Citation: BMJ pediatrics. 2018, 18(1), 244
Author: Thomas-Jones E, Lloyd A, Roland D, Sefton G, Tume L, Hood K, Huang C, Edwards D, Oliver A, Skone R, Lacy D, Sinha I, Preston J, Mason B, Jacob N, Trubey R, Strange H, Moriarty Y, Grant A, Allen D, Powell C
Abstract: BACKGROUND: In hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions.
METHODS: This study will be conducted in two district and two specialist children's hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process.
DISCUSSION: This paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS.
TRIAL REGISTRATION: Sponsor: Cardiff University, 30-36 Newport Road, Cardiff, CF24 0DE Sponsor ref.: SPON1362-14. Funder: National Institute for Health Research, Health Services & Delivery Research Programme (NIHR HS&DR) Funder reference: 12/178/17. Research Ethics Committee reference: 15/SW/0084 [13/04/2015]. PROSPERO reference: CRD42015015326 [23/01/2015].
ISRCTN: 94228292 https://doi.org/10.1186/ISRCTN94228292 [date of application 13/05/2015; date of registration: 18/08/2015]. Prospective registration prior to data collection and participant consent commencing in September 2014.
KEYWORDS: And quality improvement; Mortality; Paediatric-early warning systems; Patient safety; Track-and-trigger tools
Link to PubMed record
Monday, 6 August 2018
WUTH publication: A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in the UK: Paediatric early warning system - utilisation and mortality avoidance- the PUMA study protocol
Friday, 20 July 2018
WUTH publication: Severity and threshold of peanut reactivity during hospital-based open oral food challenges: An international multicenter survey
Citation: Pediatric allergy and immunology. 2018, 29(7), 754-761. Epub 2018 Sep 17
Author: Arkwright PD, MacMahon J, Koplin J, Rajput S, Cross S, Fitzsimons R, Davidson N, Deshpande V, Rao N, Lumsden C, Lacy D, Allen KJ, Vance G, Mwenechanya J, Fox AT, Erlewyn-Lajeunesse M, Mistry H, Hourihane JO
Abstract: BACKGROUND: Peanut allergy is classically managed by food avoidance. Immunotherapy programmes are available at some academic centers for selected patients reacting to small amounts of peanut during food challenge. We aimed to determine and compare reaction thresholds and prevalence of anaphylaxis during peanut oral challenges at multiple specialist allergy centers.
METHODS: A retrospective, international survey of anonymized case records from seven specialist paediatric allergy centers from the UK and Ireland, as well as the Australian HealthNuts study. Demographic information, allergy test results, reaction severity and threshold during open oral peanut challenges were collated and analysed.
RESULTS: Of the 1,634 children aged 1 to 18 years old included, 525 (32%) failed their peanut challenge. 28% reacted to 25mg, while 38% only reacted after consuming 1g or more of whole peanut. Anaphylaxis (55 (11%)) was 3-times more common in teenagers than younger children and the likelihood increased at all ages as children consuming more peanut at the challenge. Children who developed anaphylaxis to smaller 25-200mg whole peanut were significantly older. Previous history of reaction did not predict reaction threshold or severity.
CONCLUSIONS: More than a third of the children in this large international cohort tolerated the equivalent of one peanut in an oral challenge. Anaphylaxis, particularly to small amounts of peanut was more common in older children. Tailored immunotherapy programmes might be considered not only for children with low, but also higher reaction thresholds. Whether these programmes could prevent heightened sensitivity and anaphylaxis to peanut with age also deserves further study. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: anaphylaxis; children; food allergy; oral food challenge; peanut; threshold
Link to PubMed record
Author: Arkwright PD, MacMahon J, Koplin J, Rajput S, Cross S, Fitzsimons R, Davidson N, Deshpande V, Rao N, Lumsden C, Lacy D, Allen KJ, Vance G, Mwenechanya J, Fox AT, Erlewyn-Lajeunesse M, Mistry H, Hourihane JO
Abstract: BACKGROUND: Peanut allergy is classically managed by food avoidance. Immunotherapy programmes are available at some academic centers for selected patients reacting to small amounts of peanut during food challenge. We aimed to determine and compare reaction thresholds and prevalence of anaphylaxis during peanut oral challenges at multiple specialist allergy centers.
