kamini Jain - Academia.edu (original) (raw)
Papers by kamini Jain
Cochrane Database of Systematic Reviews
British Paediatric Respiratory Society
children who are admitted on high flow oxygen can be weaned to low flow oxygen in under 3 months.... more children who are admitted on high flow oxygen can be weaned to low flow oxygen in under 3 months. Although no specific risk factors were identified, it was recognised that the average length of time spent ventilated in NICU was greater than for babies who were not admitted to the respiratory ward. These figures are helpful information for parents of these babies. They have formed the basis of MDT work between neonatologists and respiratory physicians to improve inpatient management
Paediatric respiratory epidemiology, 2020
European Respiratory Journal, 2020
Cystic fibrosis (CF) is one of the commonest life-limiting genetic disorders in the Caucasian pop... more Cystic fibrosis (CF) is one of the commonest life-limiting genetic disorders in the Caucasian population. Management involves frequent administration of antibiotics including aminoglycosides. With improving survival, it is time to focus on various age-related and treatment-associated adverse influences. The objective of this research was to evaluate renal function in CF, determine the effects of cumulative antibiotic exposure and to identify ways to reduce associated comorbidity. A cross-sectional study showed that a small number of adults and children with CF had low glomerular filtration rate (GFR), and there was no association between GFR and cumulative antibiotic exposure. An above normal GFR was identified in one in four children with CF. Estimated GFR calculated by creatinine-based equations did not accurately predict the GFR measured by the gold standard 51Cr-EDTA (51chromium-ethylenediamine tetraacetic Acid). Pure tone audiograms identified a raised hearing threshold in one ...
Paediatric respiratory infection and immun., 2021
European Respiratory Journal, 2020
Paediatric respiratory epidemiology, 2019
The Leicester Children’s Hospital offers specialist care to approximately 80 patients requiring l... more The Leicester Children’s Hospital offers specialist care to approximately 80 patients requiring long-term ventilation (LTV). In November 2015, funding was secured for a Specialist Clinical Psychologist to join the team as the first to hold a dedicated post with this population in the UK. In the first year, 12 referrals were made to Psychology representing approximately 15% of the patient population. In year two, a further 6 families were referred, followed by 7 more in year three. Projected data for year four suggests a further 12 families will be referred for psychological support. Referral numbers by end of year four will reach approximately 46% of the total patient population. In year two, 100% of referrals were for parents presenting with clinical levels of anxiety, distress and low mood associated with their child’s medical condition, predominantly those whose children required tracheostomy-ventilation. Current data indicates a trend for increasing numbers of fathers requiring support with managing feelings associated with having a child on LTV. Themes seem to include feelings of responsibility and guilt, managing shifts in perceived paternal role, and high anxiety relating to performing care tasks. Future service delivery will need to be shaped to account for differences in psychological needs between family members. Specific psychological interventions aimed at fathers can be piloted alongside other, family-based interventions. More research is needed into the long-term psychological impact of having a child requiring LTV on all parts of the family system and at different points in the journey.
Neonatology and paediatric intensive care, 2019
Background: Many children with complex health conditions and long-term ventilation (LTV) now surv... more Background: Many children with complex health conditions and long-term ventilation (LTV) now survive into adulthood, however, transition pathways for transfer from paediatric to adult LTV services are not well established. At our centre, young people on LTV were referred to adult team, without a formal transition process. Aims: To develop a transition pathway with an aim to provide a high-quality transition service for children on LTV Method: A scoping exercise was done to assess the number of patients between the ages 16-18 and 14-16 years. A transition themed day was organised including adult and paediatric LTV teams to explore ideas and plan the pathway. A letter was sent to families that explained the process and invited them to share queries or suggestions. A transition activity was planned and undertaken every 3 months as an alternate transition clinic and a transition meeting. Patients eligible for transition were discussed in the transition meetings and seen in transition clinics, where adult and paediatric multidisciplinary teams consulted jointly. Patient feedback was requested. A transition passport was prepared to use prospectively for 14-16 year old patients. Results: After implementation of the transition pathway, 11 patients were transitioned in one-year period, all of whom had met the adult team and had been discussed in the transition meetings compared to none in the previous years. Patient feedback was 100% positive. There is a regular communication between the adult and paediatric teams. Conclusion: A formal transition pathway for children with LTV improves communication, delivers better handover of care to adult team and enhances patient satisfaction.
