ORCID Profile
0000-0001-5119-371X
Current Organisations
Sydney Children's Hospital Randwick
,
UNSW Australia
,
Royal Australasian College of Physicians
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Publisher: European Respiratory Society (ERS)
Date: 10-2022
Publisher: BMJ
Date: 11-03-2022
DOI: 10.1136/ARCHDISCHILD-2021-322536
Abstract: To investigate the validity and home use of a personal ultrasonic spirometer. Supervised spirometry was performed using laboratory equipment and a personal ultrasonic spirometer. In addition, the ability of children to perform acceptable spirometry during supervised telehealth appointments at home was assessed. 59 children completed spirometry on both devices. There was high between-device intraclass correlation coefficient (ICC) for forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC): ICC 0.991 (95% CI 0.985 to 0.995) and 0.989 (95% CI 0.981 to 0.993), respectively. Bland-Altman analysis revealed mean bias and limits of agreement of −0.01 (−0.22 to 0.24) L for FEV 1 and −0.02 (−0.30 to 0.33) L for FVC. 125 of 140 (89%) supervised telehealth spirometry sessions were acceptable. There was excellent reliability in between-device measurements however, the limits of agreement were wide. Therefore, caution is needed if the device is used interchangeably with laboratory equipment. High success rates of telehealth spirometry sessions indicate the device is suitable for this application.
Publisher: Wiley
Date: 26-02-2014
DOI: 10.1111/JPC.12504
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.JCF.2013.09.001
Abstract: It is unclear whether annual multidisciplinary reviews in cystic fibrosis (CF) patients should be conducted in dedicated annual review (AR) clinics or during continuous assessments throughout the year. Our aim was to assess the effect of introducing an AR clinic. A retrospective written and electronic record review of CF patients was carried out for 2007 (no AR Clinic) and 2010 (established AR Clinic) calendar years. An internet-based satisfaction survey was distributed to families attending the AR clinic. In total, 123 children (mean age 9.5 years, range 1.32-18.8 years) and 141 children (8.3 years, 1.1-18.3 years) were included in 2007 and 2010 respectively. There was a significant increase in multidisciplinary reviews (documented annual review 28% vs 85%, P < 0.001 dietary assessment 46% vs 92%, P < 0.001) and investigations (OGTT 2% vs 74%, P < 0.001 abdominal ultrasound 35% vs 85%, P < 0.001) conducted after the introduction of AR clinic. The majority of the families surveyed (85%) were satisfied or very satisfied with the AR clinic. CF AR clinic significantly improves the number of annual investigations and multidisciplinary reviews performed. Families were satisfied with this new process.
Publisher: Wiley
Date: 31-03-2017
DOI: 10.1111/JPC.13520
Publisher: Wiley
Date: 24-03-2022
DOI: 10.1002/PPUL.25890
Abstract: To examine objective daytime predictors of nocturnal hypercapnic hypoventilation (NHH) and identify a forced vital capacity (FVC) z‐score cut off that predicts NHH using the 2012 Global Lung Function Initiative (GLI) reference equations in pediatric neuromuscular patients. Single‐centre retrospective medical record review. Tertiary pediatric hospital in Australia. Children ( years old) with a neuromuscular disorder (NMD) who had a diagnostic sleep study over a 5‐year period. Fifty children were included, median age 11.9 years (interquartile range [IQR]: 4.5–14.3). The majority of children had a diagnosis of Duchenne Muscular Dystrophy (32%). NHH was diagnosed in 18 children (36%). Multivariate logistic regression analysis performed for the entire cohort confirmed a statistically significant association between NHH and scoliosis (odds ratio [OR]: 3.3, p = 0.03), but not age (OR: 1.01, p = 0.26), body mass index z‐score (OR: 0.86, p = 0.26) or use of a wheelchair for mobility (OR: 1.25, p = 0.72). For the subset of 29 children who had spirometry testing (median age 12.9 years [IQR: 10.2–14.3]), FVC z‐score was the only statistically significant predictor of NHH (OR: 0.45, p = 0.02). NHH was predicted by an FVC z‐score −3.24 (sensitivity 78%, specificity 73%), or FVC % predicted (sensitivity 78%, specificity 73%). There was a strong positive correlation between FVC and forced expiratory volume in 1 s z‐scores (r p = 0.98, p = 0.00) and FVC and peak expiratory flow z‐scores (r p = 0.72, p = 0.00). Children with a NMD and scoliosis or a lower FVC z‐score have increased odds of having NHH.
Publisher: American Academy of Pediatrics (AAP)
Date: 12-2021
Abstract: The validity of oropharyngeal swabs obtained by parents is described, and a case for parent-collection to be used as part of remote care is presented.
Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-033916
Abstract: Chronic gastrointestinal and respiratory conditions of childhood can have long-lasting physical, psychosocial and economic effects on children and their families. Alterations in diet and intestinal and respiratory microbiomes may have important implications for physical and psychosocial health. Diet influences the intestinal microbiome and should be considered when exploring disease-specific alterations. The concepts of gut-brain and gut-lung axes provide novel perspectives for examining chronic childhood disease(s). We established the ‘ E valuating the A limentary and R espiratory T racts in H ealth and disease’ (EARTH) research programme to provide a structured, holistic evaluation of children with chronic gastrointestinal and/or respiratory conditions. The EARTH programme provides a framework for a series of prospective, longitudinal, controlled, observational studies (comprised of in idual substudies), conducted at an Australian tertiary paediatric hospital (the methodology is applicable to other settings). Children with a chronic gastrointestinal and/or respiratory condition will be compared with age and gender matched healthy controls (HC) across a 12-month period. The following will be collected at baseline, 6 and 12 months: (i) stool, (ii) oropharyngeal swab/sputum, (iii) semi-quantitative food frequency questionnaire, (iv) details of disease symptomatology, (v) health-related quality of life and (vi) psychosocial factors. Data on the intestinal and respiratory microbiomes and diet will be compared between children with a condition and HC. Correlations between dietary intake (energy, macro-nutrients and micro-nutrients), intestinal and respiratory microbiomes within each group will be explored. Data on disease symptomatology, quality of life and psychosocial factors will be compared between condition and HC cohorts. Results will be hypothesis-generating and direct future focussed studies. There is future potential for direct translation into clinical care, as diet is a highly modifiable factor. Ethics approval: Sydney Children’s Hospitals Network Human Research Ethics Committee (HREC/18/SCHN/26). Results will be presented at international conferences and published in peer-reviewed journals. NCT04071314
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JCF.2017.07.011
Abstract: The pathogenesis of gut inflammation, bacterial dysbiosis and increased rates of malignancy in CF is unclear. Fecal M2-pyruvate kinase (M2-PK) is a biomarker indicative of cellular proliferation that may be raised in intestinal malignancy and inflammation. Biomarkers, including M2-PK, may be useful in assessing effects of novel therapies on the gastrointestinal tract. M2-PK was measured in stools collected from patients with CF and HC (0-10years). Linear mixed model analysis was used. M2-PK levels did not significantly change in children with CF (36 patients, 77 s les) (P=0.998) or HC (45 patients, 45 s les) (P=0.21), over the age range 0-10years. Patients with CF had elevated M2-PK compared to HC (median [IQR range]: 10.7 [5.7-28.6 1.0-239.1] (n=77) vs. 1.0 [1.0-1.0 1.0-50.0] (n=45) U/mL, respectively P=0.001). Fecal M2-PK was elevated in children with CF compared with HC during infancy and throughout childhood suggesting abnormalities in the CF gut exist in early life.
Publisher: Wiley
Date: 20-03-2019
DOI: 10.1113/EP087441
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.RESP.2017.02.004
Abstract: Quantitatively measure and validate analysis of neural respiratory drive (NRD) using a commercial polysomnography system in children during sleep. Surface electromyogram of the diaphragm (sEMGdi) recorded from primary snoring children were analysed. A subset was re-analysed to assess intra- and inter-investigator reproducibility. Effects of different band pass filter settings (20-100Hz vs 10-1000Hz) on sEMGdi litude were evaluated. Mean sEMGdi from 45 children aged 4.38 years (median IQR 3.00-7.96) was 5.05μV (SD 2.73). The sEMGdi had a high intra-subject intraclass correlation coefficient (ICC) of 0.88. sEMGdi analysis was reproducible with high ICC between occasions (0.99 95% CI 0.98-0.99) and between investigators (0.98 95% CI 0.97-0.99). There was also a high ICC (0.99, 95% CI 0.96-1.00) between the sEMGdi measured using different band-pass filter settings. Age and BMI were negative predictors of sEMGdi (p<0.0001 and p=0.0004 respectively). NRD in children during sleep as assessed by sEMGdi can be quantified in a reliable and reproducible fashion.
Publisher: Wiley
Date: 10-2021
DOI: 10.1002/HSR2.410
Publisher: Cambridge University Press (CUP)
Date: 08-2009
DOI: 10.1017/S0965539509990052
Abstract: Congenital cystic adenomatoid malformations of the lung (CCAMs) were originally described by Ch'In and Tang in 1949 as rare lung lesions occurring in premature or stillborn infants with anasarca. In 1977 Stocker et al ided CCAM into three types based on their clinical and pathological features. The nomenclature has since changed to congenital pulmonary airway malformations (CPAMs) to reflect the possible absence of cystic changes and the probable underlying pathogenesis of different types. CPAMs are relatively rare congenital abnormalities with a reported incidence varying from 1 in 10,000 to 1 in 35,000. There is a slight male predominance, but no racial predilection has been noted. This review will outline the current nomenclature and features of different types of CPAMs, highlight possible mechanisms underlying the development of CPAMs, review current antenatal imaging modalities and interventions, address the debate surrounding the postnatal management of CPAMs, and suggest areas for future research.
Publisher: Springer Science and Business Media LLC
Date: 08-2012
DOI: 10.2165/11597360-000000000-00000
Abstract: Asthma is a prevalent health condition in children, with economic implications for the in idual and their family, as well as for societies with nationalized healthcare. Pharmaceutical cost is the main driver of healthcare expenditure in asthma. Existent explicit guidelines are meant to guide asthma management across all age groups, but they are failing. Pharmacologic management of asthma consists of a stepwise treatment approach to achieve symptom control. Various studies suggest a significant number of medical practitioners are prescribing inhaled corticosteroids (ICS) and ICS/long-acting beta agonist (LABA) combination inhalers inappropriately, including prescribing high doses of ICS without specialist consultation. ICS/LABA combination inhalers should only be used in persistent asthmatics, which account for approximately 5% of all children with asthma. Despite this, there is an increase in prescribing rates of ICS/LABA combination inhalers in the context of a decrease in the prevalence of asthma. Furthermore, there is inappropriate prescribing of ICS/LABA combination inhalers in children under 5 years of age, and initiation of relatively more expensive ICS/LABA combination inhalers in patients who have not previously been prescribed ICS. There is evidence to suggest that cost is a significant barrier to asthma management, especially for the more expensive ICS/LABA combination inhalers. Hence, prescribing cost-effective asthma medications appropriately is one of the most important strategies in reducing the morbidity and mortality associated with asthma. It is incumbent on every medical practitioner to not prescribe expensive medications if not indicated, both for the sake of the patient and for society.
No related grants have been discovered for Sandra Ya-chu Chuang.