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Odile Petit - One of the best experts on this subject based on the ideXlab platform.
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participant profiling and pattern of crop foraging in chacma baboons papio hamadryas ursinus in zimbabwe why does investigating age sex classes matter
International Journal of Primatology, 2017Co-Authors: Cecile Schweitzer, Tommy Gaillard, Chloe Guerbois, Herve Fritz, Odile PetitAbstract:Transformation and loss of natural habitat to urbanization and agriculture provide new opportunities for primates to feed on anthropogenic food sources. Currently, mitigation strategies fail to target the individuals responsible for initiating and maintaining this behavior. As primates mainly forage on crops in groups, we investigate the crop-foraging behavior of a group of 40 chacma baboons in Zimbabwe from the perspective of collective movements, i.e., when a group of animals move together in the same direction, thus resulting in a change of location. We collected data on 110 crop-foraging events during 35 days in March–April 2014. We recorded baboon movement and behavior with a camcorder and obtained further information through video analysis. Most crop-foraging events involved less than 20% of the troop and lasted less than 3 min. Although crop-foraging parties were composed of all age–sex classes, adult females and particularly adult males initiated most crop-foraging events and made direct movements (without stopping on the road) more often than nonadult participants. Baboons made up to five successive attempts to crop forage in a single crop-foraging event. Neither the number of participants nor the success of the crop-foraging events increased over the successive attempts. Finally, crop-foraging events were more successful and more frequent in unguarded areas than in guarded areas. These results suggest that group members are highly synchronized and that crop-foraging is based on a collective decision such as classical foraging movements. In addition, the short duration of the crop-foraging events might prevent detection of baboons by farmers. The more frequent initiation of crop-foraging by adults compared to nonadults might be explained by greater energetic needs or a greater tendency of adults to take risks. These preliminary data can help inform long-term strategies for farmers to reduce crop losses to baboons, as guarding helps reduce damage but does not prevent it.
Terry P Klassen - One of the best experts on this subject based on the ideXlab platform.
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glucocorticoids for Croup in children
JAMA Pediatrics, 2019Co-Authors: Allison Gates, David W Johnson, Terry P KlassenAbstract:Clinical Question For children with Croup, do glucocorticoids reduce clinical symptoms, minimize return visits and/or (re)admissions to the hospital, shorten lengths of stay, or reduce the need for additional treatments? Bottom Line Glucocorticoids reduce symptoms of Croup at 2 hours and for at least 24 hours, reduce return visits to care, and shorten hospital stays by about 15 hours. Serious adverse events are infrequent.
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glucocorticoids for Croup in children
Cochrane Database of Systematic Reviews, 2018Co-Authors: Allison Gates, David W Johnson, Michelle Gates, Ben Vandermeer, Cydney Johnson, Lisa Hartling, Terry P KlassenAbstract:BACKGROUND Glucocorticoids are commonly used for Croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011. OBJECTIVES To examine the effects of glucocorticoids for the treatment of Croup in children aged 0 to 18 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 2, 2018), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE (1946 to 3 April 2018), and Embase (Ovid) (1996 to 3 April 2018, week 14), and the trials registers ClinicalTrials.gov (3 April 2018) and the World Health Organization International Clinical Trials Registry Platform (ICTRP, 3 April 2018). We scanned the reference lists of relevant systematic reviews and of the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated children aged 0 to 18 years with Croup and measured the effects of glucocorticoids, alone or in combination, compared to placebo or another pharmacologic treatment. The studies needed to report at least one of our primary or secondary outcomes: change in Croup score; return visits, (re)admissions or both; length of stay; patient improvement; use of additional treatments; and adverse events. DATA COLLECTION AND ANALYSIS One author extracted data from each study and another verified the extraction. We entered the data into Review Manager 5 for meta-analysis. Two review authors independently assessed risk of bias for each study using the Cochrane 'Risk of bias' tool and the certainty of the body of evidence for the primary outcomes using the GRADE approach. MAIN RESULTS We added five new RCTs with 330 children. This review now includes 43 RCTs with a total of 4565 children. We assessed most (98%) studies as at high or unclear risk of bias. Compared to placebo, glucocorticoids improved symptoms of Croup at two hours (standardised mean difference (SMD) -0.65, 95% confidence interval (CI) -1.13 to -0.18; 7 RCTs; 426 children; moderate-certainty evidence), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; 8 RCTs; 351 children; low-certainty evidence). Compared to placebo, glucocorticoids reduced the rate of return visits or (re)admissions or both (risk ratio 0.52, 95% CI 0.36 to 0.75; 10 RCTs; 1679 children; moderate-certainty evidence). Glucocorticoid treatment reduced the length of stay in hospital by about 15 hours (mean difference -14.90, 95% CI -23.58 to -6.22; 8 RCTs; 476 children). Serious adverse events were infrequent. Publication bias was not evident. Uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing Croup symptoms in children. AUTHORS' CONCLUSIONS Glucocorticoids reduced symptoms of Croup at two hours, shortened hospital stays, and reduced the rate of return visits to care. Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of Croup within six hours.