METHODS: A retrospective, international survey of anonymized case records from seven specialist paediatric allergy centers from the UK and Ireland, as well as the Australian HealthNuts study. Demographic information, allergy test results, reaction severity and threshold during open oral peanut challenges were collated and analysed.
RESULTS: Of the 1,634 children aged 1 to 18 years old included, 525 (32%) failed their peanut challenge. 28% reacted to 25mg, while 38% only reacted after consuming 1g or more of whole peanut. Anaphylaxis (55 (11%)) was 3-times more common in teenagers than younger children and the likelihood increased at all ages as children consuming more peanut at the challenge. Children who developed anaphylaxis to smaller 25-200mg whole peanut were significantly older. Previous history of reaction did not predict reaction threshold or severity.
CONCLUSIONS: More than a third of the children in this large international cohort tolerated the equivalent of one peanut in an oral challenge. Anaphylaxis, particularly to small amounts of peanut was more common in older children. Tailored immunotherapy programmes might be considered not only for children with low, but also higher reaction thresholds. Whether these programmes could prevent heightened sensitivity and anaphylaxis to peanut with age also deserves further study. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: anaphylaxis; children; food allergy; oral food challenge; peanut; threshold
Link to PubMed record
Tuesday, 3 July 2018
WUTH publication: Anaesthetic management of robotic-assisted gynaecology surgery in the morbidly obese - A case series of 46 patients in a UK university teaching hospital
Citation: Indian Journal of Anaesthesia. 2018, 62(6), 443-448
Author: Sadashivaiah J, Ahmed D, Gul N
Abstract: BACKGROUND AND AIMS: The evolution of robotic technology has enhanced the scope of laparoscopic surgery. Morbid obesity [body mass index (BMI) >40 kg/m2] due to significant physiological attributes presents a significant surgical and anaesthetic challenge. Robotic surgery in this subset of patients can present with its own problems due to surgical requirements of prolonged pneumoperitoneum and steep Trendelenburg position.
METHODS: We reviewed the anaesthetic management of 46 morbidly obese patients undergoing robotic-assisted laparoscopic gynaecology surgery. Patient characteristics, anaesthetic management, length of hospital stay (LOS), complications, and readmissions within 30 days were noted. Mean with standard deviation was used for statistical analysis.
RESULTS: The mean [standard deviation (SD)] weight and BMI were 121.2 (18.49) kg and 47.83 (7.89) kg/m2, respectively. The mean (SD) anaesthetic and surgical times were 229 (75.9) and 167.7 (62.7) min, respectively. The mean (SD) LOS was 1.57 (1.03) days. About 70% of patients were discharged on the first day after surgery. Six patients needed critical care support. There were two readmissions within 30 days.
CONCLUSION: Good preparation, teamwork, and multidisciplinary input helped us to conduct complex robotic-assisted and long-duration surgery in morbidly obese patients with minimal complications.
KEYWORDS: Anaesthetic management; laparoscopy complications; morbid obesity; pneumoperitoneum
Link to PubMed record
Author: Sadashivaiah J, Ahmed D, Gul N
Abstract: BACKGROUND AND AIMS: The evolution of robotic technology has enhanced the scope of laparoscopic surgery. Morbid obesity [body mass index (BMI) >40 kg/m2] due to significant physiological attributes presents a significant surgical and anaesthetic challenge. Robotic surgery in this subset of patients can present with its own problems due to surgical requirements of prolonged pneumoperitoneum and steep Trendelenburg position.
METHODS: We reviewed the anaesthetic management of 46 morbidly obese patients undergoing robotic-assisted laparoscopic gynaecology surgery. Patient characteristics, anaesthetic management, length of hospital stay (LOS), complications, and readmissions within 30 days were noted. Mean with standard deviation was used for statistical analysis.
RESULTS: The mean [standard deviation (SD)] weight and BMI were 121.2 (18.49) kg and 47.83 (7.89) kg/m2, respectively. The mean (SD) anaesthetic and surgical times were 229 (75.9) and 167.7 (62.7) min, respectively. The mean (SD) LOS was 1.57 (1.03) days. About 70% of patients were discharged on the first day after surgery. Six patients needed critical care support. There were two readmissions within 30 days.
CONCLUSION: Good preparation, teamwork, and multidisciplinary input helped us to conduct complex robotic-assisted and long-duration surgery in morbidly obese patients with minimal complications.
