Child Life and Health

Dr Tsz-Yan Milly Lo

Milly Lo's research focuses on employing data informatics approach to big data generated from routine clinical care for research to improve patient treatments, outcome, and safety in paediatric critical care.

Dr Tsz-Yan Milly Lo

Consultant Paediatric Intensivist / Research Lead for Paediatric Critical Care Medicine / NRS Career Research Clinician / Hon. Reader

  • Child Life and Health
  • Anaesthesia, Critical care and Pain Medicine
  • Usher Institute of Population Health Sciences

Contact details

Biographical Profile

After completing clinical training in paediatric intensive care medicine in Edinburgh, Birmingham, and Melbourne (Australia), Dr. Lo returns to the Edinburgh’s Sick Children Hospital as a consultant paediatric intensivist and research lead.

Dr. Lo’s research training includes successful completion of a PhD degree and post-doctoral research fellowship in childhood brain trauma in Edinburgh (UK) and Toronto (Canada) respectively.  Since returning to Edinburgh, Dr. Lo has set-up and is leading a dynamic multi-disciplinary data-informatics improvement research programme (IMPACT-ACE) and a European Research Area Network (ERA-NET) funded multi-national data informatics paediatric brain trauma initiative (KidsBrainIT).

Group Members

  • Dr. Ian Piper - Principal Research Health Care Scientist & Co-ordinator of BrainIT
  • Ms Tricia Johnstone - KidsBrainIT Research Nurse

Background

In the paediatric intensive care patient management, the routinely collected multi-parameter bedside physiological monitoring data that is available for clinical interpretation is under-used.  Vital information is discarded rather than being used for clinical management, research, and quality improvement.  Reasons for this data under-use include difficulty of accessing and using the data from its original sources, information overload from the plethora of routine data generated with advances in monitoring technologies, variability in clinical documentation methods and quality between different units.

To allow continuous improvement and consistent delivery of best care to all patients, we urgently need to develop and implement a practical way to systematically capture, analyse and integrate the vital improvement information embedded in the massive amount of routine clinical and physiological data generated during patient care.

Multi-centre ‘intensive care big-data’ initiatives such as the adult BrainIT group have successfully improved adult brain trauma care with new research ideas and data-driven improvement interventions. No-one has attempted to setup a similar approach in children with brain trauma.  Because of the age-related developmental differences in post-brain trauma physiological responses and outcome, a similar informatics based initiative in paediatrics is much needed to foster advances in this field.

Research Overview

My improvement research programme has 2 key themes:

Neuro-critical care related research

KidsBrainIT is a new international childhood brain trauma ‘big-data’ initiative.  Phase-1 is funded by a prestigious EU grant (621,843 Euros over 2 years) through the European Research Area Networks – the Network of European Funding for Neuroscience Research (ERA-NET NEURON).  KidsBrainIT data-banks and uses high-quality routinely collected anonymised clinical, physiological and outcome data from paediatric patients with life threatening brain trauma recruited in 10 PICU from 4 countries (7 UK, 1 Belgium, 1 Spain, and 1 Romania) for research to better understand the importance of bespoke clinical management improvements.  In Phase-1, we are focusing on investigating bespoke treatment of increased brain pressure from brain swelling in paediatric brain trauma, and how optimal cerebral perfusion pressure relates to outcome.  Prof. Aziz Sheikh has kindly offered the KidsBrainIT team a base at the Usher Institute of Population Health Sciences and Informatics in Edinburgh Bioquarter.  With this exciting and amazing support at the Usher Institute, new collaborations and funding applications are being developed for future phases of KidsBrainIT.

I plan to use KidsBrainIT as a proof-of-concept to demonstrate the benefits of data-intensive informatics in improvement research and to translate this concept beyond disease specific research and quality improvement work in order to benefit the broader critical care setting and other areas of health care across the world in the future.

Other critical care related research

Team IMPACT-ACE: The ethos of our improvement research programme in paediatric critical care medicine is to Improve Patient Care Through research and Appreciating Clinical Excellence (IMPACT-ACE).  Since its inception in 2013, I have successfully built a dynamic multi-disciplinary research team consists of front-line clinical staff of all grades who are passionate in improving the quality of clinical care we deliver and maintaining clinical excellence.  Furthermore, IMPACT-ACE is about team work, open collaborations with different teams within our unit and beyond, engaging and empowering our clinical staff to pursue positive changes in clinically relevant topics they are passionate about.

Our active collaborations include multi-disciplinary clinical front line staff (nurses, allied health professionals such as physiotherapists, dietians, and pharmacists, and medical staff), clinical electronic data management and education teams, quality assurance / improvement team (Datix, data reporting to Scottish Patient Safety Programme), Learning from Excellence team, staff engagement team, and our own research team which is now based at the Usher Institute in the University of Edinburgh, and scientists in Edinburgh, the rest of the UK, and the EU.  This approach ensures we bring formal academic support to our clinical staff to empower them to improve clinical care while enhancing staff engagement to deliver and maintain clinical excellence through a translational and evidence based approach.  We are the first PICU in the UK in developing this collaborative approach to bring clinicians and scientists together.

Sources of Funding

  • Chief Investigator.  KidsBrainIT Phase-1.  European Research Area Networks - The Network of European Funding for Neuroscience Research (ERA-NET NEURON) (621,834 Euros, administered through Child Life and Health, University of Edinburgh) Aug 2017 – July 2019.