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glucocorticoids for Croup
Cochrane Database of Systematic Reviews, 2011Co-Authors: Kelly Russell, Yuanyuan Liang, Kathleen Ogorman, David W Johnson, Terry P KlassenAbstract:Background Since the initial publication of this systematic review in 1997, several randomized trials examining the benefit of glucocorticoids have been published. The objective of this review is to provide evidence to guide clinicians in their treatment of patients with Croup by determining the effectiveness of glucocorticoids and to identify areas requiring future research. Objectives To determine the effect of glucocorticoids for children with Croup. Search methods We searched CENTRAL (2010, Issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (1966 to July week 2, 2010) and EMBASE.com (1974 to July 2010). We also contacted authors of identified Croup trials published in the last 10 years to inquire about additional published or unpublished trials. Selection criteria Randomized controlled trials (RCTs) that examine children with Croup and objectively measure the effectiveness of glucocorticoids. Data collection and analysis Two review authors identified studies for potential relevance based on the review of the title and abstract (when available). Two review authors independently reviewed studies for relevance using a priori inclusion criteria and assessed trial quality. Differences were resolved by consensus. One review author extracted data using a structured form and another review author checked the results for accuracy. We performed standard statistical analyses. Main results Thirty-eight studies were included (n = 4299). Glucocorticoids were associated with an improved Westley score (maximum 17 points) at six hours with a mean difference of -1.2 (95% confidence interval (CI) -1.6 to -0.8) and at 12 hours -1.9 (95% CI -2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, 95% CI -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in participants treated with glucocorticoids (risk ratio (RR) 0.5; 95% CI 0.3 to 0.7). Length of time spent in accident and emergency or hospital (mean difference 12 hours, five to 19 hours) was significantly decreased for participants treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%; 95% CI 1 to 20). Authors' conclusions Dexamethasone and budesonide are effective in relieving the symptoms of Croup as early as six hours after treatment. Fewer return visits and/or (re)admissions are required and the length of time spent in hospital is decreased. Research is required to examine the most beneficial method for disseminating Croup practice guidelines and to increase the uptake of evidence.
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a randomized trial of a single dose of oral dexamethasone for mild Croup
The New England Journal of Medicine, 2004Co-Authors: Candice Bjornson, Terry P Klassen, Janielee Williamson, Rollin Brant, Craig Mitton, Amy C Plint, Blake Bulloch, Lisa M Evered, David W JohnsonAbstract:background The benefits of dexamethasone treatment for moderate-to-severe Croup are well established. However, most children with Croup have mild symptoms, and it is unknown whether they would derive the same degree of benefit from dexamethasone treatment as children with more severe disease. methods We conducted a double-blind trial at four pediatric emergency departments in which 720 children with mild Croup were randomly assigned to receive one oral dose of either dexamethasone (0.6 mg per kilogram of body weight) or placebo. The children had mild Croup, as defined by a score of ≤2 on the Croup scoring system of Westley et al. The primary outcome was a return to a medical care provider for Croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of Croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child’s illness. results Baseline clinical characteristics were similar in the two groups. Return to medical care was significantly lower in the dexamethasone group (7.3 percent vs. 15.3 percent, P<0.001). In the dexamethasone group, there was quicker resolution of Croup symptoms (P=0.003), less lost sleep (P<0.001), and less stress on the part of the parent (P<0.001). conclusions For children with mild Croup, dexamethasone is an effective treatment that results in consistent and small but important clinical and economic benefits. Although the longterm effects of this treatment are not known, our data support the use of dexamethasone in most, if not all, children with Croup.
