269 results on '"Duncan MacRae"'
Search Results
2. Co-ordinated multidisciplinary intervention to reduce time to successful extubation for children on mechanical ventilation : the SANDWICH cluster stepped-wedge RCT
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Bronagh Blackwood, Kevin P Morris, Joanne Jordan, Lisa McIlmurray, Ashley Agus, Roisin Boyle, Mike Clarke, Christina Easter, Richard G Feltbower, Karla Hemming, Duncan Macrae, Clíona McDowell, Margaret Murray, Roger Parslow, Mark J Peters, Glenn Phair, Lyvonne N Tume, Timothy S Walsh, and Daniel F McAuley
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Noninvasive Ventilation ,Health Policy ,Cost-Benefit Analysis ,Airway Extubation ,Humans ,Ventilator Weaning/methods ,Child ,Intensive Care Units, Pediatric ,Respiration, Artificial ,Ventilator Weaning - Abstract
Background Daily assessment of patient readiness for liberation from invasive mechanical ventilation can reduce the duration of ventilation. However, there is uncertainty about the effectiveness of this in a paediatric population. Objectives To determine the effect of a ventilation liberation intervention in critically ill children who are anticipated to have a prolonged duration of mechanical ventilation (primary objective) and in all children (secondary objective). Design A pragmatic, stepped-wedge, cluster randomised trial with economic and process evaluations. Setting Paediatric intensive care units in the UK. Participants Invasively mechanically ventilated children (aged Interventions The intervention incorporated co-ordinated multidisciplinary care, patient-relevant sedation plans linked to sedation assessment, assessment of ventilation parameters with a higher than usual trigger for undertaking an extubation readiness test and a spontaneous breathing trial on low levels of respiratory support to test extubation readiness. The comparator was usual care. Hospital sites were randomised sequentially to transition from control to intervention and were non-blinded. Main outcome measures The primary outcome measure was the duration of invasive mechanical ventilation until the first successful extubation. The secondary outcome measures were successful extubation, unplanned extubation and reintubation, post-extubation use of non-invasive ventilation, tracheostomy, post-extubation stridor, adverse events, length of intensive care and hospital stay, mortality and cost per respiratory complication avoided at 28 days. Results The trial included 10,495 patient admissions from 18 paediatric intensive care units from 5 February 2018 to 14 October 2019. In children with anticipated prolonged ventilation (n = 8843 admissions: control, n = 4155; intervention, n = 4688), the intervention resulted in a significantly shorter time to successful extubation [cluster and time-adjusted median difference –6.1 hours (interquartile range –8.2 to –5.3 hours); adjusted hazard ratio 1.11, 95% confidence interval 1.02 to 1.20; p = 0.02] and a higher incidence of successful extubation (adjusted relative risk 1.01, 95% confidence interval 1.00 to 1.02; p = 0.03) and unplanned extubation (adjusted relative risk 1.62, 95% confidence interval 1.05 to 2.51; p = 0.03), but not reintubation (adjusted relative risk 1.10, 95% confidence interval 0.89 to 1.36; p = 0.38). In the intervention period, the use of post-extubation non-invasive ventilation was significantly higher (adjusted relative risk 1.22, 95% confidence interval 1.01 to 1.49; p = 0.04), with no evidence of a difference in intensive care length of stay or other harms, but hospital length of stay was longer (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.97; p = 0.01). Findings for all children were broadly similar. The control period was associated with lower, but not statistically significantly lower, total costs (cost difference, mean £929.05, 95% confidence interval –£516.54 to £2374.64) and significantly fewer respiratory complications avoided (mean difference –0.10, 95% confidence interval –0.16 to –0.03). Limitations The unblinded intervention assignment may have resulted in performance or detection bias. It was not possible to determine which components were primarily responsible for the observed effect. Treatment effect in a more homogeneous group remains to be determined. Conclusions The intervention resulted in a statistically significant small reduction in time to first successful extubation; thus, the clinical importance of the effect size is uncertain. Future work Future work should explore intervention sustainability and effects of the intervention in other paediatric populations. Trial registration This trial is registered as ISRCTN16998143. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 18. See the NIHR Journals Library website for further project information.
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- 2022
3. Cardiovascular Physiology in Infants, Children, and Adolescents
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Ajay Desai and Duncan Macrae
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- 2022
4. Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial
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Joanne Jordan, Richard G. Feltbower, Karla Hemming, Ashley Agus, Cliona McDowell, Mark J. Peters, Margaret Murray, Lisa McIlmurray, Daniel F. McAuley, Bronagh Blackwood, Duncan Macrae, Christina Easter, Roger C Parslow, Timothy S. Walsh, Mike Clarke, Lyvonne N Tume, and Kevin P Morris
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Male ,medicine.medical_specialty ,Sedation ,medicine.medical_treatment ,Intensive Care Units, Pediatric ,Spontaneous breathing trial ,law.invention ,Randomized controlled trial ,law ,Intensive care ,medicine ,Humans ,Hypnotics and Sedatives ,Cluster randomised controlled trial ,Child ,Original Investigation ,Mechanical ventilation ,Pediatric intensive care unit ,Duration of Therapy ,business.industry ,Infant ,General Medicine ,Length of Stay ,Respiration, Artificial ,Child, Preschool ,Emergency medicine ,Breathing ,Airway Extubation ,Female ,medicine.symptom ,business ,Ventilator Weaning - Abstract
Importance There is limited evidence on the optimal strategy for liberating infants and children from invasive mechanical ventilation in the pediatric intensive care unit.Objective To determine if a sedation and ventilator liberation protocol intervention reduces the duration of invasive mechanical ventilation in infants and children anticipated to require prolonged mechanical ventilation.Design, Setting, and Participants A pragmatic multicenter, stepped-wedge, cluster randomized clinical trial was conducted that included 17 hospital sites (18 pediatric intensive care units) in the UK sequentially randomized from usual care to the protocol intervention. From February 2018 to October 2019, 8843 critically ill infants and children anticipated to require prolonged mechanical ventilation were recruited. The last date of follow-up was November 11, 2019.Interventions Pediatric intensive care units provided usual care (n = 4155 infants and children) or a sedation and ventilator liberation protocol intervention (n = 4688 infants and children) that consisted of assessment of sedation level, daily screening for readiness to undertake a spontaneous breathing trial, a spontaneous breathing trial to test ventilator liberation potential, and daily rounds to review sedation and readiness screening and set patient-relevant targets.Main Outcomes and Measures The primary outcome was the duration of invasive mechanical ventilation from initiation of ventilation until the first successful extubation. The primary estimate of the treatment effect was a hazard ratio (with a 95% CI) adjusted for calendar time and cluster (hospital site) for infants and children anticipated to require prolonged mechanical ventilation.Results There were a total of 8843 infants and children (median age, 8 months [interquartile range, 1 to 46 months]; 42% were female) who completed the trial. There was a significantly shorter median time to successful extubation for the protocol intervention compared with usual care (64.8 hours vs 66.2 hours, respectively; adjusted median difference, −6.1 hours [interquartile range, −8.2 to −5.3 hours]; adjusted hazard ratio, 1.11 [95% CI, 1.02 to 1.20], P = .02). The serious adverse event of hypoxia occurred in 9 (0.2%) infants and children for the protocol intervention vs 11 (0.3%) for usual care; nonvascular device dislodgement occurred in 2 (0.04%) vs 7 (0.1%), respectively.Conclusions and Relevance Among infants and children anticipated to require prolonged mechanical ventilation, a sedation and ventilator liberation protocol intervention compared with usual care resulted in a statistically significant reduction in time to first successful extubation. However, the clinical importance of the effect size is uncertain.Trial Registration isrctn.org Identifier: ISRCTN16998143
- Published
- 2021
5. Long term outcome of babies with pulmonary hypertension
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Andrew, Durward and Duncan, Macrae
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Meconium Aspiration Syndrome ,Hypertension, Pulmonary ,Pediatrics, Perinatology and Child Health ,Infant, Newborn ,Humans ,Infant ,Female ,Child ,Hernias, Diaphragmatic, Congenital ,Lung ,Bronchopulmonary Dysplasia - Abstract
Neonatal pulmonary hypertension (PH) is associated with many severe congenital abnormalities (congenital diaphragmatic hernia) or acquired cardiorespiratory diseases such as pneumonia, meconium aspiration and bronchopulmonary dysplasia (BPD). If no cause is found it may be labelled idiopathic persistent pulmonary hypertension of the newborn. Although PH may result in life threatening hypoxia and circulatory failure, in the majority of cases, it resolves in the neonatal period following treatment of the underlying cause. However, in some cases, neonatal PH progresses into infancy and childhood where symptoms include failure to thrive and eventually right heart failure or death if left untreated. This chronic condition is termed pulmonary vascular hypertensive disease (PHVD). Although classification and diagnostic criteria have only recently been proposed for pediatric PHVD, little is known about the pathophysiology of chronic neonatal PH, or why pulmonary vascular resistance may remain elevated well beyond infancy. This review explores the many factors involved in chronic PH and what implications this may have on long term outcome when the disease progresses beyond the neonatal period.
