Abstract:
OBJECTIVE:The value of comparative effectiveness trials in informing clinical and policy decisions depends heavily on the choice of control arm (comparator). Our objective is to identify challenges in comparator reasoning and to determine justification criteria for selecting a control arm in paediatric clinical trials. DESIGN:A literature search was completed to identify existing sources of guidance on comparator selection. Subsequently, we reviewed a randomly selected sample of comparators selected for paediatric investigation plans (PIPs) adopted by the Paediatric Committee of the European Medicines Agency in 2013. We gathered descriptive information and evaluated their review process to identify challenges and compromises between regulators and sponsors with regard to the selection of the comparator. A tool to help investigators justify the selection of active controls and placebo arms was developed using the existing literature and empirical data. RESULTS:Justifying comparator selection was a challenge in 28% of PIPs. The following challenging paediatric issues in the decision-making process were identified: use of off-label medications as comparators, ethical and safe use of placebo, duration of placebo use, an undefined optimal dosing strategy, lack of age-appropriate safety and efficacy data, and drug dosing not supported by extrapolation of safety/efficacy evidence from other populations. CONCLUSIONS:In order to generate trials that will inform clinical decision-making and support marketing authorisations, researchers must systemically and transparently justify their selection of the comparator arm for their study. This report highlights key areas for justification in the choice of comparator in paediatric clinical trials.
journal_name
Arch Dis Childjournal_title
Archives of disease in childhoodauthors
Kelly LE,Davies EH,Saint-Raymond A,Tomasi P,Offringa Mdoi
10.1136/archdischild-2016-310644subject
Has Abstractpub_date
2016-10-01 00:00:00pages
962-7issue
10eissn
0003-9888issn
1468-2044pii
archdischild-2016-310644journal_volume
101pub_type
杂志文章,评审abstract::Twenty-one children who had been diagnosed as having laryngomalacia by direct laryngoscopy in infancy were reviewed 7 to 12 years later. The natural history of the disease is documented. A wide variation in the time of onset and duration of the stridor was found and there was a high incidence of feeding difficulties. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.52.3.215
更新日期:1977-03-01 00:00:00
abstract::Children at three inner city child health clinics were offered haemoglobin estimation by fingerprick blood test when attending for immunisation against measles. Of the 98 immunised, 92 (94%) participated in the study, together with 58 other children. Anaemia (haemoglobin concentration less than 110 g/l) was found in 3...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.65.8.892
更新日期:1990-08-01 00:00:00
abstract::This paper reviews the diagnostic features of cluster headache-like disorder and describes its presentation in childhood. Case note summaries of patients with this condition are presented in the context of a brief summary of the literature. Four patients (two girls; aged 12 to 15 years) with cluster headache-like diso...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.81.6.511
更新日期:1999-12-01 00:00:00
abstract::Thirty jaundiced neonates with diarrhoea who were being treated with phototherapy and 30 matched control infants were studied to try and find out the cause of the diarrhoea. Faecal osmolality and electrolyte concentrations were measured, which gave clear evidence that the diarrhoea arose from intestinal secretion. Rec...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.64.8.1161
更新日期:1989-08-01 00:00:00
abstract::Social inequalities in a variety of indicators of child health were measured using a 'small area' geographical method of social classification. Cross sectional analyses of routine child health information and of a population survey of the height of primary school children were used. Social classification was by census...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.68.5.626
更新日期:1993-05-01 00:00:00
abstract::We describe the results of a prospective study in which 120 women who developed hypertension in the last trimester of pregnancy were randomly allocated in double blind manner to atenolol or placebo. The mean duration of treatment was five weeks. The only difference between groups during the neonatal period was in resp...
