Publications by authors named "Victoria Owen"

19 Publications

  • Page 1 of 1

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.

Am J Kidney Dis 2021 03 9;77(3):365-375.e1. Epub 2020 Oct 9.

Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Rationale & Objective: Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function.

Study Design: Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016.

Setting & Participants: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort.

Exposure: Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.

Outcome: Major surgery defined as surgery requiring admission to the hospital for at least 24 hours.

Analytical Approach: Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.

Results: 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.

Limitations: Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.

Conclusions: People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.
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http://dx.doi.org/10.1053/j.ajkd.2020.08.009DOI Listing
March 2021

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.

Am J Kidney Dis 2021 03 9;77(3):365-375.e1. Epub 2020 Oct 9.

Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Rationale & Objective: Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function.

Study Design: Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016.

Setting & Participants: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort.

Exposure: Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.

Outcome: Major surgery defined as surgery requiring admission to the hospital for at least 24 hours.

Analytical Approach: Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.

Results: 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.

Limitations: Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.

Conclusions: People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.
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http://dx.doi.org/10.1053/j.ajkd.2020.08.009DOI Listing
March 2021

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.

Am J Kidney Dis 2021 03 9;77(3):365-375.e1. Epub 2020 Oct 9.

Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Rationale & Objective: Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function.

Study Design: Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016.

Setting & Participants: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort.

Exposure: Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.

Outcome: Major surgery defined as surgery requiring admission to the hospital for at least 24 hours.

Analytical Approach: Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.

Results: 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.

Limitations: Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.

Conclusions: People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.
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http://dx.doi.org/10.1053/j.ajkd.2020.08.009DOI Listing
March 2021

Relations among school/daycare functioning, fear of hypoglycaemia and quality of life in parents of young children with type 1 diabetes.

J Clin Nurs 2015 May 22;24(9-10):1199-209. Epub 2014 Jul 22.

Center for Translational Science, Children's National Health System, Washington, DC, USA.

Aims And Objectives: To investigate the type 1 diabetes-related school/daycare experiences of parents of young children and to examine the relationship among child school/daycare functioning, parent fear of hypoglycaemia and parent type 1 diabetes-related quality of life.

Background: Parents of young children who attend school/daycare must rely on others for daily type 1 diabetes management. Worry about school/daycare type 1 diabetes management may cause parental distress and contribute to diminished parent quality of life. Parental concerns about type 1 diabetes management in young children in the school/daycare setting have not been well described in the literature.

Design: Descriptive correlational and cross-sectional parent report of questionnaires design.

Methods: As part of a randomised controlled trial for parents of young children with type 1 diabetes, 134 parents completed self-report measures at baseline. Data included demographic, school/daycare, and medical information, parent reports of child school/daycare functioning, parent fear of hypoglycaemia and parent type 1 diabetes-related quality of life.

Results: Parents of younger children, children on a more intensive medical regimen and children who had experienced type 1 diabetes-related unconsciousness or seizures had more school/daycare concerns. Parents who perceived their children had higher school/daycare functioning had less fear about hypoglycaemia and reported better type 1 diabetes-related quality of life. School/daycare functioning and fear of hypoglycaemia were significantly associated with parent type 1 diabetes-related quality of life.

Conclusions: Parents' concerns about school/daycare functioning and fear of hypoglycaemia play an important role in parents' type 1 diabetes-related quality of life.

Relevance To Clinical Practice: Members of the healthcare team should be aware of concerns related to children attending school/daycare and provide additional support as warranted.
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http://dx.doi.org/10.1111/jocn.12658DOI Listing
May 2015

Text message interventions for children and adolescents with type 1 diabetes: a systematic review.

Diabetes Technol Ther 2013 May 3;15(5):362-70. Epub 2013 Apr 3.

Center for Translational Science, Children's National Medical Center, Washington, DC 20010, USA.