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- 2022
6. Intensive care of the adult with congenital heart disease
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Chessa M, Baumgartner H, Eicken Andreas, Giamberti A (series Editors) Eduardo da Cruz, Duncan Macrae Garry Webb (Editors), Chessa, M, Baumgartner, H, Eicken, Andrea, Giamberti, A (series Editors) Eduardo da Cruz, and Duncan Macrae Garry Webb, (Editors)
- Published
- 2019
7. Rethinking animal models of sepsis - working towards improved clinical translation whilst integrating the 3Rs
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Manu Shankar-Hari, Elliot Lilley, Manasi Nandi, Duncan Macrae, Simon K. Jackson, and Jordi L. Tremoleda
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Immunology & Inflammation ,Computer science ,construct validity ,3Rs ,Sepsis ,Translational Research, Biomedical ,sepsis ,Animal model ,Health care ,medicine ,Animals ,Humans ,Face validity ,Diabetes & Metabolic Disorders ,research animals ,Clinical Trials as Topic ,mechanistic ,Impact assessment ,business.industry ,Clinical translation ,Construct validity ,General Medicine ,Patient data ,medicine.disease ,Therapeutics & Molecular Medicine ,Disease Models, Animal ,Harm ,Editorial ,Risk analysis (engineering) ,Cardiovascular System & Vascular Biology ,Society & Bioethics ,business - Abstract
Sepsis is a major worldwide healthcare issue with unmet clinical need. Despite extensive animal research in this area, successful clinical translation has been largely unsuccessful. We propose one reason for this is that, sometimes, the experimental question is misdirected or unrealistic expectations are being made of the animal model. As sepsis models can lead to a rapid and substantial suffering – it is essential that we continually review experimental approaches and undertake a full harm:benefit impact assessment for each study. In some instances, this may require refinement of existing sepsis models. In other cases, it may be replacement to a different experimental system altogether, answering a mechanistic question whilst aligning with the principles of reduction, refinement and replacement (3Rs). We discuss making better use of patient data to identify potentially useful therapeutic targets which can subsequently be validated in preclinical systems. This may be achieved through greater use of construct validity models, from which mechanistic conclusions are drawn. We argue that such models could provide equally useful scientific data as face validity models, but with an improved 3Rs impact. Indeed, construct validity models may not require sepsis to be modelled, per se. We propose that approaches that could support and refine clinical translation of research findings, whilst reducing the overall welfare burden on research animals.
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- 2020
8. Contributors
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Tundi Agardy, Sophy Allen, David Allen, Colin G. Attwood, Fernanda Balata, Alex N. Banks, M. Bedington, Francis Binney, Sarah E. Birchenough, Julie Black, Samantha Blampied, Ian Bond, Jessica Bone, Fiona Bowles, George M. Branch, Susan Burton, Richard W.G. Caldow, Alex J. Caveen, Paul Chambers, I. Chapman, Robert W.E. Clark, J.R. Clark, Ken Collins, Laura H. Crossley, Ian W. Croudace, Terence P. Dawson, John A. Dearing, Chantelle de Gruchy, Kalli De Meyer, Ian Durbach, Sophie Elliott, Ken Findlay, Stephen Fletcher, Paulo A.C. Flores, Daniel J. Franklin, Tim Frayling, J.D. Goss-Custard, S.M. Grant, Victoria Jane Gravestock, Jean M. Harris, Andrew Harwood, Roger J.H. Herbert, Amy Hill, Keith Hiscock, Malcolm D. Hudson, Stephen Hull, John Humphreys, Robert A. Irving, Simon J Cripps, Gareth Jeffreys, Magnus L. Johnson, Inti Keith, Mel Kershaw, Peter Langdon, Durwyn Liley, Amanda T. Lombard, Heitor S. Macedo, Duncan MacRae, Judy Mann-Lang, Bruce Q. Mann, Heike Markus-Michalczyk, Neil McCulloch, Kevin McIlwee, Rodrigo P. Medeiros, S.B. Mitchell, Greg Morel, Thomas Mullier, Matthew Murphy, Rosie Nicoll, Patrick E. Osborne, Mia Pantzar, Simon Pengelly, Martin R. Perrow, D.A. Purdie, Alice S.J. Puritz-Evans, Dale P. Rodmell, Kathryn Ross, Helen Rowell, Daniela Russi, Jessica M. Savage, David Sear, Emma Sheehan, Jean-Luc Solandt, Walter Steenbock, Richard A. Stillman, Phil Taylor, Ann Thornton, Peter Tinsley, R. Torres, P.N. Trathan, R.J. Uncles, Nick Underdown, Duncan Vaughan, Talwyn Whetter, A. Willcocks, Chris Williams, Ilka Win, and Lewis Yates
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- 2020
9. A new approach to monitoring Marine Protected Area Management Success in the Dutch Caribbean
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Kalli De Meyer and Duncan MacRae
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Geography ,business.industry ,Corporate governance ,Environmental resource management ,Biodiversity ,Marine protected area ,Safeguarding ,business ,Protected area ,Ecosystem services - Abstract
There is ample evidence to show that Marine Protected Areas (MPAs) are an effective and preferred tool for safeguarding biodiversity and ecosystem services (Babcock et al., 2010; Sala and Giakoumi, 2017; Sandin et al., 2008; Shears and Babcock, 2003). Current efforts to demonstrate Protected Area Management Effectiveness (PAME) rely heavily on assessments of the state of biological resources within the Protected Area (PA) (Leverington et al., 2010; Cook et al., 2014). Where they do address MPAs effectiveness as a ‘governance tool’ the outputs are largely narrative (Pomeroy et al., 2004) or rely heavily on subjective assessments of MPA performance (Staub and Hatziolos, 2004).
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- 2020
10. Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
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Philip C. Spinella, Stacey L. Valentine, Mark W. Hall, Nina A. Guzzetta, Jennifer A. Muszynski, Scot T. Bateman, Duncan Macrae, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
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medicine.medical_specialty ,Critical Care ,Anemia ,Critical Illness ,MEDLINE ,030204 cardiovascular system & hematology ,Intensive Care Units, Pediatric ,Critical Care and Intensive Care Medicine ,Article ,03 medical and health sciences ,0302 clinical medicine ,Sepsis ,medicine ,Humans ,Child ,Intensive care medicine ,Evidence-Based Medicine ,Extramural ,business.industry ,Critically ill ,Consensus conference ,Shock ,030208 emergency & critical care medicine ,medicine.disease ,Shock (circulatory) ,Pediatrics, Perinatology and Child Health ,Critical illness ,Pediatric critical care ,medicine.symptom ,Erythrocyte Transfusion ,business - Abstract
OBJECTIVES: To present the recommendations and supporting literature for RBC transfusions in critically ill children with nonhemorrhagic shock developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.DESIGN: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.METHODS: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The nonhemorrhagic shock subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.RESULTS: Transfusion and Anemia Expertise Initiative Consensus Conference experts developed and voted on a total of four clinical and four research recommendations focused on RBC transfusion in the critically ill child with nonhemorrhagic shock. All recommendations reached agreement (> 80%). Of the four clinical recommendations, three were based on consensus panel expertise, whereas one was based on weak pediatric evidence. In hemodynamically stabilized critically ill children with a diagnosis of severe sepsis or septic shock, we recommend not administering a RBC transfusion if the hemoglobin concentration is greater than or equal to 7 g/dL. Future studies are needed to determine optimum transfusion thresholds for critically ill children with nonhemorrhagic shock undergoing acute resuscitation.CONCLUSIONS: The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric-specific clinical and research recommendations regarding RBC transfusion in the critically ill child with nonhemorrhagic shock. Although agreement among experts was strong, available pediatric evidence was scant-revealing significant gaps in the existing literature.
