Loading...
22 results
Search Results
Now showing 1 - 10 of 22
- COVID-19 and the mental health of children with respiratory illnessPublication . Sinha, Ian P.; Murphy, Ruth; Biffin, Holly; Gait, Lucy; Abrams, Elissa M.; Lee, Alice R.; Gray-ffrench, Madeleine; Fernandes, Ricardo M.; Watson, Edward; Hawcut, Daniel B.; Southern, Kevin W.; Brown, AlexandraChildren and young people have been deeply affected by the COVID-19 pandemic. Lockdowns and new ways of living have necessitated massive adjustments. Despite heroic efforts from teachers, there has been a huge impact on education, and children lost the psychosocial benefits of being in school. News coverage is incessant, and polarised narratives and opinions are amplified in social media echo-chambers. In this report, co-authored with an adolescent from our clinic, we discuss the psychological impact of the COVID-19 pandemic on children and young people with respiratory problems.
- Quality and risk of bias appraisals of systematic reviews are inconsistent across reviewers and centersPublication . Gates, Michelle; Gates, Allison; Duarte, Gonçalo Silva; Cary, Maria; Becker, Monika; Prediger, Barbara; Vandermeer, Ben; Fernandes, Ricardo M.; Pieper, Dawid; Hartling, LisaObjective: The objective of the study was to evaluate the inter-rater and intercenter reliability, usability, and utility of A MeaSurement Tool to Assess systematic Reviews (AMSTAR), AMSTAR 2, and Risk Of Bias In Systematic reviews (ROBIS). Study design and setting: This is a prospective evaluation using 30 systematic reviews of randomized trials, undertaken at three international centers. Results: Reviewers completed AMSTAR, AMSTAR 2, and ROBIS in median (interquartile range) 15.7 (11.3), 19.7 (12.1), and 28.7 (17.4) minutes and reached consensus in 2.6 (3.2), 4.6 (5.3), and 10.9 (10.8) minutes, respectively. Across all centers, inter-rater reliability was substantial to almost perfect for 8/11 AMSTAR, 9/16 AMSTAR 2, and 12/24 ROBIS items. Intercenter reliability was substantial to almost perfect for 6/11 AMSTAR, 12/16 AMSTAR 2, and 7/24 ROBIS items. Intercenter reliability for confidence in the results of the review or overall risk of bias was moderate (Gwet's first-order agreement coefficient (AC1) 0.58, 95% confidence intervals [CI]: 0.30 to 0.85) to substantial (AC1 0.74, 95% CI: 0.30 to 0.85) for AMSTAR 2 and poor (AC1 -0.21, 95% CI: -0.55 to 0.13) to moderate (AC1 0.56, 95% CI: 0.30 to 0.83) for ROBIS. It is not clear whether using the appraisals of any tool as an inclusion criterion would alter an overview's findings. Conclusions: Improved guidance may be needed to facilitate the consistent interpretation and application of the newer tools (especially ROBIS).
- Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques : a systematic review and network meta-analysis of human cadaveric studiesPublication . Diniz, Pedro; Pacheco, Jácome; Fernandes, Ricardo M.; Pereira, Hélder; Ferreira, Frederico Castelo; Kerkhoffs, Gino M. M. J.Purpose: Current treatment recommendations emphasize early loading, with preservation of tendon length and physiologic tension. The objective of this systematic review and network meta-analysis was to compare failure load and elongation after cyclic loading of Achilles tendon repair techniques at time-zero. Methods: The databases PubMed, CENTRAL and Web of Science were searched for all published in-vitro studies comparing Achilles tendon repair techniques, or augmentation with autografts/biomaterials, and reports of failure load or elongation after cyclic loading. Only studies using human cadaveric Achilles tendons and matched pairs, or randomized specimen allocation, were selected for quantitative synthesis. A network meta-analysis per primary outcome was performed. Results were summarized as P score rankings and their validity was assessed using statistical methods. Results: Sixteen studies, comprising 367 tendon repairs, were included. The following repair techniques were used (n = number of studies): Krackow (n = 8), Achillon (n = 4), double Krackow (n = 3), Bunnell (n = 3), Percutaneous Achilles Repair System (n = 3), Percutaneous Achilles Repair System Midsubstance (n = 2), Kessler (n = 3), double Kessler (n = 1), modified triple Kessler (n = 1), triple bundle (n = 1), a multifilament stainless steel cable-crimp technique (n = 1) and a double loop knot stitch (n = 1). Five studies assessed augmentation with autografts/biomaterials. Regarding the failure load, biomaterial augmented Krackow repairs occupied the first four positions in the ranking, followed by the multifilament stainless steel cable-crimp and Percutaneous Achilles Repair System Midsubstance techniques. Concerning elongation after cyclic loading, the triple Kessler was ranked first, followed by the Achillon and Percutaneous Achilles Repair System Midsubstance techniques. A negligible correlation between ranks was found (rs = 0.11; p = 0.75n.s.), meaning that a higher repair tensile strength is not necessarily related to improved performance in regard to avoidance of elongation. Conclusion: In the failure load network meta-analysis, biomaterial augmented Krackow repairs ranked highest, but noticeable statistical heterogeneity was found. Regarding elongation with cyclic loading, the modified triple Kessler stitch showed the highest probability of ranking first.
