. To assess feasibility, implementation outcomes, and intervention effectiveness, the implementation team will use the Consolidated Framework for Implementation Research (CIFR) and process assessment (mixed methods). The implementation process will be evaluated over time, with focus groups, interviews, questionnaires, and observations used to provide formative feedback. Over time, the barriers and enablers for successful implementation will be analysed, with recommendations based on “lessons learned.” All outcomes will be reported using standard descriptive statistics and analytical techniques, with appropriate allowance for patient differentials in severity and relevant characteristics. The results will inform the fine-tune of the Liberation bundle adaptation and implementation process. The expected primary output is a detailed adaptation and implementation guideline, including clinical resources (and investment) required, to adopt PICU-STARS in other children’s hospitals. The authors thank the PICU education and Liberation Implementation team, and our patients and families for their inspiration and valuable comments on protocol drafts. Results will be made available to critical care survivors, their caregivers, relevant societies, and other researchers. ACTRN, ACTRN382863 . Registered 19/10/2021 - Retrospectively registered. recruiting.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-025997
Abstract: Emergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care. The Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0–16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age ( , 1–7 and years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO 2 % (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis. Ethics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal. ACTRN12617000147381.
Publisher: Elsevier BV
Date: 12-2013
Publisher: Elsevier BV
Date: 02-2016
Publisher: Wiley
Date: 22-04-2013
DOI: 10.1111/JPC.12189
Abstract: The study aims to describe the cohort of women and babies who are classified as small-for-gestational age (SGA) at term by both an Australian customised birthweight model (CBM) and a commonly used population-based standard, and to investigate and compare the utility of these models in identifying babies at risk of experiencing adverse outcomes Routinely collected data on 54 890 singleton-term births at the Mater Mothers' Hospitals, Brisbane, with birthweight less than 4000 g between January 1997 and December 2008, was extracted. Each birth was classified as SGA (<10th centile) or not SGA by either and/or both methods: population-based standards (SGApop ) and CBM (SGAcust ). Babies classified as SGApop , SGAcust or SGAboth were compared with those not classified as SGA by both methods using relative risk and 95% confidence interval, and those only classified as SGAcust were compared with those only classified as SGApop . Maternal demographics, maternal risk factors for fetal growth restriction, pregnancy and labour complications and adverse neonatal outcomes are reported. A total of 4768 (8.7%) births were classified as SGApop , while 6479 (11.8%) were SGAcust of whom 4138 (63.9%) were also classified as SGApop . Maternal risk factors such as smoking and hypertension were statistically higher for the SGAcust group when compared with SGApop . For the majority of adverse neonatal outcomes, a trend was noted to increased identification using the CBM. The CBM provides a modest improvement when compared to a population-based standard to identity term infants at birth who are at risk of adverse neonatal outcomes.
Publisher: Wiley
Date: 22-03-2017
DOI: 10.1111/AJO.12591
Abstract: Prelabour caesarean section (CS) at early term (37 To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term. A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (37 The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term. Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations.
Publisher: American Medical Association (AMA)
Date: 02-2023
DOI: 10.1001/JAMAPEDIATRICS.2022.4912
Abstract: Most children admitted to pediatric intensive care units (PICUs) receive intravenous fluids. A recent systematic review suggested mortality benefit in critically ill adults treated with balanced solutions compared with sodium chloride, 0.9% (saline). There is a lack of clinically directive data on optimal fluid choice in critically ill children. To determine if balanced solutions decrease the rise of plasma chloride compared with saline, 0.9%, in critically ill children. This single-center, 3-arm, open-label randomized clinical trial took place in a 36-bed PICU. Children younger than 16 years admitted to the PICU and considered to require intravenous fluid therapy by the treating clinician were eligible. Children were screened from November 2019 to April 2021. Enrolled children were 1:1:1 allocated to gluconate/acetate–buffered solution, lactate-buffered solution, or saline as intravenous fluids. The primary outcome was an increase in serum chloride of 5 mEq/L or more within 48 hours from randomization. New-onset acute kidney injury, length of hospital and intensive care stay, and intensive care–free survival were secondary outcomes. A total of 516 patients with a median (IQR) age of 3.8 (1.0-10.4) years were randomized with 178, 171, and 167 allocated to gluconate/acetate–buffered solution, lactate-buffered solution, and saline, respectively. The serum chloride level increased 5 mEq/L or more in 37 patients (25.2%), 34 patients (23.9%), and 58 patients (40.0%) in the gluconate/acetate–buffered solution, lactate-buffered solution, and saline groups. The odds of a rise in plasma chloride 5 mEq/L or more was halved with the use of gluconate/acetate–buffered solution compared with saline (odds ratio, 0.50 [95% CI, 0.31-0.83] P = .007) and with the use of lactate-buffered solution compared with saline (odds ratio, 0.47 [95% CI, 0.28-0.79] P = .004). New-onset acute kidney injury was observed in 10 patients (6.1%), 6 patients (3.7%), and 5 patients (3.2%) in the gluconate/acetate–buffered solution, lactate-buffered solution, and saline groups, respectively. Balanced solutions (gluconate/acetate–buffered solution and lactate-buffered solution) administered as intravenous fluid therapy reduced the incidence of rise in plasma chloride compared with saline in children in PICU. anzctr.org.au Identifier: ACTRN12619001244190
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.EARLHUMDEV.2012.01.010
Abstract: Within the able majority of ELBW survivors, there is a lack of identified predictors of which children will require extra support despite having escaped significant disability. Investigate the predictive validity of early motor scores, compared to that of perinatal descriptors or early growth, on long-term motor impairment in non-disabled ELBW (<1000g) children. Prospective longitudinal study. 48 non-disabled ELBW children (27 male) completed the Neurosensory Motor Developmental Assessment (NSMDA) at 8 months, 2 years and 4 years post term and The Motor Assessment Battery for Children (MABC) at 11-13 years of age. Other possible predictors of long-term outcomes (gestational age, birthweight, multiple birth, head circumference measures and gender) were retrieved from the records. Early motor assessment (NSMDA score) independently predicted the MABC total score at 11-13 years of age with a positive predictive value of 87% by 4 years post term. There was increased risk of long-term motor impairment associated with male gender but the degree of prematurity, multiple birth status or early growth measures did not predict motor outcome. Postural control and sensory motor scores at 4 years post term, rather than neurological score, were associated with long-term motor outcomes for the ELBW children at 11-13 years of age. Early motor scores are valid markers of long-term motor outcomes for "apparently normal" ELBW children. Early postural competence and sensory motor function are discriminating in regards to long-term motor function in neurologically normal ELBW children.
