Publications by authors named "Barry Lyons"

28 Publications

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The use of Lean Methodology to reduce personal protective equipment wastage in children undergoing congenital cardiac surgery, during the COVID-19 pandemic.

Paediatr Anaesth 2021 02 20;31(2):213-220. Epub 2020 Dec 20.

Children's Health Ireland at Crumlin, Dublin, Ireland.

Background: The COVID-19 pandemic has compounded many existing healthcare delivery challenges including long waiting lists and cost containment. New challenges have arisen, such as demand on supply of personal protective equipment (PPE) and the implications of social distancing on staff, patients, and their families. Despite the pandemic, the need to deliver safe, urgent congenital cardiac surgery has remained.

Objective: To demonstrate how Lean methodology can improve PPE supply chain demand and reduce staff exposure to children with unknown SARS-CoV-2 status undergoing congenital cardiac surgery, during the COVID-19 pandemic.

Methods: We implemented the define, measure, analyze, improve, and control method (DMAIC) and Value Stream Maps to eliminate waste steps during testing for SARS-CoV-2 for children undergoing congenital cardiac surgery.

Results: Following a 3-week period of implementation of this new value stream map, we reduced PPE set usage from 13 to 1 per patient, resulting in an annual saving of over €36,000 and reducing single-use plastic waste by nearly 70 000 pieces per annum. We reduced numbers of staff exposed to patients with an unknown SARS-CoV-2 status from 13 to 1.

Conclusion: The use of Lean methodology can reduce waste of PPE and plastic, resulting in cost savings, while reducing staff exposure when testing patients with congenital cardiac disease for SARS-CoV-2. By preventing admission of SARS-CoV-2-positive patients, we can reduce use of isolation beds and prevent cancellation of surgery, improving patient flow and departmental efficiency. Other departments in our institution are implementing similar admission pathways to allow surgical services to restart during the ongoing pandemic.
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http://dx.doi.org/10.1111/pan.14102DOI Listing
February 2021

Medication Errors in Anesthesiology: Is It Time to Train by Example? Vignettes Can Assess Error Awareness, Assessment of Harm, Disclosure, and Reporting Practices.

J Patient Saf 2020 Oct 1. Epub 2020 Oct 1.

Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin 2, Ireland.

Background: Perioperative medication errors (MEs) are complex, multifactorial, and a significant source of in-hospital patient morbidity. Anesthesiologists' awareness of error and the potential for harm is not well understood, nor is their attitude to reporting and disclosure. Anesthesiologists are not routinely exposed to medication safety training.

Methods: Ten clinical vignettes, describing an ME or a near miss, were developed using eDelphi consensus. An online survey instrument presented these vignettes to anesthesiologists along with a series of questions assessing error awareness, potential harm severity, the likelihood of reporting, and the likelihood of open disclosure to the patient. The study also explored the influence of prior medication safety training.

Results: Eighty-nine anesthesiologists from 14 hospitals across Ireland (53.9% were residents, and 46.1% were attendings) completed the survey. Just 35.6% of anesthesiologists recalled having had medication safety training, more commonly among residents than attendings, although this failed to reach significance (P < 0.081). Medication error awareness varied with the vignette presented. Harm severity assessment was positively associated with error awareness. The likelihood of patient disclosure and incident reporting was both low and independent of harm severity assessment.

Conclusions: Perioperative ME awareness and assessment of potential harm by anesthesiologists is variable. Self-reported rates of incident reporting and error disclosure fall short of the standards that might apply in an environment focused on candor and safety. An extensive education program is required to raise awareness of error and embed appropriate reporting and disclosure behaviors. Vignettes, designed by consensus, may be valuable in the delivery of such a curriculum.
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http://dx.doi.org/10.1097/PTS.0000000000000785DOI Listing
October 2020

Stories of shame.

Lancet 2018 04;391(10130):1568-1569

Department of Social Work and Social Care, University of Birmingham, Birmingham, UK; Medical Humanities and Philosophy, University of Exeter, Exeter, UK.

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http://dx.doi.org/10.1016/S0140-6736(18)30897-3DOI Listing
April 2018

Shame, stigma and medicine.

