ORCID Profile
0000-0002-6077-4169
Current Organisations
Nottingham University Hospitals NHS Trust
,
University of Nottingham
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Publisher: Springer Science and Business Media LLC
Date: 16-05-2022
Publisher: Wiley
Date: 16-08-2016
DOI: 10.1111/NICC.12253
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-08-2022
DOI: 10.1097/PCC.0000000000003055
Abstract: To identify a PICU Core Outcome Measurement Set (PICU COMS), a set of measures that can be used to evaluate the PICU Core Outcome Set (PICU COS) domains in PICU patients and their families. A modified Delphi consensus process. Four webinars attended by PICU physicians and nurses, pediatric surgeons, rehabilitation physicians, and scientists with expertise in PICU clinical care or research ( n = 35). Attendees were from eight countries and convened from the Pediatric Acute Lung Injury and Sepsis Investigators Pediatric Outcomes STudies after PICU Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network PICU COS Investigators. Measures to assess outcome domains of the PICU COS are as follows: cognitive, emotional, overall (including health-related quality of life), physical, and family health. Measures evaluating social health were also considered. None. Measures were classified as general or additional based on generalizability across PICU populations, feasibility, and relevance to specific COS domains. Measures with high consensus, defined as 80% agreement for inclusion, were selected for the PICU COMS. Among 140 candidate measures, 24 were delineated as general (broadly applicable) and, of these, 10 achieved consensus for inclusion in the COMS (7 patient-oriented and 3 family-oriented). Six of the seven patient measures were applicable to the broadest range of patients, diagnoses, and developmental abilities. All were validated in pediatric populations and have normative pediatric data. Twenty additional measures focusing on specific populations or in-depth evaluation of a COS subdomain also met consensus for inclusion as COMS additional measures. The PICU COMS delineates measures to evaluate domains in the PICU COS and facilitates comparability across future research studies to characterize PICU survivorship and enable interventional studies to target long-term outcomes after critical illness.
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOPEN-2020-038974
Abstract: Annually in the UK, 20 000 children become very ill or injured and need specialist care within a paediatric intensive care unit (PICU). Most children survive. However, some children and their families may experience problems after they have left the PICU including physical, functional and/or emotional problems. It is unknown which children and families experience such problems, when these occur or what causes them. The aim of this mixed-method longitudinal cohort study is to understand the physical, functional, emotional and social impact of children surviving PICU (aged: 1 month–17 years), their parents and siblings, during the first year after a PICU admission. A quantitative study involving 300 child survivors of PICU 300 parents and 150–300 siblings will collect data (using self-completion questionnaires) at baseline, PICU discharge, 1, 3, 6 and 12 months post-PICU discharge. Questionnaires will comprise validated and reliable instruments. Demographic data, PICU admission and treatment data, health-related quality of life, functional status, strengths and difficulties behaviour and post-traumatic stress symptoms will be collected from the child. Parent and sibling data will be collected on the impact of paediatric health conditions on the family’s functioning capabilities, levels of anxiety and social impact of the child’s PICU admission. Data will be analysed using descriptive and inferential statistics. Concurrently, an embedded qualitative study involving semistructured interviews with 24 enrolled families at 3 months and 9 months post-PICU discharge will be undertaken. Framework analysis will be used to analyse the qualitative data. The study has received ethical approval from the National Health Services Research Ethics Committee (Ref: 19/WM/0290) and full governance clearance. This will be the first UK study to comprehensively investigate physical, functional, emotional and social consequences of PICU survival in the first-year postdischarge. Clinical Trials Registration Number: ISRCTN28072812 [Pre-results]
Publisher: Springer Science and Business Media LLC
Date: 13-09-2022
DOI: 10.1007/S00431-022-04595-5
Abstract: The impact of ethnicity on parental health outcome after paediatric intensive care unit (PICU) discharge remains unclear. Thirteen medical and healthcare databases, unpublished studies and grey literature were searched up to November 5, 2021. We performed a mixed-method systematic review to understand the impact of ethnicity on parental outcomes after PICU discharge, including eight quantitative and eight qualitative studies. Among 1529 parents included, 1064 (72%) were White. Higher prevalence of post-traumatic stress disorder was seen in Black parents (17% White vs 36% Black, p = .03). Latino ethnicity was found to have protective effect against anxiety as compared to White parents (coefficient - 4.27, p < .001). A total of 91 findings were aggregated into 14 categories, and the five synthesized themes from the eight qualitative studies were long-term psychological impact after PICU, use of coping strategies, challenges of re-integration, changes in relationships and the utilization of formal support services and resources. Mixed-method synthesis found that parents of ethnic minority group were underrepresented (18%) and had higher attrition rates in a longitudinal study as compared to White parents following childhood critical illness. Conclusion: There are significant gaps in evidence related to the impact of ethnicity on long-term parental health outcomes after PICU discharge. Ethnic ersity and inclusiveness in long-term PICU research may aid understanding of the parental experiences and outcomes to close the gap in health disparity.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2020
DOI: 10.1186/S13054-020-02988-2
Abstract: Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days) 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7–43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09–19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12–0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability ( n = 47, 10%), oversedation ( n = 39, 9%), and medical contraindication ( n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.
Publisher: Wiley
Date: 03-06-2021
DOI: 10.1111/JAN.14911
Abstract: To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity. This study uses a prospective, longitudinal design. The s le will include children ( N = 110) and at least one parent ( N = 110) admitted to the PICU (KKH‐AM start‐up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi‐structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio‐recorded with verbatim transcription. We will use framework analysis for qualitative data analysis. Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia. This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre‐disposing risk factors during the PICU admission will inform future interventions to improve long‐term outcomes of children and parents following paediatric critical illness. Trial registration: Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.
Publisher: Springer Science and Business Media LLC
Date: 05-07-2023
DOI: 10.1007/S44253-023-00007-0
Abstract: The post-intensive care syndrome in pediatrics (PICS-p) framework offers a new understanding of the long-term impact of critical illness on child’s and family’s health. However, a comprehensive theoretical guide to investigate potential factors influencing these outcomes and recoveries is needed. The aim of the study is to conceptualize post-intensive care outcomes in children and their families after PICU discharge in the context of the child’s surrounding environment and systems. We used Theory Adaptation, a shift in the use and perspective of the Bioecological Theory of Human Development (BTHD), and Theory Synthesis, the integration of BTHD and the PICS-p, to provide a novel PICSS-PF perspective for understanding PICS-p within the broader context of the child and family. This integration helps to see higher-order perspectives to link post-PICU outcomes and child development within the context of child’s surroundings. While PICS-p is a model for understanding and studying post-PICU outcomes and recovery in four domains of physical, cognitive, emotional, and social health, the BTHD offers a new lens for a holistic view of the contextual systems and factors affecting the outcomes and recovery. The BTHD contextual systems include intrapersonal (demographics, clinical), interpersonal (adjacent people’s characteristics and interactions), institutional (family situations, PICU environment), community, social resources, and networks. Knowing the complex nature of post-PICU outcomes in children and their families, the PICSS-PF helps in the better understanding of the complex interplay of factors that contribute to PICS in children and their families, leading to the development of more effective interventions to address this condition.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2016
Publisher: Springer Science and Business Media LLC
Date: 31-03-2022
DOI: 10.1186/S13054-022-03957-7
Abstract: Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in low-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/NICC.12605
Publisher: Wiley
Date: 23-04-2020
DOI: 10.1111/NICC.12510
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Joseph Manning.