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.EJCA.2008.05.003
Abstract: To determine if patients with advanced cancer are interested in participation in palliative care research, particularly RCTs, and the importance of demographic factors in decision making. It sought relatives' views towards supporting trial entry, and assessed if demographic factors can predict participation. A questionnaire was developed through multiprofessional focus groups, patient and relative interviews and pilot studies. Consecutive patients known by the palliative care service to have advanced disease were approached. Relatives of consenting patients completed a parallel survey. K-means cluster analysis was used to differentiate between those willing and unwilling to participate. Multivariate logistic regression identified demographic factors predicting willingness. One hundred and one patients and 100 relatives were included. 92% of patients would participate in studies involving simple interventions, whereas only 26% would consider studies of complex interventions. A similar pattern was observed for relative support. Over 75% of participants expressed altruistic views. Concepts of 'randomisation', 'placebo-control' and 'blinding' deterred about one-half. Many were prepared to complete short questionnaires, accept extra medications, investigations, hospital visits or admissions within a trial context but the possibility of side-effects was a major deterrent. Patient age was the only significant predictor of willingness to participate, with older patients less likely to participate. Despite the likely absence of in idual benefit, many patients appear willing to participate in palliative care research. Trial design and the possibility of side-effects proved very influential in their decision making. Clinical trials in palliative care are more likely to be successful if developed in accordance with the views of patients and their relatives.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.JPAINSYMMAN.2019.12.356
Abstract: Medications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval (the time from the start of the Q wave to the end of the T wave) on a standard electrocardiogram (ECG). To document the prevalence of a prolonged QT interval corrected for heart rate (QTc) interval in the palliative/oncology setting, compare automatic ECG QTc measurements with manual readings and identify any correlation between QTc prolongation and the use of drugs or other risk factors. A convenience s le of consecutive patients with cancer, admitted under or known to the palliative/supportive care teams in two metropolitan hospitals, and willing to provide an ECG recording and basic demographic information including QTc risk factors were included. Both automated and manually calculated QTc intervals were recorded. Multivariable analysis was used to determine risk factors independently associated with prolonged QTc intervals. Of the 389 participants, there was a significant difference in mean QTc between sites using automated but not manual calculations. Manual readings were therefore used with predetermined cutoffs of 0.44 seconds (males) and 0.46 seconds (females). Seventy-two (18.5%) of the participants had a prolonged QTc with six (1.5%) having a prolongation of >0.50 seconds. At-risk drugs were being taken by 218 participants (56.0% of total cohort). Factors shown to be associated with QTc prolongation included age, gender, performance status, and hypocalcemia. No specific medication was associated with increased risk. Although almost 20% of patients receiving palliative care had prolongation of QTc, the possibility of serious consequences appeared to be low despite the frequent occurrence of risk factors.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.HLC.2022.02.004
Abstract: Infants with hypoplastic left heart syndrome (HLHS) or similar single ventricle cardiac lesions require a three-stage surgical approach, the first step being the Stage I Norwood procedure. The Queensland Children's Hospital (QCH) in Australia is a tertiary hospital providing the only cardiac surgical service to children in Queensland and northern New South Wales. To review the centre's outcomes of Norwood procedures performed in the last 6 years. We retrospectively evaluated all infants undergoing the stage I Norwood procedure between January 2015 and August 2021. Mortality, intensive care length of stay, events of cardiac arrest following surgery and duration of mechanical ventilation were calculated and analysed for subgroups depending on type of pulmonary shunt type (right-ventricle-to-pulmonary-artery shunt [RVPAS] vs the modified Blalock-Taussig shunt [MBTS]). Forty-nine (49) patients were included. Overall survival to stage two operation (Glenn) was 90%. Both shunts were used evenly with the RVPA conduit preferred for HLHS and the MBTS largely chosen for hypoplastic left heart variants. In univariable analysis there was no difference in cardiac arrest or mortality rate for the patient with a RVPAS compared to the patient with a MBTS. We show that a recently established Norwood program can achieve results that are comparable to those reported by longer established centres, and the international literature.
Publisher: Springer Science and Business Media LLC
Date: 05-2008
DOI: 10.1007/S00520-008-0441-1
Abstract: Clinical trials in palliative care (PC), especially randomised controlled trials (RCTs), are notoriously difficult to complete. One perceived challenge is gatekeeping, the reluctance of some healthcare professionals (HCPs) to refer patients for research studies. This study aimed to identify the extent of gatekeeping from palliative RCTs. An anonymous questionnaire was sent to 597 HCPs with an interest in PC in Australia and New Zealand to assess their willingness to refer patients for RCTs. Respondents considered key issues that might affect their decision, documented willingness to refer to RCTs of increasing complexity in a hypothetical pain situation and documented the degree of patient inconvenience considered acceptable. Demographic data were collected. One hundred ninety-eight questionnaires were returned (33%), 122 from doctors and 76 from other HCPs. Very few were willing to refer to complicated studies involving many extra tests and/or hospital visits. Non-medical HCPs were less interested than doctors in studies that involved randomisation, placebo controls or double-blind methodology. The majority would refer patients for non-pharmacological studies, but were less willing to refer for pharmacological studies with possible side effects. Non-medical HCPs were less willing than doctors to refer to trials that involved patient inconvenience. Two factors predicted for greater willingness to refer: previous research experience and male gender. The survey revealed an unwillingness on the part of many HCPs to refer patients for RCTs in PC. It identifies trial-related factors that may encourage or discourage referral. Gatekeeping has the potential block recruitment and introduce a selection bias.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.IJNURSTU.2015.04.011
Abstract: Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding. To determine if caseload midwifery or young women's clinic are associated with improved perinatal outcomes when compared to standard care. A retrospective cohort study. A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women's clinic (rostered midwife). All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012. Caseload midwifery and young women's clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (<37 weeks gestation), low birth weight infants (<2500g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth). 1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38-0.90, p=0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22-0.82, p=0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants. Participants allocated to young women's clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24-1.00, p=0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes. Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission.
