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  1. Article ; Online: Point-of-care diagnostic technology in paediatric ambulatory care: a qualitative interview study of English clinicians and stakeholders.

    Raymond, Meriel Elizabeth / Bird, Chris / van Hecke, Oliver / Glogowska, Margaret / Hayward, Gail

    BMJ open

    2022  Volume 12, Issue 6, Page(s) e059103

    Abstract: Point-of-care (POC) tests have the potential to improve paediatric healthcare. However, both the development and evaluation of POC technology have almost solely been focused on adults. We aimed to explore frontline clinicians' and stakeholders' current ... ...

    Abstract Point-of-care (POC) tests have the potential to improve paediatric healthcare. However, both the development and evaluation of POC technology have almost solely been focused on adults. We aimed to explore frontline clinicians' and stakeholders' current experience of POC diagnostic technology in children in England; and to identify areas of unmet need.
    Design, setting and participants: Qualitative semistructured telephone interviews were carried out with purposively sampled participants from clinical paediatric ambulatory care and charity, industry and policymaking stakeholders. The interviews were audio-recorded, transcribed and analysed thematically.
    Results: We interviewed 19 clinicians and 8 stakeholders. The main perceived benefits of POC tests and technologies were that they aided early decision-making and could be convenient and empowering when used independently by patients and families. Clinicians and stakeholders wanted more POC tests to be available for use in clinical practice. Most recognised that play and reward are important components of successful POC tests for children. Clinicians wanted tests to give them answers, which would result in a change in their clinical management. Detecting acute serious illness, notably distinguishing viral and bacterial infection, was perceived to be an area where tests could add value. POC tests were thought to be particularly useful for children presenting atypically, where diagnosis was more challenging, such as those less able to communicate, and for rare serious diseases. Many participants felt they could be useful in managing chronic disease.
    Conclusions: This exploratory study found that clinicians and stakeholders supported the use of diagnostic POC technology in paediatric ambulatory care settings in England. Some existing tests are not fit for purpose and could be refined. Industry should be encouraged to develop new child-friendly tests tackling areas of unmet need, guided by the preferred characteristics of those working on the ground.
    MeSH term(s) Ambulatory Care ; Child ; Humans ; Point-of-Care Systems ; Point-of-Care Testing ; Qualitative Research ; Technology
    Language English
    Publishing date 2022-06-07
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-059103
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  2. Article ; Online: Primary care preparedness for the SARS-CoV-2 pandemic: a survey of NHS GPs.

    Pilbeam, Caitlin / Edwards, George / Tonkin-Crine, Sarah / Raymond, Meriel / Van Hecke, Oliver / Gobat, Nina

    Family practice

    2021  Volume 39, Issue 3, Page(s) 332–339

    Abstract: Background: Primary care manages a significant proportion of healthcare in the United Kingdom and should be a key part of the SARS-CoV-2 pandemic response.: Aim: To assess preparedness for the SARS-CoV-2 pandemic by understanding GPs' perception of ... ...

    Abstract Background: Primary care manages a significant proportion of healthcare in the United Kingdom and should be a key part of the SARS-CoV-2 pandemic response.
    Aim: To assess preparedness for the SARS-CoV-2 pandemic by understanding GPs' perception of their ability to manage current and future service demand, set-up of triage processes, and training in Covid-19 infection prevention and control procedures.
    Design and setting: Cross-sectional survey of practicing GPs in the United Kingdom, with 2 rounds of data collection early in the pandemic.
    Methods: Online survey, scripted and hosted by medeConnect Healthcare, comprising 6 closed prompts on 7-point Likert scales, and an optional free-text component. Quantitative data were analysed using descriptive statistics. Free-text data were analysed thematically.
    Results: One thousand two GPs completed each round; 51 GPs completed free-text responses in March, and 64 in April. Quantitative data showed greatest confidence in triage of Covid-19 patients, and GPs were more confident managing current than future Covid-19 demand. GPs' responses were more optimistic and aligned in April than March. Free-text data highlighted that GPs were concerned about lack of appropriate personal protective equipment and personal risk of Covid-19 infection in March, and unmet needs of non-Covid-19 patients in April. In both rounds, GPs expressed feeling overlooked by government and public health bodies.
    Conclusion: Guidance to support general practice clinicians to manage future waves of Covid-19 or other health emergencies must be tailored to general practice from the outset, to support clinicians to manage competing health demands, and mitigate impacts on primary care providers' wellbeing.
    MeSH term(s) COVID-19/epidemiology ; Cross-Sectional Studies ; Humans ; Pandemics/prevention & control ; Primary Health Care ; SARS-CoV-2 ; State Medicine
    Language English
    Publishing date 2021-12-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605939-9
    ISSN 1460-2229 ; 0263-2136
    ISSN (online) 1460-2229
    ISSN 0263-2136
    DOI 10.1093/fampra/cmab145
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  3. Article ; Online: Typhoidal Salmonella human challenge studies: ethical and practical challenges and considerations for low-resource settings.