M-health/e-health, 2019
Introduction: The paediatric long-term ventilation and complex respiratory care team is responsib... more Introduction: The paediatric long-term ventilation and complex respiratory care team is responsible for care of 231 children including 75 on long-term ventilation. These children need regular reviews, aimed at preventing infection and hospital admissions and maintaining optimal lung health. Due to their multiple issues, it is difficult for parents to bring them to hospital frequently for follow up appointments. We organised virtual clinics to review these children. A multidisciplinary team (respiratory consultants and trainees, specialist nurses, physiotherapists, psychologist, admin and speech therapists) attends these clinics. Aims: To assess the utility of virtual clinics in management of children with long-term ventilation and complex respiratory needs, and effect on parental and staff satisfaction Methods: We reviewed the data from our virtual clinic between May 2017- December 2018. Data on parental and staff satisfaction were collected. Results: During the 20 month period (May 2017- December 2018), 504 patients were discussed in weekly virtual clinics. Various aspects assessed in these clinics included pertinent microbiology, recent sleep studies and decisions on weaning home oxygen, and review of emergency management plans. Parents were updated on virtual clinic outcomes. Staff and parental satisfaction improved following the introduction of virtual clinic. Conclusion: Virtual clinic ensured timely reviews of our patient cohort and helped us to improve care of children in the community, this improved both parental and staff satisfaction.
Paediatric respiratory infection and immun., 2019
Paediatric respiratory infection and immun., 2019
QUALITY IMPROVEMENT; EMBEDDING A CULTURE OF QUALITY IMPROVEMENT, 2019
Background and aims The paediatric long-term ventilation (LTV) team is responsible for the care o... more Background and aims The paediatric long-term ventilation (LTV) team is responsible for the care of 231 children, 75 of these children are having long-term ventilation including invasive tracheostomy ventilation and non-invasive mask ventilation. The team receives enquiries from parents and community team during the week, there is additional workload from jobs created from clinic reviews, discussions in virtual clinic and clinical reviews of these children. To deal with the jobs more efficiently and to ensure that all jobs are undertaken aptly, we designed a red amber green (RAG) approach to manage these jobs. We present the data on our experience in using the RAG approach in managing our workload over the last 16 months (May 2017- September 2018). Methods All jobs for the LTV team were noted in the LTV database, all team members had access to this database. All pending jobs were initially red; these were turned to green when completed. Data on pending jobs and whether jobs were completed aptly, and staff satisfaction were collected. Results A total of 381 jobs were noted in LTV database from May 2017 to September 2018. 84 oximetry results were chased. 45 repeat oximetries, 11 polysomnographies and 18 capnographies were arranged. Results of 140 respiratory samples were chased, 43 children were thereafter started on antibiotics. The above results and management plans were discussed with parents. Clinical reviews were arranged for 21 children. 74 community referrals were sorted. 10 referrals to other specialties were done. 15 repeat prescriptions were sent. 11 Respiratory emergency management plans were updated. RAG approach ensured that all jobs were completed timely and appropriately, weekly reviews of the database helped ensure that the team was up to date with the pending jobs. There was improved staff satisfaction with the RAG approach. Conclusions The LTV team coordinates the care of children with complex respiratory issues and has high workload with varied issues including chasing pending results, organising investigations, starting medications and arranging clinical reviews. The RAG approach helped the LTV team to better organise the workload, pending jobs were completed timely and aptly and this improved both parental and staff satisfaction.