- Circulating tumor cell detection methods in renal cell carcinoma : a systematic reviewPublication . Palmela Leitão, Tito; Miranda, Miguel; Polido, Joana; Morais, João; Corredeira, Patrícia; Alves, Patrícia; Ribeiro-de-Oliveira, Tiago; Pereira E Silva, Ricardo; Fernandes, Ricardo M.; Ferreira, João; Reis, José Palma; Lopes, Tomé; Costa, LuisCirculating tumor cells (CTCs) have a potential role as the missing renal cell carcinoma (RCC) biomarker. However, the available evidence is limited, and detection methods lack standardization, hindering clinical use. We performed a systematic review on CTC enrichment and detection methods, and its role as a biomarker in RCC. Full-text screening identified 54 studies. Reviewed studies showed wide heterogeneity, low evidence level, and high risk of bias. Various CTC detection platforms and molecular markers have been used, but none has proven to be superior. CTC detection and CTC count seem to correlate with staging and survival outcomes, although evidence is inconsistent. CTC research is still in an exploratory phase, particularly in RCC. Further studies are still necessary to achieve a standardization of techniques, molecular markers, CTC definitions, and terminology. This is essential to ascertain the role of CTCs as a biomarker and guide future liquid biopsy research in RCC.
- Satisfaction of patients with nonvitamin K anticoagulants compared to vitamin K antagonists : a systematic review and meta-analysisPublication . Katerenchuk, Vasyl; Duarte, Gonçalo Silva; Martins E Pereira, Gonçalo; Fernandes, Ricardo M.; Ferreira, Joaquim J; Pinto, Fausto J.; Costa, João; Caldeira, DanielOBJECTIVE: To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs). METHODS: We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines. RESULTS: We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99-5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18-0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53-7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00-10.73, combined n = 5,535). CONCLUSION: In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients’ satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.
- COVID-19 in children : what did we learn from the first wave?Publication . Bogiatzopoulou, Aliki; Mayberry, Huw; Hawcutt, Daniel B.; Whittaker, Elizabeth; Munro, Alasdair; Roland, Damian; Simba, Justus; Gale, Christopher; Felsenstein, Susanna; Abrams, Elissa; Jones, Caroline B.; Lewins, Ian; Rodriguez-Martinez, Carlos R.; Fernandes, Ricardo M.; Stilwell, Philippa A.; Swann, Olivia; Bhopal, Sunil; Sinha, Ian; Harwood, RachelA pandemic caused by the novel coronavirus, severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2), has caused high rates of mortality, predominantly in adults. Children are significantly less affected by SARS-CoV-2 with far lower rates of recorded infections in children compared to adults, milder symptoms in the majority of children and very low mortality rates. A suspected late manifestation of the disease, paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS), has been seen in small numbers of children and has a more severe disease course than acute SARS-CoV-2. The pandemic has meant that children around the world have been kept off school, isolated from their extended family and friends and asked to stay inside. The UK has been declared as being in an economic recession and unemployment rates are increasing. These indirect effects of SARS-CoV-2 are likely to have a significant impact on many children for years to come. Consolidating the knowledge that has accumulated during the first wave of this pandemic is essential for recognising the clinical signs, symptoms and effective treatment strategies for children; identifying children who may be at increased risk of severe SARS-CoV-2 infection; planning the safe delivery of healthcare and non-health related services that are important for childrens' wellbeing; and engaging in, and developing, research to address the things that are not yet known. This article summarises the evidence that has emerged from the early phase of the pandemic and offers an overview for those looking after children or planning services.