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- 2018
11. 25. Science And The Formation Of Policy In A Democracy
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Duncan MacRae Jr
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- 2019
12. Sedation AND Weaning In Children (SANDWICH): protocol for a cluster randomised stepped wedge trial
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Lyvonne N Tume, Margaret Murray, Kevin P Morris, Mark J. Peters, Duncan Macrae, Joanne Jordan, Ashley Agus, Lisa McIlmurray, Roisin Boyle, Roger C Parslow, Mike Clarke, Cliona McDowell, Karla Hemming, Bronagh Blackwood, Daniel F. McAuley, and Timothy S. Walsh
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medicine.medical_specialty ,paediatric ,Cost-Benefit Analysis ,Sedation ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,Intervention (counseling) ,Protocol ,medicine ,Humans ,Multicenter Studies as Topic ,030212 general & internal medicine ,Child ,Randomized Controlled Trials as Topic ,Mechanical ventilation ,Protocol (science) ,business.industry ,Intensive Care ,clinical trial ,General Medicine ,Respiration, Artificial ,stepped wedge ,Patient recruitment ,Clinical trial ,Ventilation (architecture) ,Physical therapy ,ventilator weaning ,Deep Sedation ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
IntroductionWeaning from ventilation is a complex process involving several stages that include recognition of patient readiness to begin the weaning process, steps to reduce ventilation while optimising sedation in order not to induce distress and removing the endotracheal tube. Delay at any stage can prolong the duration of mechanical ventilation. We developed a multicomponent intervention targeted at helping clinicians to safely expedite this process and minimise the harms associated with unnecessary mechanical ventilation.Methods and analysisThis is a 20-month cluster randomised stepped wedge clinical and cost-effectiveness trial with an internal pilot and a process evaluation. It is being conducted in 18 paediatric intensive care units in the UK to evaluate a protocol-based intervention for reducing the duration of invasive mechanical ventilation. Following an initial 8-week baseline data collection period in all sites, one site will be randomly chosen to transition to the intervention every 4 weeks and will start an 8-week training period after which it will continue the intervention for the remaining duration of the study. We aim to recruit approximately 10 000 patients. The primary analysis will compare data from before the training (control) with that from after the training (intervention) in each site. Full details of the analyses will be in the statistical analysis plan.Ethics and disseminationThis protocol was reviewed and approved by NRES Committee East Midlands—Nottingham 1 Research Ethics Committee (reference: 17/EM/0301). All sites started patient recruitment on 5 February 2018 before randomisation in April 2018. Results will be disseminated in 2020. The results will be presented at national and international conferences and published in peer-reviewed medical journals.Trial registration numberISRCTN16998143.
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- 2019
13. Tight glycemic control may be harmful in hyperglycemic, critically ill children
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Duncan Macrae
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Critically ill ,business.industry ,Pediatrics, Perinatology and Child Health ,medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Control (linguistics) ,Intensive care medicine ,business ,Glycemic - Published
- 2017
14. In-hospital interstage improves interstage survival after the Norwood stage 1 operation
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Margarita Bartsota, Guido Michielon, Alain Fraisse, Julene S. Carvalho, Pierce Daubeney, Sylvia Krupickova, Carles Bautista, Margarita Burmester, Ajay Desai, Giovanni DiSalvo, Zdenek Slavik, and Duncan Macrae
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Norwood Procedures ,Interstage ,Hypoplastic left heart syndrome ,Congenital ,03 medical and health sciences ,0302 clinical medicine ,Hypoplastic Left Heart Syndrome ,Medicine ,Humans ,030212 general & internal medicine ,Survival rate ,Retrospective Studies ,business.industry ,Mortality rate ,Palliative Care ,Infant, Newborn ,Retrospective cohort study ,General Medicine ,medicine.disease ,Norwood Operation ,Hospitals ,Surgery ,Transplantation ,Treatment Outcome ,Norwood procedure ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The interstage mortality rate after a Norwood stage 1 operation remains 12–20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood–Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock–Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan–Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan–Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome.
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- 2019
15. IV Fluids After Pediatric Cardiac Surgery
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Duncan Macrae
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Heart Defects, Congenital ,medicine.medical_specialty ,business.industry ,MEDLINE ,Heart ,Critical Care and Intensive Care Medicine ,Cardiac surgery ,Text mining ,Fluid therapy ,Surveys and Questionnaires ,Pediatrics, Perinatology and Child Health ,medicine ,Fluid Therapy ,Humans ,Cardiac Surgical Procedures ,Intensive care medicine ,business ,Child - Published
- 2019
16. Endocrinologic Diseases in Pediatric Cardiac Intensive Care
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Duncan Macrae, Michael S. D. Agus, Steven M. Schwartz, Jaclyn Sawyer, and Carmen L. Soto-Rivera
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medicine.medical_specialty ,Heart Diseases ,Critical Illness ,MEDLINE ,Disease ,030204 cardiovascular system & hematology ,Endocrine System Diseases ,Intensive Care Units, Pediatric ,Critical Care and Intensive Care Medicine ,Article ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Complex congenital heart disease ,Child ,Intensive care medicine ,Critically ill ,business.industry ,Coronary Care Units ,Thyroid ,Pathophysiology ,Cardiac surgery ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,business - Abstract
The objectives of this review are to discuss the pathophysiology, clinical impact and treatment of hyperglycemia, and disturbances in thyroid and adrenal function prior to and following cardiac surgery in children. MEDLINE and PubMed. Disturbances in glucose metabolism and thyroid and adrenal function are common in critically ill children with cardiac disease and in particular in children undergoing cardiac surgery for complex congenital heart disease. An understanding of the pathophysiology, clinical impact and treatment of these disturbances is essential for the management of these at risk patients.
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- 2016
17. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study
