Lady Cilento Childrens Hospital
Lady Cilento Childrens Hospital
Lyon C.,Lady Cilento Childrens Hospital
Architectural Design | Year: 2017
How can healthcare designers reliably cater for both functional needs and patient wellbeing? An evidence-based approach is the answer. Corbett Lyon, a founding director of Melbourne-based practice Lyons, explains how over the last two decades his firm has engaged with all levels of stakeholders – from managers, clinicians and administrators to patients and communities – to produce buildings that are at their service. After spending most of the twentieth century on the sidelines of this area of design, such research is allowing architects to reclaim a central role in a fiueld that affects us all, from hospital facilities to care homes. © 2017 John Wiley & Sons Ltd.
Morawska A.,University of Queensland |
Mitchell A.,University of Queensland |
Burgess S.,Lady Cilento Childrens Hospital |
Fraser J.,University of Sydney
Journal of Consulting and Clinical Psychology | Year: 2017
Objective: Parents play an important role in children's illness management, in promoting child adjustment and reducing behavior problems. Little research has focused on the evaluation of parenting interventions in the context of childhood chronic illness. The aim of this study was to test the efficacy of a brief, group parenting intervention (Healthy Living Triple P) in improving parenting skills and parent adjustment, and reducing child behavioral and emotional difficulties in the context of childhood asthma and eczema. Method: One hundred seven parents of children with a diagnosis of asthma and/or eczema were randomly assigned to intervention (n = 52) or care as usual (CAU; n = 55). Parents completed self-report measures of their child's behavioral and emotional adjustment, their own parenting, and their own level of adjustment at pre- and postintervention and at 6-month follow-up. Parent-child interactions were observed and coded at each time point. The intervention consisted of 2 group sessions of 2 hr each delivered by trained, accredited practitioners. Results: Attrition was low, with T2 and T3 assessment completed by 84.6% and 80.8% of intervention families and 92.7% and 81.8% of CAU families, respectively. Intention-to-treat analyses indicated that overall parent-reported ineffective parenting as well as parental overreactivity reduced as a result of intervention. Parent report of child behavior problems also decreased, but there were no changes in children's emotional adjustment. No changes in observed parent or child behavior were found. Stress reduced for parents in the intervention group compared to the CAU group, but there were no changes in parental anxiety or depression. Effects showed evidence of reliable and clinical change and were maintained at 6-month follow-up. Conclusions: The intervention shows promise as an addition to clinical services for children with asthma and eczema and may have broader application to other chronic health conditions. © 2017 American Psychological Association.
Chang A.B.,University of Queensland |
Oppenheimer J.J.,New Jersey Medical School and Pulmonary and Allergy Associates |
Weinberger M.M.,University of Iowa |
Rubin B.K.,Virginia Commonwealth University |
And 3 more authors.
Chest | Year: 2017
Background Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. Methods We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients’ values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. Results Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. Conclusions Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks’ duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed). © 2017 American College of Chest Physicians
Pearn J.,Lady Cilento Childrens Hospital
The Medico-legal journal | Year: 2016
The history of our current law dates from Palaeolithic times. The first written laws were codified by the rulers of Mesopotamian kingdoms, from the beginning of the second millennium B.C.E. This history, and those of the medico-legal specialties in particular, trace their origins to Hammurabi's Code. Hammurabi (ruled 1792-1750 B.C.E.) was the sixth King of the First Dynasty of ancient Babylon, today an archaeological site in modern-day Iraq. Hammurabi's Laws (c.1760 B.C.E.), inscribed on at least one diorite stele, were set up in public places in Babylon, towards the end of the King's 43-year reign. Comprising almost 300 specific laws, with judicial punishment for transgressions, Hammurabi's Code reflects his role both as a guardian of the vulnerable and as a protector of the weak and powerless. Just as medical papyri from ancient Egypt (e.g. the Edwin Smith papyrus c.1600 B.C.E.) are regarded as the origins of western medicine, so Hammurabi is the pioneer of "medical" laws as these have evolved to their sophisticated state today. © The Author(s) 2016.
Francis A.,Lady Cilento Childrens Hospital |
Francis A.,University of Queensland |
Trnka P.,Lady Cilento Childrens Hospital |
Trnka P.,University of Queensland |
And 2 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2016
Background and objectives FSGS can recur after kidney transplantation and is associated with poor graft outcomes. We aimed to assess the incidence of FSGS recurrence post-transplant and determine the effect of graft source on recurrence and graft survival in patients with biopsy-proven FSGS. Design, setting, participants, & measurements Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed incidence of FSGS, the influence of donor type on the risk of FSGS recurrence, and graft loss in recipients with ESRD caused by primary FSGS using Kaplan–Meier and logistic regression analyses. Results Between 1992 and 2011, 736 first kidney transplants were performed in 666 adults and 70 children (≤20 years old) with biopsy–proven primary FSGS. FSGS recurred in 76 (10.3%) patients. Younger age (P<0.001), nonwhite ethnicity (P=0.02), and having a live donor (P=0.02) were independent risk factors associated with recurrence. Median graft survival was significantly better for live donor compared with deceased donor grafts (14.8 versus 12.1 years; P<0.01). Disease recurrence predicted poor graft outcomes, with 52% (95% confidence interval, 40% to 63%) 5-year graft survival in the recurrence group compared with 83% (95% confidence interval, 79% to 86%) in the group without recurrent disease (P<0.001). Conclusions FSGS recurrence after kidney transplantation was more common in live donor kidneys. Despite this, graft survival in live donor recipients was significantly better for both children and adults with FSGS. We propose that live donor transplantation should not be avoided in patients with FSGS. © 2016 by the American Society of Nephrology.
