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5. Specific Infections in Children

Author

Russell, Neal, primary, Johnson, Sarah May, additional, Chapman, Andrew, additional, Harkensee, Christian, additional, Garry, Sylvia, additional, and Williams, Bhanu, additional

Published
2021
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6. Gaza, armed conflict and child health

Author

Boukari, Yamina, primary, Kadir, Ayesha, additional, Waterston, Tony, additional, Jarrett, Prudence, additional, Harkensee, Christian, additional, Dexter, Erin, additional, Cinar, Erva Nur, additional, Blackett, Kerry, additional, Nacer, Hadjer, additional, Stevens, Amy, additional, and Devakumar, Delanjathan, additional

Published
2024
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9. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Author

Irwin, Adam, Akula, Akhila, Bamford, Alasdair, Chang, Amanda, da Silva, Andre, Whitelaw, Andrew, Dramowski, Angela, Vasudevan, Anil Kumar, Sharma, Anita, Justicia, Antonio, Chikkappa, Ashok, Slowinska-Jarzabek, Barbara, Rippberger, Bianca, Zhao, Changan, Tersigni, Chiara, Cheng, Chinglan, Harkensee, Christian, Jing, Chuamei, Zhu, Chunmei, Li, Chunyan, Tagliabue, Claudia, Epalza, Cristina, Jacqueline, Daglish, Tian, Daiyin, Jinka, Dasaratha, Gkentzi, Despoina, Dharmapalan, Dhanya, Benadof, Dona, Papadimitriou, Eleni, Iosifidis, Elias, Roilides, Emmanuel, Yarci, Erbu, Majda-Stanisławska, Ewa, Gowin, Ewelina, Chappell, Faye, Torres, Federico Martinon, Collett-White, Francis, Liu, Gang, Lu, Gen, Syrogiannopoulos, George, Pitsava, Georgia, Alvarez-Uria, Gerardo, Renk, Hana, Mahmood, Hana, Saxen, Harri, Finlayson, Heather, Green, Helen, Rabie, Helena, Kandraju, Hemasree, Zhang, Hong, Okokon, Ita, Cross, Jack, Herberg, Jethro, Li, Jianping, Zhang, Jiaosheng, Deng, Jikui, Liu, Jing, Qian, Jing, Yang, Jinhong, Sicińska, Joanna, Hübner, Johannes, Fukuoka, Kahoru, Yao, Kaihu, Cheung, Kaman, Ojeda, Karla, Kaffe, Katerina, Kreitmeyer, Katharina, Doerholt, Katja, Grimwood, Keith, Ledoare, Kirsty, Vazouras, Konstantinos, Shen, Kunling, Tang, Lanfang, Zhang, Lehai, Lin, Li, Ashkenazi-Hoffnung, Liat, Wu, Lijuan, Wang, Lijun, Teston, Lilian, Galli, Luisa, Speirs, Lynne, Tsolia, Maria, Hufnagel, Markus, Knuf, Markus, Duse, Marzia, Ding, Mingjie, Rozic, Mojca, Premru, Mueller, O'Connell, Natasha, Rieber, Nikolaus, Spyridis, Nikos, Tunga, Onkaraiah, Conejo, Pablo Rojo, McMaster, Paddy, Lumbiganon, Pagakrong, Pansa, Paola, D'Argenio, Patrizia, Moriarty, Paul, Nikolic, Petra, Wang, Ping, Paopongsawan, Pongsatorn, Cao, Qing, Deng, Qiulian, Laxminarayan, Ramanan, Kanithi, Ravishankar, Jimenez, Rodolfo, Cao, Sancheng, Singh, Sanjeev, Rees, Sarah, Praveen, Saroey, Kekomaki, Satu, Hackett, Scott, Ashkenazi, Shai, Chang, Si