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Robinder G Khemani, Lincoln Smith, Yolanda M Lopez-Fernandez, Jeni Kwok, Rica Morzov, Margaret J Klein, Nadir Yehya, Douglas Willson, Martin C J Kneyber, Jon Lillie, Analia Fernandez, Christopher J L Newth, Philippe Jouvet, Neal J Thomas, Eugenia Abaleke, Kate G Ackerman, Carlos Acuña, Michelle Adu-Darko, Jeremy T Affolter, Rachel Agbeko, Ahmed Al Amoudi, Ahmad Alahmadti, Nedaa Aldairi, Omar Alibrahim, Kiona Allen, Christine Allen, Awni Al-Subu, María Althabe, Jimena Alvear, Ayse Berna Anil, Heather Anthony, Angela Aramburo, David Arjona Villanueva, Neda Ashtari, Antonio Ávila Vera, Paul Baines, Melissa Bales, Samantha Barr, Dana Barry, Florent Baudin, John Beca, Holly Belfield, Fernando Beltramo, Laura Benken, Anoopindar Bhalla, Andrea Blom, Priscila Botta, Pierre Bourgoin, Marta Brezmes, George Briassoulis, Armelle Bridier, Joe Brierley, Sonia Brio Sanagustin, Elizabeth Broden, Warwick Butt, Kris Bysani, Cristina Camilo, Anna Camporesi, Santiago Campos-Miño, Fulya Kamit Can, Patricia Capocasa, Daniel Caro I, Christopher Carroll, Pablo Castellani, Andres E. Castillo, Yang Chen, Ranjit S. Chima, Fabrizio Chiusolo, Karina Cinquegrani, Bria Coates, Alvaro Coronado-Munoz, Ambar Cortéz, Pablo Cruces Romero, Melissa Cullimore, Natalie Cvijanovich, Mary K. Dahmer, Akash Deep, Carmel Delzoppo, Matteo Di Nardo, Franco Díaz, Sandra Dijkstra, W. Keith Dockery, Troy E. Dominguez, Mariana Dumitrascu, Oguz Dursun, Buvana Dwarakanathan, Ismail Elghuwael, Guillaume Emeriaud, Simon Erickson, Segundo Fernando Español, Jim Brian Estil, Calandra Feather, Yael Feinstein, Analía Fernández, Marcela Ferreyra, Heidi Flori, Yanina Vanesa Fortini, Peter-Marc Fortune, Mary Ellen French, Mirella Gaboli, Helen Gale, Paula García Casas, Maria García González, Richa Gautam, Rainer Gedeit, Mathieu Genuini, Shira Gertz, Martin Giampieri, Carlos Gil Escobar, John S. Giuliano Jr, Loreto Godoy Mundaca, Concepción Goni Orayen, Jose Manuel Gonzalez Gomez, Beatriz Govantes, Julie Guichoux, Gustavo Alfredo Guzman Rivera, Bereketeab Haileselassie, Yong Y Han, Amy Harrell, Silvia Hartmann, Tarek Hazwani, Glenda Hefley, Grace Henderson, Deyin D. Hsing, Amber Hughes-Schalk, Janet Hume, Stavroula Ilia, David Inwald, Thomas Iolster, Ledys María Izquierdo, Shirin Jafari-Namin, Nancy Jaimon, Alberto E Jarillo Quijada, J. Dean Jarvis, Chaandini Jayachandran, Claire Jennings, Asumthia S. Jeyapalan, Nestor Javier Jimenez Rivera, Dawn Jones, Mary Kasch, Jane't Keary, Connor Kelley, Aaron Kessel, Robinder Khemani, Yoshiko Kida, Caroline King, Martin Kneyber, Allison Kniola, Kelli Krallman, Sherri Kubis, Lucinda Kustka, Michihito Kyo, Luis Martín Landry, Samir Latifi, Angela Lawton-Woodhall, John C. Lin, Ana M. Llorente de la Fuente, Yurika Paola Lopez Alarcón, Yolanda López Fernández, Jesús Lopez-Herce, Lucy Chai See Lum, Duncan Macrae, Aline B. Maddux, Paula Madurga Revilla, Sidharth Mahapatra, Matthieu Maria, Lidia Martínez, Amelia Martinez de Azagra, Alejandro Fabio Martínez León, Liliana Mazzillo Vega, Jenni McCorkell, Karen McIntyre, Tania Medina, Alberto Medina, Christie Mellish, Mikel Mendizabal, Courtney Merritt, Reinout Mildner, Christophe Milesi, Vicent Modesto I Alapont, Cecilia Monjes, Tracey Monjure, María José Montes, Antonio Morales Martinez, Ryan Morgan, Peter M. Mourani, Kathy Murkowski, Marie Murphy, Natalie Napolitano, Dan Nerheim, Sholeen T. Nett, Christopher Newth, Ryan Nofziger, Maria Jose Nunez, Shinichiro Ohshimo, Eider Onate Vergara, Ebru A Ongun, Daniel Orqueda, Siva Oruganti, Izabela Pagowska-Klimek, Daniel Palanca Arias, Jon Pappachan, Rosalba Pardo Carrero, Margaret M. Parker, Julio Parrilla, Nikhil Patankar, Paula Pávez Madrid, Valerie Payen, Fernando Paziencia, Claudia Pedraza, Germán Perez Lozano, Javier Pilar Orive, Byron Enrique Piñeres Olave, Alyssa Pintimalla, Neethi Pinto, Adrian Plunkett, Steve Pon, Marti Pons Odena, Rossana Poterala, Haiping Qiao, Deyanira Quiñonez Lopez, Kimberly Ralston, Grimaldo Ramirez Cortez, Anna Ratiu, Miriam Rea, Susana Reyes Dominguez, Chiara Rodgers, Patricia Rodriguez Campoy, Laurie Ronan, Deheza Rosemary, Courtney Rowan, Kalaimaran Sadasivam, Juan Ignacio Sanchez Diaz, Ron Sanders, James Santanelli, Anil Sapru, James Schneider, Jesica Sforza, Sara Shea, Steven L. Shein, Claire Sherring, Victoria Sheward, Nobuaki Shime, Avani Shukla, Alejandro Siaba Serrate, Yamila Sierra, Lindsay Sikora, Catarina Silvestre, Marcy Singleton, Daniel Sloniewsky, Rebecca Smith, Hanqiu Song, Marta Sousa Moniz, Michael Spaeder, Debbie Spear, Philip Spinella, Julie Starck, Erin Stoneman, Felice Su, Gayathri Subramanian, Erin Sullivan, Santosh Sundararajan, Todd Sweberg, Kim Sykes, Yuichi Tabata, Chian Wern Tai, Joana Tala, Swee Fong Tang, José Tantalean, Ryan Taylor, Neal Thomas, Shane Tibby, Kelly S Tieves, Luis Torero, Silvio Fabia Torres, Balagangadhar Totapally, Brendan Travert, Edward Truemper, Gonzalo Turón, Katri Typpo, Juan Ramón Valle, Sonia I Vargas G, Pablo Vasquez Hoyos, Daniel Vasquez Miranda, Martin Vavrina, Nilda Águeda Vidal, Manpreet Virk, Laura Walsh, Adriana Wegner Araya, James Weitz, Lawren Wellisch, Paul Wellman, Katherine Woods, Rocio Yerovi, Toni Yunger, Cesar Zuluaga Orrego, Jiri Zurek, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Internationality ,Cross-sectional study ,Acute Lung Injury ,Kaplan-Meier Estimate ,Lung injury ,Intensive Care Units, Pediatric ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Anesthesiology ,Cause of Death ,Epidemiology ,Severity of illness ,Medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Child ,Cause of death ,Respiratory Distress Syndrome ,business.industry ,Incidence (epidemiology) ,Age Factors ,Prognosis ,Combined Modality Therapy ,Survival Analysis ,United States ,Cross-Sectional Studies ,030228 respiratory system ,Area Under Curve ,Child, Preschool ,Emergency medicine ,Female ,business - Abstract
Summary Background Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Reseau en Sante Respiratoire du Fonds de Recherche Quebec-Sante, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
- Published
- 2018
18. Goal-directed therapy may improve outcome in complex patients - depending on the chosen treatment end point
- Author
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Bernhard Frey and Duncan Macrae
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medicine.medical_specialty ,Physical medicine and rehabilitation ,End point ,business.industry ,Treatment outcome ,Critical illness ,Medicine ,Goal directed therapy ,Evidence-based medicine ,Critical Care and Intensive Care Medicine ,business ,Outcome (game theory) - Published
- 2018
19. Paediatric Cardiac Intensive Care
- Author
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Ajay Desai, Lidia Casanueva, and Duncan Macrae
- Published
- 2018
20. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association
- Author
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Sarah Tabbutt, Rune Toms, Peter C. Laussen, Graeme MacLaren, Chitra Ravishankar, Dianne L. Atkins, Daniel J. Licht, Ericka L. Fink, John L. Jefferies, Ricardo A. Samson, Allan DeCaen, Catherine D. Krawczeski, Paul A. Checchia, Bradley S. Marino, George M. Hoffman, Monica E. Kleinman, Ian Adatia, James S. Tweddell, Mary Fran Hazinski, Duncan Macrae, and Ravi R. Thiagarajan
- Subjects
medicine.medical_specialty ,Resuscitation ,Adenosine ,Heart disease ,Heart Diseases ,medicine.medical_treatment ,Hypertension, Pulmonary ,Vasodilator Agents ,Pediatric advanced life support ,Population ,Guidelines as Topic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Extracorporeal membrane oxygenation ,Medicine ,Humans ,030212 general & internal medicine ,Cardiopulmonary resuscitation ,Intensive care medicine ,education ,Child ,Heart Failure ,education.field_of_study ,business.industry ,Basic life support ,Arrhythmias, Cardiac ,medicine.disease ,Cardiopulmonary Resuscitation ,Advanced life support ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care.