Med Humanit 2017 12;43(4):208-210

Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.

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http://dx.doi.org/10.1136/medhum-2017-011392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739841PMC
December 2017

Health-related shame: an affective determinant of health?

Med Humanit 2017 Dec 8;43(4):257-263. Epub 2017 Jun 8.

Trinity College Dublin, School of Medicine, Dublin 2, Ireland.

Despite shame being recognised as a powerful force in the clinical encounter, it is underacknowledged, under-researched and undertheorised in the contexts of health and medicine. In this paper we make two claims. The first is that emotional or affective states, in particular shame, can have a significant impact on health, illness and health-related behaviours. We outline four possible processes through which this might occur: (1) acute shame avoidance behaviour; (2) chronic shame health-related behaviours; (3) stigma and social status threat and (4) biological mechanisms. Second, we postulate that shame's influence is so insidious, pervasive and pernicious, and so critical to clinical and political discourse around health, that it is imperative that its vital role in health, health-related behaviours and illness be recognised and assimilated into medical, social and political consciousness and practice. In essence, we argue that its impact is sufficiently powerful for it to be considered an affective determinant of health, and provide three justifications for this. We conclude with a proposal for a research agenda that aims to extend the state of knowledge of health-related shame.
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http://dx.doi.org/10.1136/medhum-2017-011186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739839PMC
December 2017

Faith, Hope And (No) Clarity.

Authors:
Barry Lyons

J Med Ethics 2016 Aug;42(8):520-1

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http://dx.doi.org/10.1136/medethics-2016-103807DOI Listing
August 2016

The Jacobs Parental Prerogative Test.

Am J Bioeth 2015 ;15(2):52-3

a Trinity College Dublin.

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http://dx.doi.org/10.1080/15265161.2014.990764DOI Listing
October 2015

Adherence to imatinib among patients attending Saskatchewan Cancer Agency Pharmacies.

J Oncol Pharm Pract 2015 Dec 5;21(6):403-8. Epub 2014 Jun 5.

College of Pharmacy and Nutrition, University of Saskatchewan, Canada

Rationale: Chronic use of imatinib confers an important survival benefit for individuals with chronic myeloid leukemia. In Saskatchewan, the provincial cancer agency addresses important barriers to adherence by providing imatinib at no cost through specialized cancer centers.

Objective: To describe adherence to imatinib dispensed through the Saskatchewan Cancer Agency.

Study Design And Methods: We conducted a retrospective analysis of electronic pharmacy dispensation records from the Saskatchewan Cancer Agency. All dispensations for imatinib classified for hematologic malignancies were electronically abstracted by cancer center personnel and securely forwarded to investigators with all meaningful patient identifiers removed. All subjects receiving a new dispensation (i.e. using a 6-month washout period) for imatinib between 1 June 2004 and 31 December 2011 were included. The primary endpoint was optimal adherence to imatinib during the first year of therapy, defined as a medication possession ratio ≥ 80%.

Results: Ninety-one subjects were started on imatinib during the observation period. During the first year of therapy, 82.4% (75/91) maintained a medication possession ratio ≥ 80%. The percentage of individuals maintaining optimal adherence decreased only slightly when the observation period was extended to 2 (78.4%) or 3 years (78.8%).

Conclusions: Non-adherence to imatinib is relatively infrequent when provided by the Saskatchewan Cancer Agency.
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http://dx.doi.org/10.1177/1078155214537926DOI Listing
December 2015

Integrating pharmacists into primary care teams: barriers and facilitators.

Int J Pharm Pract 2014 Aug 27;22(4):292-9. Epub 2013 Nov 27.

College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.

Objectives: This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada.

Methods: Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees.

Key Findings: Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways.

Conclusions: Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located.
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http://dx.doi.org/10.1111/ijpp.12080DOI Listing
August 2014

Towards the development of an autocontamination trap system to manage populations of emerald ash borer (Coleoptera: Buprestidae) with the native entomopathogenic fungus, Beauveria bassiana.