KEYWORDS: Anaesthetic management; laparoscopy complications; morbid obesity; pneumoperitoneum
Link to PubMed record
Tuesday, 19 June 2018
WUTH publication: Is it necessary to change instruments between sampling sites when taking multiple tissue specimens in musculoskeletal infections?
Citation: Annals of the Royal College of Surgeons of England. 2018, 100(7), 563-565 [Epub 2018 Jun 18]
Author: Makki D, Abdalla S, El Gamal TA, Harvey D, Jackson G, Platt S
Abstract: Introduction Surgical debridement of orthopaedic infections allows biopsy for microbiology and facilitates successful treatment. It is recommended that biopsy instruments are changed when taking multiple samples. This study compared assessed cross-contamination between biopsy sites when using same instruments to take tissue samples from multiple sites. Materials and methods During the surgical debridement, we defined five sampling sites and marked them with diathermy. Two sampling techniques were performed on same patient to minimise any potential bias arising from the type of host and the severity of infection. First, fresh instruments were used for each biopsy site. Titleond, the instruments used in the first sampling site were reused to take samples from the remaining sites. By comparing the microbiology results of the samples taken by each technique for each site we determined cross-contamination with microorganisms. Results Fifteen patients with foot and ankle infections (mean age 56 years) were included. Ten patients were diabetic and five had neuropathies. Cross-contamination between sampling sites occurred in eight cases when the same instruments were used to take biopsies (P = 0.002, Fisher's exact test). One or more microorganisms were involved in cross-contamination and the latter always occurred between two consecutive sites rather than sites that were further apart. Conclusion It is important to use fresh instruments for each biopsy site when taking multiple samples in musculoskeletal infection as cross-contamination might occur otherwise and affect microbiological studies.
KEYWORDS: Multiple samples; Orthopaedic infections; Sampling instruments; Tissue sampling
Link to PubMed record
Author: Makki D, Abdalla S, El Gamal TA, Harvey D, Jackson G, Platt S
Abstract: Introduction Surgical debridement of orthopaedic infections allows biopsy for microbiology and facilitates successful treatment. It is recommended that biopsy instruments are changed when taking multiple samples. This study compared assessed cross-contamination between biopsy sites when using same instruments to take tissue samples from multiple sites. Materials and methods During the surgical debridement, we defined five sampling sites and marked them with diathermy. Two sampling techniques were performed on same patient to minimise any potential bias arising from the type of host and the severity of infection. First, fresh instruments were used for each biopsy site. Titleond, the instruments used in the first sampling site were reused to take samples from the remaining sites. By comparing the microbiology results of the samples taken by each technique for each site we determined cross-contamination with microorganisms. Results Fifteen patients with foot and ankle infections (mean age 56 years) were included. Ten patients were diabetic and five had neuropathies. Cross-contamination between sampling sites occurred in eight cases when the same instruments were used to take biopsies (P = 0.002, Fisher's exact test). One or more microorganisms were involved in cross-contamination and the latter always occurred between two consecutive sites rather than sites that were further apart. Conclusion It is important to use fresh instruments for each biopsy site when taking multiple samples in musculoskeletal infection as cross-contamination might occur otherwise and affect microbiological studies.
KEYWORDS: Multiple samples; Orthopaedic infections; Sampling instruments; Tissue sampling
Link to PubMed record
Monday, 18 June 2018
WUTH publication: Lessons from cadaveric dissection in AWR
Citation: Hernia: the journal of hernias and abdominal wall surgery. 2018 Jun 15 [Epub ahead of print]
Author: Walsh C, Battersby C, Suggett N, Slade D
Link to PubMed record
Author: Walsh C, Battersby C, Suggett N, Slade D
Link to PubMed record
Thursday, 14 June 2018
Stroke
Relevant
articles from MA Healthcare journals to support your staff’s education and
practice
June 2018
Both the diagnosis
and care of stroke victims is a key issue for health professionals in the UK;
today there are over 1.2 million stroke survivors that are discharged from hospitals who need care. It
is a condition that is currently one of the largest causes of disability, and
one third of survivors require help with daily activities from others, such as
professional carers, family and friends.
We have provided a list of relevant articles from MA Healthcare
journals dealing with stroke, thereby providing your NHS staff with research,
information and tips that will support both their work and their patients.