- Published
- 2018
21. Mitigating Latent Threats Identified through an Embedded In Situ Simulation Program and Their Comparison to Patient Safety Incidents: A Retrospective Review
- Author
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Philip Knight, Helen MacGloin, Mary Lane, Lydia Lofton, Ajay Desai, Elizabeth Haxby, Duncan Macrae, Cecilia Korb, Penny Mortimer, and Margarita Burmester
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education ,incident reporting and analysis ,Pediatrics, Perinatology and Child Health ,patient safety ,lcsh:RJ1-570 ,lcsh:Pediatrics ,in situ characterization ,simulation ,quality improvement - Abstract
ObjectiveTo assess the impact of service improvements implemented because of latent threats (LTs) detected during in situ simulation.DesignRetrospective review from April 2008 to April 2015.SettingPaediatric Intensive Care Unit in a specialist tertiary hospital.InterventionService improvements from LTs detection during in situ simulation. Action plans from patient safety incidents (PSIs).Main outcome measuresThe quantity, category, and subsequent service improvements for LTs. The quantity, category, and subsequent action plans for PSIs. Similarities between PSIs and LTs before and after service improvements.Results201 Simulated inter-professional team training courses with 1,144 inter-professional participants. 44 LTs were identified (1 LT per 4.6 courses). Incident severity varied: 18 (41%) with the potential to cause harm, 20 (46%) that would have caused minimal harm, and 6 (13%) that would have caused significant temporary harm. Category analysis revealed the majority of LTs were resources (36%) and education and training (27%). The remainder consisted of equipment (11%), organizational and strategic (7%), work and environment (7%), medication (7%), and systems and protocols (5%). 43 service improvements were developed: 24 (55%) resources/equipment; 9 (21%) educational; 6 (14%) organizational changes; 2 (5%) staff communications; and 2 (5%) guidelines. Four (9%) service improvements were adopted trust wide. 32 (73%) LTs did not recur after service improvements. 24 (1%) of 1,946 PSIs were similar to LTs: 7 resource incidents, 7 catastrophic blood loss, 4 hyperkalaemia arrests, 3 emergency buzzer failures, and 3 difficulties contacting staff. 34 LTs (77%) were never recorded as PSIs.ConclusionAn in situ simulation program can identify important LTs which traditional reporting systems miss. Subsequent improvements in workplace systems and resources can improve efficiency and remove error traps.
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- 2018
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22. Publication Ethics, Today’s Challenges: Navigating and Combating Questionable Practices
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Jenny Lunn, Barbara Epstein, Jayne Marks, and Duncan MacRae
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Political science ,Publication ethics ,Engineering ethics - Published
- 2018
23. Correction to: Paediatric intensive care admission blood pressure and risk of death in 30,334 children
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Adela Matettore, Mark J. Peters, Duncan Macrae, David A Harrison, Thomas Brick, Samiran Ray, and David Inwald
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medicine.medical_specialty ,Blood pressure ,business.industry ,Paediatric intensive care ,Pain medicine ,Anesthesiology ,Emergency medicine ,medicine ,Risk of death ,Critical Care and Intensive Care Medicine ,business - Abstract
The authors of the article entitled "Paediatric Intensive Care admission blood pressure and risk of death in 30,334 children" inform that due to an error in their database extraction, the following corrections to the data published should be notified.
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- 2019
24. Paediatric intensive care admission blood pressure and risk of death in 30,334 children
- Author
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Adela Matettore, Mark J. Peters, Duncan Macrae, Samiran Ray, David A Harrison, Thomas Brick, and David Inwald
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Male ,medicine.medical_specialty ,Adolescent ,business.industry ,Critical Illness ,Pain medicine ,Paediatric intensive care ,Infant ,Blood Pressure ,Blood Pressure Determination ,Intensive Care Units, Pediatric ,Critical Care and Intensive Care Medicine ,Survival Analysis ,Hospitalization ,Blood pressure ,Child, Preschool ,Anesthesiology ,Emergency medicine ,medicine ,Humans ,Female ,Hospital Mortality ,Risk of death ,Child ,business - Published
- 2019
25. Nonpulmonary treatments for pediatric acute respiratory distress syndrome
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Sandrine ESSOURI, Martha Curley, Duncan Macrae, Anil Sapru, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Rimensberger, Peter
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medicine.medical_specialty ,Respiratory Distress Syndrome, Newborn/therapy ,MEDLINE ,Conscious Sedation ,Erythrocyte Transfusion/methods ,Respiration, Artificial/methods ,Acute respiratory distress ,Lung injury ,Critical Care and Intensive Care Medicine ,Patient Care Planning ,Fluid Therapy/methods ,medicine ,Pain Management ,Humans ,Newborn/therapy ,Intensive care medicine ,Pain Management/methods ,Artificial/methods ,Conscious Sedation/methods ,Respiratory Distress Syndrome, Newborn ,Respiratory Distress Syndrome ,ddc:618 ,business.industry ,Respiration ,Consensus conference ,respiratory system ,Respiration, Artificial ,Pediatrics, Perinatology and Child Health ,Acute Disease ,Neuromuscular Blockade ,Fluid Therapy ,Diet Therapy/methods ,Neuromuscular Blockade/methods ,business ,Erythrocyte Transfusion ,Diet Therapy - Abstract
OBJECTIVE: To describe the recommendations from the Pediatric Acute Lung Injury Consensus Conference on nonpulmonary treatments in pediatric acute respiratory distress syndrome.DESIGN: Consensus conference of experts in pediatric acute lung injury.METHODS: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The nonpulmonary subgroup comprised three experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was utilized.RESULTS: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, 30 of which related to nonpulmonary treatment. All 30 recommendations had strong agreement. Patients with pediatric acute respiratory distress syndrome should receive 1) minimal yet effective targeted sedation to facilitate mechanical ventilation; 2) neuromuscular blockade, if sedation alone is inadequate to achieve effective mechanical ventilation; 3) a nutrition plan to facilitate their recovery, maintain their growth, and meet their metabolic needs; 4) goal-directed fluid management to maintain adequate intravascular volume, end-organ perfusion, and optimal delivery of oxygen; and 5) goal-directed RBC transfusion to maintain adequate oxygen delivery. Future clinical trials in pediatric acute respiratory distress syndrome should report sedation, neuromuscular blockade, nutrition, fluid management, and transfusion exposures to allow comparison across studies.CONCLUSIONS: The Consensus Conference developed pediatric-specific definitions for pediatric acute respiratory distress syndrome and recommendations regarding treatment and future research priorities. These recommendations for nonpulmonary treatment in pediatric acute respiratory distress syndrome are intended to promote optimization and consistency of care for patients with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.
- Published
- 2015
26. Extracorporeal Support in Children With Pediatric Acute Respiratory Distress Syndrome
- Author
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Sandrine ESSOURI, Duncan Macrae, Anil Sapru, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Rimensberger, Peter
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medicine.medical_specialty ,Inservice Training ,Respiratory Distress Syndrome, Newborn/therapy ,medicine.medical_treatment ,Conscious Sedation ,Acute respiratory distress ,Lung injury ,Critical Care and Intensive Care Medicine ,Extracorporeal ,law.invention ,Extracorporeal Membrane Oxygenation ,law ,Extracorporeal membrane oxygenation ,Cardiopulmonary bypass ,Humans ,Medicine ,Newborn/therapy ,Intensive care medicine ,Patient Care Team ,Respiratory Distress Syndrome ,Respiratory Distress Syndrome, Newborn ,ddc:618 ,business.industry ,Consensus conference ,Hemofiltration/methods ,Life support ,Expert opinion ,Acute Disease ,Pediatrics, Perinatology and Child Health ,Extracorporeal Membrane Oxygenation/adverse effects ,Hemofiltration ,business - Abstract
OBJECTIVE: Extracorporeal life support has undergone a revolution in the past several years with the advent of new, miniaturized equipment and success in supporting patients with a variety of illnesses. Most experience has come with the use of extracorporeal membrane oxygenation, a modified form of cardiopulmonary bypass that can support the heart, lungs, and circulation for days to months at a time. To describe the recommendations for the use of extracorporeal membrane oxygenation in children with pediatric acute respiratory distress syndrome based on a review of the literature and expert opinion.DESIGN: Consensus conference of experts in pediatric acute lung injury.METHODS: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The extracorporeal support subgroup comprised two international experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was used.RESULTS: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, 11 of which related to extracorporeal support. All recommendations had agreement, with 10 recommendations (91%) achieving strong agreement. These recommendations included the utilization of extracorporeal support for reversible causes of pediatric acute respiratory distress syndrome, consideration of quality of life when making the decision to use extracorporeal support, and the use of the Extracorporeal Life Support Organization registry to report all extracorporeal support activity, among others.CONCLUSIONS: Pediatric extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome could benefit from more specific data collection and collaboration of focused investigators to establish validated criteria for optimal application of extracorporeal membrane oxygenation and patient management protocols. Until that time, consensus opinion offers some insight into guidelines.