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1465-3362.2010.00214.X
Abstract: To study the prevalence of use of illicit drugs by women of reproductive age before and during pregnancy and the changes in rates of illicit drug use in pregnancy over recent years. All pregnant women attending the public antenatal clinic over a 7 year period (2000-2006) were routinely interviewed about their use of illicit drugs by a midwife at the antenatal booking visit. Records for 25,049 women, who self-reported previous and current use of cannabis, hetamines, ecstasy and heroin, were included in the study. Cannabis was the most common illicit drug used before and during pregnancy 9.3% of women were engaged in regular use prior to pregnancy and 2.5% were users during pregnancy. A very low proportion of women reported use of hetamines, ecstasy or heroin in pregnancy. There was an increase in ever regular use and any past use of cannabis, hetamines and ecstasy over time. The prevalence of illicit drug use by young women prior to becoming pregnant is of concern. While pregnancy appears to be a strong motivator for women to cease substance use, there is a need to study whether women resume drug use after their baby is born.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2021
DOI: 10.1186/S13063-021-05376-5
Abstract: Intravenous fluid therapy represents the most common intervention critically ill patients are exposed to. Hyperchloremia and metabolic acidosis associated with 0.9% sodium chloride have been observed to lead to worse outcomes, including mortality. Balanced solutions, such as Plasma-Lyte 148 and Compound Sodium Lactate, represent potential alternatives but the evidence on optimal fluid choices in critically ill children remains scarce. This study aims to demonstrate whether balanced solutions, when used as intravenous fluid therapy, are able to reduce the incidence of a rise in serum chloride level compared to 0.9% sodium chloride in critically ill children. This is a single-centre, open-label randomized controlled trial with parallel 1:1:1 assignment into three groups: 0.9% sodium chloride, Plasma-Lyte 148, and Compound Sodium Lactate solutions for intravenous fluid therapy. The intervention includes both maintenance and bolus fluid therapy. Children aged 16 years admitted to intensive care and receiving intravenous fluid therapy during the first 4 h of admission are eligible. The primary outcome measure is a ≥ 5mmol/L increase in serum chloride level within 48 h post-randomization. The enrolment target is 480 patients. The main analyses will be intention-to-treat . This study tests three types of intravenous fluid therapy in order to compare the risk of hyperchloremia associated with normal saline versus balanced solutions. This pragmatic study is thereby assessing the most common intervention in paediatric critical care. This is a single-centre open-label study with no blinding at the level of delivery of the intervention. Certain paediatric intensive care unit (PICU) patient groups such as those admitted with a cardiac condition or following a traumatic brain injury are excluded from this study. The study has received ethical approval (HREC/19/QCHQ/53177: 06/06/2019). It is registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12619001244190 ) from 9th September 2019. Recruitment commenced on 12th November 2019. The primary results manuscript will be published in a peer-reviewed journal.
Publisher: Frontiers Media SA
Date: 31-05-2021
Abstract: Introduction: Septic shock in children still carries substantial mortality and morbidity. While resuscitation with 40–60 mL/kg intravenous fluid boluses remains a cornerstone of initial resuscitation, an increasing body of evidence indicates potential for harm related to high volume fluid administration. We hypothesize that a protocol on early use of inotropes in children with septic shock is feasible and will lead to less fluid bolus use compared to standard fluid resuscitation. Here, we describe the protocol of the Early Resuscitation in Paediatric Sepsis Using Inotropes – A Randomised Controlled Pilot Study in the Emergency Department (RESPOND ED). Methods and analysis: The RESPOND ED study is an open label randomised controlled, two arm, multicentre pilot study conducted at four specialised paediatric Emergency Departments. Forty children aged between 28 days and 18 years treated for presumed septic shock will be randomized in a 1:1 ratio to early inotropes vs. standard fluid resuscitation. Early inotrope treatment is defined as the commencement of a continuous intravenous adrenaline infusion after 20 mL/kg fluid bolus resuscitation. Standard fluid resuscitation is defined as delivery of 40 to 60 mL/kg fluid bolus resuscitation prior to commencement of inotropes. In addition to feasibility outcomes, survival free of organ dysfunction censored at 28 days will be assessed as the main clinical outcome. The study cohort will be followed up at 28 days, and at 6 months post enrolment to assess quality of life and functional status. Biobanking nested in the study cohort will be performed to enable ancillary biomarker studies. Ethics and dissemination: The trial has ethical clearance (Children's Health Queensland, Brisbane, HREC/18/QCHQ/49168) and is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619000828123). Enrolment commenced on July 21st, 2019. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12619000828123.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2015
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.NEDT.2014.11.005
Abstract: Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking. To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students. Randomised three arm intervention trial. Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination. Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients. There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026). Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.
Publisher: Springer Science and Business Media LLC
Date: 21-03-2022
DOI: 10.1186/S12874-022-01551-7
Abstract: In 2016, international standards governing clinical research recommended that the approach to monitoring a research project should be undertaken based on risk, however it is unknown whether this approach has been adopted in Australia and New Zealand (ANZ) throughout critical care research. The aims of the project were to: 1) Gain an understanding of current research monitoring practices in academic-led clinical trials in the field of critical care research, 2) Describe the perceived barriers and enablers to undertaking research monitoring. Electronic survey distributed to investigators, research co-ordinators and other research staff currently undertaking and supporting academic-led clinical trials in the field of critical care in ANZ. Of the 118 respondents, 70 were involved in the co-ordination of academic trials the remaining results pertain to this sub-s le. Fifty-eight (83%) were working in research units associated with hospitals, 29 (41%) were experienced Research Coordinators and 19 (27%) Principal Investigators 31 (44%) were primarily associated with paediatric research. Fifty-six (80%) develop monitoring plans with 33 (59%) of these undertaking a risk assessment the most common barrier reported was lack of expertise. Nineteen (27%) indicated that centralised monitoring was used, noting that technology to support centralised monitoring (45/51 88%) along with support from data managers and statisticians (45/52 87%) were key enablers. Coronavirus disease-19 (COVID-19) impacted monitoring for 82% (45/55) by increasing remote (25/45 56%) and reducing onsite (29/45 64%) monitoring. Contrary to Good Clinical Practice guidance, risk assessments to inform monitoring plans are not being consistently performed due to lack of experience and guidance. There is an urgent need to enhance risk assessment methodologies and develop technological solutions for centralised statistical monitoring.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.DIABRES.2018.11.010
Abstract: To develop a risk "engine" or calculator, integrating the risks of hyperglycemia, maternal BMI and other basic demographic data commonly available at the time of the pregnancy oral glucose tolerance test (OGTT), to predict an in idual's absolute risk of specific adverse pregnancy outcomes. Data from the Brisbane HAPO cohort was analysed using logistic regression to determine the relationship between four clinical outcomes (primary CS, birth injury, large-for-gestational age, excess neonatal adiposity) with different combinations of OGTT results and maternal demographics (age, height, BMI, parity). Existing sets of international GDM diagnostic criteria were also applied to the cohort. 191 (15.3%) women were diagnosed as GDM by one or more existing criteria. All international criteria performed poorly compared to risk models utilising OGTT results only, or OGTT results in combination with maternal demographics. The risk engine's empirical performance on receiver - operator curve analysis was superior to the existing GDM diagnostic criteria tested. This concept shows promise for use in clinical practice, but further development is required.