    Raymond, Meriel / Gibani, Malick M / Day, Nicholas P J / Cheah, Phaik Yeong

    Trials

    2019  Volume 20, Issue Suppl 2, Page(s) 704

    Abstract: Typhoidal Salmonella is a major global problem affecting more than 12 million people annually. Controlled human infection models (CHIMs) in high-resource settings have had an important role in accelerating the development of conjugate vaccines against ... ...

    Abstract Typhoidal Salmonella is a major global problem affecting more than 12 million people annually. Controlled human infection models (CHIMs) in high-resource settings have had an important role in accelerating the development of conjugate vaccines against Salmonella Typhi.The typhoidal Salmonella model has an established safety profile in over 2000 volunteers in high-income settings, and trial protocols, with modification, could be readily transferred to new study sites. To date, a typhoidal Salmonella CHIM has not been conducted in a low-resource setting, although it is being considered.Our article describes the challenges posed by a typhoidal Salmonella CHIM in the high-resource setting of Oxford and explores considerations for an endemic setting.Development of CHIMs in endemic settings is scientifically justifiable as it remains unclear whether findings from challenge studies performed in high-resource non-endemic settings can be extrapolated to endemic settings, where the burden of invasive Salmonella is highest. Volunteers are likely to differ across a range of important variables such as previous Salmonella exposure, diet, intestinal microbiota, and genetic profile. CHIMs in endemic settings arguably are ethically justifiable as affected communities are more likely to gain benefit from the study. Local training and research capacity may be bolstered.Safety was of primary importance in the Oxford model. Risk of harm to the individual was mitigated by careful inclusion and exclusion criteria; close monitoring with online diary and daily visits; 24/7 on-call staffing; and access to appropriate hospital facilities with capacity for in-patient admission. Risk of harm to the community was mitigated by exclusion of participants with contact with vulnerable persons; stringent hygiene and sanitation precautions; and demonstration of clearance of Salmonella infection from stool following antibiotic treatment.Safety measures should be more stringent in settings where health systems, transport networks, and sanitation are less robust.We compare the following issues between high- and low-resource settings: scientific justification, risk of harm to the individual and community, benefits to the individual and community, participant understanding, compensation, and regulatory requirements.We conclude that, with careful consideration of country-specific ethical and practical issues, a typhoidal Salmonella CHIM in an endemic setting is possible.
    MeSH term(s) Developed Countries/economics ; Developing Countries/economics ; Health Resources ; Healthy Volunteers ; Humans ; Research Design/legislation & jurisprudence ; Salmonella typhi/immunology ; Salmonella typhi/pathogenicity ; Therapeutic Human Experimentation/economics ; Therapeutic Human Experimentation/ethics ; Therapeutic Human Experimentation/legislation & jurisprudence ; Typhoid Fever/economics ; Typhoid Fever/microbiology ; Typhoid Fever/therapy ; Typhoid-Paratyphoid Vaccines/administration & dosage ; Typhoid-Paratyphoid Vaccines/adverse effects ; Typhoid-Paratyphoid Vaccines/economics
    Chemical Substances Typhoid-Paratyphoid Vaccines
    Language English
    Publishing date 2019-12-19
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1468-6708
    ISSN (online) 1745-6215 ; 1468-6694
    ISSN 1468-6708
    DOI 10.1186/s13063-019-3844-z
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  4. Article ; Online: Bullous Henoch Schonlein purpura.