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a randomized controlled trial of mist in the acute treatment of moderate Croup
Academic Emergency Medicine, 2002Co-Authors: Gina Neto, Terry P Klassen, Osama Kentab, Martin H OsmondAbstract:Objective: To determine whether the use of mist improves clinical symptoms in children presenting to the emergency department (ED) with moderate Croup. Methods: Children 3 months to 6 years of age were eligible for the study if they presented to the ED with moderate Croup. Moderate Croup was defined as a Croup score of 2-7. The patients were randomly assigned to receive either mist (humidified oxygen) via mist stick or no mist. The patients had Croup scores measured at baseline and every 30 minutes for up to two hours. At these intervals the following parameters were also measured: heart rate, respiratory rate, oxygen saturation, and patient comfort score. The patients were treated until the Croup score was less than 2 or until two hours had elapsed. All patients initially received a dose of oral dexamethasone (0.6 mg/kg). Other treatments, such as racemic epinephrine or inhaled budesonide, were given at the discretion of the treating physician. The research assistants were unaware of the assigned treatments. Results: There were 71 patients enrolled in the study; 35 received mist and 36 received no mist. The two treatment groups had similar characteristics at baseline. The median baseline Croup score was 4 in both groups. The outcomes were measured as the change from baseline at 30, 60, 90, and 120 minutes. The change in the Croup score from baseline in the mist group was not statistically different from the Croup score change in the group that did not receive mist (p = 0.39). There was also no significant difference in improvement of oxygen saturation, heart rate, or respiratory rate at any of the assessment times. There was no adverse effect from the mist therapy. Conclusions: Mist therapy is not effective in improving clinical symptoms in children presenting to the ED with moderate Croup.
David W Johnson - One of the best experts on this subject based on the ideXlab platform.
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glucocorticoids for Croup in children
JAMA Pediatrics, 2019Co-Authors: Allison Gates, David W Johnson, Terry P KlassenAbstract:Clinical Question For children with Croup, do glucocorticoids reduce clinical symptoms, minimize return visits and/or (re)admissions to the hospital, shorten lengths of stay, or reduce the need for additional treatments? Bottom Line Glucocorticoids reduce symptoms of Croup at 2 hours and for at least 24 hours, reduce return visits to care, and shorten hospital stays by about 15 hours. Serious adverse events are infrequent.
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glucocorticoids for Croup in children
Cochrane Database of Systematic Reviews, 2018Co-Authors: Allison Gates, David W Johnson, Michelle Gates, Ben Vandermeer, Cydney Johnson, Lisa Hartling, Terry P KlassenAbstract:BACKGROUND Glucocorticoids are commonly used for Croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011. OBJECTIVES To examine the effects of glucocorticoids for the treatment of Croup in children aged 0 to 18 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 2, 2018), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE (1946 to 3 April 2018), and Embase (Ovid) (1996 to 3 April 2018, week 14), and the trials registers ClinicalTrials.gov (3 April 2018) and the World Health Organization International Clinical Trials Registry Platform (ICTRP, 3 April 2018). We scanned the reference lists of relevant systematic reviews and of the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated children aged 0 to 18 years with Croup and measured the effects of glucocorticoids, alone or in combination, compared to placebo or another pharmacologic treatment. The studies needed to report at least one of our primary or secondary outcomes: change in Croup score; return visits, (re)admissions or both; length of stay; patient improvement; use of additional treatments; and adverse events. DATA COLLECTION AND ANALYSIS One author extracted data from each study and another verified the extraction. We entered the data into Review Manager 5 for meta-analysis. Two review authors independently assessed risk of bias for each study using the Cochrane 'Risk of bias' tool and the certainty of the body of evidence for the primary outcomes using the GRADE approach. MAIN RESULTS We added five new RCTs with 330 children. This review now includes 43 RCTs with a total of 4565 children. We assessed most (98%) studies as at high or unclear risk of bias. Compared to placebo, glucocorticoids improved symptoms of Croup at two hours (standardised mean difference (SMD) -0.65, 95% confidence interval (CI) -1.13 to -0.18; 7 RCTs; 426 children; moderate-certainty evidence), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; 8 RCTs; 351 children; low-certainty evidence). Compared to placebo, glucocorticoids reduced the rate of return visits or (re)admissions or both (risk ratio 0.52, 95% CI 0.36 to 0.75; 10 RCTs; 1679 children; moderate-certainty evidence). Glucocorticoid treatment reduced the length of stay in hospital by about 15 hours (mean difference -14.90, 95% CI -23.58 to -6.22; 8 RCTs; 476 children). Serious adverse events were infrequent. Publication bias was not evident. Uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing Croup symptoms in children. AUTHORS' CONCLUSIONS Glucocorticoids reduced symptoms of Croup at two hours, shortened hospital stays, and reduced the rate of return visits to care. Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of Croup within six hours.