Publisher: Elsevier BV
Date: 05-2021
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-059301
Abstract: Approximately 20%–40% of comatose children with risk factors in intensive care have electrographic-only seizures these go unrecognised due to the absence of continuous electroencephalography (EEG) monitoring (cEEG). Utility of cEEG with high-quality assessment is currently limited due to high-resource requirements. New software analysis tools are available to facilitate bedside cEEG assessment using quantitative EEG (QEEG) trends. The primary aim of this study is to describe accuracy of interpretation of QEEG trends by paediatric intensive care unit (PICU) nurses compared with cEEG assessment by neurologist (standard clinical care) in children at risk of seizures and status epilepticus utilising diagnostic test statistics. The secondary aims are to determine time to seizure detection for QEEG users compared with standard clinical care and describe impact of confounders on accuracy of seizure detection. This will be a single-centre, prospective observational cohort study evaluating a paediatric QEEG programme utilising the full 19 electrode set. The setting will be a 36-bed quaternary PICU with medical, cardiac and general surgical cases. cEEG studies in PICU patients identified as ‘at risk of seizures’ will be analysed. Trained bedside clinical nurses will interpret the QEEG. Seizure events will be marked as seizures if QEEG criteria occur. Post-hoc dedicated neurologists, who remain blinded to the QEEG analysis, will interpret the cEEG. Determination of standard test characteristics will assess the primary hypothesis. To calculate 95% (CIs) around the sensitivity and specificity estimates with a CI width of 10%, the s le size needed for sensitivity is 80 patients assuming each EEG will have approximately 9 to 18 1-hour epochs. The study has received approval by the Children’s Health Queensland Human Research Ethics Committee (HREC/19/QCHQ/58145). Results will be made available to the funders, critical care survivors and their caregivers, the relevant societies, and other researchers. Australian New Zealand Clinical Trials Registry (ANZCTR) 12621001471875.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.WOMBI.2016.10.010
Abstract: In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students. To develop and validate an instrument to measure woman centred care behaviours in midwifery students. We identified four core concepts woman's sphere, holism, self-determination and the shared power relationship. We mapped 18 in idual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred. Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69). Test and re-test reliability of the instrument was high for each of the in idual raters (Kappa 0.946 and 0.849 respectively p<0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p<0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours. The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2016
DOI: 10.1007/S00520-016-3125-2
Abstract: Anxiety is a major component of breathlessness and is often palliated with benzodiazepines. Midazolam is a short-acting water-soluble benzodiazepine with a rapid onset of action and short half-life. Intranasal midazolam had been shown to be of marked clinical benefit in an uncontrolled pilot study for the control of dyspnoea. A blinded randomised controlled study was therefore undertaken across four Australasian palliative care services. All participants received six numbered study nasal spray (SNS) bottles, three of which contained midazolam and three placebo. They were instructed to use one SNS bottle on each day they were breathless, for 6 days within 2 weeks. Dyspnoea scores were recorded before and at set time intervals following the first use of each SNS bottle. Across all SNS bottles, the maximum change of 2.1 on an 11-point numerical rating scale was seen at 60 min. There was no difference in dyspnoea score between the two arms. Approximately 50 % of participants in each arm had a positive response (i.e. ≥2 point change in dyspnoea score from baseline). Anxiety scores at baseline were low. The most common adverse event was local nasal reactions. Intranasal midazolam had no clinical benefit over intranasal placebo for the control of dyspnoea. The low level of anxiety at baseline and dose of active drug delivered may have been important factors. Many participants found the SNS bottles to be a challenging mode of drug delivery. This study confirms the importance of placebo-controlled trials for defining best clinical practise.
Publisher: AMPCo
Date: 06-2010
DOI: 10.5694/J.1326-5377.2010.TB03662.X
Abstract: To audit and describe the effects of participation in the Dose Adjustment for Normal Eating (DAFNE) course on clinical outcomes in people with type 1 diabetes mellitus (T1DM). Audit of clinical outcomes before and 1 year after DAFNE training for 145 people with T1DM who participated in courses at seven Australian diabetes centres between February 2005 and March 2007. Participants had been diagnosed with T1DM at least 1 year before and were beyond the "honeymoon phase", with glycated haemoglobin (HbA(1c)) < 12% and no severe diabetes complications. They were aged over 17 years and able to understand written and spoken English. A 5-day structured education program covering T1DM management with an emphasis on unrestricted diet, precise carbohydrate estimation and prandial insulin dosing using insulin-to-carbohydrate ratios. Glycaemic control (HbA(1c) levels), weight, severe hypoglycaemia, and quality of life scores on general (Hospital Anxiety and Depression) and diabetes-specific (Problem Areas in Diabetes) scales. Mean HbA(1c) fell from 8.2% to 7.8% (95% CI for change, - 0.5% to - 0.2% P < 0.0001) and weight from 75.1 to 74.2 kg (95% CI for change, - 1.6 to - 0.2 kg P = 0.012). Severe hypoglycaemia was less frequent after DAFNE training (P = 0.0001). Quality of life improved (P < 0.0001 for both scales). One year after participation in the DAFNE program of structured education, people with T1DM showed improved glycaemic control, reduced incidence of severe hypoglycaemia, slightly reduced weight and improved quality of life. The DAFNE course offers one means of improving clinical outcomes in T1DM.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-05-2023
Publisher: Springer Science and Business Media LLC
Date: 30-08-2013
Publisher: Wiley
Date: 19-05-2014
DOI: 10.1111/AJO.12220
Abstract: Births by elective caesarean section (CS) are rising, particularly before 39 weeks' gestation, which may be associated with unacceptably high risk of adverse neonatal outcomes. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39 weeks. To evaluate the association between gestational age (GA) at delivery and neonatal outcomes after elective CS between 37 and 41 weeks. Retrospective cohort study of viable singleton neonates delivered by elective CS at Mater Mothers' Hospitals (1998-2009). Neonates were stratified into two GA groups with early term (ET, 37-38 weeks) compared with the reference group of full and late term (FLT, 39-41 weeks). The primary outcome examined was serious respiratory morbidity secondary outcomes included depression at birth, nursery admission and assisted ventilation. Fourteen thousand and four hundred and forty-seven mother-baby pairs were included (59.9% delivered before 39 weeks). There was a significantly decreasing risk of adverse neonatal outcomes with increasing GA. Compared to FLT, delivery at ET almost tripled the risk of the primary outcome (AOR 2.74 95% CI 1.79-4.21). Rates of most secondary outcomes were at least doubled. Elective CS performed at 37-38 weeks is associated with poorer neonatal outcomes compared to those delivered at 39-41 weeks. This study supports recent recommendations to delay delivery by elective CS until week 39 if possible.