J Econ Entomol 2012 Dec;105(6):1929-39

Natural Resources Canada, Canadian Forest Service, 1219 Queen Street East, Sault Ste. Marie, ON, P6A 2E5 Canada.

Emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) is an invasive species from Asia that was discovered in North America Canada, in 2002. Herein, we describe studies to develop an autocontamination trapping system to disseminate Beauveria bassiana to control beetle populations. The standard trap for emerald ash borer in Canada is a light green prism trap covered in an insect adhesive and baited with (Z)-3-hexenol. We compared of green multifunnel traps, green intercept panel traps (both with and without fluon coating) and green prism traps for capturing emerald ash borer in a green ash plantation. The coated green multifunnel traps captured significantly more males and more females than any other trap design. We examined the efficacy of two native B. bassiana isolates, INRS-CFL and L49-1AA. In a field experiment the INRS-CFL isolate attached to multifunnel traps in autocontamination chambers retained its pathogenicity to emerald ash borer adults for up to 43 d of outdoor exposure. Conidia germination of the INRS-CFL isolate was >69% after outdoor exposure in the traps for up to 57 d. The L49-1AA isolate was not pathogenic in simulated trap exposures and the germination rate was extremely low (<5.3%). Mean (+/- SEM) conidia loads on ash borer adults after being autocontaminated in the laboratory using pouches that had been exposed in traps out of doors for 29 d were 579,200 (+/- 86,181) and 2,400 (+/- 681) for the INRS-CFL and the LA9-1AA isolates, respectively. We also examined the fungal dissemination process under field conditions using the L49-1AA isolate in a green ash plantation. Beetles were lured to baited green multifunnel traps with attached autocontamination chambers. Beetles acquired fungal conidia from cultures growing on pouches in the chambers and were recaptured on Pestick-coated traps. In total, 2,532 beetles were captured of which 165 (6.5%) had fungal growth that resembled B. bassiana. Of these 25 beetles were positive for the L49-1AA isolate.
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http://dx.doi.org/10.1603/ec12325DOI Listing
December 2012

Solidarity, children and research.

Authors:
Barry Lyons

Bioethics 2012 Sep;26(7):369-75

Centre for Social Ethics and Policy, School of Law, University of Manchester. Oxford Road Manchester M13 9PL, UK.

While research on children is supported by many professional guidelines, international declarations and domestic legislation, when it is undertaken on children with no possibility of direct benefit it rests on shaky moral foundations. A number of authors have suggested that research enrolment is in the child's best interests, or that they have a moral duty or societal obligation to participate. However, these arguments are unpersuasive. Rather, I will propose in this paper that research participation by children seems most reasonable when considered as an act of solidarity; a form of identification with, and provision of practical assistance to, those who are less well off. This is an articulation of the view that many children, and their parents, seem to take seriously the suffering of others, and wish to assist in advancing other children's wellbeing. Perhaps, by fostering an environment in which children are encouraged to take solidarity seriously, participation in research which holds out substantial hope of benefit to those less well off would come to be perceived as a behavioural norm rather than an exceptional practice.
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http://dx.doi.org/10.1111/j.1467-8519.2012.01988.xDOI Listing
September 2012

The Irish Council for Bioethics -- an unaffordable luxury?

Authors:
Barry Lyons

Camb Q Healthc Ethics 2012 Jul;21(3):375-83

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http://dx.doi.org/10.1017/S0963180112000096DOI Listing
July 2012

Evidence for a volatile pheromone in Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) that increases attraction to a host foliar volatile.

Environ Entomol 2011 Aug;40(4):904-16

Natural Resources Canada, Canadian Forest Service-Atlantic Forestry Centre, Fredericton, NB, Canada.

