Browsing by Person "Williams, Linda J."

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An analysis of clinical predictive values for radiographic pneumonia in children
(BMJ, 2020-08-13) Rees, Chris A.; Basnet, Sudha; Gentile, Angela; Gessner, Bradford D.; Kartasasmita, Cissy B.; Lucero, Marilla; Martinez, Luis; O'Grady, Kerry-Ann F.; Ruvinsky, Raul O.; Turner, Claudia; Campbell, Harry; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Nisar, Yasir B.; Qazi, Shamim A.; Neuman, Mark I.; The study was funded by the Bill & Melinda Gates Foundation (#OPP1106190) through a grant to the WHO.
Introduction: Healthcare providers in resource-limited settings rely on the presence of tachypnoea and chest indrawing to establish a diagnosis of pneumonia in children. We aimed to determine the test characteristics of commonly assessed signs and symptoms for the radiographic diagnosis of pneumonia in children 0–59 months of age. Methods: We conducted an analysis using patient-level pooled data from 41 shared datasets of paediatric pneumonia. We included hospital-based studies in which >80% of children had chest radiography performed. Primary endpoint pneumonia (presence of dense opacity occupying a portion or entire lobe of the lung or presence of pleural effusion on chest radiograph) was used as the reference criterion radiographic standard. We assessed the sensitivity, specificity, and likelihood ratios for clinical findings, and combinations of findings, for the diagnosis of primary endpoint pneumonia among children 0–59 months of age. Results: Ten studies met inclusion criteria comprising 15 029 children; 24.9% (n=3743) had radiographic pneumonia. The presence of age-based tachypnoea demonstrated a sensitivity of 0.92 and a specificity of 0.22 while lower chest indrawing revealed a sensitivity of 0.74 and specificity of 0.15 for the diagnosis of radiographic pneumonia. The sensitivity and specificity for oxygen saturation <90% was 0.40 and 0.67, respectively, and was 0.17 and 0.88 for oxygen saturation <85%. Specificity was improved when individual clinical factors such as tachypnoea, fever and hypoxaemia were combined, however, the sensitivity was lower. Conclusions: No single sign or symptom was strongly associated with radiographic primary end point pneumonia in children. Performance characteristics were improved by combining individual signs and symptoms.
External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia
(International Society of Global Health, 2021-10-09) Rees, Chris A.; Hooli, Shubhada; King, Carina; McCollum, Eric D.; Colbourn, Tim; Lufesi, Norman; Mwansambo, Charles; Lazzerini, Marzia; Madhi, Shabir Ahmed; Cutland, Clare; Nunes, Marta; Gessner, Bradford D.; Basnet, Sudha; Kartasasmita, Cissy B.; Mathew, Joseph L.; Zaman, Syed Mohammad Akram uz; Paranhos-Baccala, Glaucia; Bhatnagar, Shinjini; Wadhwa, Nitya; Lodha, Rakesh; Aneja, Satinder; Santosham, Mathuram; Picot, Valentina S.; Sylla, Mariam; Awasthi, Shally; Bavdekar, Ashish; Pape, Jean-William; Rouzier, Vanessa; Chou, Monidarin; Rakoto-Andrianarivelo, Mala; Wang, Jianwei; Nymadawa, Pagbajabyn; Vanhems, Philippe; Russomando, Graciela; Asghar, Rai; Banajeh, Salem; Iqbal, Imran; MacLeod, William; Maulen-Radovan, Irene; Mino, Greta; Saha, Samir; Singhi, Sunit; Thea, Donald M.; Clara, Alexey W.; Campbell, Harry.; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Qazi, Shamim A.; Nisar, Yasir B.; Neuman, Mark I.
Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.
The impact of meridian balance method electro-acupuncture treatment on chronic pelvic pain in women: a three-armed randomised controlled feasibility study using a mixed-methods approach
(SAGE Publications, 2018-05-14) Chong, Ooi Thye; Critchley, Hilary O. D.; Williams, Linda J.; Haraldsdottir, Erna; Horne, Andrew W.; Fallon, Marie T.
Introduction: Chronic pelvic pain (CPP) is estimated to affect 6%–27% of women worldwide. In the United Kingdom, over 1 million women suffer from CPP and it has been highlighted as a key area of unmet need. Standard treatments are associated with unacceptable side effects. The meridian balance method electro-acupuncture (BMEA), and traditional Chinese medicine health consultation (TCM HC) (BMEA + TCM HC = BMEA treatment) may be an effective adjunct to standard treatment. Aim: The aim of our study was to evaluate the feasibility of a future trial, to determine the effectiveness of the BMEA treatment for CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to assess the effectiveness of the BMEA treatment and acceptability of the study’s methodology. Methods: Women with CPP were randomised into BMEA treatment (group 1), TCM HC alone (group 2) (each intervention administered twice weekly for 4 weeks) or National Health Service standard care (NHS SC, group 3). Primary outcomes were assessed by the proportion of eligible participants randomised, and the proportion of randomised participants who returned follow-up questionnaires. Interventions were assessed by validated pain/physical/emotional functioning questionnaires at baseline (0), 4, 8 and 12 weeks. Focus groups and semi-structured telephone interviews were embedded in the study. Results: A total of 30 women (51% of those referred) were randomised over 8 months. Retention rates were 80% (95% confidence interval (CI): 74–96), 53% (95% CI: 36–70) and 87% (95% CI: 63–90), in groups 1, 2, and 3, respectively. Qualitative data suggested a favourable trial experience in groups 1 and 3. Discussion: Group 2 retention rate was problematic and has implications for our next trial. Conclusion: Our study suggests that a future trial to determine the effectiveness of BMEA treatment for women with CPP is feasible but with modifications to the study design.