Introduction The RCPCH endorsed Brain Pathways Guideline (www.headsmart.org.uk) for selecting pat... more Introduction The RCPCH endorsed Brain Pathways Guideline (www.headsmart.org.uk) for selecting patients for scanning with symptoms of brain tumour has been a sustained collaboration between Children's Brain Tumour Research Centre (CBTRC), Samantha Dickson Brain Tumour Trust (SDBTT), University of Southampton and the RCPCH. The clinical guideline and the HeadSmart Campaign aim to reduce median symptom interval (SI) for UK children to 5 weeks, by enhancing public and professional awareness and offering web-based support for selection of children for scanning, observation or reassurance. The strategy was developed in response to: ▶ delays in diagnosis observed by specialists; ▶ media reports of delays; ▶ questions in the House of Commons; ▶ the All Party Parliamentary Group Manifesto (2010), which placed delays in diagnosis as its top action point. Aims The HeadSmart campaign aims to reduce SI to a median of 5 weeks, to equal the best reported worldwide. It is supported by a decision support website, a Clinical Champions' network recording SI for newly diagnosed patients, and an evaluation programme; a Health Economic model is in development. Methods CBTRC developed a research strategy, SDBTT identified funding from Community Fund (2002). A literature review, meta-analysis of reported symptom intervals and a Delphi consensus process generated the Clinical Guideline which was endorsed by RCPCH (2005) and supported by other Colleges, accredited by NHS Evidence and is being considered within NICE Cancer Referral Guidance review. The dissemination strategy included: ▶ Survey of healthcare professionals' awareness of childhood brain tumours and the HeadSmart campaign ▶ Survey of public awareness of childhood brain tumours and the HeadSmart campaign ▶ Development of the HeadSmart website ▶ Presentation of guideline material at regional and national professional meetings ▶ Recruitment of clinical champions ▶ Media campaign – television, radio and facebook Concurrent government reports have prioritised timely diagnosis and access to treatment and justify prioritisation of children within health service developments. Conclusions This approach is enhancing awareness of clinical presentations of a rare but important childhood condition in primary and secondary care. Early results (see linked abstracts) show promising reduction in SI, the campaign will run until 2013. This model of prioritising diagnostics in children may be applicable to other childhood conditions.
Objective:To systematically review the literature with the primary aim of identifying behavioural... more Objective:To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups.Design:Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools.Setting:Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020.Participants:Patient or population including pregnant women, newborns and children aged under...
IntroductionEvery year 2.4 million deaths occur worldwide in babies younger than 28 days. Approxi... more IntroductionEvery year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice.Methods and analysisThis is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in additi...
Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Afr... more Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all ...
IntroductionThe craniofacial abnormalities found in infants with cleft palate (CP) decrease their... more IntroductionThe craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a ‘low-cost, high-impact’ intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial.Methods and analysisThe aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3–5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep.Research plan1. Multicentre randomised controlled trial of side-lying compared with back-lyin...
Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently... more Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently established to deliver genomic testing with equity of access for patients affected by rare diseases and cancer. The overarching aim of this research is to evaluate the implementation of the GMS during its early years, identify barriers and enablers to successful implementation, and provide recommendations for practice. The focus will be on the use of genomic testing for paediatric rare diseases. Methods: This will be a four-year mixed-methods research programme using clinic observations, interviews and surveys. Study 1 consists of qualitative interviews with designers/implementers of the GMS in Year 1 of the research programme, along with documentary analysis to understand the intended outcomes for the Service. These will be revisited in Year 4 to compare intended outcomes with what happened in practice, and to identify barriers and facilitators that were encountered along the way. Stud...
BackgroundChildren with Down syndrome (DS) are at high risk of respiratory tract infections (RTIs... more BackgroundChildren with Down syndrome (DS) are at high risk of respiratory tract infections (RTIs) due to anatomical variations, comorbidities, and immune system immaturity. Evidence on interventions to reduce this risk is incomplete. This study aims to quantify the effect of antibiotics prescribed for RTIs in primary care on the subsequent risk of RTI‐related hospitalization for children with DS versus controls.MethodsWe conducted a retrospective cohort study of 992 children with DS and 4874 controls managed by UK National Health Service General Practitioners (GPs) and hospitals as identified in CALIBER (Clinical disease research using LInked Bespoke studies and Electronic health Records), 1997–2010. Univariate and multivariate logistic regression were undertaken.ResultsIn children with DS, the prescription of antibiotics following an RTI‐related GP consultation did not significantly reduce the risk of RTI‐related hospitalization in the subsequent 28 days (risk with antibiotics, 1....