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000441915
Abstract: b i Objective: /i /b To evaluate the impact of entry method and access diameter at fetoscopic surgery for twin-twin transfusion syndrome in twin pregnancies with at least one survivor. The outcomes evaluated were prelabour rupture of membranes (PROM) and birth weeks, preterm birth (PTB) weeks, and latency to birth. b i Methods: /i /b A retrospective analysis of prospectively collected data of consecutive laser procedures from 6 centers was performed. Three entry methods (sheath + trocar cannula + trocar cannula + Seldinger) and 6 access diameters (2.3, 3.0, 3.3, 3.5, 3.8, 4.0 mm) were used. Exclusion criteria were subsequent invasive interventions, termination of pregnancy or double fetal death after laser. Multivariate analysis was performed to determine risk factors for the study outcomes. b i Results: /i /b Six hundred seventy three fetoscopic laser cases were analyzed. The use of different entry methods and access diameters did not affect PROM or birth weeks, or latency from laser to birth. Access diameter was associated with PTB weeks. Cervical length was associated with PROM and birth weeks, and latency from laser to birth. b i Conclusion: /i /b Instrument choice at fetoscopic laser procedures did not affect outcomes weeks. Access diameter may affect the likelihood for PTB weeks. Cervical length is critically associated with obstetrical outcomes following laser surgery.
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: Springer Science and Business Media LLC
Date: 17-05-2022
DOI: 10.1186/S13054-022-03983-5
Abstract: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. We analyzed a convenience s le of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07 p = 0.177). In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.
Publisher: Wiley
Date: 13-03-2017
DOI: 10.1111/AJO.12588
Abstract: Using data from a randomised controlled trial (RCT) comparing two policies of prostaglandin (PGE2) vaginal gel induction of labour (IOL) at term, this study aimed to determine: (i) demographic/clinical factors that predict IOL outcomes and (ii) clinical characteristic(s) of women who would benefit from a policy of amniotomy once technically possible as opposed to giving more PGE2. Following an initial PGE2 dose, women were randomised to amniotomy or repeat-PGE2. Using RCT data, two multivariate models were developed, assessing the relationship between demographic/clinical characteristics and the outcomes of caesarean section (CS), and vaginal delivery within 24 h (VD < 24 h). Regression-equations were used to predict the likelihood of CS and VD < 24 h, varying independent predictors from the multivariate analyses. Of 245 term women undergoing IOL, 90 had a CS, 155 delivered vaginally and 79 had a VD < 24 h. Controlling for confounders, nulliparity [adjusted odds ratio (aOR) = 3.71 (1.55, 8.88)] and modified Bishop's score (MBS) at first review [aOR = 0.78 (0.66, 0.92)] were independently associated with CS. Nulliparity [aOR = 0.06 (0.02, 0.15)], MBS at first review [aOR = 1.66 (1.35, 2.05)], and a policy of early amniotomy [aOR = 2.28 (1.04, 5.00)] were associated with VD < 24 h. Modelling using regression equations, and varying both MBS at first review and parity, there was no scenario where repeat PGE2 was predicted to be superior to an earlier amniotomy. Following IOL using PGE2 vaginal gel at term, both parity and cervical favourability at first review are associated with CS and VD < 24 h. All combinations of parity and MBS at first review predicted fewer CS and greater likelihood of VD < 24 h with a policy of amniotomy once technically possible.
Publisher: BMJ
Date: 17-04-2017
DOI: 10.1136/JCLINPATH-2016-204304
Abstract: Progesterone receptor (PR) expression is prognostic in early stage breast cancer. There are several reports of discordant expression between primary tumour and axillary lymph node (ALN) metastasis expression of oestrogen receptor (ER) and PR. We sought to determine whether expression of these biomarkers in the synchronous ALN metastases of ER positive (+), HER2 negative (−) breast cancer could provide more accurate prognostic information. The retrospective cohort included 229 patients from a single institution with ER+, HER2− breast cancer who had synchronous ALN metastatic disease (2005–2014). PR expression was correlated with relapse-free survival, and subset analysis was performed for patients who received adjuvant tamoxifen or an aromatase inhibitor. One patient had an ER+ primary tumour, which was ER− in the ALN metastasis. 27 (11.3%) were PR− in the primary tumour and 56 (23.6%) in the ALN metastasis. The predominant change was from PR+ in the primary tumour to PR− in the lymph node. Absence of PR expression in the ALN was significantly associated with relapse however, this was not the case in the primary tumour. In a subset analysis of patients taking adjuvant endocrine therapy, poorer prognosis was limited to those with PR− metastases on tamoxifen (HR=5.203, 95% CI 1.649 to 16.416, p=0.005). No significant prognostic effect of PR− metastases in patients taking aromatase inhibitors was seen (HR=1.519, 95% CI 0.675 to 3.418, p=0.312). Evaluation of PR expression in ALN metastasis may enable prediction of patients who are less likely to benefit from adjuvant tamoxifen. This study should be replicated in other cohorts.
Publisher: Mary Ann Liebert Inc
Date: 12-2008
Abstract: The process of dying for many Australians is not ideal. To improve the care of the dying in our community, the barriers preventing optimal care must be identified. Forty-two important barriers were identified by focus groups. Health care professionals (HCPs) working in palliative care (PC) throughout Queensland were asked to rate the importance of each of the barriers. Inadequate funding for PC, lack of after-hours care, insufficient medical support and the lack of HCPs in PC across several different settings were highlighted as the most important barriers. Uncertainty regarding death certification, society's difficulty in responding to cultural needs, patient fears that active treatment would be stopped and fear of palliative care were considered the least important barriers. Many HCPs seem concerned about issues they are less likely to influence. The results of this survey may be useful for future workforce planning.