Analysis by gas chromatography/mass spectrometry (GC/MS) of volatiles from virgin female emerald ash borer, Agrilus planipennis Fairmaire confirmed the emission of (3Z)-lactone [(3Z)-dodecen-12-olide] but not its geometric isomer, (3E)-lactone [(3E)-dodecen-12-olide]. Gas chromatographic/electroantennographic (GC/EAD) analysis of synthetic (3Z)-lactone, which contained 10% (3E)-lactone, showed a strong response of male and female antennae to both isomers. EAG analysis with 0.01- to 100-μg dosages showed a positive dose response, with females giving significantly higher responses than males. In field experiments with sticky purple prism traps, neither lactone isomer affected catches when combined with ash foliar or cortical volatiles (green leaf volatiles or Phoebe oil, respectively). However, on green prism traps, the (3Z)-lactone significantly increased capture of male A. planipennis when traps were deployed in the canopy. Captures of males on traps with both (3E)-lactone and (3Z)-hexenol or with (3Z)-lactone and (3Z)-hexenol were increased by 45-100%, respectively, compared with traps baited with just (3Z)-hexenol. In olfactometer bioassays, males were significantly attracted to (3E)-lactone, but not the (3Z)-lactone or a 60:40 (3E):(3Z) blend. The combination of either (3E)- or (3Z)-lactone with Phoebe oil was not significantly attractive to males. Males were highly attracted to (3Z)-hexenol and the (3Z)-lactone + (3Z)-hexenol combination, providing support for the field trapping results. These data are the first to demonstrate increased attraction with a combination of a pheromone and a green leaf volatile in a Buprestid species.
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http://dx.doi.org/10.1603/EN11029DOI Listing
August 2011

'The good that is interred in their bones': are there property rights in the child?

Authors:
Barry Lyons

Med Law Rev 2011 ;19(3):372-400

Centre for Ethics and Social Policy, School of Law, University of Manchester, Manchester M13 9PL, UK.

Bone marrow donation between siblings is a common medical procedure. In some instances, the donor will be a young child incapable of providing either consent or assent, and the intervention is made lawful through the consent of the parent(s). Although a number of justifications have been formulated to cover this act with legitimacy, these fail to describe accurately the transaction that takes place. In the absence of the child authorising his parents to act as his proxy, it is unclear why parental consent is sufficient to permit the redistribution of his biological wealth. Instead, where the donor is such a young child, the whole procedure may be construed as the appropriation of bodily tissue from one unconsenting human and its conveyance to a third, albeit related, party. This paper argues that if the parentally authorised transfer of biological material from an unconsenting human to another is legally permissible, it must be on the basis of an implicitly acknowledged property right in the child.
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http://dx.doi.org/10.1093/medlaw/fwr014DOI Listing
January 2012

Foliar residue dynamics of azadirachtins following direct stem injection into white and green ash trees for control of emerald ash borer.

Pest Manag Sci 2011 Oct 12;67(10):1277-84. Epub 2011 May 12.

Canadian Forest Service, Natural Resources Canada, Sault Ste. Marie, Ontario, Canada.

Background: Azadirachtins are natural insecticides derived from the neem tree. The emerald ash borer (EAB) is an exotic invasive insect pest that infests various ash tree species and has the potential for significant economic, aesthetic and ecological impacts throughout North America. The initial translocation and foliar residue dynamics of azadirachtins were examined following direct injection into white and green ash trees growing in urban scenarios as a potential control for EAB.

Results: Substantial concentrations of azadirachtins A and B [mean maxima > 0.98 mg kg(-1) fresh weight (f.w.)] were observed within 2 days of injecting a specifically designed formulation of azadirachtins. Foliar residues declined exponentially through time, with half-life estimates ranging from 5.1 to 12.3 days. At the time of leaf senescence, foliar residue levels approximated 0.01 mg kg(-1) f.w., strongly mitigating the potential effects of non-target biota in soil or aquatic compartments.

Conclusion: The magnitude and duration of exposures observed in this field study were considered to be above the thresholds required for biological effectiveness against both larval and adult life stages of EAB. Results support the use of azadirachtins as an environmentally acceptable systemic insecticide for control of EAB and protection of high-value ash trees in urban environments.
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http://dx.doi.org/10.1002/ps.2183DOI Listing
October 2011

Comparison of male and female emerald ash borer (Coleoptera: Buprestidae) responses to phoebe oil and (Z)-3-hexenol lures in light green prism traps.

