G310 Canadian and united kingdom/ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis; a PERC and PERUKI study

2019 ◽  
Author(s):  
L Simone ◽  
MD Lyttle ◽  
D Roland ◽  
D Stephens ◽  
S Schuh
Keyword(s):  
United Kingdom ◽  
Lumbar Puncture ◽  
Practice Patterns

scholarly journals Inequity in Access to Transplantation in the United Kingdom

2020 ◽  
Vol 15 (6) ◽  
pp. 830-842 ◽  
Author(s):  
Rishi Pruthi ◽  
Matthew L. Robb ◽  
Gabriel C. Oniscu ◽  
Charles Tomson ◽  
Andrew Bradley ◽  
...  
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Kidney Transplantation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Practice Patterns ◽  
Universal Health Care ◽  
The United Kingdom ◽  
Universal Health Care System ◽  
Universal Health

Background and objectivesDespite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns.Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center.ResultsSeven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9).ConclusionsPatient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.

scholarly journals Practice Patterns and Opening Pressure Measurements Using Fluoroscopically Guided Lumbar Puncture

2012 ◽  
Vol 33 (5) ◽  
pp. 823-825 ◽  
Author(s):  
A.S. Abel ◽  
J.R. Brace ◽  
A.M. Mckinney ◽  
A.R. Harrison ◽  
M.S. Lee
Keyword(s):  
Lumbar Puncture ◽  
Practice Patterns ◽  
Pressure Measurements ◽  
Opening Pressure

scholarly journals Prevention of headache after lumbar puncture: questionnaire survey of neurologists and neurosurgeons in United Kingdom:

BMJ ◽  
1998 ◽  
Vol 316 (7146) ◽  
pp. 1709-1710 ◽  
Author(s):  
M G Serpell ◽  
G J Haldane ◽  
D R S Jamieson ◽  
D Carson
Keyword(s):  
United Kingdom ◽  
Lumbar Puncture ◽  
Questionnaire Survey

scholarly journals FP739VARIATION IN THE PRACTICE PATTERNS OF ASSESSING PATIENT SUITABILITY FOR RENAL TRANSPLANTATION IN THE UNITED KINGDOM

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii323-iii323
Author(s):  
Rishi Pruthi ◽  
Sarah Tonkin-Crine ◽  
Melania Calestani ◽  
Rommel Ravanan ◽  
Geraldine Leydon ◽  
...  
Keyword(s):  
United Kingdom ◽  
Renal Transplantation ◽  
Practice Patterns ◽  
The United Kingdom

scholarly journals Variation in Practice Patterns for Listing Patients for Renal Transplantation in the United Kingdom

2018 ◽  
Vol 102 (6) ◽  
pp. 961-968 ◽  
Author(s):  
Rishi Pruthi ◽  
Sarah Tonkin-Crine ◽  
Melania Calestani ◽  
Geraldine Leydon ◽  
Caroline Eyles ◽  
...  
Keyword(s):  
United Kingdom ◽  
Renal Transplantation ◽  
Practice Patterns ◽  
The United Kingdom

scholarly journals Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis

2019 ◽  
Vol 36 (3) ◽  
pp. 148-153 ◽  
Author(s):  
Laura Simone ◽  
Mark D Lyttle ◽  
Damian Roland ◽  
Derek Stephens ◽  
Suzanne Schuh
Keyword(s):  
Lumbar Puncture ◽  
Bacterial Infections ◽  
Practice Patterns ◽  
Primary Objective ◽  
Comfort Level ◽  
Low Grade ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Young Infants ◽  
Syncytial Virus

BackgroundSerious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis.MethodsA cross-sectional survey of two national paediatric emergency research networks (PediatricEmergency Research Canada (PERC) and the PediatricEmergency Research UK/Ireland (PERUKI)) was conducted January to November 2017 using a modified Dillman technique. The survey was preceded by a clinical vignette describing a well appearing, 21-day-old infant with low-grade fever, respiratory findings typical of bronchiolitis and no perinatal serious bacterial infection (SBI) risk features.ResultsThe response rate from PERC was 169/250 (68%) and 172/201 (86%) from PERUKI. Nine physicians in training were excluded, leaving 332 eligible participants. Although most physicians believe that neonates with bronchiolitis rarely have meningitis (PERC 141/161 (87.6%); PERUKI 154/171 (90%)) and feel comfortable diagnosing bronchiolitis in this group (PERC 136/161 (84.5%); PERUKI 143/171 (83.6%)), there was significant variation in the proportion who would be likely/very likely to perform an LP (PERC 100/161 (62.1%); PERUKI 15/171 (8.8%)) (p<0.0001). Practice in Canada, <10 years in practice and lack of comfort with diagnosing bronchiolitis represent multivariable predictors of LP; OR 23.7 (95% CI 11.7 to 47.9), 2.3 (95% CI 1.2 to 4.2) and 2.5 (95% CI 1.1 to 5.0), respectively. Rapid knowledge of respiratory syncytial virus positivity would decrease LP probability from 35.4% to 20.2%.ConclusionEstimated probability of performing LPs and other interventions in otherwise healthy febrile neonates with bronchiolitis is highly variable between emergency physicians in Canada and the UK/Ireland. Network, <10 years in ED practice and comfort level with diagnosing bronchiolitis in newborns constitute independent predictors of the likelihood of LP performance.

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