Robertson J.D.,Lady Cilento Childrens Hospital
Journal of Thrombosis and Haemostasis | Year: 2015
Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens. © 2015 International Society on Thrombosis and Haemostasis.
Wright N.,Sheffield Childrens Hospital |
Wales J.,Lady Cilento Childrens Hospital
Archives of Disease in Childhood | Year: 2016
Approximately 3% of children and adolescents in the UK have severe obesity. The incidence of cardiovascular risk factors such as hypertension, hyperinsulinism and hyperlipidaemia approaches 20% in such individuals. Lifestyle intervention programmes and pharmacotherapy are effective in some individuals, but the relapse rate is high. In exceptional cases, bariatric surgery is effective. This review outlines the scale of the problem, highlights those at risk and discusses referral, current services, appropriate screening and therapeutic interventions. © 2016 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Heussler H.S.,University of Queensland |
Heussler H.S.,Lady Cilento Childrens Hospital
Current Opinion in Psychiatry | Year: 2016
Purpose of review Sleep disorders in individuals with developmental difficulties continue to be a significant challenge for families, carers, and therapists with a major impact on individuals and carers alike. This review is designed to update the reader on recent developments in this area. Recent findings A systematic search identified a variety of studies illustrating advances in the regulation of circadian rhythm and sleep disturbance in neurodevelopmental disorders. Specific advances are likely to lead in some disorders to targeted therapies. There is strong evidence that behavioural and sleep hygiene measures should be first line therapy; however, studies are still limited in this area. Nonpharmacological measures such as exercise, sensory interventions, and behavioural are reported. Behavioural regulation and sleep hygiene demonstrate the best evidence for improved sleep parameters in individuals with neurodisability. Summary Although the mainstay of management of children with sleep problems and neurodevelopmental disability is similar to that of typically developing children, there is emerging evidence of behavioural strategies being successful in large-scale trials and the promise of more targeted therapies for more specific resistant disorders. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Skellern C.Y.,Lady Cilento Childrens Hospital
Journal of Paediatrics and Child Health | Year: 2015
It has been 50 years since Kempe et al. published 'The Battered Child Syndrome', describing harm from inflicted injury mechanisms derived from parents and care givers. Since then, there has emerged a rapidly expanding literature on paediatric forensic medicine and child protection, which has offered new insights into injury mechanisms, informed us of the sequelae of abuse and neglect, aided diagnosis and guided clinical practice in the treatment and management of children who become involved in the child protection system. Through the scrutiny of government inquiries and at times uncomfortable media exposure, there have been improvements in child protection and forensic practices resulting in recognition of need for specialised forensic training, improved funding, development of resources and development of professional standards that support accountable, objective, safe and robust practice. From the perspective of an Australian child protection paediatrician, this paper chronicles some of the most significant and at times controversial research in the last 50 years in child protection that have played a key role in shaping our current understanding of child abuse and neglect. © 2014 The Author. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Skellern C.,Lady Cilento Childrens Hospital |
Skellern C.,University of Queensland
Journal of Forensic and Legal Medicine | Year: 2015
In the rules of evidence in all legal jurisdictions, medical experts are required to maintain objectivity when providing opinions. When interpreting medical evidence, doctors must recognise, acknowledge and manage uncertainties to ensure their evidence is reliable to legal decision-makers. Even in the forensic sciences such as DNA analysis, implicit bias has been shown to influence how results are interpreted from cognitive and contextual biases unconsciously operating. In cases involving allegations of child abuse there has been significant exposure in the media, popular magazines, legal journals and in the published medical literature debating the reliability of medical evidence given in these proceedings. In these cases judges have historically been critical of experts they perceived had sacrificed objectivity for advocacy by having an investment in a 'side'. This paper firstly discusses the issue of bias then describes types of cognitive biases identified from psychological research applied to forensic evidence including adversarial bias, context bias, confirmation bias and explains how terminology can influence the communication of opinion. It follows with previously published guidelines of how to reduce the risk of bias compromising objectivity in forensic practices then concludes with my own recommendations of practices that can be used by child protection paediatricians and within an organisation when conducting forensic evaluations of suspicious childhood injury to improve objectivity in formulation of opinion evidence. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.