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Article ; Online: Fostering patient-centred care: The Ask One Question initiative.

Lawson McLean, Aaron / Fitchett, Elizabeth J A / Gelding, Susan V

2024 Volume 58, Issue 5, Page(s) 613–614

Language	English
Publishing date	2024-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	195274-2
ISSN	1365-2923 ; 0308-0110
ISSN (online)	1365-2923
ISSN	0308-0110
DOI	10.1111/medu.15336
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Article: Prescription of Steroids in General Pediatric Intensive Care Patients-A Two-Center Retrospective Observational Study.

Mitting, Rebecca / Fitchett, Elizabeth J A / Peters, Mark J / Ray, Samiran

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2022 Volume 24, Issue 1, Page(s) e54–e59

Abstract: Objectives: Designing randomized trials to determine utility, dose, and timing of steroid administration in the management of critically unwell children may be difficult owing to a high proportion of patients who receive steroid as part of current care. ...

Abstract	Objectives: Designing randomized trials to determine utility, dose, and timing of steroid administration in the management of critically unwell children may be difficult owing to a high proportion of patients who receive steroid as part of current care. We aimed to describe steroid use among all patients on two general PICUs. Design: Retrospective observational study using a multilevel logistic regression model. Setting: Two tertiary, general mixed medical and surgical PICUs. Patients: All admissions between 2016 and 2019. All parenteral or enteral steroid prescriptions were identified, and steroid type, frequency, timing, and peak daily doses were recorded. The outcome measure was mortality prior to PICU discharge. Interventions: None. Measurements and main results: There were 5,483 admissions during the study period, and 1,804 (33%) of these involved prescription of at least one steroid. Among patients prescribed steroids, the median peak daily dose when steroids were prescribed was 2.4 mg/kg/d prednisolone equivalent (interquartile range, 1.6-3.6), and the median time to peak steroid doses was 2 days (1-5 d). Administration of steroid was associated with increased risk-adjusted mortality odds ratio (OR) of 1.37 (95% CI, 1.04-1.79). Steroids were prescribed in 42.3% of admissions, in which the child did not survive to PICU discharge. Among children who were prescribed steroids, use of hydrocortisone (OR, 6.75; 95% CI, 3.79-12.27) and methylprednisolone (OR, 7.85; 95% CI, 4.21-14.56), or starting steroids later than 2 days after PICU admission were associated with an increased mortality (OR, 1.93; 95% CI, 1.15-3.25). Conclusions: Steroids are widely used in pediatric critical illness and nonsurvival associated with increased frequency of use. This association appears to be related to steroid class and timing of dose, both likely to reflect indication for steroid prescription. Prospective trials are required to estimate these complex risks and benefits, and study design will need to consider these patterns.
MeSH term(s)	Child ; Humans ; Infant ; Prospective Studies ; Methylprednisolone/therapeutic use ; Retrospective Studies ; Intensive Care Units, Pediatric ; Steroids ; Critical Care
Chemical Substances	Methylprednisolone (X4W7ZR7023) ; Steroids
Language	English
Publishing date	2022-10-14
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000003093
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Article ; Online: Adoption of C-reactive protein rapid tests for the management of acute childhood infections in hospitals in the Netherlands and England: a comparative health systems analysis.

Dewez, Juan Emmanuel / Nijman, Ruud G / Fitchett, Elizabeth J A / Li, Edmond C / Luu, Queena F / Lynch, Rebecca / Emonts, Marieke / de Groot, Ronald / van der Flier, Michiel / Philipsen, Ria / Ettelt, Stefanie / Yeung, Shunmay

BMC health services research

2024 Volume 24, Issue 1, Page(s) 351

Abstract: Background: The adoption of C-reactive protein point-of-care tests (CRP POCTs) in hospitals varies across Europe. We aimed to understand the factors that contribute to different levels of adoption of CRP POCTs for the management of acute childhood ... ...