Daily management challenges and declines in glycemic control are evident among youth with type 1 diabetes (T1D) as responsibility for care transitions from parent to youth. Many behavioral interventions developed for youth and their caregivers have demonstrated a small yet significant impact, and one method to potentially augment or increase their potency may be the use of mobile health strategies such as text messages. The primary aim of this systematic review was to evaluate the current literature regarding interventions incorporating text message-based interventions for youth with T1D. Feasibility was demonstrated across all text message programs, but participant satisfaction and glycated hemoglobin results were mixed. Retention rates varied, and technical difficulties were reported in several studies. Current evidence suggests that text message-based interventions that include text messages are feasible and enjoyable, but yet their clinical significance for long-term daily T1D management behaviors and glycemic control is unclear. Researchers are recommended to carefully consider the format, frequency, and timing of text message interventions and to fully test software before implementation. Future research needs include utilization of experimental designs such as randomized controlled trials, SMART design trials, and stepped wedge design trials to clarify specific medical and psychosocial outcomes, the role of caregivers/peers and incentives, and utility in clinical settings.
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http://dx.doi.org/10.1089/dia.2012.0291DOI Listing
May 2013

Teachers' recognition of children with ADHD: role of subtype and gender.

Child Adolesc Ment Health 2013 Feb 9;18(1):18-23. Epub 2012 Mar 9.

Nottinghamshire Healthcare NHS Trust, Nottingham, UK.

Background: This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management.

Method: Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions.

Results: Of 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers' recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful.

Conclusions: Results suggest a need for better teacher awareness about inattentive subtype of ADHD.
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http://dx.doi.org/10.1111/j.1475-3588.2012.00653.xDOI Listing
February 2013

Validation of the IMPACT outcome prediction score using the Nottingham Head Injury Register dataset.

J Trauma 2011 Aug;71(2):387-92

Nottingham University Hospitals NHS Trust, Intensive Care Unit, Queen's Medical Centre Campus, Nottingham, United Kingdom.

Background: Comparison of traumatic brain injury (TBI) outcomes is severely limited by the absence of a universally accepted and validated outcome prediction score. The IMPACT group recently reported models predicting mortality and unfavorable outcome after TBI, based on the outcomes of patients with moderate and severe head injury reported in two large clinical trials.

Methods: We have used prospectively collected data from 1,276 adult patients from the Nottingham Head Injury Register admitted to a single UK neurosurgical unit during a 10-year period to validate the IMPACT score models. The two models were validated for discrimination, calibration, and accuracy, using multiple imputation to adjust for missing data.

Results: One thousand sixty-one patients (83%) had a complete set of data. For the multiply imputed analysis, the IMPACT prognostic models showed satisfactory discrimination (area under the receiver operator curve for mortality, 0.835; 95% confidence interval, 0.811-0.858; unfavorable outcome, 0.828; 95% confidence interval, 0.805-0.851) and accuracy (Brier Accuracy Score for mortality, 0.403, p < 0.01; unfavorable outcome, 0.371, p < 0.01). Good calibration was evident for unfavorable outcome, but mortality risk was underestimated by the scoring system in our sample (Hosmer-Lemeshow test: mortality: p < 0.01; unfavorable outcome: p = 0.6). These results were not significantly changed when repeated using patients with complete data only.

Conclusion: The 2005 IMPACT model for unfavorable outcome performs well when used to predict outcome in adults with moderate and severe TBI presenting to a British neurosurgical center. However, the model for mortality fitted less well, slightly overestimating mortality in the higher-risk groups.
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http://dx.doi.org/10.1097/TA.0b013e31820ceaddDOI Listing
August 2011

Community care in a hospital setting.

Authors:
Victoria Owen

Nurs Stand 2010 Jul 14-20;24(45):20-1

The concept of a community hospital has taken off in a new direction in Oxford. Rehabilitation is now provided within the acute hospital.
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http://dx.doi.org/10.7748/ns.24.45.20.s25DOI Listing
September 2010

Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years.

