Evelina Childrens Hospital London

City of Westminster, United Kingdom

Evelina Childrens Hospital London

City of Westminster, United Kingdom
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Kneen R.,Alder Hey Childrens NHS Foundation Trust | Kneen R.,University of Liverpool | Michael B.D.,University of Liverpool | Michael B.D.,The Walton Center Neurology Foundation Trust | And 10 more authors.
Journal of Infection | Year: 2012

In the 1980s the outcome of patients with herpes simplex encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 h after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to-day clinical practice appears to be limited. The emergency management of meningitis in children and adults was revolutionised by the introduction of a simple algorithm as part of management guidelines.In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a similar simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis. © 2012.


Smith B.G.,Evelina Childrens Hospital | Tibby S.M.,Evelina Childrens Hospital London | Qureshi S.A.,Evelina Childrens Hospital | Rosenthal E.,Evelina Childrens Hospital | Krasemann T.,Evelina Childrens Hospital
Catheterization and Cardiovascular Interventions | Year: 2012

Purpose To quantify the impact of relocation to a purpose built pediatric cardiac catheterization laboratory, on patient radiation dose and fluoroscopy time. To provide guide values for radiation exposure during common structural interventions. Material and methods Design: A retrospective review of common structural cardiac interventions performed over 10-years. The era comprised two 5-year periods before and after relocation using different catheter laboratories. Multivariable analysis adjusted for the following variables: era (pre- and post-move), year, operator seniority, patient age, procedure type. Setting: A quaternary referral congenital cardiac centre. Patients: All patients <18 yrs (n = 756) in whom one of 6 common structural interventions were undertaken between 2000 and 2009. Main outcome measures: Radiation dose and fluoroscopy time. Results The move to the new laboratory (latter era) was associated with a dramatic reduction in multivariable-adjusted radiation dose, ranging from 64% (aortic coarctation stenting) to 87% (patent arterial duct closure). There was also a year upon year increase in radiation dose of 5.2% [95% confidence interval (CI): 0.6-10.0%], which persisted after the relocation. However, this was associated with a 5.1% yearly decrease in fluoroscopy time (95% CI: -7.9 to -2.2%). Conclusion Use of state-of-the-art catheter equipment is associated with a dramatic reduction in radiation exposure. However, the surprising finding of year upon year increase in exposure (despite the new equipment) combined with decreased fluoroscopy time suggests a temporal decrease in hardware efficiency. This has major implications for hardware replacement. © 2012 Wiley Periodicals, Inc.


Gabriel J.,University Hospital Muenster | Scheld H.-H.,University Hospital Muenster | Tjan T.D.T.,University Hospital Muenster | Osada N.,University of Munster | Krasemann T.,Evelina Childrens Hospital London
Cardiology in the Young | Year: 2011

A ventricular septal defect in transposition of the great arteries is frequently closely related to the cardiac valves. The valvar function after arterial switch operation of patients with transposition of the great arteries and ventricular septal defect or intact ventricular septum was compared. We analysed the function of all cardiac valves in patients who underwent the arterial switch operations pre- and post-operatively, 1 year after the procedure and on follow-up. The study included 92 patients - 64 with transposition of the great arteries/intact ventricular septum and 28 with transposition of the great arteries/ventricular septal defect. The median age at surgery was 5.5 days in transposition of the great arteries/intact ventricular septum (0-73 days) and 7.0 days in transposition of the great arteries/ventricular septal defect (4-41 days). Follow-up was 51.7 months in transposition of the great arteries/intact ventricular septum (3.3-177.3 months) and 55 months in transposition of the great arteries/ventricular septal defect (14.6-164.7 months). Neo-aortic, neo-pulmonary, and mitral valvar function did not differ. Tricuspid regurgitation was more frequent 1 year post-operatively in transposition of the great arteries/ventricular septal defect (n = 4) than in transposition of the great arteries/intact ventricular septum. The prevalence of neo-aortic regurgitation and pulmonary stenosis increased over time, especially in patients with transposition of the great arteries/intact ventricular septum. The presence of a ventricular septal defect in patients undergoing arterial switch operation for transposition of the great arteries only has a minor bearing for the development of valvar dysfunction on the longer follow-up. © 2011 Cambridge University Press.


Smith B.G.,Evelina Childrens Hospital London | Tibby S.M.,Evelina Childrens Hospital London | Qureshi S.A.,Evelina Childrens Hospital London | Rosenthal E.,Evelina Childrens Hospital London | Krasemann T.,Evelina Childrens Hospital London
Catheterization and Cardiovascular Interventions | Year: 2012

Purpose: To quantify the impact of relocation to a purpose built pediatric cardiac catheterization laboratory, on patient radiation dose and fluoroscopy time. To provide guide values for radiation exposure during common structural interventions. Material and methods: Design: A retrospective review of common structural cardiac interventions performed over 10-years. The era comprised two 5-year periods before and after relocation using different catheter laboratories. Multivariable analysis adjusted for the following variables: era (pre- and post-move), year, operator seniority, patient age, procedure type. Setting: A quaternary referral congenital cardiac centre. Patients: All patients <18 yrs (n = 756) in whom one of 6 common structural interventions were undertaken between 2000 and 2009. Main outcome measures: Radiation dose and fluoroscopy time. Results: The move to the new laboratory (latter era) was associated with a dramatic reduction in multivariable-adjusted radiation dose, ranging from 64% (aortic coarctation stenting) to 87% (patent arterial duct closure). There was also a year upon year increase in radiation dose of 5.2% [95% confidence interval (CI): 0.6-10.0%], which persisted after the relocation. However, this was associated with a 5.1% yearly decrease in fluoroscopy time (95% CI: -7.9 to -2.2%). Conclusion: Use of state-of-the-art catheter equipment is associated with a dramatic reduction in radiation exposure. However, the surprising finding of year upon year increase in exposure (despite the new equipment) combined with decreased fluoroscopy time suggests a temporal decrease in hardware efficiency. This has major implications for hardware replacement. © 2012 Wiley Periodicals, Inc.


PubMed | Evelina Childrens Hospital London
Type: Journal Article | Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions | Year: 2012

To quantify the impact of relocation to a purpose built pediatric cardiac catheterization laboratory, on patient radiation dose and fluoroscopy time. To provide guide values for radiation exposure during common structural interventions.A retrospective review of common structural cardiac interventions performed over 10-years. The era comprised two 5-year periods before and after relocation using different catheter laboratories. Multivariable analysis adjusted for the following variables: era (pre- and post-move), year, operator seniority, patient age, procedure type.A quaternary referral congenital cardiac centre.All patients <18 yrs (n = 756) in whom one of 6 common structural interventions were undertaken between 2000 and 2009.Radiation dose and fluoroscopy time.The move to the new laboratory (latter era) was associated with a dramatic reduction in multivariable-adjusted radiation dose, ranging from 64% (aortic coarctation stenting) to 87% (patent arterial duct closure). There was also a year upon year increase in radiation dose of 5.2% [95% confidence interval (CI): 0.6-10.0%], which persisted after the relocation. However, this was associated with a 5.1% yearly decrease in fluoroscopy time (95% CI: -7.9 to -2.2%).Use of state-of-the-art catheter equipment is associated with a dramatic reduction in radiation exposure. However, the surprising finding of year upon year increase in exposure (despite the new equipment) combined with decreased fluoroscopy time suggests a temporal decrease in hardware efficiency. This has major implications for hardware replacement.

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