J Econ Entomol 2011 Feb;104(1):173-9

Great Lakes Forestry Centre, Canadian Forest Service, 1219 Queen St. E., Sault Ste. Marie, ON, Canada P6A 2E5.

We conducted trapping experiments for the emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) in Michigan, U.S.A., and Ontario, Canada, to compare unbaited light green sticky prism traps with traps baited with phoebe oil, (Z)-3-hexenol (Z3-6:OH), or blends of other green leaf volatiles (GLVs) with Z3-6:OH. Traps were placed in the lower canopy of ash trees (Fraxinus spp.). Catches with Z3-6:OH-baited traps showed a significant male bias and these traps caught significantly more males than the unbaited controls at both sites. They were also superior to phoebe oil-baited traps and those baited with GLV blends. Catches with phoebe oil showed a significant female bias but there was no difference in the number of females captured between traps baited with phoebe oil or Z3-6:OH lures. Catches were analyzed at regular time intervals to examine the response of A. planipennis to the lures over the course of the flight season. Z3-6:OH-baited traps consistently caught more males than the controls at each interval throughout the flight season. Catches of females with Z3-6:OH and phoebe oil were significantly better than the controls early in the flight season but declined to control levels by midseason. Our results suggest that Z3-6:OH-baited green traps placed in the ash canopy would be a superior lure for detecting and monitoring A. planipennis throughout the flight season.
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http://dx.doi.org/10.1603/ec10197DOI Listing
February 2011

Obliging children.

Authors:
Barry Lyons

Med Law Rev 2011 2;19(1):55-85. Epub 2011 Feb 2.

Centre for Ethics and Social Policy, School of Law, University of Manchester, UK.

Children may sometimes undergo healthcare procedures that are not intended to improve their health status. Such interventions might include the use of young children as bone marrow donors or their enrolment in non-therapeutic research. One of the justifications used to legitimise these interventions is the premise that children have obligations to others; to their family in the case of related bone marrow transplantation, and to wider society in the case of non-therapeutic research. However, this 'obligation model' (the notion that children possess positive obligations to advance the health status of others) fails as a justificatory paradigm because it is based upon a confusion, identified by Hart, between two notions; that of 'being under an obligation to do something' and that of 'being obliged to do something'. Instead the 'obligation model' is a device employed to put a justificatory gloss upon a consequentialist decision-making process; removing the legitimising gloss allows for a more transparent look at the conflict between parental rights and an individual child's right to bodily integrity.
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http://dx.doi.org/10.1093/medlaw/fwq031DOI Listing
June 2011

The overwintering physiology of the emerald ash borer, Agrilus planipennis fairmaire (coleoptera: buprestidae).

J Insect Physiol 2011 Jan 18;57(1):166-73. Epub 2010 Nov 18.

Department of Biology, The University of Western Ontario, London, Ontario, Canada N6A 5B7.

Ability to survive cold is an important factor in determining northern range limits of insects. The emerald ash borer (Agrilus planipennis) is an invasive beetle introduced from Asia that is causing extensive damage to ash trees in North America, but little is known about its cold tolerance. Herein, the cold tolerance strategy and mechanisms involved in the cold tolerance of the emerald ash borer were investigated, and seasonal changes in these mechanisms monitored. The majority of emerald ash borers survive winter as freeze-intolerant prepupae. In winter, A. planipennis prepupae have low supercooling points (approximately -30°C), which they achieve by accumulating high concentrations of glycerol (approximately 4M) in their body fluids and by the synthesis of antifreeze agents. Cuticular waxes reduce inoculation from external ice. This is the first comprehensive study of seasonal changes in cold tolerance in a buprestid beetle.
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http://dx.doi.org/10.1016/j.jinsphys.2010.11.003DOI Listing
January 2011

The limits of parental authority?

Authors:
Barry Lyons

Am J Bioeth 2010 Jan;10(1):50-2

School of Law, University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1080/15265160903460871DOI Listing
January 2010

A contact sex pheromone component of the emerald ash borer Agrilus planipennis Fairmaire (Coleoptera: Buprestidae).

Naturwissenschaften 2009 May 24;96(5):601-8. Epub 2009 Feb 24.