Abstract	Background: The adoption of C-reactive protein point-of-care tests (CRP POCTs) in hospitals varies across Europe. We aimed to understand the factors that contribute to different levels of adoption of CRP POCTs for the management of acute childhood infections in two countries. Methods: Comparative qualitative analysis of the implementation of CRP POCTs in the Netherlands and England. The study was informed by the non-adoption, abandonment, spread, scale-up, and sustainability (NASSS) framework. Data were collected through document analysis and qualitative interviews with stakeholders. Documents were identified by a scoping literature review, search of websites, and through the stakeholders. Stakeholders were sampled purposively initially, and then by snowballing. Data were analysed thematically. Results: Forty-one documents resulted from the search and 46 interviews were conducted. Most hospital healthcare workers in the Netherlands were familiar with CRP POCTs as the tests were widely used and trusted in primary care. Moreover, although diagnostics were funded through similar Diagnosis Related Group reimbursement mechanisms in both countries, the actual funding for each hospital was more constrained in England. Compared to primary care, laboratory-based CRP tests were usually available in hospitals and their use was encouraged in both countries because they were cheaper. However, CRP POCTs were perceived as useful in some hospitals of the two countries in which the laboratory could not provide CRP measures 24/7 or within a short timeframe, and/or in emergency departments where expediting patient care was important. Conclusions: CRP POCTs are more available in hospitals in the Netherlands because of the greater familiarity of Dutch healthcare workers with the tests which are widely used in primary care in their country and because there are more funding constraints in England. However, most hospitals in the Netherlands and England have not adopted CRP POCTs because the alternative CRP measurements from the hospital laboratory are available in a few hours and at a lower cost.
MeSH term(s)	Child ; Humans ; Netherlands ; C-Reactive Protein/analysis ; Point-of-Care Testing ; Hospitals ; Systems Analysis
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2024-03-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10698-6
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Article ; Online: Global public and philanthropic investment in childhood cancer research: systematic analysis of research funding, 2008-16.

Loucaides, Eva M / Fitchett, Elizabeth J A / Sullivan, Richard / Atun, Rifat

The Lancet. Oncology

2020 Volume 20, Issue 12, Page(s) e672–e684

Abstract: Childhood cancers caused an estimated 75 000 deaths in children aged 0-14 years in 2018, of which 90% were in low-income and middle-income countries, and yet this group is missing from global health agendas. We examined global patterns in public and ... ...

Abstract	Childhood cancers caused an estimated 75 000 deaths in children aged 0-14 years in 2018, of which 90% were in low-income and middle-income countries, and yet this group is missing from global health agendas. We examined global patterns in public and philanthropic funding for childhood cancer research-a proxy for global research activity-to address the critical gaps in knowledge. We used data from the Dimensions database to systematically search for and analyse 3414 grants from 115 funders across 35 countries between 2008 and 2016, organised by funding source, recipient, tumour type, research focus, and pipeline categories, to investigate trends over time. During this period, global funding for childhood cancer research was US$2 billion, of which $772 million (37·9%) was for general childhood cancer, $449 million (22·0%) was for leukaemias, and $330 million (16·2%) was for CNS tumours. $1·6 billion (77·7%) of funding was awarded from, and to, institutions based in the USA. Preclinical research received $1·2 billion (59·3%), and around $525 million (25·7%) included support for clinical trials, but only $113 million (5·5%) supported health-care delivery research. Overall, funding was inadequate and geographically inequitable, and new commitments to funding have declined since 2011.
MeSH term(s)	Biomedical Research/economics ; Child ; Fund Raising/economics ; Global Health/economics ; Humans ; Investments/economics ; Neoplasms/epidemiology ; Neoplasms/prevention & control ; Research Support as Topic/economics
Language	English
Publishing date	2020-01-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2049730-1
ISSN	1474-5488 ; 1470-2045
ISSN (online)	1474-5488
ISSN	1470-2045
DOI	10.1016/S1470-2045(19)30662-X
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Article ; Online: Adoption of C-reactive protein point-of-care tests for the management of acute childhood infections in primary care in the Netherlands and England: a comparative health systems analysis.

Dewez, Juan Emmanuel / Nijman, Ruud G / Fitchett, Elizabeth J A / Lynch, Rebecca / de Groot, Ronald / van der Flier, Michiel / Philipsen, Ria / Vreugdenhil, Harriet / Ettelt, Stefanie / Yeung, Shunmay

BMC health services research

2023 Volume 23, Issue 1, Page(s) 191

Abstract: Background: The use of point of care (POC) tests varies across Europe, but research into what drives this variability is lacking. Focusing on CRP POC tests, we aimed to understand what factors contribute to high versus low adoption of the tests, and ... ...