Arch Pediatr Adolesc Med 2010 May;164(5):462-9

Section of Developmental Psychiatry, University of Nottingham, Queen's Medical Centre, Nottingham, England.

Objectives: To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder (ADHD) and the predictive utility of teacher ratings.

Design: A population-based 5-year follow-up of a randomized, school-based intervention.

Setting: Schools in England.

Participants: Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores. Follow-up data were collected on 487 children in 308 schools.

Interventions: Following screening, using a 2 x 2 factorial design, schools randomly received an educational intervention (books about ADHD for teachers), the names of children with high hyperactivity/inattention scores between ages 4 and 5 years (identification), both educational intervention and identification, or no intervention.

Outcome Measures: Parent-rated hyperactivity/inattention, impairment in classroom learning, and access to specialist health services for mental health or behavioral problems.

Results: None of the interventions were associated with improved outcomes. However, children receiving the identification-only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up (adjusted odds ratio, 2.11; 95% confidence interval, 1.12-4.00). Regardless of intervention, high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up.

Conclusions: We did not find evidence of long-term, generalizable benefits following a school-based universal screening program for ADHD. There may be adverse effects associated with labeling children at a young age.
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http://dx.doi.org/10.1001/archpediatrics.2010.40DOI Listing
May 2010

White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia.

World J Gastrointest Endosc 2009 Oct;1(1):45-50

Rajvinder Singh, Anthony Shonde, Philip Kaye, Christopher Hawkey, Krish Ragunath, Wolfson Digestive Diseases Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, NG7 2UH, Nottingham, United Kingdom.

Aim: To evaluate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 3 different techniques: high resolution white light endoscopy (WLE), Narrow Band Imaging (NBI) and Chromoendoscopy (CHR), all with magnification in differentiating adenocarcinomas, adenomatous and hyperplastic colorectal polyps.

Methods: Each polyp was sequentially assessed first by WLE, followed by NBI and finally by CHR. Digital images of each polyp with each modality were taken and stored. Biopsies or polypectomies were then performed followed by blinded histopathological analysis. Each image was blindly graded based on the Kudo's pit pattern (KPP). In the assessment with NBI, the mesh brown capillary network pattern (MBCN) of each polyp was also described. The Sn, Sp, PPV and NPV of differentiating hyperplastic (Type I & II-KPP, Type I-MBCN) adenomatous (Types III, IV-KPP, Type II-MBCN) and carcinomatous polyps (Type V-KPP, Type III-MCBN) was then compared with reference to the final histopathological diagnosis.

Results: A total of 50 colorectal polyps (5 adenocarcinomas, 38 adenomas, 7 hyperplastic) were assessed. CHR and NBI [KPP, MBCN or the combined classification (KPP & MBCN)] were superior to WLE in the prediction of polyp histology (P < 0.001, P = 0.002, P = 0.001 and P < 0.001, respectively). NBI, using the MBCN pattern or the combined classification showed higher numerical accuracies compared to CHR, but this was not statistically significant (P = 0.625, 0.250).

Conclusion: This feasibility study demonstrated that this combined classification with NBI could potentially be useful in routine clinical practice, allowing the endoscopist to predict histology with higher accuracies using a less cumbersome and technically less challenging method.
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http://dx.doi.org/10.4253/wjge.v1.i1.45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999075PMC
October 2009

Predicting progression to glaucoma in ocular hypertensive patients.

J Glaucoma 2010 Jun-Jul;19(5):304-9

Glaucoma Research Unit, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK.

Purpose: To assess the ability of Heidelberg Retina Tomograph (HRT) Moorfields Regression Analysis (MRA) and Glaucoma Probability Score (GPS) classifications at baseline to predict glaucomatous progression in ocular hypertensive eyes.

Methods: One hundred ninety-eight ocular hypertensive subjects underwent regular HRT and visual field (VF) testing from 1993 to 2001. HRT progression was assessed using linear regression of rim area/time. VF progression was assessed by pointwise linear regression of sensitivity/time. Subjects were classified as progressing or stable at the end of the study period. The relationship between baseline abnormal (outside normal limits combined with borderline classification) MRA and GPS classification and progression status was assessed by odds ratios (ORs).