Natural Resources Canada, Canadian Forest Service, Atlantic Forestry Centre, P O Box 4000, Fredericton, NB E3B 5P7, Canada.

Analyses of the elytral hydrocarbons from male and female emerald ash borer, Agrilus planipennis Fairmaire, that were freshly emerged vs. sexually mature (>10 days old) revealed a female-specific compound, 9-methyl-pentacosane (9-Me-C(25)), only present in sexually mature females. This material was synthesized by the Wittig reaction of 2-decanone with (n-hexadecyl)-triphenylphosphonium bromide followed by catalytic reduction to yield racemic 9-Me C(25), which matched the natural compound by gas chromatography/mass spectrometry (retention time and EI mass spectrum). In field bioassays with freeze-killed sexually mature A. planipennis females, feral males spent significantly more time in contact and attempting copulation with unwashed females than with females that had been washed in n-hexane to remove the cuticular lipids. Hexane-washed females to which 9-Me-C(25) had been reapplied elicited similar contact time and percentage of time attempting copulation as unwashed females, indicating that 9-methyl-pentacosane is a contact sex pheromone component of A. planipennis. This is the first contact sex pheromone identified in the Buprestidae.
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http://dx.doi.org/10.1007/s00114-009-0513-1DOI Listing
May 2009

Health-related quality of life after prolonged pediatric intensive care unit stay.

Pediatr Crit Care Med 2009 Jan;10(1):41-4

Department of Anaesthesia and Intensive Care Medicine, Our Lady's Hospital for Sick Children, Crumlin Road, Crumlin, Dublin, Ireland.

Objective: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care.

Design: Retrospective cohort and prospective follow-up study.

Setting: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital.

Patients: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004.

Interventions: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores.

Measurements And Main Results: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent.

Conclusions: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.
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http://dx.doi.org/10.1097/PCC.0b013e31819371f6DOI Listing
January 2009

The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery.

Paediatr Anaesth 2006 May;16(5):560-7

Department of Anesthesiology, Medical & Surgical ICU, Children's Hospital Boston, Boston, MA, USA.

Background: The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non-ETS-exposed children.

Methods: Fifty-four children aged 5-15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward.

Results: The ETS-exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval -18.1 to -1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s -4.5%, P = 0.07; forced vital capacity -4.1%, P = 0.10; forced expiratory flow between 25% and 75%-3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near-complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children.

Conclusions: Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia.
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http://dx.doi.org/10.1111/j.1460-9592.2005.01821.xDOI Listing
May 2006

Herbal medicine use by children presenting for ambulatory anesthesia and surgery.

Paediatr Anaesth 2004 Nov;14(11):916-9

Department of Anaesthesia & Critical Care Medicine, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.

Background: Herbal medicine use has become increasingly popular throughout the world. Some of these agents may have serious interactions with anesthetic drugs. Children may potentially be more vulnerable to such interactions because of altered drug handling. While the prevalence of herbal medicine use by children with some chronic illnesses has been estimated, the incidence of this in a population of otherwise healthy children admitted for minor ambulatory anesthesia and surgery is currently unknown.

Methods: Parents of 601 children presenting consecutively for ambulatory surgery were asked to complete a questionnaire detailing administration of herbal medicines to their child.

Results: This study identified that 6.4% of children were currently taking an herbal preparation; while a further 10.1% had taken an herbal medicine in the past. Echinacea and arnica were the commonest used herbal remedies. A significant number of children had taken agents which may interact with anesthesia and surgery: St John's Wort, valerian, garlic and gingko. Information on herbal medicines was mostly obtained by parents from nonmedical sources.

Conclusions: A total of 16.6% of children had a current or past history of ingestion of herbal medicines. This finding may have implications for the perioperative management of children presenting for day-case surgery.
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http://dx.doi.org/10.1111/j.1460-9592.2004.01353.xDOI Listing
November 2004

Postoperative behavioral changes following anesthesia with sevoflurane.

Paediatr Anaesth 2004 Oct;14(10):866-70

Department of Anaesthesia & Critical Care Medicine, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.