Abstract	Background: The use of point of care (POC) tests varies across Europe, but research into what drives this variability is lacking. Focusing on CRP POC tests, we aimed to understand what factors contribute to high versus low adoption of the tests, and also to explore whether they are used in children. Methods: We used a comparative qualitative case study approach to explore the implementation of CRP POC tests in the Netherlands and England. These countries were selected because although they have similar primary healthcare systems, the availability of CRP POC tests in General Practices is very different, being very high in the former and rare in the latter. The study design and analysis were informed by the non-adoption, abandonment, spread, scale-up and sustainability (NASSS) framework. Data were collected through a review of documents and interviews with stakeholders. Documents were identified through a scoping literature review, search of websites, and stakeholder recommendation. Stakeholders were selected purposively initially, and then by snowballing. Data were analysed thematically. Results: Sixty-five documents were reviewed and 21 interviews were conducted. The difference in the availability of CRP POC tests is mainly because of differences at the wider national context level. In the two countries, early adopters of the tests advocated for their implementation through the generation of robust evidence and by engaging with all relevant stakeholders. This led to the inclusion of CRP POC tests in clinical guidelines in both countries. In the Netherlands, this mandated their reimbursement in accordance with Dutch regulations. Moreover, the prevailing better integration of health services enabled operational support from laboratories to GP practices. In England, the funding constraints of the National Health Service and the prioritization of alternative and less expensive antimicrobial stewardship interventions prevented the development of a reimbursement scheme. In addition, the lack of integration between health services limits the operational support to GP practices. In both countries, the availability of CRP POC tests for the management of children is a by-product of the test being available for adults. The tests are less used in children mainly because of concerns regarding their accuracy in this age-group. Conclusions: The engagement of early adopters combined with a more favourable and receptive macro level environment, including the role of clinical guidelines and their developers in determining which interventions are reimbursed and the operational support from laboratories to GP practices, led to the greater adoption of the tests in the Netherlands. In both countries, CRP POC tests, when available, are less used less in children. Organisations considering introducing POC tests into primary care settings need to consider how their implementation fits into the wider health system context to ensure achievable plans.
MeSH term(s)	Child ; Humans ; C-Reactive Protein/analysis ; England ; Infections ; Netherlands ; Point-of-Care Systems ; Point-of-Care Testing ; Primary Health Care ; State Medicine ; Systems Analysis
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-09065-8
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Article ; Online: Research funding for newborn health and stillbirths, 2011-20: a systematic analysis of levels and trends.

Agravat, Priyesh / Loucaides, Eva M / Kumar, Meghan Bruce / Howells, Anna / García, Alexandra Molina / Sebina, Ismail / Balanza, Núria / Fitchett, Elizabeth J A / Lawn, Joy E

The Lancet. Global health

2023 Volume 11, Issue 11, Page(s) e1794–e1804

Abstract: Background: Worldwide, an estimated 4·4 million newborn deaths and stillbirths occurred in 2020, and 98% of these deaths occurred in low-income and middle-income countries (LMICs). We aimed to analyse new research grants for newborns and stillbirth ... ...

Abstract	Background: Worldwide, an estimated 4·4 million newborn deaths and stillbirths occurred in 2020, and 98% of these deaths occurred in low-income and middle-income countries (LMICs). We aimed to analyse new research grants for newborns and stillbirth awarded by major funders in 2019-20, and all research funding allocated to LMIC-based institutions in 2011-20. Methods: For this systematic analysis, we searched Dimensions, the world's largest research funding database, for grants relevant to neonatal and stillbirth research. Included grants were categorised by in-depth content analysis, with descriptive quantitative analyses by funder and recipient countries, research pipeline, topic, and year. Findings: Globally, in 2019-20, major funders awarded a mean annual total of US$577·1 million per year for newborn and stillbirth research (mean total of 550 grants per year). $166·3 million (28·8%) of $577·1 million was directed to small and vulnerable newborn research, but only $8·4 million (1·5%) was directed to stillbirth research. The majority of funding, $537·0 million (93·0%), was allocated to organisations based in high-income countries. Between 2011 and 2020, LMIC-based recipients were named on 1985 grants from all funders worth $486·7 million, of which $73·1 million (15·0%) was allocated to small and vulnerable newborn research and $12·0 million (2·5%) was allocated to stillbirth research. Most LMIC funding supported preclinical or observational studies ($236·8 million [48·7%] of $486·7 million), with implementation research receiving only $13·9 million (2·9%). Interpretation: Although investment in research related to neonatal health and stillbirths has increased between 2011 and 2020, there are marked disparities in distribution geographically, between major causes of mortality, and among research pipeline types. Stillbirth research received minimal funding in both high-income countries and LMICs, despite a similar number of deaths compared with neonates. Direct investment in LMIC-led research, especially for implementation research, could accelerate the slow global progress on stillbirth prevention and newborn survival. Funding: None. Translations: For the French, German and Spanish translations of the abstract see Supplementary Materials section.
MeSH term(s)	Pregnancy ; Female ; Infant, Newborn ; Humans ; Stillbirth/epidemiology ; Infant Health ; Perinatal Death ; Financing, Organized ; Income
Language	English
Publishing date	2023-10-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(23)00379-0
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Article: The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service Evaluation.

Fitchett, Elizabeth J A / Rubens, Matthew / Styles, Katherine / Bycroft, Thomas / Nadel, Simon / Gómez, Carlos M H / Mitting, Rebecca

Journal of pediatric intensive care

2021 Volume 11, Issue 4, Page(s) 335–340

Abstract: One strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric ... ...