  • Chief Investigator.  KidsBrainIT Novel Technology Development Study.  Sick Kids Friends Foundation Large Programme Grant (£35,000, administered through NHS Lothian) Nov 2017 – Oct 2019.
  • Research Award Holder.  NHS Research Scotland (NRS) Career Researcher Clinician Award (£44,901, administered through NHS Lothian) April 2016 – March 2018 (renewable on successful review).
  • PI, Co-grant holder.  Improving chest physiotherapy in the PICU: implementing real-time hand positioning and force distribution feedback.  Institute of Physics and Engineering in Medicine Innovation and Research Awards.  (£5,825, administered through NHS Lothian)  Dec 2015 – Nov 2016.
  • Chief Investigator.  Paediatric critical care sedation practice and its relationship with ventilator associated pneumonia.  Edinburgh and Lothian Health Foundation Research Grant.  (£39,874, administered through NHS Lothian) July 2014 – June 2016.
  • Research Award Holder. NHS Research Scotland (NRS) Career Research Fellowship. (£42,890, administered through NHS Lothian) April 2013 – March 2016.

Selected Publications

Güiza F, Depreitere B, Piper I, Citerio G, Jorens P, Maas A, Schuhmann MU, Lo TYM, Donald R, Jones P, Maier G, Van den Berghe G, Meyfroidt G.  Early detection of increased intracranial pressure episodes in traumatic brain injury: External validation in an adult and in a pediatric cohort.  Critical Care Medicine.  2017. 45(3): e316-e320.

Güiza F, Meyfroidt G, Lo TYM, Jones PA, Greet Van den B, Depreitere B.  Continuous optimal CPP based on minute-by-minute monitoring data: a study on a pediatric population.  Acta Neurochir.  2016. 122: 187-191.

Guiza F, Depreitere B, Piper I, Citerio G, Chambers I, Jones PA, Lo TYM, Enblad P, Nillson P, Feyen B, Jorens P, Maas A, Schuhmann MU, Donald R, Moss L, Van den Berghe G, Meyfroidt G.  Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury.  Intensive Care Medicine.  2015; 41(6): 1067-1076. 

Lo TYM, Jones PA, Minns RA.  Combining coma score and serum biomarker levels to predict unfavourable outcome following childhood brain trauma.  Journal of Neurotrauma.  2010; 27(12): 2139 – 2145. 

Lo TYM, Reynolds F.  To use intraosseous (IO) access or not to use IO access: Determinants of trainees’ decision in paediatric emergencies.  European Journal of Emergency Medicine.  2009; 16(6): 301 – 304.

Lo TYM, Jones PA, Minns RA.  Pediatric brain trauma outcome prediction using paired serum levels of inflammatory mediators and brain specific proteins.  Journal of Neurotrauma.  2009; 26(9): 1479-1487.

Arshid M, Lo TYM, Reynolds F.  Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: Time to stop the blind leading the blind.  Resuscitation.  2009; 80(5): 558 - 560.

Lo TYM, Morrison R, Atkins K, Reynolds F.  Novel manikin for chest re-opening simulation training.  Intensive Care Medicine.  2009; 35(6): 1143 - 1144.

Lo TYM, Morrison R, Atkins K, Reynolds F.  Effective performance of a new post-operative cardiac resuscitation simulation training scheme in the Paediatric Intensive Care Unit.  Intensive Care Medicine.  2009; 35(4): 725 – 729.

Dieppe C, Lo TYM, McFadzean J, Rowney DA.  Specialist team retrieval of head injured patients – Fact, fiction, or formula?  Intensive Care Medicine.  2009; 35(2): 334 – 338.

Lo TYM, Jones PA, Chambers IR, Beattie TF, Forsyth R, Mendelow AD, Minns RA.  Modulating effect of apolipoprotein E polymorphisms on secondary brain insult and outcome after childhood brain trauma.  Child’s Nervous System.  2009; 25(1): 47 – 54.

Jones PA, Chambers IR, Minns RA, Lo TYM, Myles LM, Steers AJW.  Are head injury guidelines changing the outcome of head injured children? A regional investigation.  Acta Neurochirurgica (Supplement).  2008; 102: 81 - 84.

Lo TYM, Jones PA, Freeman JA, McFadzean J, Minns RA.  The role of High Frequency Oscillatory Ventilation (HFOV) in the management of children with severe traumatic brain injury (TBI) and concomitant lung pathology where conventional ventilation had failed.  Pediatric Critical Care Medicine.  2008; 9(5) e38-42.

Chambers IR, Jones PA, Lo TYM, Forsyth R, Fulton B, Andrews PJD, Mendelow AD, Minns RA.  Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury.  Journal of Neurology, Neurosurgery, and Psychiatry.  2006; 77: 234-240.

Lo TYM, McPhillips M, Minns RA, Gibson RJ.  Cerebral atrophy following shaken impact syndrome and other non-accidental head injury (NAHI).  Pediatric Rehabilitation.  January – March 2003; 6(1): 47-55.

Jones PA, Minns RA, Lo TYM, Andrews PJD, Taylor GS, Ali S. Graphical display of the variability and inter-relationships of pressure signals in children with traumatic brain injury.  Physiological Measurement.  February 2003; 24: 201-211.

Lo TYM, Myles LM, Minns RA.  Separate cerebrospinal fluid access device with ventriculoperitoneal shunting in childhood hydrocephalus: Long term risks and benefits.  Developmental Medicine & Child Neurology.  January 2003; 45(1): 28-33

Other Responsibilities

  • Consultant paediatric intensivist at Royal Hospital for Sick Children in Edinburgh
  • Research lead for paediatric critical care medicine

Collaborators

BrainIT

Links