Min, Drysdale, Simon, Koning, Sonia, Subramanian, Sreeram, Murki, Srinivas, Vergnano, Stefania, Gandra, Sumanth, Esposito, Susanna, Anugulruengkitt, Suvaporn, Puthanakit, Thanyawee, Behrends, Uta, Papaevangelous, Vana, Jian, Victoria, Li, Wei, Zhao, Wei, Wang, Wei, Zhang, Wenshuang, Mu, Xiaoping, Dong, Xiaoyie, Jiang, Xiyuan, Chen, Xu, Wang, Yi, Zheng, Yuejie, Horikoshi, Yuho, Aboderin, Aaron, Olayinka, Adebola, Dedeic-Ljubovic, Amela, McCorry, Ann, Enimil, Anthony, Neubert, Antje, solano, antonio, Pignatari, Antonio, Poojary, Aruna, Kambaralieva, Baktygul, McCullagh, Bernadette, Carevi, Biljana, Van Herendael, Bruno, Gormley, Cairine, Carvajal, Camila, Ramírez, Carlos, Fitzgerald, David, Sabuda, Deana, Konopnicki, Deborah, Lacej, Denada, Pierard, Denis, Rios, Edgar, Marshall, Emily, Firre, Eric, van Elzakker, Erika, Shaqiri, Erjona, Darwish Elhajji, Feras, Gawrys, Gerard, Markovic, Goran, Kunsihima, Hiroyuki, Chen, Hui Hiong, Sviestina, Inese, Pristas, Irina, Hoxha, Iris, Korinteli, Irma, Mareković, Ivana, Soltani, Jafar, Labarca, Jaime, AlSalman, Jameela, Horvatic, Jasminka, Frimpong, Juliet Ampomah, Pagava, Karaman, Kei, Kasahara, Okinaka, Keiji, Iregbu, Kenneth, Ghazaryan, Lilit, Raka, Lul, Gessner-Wharton, Mallory, Aldeyab, Mamoon, Cooper, Mandelin, del Castillo, Marcelo, Hojman, Martin, Hudson, Melissa, Alshehri, Mohamed, Ling, Moi Lin, Greer, Nickie, Oduyebo, Oyinlola, Buijtels, Patricia, TEROL BARRERO, PEDRO, Zarb, Peter, Schelstraete, PEtra, Nwajiobi-Princewill, Princewill Ifeanyi Philip, Khanna, Priya, Quiros, Rodolfo, Simovic, Sanja, Thompson, Sarah, Chan, Si Min, Burokiene, Sigita, Rachina, Svetlana, Usonis, Vytautas, Cornistein, Wanda, Holemans, Xavier, Gu, Yoshiaki, Brothers, Adam, Hersh, Adam, Fernandez, Alfred, Tribble, Alison, Hurst, Amanda, Green, Andrea, Hammer, Benjamin, Lee, Betty P, Kuzmic, Brenik, Shapiro, Craig, Boge, Craig, Haslam, David, Berman, David, Naeem, Fouzia, Johnson, George, Schwenk, Hayden, Orr, Hillary, Maples, Holly, Olsen, Jared, Gerber, Jeffrey, Girotto, Jennifer, Zweiner, Jennifer, Goldman, Jennifer, Gillon, Jessica, Tansmore, Jessica, Manaloor, John, Courter, Joshua, Mongkolrattanothai, Kanokporn, Patel, Karisma, Merkel, Kathryn, Namtu, Katie, Flett, Kelly, Lee, Kelly, Nichols, Kristen, Klein, Kristin, Handy, Lori, Castagnini, Luis, Mazade, Marc, Heger, Margaret, Fernandez, Marisol, Chang, Michael, Crawford, Michelle, Nelson, Miranda, Bennett, Nicholas, Jaggi, Preeti, Hamdy, Rana, Banerjee, Ritu, Olivero, Rosemary, Patel, Sameer, Arnold, Sandra, Ogrin, Sara, Jones, Sarah, Parker, Sarah, Kubes, Sarah, Hymes, Saul, Weissman, Scott, Chan, Shannon, Henderson, Sheryl, Metjian, Talene, Hsia, Yingfen, Lee, Brian R, Versporten, Ann, Yang, Yonghong, Bielicki, Julia, Jackson, Charlotte, Newland, Jason, Goossens, Herman, Magrini, Nicola, and Sharland, Mike

Published
2019
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10. Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece.