(Access to links via OpenAthens
authentication currently only work on the desktop version of our MAG Online Library)
British Journal of
Cardiac Nursing:
·
Room for improvement in stroke prevention
and treatment http://www.magonlinelibrary.com/doi/10.12968/bjca.2017.12.4.162
·
Initial assessment and management of stroke
British Journal of
Hospital Medicine:
British Journal of
Neuroscience Nursing:
·
Antithrombotic treatment for ischaemic stroke http://www.magonlinelibrary.com/doi/10.12968/bjnn.2017.13.Sup5.S26
·
Thrombectomy in acute ischaemic stroke
and the implications for nursing practice http://www.magonlinelibrary.com/doi/10.12968/bjnn.2016.12.Sup5.S28
·
A 2-week stroke review identifies unmet needs in
patients discharged home from a hyperacute stroke unit
·
Managing atrial fibrillation to prevent stroke
International Journal
of Therapy and Rehabilitation:
·
Hyper acute stroke unit patient suitability for
early supported discharge: Coordination and data analysis project http://www.magonlinelibrary.com/doi/10.12968/ijtr.2016.23.Sup11.S536
·
A qualitative study exploring patients',
with mild to moderate stroke, and their carers' perceptions of healthy
lifestyles http://www.magonlinelibrary.com/doi/10.12968/ijtr.2017.24.9.375
·
Factors associated with outcomes of inpatient
stroke rehabilitation
·
Immediate effects of arm slings on posture,
balance and gait in sub-acute stroke patients: A case control study
Nursing and
Residential Care:
·
Stroke and dysphagia: fluids, diet and
medication http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.1.12
·
Ibuprofen linked to heart attack and stroke http://www.magonlinelibrary.com/doi/10.12968/nrec.2015.17.9.487
Nurse Prescribing:
·
Antithrombotic treatment for ischaemic stroke http://www.magonlinelibrary.com/doi/10.12968/npre.2017.15.7.345
·
What acute care nurses should know about stroke
medications http://www.magonlinelibrary.com/doi/10.12968/npre.2016.14.2.68
British Journal of
Nursing:
·
Adherence to medication and self-management in
stroke patients http://www.magonlinelibrary.com/doi/10.12968/bjon.2014.23.3.158
·
Preventing muscular contractures through routine
stroke patient care http://www.magonlinelibrary.com/doi/10.12968/bjon.2014.23.14.781
British Journal of
Community Nursing:
·
Recognising and managing atrial fibrillation in
the community http://www.magonlinelibrary.com/doi/10.12968/bjcn.2014.19.9.422
·
Living with companion animals after stroke:
experiences of older people in community and primary care nursing
British Journal of
Healthcare Assistants:
·
Stroke and stroke rehabilitation, 3: nursing
skills http://www.magonlinelibrary.com/doi/10.12968/bjha.2016.10.1.20
·
Stroke and stroke rehabilitation, 4:
occupational therapy http://www.magonlinelibrary.com/doi/10.12968/bjha.2016.10.2.67
Journal of Paramedic
Practice:
·
World Stroke Day highlights continuing need for
rapid assessment and transport of stroke patients by paramedics
·
Stroke assessment and management in pre-hospital
settings http://www.magonlinelibrary.com/doi/10.12968/jpar.2017.9.8.354
Independent Nurse:
British Journal of
Healthcare Management:
·
E-health for stroke survivors and their
carers http://www.magonlinelibrary.com/doi/10.12968/bjhc.2017.23.10.462
·
Vision problems following stroke: Developing a
best practice statement http://www.magonlinelibrary.com/doi/10.12968/bjhc.2015.21.7.326
Wednesday, 13 June 2018
Pain Management
Relevant
articles from MA Healthcare journals to support your staff’s education and
practice
June 2018
Health
Professionals across the NHS are actively involved in helping thousands of
patients each year with effective pain management. This is a crucial element of
care provision – via accurate diagnoses and early interventions, professionals
can reduce the severity of pain and the risk of chronic conditions, as well as
greatly improve the quality of life and overall mental and physical health of
the patient.
