Medicine & Dentistry-Pediatrics
Summary of research:
Meta-analysis and systematic reviews: I have been very involved in the performance of systematic reviews on important topics, such as treatment of otitis media, croup, febrile infant and acute asthma. These reviews have helped guide clinical practice in certain areas. Additionally, I have participated in the development of methodological standards for doing systematic reviews, including quality assessment of randomized trials, language of publication and the assessment of publication bias. This methodological work had an impact on the way systematic reviews are being performed. Glucocorticoids in Croup: This is a research program that has had substantial influence on how croup is treated around the world. Three randomized controlled trials in this area have helped clarify that either nebulized budesonide or oral dexamethasone will be effective in reducing hospitalizations, shortening stays in emergency departments and hasten the clinical improvement of children with croup. Two editorials in the New England Journal of Medicine (August 4, 1994 and August 20, 1998) have cited this work and stated that the approach advocated by these trials should be adopted. Treatment in Bronchiolitis: Much controversy has surrounded the use of bronchodilators in bronchiolitis. In an early RCT, we demonstrated that salbutamol was superior to placebo when administered to infants presenting to the ED with bronchiolitis. While not answering the question definitively, it provided a certain level of evidence for the use of salbutamol and this study was included in a systematic review examining this question. We went on to perform a RCT comparing epinephrine to salbutamol, demonstrating that epinephrine reduces stays in the ED and reduces the probability of admissions. This approach has become the standard approach in some EDs and the MRC recently funded a trial for inpatients with bronchiolitis on this question. We have also demonstrated that glucocorticoids are ineffective for inpatients with bronchiolitis.