Author

Simonek, Tomas, Zahos, Helen, Mahroof-Shaffi, Siyana, and Harkensee, Christian

Subjects
ANTIBIOTICS, COMMUNICABLE disease epidemiology, COMMUNICABLE diseases, REFUGEE camps, SEASONS, FOCUS groups, PSYCHOLOGY of refugees, DRUG resistance in microorganisms, ANTIMICROBIAL stewardship, FISHER exact test, RETROSPECTIVE studies, DESCRIPTIVE statistics, ODDS ratio, PHYSICIAN practice patterns, DRUG prescribing, HEALTH facilities, DATA analysis software, CONFIDENCE intervals, DISEASE incidence, MEDICAL referrals
Abstract

Background Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean. This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019. Methods This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp. Results Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance. Conclusions The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Microsatellite scanning of the immunogenome for associations with graft-versus-host disease following haematopoietic stem cell transplantation

Author

Harkensee, Christian

Subjects
617.9
Abstract

Non-HLA gene polymorphisms contribute to the immune response, leading to complications of haematopoietic stem cell transplantation (HSCT). A systematic approach using 4,321 microsatellite (MS) markers typing for 2,909 immune response genes (‘immunogenome’) on pooled DNA of 922 Japanese donors and recipients of HSCT was used to identify recipient and donor risk loci for graft-versus-host disease (GVHD). Splitting the population into discovery and confirmation cohorts (460/462 pairs), DNA pools were created for a 2-step pooled DNA screening. Fisher’s exact test for 2x2 (each MS allele) and 2xm Chi Square tests were performed, comparing allele frequencies of recipient/donor pools with GVHD grade 0-1 with those of GVHD grade 2-4. The independent, 2-step pooled DNA screening process has effectively reduced false-positive associations. In the final pooled DNA analysis, 17 (recipient) and 31 (donor) MS loci remained associated with risk or protection from GVHD and were further investigated by individual genotyping in the combined cohorts. Ten of these loci were confirmed to have consistent associations with GVHD; of these, two associations remained when applying multiple testing correction and multivariate statistics: D6S0035i (MAPK14, p=0.00035, OR=0.68) and D1S0818i (ELTD1, p=0.000078, OR=1.52). These findings implicate important new immunoregulatory genes with the process of moderate to severe acute GVHD. These data show that genetic susceptibility to GVHD following HSCT is complex and depends on multiple recipient and donor risk loci. Large-scale genomic screening with microsatellites on pooled DNA, here described for the first time in a HSCT population, is a useful method for the systematic evaluation of multigeneic traits.

Published
2012

14. Humanitarian paediatrics: A statement of purpose

Author

Martinez Garcia, Daniel, primary, Amsalu, Ribka, additional, Harkensee, Christian, additional, Janet, Sophie, additional, Kadir, Ayesha, additional, Kampalath, Vinay N., additional, Nejat, Sahar, additional, and Wise, Paul H., additional

Published
2022
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18. Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece.

Author

Hart, Paul L, Zahos, Helen, Salt, Nicola, Schofield, Roger, Mahroof-Shaffi, Siyana, Simonek, Tomas, and Harkensee, Christian

Subjects
NON-communicable diseases, HEALTH services accessibility, MEDICAL information storage & retrieval systems, CONFIDENCE intervals, PSYCHOLOGY of refugees, CHRONIC diseases, RETROSPECTIVE studies, ACQUISITION of data, MENTAL health, FISHER exact test, PRIMARY health care, REFUGEE camps, MEDICAL records, DESCRIPTIVE statistics, SOCIODEMOGRAPHIC factors, ODDS ratio, DATA analysis software, MEDICAL needs assessment, EVALUATION
Abstract

Background Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe's largest refugee camp. Methods A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions. Results The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies. Conclusions The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Author