QUALITY IMPROVEMENT; EMBEDDING A CULTURE OF QUALITY IMPROVEMENT, 2019
Introduction The paediatric long-term ventilation (LTV) team is responsible for the care of 231 c... more Introduction The paediatric long-term ventilation (LTV) team is responsible for the care of 231 children, 75 of these children are having long-term ventilation including invasive tracheostomy ventilation and non-invasive mask ventilation. Our cohort of children benefit from regular reviews aimed at prevention of infection and keeping them healthy. Due to their underlying issues, it is difficult for parents to bring them to hospital frequently. We therefore started virtual clinics to review these children. Virtual clinics are booked clinics where the patients do not attend in person. We take referrals from our community team and neighboring trusts. Our LTV multidisciplinary team that includes respiratory consultants and trainees, specialist nurses, physiotherapists, psychologist, admin and speech therapists, attends these clinics. Aims The aim of this study was to review the working of virtual clinic and the parental and staff satisfaction following its introduction. Methods We reviewed our data from the virtual clinic over 12 months (September 2015- September 2016). Data on parental and staff satisfaction were collated. Results 272 patients were reviewed during this period in weekly virtual clinic that were conducted over a 2 hour period every Wednesday morning. Up to 10 children were reviewed during each virtual clinic. These reviews included review of recent microbiology, results of recent sleep studies and decision on weaning home oxygen and reviews of respiratory emergency management plans. Children were also discharged sooner from the hospital with the provision of follow up in virtual clinic, thereby helping reducing the length of stay. All the virtual clinic reviews were discussed with parents. There was improved staff and parental satisfaction following the introduction of virtual clinic. Conclusion Virtual clinic helps in timely reviews of our paediatric LTV cohort without these children having to travel to the hospital. This reduced the pressure on our outpatient waiting lists, prevented hospital admissions and helped in reducing the length of stay. Virtual clinics are a cost effective way of providing patient care for children with complex respiratory problems. The virtual clinic helped the LTV team to better manage children in the community and this improved both parental and staff satisfaction
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, Jan 15, 2015
Circadian variation in renal toxicity of aminoglycosides has been demonstrated in animal and huma... more Circadian variation in renal toxicity of aminoglycosides has been demonstrated in animal and human studies. People with CF are frequently prescribed aminoglycosides. Altered pharmacokinetics of aminoglycosides are predictive of toxicity. To investigate whether the time of day of aminoglycoside administration modulates renal excretion of tobramycin and toxicity in children with CF. To determine whether circadian rhythms are disrupted in children with CF during hospital admission. Children (age 5-18years) with CF scheduled for tobramycin therapy were randomly allocated to receive tobramycin at 0800 or 2000h. Serum tobramycin levels were drawn at 1h and between 3.5 and 5h post-infusion between days 5 and 9 of therapy. Melatonin levels were measured serially at intervals from 1800h in the evening until 1200h on the next day. Circadian rhythm was categorised as normal when dim light melatonin onset was demonstrated between 1800 and 2200h and/or peak melatonin levels were observed during ...
The Indian Journal of Pediatrics, 2000
Cochrane Database of Systematic Reviews, 2013
Editorial group: Cochrane Cystic Fibrosis and Genetic Disorders Group Publication status and date... more Editorial group: Cochrane Cystic Fibrosis and Genetic Disorders Group Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 9, 2018.
Journal of Cystic Fibrosis, 2013
Journal of Cystic Fibrosis, 2013
Chronic kidney disease (CKD) in cystic fibrosis is becoming increasingly recognized. Formal metho... more Chronic kidney disease (CKD) in cystic fibrosis is becoming increasingly recognized. Formal methods to measure glomerular filtration rate (GFR) are cumbersome. A rapid, minimally-invasive method of measuring GFR would be useful. Methods: GFR was measured using Cr 51 EDTA in stable CF patients. Serum creatinine and cystatin C, and a urinary biomarker panel (including KIM1, NAG, Il-18, NGAL and cystatin C) were assayed. GFR was estimated using creatinine (Schwartz formula for children; MDRD formula for adults) and cystatin C based formulas (MacIsaac and Larsson). Bland-Altman plots were used to evaluate agreement. Received operator characteristic (ROC) plots were used to evaluate the ability of estimated GFR and urinary biomarkers to classify patients as stage II CKD or worse (GFR <90 ml/min/1.73 m 2). Results: GFR and creatinine were measured in 67 patients (51 children and 16 adults); biomarkers were available for 63 patients. GFR was low (Stage II CKD; <90 ml/min/1.73 m 2) in 6/67 (9.0%) of patients. Creatinine and cystatin C based formulas for predicting GFR performed poorly (see table). KIM-1 performed best at predicting low GFR (sensitivity 83% and specificity 72%).