journal_title:Archives of disease in childhood
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/adc.59.11.1061
更新日期:1984-11-01 00:00:00
abstract:BACKGROUND:The mode of delivery has recently gained attention as another potential perinatal risk factor for childhood obesity but results are conflicting. OBJECTIVE:To examine whether caesarean section is independently associated with childhood obesity after adjusting for a broad range of confounding factors. METHOD...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/archdischild-2012-303459
更新日期:2013-07-01 00:00:00
abstract::Ten children with severe asthma, who had been well controlled on maintenance betamethasone valerate aerosol for an average of 11 months, were given placebo aerosols without their knowledge. The period of placebo substitution was campared with one 28-day period of betamethasone valerate therapy beforehand, and two 28-d...
journal_title:Archives of disease in childhood
pub_type: 临床试验,杂志文章
doi:10.1136/adc.50.5.387
更新日期:1975-05-01 00:00:00
abstract::Trigeminal neuralgia (TN) is a frequent cause of paroxysmal facial pain and headache in adults. Glossopharyngeal neuralgia (GPN) is less common, but can cause severe episodic pain in the ear and throat. Neurovascular compression of the appropriate cranial nerve as it leaves the brain stem is responsible for the sympto...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.82.4.311
更新日期:2000-04-01 00:00:00
abstract::There may be insufficient awareness of dopa responsive dystonia (DRD), which has a characteristic diurnal variation of symptoms. Two children are reported in whom the diagnosis of DRD was missed. The first was thought to have hysteria and the second hereditary spastic paraparesis. A full history is vital for the diagn...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.73.3.256
更新日期:1995-09-01 00:00:00
abstract::Early postnatal malnutrition produces delay in growth and developmental processes, and children from a low socioeconomical level where undernutrition is prevalent are shorter than those from higher socioeconomic levels. We examined the effects of severe and early protein energy malnutrition on growth and bone maturati...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.61.3.257
更新日期:1986-03-01 00:00:00
abstract::We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.88.4.330
更新日期:2003-04-01 00:00:00
abstract::Fine needle aspiration biopsy (FNAB) offers a simple outpatient technique for specimen collection in child tuberculosis suspects with peripheral lymphadenopathy. To perform FNAB with mycobacterial culture on an outpatient basis requires use of a sterile transport medium to facilitate bedside inoculation, maintain orga...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2009.164038
更新日期:2010-01-01 00:00:00
abstract::A 19 day old infant was successfully resuscitated from ventricular fibrillation. The 12 lead ECG was normal, with a normal QT interval, and remains so over three years follow up. DNA analysis revealed a missense mutation (R1193Q) in the SCN5A gene, previously linked with familial sudden unexpected nocturnal death synd...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2004.058115
更新日期:2005-05-01 00:00:00
abstract:BACKGROUND:Rectal measurement is considered a gold standard in many healthcare systems for body temperature measurement in children. Although this method has several disadvantages, an ideal alternative thermometer has not yet been introduced. However tympanic and infrared skin thermometers are potential alternatives. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2010.185801
更新日期:2010-12-01 00:00:00
abstract::At the mid-radius, pre-pubertal asthmatic children had smaller periosteal and endosteal circumferences and thicker cortical shells compared to controls, when assessed by peripheral quantitative computed tomography. Asthmatics had diminished periosteal expansion for muscle size, suggesting that asthma, its treatment, o...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2005.084996
更新日期:2006-04-01 00:00:00
abstract:AIM:To investigate the emotional reactions of registrars following the death of a child. METHODS:A multicentre study to determine the sources of support for registrars and the use of debriefing following a child's death. A questionnaire was sent or given to registrars within the South West Region. RESULTS:There was a...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,多中心研究
doi:10.1136/adc.2005.076760
更新日期:2006-09-01 00:00:00
abstract::During a five and a half year period, exchange transfusions were performed through the peripheral vessels in 201 of the 214 infants (94%) who required either double volume or partial plasma exchange transfusions. Peripheral vessel exchange transfusion is simple, practicable, and safe with few complications. Technical ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.65.7_spec_no.676
更新日期:1990-07-01 00:00:00