Abstract	One strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12-1.85;
Language	English
Publishing date	2021-04-01
Publishing country	Germany
Document type	Journal Article
ISSN	2146-4618
ISSN	2146-4618
DOI	10.1055/s-0041-1726454
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Article ; Online: Measles and Rubella Incidence and Molecular Epidemiology in Senegal: Temporal and Regional Trends during Twelve Years of National Surveillance, 2010-2021.

Jallow, Mamadou Malado / Sadio, Bacary Djilocalisse / Mendy, Marie Pedapa / Sy, Sara / Fall, Amary / Kiori, Davy / Ndiaye, Ndiendé Koba / Diaw, Yague / Goudiaby, Déborah / Diop, Boly / Niang, Mbayame Ndiaye / Fitchett, Elizabeth J A / Dia, Ndongo

Viruses

2022 Volume 14, Issue 10

Abstract: We investigated the epidemiology of measles and rubella infections in Senegal based on data from twelve consecutive years of laboratory-based surveillance (2010−2021) and conducted phylogenetic analyses of circulating measles viruses. Sera from measles- ... ...

Abstract	We investigated the epidemiology of measles and rubella infections in Senegal based on data from twelve consecutive years of laboratory-based surveillance (2010−2021) and conducted phylogenetic analyses of circulating measles viruses. Sera from measles-suspected cases were collected and tested for measles and rubella-specific IgM antibodies using enzyme-linked immunosorbent assays (ELISA). Throat swabs were collected from patients with clinically diagnosed measles for confirmation by reverse-transcription polymerase chain reaction (RT-PCR) and viral genotyping. Among 8082 laboratory-tested specimens from measles-suspected cases, serological evidence of measles and rubella infection was confirmed in 1303/8082 (16.1%) and 465/6714 (6.9%), respectively. The incidence of rubella is now low—0.8 (95% CI 0.4−1.3) cases per million people in 2021—whereas progress towards measles pre-elimination targets (<1.0 case per million people per year) appears to have stalled; there were 10.8 (95% CI 9.3−12.5) cases per million people in 2021. Phylogenetic analyses revealed that all Senegalese measles strains belonged to genotype B3. The rubella virus sequence obtained in this study was consistent with genotype 1C. Our national surveillance data suggest that despite their low incidence both measles and rubella remain endemic in Senegal with a concerning stagnation in the decline of measles infections that represents a significant challenge to the goal of regional elimination.
MeSH term(s)	Humans ; Molecular Epidemiology ; Phylogeny ; Incidence ; Senegal/epidemiology ; Rubella/epidemiology ; Measles/epidemiology ; Rubella virus/genetics ; Measles virus/genetics ; Antibodies, Viral ; Genotype ; Immunoglobulin M
Chemical Substances	Antibodies, Viral ; Immunoglobulin M
Language	English
Publishing date	2022-10-17
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v14102273
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Article ; Online: Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review.

Molina García, Alexandra / Cross, James H / Fitchett, Elizabeth J A / Kawaza, Kondwani / Okomo, Uduak / Spotswood, Naomi E / Chiume, Msandeni / Ezeaka, Veronica Chinyere / Irimu, Grace / Salim, Nahya / Molyneux, Elizabeth M / Lawn, Joy E

EClinicalMedicine

2022 Volume 44, Page(s) 101259

Abstract: Background: Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles ... ...

Abstract	Background: Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements). Methods: Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively. Findings: 3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Interpretation: The 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of Funding: This work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the "la Caixa" Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government).
Language	English
Publishing date	2022-01-10
Publishing country	England
Document type	Journal Article ; Review
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2021.101259
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Article ; Online: Serious bacterial infections in neonates: improving reporting and case definitions.

Vergnano, Stefania / Seale, Anna C / Fitchett, Elizabeth J A / Sharland, Mike / Heath, Paul T

International health

2017 Volume 9, Issue 3, Page(s) 148–155

Abstract: Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for ...

Abstract	Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for reporting serious neonatal bacterial infections have recently been published as the STROBE-NI checklist and, in the context of maternal vaccination, definitions have been published by the Brighton Collaboration Global Alignment of Immunization safety Assessment in pregnancy (GAIA) project. Standardisation of reporting criteria is essential to allow data comparability. This an important step in providing a clearer picture of the burden of serious bacterial infections in neonates and a welcome progress for guiding new investments in interventions.
Language	English
Publishing date	2017-05-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2526175-7
ISSN	1876-3405 ; 1876-3413
ISSN (online)	1876-3405
ISSN	1876-3413
DOI	10.1093/inthealth/ihx011
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