Cochrane Database of Systematic Reviews
British Paediatric Respiratory Society
children who are admitted on high flow oxygen can be weaned to low flow oxygen in under 3 months.... more children who are admitted on high flow oxygen can be weaned to low flow oxygen in under 3 months. Although no specific risk factors were identified, it was recognised that the average length of time spent ventilated in NICU was greater than for babies who were not admitted to the respiratory ward. These figures are helpful information for parents of these babies. They have formed the basis of MDT work between neonatologists and respiratory physicians to improve inpatient management
Paediatric respiratory epidemiology, 2020
European Respiratory Journal, 2020
Cystic fibrosis (CF) is one of the commonest life-limiting genetic disorders in the Caucasian pop... more Cystic fibrosis (CF) is one of the commonest life-limiting genetic disorders in the Caucasian population. Management involves frequent administration of antibiotics including aminoglycosides. With improving survival, it is time to focus on various age-related and treatment-associated adverse influences. The objective of this research was to evaluate renal function in CF, determine the effects of cumulative antibiotic exposure and to identify ways to reduce associated comorbidity. A cross-sectional study showed that a small number of adults and children with CF had low glomerular filtration rate (GFR), and there was no association between GFR and cumulative antibiotic exposure. An above normal GFR was identified in one in four children with CF. Estimated GFR calculated by creatinine-based equations did not accurately predict the GFR measured by the gold standard 51Cr-EDTA (51chromium-ethylenediamine tetraacetic Acid). Pure tone audiograms identified a raised hearing threshold in one ...
Paediatric respiratory infection and immun., 2021
European Respiratory Journal, 2020
Paediatric respiratory epidemiology, 2019
The Leicester Children’s Hospital offers specialist care to approximately 80 patients requiring l... more The Leicester Children’s Hospital offers specialist care to approximately 80 patients requiring long-term ventilation (LTV). In November 2015, funding was secured for a Specialist Clinical Psychologist to join the team as the first to hold a dedicated post with this population in the UK. In the first year, 12 referrals were made to Psychology representing approximately 15% of the patient population. In year two, a further 6 families were referred, followed by 7 more in year three. Projected data for year four suggests a further 12 families will be referred for psychological support. Referral numbers by end of year four will reach approximately 46% of the total patient population. In year two, 100% of referrals were for parents presenting with clinical levels of anxiety, distress and low mood associated with their child’s medical condition, predominantly those whose children required tracheostomy-ventilation. Current data indicates a trend for increasing numbers of fathers requiring support with managing feelings associated with having a child on LTV. Themes seem to include feelings of responsibility and guilt, managing shifts in perceived paternal role, and high anxiety relating to performing care tasks. Future service delivery will need to be shaped to account for differences in psychological needs between family members. Specific psychological interventions aimed at fathers can be piloted alongside other, family-based interventions. More research is needed into the long-term psychological impact of having a child requiring LTV on all parts of the family system and at different points in the journey.
Neonatology and paediatric intensive care, 2019
Background: Many children with complex health conditions and long-term ventilation (LTV) now surv... more Background: Many children with complex health conditions and long-term ventilation (LTV) now survive into adulthood, however, transition pathways for transfer from paediatric to adult LTV services are not well established. At our centre, young people on LTV were referred to adult team, without a formal transition process. Aims: To develop a transition pathway with an aim to provide a high-quality transition service for children on LTV Method: A scoping exercise was done to assess the number of patients between the ages 16-18 and 14-16 years. A transition themed day was organised including adult and paediatric LTV teams to explore ideas and plan the pathway. A letter was sent to families that explained the process and invited them to share queries or suggestions. A transition activity was planned and undertaken every 3 months as an alternate transition clinic and a transition meeting. Patients eligible for transition were discussed in the transition meetings and seen in transition clinics, where adult and paediatric multidisciplinary teams consulted jointly. Patient feedback was requested. A transition passport was prepared to use prospectively for 14-16 year old patients. Results: After implementation of the transition pathway, 11 patients were transitioned in one-year period, all of whom had met the adult team and had been discussed in the transition meetings compared to none in the previous years. Patient feedback was 100% positive. There is a regular communication between the adult and paediatric teams. Conclusion: A formal transition pathway for children with LTV improves communication, delivers better handover of care to adult team and enhances patient satisfaction.