    Raymond, Meriel / Spinks, Joanne

    Archives of disease in childhood

    2012  Volume 97, Issue 7, Page(s) 617

    MeSH term(s) Blister/diagnosis ; Blister/drug therapy ; Child ; Female ; Glucocorticoids/therapeutic use ; Humans ; Leg Dermatoses/diagnosis ; Leg Dermatoses/drug therapy ; Prednisolone/therapeutic use ; Purpura, Schoenlein-Henoch/diagnosis ; Purpura, Schoenlein-Henoch/drug therapy
    Chemical Substances Glucocorticoids ; Prednisolone (9PHQ9Y1OLM)
    Language English
    Publishing date 2012-07
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/archdischild-2011-300854
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  5. Article ; Online: Adenovirus vectors activate Vδ2

    Provine, Nicholas M / Amini, Ali / Garner, Lucy C / FitzPatrick, Michael E B / Dold, Christina / Silva Reyes, Laura / Chinnakannan, Senthil / Oguti, Blanche / Raymond, Meriel / Troise, Fulvia / Capone, Stefania / Folgori, Antonella / Barnes, Eleanor / Rollier, Christine S / Pollard, Andrew J / Klenerman, Paul

    European journal of immunology

    2022  Volume 52, Issue 5, Page(s) 835–837

    Abstract: ... ...

    Abstract Vδ2
    MeSH term(s) Adenoviridae/genetics ; Cytokines ; Interferon Type I ; Interleukin-18 ; Receptors, Antigen, T-Cell, gamma-delta/genetics ; T-Lymphocyte Subsets
    Chemical Substances Cytokines ; Interferon Type I ; Interleukin-18 ; Receptors, Antigen, T-Cell, gamma-delta
    Language English
    Publishing date 2022-01-17
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 120108-6
    ISSN 1521-4141 ; 0014-2980
    ISSN (online) 1521-4141
    ISSN 0014-2980
    DOI 10.1002/eji.202149367
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  6. Article ; Online: In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis.

    Van Hecke, Oliver / Raymond, Meriel / Lee, Joseph J / Turner, Philip / Goyder, Clare R / Verbakel, Jan Y / Van den Bruel, Ann / Hayward, Gail

    PloS one

    2020  Volume 15, Issue 7, Page(s) e0235605

    Abstract: Introduction: Paediatric consultations form a significant proportion of all consultations in ambulatory care. Point-of-care tests (POCTs) may offer a potential solution to improve clinical outcomes for children by reducing diagnostic uncertainty in ... ...

    Abstract Introduction: Paediatric consultations form a significant proportion of all consultations in ambulatory care. Point-of-care tests (POCTs) may offer a potential solution to improve clinical outcomes for children by reducing diagnostic uncertainty in acute illness, and streamlining management of chronic diseases. However, their clinical impact in paediatric ambulatory care is unknown. We aimed to describe the clinical impact of all in-vitro diagnostic POCTs on patient outcomes and healthcare processes in paediatric ambulatory care.
    Methods: We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception to 29 January 2020 without language restrictions. We included studies of children presenting to ambulatory care settings (general practice, hospital outpatient clinics, or emergency departments, walk-in centres, registered drug shops delivering healthcare) where in-vitro diagnostic POCTs were compared to usual care. We included all quantitative clinical outcome data across all conditions or infection syndromes reporting on the impact of POCTs on clinical care and healthcare processes. Where feasible, we calculated risk ratios (RR) with 95% confidence intervals (CI) by performing meta-analysis using random effects models.
    Results: We included 35 studies. Data relating to at least one outcome were available for 89,439 children of whom 45,283 had a POCT across six conditions or infection syndromes: malaria (n = 14); non-specific acute fever 'illness' (n = 7); sore throat (n = 5); acute respiratory tract infections (n = 5); HIV (n = 3); and diabetes (n = 1). Outcomes centred around decision-making such as prescription of medications or hospital referral. Pooled estimates showed that malarial-POCTs (Plasmodium falciparum) better targeted antimalarial treatment by reducing over-treatment by a third compared to usual care (RR 0.67; 95% CI [0.58 to 0.77], n = 36,949). HIV-POCTs improved initiating earlier antiretroviral therapy compared to usual care (RR, 3.11; 95% CI [1.55 to 6.25], n = 912). Across the other four conditions, there was limited evidence for the benefit of POCTs in paediatric ambulatory care except for acute respiratory tract infections (RTI) in low-and-middle-income countries (LMICs), where POCT C-Reactive Protein (CRP) may reduce immediate antibiotic prescribing by a third (risk difference, -0.29 [-0.47, -0.11], n = 2,747). This difference was shown in randomised controlled trials in LMICs which included guidance on interpretation of POCT-CRP, specific training or employed a diagnostic algorithm prior to POC testing.
    Conclusion: Overall, there is a paucity of evidence for the use of POCTs in paediatric ambulatory care. POCTs help to target prescribing for children with malaria and HIV. There is emerging evidence that POCT-CRP may better target antibiotic prescribing for children with acute RTIs in LMIC, but not in high-income countries. Research is urgently needed to understand where POCTs are likely to improve clinical outcomes in paediatric settings worldwide.
    MeSH term(s) Ambulatory Care/methods ; Humans ; Pediatrics/methods ; Point-of-Care Testing
    Keywords covid19
    Language English
    Publishing date 2020-07-06
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0235605
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  7. Article ; Online: MAIT cell activation augments adenovirus vector vaccine immunogenicity.