- Published
- 2015
27. Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study
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Suzanna Lubran, Hoang Thi Tran, Duncan Macrae, Colin Partridge, and Katie Gallagher
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Male ,Parents ,medicine.medical_specialty ,Attitude of Health Personnel ,Nurse's Role ,Developing countries ,Interviews as Topic ,03 medical and health sciences ,Nursing care ,Education, Nursing, Continuing ,0302 clinical medicine ,Nursing ,Professional-Family Relations ,Neonatal Nursing ,030225 pediatrics ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Nurse education ,Obstetrical nursing ,Qualitative Research ,Primary nursing ,Parent experience ,Nurses, Neonatal ,business.industry ,lcsh:RJ1-570 ,Infant, Newborn ,lcsh:Pediatrics ,Infant mortality ,Team nursing ,Vietnam ,Family medicine ,Pediatrics, Perinatology and Child Health ,Intensive Care, Neonatal ,Neonatal nursing ,Female ,Neonatal intensive care ,business ,Attitude to Health ,Research Article ,Qualitative research - Abstract
Background Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. Method Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. Results Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. Conclusions Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0909-6) contains supplementary material, which is available to authorized users.
- Published
- 2017
28. Mitigating Latent Threats Identified through an Embedded
- Author
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Philip, Knight, Helen, MacGloin, Mary, Lane, Lydia, Lofton, Ajay, Desai, Elizabeth, Haxby, Duncan, Macrae, Cecilia, Korb, Penny, Mortimer, and Margarita, Burmester
- Subjects
education ,incident reporting and analysis ,patient safety ,in situ characterization ,simulation ,Pediatrics ,Original Research ,quality improvement - Abstract
Objective To assess the impact of service improvements implemented because of latent threats (LTs) detected during in situ simulation. Design Retrospective review from April 2008 to April 2015. Setting Paediatric Intensive Care Unit in a specialist tertiary hospital. Intervention Service improvements from LTs detection during in situ simulation. Action plans from patient safety incidents (PSIs). Main outcome measures The quantity, category, and subsequent service improvements for LTs. The quantity, category, and subsequent action plans for PSIs. Similarities between PSIs and LTs before and after service improvements. Results 201 Simulated inter-professional team training courses with 1,144 inter-professional participants. 44 LTs were identified (1 LT per 4.6 courses). Incident severity varied: 18 (41%) with the potential to cause harm, 20 (46%) that would have caused minimal harm, and 6 (13%) that would have caused significant temporary harm. Category analysis revealed the majority of LTs were resources (36%) and education and training (27%). The remainder consisted of equipment (11%), organizational and strategic (7%), work and environment (7%), medication (7%), and systems and protocols (5%). 43 service improvements were developed: 24 (55%) resources/equipment; 9 (21%) educational; 6 (14%) organizational changes; 2 (5%) staff communications; and 2 (5%) guidelines. Four (9%) service improvements were adopted trust wide. 32 (73%) LTs did not recur after service improvements. 24 (1%) of 1,946 PSIs were similar to LTs: 7 resource incidents, 7 catastrophic blood loss, 4 hyperkalaemia arrests, 3 emergency buzzer failures, and 3 difficulties contacting staff. 34 LTs (77%) were never recorded as PSIs. Conclusion An in situ simulation program can identify important LTs which traditional reporting systems miss. Subsequent improvements in workplace systems and resources can improve efficiency and remove error traps.
- Published
- 2017
29. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)
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Peter C. Rimensberger, Jürg Hammer, Dick G. Markhorst, Etienne Javouhey, Martí Pons-Òdena, Martin C. J. Kneyber, Duncan Macrae, Daniele De Luca, Pierre Henri Jarreau, Jesús López-Herce, Gerhard K. Wolf, Joe Brierley, Alberto Medina, Paolo Biban, Edoardo Calderini, Fabrizio Racca, Amsterdam Reproduction & Development (AR&D), ACS - Diabetes & metabolism, Pediatric surgery, Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, The University of Groningen, parent, Division of Pediatrics and Neonatal Critical Care, 'A.Beclere' Medical Center, South Paris University Hospitals, APHP and South Paris-Saclay University, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR T9405), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Royal Brompton and Harefield NHS Trust, Department of Paediatrics, Division of Paediatric Critical Care Medicine, VU University Medical Center, Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Paediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu Uni-versity Hospital, Universitat de Barcelona, Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria General Hospital, Department of Pediatrics,Children's Hospital Traunstein, Ludwig Maximilians University Munich, Department of Paediatrics, Division of Paediatric Emergency and Critical Care, Verona University Hospital, Departments of Critical Care and Paediatric Bioethics, Great Ormond St Hospital for Children NHS Trust, Service of Neonatology and Pediatric Intensive Care, Department of Paediatrics, University Hospital of Geneva, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Subjects
INTENSIVE-CARE-UNIT ,END-EXPIRATORY PRESSURE ,ACUTE VIRAL BRONCHIOLITIS ,Physiology ,medicine.medical_treatment ,Conference Reports and Expert Panel ,RESPIRATORY-DISTRESS-SYNDROME ,Artificial/methods/standards ,Critical Care and Intensive Care Medicine ,Pediatrics ,Severity of Illness Index ,law.invention ,Pediatrics/standards ,Respiratory Insufficiency/therapy ,0302 clinical medicine ,Mechanical ventilation ,Randomized controlled trial ,law ,Positive airway pressure ,Child ,FREQUENCY OSCILLATORY VENTILATION ,ddc:618 ,Respiration ,SPINAL MUSCULAR-ATROPHY ,Tidal Volume/physiology ,RANDOMIZED CONTROLLED-TRIAL ,Intensive care unit ,3. Good health ,Intensive Care Units ,FLOW NASAL CANNULA ,Ventilation (architecture) ,Pediatric/standards ,Respiratory Insufficiency ,medicine.medical_specialty ,Airway Extubation/methods ,Monitoring ,Critical Care ,POSITIVE AIRWAY PRESSURE ,Ventilators ,Acute Lung Injury ,Intensive Care Units, Pediatric ,03 medical and health sciences ,Intensive care ,Anesthesiology ,Lung disease ,Paediatrics ,medicine ,Tidal Volume ,Humans ,Physiologic ,Intensive care medicine ,Monitoring, Physiologic ,Ventilators, Mechanical ,business.industry ,030208 emergency & critical care medicine ,Acute Lung Injury/therapy ,Mechanical ,Respiration, Artificial ,Clinical trial ,030228 respiratory system ,Airway Extubation ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children.MethodsThe European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms.ResultsThe Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with ?strong agreement?. The final iteration of the recommendations had none with equipoise or disagreement.ConclusionsThese recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.; Une grande partie de la pratique courante en ventilation mécanique pédiatrique est basée sur des expériences personnelles et ce que les praticiens en soins intensifs pédiatriques ont adopté à partir de l'expérience adulte et néonatale.