Hsia, Yingfen, Lee, Brian R, Versporten, Ann, Yang, Yonghong, Bielicki, Julia, Jackson, Charlotte, Newland, Jason, Goossens, Herman, Magrini, Nicola, Sharland, Mike, Irwin, Adam, Akula, Akhila, Bamford, Alasdair, Chang, Amanda, da Silva, Andre, Whitelaw, Andrew, Dramowski, Angela, Vasudevan, Anil Kumar, Sharma, Anita, Justicia, Antonio, Chikkappa, Ashok, Slowinska-Jarzabek, Barbara, Rippberger, Bianca, Zhao, Changan, Tersigni, Chiara, Cheng, Chinglan, Harkensee, Christian, Jing, Chuamei, Zhu, Chunmei, Li, Chunyan, Tagliabue, Claudia, Epalza, Cristina, Jacqueline, Daglish, Tian, Daiyin, Jinka, Dasaratha, Gkentzi, Despoina, Dharmapalan, Dhanya, Benadof, Dona, Papadimitriou, Eleni, Iosifidis, Elias, Roilides, Emmanuel, Yarci, Erbu, Majda-Stanisławska, Ewa, Gowin, Ewelina, Chappell, Faye, Torres, Federico Martinon, Collett-White, Francis, Liu, Gang, Lu, Gen, Syrogiannopoulos, George, Pitsava, Georgia, Alvarez-Uria, Gerardo, Renk, Hana, Mahmood, Hana, Saxen, Harri, Finlayson, Heather, Green, Helen, Rabie, Helena, Kandraju, Hemasree, Zhang, Hong, Okokon, Ita, Cross, Jack, Herberg, Jethro, Li, Jianping, Zhang, Jiaosheng, Deng, Jikui, Liu, Jing, Qian, Jing, Yang, Jinhong, Sicińska, Joanna, Hübner, Johannes, Fukuoka, Kahoru, Yao, Kaihu, Cheung, Kaman, Ojeda, Karla, Kaffe, Katerina, Kreitmeyer, Katharina, Doerholt, Katja, Grimwood, Keith, Ledoare, Kirsty, Vazouras, Konstantinos, Shen, Kunling, Tang, Lanfang, Zhang, Lehai, Lin, Li, Ashkenazi-Hoffnung, Liat, Wu, Lijuan, Wang, Lijun, Teston, Lilian, Galli, Luisa, Speirs, Lynne, Tsolia, Maria, Hufnagel, Markus, Knuf, Markus, Duse, Marzia, Ding, Mingjie, Rozic, Mojca, Premru, Mueller, O'Connell, Natasha, Rieber, Nikolaus, Spyridis, Nikos, Tunga, Onkaraiah, Conejo, Pablo Rojo, McMaster, Paddy, Lumbiganon, Pagakrong, Pansa, Paola, D'Argenio, Patrizia, Moriarty, Paul, Nikolic, Petra, Wang, Ping, Paopongsawan, Pongsatorn, Cao, Qing, Deng, Qiulian, Laxminarayan, Ramanan, Kanithi, Ravishankar, Jimenez, Rodolfo, Cao, Sancheng, Singh, Sanjeev, Rees, Sarah, Praveen, Saroey, Kekomaki, Satu, Hackett, Scott, Ashkenazi, Shai, Chang, Si Min, Drysdale, Simon, Koning, Sonia, Subramanian, Sreeram, Murki, Srinivas, Vergnano, Stefania, Gandra, Sumanth, Esposito, Susanna, Anugulruengkitt, Suvaporn, Puthanakit, Thanyawee, Behrends, Uta, Papaevangelous, Vana, Jian, Victoria, Li, Wei, Zhao, Wei, Wang, Wei, Zhang, Wenshuang, Mu, Xiaoping, Dong, Xiaoyie, Jiang, Xiyuan, Chen, Xu, Wang, Yi, Zheng, Yuejie, Horikoshi, Yuho, Aboderin, Aaron, Olayinka, Adebola, Dedeic-Ljubovic, Amela, McCorry, Ann, Enimil, Anthony, Neubert, Antje, solano, antonio, Pignatari, Antonio, Poojary, Aruna, Kambaralieva, Baktygul, McCullagh, Bernadette, Carevi, Biljana, Van