- Developments in the design, conduct, and reporting of child health trialsPublication . Baba, Ami; Aregbesola, Alex; Caldwell, Patrina H.Y.; Elliott, Sarah A.; Elsman, Ellen B.M.; Fernandes, Ricardo M.; Hartling, Lisa; Heath, Anna; Kelly, Lauren E.; Preston, Jennifer; Sammy, Adrian; Webbe, James; Williams, Katrina; Woolfall, Kerry; Klassen, Terry P.; Offringa, MartinTo identify priority areas to improve the design, conduct, and reporting of pediatric clinical trials, the international expert network, Standards for Research (StaR) in Child Health, was assembled and published the first 6 Standards in Pediatrics in 2012. After a recent review summarizing the 247 publications by StaR Child Health authors that highlight research practices that add value and reduce research "waste," the current review assesses the progress in key child health trial methods areas: consent and recruitment, containing risk of bias, roles of data monitoring committees, appropriate sample size calculations, outcome selection and measurement, and age groups for pediatric trials. Although meaningful change has occurred within the child health research ecosystem, measurable progress is still disappointingly slow. In this context, we identify and review emerging trends that will advance the agenda of increased clinical usefulness of pediatric trials, including patient and public engagement, Bayesian statistical approaches, adaptive designs, and platform trials. We explore how implementation science approaches could be applied to effect measurable improvements in the design, conducted, and reporting of child health research.
- The PREPIT project : Pregraduate Research Program Impact & Trajectories : a work in progressPublication . Henriques, Susana Oliveira; Barrosa, Sónia; Fernandes, Ricardo M.Introduction: The GAPIC – Gabinete de Apoio à Investigação Científica, Tecnológica e Inovação (Scientific Research, Technology and Innovation Support Office) of Faculdade de Medicina da Universidade de Lisboa (FMUL) is celebrating its 30th anniversary. During the past 30 years, GAPIC has developed several initiatives to promote and disseminate scientific research, mostly among undergraduate students and young graduates. These initiatives have been fundamental in the career path of young students and have had an increase impact in the future of society and the quality of life of its citizens. To assess the impact of GAPIC Programs in terms of gains in knowledge, skills and attitudes; barriers and opportunities; scientific production and professional trajectories of undergraduate students who participated in the GAPIC scientific research projects from 1997/98 to 2014/2015, the PREPIT Project is being developed with the collaboration of the FMUL´s library team. Two primary objectives were defined: i) Evaluate scientific productivity indicators of participants in GAPIC undergraduate programs in short and long term (study A); ii) Characterize the perspectives of participants in GAPIC undergraduate programs on the importance and impact of these (study B). Secondary objectives are: i) Identify predictors of scientific productivity indicators of these participants in short and long term (study A); ii) Characterize professional and academic trajectories among participants and identify predictors of these trajectories (study B). As a work in progress, only preliminary results are presented. Methods: Study Design1: two-component observational study: cohort, retrospective, bibliometric (study A) and cross-sectional, by electronic survey (study B). Population: all undergraduate students accepted to the GAPIC “Education for Science” program (or equivalent) from 1997/98 to 2014/2015. Data Collection and Instruments: i) data collection for the bibliometric cohort study (study A): academic year/GAPIC program; number of participations; demographic data; project description; ORCID iD. The definition of scientific profiles will be done through WoS and Scopus bibliometric data. Data will be exported to Excel and analyzed through SPSS. For data collection by electronic survey (study B) SurveyMonkey platform will be used. The survey will include closed, single and multiple choice questions, with Likert2 items. A modified Dillmman methodology3 with 3 reminders will be used and the survey will be open for 4 weeks. Study B protocol will be submitted to the Ethics Committee. Results and discussion: Based on author name and ORCID iD search, by now we have collected preliminary bibliometric data from 553 students involved in 387 GAPIC projects. As this is a work in progress more results will be available soon after the distribution and analysis of the electronic survey results. At the end of the project we aim to achieve all the proposed objectives, to gain an in-depth understanding of the impact and relevance of integrating research in all stages of medical education and positively contribute to support future research training interventions.