Results: An abnormal superotemporal MRA was the only classification found to be predictive of HRT progression in isolation (OR 3.05, 1.25-7.47). Abnormal global, superotemporal, superonasal, and temporal MRA classifications were all associated with significant ORs for predicting HRT or VF progression (OR range: 1.77-2.54). Abnormal GPS classifications were not predictive of disease behavior. Combined abnormal GPS and MRA classifications were associated with higher ORs than either classification in isolation.

Conclusions: Patients with an abnormal MRA and GPS classification at presentation may be at increased risk of HRT or VF change.
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http://dx.doi.org/10.1097/IJG.0b013e3181b6e5a1DOI Listing
September 2010

Comparison of high-resolution magnification narrow-band imaging and white-light endoscopy in the prediction of histology in Barrett's oesophagus.

Scand J Gastroenterol 2009 ;44(1):85-92

Wolfson Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Objective: To evaluate whether there is any appreciable difference in imaging characteristics between high-resolution magnification white-light endoscopy (WLE-Z) and narrow-band imaging (NBI-Z) in Barrett's oesophagus (BE) and if this translates into superior prediction of histology.

Material And Methods: This was a prospective single-centre study involving 21 patients (75 areas, corresponding NBI-Z and WLE-Z images) with BE. Mucosal patterns (pit pattern and microvascular morphology) were evaluated for their image quality on a visual analogue scale (VAS) of 1-10 by five expert endoscopists. The endoscopists then predicted mucosal morphology based on four subtypes which can be visualized in BE. Type A: round pits, regular microvasculature; type B: villous/ridge pits, regular microvasculature; type C: absent pits, regular microvasculature; type D: distorted pits, irregular microvasculature. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) were then compared with the final histopathological analysis and the interobserver variability calculated.

Results: The overall pit and microvasculature quality was significantly higher for NBI-Z, pit: NBI-Z=6, WLE-Z=4.5, p < 0.001; microvasculature: NBI-Z=7.3, WLE-Z=4.9, p < 0.001. This translated into a superior prediction of histology (Sn: NBI-Z: 88.9, WLE-Z: 71.9, p < 0.001). For the prediction of dysplasia, NBI-Z was superior to WLE-Z (chi(2)=10.3, p < 0.05). The overall kappa agreement among the five endoscopists for NBI-Z and WLE-Z, respectively, was 0.59 and 0.31 (p < 0.001).

Conclusions: NBI-Z is superior to WLE-Z in the prediction of histology in BE, with good reproducibility. This novel imaging modality could be an important tool for surveillance of patients with BE.
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http://dx.doi.org/10.1080/00365520802400818DOI Listing
March 2009

Glaucoma and fitness to drive: using binocular visual fields to predict a milestone to blindness.

Invest Ophthalmol Vis Sci 2008 Jun;49(6):2449-55

Department of Optometry and Visual Science, City University, London, United Kingdom.

Purpose: To use binocular integrated visual field (IVF) measures to predict which patients will lose visual function to a level below the legal standard for driving.

Methods: Data from patients attending a glaucoma clinic were collected longitudinally. The time from baseline until failure to meet the criteria of the driver's license test was modeled with Cox regression. Visual field status at baseline and visual field deterioration rate at 2 years from baseline for various monocular and binocular VF indices were investigated as predictor variables. The model that provided the best fit to the data was validated using bootstrap resampling.

Results: Of the patients, 20% (60/299; 95% confidence interval, 16%-25%) failed to meet the visual field criteria to prevent driver's license loss during an average follow-up of 7 years. The median age of patients was 64 years. The binocular IVF measurements gave a better fit to the observed data than the monocular measurements. Initial average visual field sensitivity and rate of visual field loss of sensitivity were significant predictors of failure to meet driver's license test criteria.