Herendael, Bruno, Gormley, Cairine, Carvajal, Camila, Ramírez, Carlos, Fitzgerald, David, Sabuda, Deana, Konopnicki, Deborah, Lacej, Denada, Pierard, Denis, Rios, Edgar, Marshall, Emily, Firre, Eric, van Elzakker, Erika, Shaqiri, Erjona, Darwish Elhajji, Feras, Gawrys, Gerard, Markovic, Goran, Kunsihima, Hiroyuki, Chen, Hui Hiong, Sviestina, Inese, Pristas, Irina, Hoxha, Iris, Korinteli, Irma, Mareković, Ivana, Soltani, Jafar, Labarca, Jaime, AlSalman, Jameela, Horvatic, Jasminka, Frimpong, Juliet Ampomah, Pagava, Karaman, Kei, Kasahara, Okinaka, Keiji, Iregbu, Kenneth, Ghazaryan, Lilit, Raka, Lul, Gessner-Wharton, Mallory, Aldeyab, Mamoon, Cooper, Mandelin, del Castillo, Marcelo, Hojman, Martin, Hudson, Melissa, Alshehri, Mohamed, Ling, Moi Lin, Greer, Nickie, Oduyebo, Oyinlola, Buijtels, Patricia, TEROL BARRERO, PEDRO, Zarb, Peter, Schelstraete, Petra, Nwajiobi-Princewill, Princewill Ifeanyi Philip, Khanna, Priya, Quiros, Rodolfo, Simovic, Sanja, Thompson, Sarah, Chan, Si Min, Burokiene, Sigita, Rachina, Svetlana, Usonis, Vytautas, Cornistein, Wanda, Holemans, Xavier, Gu, Yoshiaki, Brothers, Adam, Hersh, Adam, Fernandez, Alfred, Tribble, Alison, Hurst, Amanda, Green, Andrea, Hammer, Benjamin, Lee, Betty P, Kuzmic, Brenik, Shapiro, Craig, Boge, Craig, Haslam, David, Berman, David, Naeem, Fouzia, Johnson, George, Schwenk, Hayden, Orr, Hillary, Maples, Holly, Olsen, Jared, Gerber, Jeffrey, Girotto, Jennifer, Zweiner, Jennifer, Goldman, Jennifer, Gillon, Jessica, Tansmore, Jessica, Manaloor, John, Courter, Joshua, Mongkolrattanothai, Kanokporn, Patel, Karisma, Merkel, Kathryn, Namtu, Katie, Flett, Kelly, Lee, Kelly, Nichols, Kristen, Klein, Kristin, Handy, Lori, Castagnini, Luis, Mazade, Marc, Heger, Margaret, Fernandez, Marisol, Chang, Michael, Crawford, Michelle, Nelson, Miranda, Bennett, Nicholas, Jaggi, Preeti, Hamdy, Rana, Banerjee, Ritu, Olivero, Rosemary, Patel, Sameer, Arnold, Sandra, Ogrin, Sara, Jones, Sarah, Parker, Sarah, Kubes, Sarah, Hymes, Saul, Weissman, Scott, Chan, Shannon, Henderson, Sheryl, Metjian, Talene, GARPEC and Global-PPS networks, on behalf of the, GARPEC Network, Global-PPS Network, Children's Hospital, HUS Children and Adolescents, and Clinicum