- National survey of feasibility of NIV trials for management of children with bronchiolitisPublication . Rosala Hallas, Anna; Jones, Ashley P; Bedson, Emma; Compton, Vanessa; Fernandes, Ricardo M.; Lacy, David; Lyttle, Mark D; Peak, Matthew; Thorburn, Kent; van Miert, Clare; Woolfall, Kerry; McNamara, Paul SBackground: Bronchiolitis is a major cause of admission to hospital in children. Non-invasive ventilation (NIV) support with continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) oxygen is routinely used for infants in the UK with bronchiolitis. Objective: To establish UK paediatric practice regarding management of bronchiolitis, and to explore issues pertinent to the design of a potential future randomised controlled trial of NIV. Design: Screening logs were completed in hospitals in England capturing information on paediatric bronchiolitis admissions. An online national survey of clinical practice was disseminated to healthcare professionals (HCPs) across the UK to ascertain current management strategies. Results: Screening logs captured data on 393 infants from 8 hospitals. Reasons for admission were most commonly respiratory distress and/or poor fluid intake. Oxygen was administered for 54% of admissions. Respiratory (CPAP and HFNC) and non-respiratory support administered varied considerably. The national survey was completed by 111 HCPs from 76 hospitals. Data were obtained on criteria used to commence and wean NIV, responsibilities for altering NIV settings, minimum training requirements for staff managing a child on NIV, and numbers of trained staff. Most centres were interested in and capable of running a trial of NIV, even out of normal office hours. Conclusions: Respiratory and non-respiratory management of bronchiolitis in UK centres varies widely. A trial of HFNC oxygen therapy in this group of patients is feasible and HCPs would be willing to randomise patients into such a trial. Future work should focus on defining trial eligibility criteria.
- Analysis of the asthma scores recommended in guidelines for children presenting to the emergency department: a Pediatric Emergency Research Networks studyPublication . Gray, Charmaine; Collings, Madeline; Benito, Javier; Velasco, Roberto; Lyttle, Mark D.; Roland, Damian; Schuh, Suzanne; Shihabuddin, Bashar; Kwok, Maria; Mahajan, Prashant; Johnson, Mike; Zorc, Joseph; Khanna, Kajal; Yock-Corrales, Adriana; Fernandes, Ricardo M.; Santhanam, Indumathy; Cheema, Baljit; Ong, Gene Yong-Kwang; Jaiganesh, Thiagarajan; Powell, Colin; Dalziel, Stuart; Babl, Franz E.; Couper, Jennifer; Craig, SimonRationale: While there are numerous published paediatric asthma scores, it is unknown how commonly scores are recommended in asthma guidelines across different geographical regions globally, and what their validation status is. Objectives: (1) To describe which clinical guidelines recommend asthma scores across different geographical regions. (2) To describe the initial and subsequent validation of the commonly recommended asthma scores. Methods: Observational study of asthma scores recommended in guidelines for the management of acute paediatric asthma from institutions across the Pediatric Emergency Medicine Network; global paediatric emergency medicine research network comprising all eight local and regional paediatric emergency medicine research networks. Main results: 158 guidelines were identified. Overall, 83/158 (53%) guidelines recommend a bedside clinical score for assessment of asthma severity. While a single country-specific clinical score was recommended in all guidelines from Spain and Canada, 27/28 (96%) of the USA guidelines recommend a wide variety of scores, and scores are rarely recommended in guidelines from other research networks (PERUKI, Paediatric Emergency Research in the UK and Ireland and PREDICT, Paediatric Research in Emergency Departments International Collaborative in Australia and New Zealand) and other countries (Costa Rica, South Africa, Nigeria, Singapore, India).The Pediatric Respiratory Assessment Measure (PRAM) and the pulmonary score (PS) were the most frequently used scoring instruments. While the PRAM has undergone the most extensive validation, including construct validity, validation studies for the PS are limited. Inter-rater reliability, as well as the criterion, responsiveness and discriminative validity aspects represent the most common limitations in many of the scores. Conclusions: There are marked geographical differences in both the recommendation for and the type of clinical asthma score in clinical practice guidelines. While many asthma scores are recommended, most have insufficient validation.
- «
- 1 (current)
- 2
- 3
- »