abstract::Ethical considerations have long been a part of clinical decision making. However, just as doctors and healthcare professionals are being increasingly challenged about the evidence base for their practice, there is increasing focus on the ethical dimension of clinical care. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,评审
doi:10.1136/adc.2004.062752
更新日期:2005-09-01 00:00:00
abstract:AIMS:To evaluate a systematic approach to the development and implementation of evidence based asthma management guidelines. METHODS:Comparative study of children (2-18 years) with acute asthma; a control cohort (cohort 1) was recruited before implementation of the guidelines and two cohorts were recruited after imple...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2003.032110
更新日期:2004-07-01 00:00:00
abstract::A retrospective study was made of 30 children with Leber's amaurosis (congenital retinal blindness). 24 presented with severe visual impairment, typical ophalmological findings, and absent electroretinograms. 6 other children, though presenting with marked visual loss and absent electroetinograms were later shown to b...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.52.5.399
更新日期:1977-05-01 00:00:00
abstract:OBJECTIVES:To assess factors associated with granting of the Disability Living Allowance (DLA) for Down syndrome. DESIGN:Cross-sectional survey. SETTING:Families with a child with Down syndrome enrolled in a community-based trial of vitamin supplementation. PARTICIPANTS:156 children with trisomy 21 (59% male, 20% no...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2006.112839
更新日期:2008-01-01 00:00:00
abstract::A two year prospective study identified 1922 cases of meningitis in children under 1 year of age. A further 201 cases were identified from other sources. The annual incidence of meningitis during the first year of life was 1.6/1000; during the first 28 days of life it was 0.32/1000, and among postneonatal infants it w...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.66.5.603
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND:Recent research in febrile neutropaenia (FN) has focused on reducing the intensity of treatment for those thought to be at low risk of significant morbidity or mortality. This has not led to a reduced burden of treatment for either families or healthcare systems. An alternative approach is to discharge all p...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/archdischild-2019-317908
更新日期:2020-09-01 00:00:00
abstract::Three children with cystic fibrosis developed steatorrhoea unresponsive to changes in pancreatic supplements. The final diagnoses were chronic giardiasis, stagnant loop syndrome, and Crohn's disease. Refractory intestinal symptoms in cystic fibrosis merit further investigation. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.63.12.1496
更新日期:1988-12-01 00:00:00
abstract::The performance of indirect indices of infection in the newborn vary because of differences in techniques, including diagnostic cut off levels. We have compared serial neutrophil band cell counts with C reactive protein measured by rate nephelometry. The 'gold standard' was a positive culture and the performance of th...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.67.7_spec_no.808
更新日期:1992-07-01 00:00:00
abstract:AIMS:To investigate whether sagittal synostosis (SS) has consequences for children's mental and psychomotor development, and whether surgery has any impact on this. METHODS:The study involved 28 children with SS who underwent corrective surgery at a mean age of 8.0 (SD 7.16) months, and 28 normal controls. All the chi...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2003.035824
更新日期:2005-04-01 00:00:00
abstract::Two infants presented with a salt-losing syndrome, the presenting features of which were subtle. One case appeared to be transient. Deficient production of aldosterone was shown by plasma renin activity and plasma aldosterone profile. Gas chromatography-mass spectrometry of urine indicated a defect in 18-dehydrogenati...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.52.7.580
更新日期:1977-07-01 00:00:00
abstract::Chlamydia trachomatis was identified in 37 of 73 consecutive neonates with purulent conjunctivitis, including four delivered by caesarean section with intact membranes. Most (28/37) presented in the first week. Infection was significantly associated with referral from the community. Genital C. trachomatis infection wa...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.61.8.797
更新日期:1986-08-01 00:00:00
abstract::An infant with severe hypertension who had a nephroblastoma which was secreting active renin is described. Nephroblastoma must be included in the differential diagnosis of hypertension associated with increased renin concentrations, even in the absence of an abdominal mass. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.66.4.525
更新日期:1991-04-01 00:00:00