M-health/e-health, 2019
Introduction: The paediatric long-term ventilation and complex respiratory care team is responsib... more Introduction: The paediatric long-term ventilation and complex respiratory care team is responsible for care of 231 children including 75 on long-term ventilation. These children need regular reviews, aimed at preventing infection and hospital admissions and maintaining optimal lung health. Due to their multiple issues, it is difficult for parents to bring them to hospital frequently for follow up appointments. We organised virtual clinics to review these children. A multidisciplinary team (respiratory consultants and trainees, specialist nurses, physiotherapists, psychologist, admin and speech therapists) attends these clinics. Aims: To assess the utility of virtual clinics in management of children with long-term ventilation and complex respiratory needs, and effect on parental and staff satisfaction Methods: We reviewed the data from our virtual clinic between May 2017- December 2018. Data on parental and staff satisfaction were collected. Results: During the 20 month period (May 2017- December 2018), 504 patients were discussed in weekly virtual clinics. Various aspects assessed in these clinics included pertinent microbiology, recent sleep studies and decisions on weaning home oxygen, and review of emergency management plans. Parents were updated on virtual clinic outcomes. Staff and parental satisfaction improved following the introduction of virtual clinic. Conclusion: Virtual clinic ensured timely reviews of our patient cohort and helped us to improve care of children in the community, this improved both parental and staff satisfaction.
Paediatric respiratory infection and immun., 2019
Paediatric respiratory infection and immun., 2019
QUALITY IMPROVEMENT; EMBEDDING A CULTURE OF QUALITY IMPROVEMENT, 2019
Background and aims The paediatric long-term ventilation (LTV) team is responsible for the care o... more Background and aims The paediatric long-term ventilation (LTV) team is responsible for the care of 231 children, 75 of these children are having long-term ventilation including invasive tracheostomy ventilation and non-invasive mask ventilation. The team receives enquiries from parents and community team during the week, there is additional workload from jobs created from clinic reviews, discussions in virtual clinic and clinical reviews of these children. To deal with the jobs more efficiently and to ensure that all jobs are undertaken aptly, we designed a red amber green (RAG) approach to manage these jobs. We present the data on our experience in using the RAG approach in managing our workload over the last 16 months (May 2017- September 2018). Methods All jobs for the LTV team were noted in the LTV database, all team members had access to this database. All pending jobs were initially red; these were turned to green when completed. Data on pending jobs and whether jobs were completed aptly, and staff satisfaction were collected. Results A total of 381 jobs were noted in LTV database from May 2017 to September 2018. 84 oximetry results were chased. 45 repeat oximetries, 11 polysomnographies and 18 capnographies were arranged. Results of 140 respiratory samples were chased, 43 children were thereafter started on antibiotics. The above results and management plans were discussed with parents. Clinical reviews were arranged for 21 children. 74 community referrals were sorted. 10 referrals to other specialties were done. 15 repeat prescriptions were sent. 11 Respiratory emergency management plans were updated. RAG approach ensured that all jobs were completed timely and appropriately, weekly reviews of the database helped ensure that the team was up to date with the pending jobs. There was improved staff satisfaction with the RAG approach. Conclusions The LTV team coordinates the care of children with complex respiratory issues and has high workload with varied issues including chasing pending results, organising investigations, starting medications and arranging clinical reviews. The RAG approach helped the LTV team to better organise the workload, pending jobs were completed timely and aptly and this improved both parental and staff satisfaction.