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- 2017
30. A Randomized Trial of Hyperglycemic Control in Pediatric Intensive Care
- Author
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Roger Parslow, Zia Sadique, Quen Mok, Duncan Macrae, Professor David Dunger, Nazima Pathan, Joe Brierley, Mark Peters, Robert Tasker, Richard Grieve, and David Inwald
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Blood Glucose ,medicine.medical_specialty ,Randomization ,Adolescent ,Critical Care ,Critical Illness ,medicine.medical_treatment ,Subgroup analysis ,Hypoglycemia ,Intensive Care Units, Pediatric ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Intensive care ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,Cardiac Surgical Procedures ,Child ,Infusions, Intravenous ,Glycemic ,Mechanical ventilation ,business.industry ,Infant ,Health Care Costs ,General Medicine ,Length of Stay ,medicine.disease ,Respiration, Artificial ,Intensive care unit ,Surgery ,Hospitalization ,Treatment Outcome ,Child, Preschool ,Hyperglycemia ,Energy Intake ,business - Abstract
BACKGROUND Whether an insulin infusion should be used for tight control of hyperglycemia in critically ill children remains unclear. METHODS We randomly assigned children (≤16 years of age) who were admitted to the pedi atric intensive care unit (ICU) and were expected to require mechanical ventilation and vasoactive drugs for at least 12 hours to either tight glycemic control, with a target blood glucose range of 72 to 126 mg per deciliter (4.0 to 7.0 mmol per liter), or conventional glycemic control, with a target level below 216 mg per deciliter (12.0 mmol per liter). The primary outcome was the number of days alive and free from mechanical ventilation at 30 days after randomization. The main prespecified subgroup analysis compared children who had undergone cardiac surgery with those who had not. We also assessed costs of hospital and community health services. RESULTS A total of 1369 patients at 13 centers in England underwent randomization: 694 to tight glycemic control and 675 to conventional glycemic control; 60% had undergone cardiac surgery. The mean between-group difference in the number of days alive and free from mechanical ventilation at 30 days was 0.36 days (95% confidence interval [CI], −0.42 to 1.14); the effects did not differ according to subgroup. Severe hypogly cemia (blood glucose
- Published
- 2014
31. Introduction
- Author
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Duncan MacRae
- Published
- 2016
32. 5. Emperor as Reader
- Author
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Duncan MacRae
- Subjects
biology ,media_common.quotation_subject ,Emperor ,Art ,Ancient history ,biology.organism_classification ,media_common - Published
- 2016
33. 1. Gods and Humans in Rome and Its Empire
- Author
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Duncan MacRae
- Subjects
media_common.quotation_subject ,Empire ,Art ,Ancient history ,Classics ,media_common - Published
- 2016
34. 4. Rabbis and Romans
- Author
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Duncan MacRae
- Published
- 2016
35. 6. Paper Pagans
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Duncan MacRae
- Published
- 2016
36. Conclusion: Beyond Scripture and Literature
- Author
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Duncan MacRae
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Literature ,business.industry ,Philosophy ,business - Published
- 2016
37. 3. Letters of the Republic
- Author
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Duncan MacRae
- Subjects
History ,Ancient history ,The Republic - Published
- 2016
38. 2. Writing Roman Religion
- Author
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Duncan MacRae
- Subjects
media_common.quotation_subject ,Art ,Religious studies ,Civil religion ,Roman mythology ,media_common - Published
- 2016
39. [Untitled]
- Author
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Ricardo Garcia Branco, Duncan Macrae, Nazima Pathan, Rachel Williams, and Ajay Desai
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Internal medicine ,Medicine ,Critical Care and Intensive Care Medicine ,business ,Lipid profile ,Cardiac surgery - Published
- 2019
40. Pediatric Cardiac Intensive Care: A Transition to Maturity
- Author
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Peter C. Laussen, David L. Wessel, Duncan Macrae, Paul A. Checchia, Anthony C. Chang, and Des Bohn
- Subjects
medicine.medical_specialty ,Critical Care ,Heart Diseases ,business.industry ,MEDLINE ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,Maturity (finance) ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Intensive care ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Intensive care medicine ,business ,Societies, Medical - Published
- 2016
41. Legible Religion
- Author
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Duncan MacRae
- Published
- 2016
42. Consistency between guidelines and reported practice for reducing the risk of catheter-related infection in British paediatric intensive care units
- Author
-
Quen Mok, Katie Harron, Carrol Gamble, Duncan Macrae, Ruth Gilbert, Dyfrig Hughes, and Robert Tasker
- Subjects
Adult ,medicine.medical_specialty ,business.industry ,Paediatric intensive care ,MEDLINE ,Psychological intervention ,Intensive Care Units, Pediatric ,Critical Care and Intensive Care Medicine ,Asepsis ,Catheter-Related Infections ,law.invention ,Randomized controlled trial ,law ,Anesthesiology ,Practice Guidelines as Topic ,Health care ,Humans ,Medicine ,Child ,business ,Intensive care medicine - Abstract
Optimal strategies for reducing catheter-related blood stream infection (CR-BSI) differ for adults and children. National guidelines do not make child-specific recommendations. We determined whether evidence explained the inconsistencies between guidelines and reported practice in paediatric intensive care units (PICUs). We conducted a survey of eight interventions for reducing CR-BSI in all 25 British PICUs in 2009. Interventions were categorised as requiring child-specific evidence, generalisable to adults and children, or organisational recommendations. Twenty-four of the 25 PICUs responded. For child-specific interventions, practice diverged from guidelines for “Insert into subclavian/jugular veins” (18 PICUs frequently used femoral veins, supported by observational evidence for increased safety in children). Practice reflected guidelines for “Use standard but consider antimicrobial-impregnated central venous catheters (CVCs) for high-risk patients” (14 used standard only, 3 used standard and antimicrobial-impregnated despite no randomised controlled trial (RCT) evidence for antimicrobial-impregnated CVCs in children, 7 used heparin-bonded for some or all children); “Use 2% chlorhexidine for skin preparation” (20 PICUs); “Avoid routine CVC replacement” (20 PICUs). For generalisable interventions, practice was consistent with guidelines for “Administration set replacement” (21 PICUs) but deviated for “Maintenance of CVC asepsis” (11 PICUs used alcohol due to inconclusive evidence for chlorhexidine). Practice diverged from guidelines for organisational interventions: “Train healthcare workers in CVC care” (9 PICUs); “Monitor blood stream infection (BSI) rates” (8 PICUs). Guidelines should explicitly address paediatric practice and report the quality of evidence and strength of recommendations. Organisations should ensure doctors are trained in CVC insertion and invest in BSI monitoring, especially in PICUs. The type of CVC and insertion site are important gaps in evidence for children.
- Published
- 2011
43. Abstract PD-042
- Author
-
A. Narayanan, D. Timms, Duncan Macrae, Margarita Burmester, S. Gala-Peralta, Ajay Desai, I. Branescu, and T. Jackson
- Subjects
business.industry ,Blood product ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Medicine ,Critical Care and Intensive Care Medicine ,business ,Extracorporeal ,Paediatric patients - Published
- 2018
44. Year in review in Intensive Care Medicine, 2008
- Author
-
Herwig Gerlach, Jordi Mancebo, François Lemaire, Daniel De Backer, Haibo Zhang, Marc Bonten, Duncan MacRae, Göran Hedenstierna, Giorgio Conti, Elie Azoulay, Salvatore Maurizio Maggiore, Jean Chastre, Jérôme Pugin, Philipp Metnitz, Giuseppe Citerio, Alexandre Mebazaa, Jan Wernerman, Johan Groeneveld, Massimo Antonelli, Intensive care medicine, ICaR - Ischemia and repair, Antonelli, M, Azoulay, E, Bonten, M, Chastre, J, Citerio, G, Conti, G, De Backer, D, Lemaire, F, Gerlach, H, Groeneveld, J, Hedenstierna, G, Macrae, D, Mancebo, J, Maggiore, S, Mebazaa, A, Metnitz, P, Pugin, J, Wernerman, J, and Zhang, H
- Subjects
Resuscitation ,medicine.medical_specialty ,Traumatic Brain Injury ,Neurology ,Critical Care ,Sepsi ,INTRACRANIAL-PRESSURE ,Critical Care and Intensive Care Medicine ,ACTIVATED PROTEIN-C ,Sepsis ,TIGHT GLYCEMIC CONTROL ,PERSISTENT SEPTIC SHOCK ,Status Epilepticus ,BLOOD-STREAM INFECTION ,Intensive care ,Internal medicine ,Anesthesiology ,Brain Injurie ,medicine ,Humans ,Intensive care medicine ,Cross Infection ,VENTILATOR-ASSOCIATED PNEUMONIA ,business.industry ,Acute kidney injury ,Ventilator-associated pneumonia ,Intensive Care ,Year in Review 2008 ,Acute Kidney Injury ,medicine.disease ,Systemic Inflammatory Response Syndrome ,CONFUSION ASSESSMENT METHOD ,Renal Replacement Therapy ,Pneumonia ,Endocrinology ,Severe Sepsis ,Brain Injuries ,CRITICAL ILLNESS ,business ,COATED ENDOTRACHEAL-TUBES ,CRITICALLY-ILL PATIENTS ,Human - Abstract
Year in review in Intensive Care Medicine, 2008 : I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia
- Published
- 2009
45. Melanotic Neuroectodermal Tumour of Infancy
- Author
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Duncan MacRae, Damir B. Matic, Sumit K. Agrawal, and Scott Hamilton
- Subjects
medicine.medical_specialty ,Pathology ,business.industry ,Maxilla ,medicine ,Extensive resection ,Original Article ,Surgery ,Radiology ,Melanotic neuroectodermal tumour ,business - Abstract
Melanotic neuroectodermal tumour of infancy is an extremely rare neoplasm arising in newborns and young children, typically involving the face or cranium. A case arising from the maxilla, requiring extensive resection with a near-total maxillectomy, is presented. A thorough review of the literature on this unusual tumour is provided, with emphasis on prognostic factors and appropriate treatment.