Background: Behavioral disturbance following hospitalization is a relatively frequent event, some children still having negative behavioral changes (NBC) 1 month following their operation. Sevoflurane has a propensity to induce 'excitement' during induction of anaesthesia, and delirium in the immediate postoperative phase. The aim of this study was to evaluate whether this translates into prolonged behavioral change.

Methods: A total of 120 children presenting for daycase surgical procedures under anesthesia were included in the study. Children were randomized to induction and maintenance of anesthesia with sevoflurane or halothane. No additional sedative drugs were administered. Postoperative behavioral change was assessed using the Post-Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 7 and 30.

Results: The Sevoflurane group (n = 63) were more distressed on emergence of anesthesia than the Halothane group (n = 57) (P < 0.05). About 58.3, 46.8 and 38.3% of all children exhibited NBC on postoperative days 1, 7 and 30, respectively. There was no association between anesthetic agent and behavior. There was a significant relationship between decreasing age and NBC (P < 0.005).

Conclusions: Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age.
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http://dx.doi.org/10.1111/j.1460-9592.2004.01310.xDOI Listing
October 2004

Impossible laryngeal intubation in an infant with Fraser syndrome.

Paediatr Anaesth 2004 Mar;14(3):276-8

Department of Anaesthesia and Intensive Care Medicine, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.

Congenital webbing of the vocal cords is rare, and is usually incompatible with life. We report a case of an infant with Fraser syndrome who required a surgical airway because of a severe stenosis of her airway secondary to a glottic web. The decision process leading to tracheostomy in this neonate is described. The pertinent features of Fraser syndrome in relation to airway management are discussed.
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http://dx.doi.org/10.1046/j.1460-9592.2003.01217.xDOI Listing
March 2004

The McCoy straight blade does not improve laryngoscopy and intubation in normal infants.

Can J Anaesth 2004 Feb;51(2):155-9

Department of Anaesthesia and Intensive Care, Our Lady's Hospital for Sick Children, Dublin, Ireland.

Purpose: The McCoy curved blade laryngoscope has been demonstrated to improve view at laryngoscopy in adults. A straight-bladed version of this laryngoscope has recently been introduced into pediatric practice. The objective of this prospective, randomized study was to compare the intubating conditions afforded by the McCoy (#1) straight blade laryngoscope with the conventional Miller (#1) blade in neonates and infants.

Methods: Forty patients under six months of age, were randomized into two groups: one group (n = 20) had an initial laryngoscopy with the McCoy blade and then had a laryngoscopy and subsequent intubation using the Miller blade; the second group (n = 20) had an initial laryngoscopy with the Miller blade, followed by laryngoscopy and intubation using the McCoy blade. All intubations were performed by one anesthesiologist familiar with using both blades.

Results: The majority of patients (39 out of 40) had a similar or superior view (Cormack and Lehane classification) with the Miller when compared with the McCoy laryngoscope. Mean time to laryngoscopy was 14.9 (12.7) sec with the McCoy and 6.8 (2.07) sec with the Miller blade (P = 0.001), whereas mean time to intubation was 25.13 (10.4) sec with the McCoy and 12 (8.5) sec with the Miller blade (P = 0.014). There was no difference between the groups regarding desaturation and changes in heart rate during laryngoscopy and intubation.

Conclusion: Our data indicate that the McCoy blade has no advantage over the conventional pediatric Miller blade in normal infants.
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http://dx.doi.org/10.1007/BF03018775DOI Listing
February 2004

Airway management in a baby with femoral hypoplasia-unusual facies syndrome.

Paediatr Anaesth 2002 Jun;12(5):461-4

Department of Anaesthesia and Intensive Care, Our Lady's Hospital for Sick Children, Dublin, Ireland.

We report the successful fibreoptic intubation through a laryngeal mask airway (LMA) while maintaining spontaneous respiration in an anaesthetized 3-month-old female infant with femoral hypoplasia-unusual facies syndrome, in whom direct laryngoscopy and intubation proved impossible.
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http://dx.doi.org/10.1046/j.1460-9592.2002.00846.xDOI Listing
June 2002