Subjects
medicine.medical_specialty, Adolescent, medicine.drug_class, 030231 tropical medicine, Antibiotics, MEDLINE, Psychological intervention, CHILDREN, World Health Organization, Pediatrics, Essential medicines, 03 medical and health sciences, Antimicrobial Stewardship, 0302 clinical medicine, Antibiotic resistance, POINT PREVALENCE SURVEY, SURVEILLANCE, Medicine and Health Sciences, Medicine, Antimicrobial stewardship, Humans, 030212 general & internal medicine, Medical prescription, Child, Neonatal sepsis, business.industry, lcsh:Public aspects of medicine, STEWARDSHIP, Infant, Newborn, Infant, lcsh:RA1-1270, General Medicine, medicine.disease, 3142 Public health care science, environmental and occupational health, Drug Utilization, 3. Good health, Anti-Bacterial Agents, QUALITY INDICATORS, Family medicine, Child, Preschool, Health Care Surveys, Human medicine, business, Pharmacy Service, Hospital
Abstract

Summary: Background: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. Methods: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. Findings: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. Interpretation: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Funding: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS.

Published
2019

33. Chapter 15 - Infection and immunity

Author

Jones, Christine E, Sadarangani, Manish, Davies, Graham, Sharland, Mike, Narayan, Omendra, Langer, Daniel, Harkensee, Christian, Barton, Chris, Le Doare, Kirsty, and Cunnington, Aubrey

Published
2017
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35. Whistleblowers deserve protection.

Author

Harkensee, Christian

Subjects
INFANTICIDE -- Law & legislation, NEONATAL nursing, NATIONAL health services, PEDIATRIC nurses, WHISTLEBLOWING, PATIENT safety
Published
2023

37. Reducing unnecessary chest X-rays, antibiotics and bronchodilators through implementation of the NICE bronchiolitis guideline.

Author

Breakell, Richard, Thorndyke, Benjamin, Clennett, Julie, and Harkensee, Christian

Subjects
BRONCHIOLITIS, INFANT diseases, SECONDARY care (Medicine), RESPIRATORY syncytial virus infections, ANTIBIOTICS, RADIOLOGY, THERAPEUTICS, BRONCHODILATOR agents, DRUG utilization statistics, AUDITING, CHEST X rays, CLINICAL trials, COMPARATIVE studies, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, MEDICAL protocols, CONTINUING education of nurses, QUALITY assurance, RESEARCH, UNNECESSARY surgery, CONTINUING medical education, BRONCHIOLE diseases, EVALUATION research, RETROSPECTIVE studies, INAPPROPRIATE prescribing (Medicine), PREVENTION
Abstract

Chest X-rays (CXR), antibiotics and inhaled/nebulized therapy are overused in bronchiolitis, despite evidence-based guidelines suggesting supportive management only. This study investigates the effect of the implementation of the NICE bronchiolitis guideline in a secondary paediatric unit in England. We present a quality improvement project with a completed audit cycle (winter 2014-2015 and 2015-2016) pre- and post-implementation of the NICE bronchiolitis guideline. The educational intervention included sessions for raising awareness of appropriate and inappropriate management of bronchiolitis for both clinicians and nursing staff. As a result, the number of chest radiographs reduced fivefold (from 20 to 4% of patients, absolute reduction 16%), antibiotics reduced more than threefold (from 22 to 6% of patients, absolute reduction 16%) and inhaled/nebulised treatment up to twofold (from 30 to 16%, absolute reduction 14%). Overall NICE guideline compliance rose from 28 to 63%.Conclusion: Implementation of the NICE bronchiolitis guideline supported by a simple educational intervention can effectively reduce the number of inappropriate chest radiographs and antibiotic prescribing in bronchiolitis, and enhance compliance with the NICE guideline. What is Known: • Bronchiolitis management in paediatric units in the UK is variable, with poor evidence for existing guidance. Best available evidence was compiled into the NICE guideline, aiming to standardize care. • Some evidence exists for the effectiveness of quality improvement approaches to improve the management of bronchiolitis. What is New: • NICE guidance can be effectively applied to a department using simple educational tools. • Effective NICE implementation reduces the rates of unnecessary chest radiograph and antibiotic administration for patients admitted with bronchiolitis in District General Hospitals. [ABSTRACT FROM AUTHOR]

Published
2018
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39. List of Contributors

