Patrina Caldwell

• B Med FRACP PhD
• Senior Staff Specialist at The University of Sydney

Main problem. There is uncertainty about the effect of transcutaneous electrical nerve stimulation on quality of life and psychosocial outcomes in children with lower urinary tract symptoms. We aim to describe its impact on quality of life, psychosocial outcomes and lower urinary tract symptoms in Australian children with overactive bladder while e...

Main problem. There is uncertainty about the effect of transcutaneous electrical nerve stimulation on quality of life and psychosocial outcomes in children with lower urinary tract symptoms. We aim to describe its impact on quality of life, psychosocial outcomes and lower urinary tract symptoms in Australian children with overactive bladder while e...

Introduction Inequitable access to health care based on demographic factors such as ethnicity, socioeconomic status and geographical location has been consistently found in children with chronic kidney disease (CKD). However, little is known about the perspectives of caregivers on accessing health care. We described caregivers’ perspectives on acce...

Background Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environmen...

Long outpatient waiting times pose a significant global challenge in healthcare, impacting children and families with implications for health outcomes. This paper presents the eHealth system called eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation) that is designed to address waiting list challenges for pae...

To identify priority areas to improve the design, conduct, and reporting of pediatric clinical trials, the international expert network, Standards for Research (StaR) in Child Health, was assembled and published the first 6 Standards in Pediatrics in 2012. After a recent review summarizing the 247 publications by StaR Child Health authors that high...

Purpose: Children who require specialist outpatient care typically wait substantial periods during which their condition may progress, making treatment more difficult and costly. Timely and effective therapy during this period may reduce the need for lengthy specialist care. This study evaluated the cost-effectiveness of an individualized, evidenc...

Purpose: Children referred to specialist outpatient clinics by primary-care providers often have long waiting times before being seen. We assessed whether an individualized, web-based, evidence-informed management support for children with urinary incontinence while waiting reduced requests for specialist appointments. Materials and methods: A m...

1 How and Why Adolescents Search for Digital Health Information 1.1 Why Adolescents Search for Digital Health Information 1.2 How Adolescents Search for Digital Health Information 1.3 Barriers to Searching for Digital Health Information 1.4 Adolescents’ Level of Trust When Accessing Digital Health Information 2 Appraisal of Digital Health Informati...

Background: Systematic reviews provide the highest level of evidence about a topic. Ten-week workshops in conducting systematic reviews were held with hospital doctors in 2019 and 2020. Aim: This study analysed participants' feedback about the systematic review workshops to improve how we teach clinicians about conducting systematic reviews. Me...

BACKGROUND Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environmen...

Aim: This study aimed to understand parents' online health information-seeking behaviour and the potential influence of this on their relationship with their child's physician. Methods: A survey regarding parental online health information-seeking behaviour was administered to parents of children aged under 18 years admitted to an Australian ter...

Aims: To identify how the COVID-19 pandemic influences parents' use of the internet, including social media, when seeking health-related information about the pandemic relevant to their children. Methods: This study employed semi-structured interviews to explore the factors affecting parents of young children when information-seeking online abou...

Aim Health literacy is the ability to understand and interpret health information and navigate the health-care system. Low health literacy is associated with poorer health knowledge and disease management, increased chronic illness, underutilisation of preventative health services and increased hospitalisations. The aim of the study is to review th...

Background: Given the potential for social media to spread health misinformation, it is important to understand how trusts impact adolescents' engagement with health content on social media. Objective: To explore the concept of trust when adolescents (13-18 years) engage with health information on social media. Data sources: Five relevant data...

Background Children with chronic kidney disease (CKD) require multidisciplinary care to meet their complex healthcare needs. Patient navigators are trained non-medical personnel who assist patients and caregivers to overcome barriers to accessing health services through care coordination. This trial aims to determine the effectiveness of a patient...

Objective To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB). Methods This international, multicenter, prospective cohort study involved individuals of 6 to 16 years of age under TENS treatment for OAB....

Background Solifenacin is an anticholinergic that is used to treat overactive bladder syndrome (OAB) in children. It is important to ascertain the safety and tolerability of solifenacin in the paediatric population as solifenacin offers an alternative, is more bladder specific, and should have less anticholinergic side effects than other therapies....