We have provided a list of relevant articles from MA Healthcare
journals dealing with this area, thereby providing your NHS staff with
research, information and tips that will support both their work and the care
of their patients
(Access to links via OpenAthens
authentication currently only work on the desktop version of our MAG Online
British Journal of Cardiac
Nursing
·
Ablation of atrial fibrillation: pain relief by
visualisation
Published Online: April 07, 2015
British Journal of Community
Nursing
·
Wound management should not be a pain
Published Online: September 01, 2017
British Journal of Healthcare
Assistants
·
BPS1: Minimising pain at wound
dressing-related procedures
Published Online: September 27, 2013
British Journal of Healthcare
Management
·
A silent epidemic: effective pain management
in the community
Published Online: June 24, 2014
·
The clinical nurse specialist's role in
chronic pain management services
Published Online: December 15, 2014
British Journal of Hospital
Medicine
·
Postoperative pain management
Published Online: October 12, 2015
·
Analgesic prescribing in palliative care
Published Online: December 09, 2014
·
Managing Pain
Published Online: January 17, 2014
·
Diagnosis and management of acute
non-degenerative neck pain
Published Online: August 16, 2013
·
Continuous peripheral nerve blocks for
postoperative pain
Published Online: October 10, 2016
British Journal of Mental Health
Nursing
· Getting
to grips with chronic pain: Key publications
Published Online: December 06, 2016
British Journal of Midwifery
·
An exploration of the benefits and drawbacks
of intrapartum pain management strategies
Published Online: September 09, 2014
·
Non-pharmacological
pain management strategies for labour: Maintaining a physiological outlook
Published Online: February 02, 2017
·
Pain in
labour and the intrapartum use of intramuscular opioids—how effective are they?
Published Online: July 07, 2017
·
Supporting
an ethnic minority woman's choice for pain relief in labour: A reflection
Published Online: May 02, 2016
·
Lower back
pain in labour
Published Online: March 24, 2014
·
Non-pharmacological pain management
strategies for labour: Maintaining a physiological outlook
Published Online: February 02, 2017
British Journal of
Neuroscience Nursing
·
Neuropathic
pain: an overview
Published Online: June 24, 2014
British Journal of
Nursing
·
Pain management in cancer nursing
Published Online: May 23, 2014
·
Acute pain
services following surgery for colorectal cancer
Published Online: March 04, 2014
·
Managing
pain medications in long-term care: nurses' views
Published Online: May 15, 2015
·
Management of pain following craniotomy
Published Online: July 23, 2015
Dental Nursing
·
Pain part 1: introduction to pain
Published Online: July 06, 2017
Journal of
Aesthetic Nursing
·
Is there a
strong evidence base for pain relief prior to medical aesthetic procedures?
Published Online: September 29, 2013
·
Pain-management strategies for cosmetic
injectable treatments: an overview
Published Online: September 02, 2015
Journal of Paramedic Practice
·
Pain:
highlighting the law and ethics of pain relief in end-of-life patients
Published Online: July 06, 2015
·
Appropriate pain assessment tools for use in
patients with dementia in the out-of-hospital environment
Published Online: November 16, 2016
·
Continuing Professional Development: Pain
management in children in the pre-hospital environment
Published Online: March 07, 2018
·
Continuing Professional Development: Pain
management for paramedic practice
Published Online: January 29, 2015
·
A brief history of analgesia in paramedic
practice
Published Online: July 31, 2014
Journal of Wound
Care
·
The effect
of Ringer's solution within a dressing to elicit pain relief
Published Online: April 11, 2016
Independent Nurse
·
Relieving
musculoskeletal pain
Published Online: March 10, 2015
·
Managing
chronic pain in children
Published Online: October 21, 2015
International Journal of
Palliative Nursing
·
Achieving effective control in cancer pain:
a review of current guidelines
Published Online: January 20, 2014
·
How do nurses in specialist palliative care
assess and manage breakthrough cancer pain? A
Published Online: January 20, 2014
·
Treating
cancer pain: the palliative nursing dilemma
Published Online: January 25, 2016
·
Neuropathic pain in people with cancer (part
2): pharmacological and non-pharmacological management
Published Online: August 27, 2015
International
Journal of Therapy and Rehabilitation
·
Relaxation and chronic pain: A critical
review
Published Online: June 09, 2016
·
The impact of spinal cord stimulation for
upper extremity complex regional pain syndrome on level of function
Published Online: May 22, 2014
Nurse Prescribing
·
Pain and side effects in older people
Published Online: January 11, 2016
·
Pain,
inflammation and wound healing
Published Online: March 15, 2018
·
Palliative
care: Medicines for actively dying patients without pain
Published Online: July 09, 2016
·
Pain and
side effects in older people
Published Online: January 11, 2016
Nursing and Residential Care
·
Observational pain assessment in advanced
dementia
Published Online: June 14, 2014
·
The role of palliative care in pain relief
and affirming life
Published Online: March 05, 2014
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