New decade, new beginnings

Welcome to this decades first edition of Journal of Child Health Care. Before moving on I would like to take this opportunity and thank all those who have helped make the previous decade a successful one for this journal. With this New Year and decade comes some journal changes. As you may have heard Philip Darbyshire has now stepped down as Editor in Chief. I am honoured to have been offered this role. Taking on an Editor in Chief role for the Journal of Child Health Care entails attempting to fill some big shoes. Both Bernie Carter and Philip Darbyshire (Carter and Darbyshire, 2018) have their place in paediatric nursing’s hall of fame, yet they are both kind and generous with their time. Certainly both warrant being listed as part of Nursing’s ‘thriller elite’ (Darbyshire and Thompson, 2014). As Philip steps back from Journal of Child Health Care and attempts to retire, I thought I would offer some personal reflection on Philip’s impact on my career. Back in 1995, when I started my children’s nursing training, ‘Living With a Sick Child in hospital’ had just been published (Darbyshire, 1994). I devoured this book. Not least because this important research had been carried out in the same hospital that I was training to be a children’s nurse but because insights from this book helped shaped my practice as a paediatric nurse. In a foreword for ‘Living With a Sick Child in hospital’ Living Legend Patricia Benner (American Academy of Nursing, 2019) describes this book as a ‘profound work’. High praise indeed. In Alison Copley’s (1997: p 23) book review she stated that this ‘book is relevant for both the undergraduate and the post-graduate nurse’. In delivering content to aspiring, and current, children’s nurses I still continue to recommend this relevant highly book. Now out of print it is available for free from https://philipdarbyshire.com.au/books Another, more personal, impact on me was the realisation that nurses (and males) could earn the title of Doctor. This fact was part of my inspiration to start and continue my doctoral journey. It was an awkward moment in 2012 when at the International Council of Nurses Conference in Melbourne I first met Phillip and attempted to explain this in person. Later in my career, further valuable insights into nursing academia came from articles exploring Thriller and Killer Elite of nursing (Darbyshire and Thompson, 2014; Thompson and Darbyshire, 2013). Phillip, thank you for all that you have done for nursing and for the Journal of Child Health Care. As one chapter closes another edition begins. As a new Editor-in-Chief I look forward to receiving and reviewing your future manuscripts. A frustration for many authors can be publication delays. These delays can happen at multiple phases in a manuscript’s life. The Journal of Child Health Care team, and I, will endeavour to reduce these delays as far as possible. However, some delays can be reduced by authors and reviewers. During my doctoral journey I learned to edit. For a previously below par at English secondary school student, this was a new skill. Learning to edit was aided by some useful texts (Kaplan, 2012; Strunk and White, 2000) and advice from many tolerant friends. For those aspiring authors, hoping to publish with Journal of Child Health Care, you are advised to continue your editing discovery journey. This will help expedite your manuscript through our journal processes and increase your chances of manuscript acceptance. An integral and indispensable part of a peer reviewed journal are its reviewers. This is an essential element that sets journals such as Journal of Child Health Care apart from the deluge of ‘predatory’ non-journals, whose spam emails no doubt clog up your email inbox. Many frustrating publishing delays are caused by an inability to find reviewers. If we are to continue a fight against predatory publishers (Darbyshire et al., 2016; Darbyshire, 2019), when a review request is received from a reputable journal such as ours please try to say yes. This will help maintain academia’s valued peer reviewed basis and help ensure that when you read something or see something cited in ‘the literature’, that it absolutely deserves to be there

Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Background The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies. Methods Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated. Results Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily. Conclusion Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue

Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme

BACKGROUND: Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS: A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS: We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS: Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients

Coupling of effective one-dimensional two-level atoms to squeezed light

A cavity QED system is analyzed which duplicates the dynamics of a two-level atom in free space interacting exclusively with broadband squeezed light. We consider atoms in a three or four-level Lambda-configuration coupled to a high-finesse optical cavity which is driven by a squeezed light field. Raman transitions are induced between a pair of stable atomic ground states via the squeezed cavity mode and coherent driving fields. An analysis of the reduced master equation for the atomic ground states shows that a three-level atomic system has insufficient parameter flexibility to act as an effective two-level atom interacting exclusively with a squeezed reservoir. However, the inclusion of a fourth atomic level, coupled dispersively to one of the two ground states by an auxiliary laser field, introduces an extra degree of freedom and enables the desired interaction to be realised. As a means of detecting the reduced quadrature decay rate of the effective two-level system, we examine the transmission spectrum of a weak coherent probe field incident upon the cavity

Feature Fusion of Raman Chemical Imaging and Digital Histopathology using Machine Learning for Prostate Cancer Detection

The diagnosis of prostate cancer is challenging due to the heterogeneity of its presentations, leading to the over diagnosis and treatment of non-clinically important disease. Accurate diagnosis can directly benefit a patient's quality of life and prognosis. Towards addressing this issue, we present a learning model for the automatic identification of prostate cancer. While many prostate cancer studies have adopted Raman spectroscopy approaches, none have utilised the combination of Raman Chemical Imaging (RCI) and other imaging modalities. This study uses multimodal images formed from stained Digital Histopathology (DP) and unstained RCI. The approach was developed and tested on a set of 178 clinical samples from 32 patients, containing a range of non-cancerous, Gleason grade 3 (G3) and grade 4 (G4) tissue microarray samples. For each histological sample, there is a pathologist labelled DP - RCI image pair. The hypothesis tested was whether multimodal image models can outperform single modality baseline models in terms of diagnostic accuracy. Binary non-cancer/cancer models and the more challenging G3/G4 differentiation were investigated. Regarding G3/G4 classification, the multimodal approach achieved a sensitivity of 73.8% and specificity of 88.1% while the baseline DP model showed a sensitivity and specificity of 54.1% and 84.7% respectively. The multimodal approach demonstrated a statistically significant 12.7% AUC advantage over the baseline with a value of 85.8% compared to 73.1%, also outperforming models based solely on RCI and median Raman spectra. Feature fusion of DP and RCI does not improve the more trivial task of tumour identification but does deliver an observed advantage in G3/G4 discrimination. Building on these promising findings, future work could include the acquisition of larger datasets for enhanced model generalization.Comment: 19 pages, 8 tables, 18 figure

Feature Fusion of Raman Chemical Imaging and Digital Histopathology using Machine Learning for Prostate Cancer Detection

The diagnosis of prostate cancer is challenging due to the heterogeneity of its presentations, leading to the over diagnosis and treatment of non-clinically important disease. Accurate diagnosis can directly benefit a patient’s quality of life and prognosis. Towards addressing this issue, we present a learning model for the automatic identification of prostate cancer. While many prostate cancer studies have adopted Raman spectroscopy approaches, none have utilised the combination of Raman Chemical Imaging (RCI) and other imaging modalities. This study uses multimodal images formed from stained Digital Histopathology (DP) and unstained RCI. The approach was developed and tested on a set of 178 clinical samples from 32 patients, containing a range of non-cancerous, Gleason grade 3 (G3) and grade 4 (G4) tissue microarray samples. For each histological sample, there is a pathologist labelled DP - RCI image pair. The hypothesis tested was whether multimodal image models can outperform single modality baseline models in terms of diagnostic accuracy. Binary non-cancer/cancer models and the more challenging G3/G4 differentiation were investigated. Regarding G3/G4 classification, the multimodal approach achieved a sensitivity of 73.8% and specificity of 88.1% while the baseline DP model showed a sensitivity and specificity of 54.1% and 84.7% respectively. The multimodal approach demonstrated a statistically significant 12.7% AUC advantage over the baseline with a value of 85.8% compared to 73.1%, also outperforming models based solely on RCI and median Raman spectra. Feature fusion of DP and RCI does not improve the more trivial task of tumour identification but does deliver an observed advantage in G3/G4 discrimination. Building on these promising findings, future work could include the acquisition of larger datasets for enhanced model generalization