Conclusions: The IVF provides a method by which binocular visual fields can be incorporated into patient management and allows, for example, a prediction of future driver's license loss. The rate of binocular IVF sensitivity loss at 2 years of follow-up may help identify patients who could benefit from intensified intervention.
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http://dx.doi.org/10.1167/iovs.07-0877DOI Listing
June 2008

Comparison of oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children (PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial.

Thorax 2007 Dec 13;62(12):1102-6. Epub 2007 Jun 13.

Division of Child Health, University of Nottingham, University Hospital Queen's Medical Centre, Nottingham, UK.

Objective: To ascertain whether therapeutic equivalence exists for the treatment of paediatric community acquired pneumonia by the oral and intravenous (IV) routes.

Methods: A multicentre pragmatic randomised controlled non-blinded equivalence trial was undertaken in eight paediatric centres in England (district general and tertiary hospitals). Equivalence was defined as no more than a 20% difference between treatments of the proportion meeting the primary outcome measure at any time. 246 children who required admission to hospital and had fever, respiratory symptoms or signs and radiologically confirmed pneumonia were included in the study. Exclusion criteria were wheeze, oxygen saturations <85% in air, shock requiring >20 ml/kg fluid resuscitation, immunodeficiency, pleural effusion at presentation requiring drainage, chronic lung condition (excluding asthma), penicillin allergy and age <6 months. The patients were randomised to receive oral amoxicillin for 7 days (n = 126) or IV benzyl penicillin (n = 120). Children in the IV group were changed to oral amoxicillin after a median of six IV doses and received 7 days of antibiotics in total. The predefined primary outcome measure was time for the temperature to be <38 degrees C for 24 continuous hours and oxygen requirement to cease. Secondary outcomes were time in hospital, complications, duration of oxygen requirement and time to resolution of illness.

Results: Oral amoxicillin and IV benzyl penicillin were shown to be equivalent. Median time for temperature to settle was 1.3 days in both groups (p<0.001 for equivalence). Three children in the oral group were changed to IV antibiotics and seven children in the IV group were changed to different IV antibiotics. Median time to complete resolution of symptoms was 9 days in both groups.

Conclusion: Oral amoxicillin is effective for most children admitted to hospital with pneumonia (all but those with the most severe disease who were excluded from this study). Prior to this study, the British Thoracic Society guidelines on childhood pneumonia could not draw on evidence to address this issue. This will spare children and their families the trauma and pain of cannulation, and children will spend less time in hospital.
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http://dx.doi.org/10.1136/thx.2006.074906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094276PMC
December 2007

Measurement variability in Heidelberg Retina Tomograph imaging of neuroretinal rim area.

Invest Ophthalmol Vis Sci 2006 Dec;47(12):5322-30

Department of Optometry and Visual Science, City University, London, United Kingdom.

Purpose: To investigate the optimal frequency of imaging during follow-up to detect glaucoma progression by characterizing variability (noise) in neuroretinal rim area (RA) measured by Heidelberg Retina Tomograph (HRT; Heidelberg Engineering, Heidelberg, Germany).

Methods: RA noise was estimated from patient data and characterized by fitting theoretical distributions to the observed data. Multilevel regression was used to determine factors that significantly affect noise. Computer simulations of disease progression were performed by adding noise generated from the distribution derived from the observed data to the average rate of loss in RA estimated from longitudinal data. Rates of detection of disease progression were investigated for various progression rates, follow-up periods, and rates of imaging.

Results: Noise was not normally distributed and was best characterized by the hyperbolic distribution, which fit averages well while allowing for extreme values. Noise was greatly influenced by image quality, but age did not have a significant effect. Rates of detection improved for more frequent imaging, better quality images, and faster rates of disease progression.