Publisher: Wiley
Date: 10-03-2018
Publisher: Wiley
Date: 18-04-2012
Publisher: Wiley
Date: 20-12-2011
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2023-076130
Abstract: Antenatal maternal magnesium sulfate (MgSO 4 ) administration is a proven efficacious neuroprotective treatment reducing the risk of cerebral palsy (CP) among infants born preterm. Identification of the neuroprotective component with target plasma concentrations could lead to neonatal treatment with greater efficacy and accessibility. This is a prospective observational cohort study, in three tertiary Australian centres. Participants are preterm infants, irrespective of antenatal MgSO 4 exposure, born in 2013–2020 at 24 +0 to 31 +6 weeks gestation, and followed up to 2 years corrected age (CA) (to September 2023). 1595 participants are required (allowing for 17% deaths/loss to follow-up) to detect a clinically significant reduction (30% relative risk reduction) in CP when sulfate concentration at 7 days of age is 1 SD above the mean. A blood s le is collected on day 7 of age for plasma sulfate and magnesium measurement. In a subset of participants multiple blood and urine s les are collected for pharmacokinetic studies, between days 1–28, and in a further subset mother/infant blood is screened for genetic variants of sulfate transporter genes. The primary outcome is CP. Surviving infants are assessed for high risk of CP at 12–14 weeks CA according to Prechtl’s Method to assess General Movements. Follow-up at 2 years CA includes assessments for CP, cognitive, language and motor development, and social/behavioural difficulties. Multivariate analyses will examine the association between day 7 plasma sulfate/magnesium concentrations with adverse neurodevelopmental outcomes. A population pharmacokinetic model for sulfate in the preterm infant will be created using non-linear mixed-effects modelling. The study has been approved by Mater Misericordiae Ltd Human Research Ethics Committee (HREC/14/MHS/188). Results will be disseminated in peer-reviewed journal publications, and provided to the funding bodies. Using consumer input, a summary will be prepared for participants and consumer groups.
Publisher: Wiley
Date: 11-06-2013
DOI: 10.1111/JPC.12281
Abstract: This study aims to compare non-disabled otherwise healthy extremely low birthweight (ELBW) (<1000 g) children and term-born peers in an investigation of relationship between cardiorespiratory endurance and parent report of competence. Forty-eight of 105 eligible ELBW 11- to 13-year-old children (27 male) and 55 term-born school peers (28 male) completed a 20-m shuttle run, anthropometric measures, respiratory function tests and the Motor Assessment Battery for Children. Parents completed the Child Behavior Checklist (CBCL). The ELBW group had poorer cardiorespiratory endurance (P = 0.002), growth (P = 0.002), respiratory function (P = 0.003) and motor ability (P < 0.001) than term-born peers. Parents reported the ELBW children to be less competent than term-born peers: CBCL total T score mean difference -9, 95% confidence interval -14, -5 (P < 0.001). Cardiorespiratory endurance predicted competence (regression coefficient 0.865 95% confidence interval 0.352, 1.378 P = 0.001) independent of prematurity, growth, respiratory function, motor score, gender and socio-economic status. Cardiorespiratory endurance had association with social competence for all participating children, but was related to CBCL Activities Competence only for the ELBW children who were the significantly less fit group. The poor cardiorespiratory endurance prevalent in non-disabled otherwise healthy ELBW children is associated with general competence independent of prematurity and of the impact of other mild physical deficits, gender or socio-economic status. The relationship demonstrated between cardiorespiratory endurance and competence to engage in general activities of daily living, seen only in the less fit ELBW children, identifies the fitness levels in non-disabled ELBW children as a barrier to participation.
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.51893/2021.1.OA4
Abstract: Abstract Background: The NITric oxide during cardiopulmonary bypass (CPB) to improve Recovery in Infants with Congenital heart defects (NITRIC) trial, a 1320-patient, multicentre, randomised controlled trial, is aiming to improve survival free of ventilation after CPB by using nitric oxide delivered into the oxygenator of the CPB. Objective: To provide a statistical analysis plan before completion of patient recruitment and data monitoring. Final analyses for this study will adhere to this statistical analysis plan, which details all key pre-planned analyses. Stata scripts for analyses have been prepared alongside this statistical analysis plan. Methods: The statistical analysis plan was designed collaboratively by the chief investigators and trial statistician and builds on the previously published study protocol. All authors remain blinded to treatment allocation. Detail is provided on statistical analyses including cohort description, analysis of primary and secondary outcomes and adverse events. Statistical methods to compare outcomes are planned in detail to ensure methods are verifiable and reproducible. Results: The statistical analysis plan developed provides the trial outline, list of mock tables, and analysis scripts. The plan describes statistical analyses on cohort and baseline description, primary and secondary outcome analyses, process of care measures, physiological descriptors, and safety and adverse event reporting. We define the pre-specified subgroup analyses and the respective statistical tests used to compare subgroups. Conclusion: The statistical analysis plan for the NITRIC trial establishes detailed pre-planned analyses alongside Stata scripts to analyse the largest trial in the field of neonatal and paediatric heart surgery. The plan ensures standards for trial analysis validity aiming to minimise bias of analyses. Trial registration: ACTRN12617000821392
Publisher: Wiley
Date: 15-07-2012
DOI: 10.1111/J.1464-5491.2011.03551.X
Abstract: To assess associations between maternal serum vitamin D concentration and glucose metabolism in a cohort of pregnant women living in an Australian subtropical environment. Cross-sectional assessment of 25-hydroxy vitamin D concentrations in 399 Hyperglycemia and Adverse Pregnancy Outcome ancillary study participants, treated at an obstetric teaching hospital in Brisbane, Australia. All patients underwent a blinded 75-g oral glucose tolerance test at 24-32 (target 28) weeks' gestation. The mean (± standard deviation) fasting plasma glucose was 4.5 ± 0.4 mmol/l. Mean (± standard deviation) serum 25-hydroxy vitamin D was 132.5 ± 44.0 nmol/l. A difference of one standard deviation in maternal 25-hydroxy vitamin D was inversely related to fasting glucose (fasting glucose lower by 0.047 mmol/l, P=0.012) when assessed with multiple linear regression after adjusting for confounders. Maternal 25-hydroxy vitamin D correlated with β-cell function as estimated by the log-transformed homeostasis model assessment-β-cell function equation (r=0.131, P=0.009), but not with the homeostasis model assessment of insulin resistance. An association between mid-gestational 25-hydroxy vitamin D and fasting glucose was confirmed in a largely normoglycaemic and vitamin D-replete pregnant population. The correlation between 25-hydroxy vitamin D and β-cell function suggests that vitamin D may influence glucose metabolism through this mechanism. Intervention studies are required to determine causality and the role of vitamin D replacement in deficient in iduals.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJPO-2018-000424
Abstract: The aim of this study was to develop a predictive model using maternal, intrapartum and ultrasound variables for a composite of severe adverse neonatal outcomes (SANO) in term infants. Prospectively collected observational study. Mixed effects generalised linear models were used for modelling. Internal validation was performed using the K-fold cross-validation technique. This was a study of women that birthed at the Mater Mother’s Hospital in Brisbane, Australia between January 2010 and April 2017. We included all term, non-anomalous singleton pregnancies that had an ultrasound performed between 36 and 38 weeks gestation and had recordings for the umbilical artery pulsatility index, middle cerebral artery pulsatility index and the estimated fetal weight (EFW). The components of the SANO were: severe acidosis arterial, admission to the neonatal intensive care unit, Apgar score of ≤3 at 5 min or perinatal death. There were 5439 women identified during the study period that met the inclusion criteria, with 11.7% of this cohort having SANO. The final generalised linear mixed model consisted of the following variables: maternal ethnicity, socioeconomic score, nulliparity, induction of labour, method of birth and z-scores for EFW and cerebroplacental ratio. The final model had an area under the receiver operating characteristic curve of 0.71. The results of this study demonstrate it is possible to predict infants that are at risk of SANO at term with moderate accuracy using a combination of maternal, intrapartum and ultrasound variables. Cross-validation analysis suggests a high calibration of the model.