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Croup in children
Canadian Medical Association Journal, 2013Co-Authors: Candice Bjornson, David W JohnsonAbstract:Croup develops in more than 80 000 Canadian children each year, making it the second most common cause of respiratory distress in the first decade of life.[1][1],[2][2] It affects boys more than girls (1.4:1) and young children between 6 months and 3 years of age more commonly than younger infants,
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glucocorticoids for Croup
Cochrane Database of Systematic Reviews, 2011Co-Authors: Kelly Russell, Yuanyuan Liang, Kathleen Ogorman, David W Johnson, Terry P KlassenAbstract:Background Since the initial publication of this systematic review in 1997, several randomized trials examining the benefit of glucocorticoids have been published. The objective of this review is to provide evidence to guide clinicians in their treatment of patients with Croup by determining the effectiveness of glucocorticoids and to identify areas requiring future research. Objectives To determine the effect of glucocorticoids for children with Croup. Search methods We searched CENTRAL (2010, Issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (1966 to July week 2, 2010) and EMBASE.com (1974 to July 2010). We also contacted authors of identified Croup trials published in the last 10 years to inquire about additional published or unpublished trials. Selection criteria Randomized controlled trials (RCTs) that examine children with Croup and objectively measure the effectiveness of glucocorticoids. Data collection and analysis Two review authors identified studies for potential relevance based on the review of the title and abstract (when available). Two review authors independently reviewed studies for relevance using a priori inclusion criteria and assessed trial quality. Differences were resolved by consensus. One review author extracted data using a structured form and another review author checked the results for accuracy. We performed standard statistical analyses. Main results Thirty-eight studies were included (n = 4299). Glucocorticoids were associated with an improved Westley score (maximum 17 points) at six hours with a mean difference of -1.2 (95% confidence interval (CI) -1.6 to -0.8) and at 12 hours -1.9 (95% CI -2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, 95% CI -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in participants treated with glucocorticoids (risk ratio (RR) 0.5; 95% CI 0.3 to 0.7). Length of time spent in accident and emergency or hospital (mean difference 12 hours, five to 19 hours) was significantly decreased for participants treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%; 95% CI 1 to 20). Authors' conclusions Dexamethasone and budesonide are effective in relieving the symptoms of Croup as early as six hours after treatment. Fewer return visits and/or (re)admissions are required and the length of time spent in hospital is decreased. Research is required to examine the most beneficial method for disseminating Croup practice guidelines and to increase the uptake of evidence.
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viral Croup a current perspective
Journal of Pediatric Health Care, 2004Co-Authors: Alexander K C Leung, James D Kellner, David W JohnsonAbstract:Viral Croup is the most common cause of upper airway obstruction in children 6 months to 6 years of age. Parainfluenza virus accounts for the majority of cases. The disease is characterized by varying degrees of inspiratory stridor, barking cough, and hoarseness because of laryngeal and/or tracheal obstruction. The diagnosis is mainly a clinical one and diagnostic studies usually are not necessary. The management has altered dramatically in the past decade. Good evidence exists to support the routine use of corticosteroid in all children with Croup. Intervention at an earlier phase of the illness will reduce the severity of the symptoms and the rates of return to a health care practitioner for additional medical attention, visits to the emergency department, and admission to the hospital. Most children respond to a single, oral dose of dexamethasone. For those who do not tolerate the oral preparation, nebulized budesonide or intramuscular dexamethasone are reasonable alternatives. Nebulized epinephrine should be reserved for patients with moderate to severe Croup. Simultaneous administration of corticosteroid and epinephrine reduces the rate of intubation in patients with severe Croup and impending respiratory failure.
Douglas R Sidell - One of the best experts on this subject based on the ideXlab platform.