Author

Allen, Louise, Anderson, Mark, Armitage, Alice J, Baba, Megumi, Barton, Chris, Bitner-Glindzicz, Maria, Bomken, Simon, Brennan, Mary, Brierley, Joe, Byrne, Steve, Carroll, Daniel, Carroll, Will, Cartledge, Peter, Chiang, Nicole Y Z, Choonara, Imti, Clayton, Timothy H, Cunnington, Aubrey, Davie, Max, Davies, Graham, Dawson, Eleanor, Day, Ellie, Dommett, Rachel, Fewtrell, Mary, Fine-Goulden, Miriam, Foster, Helen, Garg, Shalabh, Goenka, Anu, Grech, Victor, Green, Jessica, Gregory, John W, Griffin, Hayley, Griffiths, Joanne, Hain, Richard D W, Harkensee, Christian, Hodes, Deborah, Hudson, Lee, Inwald, David P, James, Nadya, Jameson, Elisabeth, Jandial, Sharmila, Jenkins, Huw, Jones, Christine E, Kelly, Deirdre, Lachman, Peter I, Lal, Mithilesh Kumar, Langer, Daniel, Lapwood, Susie, Doare, Kirsty Le, Lenney, Warren, Li, Simon, Liang, YiFan, Linkson, Lynette M, Lodh, Rajib, Magnus, Dan, Marks, Stephen D, Marsh, Michael, Martin, Katherine, McCullagh, Gary, McDonagh, Janet, McErlane, Flora, Mehta, Anil, Merchant, Nazakat, Miall, Lawrence, Miller, Mike, Modi, Neena, Morgenstern, Daniel, Narayan, Omendra, O'Connor, David, Petransky, Ian, Phillips, Bob, Rajput, Kaukab, Ram, Dipak, Ray, Samiran, Rayfield, Sarah, Roberts, Irene A G, Robinson, Kerry, Runnacles, Jane, Ruth, Nicola, Sadarangani, Manish, Sammons, Helen, Sargant, Nwanneka N, Scott, Richard H, Sharland, Mike, Sinha, Rajiv, Sinha, Sunil K, Sinitsky, Lynn, Slaney, Charlotte, Starkey, Elizabeth, Stedmon, Jacqui, Tadros, Shereen, Tobin, Hannah, Tulloh, Robert M R, Turner, Paul J, Dr, Josef Vormoor, Warner, John O, Webster, Premila, Whyte, Lisa, Williams, Bhanu, Williams, Toni, and Yates, Helen

Published
2017
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44. Pediatric Dermatology, 3d ed

Author

Harkensee, Christian

Subjects
Pediatric Dermatology, 3d ed. (Book) -- Book reviews, Books -- Book reviews
Published
2007

49. Passive immunisation of preterm infants with palivizumab against RSV infection.

Author

Harkensee, Christian, Brodlie, Malcolm, Embleton, Nicholas D., and Mckean, Michael

Subjects
MONOCLONAL antibodies, IMMUNIZATION, PREMATURE infants, RESPIRATORY syncytial virus infections, DRUG efficacy, COST effectiveness, PREVENTION
Abstract

Summary: Palivizumab is a monocloncal antibody used for prevention of respiratory syncytial virus infection. This study reviews the literature regarding evidence of efficacy, safety and cost-effectiveness. The only randomised controlled trial into efficacy of palivizumab in preterm infants demonstrates clinical benefit and suggests a favourable safety profile. Further studies, however, do not provide evidence that costs saved by the reduction in hospitalisation would outweigh actual costs of the immunization for the recommended indications. There is considerable controversy over which groups of patients to include in immunization programs and analyses of cost-effectiveness are complicated by the fact that incidence of RSV infection, rates of hospitalisation and ventilation, health care costs and economic resources are variable among different health care systems and settings. Studies of cost-analysis, despite their implicit weaknesses, do not currently support the widespread use of palivizumab. In the absence of high quality cost-benefit analysis, we currently only recommend the use of palivizumab in infants at high risk of severe bronchiolitis, such as those with active chronic lung disease of prematurity. To illustrate current practice we also present data from an audit of the use of palivizumab in a regional centre in the North-East of England. [Copyright &y& Elsevier]

Published
2006
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