Publisher: BMJ
Date: 07-2022
DOI: 10.1136/BMJOPEN-2021-060714
Abstract: In Australia, while paediatric intensive care unit (PICU) mortality has dropped to 2.2%, one in three survivors experience long-term neurodevelopmental impairment, limiting their life-course opportunities. Unlike other high-risk paediatric populations, standardised routine neurodevelopmental follow-up of PICU survivors is rare, and there is limited knowledge regarding the best methods. The present study intends to pilot a combined multidisciplinary, online screening platform and general practitioner (GP) shared care neurodevelopmental follow-up model to determine feasibility of a larger, future study. We will also assess the difference between neurodevelopmental vulnerability and parental stress in two intervention groups and the impact of child, parent, sociodemographic and illness/treatment risk factors on child and parent outcomes. Single-centre randomised effectiveness–implementation (hybrid-2 design) pilot trial for parents of children aged ≥2 months and years discharged from PICU after critical illness or injury. One intervention group will receive 6 months of collaborative shared care follow-up with GPs (supported by online outcome monitoring), and the other will be offered self-directed screening and education about post-intensive care syndrome and child development. Participants will be followed up at 1, 3 and 6 months post-PICU discharge. The primary outcome is feasibility. Secondary outcomes include neurodevelopmental vulnerability and parental stress. An implementation evaluation will analyse barriers to and facilitators of the intervention. The study is expected to lead to a full trial, which will provide much-needed guidance about the clinical effectiveness and implementation of follow-up models of care for children after critical illness or injury. The Children’s Health Queensland Human Research Ethics Committee approved this study. Dissemination of the outcomes of the study is expected via publication in a peer-reviewed journal, presentation at relevant conferences, and via social media, podcast presentations and open-access medical education resources. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as ‘Pilot testing of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children’ (the DAISY Pilot Study). ACTRN12621000799853.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.EARLHUMDEV.2013.04.005
Abstract: To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants. One hundred and five mothers who delivered 124 babies at ≤30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared. Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis. Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.
Publisher: Wiley
Date: 20-02-2014
DOI: 10.1111/AJO.12173
Abstract: Cervical length measurement by transvaginal scanning (TVS) has been proposed by some as a universal screening test for preterm labour. The presence of prominent cervical mucous may affect assessment of the cervix however, the exact technique to measure the cervix when there is prominent mucous or funnelling has not been described. We evaluated the level of agreement in cervical length measurements amongst Australian specialists and sonographers reporting on cervical assessment using an online survey. We conducted an online survey with 11 images of the cervix to assess how obstetric sonographers and sonologists report on the cervix when there is prominent mucous or funnelling. They were asked five questions about the image of the cervix. A kappa coefficient was calculated from the responses. We had 151 complete responses to the online survey. For the images which showed funnelling or prominent cervical mucous, there was little agreement regarding the cervix being open or closed and regards the location of the internal os. The Kappa coefficient was 0.22 indicating a low level of agreement for the location of the internal os. There is lack of agreement amongst Australian specialists and sonographers reporting on cervical assessment when there is prominent mucous or funnelling seen in the cervix. We propose a method to standardise reporting on the cervix incorporating the chorioamniotic membrane for the identification of the inner cervical os when there is prominent mucous or funnelling.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/423717
Abstract: Aims . To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) 25 kg/m 2 to delay or prevent Type 2 Diabetes Mellitus. Methods . Women diagnosed with GDM in the previous 6 to 24 months and BMI 25 kg/m 2 were randomized to an intervention (I) ( n = 16 ) or a control (C) ( n = 15 ) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results . Median (IQR) results were as follows: weight: I −2.5 (2.3) kg versus C +0.2 (1.6) kg ( P = 0.009 ), waist: I −3.6 (4.5) cm versus C −0.1 (3.6) cm ( P = 0.07 ), and hip: I −5.0 (3.3) cm versus C −0.2 (2.6) cm ( P = 0.002 ). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion . A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.
Publisher: Springer New York
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 10-06-2009
Publisher: Springer Science and Business Media LLC
Date: 19-06-2009
Publisher: Wiley
Date: 28-04-2009
DOI: 10.1111/J.1440-1754.2009.01488.X
Abstract: To determine if high lactate levels within the first 12 h of life independently or in combination with Clinical Risk Index for Babies (CRIB) II can predict mortality in extremely premature babies. A retrospective review of medical charts of babies born between 2001 and 2003 with birthweight <1000 g or gestation <28 weeks was performed. Blood gases and highest umbilical lactate levels in first 12 h of life were noted. Area under the curve (AUC) was calculated for lactate, CRIB and CRIB II as a predictor of mortality. The AUC for lactate and CRIB II were combined using discriminant analysis. Two hundred nineteen infants were included in the study, 41 (18.7%) of whom died. The AUC for lactate was 0.67 (P < 0.001), while AUCs for CRIB and CRIB II score were 0.81 (P < 0.001) and 0.82 (P < 0.001), respectively. The AUC for the combined measure of lactate and CRIB II was 0.82, similar to CRIB II. Lactate predicts mortality in premature infants, but was found to be inferior to CRIB and CRIB II. Adding lactate level to CRIB II score does not improve its predictive ability.