Purpose: Infectious diseases are one of the leading causes of death among children under five (U5... more Purpose: Infectious diseases are one of the leading causes of death among children under five (U5s) across both India & globally. This is worse in slum environments with poor access to water, sanitation & hygiene (WASH), good nutrition & a safe built environment. Globally, a One Health (e.g. human, animal & environment) approach is increasingly advocated by WHO, FAO & OIE to reduce infections & antimicrobial resistance. As U5s living in peri-urban slums are exposed to household and community owned companion & livestock animals and pests, the CHIP Consortium hypothesized that utilizing a One Health approach to co-produce behavior change & slum upgrading interventions may reduce this burden where other WASH & nutrition interventions have failed. This study aimed to assess the feasibility of utilising a One Health approach to assess U5 infection & risk factor prevalence in Jaipurs urban slums prior to undertaking prospective cohort studies involving culture and culture independent samp...
Informal settlements are home to over one billion people worldwide and are characterised by high ... more Informal settlements are home to over one billion people worldwide and are characterised by high population densities and poor environmental conditions. The authors identify the impact of COVID-19 on existing water and sanitation practices and potential pathways for transmission of COVID-19 in informal settlements in India and Indonesia. In the short term, there is an urgent need for mobile hand washing, washing/bathing facilities and toilets. In the long term, COVID-19 provides an opportunity to invest in centralised water and sanitation networked solutions appropriated for high-density settings to integrate those settlements into the city, improve environmental conditions and health in cities.
This paper identifies opportunities from targeted and integrated sanitation action to achieve the... more This paper identifies opportunities from targeted and integrated sanitation action to achieve the Sustainable Development Goals (SDGs). This is contextualised to the case of Brazil through a systematic approach applied to the sanitation sector that considers the range of infrastructure, management services and people involved in different phases of the service chain, from municipal wastewater containment to safe disposal or re‐use. Articulating the social, economic and environmental dimensions of sanitation, this study analyses their links with each of the 169 SDG targets. We demonstrate that 87 targets across 16 goals require action in Brazil's sanitation sector to achieve the SDGs. Furthermore, we identify synergies between sanitation and 124 targets in four domains: basic services for resilience building, equity and empowerment, pollution reduction and waste reuse and economic well‐being. Key results include the need for Brazil to invest in closed‐loop systems that valorise w...
Introduction The RCPCH endorsed Brain Pathways Guideline (www.headsmart.org.uk) for selecting pat... more Introduction The RCPCH endorsed Brain Pathways Guideline (www.headsmart.org.uk) for selecting patients for scanning with symptoms of brain tumour has been a sustained collaboration between Children's Brain Tumour Research Centre (CBTRC), Samantha Dickson Brain Tumour Trust (SDBTT), University of Southampton and the RCPCH. The clinical guideline and the HeadSmart Campaign aim to reduce median symptom interval (SI) for UK children to 5 weeks, by enhancing public and professional awareness and offering web-based support for selection of children for scanning, observation or reassurance. The strategy was developed in response to: ▶ delays in diagnosis observed by specialists; ▶ media reports of delays; ▶ questions in the House of Commons; ▶ the All Party Parliamentary Group Manifesto (2010), which placed delays in diagnosis as its top action point. Aims The HeadSmart campaign aims to reduce SI to a median of 5 weeks, to equal the best reported worldwide. It is supported by a decision support website, a Clinical Champions' network recording SI for newly diagnosed patients, and an evaluation programme; a Health Economic model is in development. Methods CBTRC developed a research strategy, SDBTT identified funding from Community Fund (2002). A literature review, meta-analysis of reported symptom intervals and a Delphi consensus process generated the Clinical Guideline which was endorsed by RCPCH (2005) and supported by other Colleges, accredited by NHS Evidence and is being considered within NICE Cancer Referral Guidance review. The dissemination strategy included: ▶ Survey of healthcare professionals' awareness of childhood brain tumours and the HeadSmart campaign ▶ Survey of public awareness of childhood brain tumours and the HeadSmart campaign ▶ Development of the HeadSmart website ▶ Presentation of guideline material at regional and national professional meetings ▶ Recruitment of clinical champions ▶ Media campaign – television, radio and facebook Concurrent government reports have prioritised timely diagnosis and access to treatment and justify prioritisation of children within health service developments. Conclusions This approach is enhancing awareness of clinical presentations of a rare but important childhood condition in primary and secondary care. Early results (see linked abstracts) show promising reduction in SI, the campaign will run until 2013. This model of prioritising diagnostics in children may be applicable to other childhood conditions.