Background This update summarises key changes made to the protocol since the publication of the original protocol for the NAVKIDS² trial of patient navigators for children with chronic kidney disease (CKD) experiencing social disadvantage and provides the statistical analysis plan (SAP) which has not previously been published. Methods/design The o...

Aims: Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor-parent relationship....

Phenomenon: Students, alongside teachers, play a key role in feedback. Student behavior in feedback processes may impact feedback outcomes. Student feedback behavior includes recognizing, seeking, evaluating, and utilizing feedback. Student feedback behavior is influenced by numerous student attributes and environmental factors. Approach: We aim...

Background The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires c...

OBJECTIVES Daytime urinary incontinence is disabling and occurs in 17% of school-aged children. Timed-voiding is part of standard therapy. Can an alarm watch to aid timed-voiding improve treatment response to standard therapy? METHODS The WATCH (Watch with Alarm for Timed-Voiding in Children) study is a randomized controlled trial. Participants we...

Embodied Conversational Agents (ECAs) are virtual agents that exhibit humanlike verbal and non-verbal behaviours. When it comes to eHealth, ECAs can provide vital support to patients by being more reachable. In order to make ECAs more effective, humanlike empathy expressed during conversation through relational cues is essential. Empathy revolves a...

Aim Nocturnal enuresis (NE) and sleep-disordered breathing (SDB) are common in childhood. While the two disorders are linked, those links are still being clarified. Methods This study compared sleep profiles and enuresis-related behaviours between children with NE and those without, who were referred to a tertiary sleep unit with suspected SDB, us...

Aim Giggle incontinence is a distinct entity of childhood daytime urinary incontinence (DUI), where children wet themselves only when they laugh. The prevalence of true giggle incontinence is unknown, with confusion about the diagnosis of urinary incontinence occurring during laughter and true giggle incontinence. The aim of the study is to improve...

Aim Toilet training children with special needs can be challenging and can result in long‐term consequences if inadequately addressed. This study evaluates the use of a ‘Potty Monkey’ toy for toilet training children with special needs. Methods A pilot study using a ‘Potty Monkey’ to model timed voiding in children with special needs. We collected...

Background The learner has a central role in feedback. We developed a feedback workshop for medical students grounded in two concepts: (1) Student agency in feedback and its interplay in the context of brief clinical attachments; (2) The educational alliance. Aims To determine whether a brief feedback training workshop prior to a series of two-wee...

Objective To assess the role of trust when adolescents search for and appraise online health information. Study design A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, and ERIC) was performed. Google Scholar and reference lists for included studies were manually searched for additional articles. Studies were included if they exa...

Aim Adolescents increasingly use smartphones to look up online health information. This pilot study aimed to explore the search and assessment strategies of adolescents looking for online health information. Methods We performed an observed, practical task on mobile devices, followed by a semi‐structured interview with adolescent patients at The C...

Background: Enuresis (bedwetting) affects up to 20% of five-year-olds and can have considerable social, emotional and psychological effects. Treatments include alarms (activated by urination), behavioural interventions and drugs. Objectives: To assess the effects of enuresis alarms for treating enuresis in children. Search methods: We searched...

A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a pred...

Aim The internet has rapidly developed to become a default information source for parents when searching for information about their child's medical condition. This study aims to understand how parents use, search for and appraise the relevance and credibility of online information relating to children's health. Methods This research involved a pr...

Background Chronic kidney disease (CKD) is a devastating illness associated with increased mortality, reduced quality of life, impaired growth, neurocognitive impairment and psychosocial maladjustment in children. There is growing evidence of socioeconomic disparities in health outcomes among children with CKD. Patient navigators are trained non-me...

Objectives For 300 paediatric trials, we evaluated the reporting of: a data monitoring committee (DMC); interim analyses, stopping rules and early stopping; and adverse events and harm-related endpoints. Methods For this cross-sectional evaluation, we randomly selected 300 paediatric trials published in 2012 from the Cochrane Central Register of C...

Background and objectives: General practitioners (GPs) often see children with enuresis and daytime urinary incontinence, and adults with persistent enuresis. The aim of this study was to assess Australian community health practitioners' knowledge and experiences with managing these conditions. Method: Health practitioners were surveyed about th...

Objectives We evaluated 300 paediatric trials to determine: the consent and recruitment strategies used, who trial information was targeted to, how incentives were used and if they achieved their recruitment targets. Methods For this cross-sectional evaluation, we searched the Cochrane Central Register of Controlled Trials for paediatric trials pu...