Publisher: Wiley
Date: 25-11-2013
DOI: 10.1111/JHN.12193
Abstract: Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m(-2) that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information. Women were randomised at 24-28 weeks to control (supported care SC) or intervention (enhanced care EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a 'nutrition for breastfeeding' resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum. Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: -1.1 (9.5) kg versus SC: -1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days P = 0.10). An average of 2.3 out of six activity sheets per participant was returned. Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women's engagement, be in idually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2013
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-031873
Abstract: Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. H igh-flow oxygen for children’s a irway surgery: rando m i s ed controll e d t r ial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp0 2 %. Analysis will be conducted on an intention-to-treat basis. Ethical approval has been obtained by Children’s Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.RESUSCITATION.2013.04.004
Abstract: Dry, cold gas is used for neonatal resuscitation, contributing to low admission temperatures and exacerbation of lung injury. Recently, a method of heating and humidifying neonatal resuscitation gases has become available. We aimed to determine the optimal flow rate, humidifier chamber and water volume needed to reach 36°C, and near 100% humidity at the patient T-piece in the shortest possible time. A T-piece resuscitator was connected via a heated patient circuit to a humidifier chamber. Trials were performed using different gas flow rates (6, 8 and 10L/min), humidification chambers (MR290, MR225) and water volumes (30g, 108g). Temperature was recorded at the humidifier chamber (T1), distal temperature probe (T2) and the T-piece (T3) over a 20min period at 30s intervals. A test lung was added during one trial. No significant difference existed between flow rates 8L/min and 10L/min (p=0.091, p=0.631). T3 reached 36°C and remained stable at 360s (8L/min, MR225, 30mL) near 100% RH was reached at 107s (10L/min, MR225, 30mL). T3 and humidity reached and remained stable at 480s (10L/min, MR290, 30mL). Target temperature and humidity was not reached with the test lung. It is possible to deliver heated, humidified gases in neonatal resuscitation in a clinically acceptable timeframe. We suggest the set-up to achieve optimal temperature and humidity for resuscitation purposes is 10L/min of gas flow, a MR290 humidification chamber, and 30mL of water.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.EARLHUMDEV.2015.03.003
Abstract: Extremely preterm or extremely low birth weight (ELBW) children who are non-disabled and otherwise healthy are at risk of neurodevelopmental impairments. Further understanding of these impairments is needed before commencement of formal education to optimise participation levels at a critical time point for these children. To explore motor co-ordination, postural stability, limb strength and behaviour of non-disabled four to five year old children with a history of extreme prematurity or ELBW. Prospective-descriptive-cohort-study. 50 children born at less than 28 weeks gestation or who had a birth weight less than 1000g with minimal/mild motor impairments and no significant neurological/cognitive impairments. Movement Assessment Battery for Children second-edition (MABC-2), single leg stance test (SLS), lateral reach test, standing long jump test and Child Behaviour Checklist for preschool children (CBCL). The mean percentile rank of the extremely preterm or ELBW s le on MABC-2 was 31% (SD 23%). SLS right (mean ± SD 4.6 ± 2.5s) and lateral reach to the right (10.0 ± 3.9 cm) were slightly stronger than SLS left (4.4 ± 3.3s) and lateral reach left (9.9 ± 3.5 cm). The average for standing long jump was 71.6 cm (SD 21.0 cm). All participants were classified as 'normal' on CBCL syndrome scale scores, internalizing and externalizing syndrome T scores and total problem T score. This s le of non-disabled extremely preterm or ELBW children performed in the lower range of normal. These children continue to be at risk of impairments, therefore, ongoing monitoring and tailored intervention may optimise development.
Publisher: BMJ
Date: 09-2023
Publisher: Elsevier BV
Date: 08-2021
Publisher: John Wiley & Sons, Ltd
Date: 21-01-2018
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-057780
Abstract: Trauma causes 40% of child deaths in high-income countries, with haemorrhage being a leading contributor to death in this population. There is a growing recognition that fibrinogen and platelets play a major role in trauma-induced coagulopathy (TIC) but the exact physiological mechanisms are poorly understood. This is a prospective multicentre, open-label, randomised, two-arm parallel feasibility study conducted in the emergency departments, intensive care units and operating theatres of participating hospitals. Severely injured children, aged between 3 months and 18 years, presenting with traumatic haemorrhage requiring transfusion of blood products will be screened for inclusion. Sixty-eight patients will be recruited and will be allocated to fibrinogen replacement using fibrinogen concentrate (FC) or cryoprecipitate in a 1:1 ratio. Fibrinogen replacement will be administered to patients with a FIBTEM A5 of ≤10. All other aspects of the currently used rotational thromboelastometry-guided treatment algorithm and damage-control approach to trauma remain the same in both groups. The primary outcome is time to administration of fibrinogen replacement from time of identification of hypofibrinogenaemia. Clinical secondary outcomes and feasibility outcomes will also be analysed. This study has received ethical clearance from the Children’s Health Queensland Human Research Ethics Committee (HREC/17/QRCH/78). Equipment and consumables for s le testing have been provided to the study by Haemoview Diagnostics, Werfen Australia and Haemonetics Australia. FC has been provided by CSL Behring, Australia. The funding bodies and industry partners have had no input into the design of the study, and will not be involved in the preparation or submission of the manuscript for publication. The use of viscoelastic haemostatic assays and early fibrinogen replacement has the potential to improve outcomes in paediatric trauma through earlier recognition of TIC. This in turn may reduce transfusion volumes and downstream complications and reduce the reliance on donor blood products such as cryoprecipitate. The use of FC has implications for regional and remote centres who would not routinely have access to cryoprecipitate but could store FC easily. Access to early fibrinogen replacement in these centres could make a significant impact and assist in closing the gap in trauma care available to residents of these communities. Outcomes of this study will be submitted for publication in peer-reviewed journals and submitted for presentation at national and international scientific fora. NCT03508141 .
No related grants have been discovered for Kristen Gibbons.