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Pockett R.D.,University of Swansea | Campbell D.,Sheffield Childrens Hospital NHS Foundation Trust | Carroll S.,Sanofi S.A. | Rajoriya F.,Sanofi S.A. | Adlard N.,Sanofi S.A.
Journal of Medical Economics | Year: 2013

Objective: To quantify the differences in hospital length of stay (LOS) and cost between healthy and vulnerable children with cystic fibrosis (CF), insulin-dependent diabetes mellitus (IDDM), cancer, and epilepsy who contract rotavirus (RVGE) or respiratory syncytial virus (RSV). Methods: Hospital Episode Statistics (HES) data were collected for England, for children <5 years old, admitted between April 2001 and March 2008, using ICD-10 codes for RVGE and RSV. Cases were identified as having RVGE and/or RSV plus CF, IDDM, cancer, or epilepsy. Healthy controls had RVGE and/or RSV only, additional controls had eczema only. Cost, hospital LOS, and demographics were collected. Results: Four hundred and eighty-six (0.5%) cases and 101,784 (99.5%) healthy controls were admitted with RVGE or RSV, with 17,420 eczema controls. RVGE was present in 153 (31.5%) cases and 7532 (7.4%) healthy controls, and RSV in 333 (68.5%) cases and 94,252 (92.6%) healthy controls. Cases were older (1.1 years, SD=1.3 years), had greater LOS (9.9 days, SD=19.9), and cost more (£3477, SD=£7765) than healthy controls (age=0.2, SD=0.5, p<0.001; LOS=1.9 days, SD=3.1, p<0.001; cost=£595, SD=£727, p<0.001). Cost for cases was 6-times greater than healthy controls (p<0.001). Controls had a 0.3 day greater LOS (p<0.001) with RSV, but a £17 (p=0.085) lower mean cost than RVGE. Conclusion: RVGE and RSV are more serious diseases in vulnerable children, requiring more intense resource use. The importance of preventing infection in vulnerable children is underlined by hygiene and appropriate isolation and vaccination strategies. When universal vaccination is under consideration, as for rotavirus vaccines, evaluation of a vaccination programme should consider the potentially positive impact on vulnerable children. Limitations: Limitations of the study include a dependency on accurate coding, an expectation that patients are identified through laboratory testing, and the possibility of unidentified underlying conditions affecting the burden. © 2013 Informa UK Ltd. Source

Akimau P.,Sheffield Teaching Hospitals NHS Foundation Trust | Flowers M.,Sheffield Childrens Hospital NHS Foundation Trust
Foot and Ankle Surgery | Year: 2014

Background: We report our medium term outcomes following surgery for symptomatic planovalgus malalignment in children. The technique we describe commences with lateral column lengthening and includes subsequent bony and soft tissue procedures which are carried out 'a la carte' in response to the underlying pathology and the behaviour of the foot to the lateral column lengthening. Methods: Surgery was undertaken on twenty five symptomatic planovalgus feet in 15 patients at a mean age of 12 years and 6 months (5 years 7 months to 16 years and 3 months). The case-mix was principally idiopathic pes planovalgus but included overcorrected club foot and skewfoot deformity. Following lateral column lengthening (using a tricortical interpositional os calcis bone graft) the 'a la carte' elements of the surgery undertaken included both bony and soft tissue elements: heel shift; medial cuneiform osteotomy with iliac crest tricortical bone grafting, peroneus brevis/peroneus longus transfer; plantar fascia release; tibialis posterior advancement. VAS FA and AOFAS scores, clinical findings and complications were recorded. Results: Twelve patients (20 feet) were available for follow up at a mean of 4 years and 6 months years (2 years and 8 months to 6 years and 3 months). VAS FA and AOFAS scores were 82. ±. 17 (50-99), 87. ±. 14 (61-100) and 80. ±. 10 (62-100), respectively. In all patients the reconstituted medial arch was maintained. Three patients (5 feet) required a second corrective procedure. Conclusion: We propose lateral column lengthening with additional 'a la carte' procedures in the surgical treatment of symptomatic pes planovalgus in childhood as a reliable corrective surgical procedure on the basis of favourable medium term functional outcomes. © 2013 European Foot and Ankle Society. Source

Dixon S.,University of Sheffield | Shackley P.,University of Sheffield | Bonham J.,Sheffield Childrens Hospital NHS Foundation Trust | Ibbotson R.,Sheffield Hallam University
Journal of Inherited Metabolic Disease | Year: 2012