- Published
- 2008
46. Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome
- Author
-
Johan Groeneveld, François Lemaire, Göran Hedenstierna, Giorgio Conti, Daniel De Backer, Jean Chastre, Duncan MacRae, Marc Bonten, Herwig Gerlach, Jérôme Pugin, Jan Wernerman, Salvatore Maurizio Maggiore, Massimo Antonelli, Alexandre Mebazaa, Elie Azoulay, Philipp Metnitz, Haibo Zhang, Giuseppe Citerio, Jordi Mancebo, Intensive care medicine, ICaR - Ischemia and repair, Antonelli, M, Azoulay, E, Bonten, M, Chastre, J, Citerio, G, Conti, G, De Backer, D, Lemaire, F, Gerlach, H, Groeneveld, J, Hedenstierna, G, Macrae, D, Mancebo, J, Maggiore, S, Mebazaa, A, Metnitz, P, Pugin, J, Wernerman, J, and Zhang, H
- Subjects
Sepsis/diagnosis/therapy ,medicine.medical_specialty ,Resuscitation ,Critical Care ,Sepsi ,medicine.medical_treatment ,Respiration, Artificial/methods ,Critical Care and Intensive Care Medicine ,Sepsis ,Respiratory Distress Syndrome, Adult/diagnosis/therapy ,Intensive care ,Anesthesiology ,medicine ,Humans ,Hemodynamic ,Intensive Care/methods ,Intensive care medicine ,ddc:616 ,Mechanical ventilation ,Respiratory Distress Syndrome ,Pneumonia/diagnosis/therapy ,Respiratory distress ,business.industry ,Respiratory disease ,Intensive Care ,Respiratory Distress Syndrome, Adult ,Hemodynamics ,Pneumonia ,medicine.disease ,Respiration, Artificial ,business ,Human - Abstract
Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome
- Published
- 2008
47. The Council for International Organizations and Medical Sciences (CIOMS) Guidelines on Ethics of Clinical Trials
- Author
-
Duncan Macrae
- Subjects
Pulmonary and Respiratory Medicine ,Clinical Trials as Topic ,Informed Consent ,World War II ,business.industry ,History, 20th Century ,Public relations ,Medical research ,humanities ,Ethics, Research ,Helsinki declaration ,Clinical trial ,Informed consent ,Political science ,Humans ,War crime ,business ,Developing Countries ,health care economics and organizations ,Health policy ,Helsinki Declaration ,Declaration of Helsinki ,Ethical code - Abstract
Numerous bodies from many countries, including governments, government regulatory departments, research organizations, medical professional bodies, and health care providers, have issued guidance or legislation on the ethical conduct of clinical trials. It is possible to trace the development of current guidelines back to the post-World War II Nuremburg war crimes trials, more specifically the "Doctors' Trial." From that trial emerged the Nuremburg Code, which set out basic principles to be observed when conducting research involving human subjects and which subsequently formed the basis for comprehensive international guidelines on medical research, such as the Declaration of Helsinki. Most recently, the Council for International Organizations and Medical Sciences (CIOMS) produced detailed guidelines (originally published in 1993 and updated in 2002) on the implementation of the principles outlined in the Declaration of Helsinki. The CIOMS guidelines set in an appropriate context the challenges of present-day clinical research, by addressing complex issues including HIV/AIDS research, availability of study treatments after a study ends, women as research subjects, safeguarding confidentiality, compensation for adverse events, as well guidelines on consent.
- Published
- 2007
48. Scale positions and 'power' in the senate
- Author
-
Duncan Macrae and Hugh D. Price
- Subjects
Power (social and political) ,Government ,Information Systems and Management ,Strategy and Management ,Scale (social sciences) ,Law ,Assertion ,General Social Sciences ,Sociology ,General Agricultural and Biological Sciences - Abstract
When you hear people say “Senator Claghorn wields a lot of power in the government,” just what is meant by this assertion? Can power be quantitatively defined and measured? The concept of power, explored by Robert Dahl in this journal in 1957, is here reviewed with emphasis on the difficulties of defining power operationally.
- Published
- 2007
49. Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
- Author
-
Nazima Pathan, Rachel Williams, Anisha Wijeyesekera, S. McCarthy-Morrogh, David Inwald, Gary Frost, Sandra Gala-Peralta, Duncan Macrae, Gonçalo D S Correia, Beatriz Jiménez, Keng Wooi Ng, Elaine Holmes, Pathan, Nazima [0000-0002-9447-4252], and Apollo - University of Cambridge Repository
- Subjects
Blood Glucose ,Heart Defects, Congenital ,medicine.medical_specialty ,Pediatric Critical Care ,Heart disease ,INFANTS ,INTENSIVE-CARE ,LACTATE ,SERUM ,Critical Care Medicine ,Internal medicine ,General & Internal Medicine ,medicine ,Profiling (information science) ,critical illness ,Humans ,Science & Technology ,SPECTROSCOPY ,CARDIOPULMONARY BYPASS ,PLASMA ,business.industry ,metabolic profiling ,biomarkers ,Infant ,PEDIATRIC SEPTIC SHOCK ,bioinformatics ,medicine.disease ,INTERLEUKIN-10 ,congenital heart disease ,Surgery ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Metabolome ,business ,Life Sciences & Biomedicine ,CARDIAC-SURGERY - Abstract
Supplemental Digital Content is available in the text., Objective: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. Design: Laboratory and clinical study. Setting: University Hospital and Laboratory. Patients: Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. Interventions: Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). Measurements and Main Results: Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-d-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. Conclusions: This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions.
- Published
- 2015
50. Pulmonary specific ancillary treatment for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference
- Author
-
Anil Sapru, Ira Cheifetz, Sandrine ESSOURI, R. Scott Watson, Peter Rimensberger, Duncan Macrae, Melania Bembea, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Rimensberger, Peter
- Subjects
ARDS ,medicine.medical_specialty ,Delphi Technique ,AEROSOLIZED PROSTACYCLIN ,MEDLINE ,CINAHL ,Chest physiotherapy ,Cochrane Library ,Lung injury ,Suction ,Critical Care and Intensive Care Medicine ,Nitric Oxide ,law.invention ,HIGH-DOSE CORTICOSTEROIDS ,Randomized controlled trial ,Idiopathic pneumonia syndrome ,law ,ENDOTRACHEAL SUCTION ,medicine ,pulmonary therapies ,Humans ,Intensive care medicine ,Glucocorticoids ,Respiratory Distress Syndrome, Newborn ,ddc:618 ,business.industry ,PRONE POSITION ,STEM-CELL TRANSPLANTATION ,Pulmonary Surfactants ,acute respiratory distress syndrome ,RANDOMIZED CONTROLLED-TRIAL ,TNF INHIBITOR ETANERCEPT ,medicine.disease ,Review Literature as Topic ,acute lung injury ,INHALED NITRIC-OXIDE ,IDIOPATHIC PNEUMONIA SYNDROME ,Pediatrics, Perinatology and Child Health ,Acute Disease ,SURFACTANT FUNCTION ,business - Abstract
Objective: To provide an overview of the current literature on pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome to determine recommendations for clinical practice and/or future research.Data Sources: PubMed, EMBASE, CINAHL, SCOPUS, and the Cochrane Library were searched from inception until January 2013 using the following keywords in various combinations: ARDS, treatment, nitric oxide, heliox, steroids, surfactant, etanercept, prostaglandin therapy, inhaled beta adrenergic receptor agonists, N-acetylcysteine, ipratroprium bromide, dornase, plasminogen activators, fibrinolytics or other anticoagulants, and children. No language restrictions were applied. References from identified articles were searched for additional publications.Study Selection: All clinical studies pertaining to pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome were reviewed. If clinical pediatric data were sparse or unavailable, the findings from studies of adult acute respiratory distress syndrome and animal models that might be relevant to pediatric acute respiratory distress syndrome were examined.Data Extraction: All relevant studies were reviewed and pertinent data abstracted.Data Synthesis: Over the course of three international meetings, the pertinent findings of the literature review were discussed by a panel of 24 experts in the field representing 21 academic institutions and 8 countries. Recommendations developed and the supporting literature were distributed to all panel members without a conflict of interest and were scored by using the Research ANd Development/University of California, Los Angeles Appropriateness method. The modified Delphi approach was used as the methodology to achieve consensus among the panel.Conclusions: Overall, the routine use of surfactant, inhaled nitric oxide, glucocorticoids, prone positioning, endotracheal suctioning, and chest physiotherapy cannot be recommended. Inhaled nitric oxide should only be used for patients with documented pulmonary hypertension and/or right ventricular failure. Prone positioning may be considered in patients with severe pediatric acute respiratory distress syndrome. Future studies are definitely warranted to establish the role, if any, of these ancillary treatment modalities in pediatric acute respiratory distress syndrome.
- Published
- 2015
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