    Provine, Nicholas M / Amini, Ali / Garner, Lucy C / Spencer, Alexandra J / Dold, Christina / Hutchings, Claire / Silva Reyes, Laura / FitzPatrick, Michael E B / Chinnakannan, Senthil / Oguti, Blanche / Raymond, Meriel / Ulaszewska, Marta / Troise, Fulvia / Sharpe, Hannah / Morgan, Sophie B / Hinks, Timothy S C / Lambe, Teresa / Capone, Stefania / Folgori, Antonella /
    Barnes, Eleanor / Rollier, Christine S / Pollard, Andrew J / Klenerman, Paul

    Science (New York, N.Y.)

    2021  Volume 371, Issue 6528, Page(s) 521–526

    Abstract: Mucosal-associated invariant T (MAIT) cells are innate sensors of viruses and can augment early immune responses and contribute to protection. We hypothesized that MAIT cells may have inherent adjuvant activity in vaccine platforms that use replication- ... ...

    Abstract Mucosal-associated invariant T (MAIT) cells are innate sensors of viruses and can augment early immune responses and contribute to protection. We hypothesized that MAIT cells may have inherent adjuvant activity in vaccine platforms that use replication-incompetent adenovirus vectors. In mice and humans, ChAdOx1 (chimpanzee adenovirus Ox1) immunization robustly activated MAIT cells. Activation required plasmacytoid dendritic cell (pDC)-derived interferon (IFN)-α and monocyte-derived interleukin-18. IFN-α-induced, monocyte-derived tumor necrosis factor was also identified as a key secondary signal. All three cytokines were required in vitro and in vivo. Activation of MAIT cells positively correlated with vaccine-induced T cell responses in human volunteers and MAIT cell-deficient mice displayed impaired CD8
    MeSH term(s) Adenoviridae/immunology ; Animals ; CD8-Positive T-Lymphocytes/immunology ; Dendritic Cells/immunology ; Genetic Vectors/immunology ; Humans ; Immunogenicity, Vaccine ; Interferon-alpha/metabolism ; Interleukin-18/metabolism ; Lymphocyte Activation ; Mice ; Mice, Inbred C57BL ; Mucosal-Associated Invariant T Cells/immunology ; Tumor Necrosis Factor-alpha/metabolism ; Viral Vaccines/immunology
    Chemical Substances Interferon-alpha ; Interleukin-18 ; Tumor Necrosis Factor-alpha ; Viral Vaccines
    Language English
    Publishing date 2021-01-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 128410-1
    ISSN 1095-9203 ; 0036-8075
    ISSN (online) 1095-9203
    ISSN 0036-8075
    DOI 10.1126/science.aax8819
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