Despite the increase in the number of inherited metabolic diseases that can be detected at birth using a single dried blood spot sample, the impact of false positive results on parents remains a concern. We used an economic approach - the contingent valuation method - which asks parents to give their maximum willingness to pay for an extension in a screening programme and the degree to which the potential for false positive results diminishes their valuations. 160 parents of a child or children under the age of 16 years were surveyed and given descriptions of the current screening programme in the UK, an extended programme and an extended programme with no false positives. 148 (92.5%) respondents said they would accept the screen for the five extra conditions in an expanded screening programme whilst 10 (6.3%) said they would not and two were unsure. When asked to indicate if they would choose to be screened under an expanded screening programme with no false positive results, 152 (95%) said they would, five (3.1%) said they would not, two were unsure, and there was one non-response. 151 (94.4%) said they preferred the hypothetical test with no false-positives. The mean willingness to pay for the expanded programme was £178 compared to £219 for the hypothetical expanded programme without false positives (p>0.05). The results suggest that there is widespread parental support for extended screening in the UK and that the number of false-positives is a relatively small issue. © SSIEM and Springer 2011. Source

Peres L.C.,Sheffield Childrens Hospital NHS Foundation Trust
Pediatric and Developmental Pathology | Year: 2012

There is an increasing interest in the physiology and pathology of the umbilical cord because it is recognized as an important source of placental and, consequently, fetal problems. During the postmortem examination of a severely macerated 13-week-old fetus, a split umbilical cord was noted. This rare finding was seen in the middle segment of the cord, the fetal and placental ends both being normal. The pathogenesis of this lesion is not fully understood, and it is possible that it results through focal degeneration of previously formed Wharton's jelly or secondary loss of Wharton's jelly due to incomplete fusion or hypoplasia of the amniotic covering. Whatever the pathogenesis, it is assumed that an umbilical vessel devoid of its protective Wharton's jelly is more prone to compression and thrombosis with all its deleterious effects. Death in this case was probably associated with the congenital heart defect also presented by the fetus. The rarity of this lesion is probably explained by the fact that it represents the end of the spectrum of longitudinal deficiency ofWharton's jelly, a relatively common finding. © 2012 Society for Pediatric Pathology. Source

Ayoub D.M.,Clinical Radiologists | Cohen M.,Sheffield Childrens Hospital NHS Foundation Trust | Miller M.,Wright State University
American Journal of Roentgenology | Year: 2014

OBJECTIVE. The purpose of this study was to review the hypothesis that classic metaphyseal lesions represent traumatic changes in abused infants and compare these lesions with healing rickets. MATERIALS AND METHODS. Using a PubMed search, a multidisciplinary team reviewed studies that reported the histopathologic correlation of classic metaphyseal lesions. Selective studies of growth plate injury and rickets were cross-referenced. RESULTS. Nine identified classic metaphyseal lesion studies were performed by the same principal investigator. Control subjects were inadequate. Details of abuse determination and metabolic bone disease exclusion were lacking. The presence of only a single radiology reviewer prevented establishment of interobserver variability. Microscopy was performed by two researchers who were not pathologists. Classic metaphyseal lesions have not been experimentally reproduced and are unrecognized in the accidental trauma literature. The proposed primary spongiosa location is inconsistent with the variable radiographic appearances. Classic metaphyseal lesions were not differentiated from tissue processing artifacts. Bleeding and callus were uncommon in spite of the vascular nature of the metaphysis. The conclusion that excessive hypertrophic chondrocytes secondary to vascular disruption were indicative of fracture healing contradicts the paucity of bleeding, callus, and periosteal reaction. Several similarities exist between classic metaphyseal lesions and healing rickets, including excessive hypertrophic chondrocytes. "Bucket-handle" and "corner fracture" classic metaphyseal lesions resemble healing rickets within the growth plate and the perichondrial ring, respectively. The age of presentation was more typical of bone fragility disorders, including rickets, than reported in prior child abuse series. CONCLUSION. The hypothesis that classic metaphyseal lesions are secondary to child abuse is poorly supported. Their histologic and radiographic features are similar to healing infantile rickets. Until classic metaphyseal lesions are experimentally replicated and independently validated, their traumatic origin remains unsubstantiated. © American Roentgen Ray Society. Source

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