QUALITY IMPROVEMENT; EMBEDDING A CULTURE OF QUALITY IMPROVEMENT, 2019
Introduction The paediatric long-term ventilation (LTV) team is responsible for the care of 231 c... more Introduction The paediatric long-term ventilation (LTV) team is responsible for the care of 231 children, 75 of these children are having long-term ventilation including invasive tracheostomy ventilation and non-invasive mask ventilation. Our cohort of children benefit from regular reviews aimed at prevention of infection and keeping them healthy. Due to their underlying issues, it is difficult for parents to bring them to hospital frequently. We therefore started virtual clinics to review these children. Virtual clinics are booked clinics where the patients do not attend in person. We take referrals from our community team and neighboring trusts. Our LTV multidisciplinary team that includes respiratory consultants and trainees, specialist nurses, physiotherapists, psychologist, admin and speech therapists, attends these clinics. Aims The aim of this study was to review the working of virtual clinic and the parental and staff satisfaction following its introduction. Methods We reviewed our data from the virtual clinic over 12 months (September 2015- September 2016). Data on parental and staff satisfaction were collated. Results 272 patients were reviewed during this period in weekly virtual clinic that were conducted over a 2 hour period every Wednesday morning. Up to 10 children were reviewed during each virtual clinic. These reviews included review of recent microbiology, results of recent sleep studies and decision on weaning home oxygen and reviews of respiratory emergency management plans. Children were also discharged sooner from the hospital with the provision of follow up in virtual clinic, thereby helping reducing the length of stay. All the virtual clinic reviews were discussed with parents. There was improved staff and parental satisfaction following the introduction of virtual clinic. Conclusion Virtual clinic helps in timely reviews of our paediatric LTV cohort without these children having to travel to the hospital. This reduced the pressure on our outpatient waiting lists, prevented hospital admissions and helped in reducing the length of stay. Virtual clinics are a cost effective way of providing patient care for children with complex respiratory problems. The virtual clinic helped the LTV team to better manage children in the community and this improved both parental and staff satisfaction
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, Jan 15, 2015
Circadian variation in renal toxicity of aminoglycosides has been demonstrated in animal and huma... more Circadian variation in renal toxicity of aminoglycosides has been demonstrated in animal and human studies. People with CF are frequently prescribed aminoglycosides. Altered pharmacokinetics of aminoglycosides are predictive of toxicity. To investigate whether the time of day of aminoglycoside administration modulates renal excretion of tobramycin and toxicity in children with CF. To determine whether circadian rhythms are disrupted in children with CF during hospital admission. Children (age 5-18years) with CF scheduled for tobramycin therapy were randomly allocated to receive tobramycin at 0800 or 2000h. Serum tobramycin levels were drawn at 1h and between 3.5 and 5h post-infusion between days 5 and 9 of therapy. Melatonin levels were measured serially at intervals from 1800h in the evening until 1200h on the next day. Circadian rhythm was categorised as normal when dim light melatonin onset was demonstrated between 1800 and 2200h and/or peak melatonin levels were observed during ...
The Indian Journal of Pediatrics, 2000
Cochrane Database of Systematic Reviews, 2013
Editorial group: Cochrane Cystic Fibrosis and Genetic Disorders Group Publication status and date... more Editorial group: Cochrane Cystic Fibrosis and Genetic Disorders Group Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 9, 2018.
Journal of Cystic Fibrosis, 2013
Journal of Cystic Fibrosis, 2013
Chronic kidney disease (CKD) in cystic fibrosis is becoming increasingly recognized. Formal metho... more Chronic kidney disease (CKD) in cystic fibrosis is becoming increasingly recognized. Formal methods to measure glomerular filtration rate (GFR) are cumbersome. A rapid, minimally-invasive method of measuring GFR would be useful. Methods: GFR was measured using Cr 51 EDTA in stable CF patients. Serum creatinine and cystatin C, and a urinary biomarker panel (including KIM1, NAG, Il-18, NGAL and cystatin C) were assayed. GFR was estimated using creatinine (Schwartz formula for children; MDRD formula for adults) and cystatin C based formulas (MacIsaac and Larsson). Bland-Altman plots were used to evaluate agreement. Received operator characteristic (ROC) plots were used to evaluate the ability of estimated GFR and urinary biomarkers to classify patients as stage II CKD or worse (GFR <90 ml/min/1.73 m 2). Results: GFR and creatinine were measured in 67 patients (51 children and 16 adults); biomarkers were available for 63 patients. GFR was low (Stage II CKD; <90 ml/min/1.73 m 2) in 6/67 (9.0%) of patients. Creatinine and cystatin C based formulas for predicting GFR performed poorly (see table). KIM-1 performed best at predicting low GFR (sensitivity 83% and specificity 72%).