Sarah Arnup

Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial

Objective To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years. Design Randomised controlled trial. Setting 22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia. Participants Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010. Intervention Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or “usual care” (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment. Main outcome measures Children’s body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents’ body mass index (all 15 months post-enrolment). Results 118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference −0.1 (95% confidence interval −0.7 to 0.5; P=0.7)) and body mass index z score (−0.05 (−0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score −0.20 (SD 0.25, range −0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight. Conclusions Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000055303.

How does the introduction of a pain and sedation management guideline in the paediatric intensive care impact on clinical practice? A comparison of audits pre and post guideline introduction

UNLABELLED Despite the use of guidelines to inform practice for pain and sedation management there are few evaluations of the effect of their introduction on clinical practice. Previous evaluations of the protocols and guidelines used to manage pain and sedation in the paediatric intensive care unit (PICU) report increases in pain and sedation medication administration post guideline introduction. In most reported cases the guideline was accompanied by a treatment algorithm. To our knowledge there is no published data on the effect of introducing a guideline without a treatment algorithm on pain and analgesia administration. PURPOSE To evaluate the impact the introduction of a pain and sedation guideline will have on clinical practice. METHODS A 19 bed PICU was audited for one month prior to the introduction of a guideline and one month post. FINDINGS The proportion of patients receiving oral Clonidine increased (p=0.001) and the administration of Ketamine, particularly via bolus (p=0.003), reduced after the introduction of the guideline. The use of a validated pain tool to assess pain increased by 25% and communication of management plans increased by 25%. The documentation of the use of boluses increased by 36%. CONCLUSION The introduction of a clinical practice guideline for pain and sedation management in PICU contributes to changes in medication administration, use of validated pain assessments, improved documentation of boluses and communication of management plans.

Sleep well--be well study: improving school transition by improving child sleep: a translational randomised trial.

Introduction The transition to primary school appears crucial for a childs future academic and psychological well-being. Addressing conditions which negatively affect children during this period, such as poor sleep, may improve these outcomes. Sleep problems are common and in a previous efficacy randomised controlled trial, we demonstrated that sleep problems can be identified and improved using school-based screening followed by a brief behavioural intervention. This trial will determine whether the same intervention is beneficial and cost-effective when delivered by an existing school-based health workforce. Methods/design We will recruit 334 children with sleep problems from approximately 40 schools after screening for behavioural sleep problems in the first year of formal education (Grade Prep). Schools in Melbourne, Australia will be invited to participate from a randomly ordered list of eligible schools and we will approach all caregivers of Grade Prep children. Children who have a parent-reported moderate or severe sleep problem will be randomised into either ‘usual care’ or ‘intervention’ groups. Trained nurses from the Primary School Nursing programme will deliver the sleep intervention programme. Intervention: Two to three contacts between the nurse and the parent; initial 45 min face-to-face meeting or phone call, 15 min phone call 2 weeks later and an optional second 30 min face-to-face meeting. Follow-up: 6 and 12 months postrandomisation using parent and teacher surveys and child face-to-face assessments. Primary outcome: child psychosocial functioning at 6 months. Secondary outcomes: child psychosocial functioning at 12 months and child sleep, behaviour, working memory, academic achievement and parent mental health at 6 and 12 months. Cost-effectiveness analysis will compare incremental costs to difference in child psychosocial functioning at 6 months. Registration International Standard Randomised Controlled Trial Number Register (ISRCTN92448857).

Early childhood nutrition, active outdoor play and sources of information for families living in highly socially disadvantaged locations.

To compare nutrition and active play of children aged 0–4 years attending Supported Playgroups and mainstream services and to compare access, understanding and application of health information within these families.

Characterising the ambient sound environment for infants in intensive care wards

The purpose of this study is to characterise ambient sound levels of paediatric and neonatal intensive care units in an old and new hospital according to current standards.

Intellectual disability in cerebral palsy: a population‐based retrospective study

A population‐based observational study design was used to describe the epidemiology of intellectual disability in cerebral palsy (CP) in terms of clinical and neuroimaging associations, and to report the impact of intellectual disability on utilization of health services and length of survival.

Sleep problems in the first year of elementary school: The role of sleep hygiene, gender and socioeconomic status

Objectives: To determine (1) the relationship between sleep hygiene practices and parent‐reported child sleep problems in students in the first year of elementary school, (2) whether the relationship differed by (a) gender and (b) SES and (3) in a multivariate explanatory model. Design: Cross‐sectional survey of a population‐based sample. Setting: Forty‐five elementary schools in metropolitan Melbourne, Australia. Participants: Families of children aged 4–6 years in the first year of elementary school in Melbourne, Australia. Measurements: Exposures: Parent‐reported child sleep hygiene, gender and data linkage to community‐based disadvantage. Outcome: Parent‐reported child sleep problems. Analyses: Logistic regression models were used to examine each aim. Results: Of 6635 approached parents, 4901 (74.30%) participated. In the final model, using audio devices at bedtime was associated with increased risk of child sleep problems (OR 2.12, 95% CI 1.60, 2.81) as was an inconsistent bedtime routine on school nights (OR 2.52, 95% CI 1.76, 3.60) and non‐school nights (OR 1.66, 95% CI 1.09, 2.55). Boys with an inconsistent bedtime routine on non‐school nights had a higher risk (OR 2.07, 95% 1.49, 2.88) than girls (OR 1.61, 95% CI 1.15, 2.28). SES was not associated with sleep problems. Conclusion: Inconsistent bedtime routines and audio device use were each associated with an increased risk of parent‐reported sleep problems. Associations did not differ based on SES but did for boys and girls in terms of inconsistent bedtimes on weekends. Behavioral sleep interventions targeting sleep hygiene could have similar benefits for all children, regardless of socio‐economic status.

Impact of a behavioral sleep intervention on new school entrants' social emotional functioning and sleep: a translational randomized trial

ABSTRACT Objective/Background: Determine the effects and costs of a brief behavioral sleep intervention, previously shown to improve child social-emotional functioning, sleep, and parent mental health, in a translational trial. Participants: Three hundred thirty-four school entrant children from 47 primary schools in Melbourne, Australia, with parent-reported moderate to severe behavioral sleep problems. Methods: intervention group received sleep hygiene practices and standardized behavioral strategies delivered by trained school nurses in 2013 and 2014. Control group children could receive usual community care. Results: Outcome measures: child social-emotional functioning (Pediatric Quality of Life Inventory 4.0 psychosocial health summary score—primary outcome), sleep problems (parent-reported severity, Children’s Sleep Habits Questionnaire), behavior, academic function, working memory, child and parent quality of life, and parent mental health. At six months post randomization, 145 (of 168) intervention and 155 (of 166) control families completed the primary outcome for which there was no difference. Intervention compared with control children had fewer sleep problems (35.2% vs. 52.7% respectively, OR 0.5; 95% CI 0.3 to 0.8, p = 0.002) and better sleep patterns (e.g., longer sleep duration). Their parents reported fewer symptoms of depression. All differences attenuated by 12 months. There was no difference in other outcomes at either time point. Intervention costs:

A survey of how mothers think about and use voice with their hospitalized newborn infant

AUS 182/child. Conclusions: A brief behavioral sleep intervention, delivered by school nurses to children with behavioral sleep problems, does not improve social emotional functioning. Benefits to child sleep and parent mental health are evident at 6 but not 12 months. Approaches that increase intervention dosage may improve outcomes.