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the relationship between Croup and gastroesophageal reflux a systematic review and meta analysis
Laryngoscope, 2021Co-Authors: Alanna Coughran, Karthik Balakrishnan, Reza Vaezeafshar, Nicole Capdarestarest, Osama Hamdi, Douglas R SidellAbstract:Objective The mechanism by which recurrent Croup occurs is unknown. Gastroesophageal reflux is commonly implicated, although this relationship is only loosely documented. We conducted a systematic review with a meta-analysis component to evaluate the relationship between recurrent Croup and gastroesophageal reflux disease (GERD), and to assess for evidence of improvement in Croup symptoms when treated. Style design Systematic Review and Meta Analysis. Methods We searched five separate databases. Studies were included if they discussed the relationship between Croup and GERD in children, >5 subjects, and available in English. Literature retrieved was assessed according to pre-specified criteria. Retrieved articles were reviewed by two independent authors and decisions mediated by a third author. If there was a difference of opinion after first review, a second review was performed to obtain consensus. Heterogeneity was calculated and summarized in forest plots. Results Of 346 initial records, 15 met inclusion criteria. These were two retrospective cohort and 13 cross-sectional studies. Thirteen of 15 articles support an association between recurrent Croup and GERD. Although heterogeneity is high among studies that reported prevalence of GERD, there is less uncertainty in results for improvement to recurrent Croup after GERD treatment. Most studies lacked a control group and all carry a moderate-to-high risk of bias. Conclusion There is limited evidence linking GERD to recurrent Croup; Further research is needed to assess for causality as most studies are retrospective, lack a control group, and have a study design exposing them to bias. Patients treated with reflux medication appear to demonstrate a reduced incidence of Croup symptoms. Level of evidence 1 Laryngoscope, 131:209-217, 2021.
W B G Macdonald - One of the best experts on this subject based on the ideXlab platform.
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efficacy of a small single dose of oral dexamethasone for outpatient Croup a double blind placebo controlled clinical trial
BMJ, 1996Co-Authors: G C Geelhoed, Justine M Turner, W B G MacdonaldAbstract:Abstract Objective: To assess the efficacy of a single dose of oral dexamethasone 0.15 mg/kg in children with mild Croup not admitted to hospital. Design: Double blind, randomised, placebo controlled clinical trial. Setting: The emergency department of a tertiary paediatric hospital. Subjects: 100 children aged 4-122 months presenting with mild Croup. Intervention: A single oral dose of dexamethasone 0.15 mg/kg or placebo. Main outcome measure: Return to medical care with ongoing Croup. Results: Baseline characteristics of the two treatment groups were similar. Eight children (all from the placebo group) returned to medical care with ongoing Croup, one being admitted. There was no reported difference in duration of Croup symptoms, duration of viral symptoms, or rate of return to medical care for other reasons. Conclusion: Oral dexamethasone in a dose of 0.15 mg/kg is effective in reducing return to medical care with ongoing Croup in children with mild Croup. Key messages The benefits of steroids for children admitted to hospital are now well estab- lished Most children with Croup may be sent home, though up to one fifth may return with Croup A small single dose of oral dexamethasone (0.15 mg/kg) dramatically reduces the chance of reattending All children presenting with Croup should be considered for steroids
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oral and inhaled steroids in Croup a randomized placebo controlled trial
Pediatric Pulmonology, 1995Co-Authors: Gary C Geelhoed, W B G MacdonaldAbstract:It was the objective of this study to compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with Croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design. The trial was carried out in the Emergency Department Observation Ward of a tertiary pediatric hospital. The subjects for the study were 80 children (age range 5 to 158 months) who were hospitalized with Croup. Children received either 2 mg of nebulised budesonide, dexamethasone syrup (0.6 mg/kg) or a placebo. Median duration of hospitalization was shorter for children treated with dexamethasone (12 hr) and budesonide (13 hr) compared to placebo (20 hr) (P < 0.03). There was no significant difference in hospitalization time between children treated with dexamethasone and budesonide. Median time to a Croup score of < or = 1 was shorter for children treated with dexamethasone (2 hr) or budesonide (3 hr) compared to those who received placebo (8 hr) (P < 0.01). Croup scores for both steroid groups were significantly lower than the placebo group by 1 hr and remained so subsequently. The Croup scores did not differ significantly in the 2 steroid treated groups. Six of the 30 children (20%) in the placebo group required adrenaline after the first hour compared to none of the 50 children in the steroid treated groups (P < 0.02). We conclude that oral dexamethasone and inhaled budesonide are both effective in reducing symptoms and duration of hospitalization in children with Croup.