Aim To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic. Methods We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December 2014. A ran...

Background Chronic conditions are the leading cause of mortality, morbidity and disability in children. However, children and caregivers are rarely involved in identifying research priorities, which may limit the value of research in supporting patient-centred practice and policy. Objective To identify priorities of patients, caregivers and health...

Enuresis (bedwetting) is common in school‐aged children and can impact health, psychosocial well‐being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment‐resistant enuresis from a multidisciplinary perspective. Causes of treatment resista...

Aim Studies of published clinical trials involving children have shown frequent omissions in key aspects of design and conduct, but these problems may be artefactual and due to editorial processes and space limitations. To determine actual design and conduct, we analysed the completeness of key domains in trial protocols involving children submitte...

Background: Neonatal jaundice affects at least 481,000 newborns every year. Phototherapy is recommended but it's effects are limited and adverse reactions can occur. In China, phototherapy combined with Yinzhihuang oral liquid is also used for this condition. This systematic review evaluated the effectiveness and safety of combination therapy with...

Aim The internet has enabled parents to become informed medical consumers and take an active role in their child's treatment. We aimed to determine parents' online medical information‐seeking behaviour about their child's health. This included sources of information, reasons for searching, use and assessment of information and whether parents wante...

Introduction Evidence based medicine (EBM) is increasingly embraced by complementary and alternative medicine. Academics from China, Australia and UK developed a Summer School EBM course for Traditional Chinese Medicine (TCM) students in China. Methods An action research approach was used to evaluate the effects of an international collaborative a...

Objective To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. Design We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholde...

Objective: To conduct a systematic review of the evidence concerning whether and how adolescents search for online health information and the extent to which they appraise the credibility of information they retrieve. Study design: A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, ERIC) was performed. Reference lists of include...

Background: Paediatric incontinence has traditionally been managed through a discipline-specific approach by doctors, nurses, physiotherapists and psychologists. We evaluated a workshop aiming to increase health professionals' knowledge, confidence and willingness to involve other health professionals when managing paediatric incontinence. Method...

Aim: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years. Methods: Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 ye...

Non-life threatening chronic health conditions can significantly reduce the quality of life for the patient and their family. Given pressure on specialist services and lengthy wait-times, we propose a novel approach that involves a website and virtual specialist for patients while they are awaiting their specialist appointment. To capture patient h...

Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer pr...

Objectives: For child health randomized controlled trials (RCTs) published in 2012, we aimed to describe design and reporting characteristics and evaluate changes since 2007; assess the association between trial design and registration and risk of bias (RoB); and assess the association between RoB and effect size. Study design: For 300 RCTs, we...

Background About 85.3% of hemolytic disease of the newborn (HDN) is caused by maternal-fetal ABO blood group incompatibility. However, there is currently no recommended “best” therapy for ABO incompatibility during pregnancy. Objectives To systematically assess the safety and effectiveness of oral Chinese herbal medicine (CHM) for preventing HDN d...

PRISMA checklist. (DOCX)

The preliminary protocol of the review. (PDF)

Aim: The aim of this study was to determine whether there is a match between the health problems that children face and the clinical trials that are being conducted, especially in low- and middle-income countries (LMICs). Methods: All trials on the World Health Organisation International Clinical Trials Registry Platform registered from 2005 to...

This chapter looks at how gamification of existing technology can be used to incorporate the factors that have been found to improve patient adherence. Lack of adherence to medical advice is a major problem because it reduces the likelihood of improved health outcomes and is a waste of costly and scarce resources. To provide intrinsically motivatin...

Background: Increasing the amount of clinical research that occurs in healthcare settings has been identified as an important mechanism to improve healthcare outcomes. While clinicians are key persons in achieving this aim, research participation amongst clinicians is generally limited. Aims: To identify the factors (barriers and facilitators) i...

Background and objective: The last decade has seen dramatic changes in the regulatory landscape to support more trials involving children, but child-specific challenges and inequitable conduct across income regions persist. The goal of this study was to describe the attitudes and opinions of stakeholders toward trials in children, to inform additi...

Knowledge is only useful if the intended user is able to utilize the system. In early knowledge based systems, known as expert systems, the user interface provided the means through which knowledge was acquired and accessed. Today it is possible to interact with the knowledge of an expert through a humanlike interface, in the form of an embodied co...

