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Dr Tsz-Yan Milly Lo

Milly Lo's research focuses on employing a 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 returned 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), a European Research Area Network (ERA-NET) funded multi-national data informatics paediatric brain trauma initiative (KidsBrainIT) and a triple helix partnership (academic-clinical-industry) to improve seizure detection in paediatric critical care (Window in the Brain).

Group Members

  • Dr. Ian Piper - Principal Research Health Care Scientist
  • Dr. Shima Abdullateef  - Post-doctoral Research Fellow
  • Dr. Laura Smith - Research Group Co-ordinator
  • Principal Supervisor:
    • John Palmer - PhD Student (MRC DTP Precision Medicine Programme)
  • Co-Supervisor:
    • Evangelos Kafantaris - PhD Student (School of Engineering)
    • Hollan Haule - PhD Student (School of Engineering)

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 was much needed to foster advances in this field.

Research Overview

My improvement research programme has 3 key themes:

Neuro-critical care related research

KidsBrainIT is a new international childhood brain trauma ‘big-data’ initiative.  Phase-1 was 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 use high-quality routinely collected anonymised clinical, physiological and outcome data from paediatric patients with life threatening brain trauma recruited in 16 PICU from 7 countries (9 UK, 1 Belgium, 1 Spain, 1 Latvia, 1 Italy, 1 Germany and 2 Romania) for research to better understand the importance of bespoke clinical management improvements.  In Phase-1, we focused 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 kindly provided the KidsBrainIT team a base at the Usher Institute of Population Health Sciences and Informatics in Edinburgh BioQpuarter.  With this exciting and amazing support, new collaborations and funding applications are being developed for future phases of KidsBrainIT.

KidsBrainIT as a proof-of-concept that demonstrates the benefits of data-intensive informatics in improvement research, with the potential 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.

Window in the Brain

The Window in the Brain (WiB) team studies brain wave tests (EEG) to better understand brain connectivity and how it is affected in different illnesses and injuries. This research aims to develop tools to help doctors and nurses to identify illness or injuries affecting the brain and treat their patients quicker and better. Our team includes a partnership of industry experts, clinical staff and researchers in engineering, neurology and intensive care. We also work closely with families with experience of EEG and hospital care. Detecting seizures in PCCU is very difficult as it requires experts to collect multi-channel electroencephalogram (EEG) recordings and specialist doctors to review these recordings, which is not possible to deliver as a 24/7 service in PCCU.

In the MRC Confidence in Concept funded pilot study (Window in the Brain-1), we carried out a single centre study to develop and test the new technology in collaboration with our industry partner - BrainsView.

We are currently conducting a UK multi-centre study (Window in the Brain-2) funded by the Chief Scientist Office to refine the innovative seizure detection tool further.

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 consisting 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 at 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 to develop this collaborative approach to bring clinicians and scientists together.

Public Engagement

Involving patients, families and members of the public helps ensure that the clinical research we do is important and relevant, and carried out in the best way possible. We have set up the first Scottish Patient and Public Involvement (PPI) group for paediatric critical care research called 'Intensive-Share'. Further details can be found here.

Sources of Funding

  • Chief Investigator. A Window in the Brain-2. Chief Scientist Office (£298,740 administered via the Usher Institute, University of Edinburgh) June 2022 - May 2025.

  • PI, Co-grant Holder.  Intensive-Share: Developing a Patient and Public Involvement Group for Paediatric Critical Care. CMVM Wellcome Trust Public Engagement with Research Seed Fund (£1500) Feb 2022 - Oct 2022.

  • Chief Investigator. A Window in the Brain. MRC Confidence in Concept (CiC) Grant (£103,164 administered via the Usher Institute, University of Edinburgh) Oct 2020 - Sept 2021.

  • 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 – Dec 2020.

  • 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

Kempen B, Depreitere B, Piper I, Sahuquillo J, Mircea Iencean S, Krishnan Kanthimathinathan H, Zipfel J, Barzdina A, Pezzato S, Jones P, Lo TYM. Visualization of the Intracranial Pressure and Time Burden in Childhood Brain Trauma: What We Have Learned One Decade on With KidsBrainIT. Journal of Neurotrauma. 2024. doi: 10.1089/neu.2023.0254. Online ahead of print.

Kanfantaris E, Lo TYM, Escudero J. Stratified Multivariate Multiscale Dispersion Entropy for Physiological Signal Analysis. Transactions on Biomedical Engineering. 2022. 70(3): 1024-1035.

Kanfantaris E, Piper I, Lo TYM, Escudero J. Assessment of Outliers and Detection of Artifactual Network Segments using Univariate and Multivariate Dispersion Entropy on Physiological Signals. Entropy. 23(2): 244.

Kanfantaris E, Piper I, Lo TYM, Escudero J. Augmentation of Dispersion Entropy for Handling Missing and Outlier Samples in Physiological Signal Monitoring. Entropy. 22(3): 319.

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 the Royal Hospital for Children and Young People in Edinburgh
  • Research lead for paediatric critical care medicine

Collaborators

  • Dr. Javier Escudero (Senior Lecturer, School of Engineering, University of Edinburgh) 

  • Dr. Vera Nenadovic (BrainsView Ltd, Ontario, Canada; Nurse Practitioner; Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada)

  • Dr. Areti Manataki (Lecturer, School of Computer Science, University of St. Andrews)

  • Dr. Aileen Neilson (Senior Health Economist, Edinburgh Clinical Trials Unit / Usher Institute, University of Edinburgh) 

  • Dr. Qalab Abbas (Assistant Professor/Paediatric Intensivist, The Aga Khan University Medical College, Pakistan)

  • Dr. Laura Moss (Senior Lecturer, School of Medicine, Dentistry & Nursing, Glasgow University)

Links

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