The Impact of Biologic Therapies on Rate of Colectomy in Paediatric-onset Ulcerative Colitis - A Population-Based Cohort Study.

AIM: Biologic therapies have been associated with reduced rate of colectomy in ulcerative colitis (UC) in adults, but data are limited in paediatric-onset UC. Our aim was to define the rate of colectomy in paediatric-onset UC, including post-transition into adult care, and to evaluate the impact of biologic therapies on rate of colectomy. METHOD: All prevalent patients diagnosed with paediatric-onset UC in South-East Scotland were identified from a prospectively accrued database at our regional tertiary centre. Patients exposed to biologics or surgery were identified and further data collected from health records. Kaplan-Meier analysis was used to calculate cumulative risk of colectomy over time. RESULTS: 145 prevalent patients were identified between 2000 and 2021. Median follow-up was 7.9 years (IQR 4.1-13.1). 23 patients (16 %) underwent a colectomy. 50/145 (34 %) patients received biologic therapy, and 13/23 (57 %) patients who underwent colectomy received biologics. The cumulative risk of colectomy across the whole cohort at 1, 5, and 10 years was 3 %, 13 % and 16 %, respectively. Patients exposed to biologics had a higher colectomy rate at 5 and 10 years (22 % and 34 %). Patients in the pre-biologic era (2000-2008) had non-significantly reduced time from diagnosis to colectomy (2.4 vs 3.7 years, p = 0.204). CONCLUSION: We have defined the 1-, 5-, and 10-year colectomy rate in a population-based cohort of Paediatric-onset UC patients. Patients who received biologic therapy had a significantly increased risk of colectomy. Increased severity of disease in these patients may account for the greater colectomy risk. LEVEL OF EVIDENCE: Level 1.

Applicability of the revised trauma score in paediatric patients admitted to a South African intensive care unit: A retrospective cohort study.

CONTEXT: Revised Trauma Score (RTS) is a validated tool in assessing patients in a pre-hospital setting. There are limited data describing its potential use in guiding referral to intensive care. AIMS: Trauma scoring systems require appropriate validation in a local setting before effective application. This work examines the applicability of RTS to a paediatric intensive care trauma population. SETTINGS AND DESIGN: A retrospective record review of trauma patients admitted to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital between 2011 and 2013 was performed. SUBJECTS AND METHODS: The cohort was arbitrarily split into three subgroups based on RTS using the 33rd and 66th percentile values and groups compared. Outcome measures examined included mortality, age, gender, length of stay (LoS), duration of ventilation (DoV) and change in Glasgow Coma Scale (GCS) from admission to discharge. STATISTICAL ANALYSIS USED: Categorical values examined with Fisher's exact test. Non-categorical values examined with the Kruskal-Wallis and Dunn's multiple comparisons tests. RESULTS: Of 919 children admitted, 165 admissions were secondary to trauma. Data necessary for calculation of RTS were available in 91 patients. The mean RTS was 5.3, 33rd percentile was 4.7 and 66th was 5.9. DoV (P = 0.0104) and LoS (P = 0.0395) were significantly different between intermediate- and low-risk groups as was change in GCS between low-risk and both other groups (P < 0.0001). CONCLUSIONS: RTS is not predictive of mortality between high-risk (RTS < 4.09) and low-risk patients (RTS > 5.67) in this population. It may be useful in predicting other outcomes such as DoV and LoS.

Holmium Laser Enucleation of the Prostate: Simulation-Based Training Curriculum and Validation.

OBJECTIVE: To evaluate the face, content, and construct validity of a novel virtual reality simulator for holmium laser enucleation of the prostate (HoLEP) and to assess its feasibility and acceptability as a training model. METHODS: This prospective observational study recruited 53 participants, comprising of 3 groups: HoLEP experts (n = 11), intermediates (n = 24), and novices (n = 18). All participants received an educational package and a 15-minute familiarization exercise with the simulator. All participants then carried out a full enucleation on an identical 60 cm(3) virtual prostate. Performance was assessed using in-built simulator metrics, and a questionnaire was distributed assessing face and content validity, as well as feasibility, and acceptability. Novice, intermediate, and expert groups were compared using the Mann-Whitney U test. RESULTS: Construct validity data revealed significant differences in enucleation efficiency (grams enucleated per hour) when comparing experts to intermediates (P = .003), experts to novices (P <.001), and intermediates to novices (P = .001). Face validity was rated by experts as acceptable, with a mean score of 5.6 out of 10 when asked to rate the overall realism. Content validity questions showed that 85% of participants agreed that simulator-based assessment is essential for patient safety and 87% agreed that there was a role for a validated virtual reality simulator for use in HoLEP training. CONCLUSION: This study established face, content, and construct validity for this novel virtual reality HoLEP simulator. The majority of participants also thought that it is a feasible and acceptable model for HoLEP training.