Context: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. Objective: To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. Data sources: Electronic dat...

Background: Enuresis (bedwetting) affects up to 20% of five year-olds and 2% of adults. Although spontaneous remission often occurs, the social, emotional and psychological costs can be great. Tricyclics have been used to treat enuresis since the 1960s. Objectives: To assess the effects of tricyclic and related drugs compared with other interven...

Objective To compare a novel code-word alarm with a commercially available wireless alarm for treating enuresis. Setting A tertiary paediatric centre. Patients Children aged 6–18 with at least 3 wet nights per week in the previous 6 months referred by doctors. Outcomes Primary outcome: the proportion who achieved a full response (14 consecutive dry...

This paper reviews the literature on the impact of social media on the health of children and young people. Relevant papers were identified from Medline, Embase and PsycINFO databases. The studies identified that the health impact of social media on children and young people was greatest on mental health and specifically in the areas of self-esteem...

To understand the role that information communication technology (ICT) might play in addressing the informational and decision-making needs of live kidney donors and recipients, a comprehensive literature search was conducted to identify studies that describe the features of technological support used by living kidney donors and recipients and thei...

Treatments and interventions used to care for children in emergencies should be based on strong evidence. Well-designed clinical trials investigating these interventions for children are therefore indispensable. Parental informed consent is a key ethical requirement for the enrollment of children in such studies. However, if time is limited because...

To generate a contemporary understanding of "teaching by humiliation" as experienced by medical students in Australia. In this pilot study, we surveyed final-stage medical students from two Australian medical schools about their experiences of teaching by humiliation during their adult and paediatric clinical rotations. The students were invited to...

The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based superv...

The approaches used to educate future clinicians must be continually improved through evidence-based methods. Clinicians interested in conducting education research need to understand the terminology and conventions of health professional education, in the same way that health professional educators from education backgrounds need to be aware of cl...

Mobile technologies have become important tools for promoting and implementing healthcare. A key feature of smartphones and tablet computers is their ability to run software applications (apps), which can address specific health-related areas, including maternal and child health; however, there is little independent regulation or guidance for the d...

This chapter looks at how gamification of existing technology can be used to incorporate the factors that have been found to improve patient adherence. Lack of adherence to medical advice is a major problem because it reduces the likelihood of improved health outcomes and is a waste of costly and scarce resources. To provide intrinsically motivatin...

The eHealth website, eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation), is part of a research project that provides treatment advice to sufferers of paediatric incontinence problems who are on a medical specialist's waiting list. eHealth systems including eADVICE have problems getting patients to adhere to...

Urinary incontinence, both in the day and at night, is common in school-aged children and can be very distressing for children and their families.

Adherence to medical treatment advice is necessary to gain the intended improvement in patient outcomes. This paper looks at how empathic dialogues delivered by a relational agent can build an ongoing therapeutic alliance with the patient with the intention of improving access and adherence to the treatment advice. We present a case study and desig...

The fifth in a series of papers on practical aspects of telehealth, this paper discusses telehealth models that can facilitate the provision of specialist services to rural and remote patients closer to home. Some of the barriers to successful implementation of these models relates to workforce, funding and infrastructure at rural sites, as well as...

Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional...

The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.

Compliance relating to eHealth websites has tended to consider issues around ethics, safety, privacy and trustworthiness. However, from an adherence point of view that acknowledges the care seekers role in accessing and applying the advice they receive, it is important to evaluate whether the eHealth site is designed to assist adherence. This paper...

Safety and efficacy data on many medicines used in children are surprisingly scarce. As a result children are sometimes given ineffective medicines or medicines with unknown harmful side effects. Better and more relevant clinical trials in children are needed to increase our knowledge of the effects of medicines and to prevent the delayed or non-us...

Since the early 20th century, parenting books, pediatricians, and other health care providers have dispensed recommendations regarding children’s sleep that frequently involved behavioral and educational approaches. In the last 30 years, however, psychologists and other behavioral scientists and clinicians have amassed a critical body of research a...

The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.

Background: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as i...

The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The pra...

The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.

What's known on the subject? and What does the study add? Ambulatory urodynamic studies (UDS) allow assessment of urinary bladder function by recording bladder events during natural filling and emptying. The International Children's Continence Society supports the use of ambulatory UDS as a test of choice in children with bladder dysfunction. There...