Conclusions: Noise in HRT measurement of RA is well characterized by the hyperbolic distribution. Sensitivity of detection improves with more frequent testing, but if consistently poor-quality images are yielded for a patient, the probability of detection is low. Results from this work could be used to tailor individual follow-up patterns for patients with different rates of RA loss and image quality, especially in a clinical trial setting.
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http://dx.doi.org/10.1167/iovs.06-0096DOI Listing
December 2006

Acoustic schwannomas: awareness of radiologic error will reduce unnecessary treatment.

Otol Neurotol 2005 May;26(3):512-5

Department of Otolaryngology, Queen's Medical Center NHS Trust, University Hospital, Nottingham, UK.

Objective: To measure the intra- and interobserver error in size estimation of acoustic schwannomas from magnetic resonance imaging (MRI) scans by experienced radiologists to determine whether small amounts of tumor growth that may affect management (2 mm) could be reliably measured in clinical practice.

Design: Duplicated, blinded size estimation of acoustic neuromas (according to American Academy of Otolaryngology-Head and Neck Surgery guidelines, 1995) from MRI scans of patients with acoustic neuromas.

Setting: Tertiary referral teaching hospital and DGH.

Participants: Four radiologists (including 2 dedicated neuroradiologists) measuring positive MRI scans of 26 patients with an acoustic neuroma.

Main Outcome Measure: Intraradiologist and inter-radiologist repeatability coefficients in millimeters for the maximal tumor diameter in the anteroposterior (AP) axis, medial-longitudinal (ML) axis, and the square-root of the product of these two measurements. Repeatability coefficients give the 95% range within which the differences in repeated measurements lie.

Results: The intraradiologist repeatability for AP and ML measurements ranged from 1.51 to 6.03 mm and 2.01 to 3.83 mm, respectively. The repeatability of the square-root of the product ranged from 1.43 to 4.94 mm. The inter-radiologist repeatability was 6.48 mm and 7.46 mm for the AP and ML measurements, respectively, giving a repeatability of 3.65 mm for the square-root of the product.

Conclusion: The study indicates that, in routine clinical practice, differences in tumor size of the order of 2 mm cannot be reliably measured, even by the same radiologist. Thus, reported growth of acoustic tumors should be interpreted with caution, especially if this is the criterion for recommending treatment.
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http://dx.doi.org/10.1097/01.mao.0000169782.69341.6dDOI Listing
May 2005

A questionnaire study of the quality of life and quality of family life of individuals complaining of tinnitus pre- and post-attendance at a tinnitus clinic.

Int J Audiol 2004 Jul-Aug;43(7):410-6

MRC Institute of Hearing Research, University Park, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK.

Tinnitus is a condition that is difficult to treat, and treatment outcomes are difficult to measure The majority of people who experience tinnitus are not troubled by it; however, the troubled minority are referred by an otorhinolaryngologist for specialist clinic help. The aim of this study was to investigate how the impact of tinnitus changes following attendance at a tinnitus clinic and to find out how acceptable the questionnaires used were for measuring recovery. Fifty-seven tinnitus sufferers completed three questionnaires covering the characteristics of tinnitus, and its effect on daily life, quality of life, and quality of family life, before and after treatment at the Nottingham Tinnitus Clinic. Questionnaires were answered at patients' homes while they were on the waiting list to attend the clinic, and again I year after their first attendance. Measures of functional and social handicap were significantly reduced following attendance at the clinic (mean change in functional handicap = 13%, p<0.01, and mean change in social handicap = 8%, p<0.01). Quality of life was significantly better after treatment at the clinic (mean visual analog scale difference = 6.5%, p = 0.01). We conclude that attendance at the Nottingham Tinnitus Clinic had a positive effect on the impact of tinnitus on patients and their families, and that the questionnaires gave an accurate measure of patient distress.
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http://dx.doi.org/10.1080/14992020400050052DOI Listing
January 2005

Compliance as a Function of Status.

J Soc Psychol 1978 Dec;106(2):291-292

a Marymount Manhattan College , USA.

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http://dx.doi.org/10.1080/00224545.1978.9924188DOI Listing
December 1978