Objective:To systematically review the literature with the primary aim of identifying behavioural... more Objective:To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups.Design:Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools.Setting:Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020.Participants:Patient or population including pregnant women, newborns and children aged under...
IntroductionEvery year 2.4 million deaths occur worldwide in babies younger than 28 days. Approxi... more IntroductionEvery year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice.Methods and analysisThis is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in additi...
Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Afr... more Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all ...
IntroductionThe craniofacial abnormalities found in infants with cleft palate (CP) decrease their... more IntroductionThe craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a ‘low-cost, high-impact’ intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial.Methods and analysisThe aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3–5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep.Research plan1. Multicentre randomised controlled trial of side-lying compared with back-lyin...
Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently... more Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently established to deliver genomic testing with equity of access for patients affected by rare diseases and cancer. The overarching aim of this research is to evaluate the implementation of the GMS during its early years, identify barriers and enablers to successful implementation, and provide recommendations for practice. The focus will be on the use of genomic testing for paediatric rare diseases. Methods: This will be a four-year mixed-methods research programme using clinic observations, interviews and surveys. Study 1 consists of qualitative interviews with designers/implementers of the GMS in Year 1 of the research programme, along with documentary analysis to understand the intended outcomes for the Service. These will be revisited in Year 4 to compare intended outcomes with what happened in practice, and to identify barriers and facilitators that were encountered along the way. Stud...
BackgroundChildren with Down syndrome (DS) are at high risk of respiratory tract infections (RTIs... more BackgroundChildren with Down syndrome (DS) are at high risk of respiratory tract infections (RTIs) due to anatomical variations, comorbidities, and immune system immaturity. Evidence on interventions to reduce this risk is incomplete. This study aims to quantify the effect of antibiotics prescribed for RTIs in primary care on the subsequent risk of RTI‐related hospitalization for children with DS versus controls.MethodsWe conducted a retrospective cohort study of 992 children with DS and 4874 controls managed by UK National Health Service General Practitioners (GPs) and hospitals as identified in CALIBER (Clinical disease research using LInked Bespoke studies and Electronic health Records), 1997–2010. Univariate and multivariate logistic regression were undertaken.ResultsIn children with DS, the prescription of antibiotics following an RTI‐related GP consultation did not significantly reduce the risk of RTI‐related hospitalization in the subsequent 28 days (risk with antibiotics, 1....
Purpose: Infectious diseases are one of the leading causes of death among children under five (U5... more Purpose: Infectious diseases are one of the leading causes of death among children under five (U5s) across both India & globally. This is worse in slum environments with poor access to water, sanitation & hygiene (WASH), good nutrition & a safe built environment. Globally, a One Health (e.g. human, animal & environment) approach is increasingly advocated by WHO, FAO & OIE to reduce infections & antimicrobial resistance. As U5s living in peri-urban slums are exposed to household and community owned companion & livestock animals and pests, the CHIP Consortium hypothesized that utilizing a One Health approach to co-produce behavior change & slum upgrading interventions may reduce this burden where other WASH & nutrition interventions have failed. This study aimed to assess the feasibility of utilising a One Health approach to assess U5 infection & risk factor prevalence in Jaipurs urban slums prior to undertaking prospective cohort studies involving culture and culture independent samp...
Informal settlements are home to over one billion people worldwide and are characterised by high ... more Informal settlements are home to over one billion people worldwide and are characterised by high population densities and poor environmental conditions. The authors identify the impact of COVID-19 on existing water and sanitation practices and potential pathways for transmission of COVID-19 in informal settlements in India and Indonesia. In the short term, there is an urgent need for mobile hand washing, washing/bathing facilities and toilets. In the long term, COVID-19 provides an opportunity to invest in centralised water and sanitation networked solutions appropriated for high-density settings to integrate those settlements into the city, improve environmental conditions and health in cities.
This paper identifies opportunities from targeted and integrated sanitation action to achieve the... more This paper identifies opportunities from targeted and integrated sanitation action to achieve the Sustainable Development Goals (SDGs). This is contextualised to the case of Brazil through a systematic approach applied to the sanitation sector that considers the range of infrastructure, management services and people involved in different phases of the service chain, from municipal wastewater containment to safe disposal or re‐use. Articulating the social, economic and environmental dimensions of sanitation, this study analyses their links with each of the 169 SDG targets. We demonstrate that 87 targets across 16 goals require action in Brazil's sanitation sector to achieve the SDGs. Furthermore, we identify synergies between sanitation and 124 targets in four domains: basic services for resilience building, equity and empowerment, pollution reduction and waste reuse and economic well‐being. Key results include the need for Brazil to invest in closed‐loop systems that valorise w...
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Papers by Monica Lakhanpaul