bluuebunny/crossref_metadata_2025_split huggingface dataset:
P31 Improving paracetamol safety in a tertiary paediatric hospital
Authors: McCann Joe , Copeland Rachel , Keaney Aideen , Laverty Leanne , Marcus Simon 
Published: August 2020

AimsMedication errors are perhaps the most common threat to patient safety.1 Children are particularly at risk because of variations in age and weight necessitating individual dose calculation for each patient; doses that are ten times the correct amount are occasionally given and can be life-threatening.2 Since 2015 the hospital has been seeking, as part of a Regional Quality initiative, to improve safety related to paracetamol.MethodsPrevious work involved clarification of IV paracetamol dosing for neonates and children under 10 kg with procurement of 100 mg in 10 ml vials, as well as introduction of a ‘ready-reckoner’ reference chart for prescribing, preparation and administration inserted into each BNFC across the hospital. In September 2018, we implemented a new prescribing aide sticker into kardexes in an effort to reduce IV administration errors. We then audited whether these interventions had led to an overall reduction in adverse incidents related to paracetamol.ResultsWe demonstrated a progressive reduction in adverse incidents over the past four years; it has now been more than 1000 days since the last reported serious adverse incident related to paracetamol. A snapshot audit of prescribing showed that 100% of patients were prescribed a safe dose of paracetamol by either age or weight. There was however considerable variation in dosing for enteral prescribing (8.2–18.8 mg/kg), with the majority of children (74%) being dosed according to age, despite weight being available at time of prescription. Introduction of the paracetamol prescribing aide sticker received overwhelmingly positive feedback from both medical and nursing staff, and has now been implemented for all children requiring regular IV paracetamol.ConclusionsAnaesthetics were the most commonly implicated specialty in paracetamol errors in our institution. Enteral dosing by age banding in hospital carries the potential for some children to be significantly under-dosed leading to sub-therapeutic drug levels, or even inadvertently over-dosed for more complex children who are underweight for age. We would therefore recommend dosing of enteral paracetamol by weight, when available, in hospital. Substantial improvement in paracetamol safety can be achieved through implementation of prescribing and administration aides to reduce likelihood of human error.ReferencesEyers S, Fingleton J, Perrin K, Beasley R. Proposed MHRA changes to UK children’s paracetamol dosing recommendations: modelling study. J R Soc Med 2012;105:263–9.Kaufmann J, Laschat M, Wappler F. Medication Errors in Paediatric Emergencies: A Systematic Analysis. Dtsch Arztebl Int 2012;109:609–616.
P37 A model for reducing paediatric prescribing errors in secondary care
Authors: Morgan Kate 
Published: August 2020

BackgroundA prescribing error is a preventable error that may lead to inappropriate medication use and patient harm(1). Prescribing errors are particularly important in paediatrics where dose calculations are complicated and small errors can result in significant morbidity and mortality.1 In 2017 pharmacy data showed that paediatric prescribing errors were an issue at our Hospital regarding the severity and high numbers of errors, especially for antibiotics and analgesia.ObjectivesTo achieve a zero prescribing error rate for paediatric within the hospital.MethodForm the Paediatric Medication Errors Prevention (PMEP) group consisting of the Paediatric Consultant, Paediatric Pharmacist, Children’s Assessment Unit Sister and Practice Education Senior Nurse.Paediatric Pharmacist to record and feedback all paediatric prescribing errors weekly at Doctors’ handover.Paediatric Pharmacist/Nurses to DATIX report all significant medication prescribing errorsPaediatric Pharmacist to produce and communicate monthly pharmacy prescribing newsletter.Paediatric Pharmacist to produce quick reference charts for the drugs with the most common prescribing errors e.g. antibiotics and analgesiaPaediatric Doctors to request a second check from another Doctor or Ward Sister when prescribing any medication on the drug chart of take home prescription.Paediatric Pharmacist to target Doctors’ induction to improve prescribing and implement a prescribing test.Doctors to complete reflections for errors with their educationsal supervisors.This study did not require ethics approval.ResultsFollowing implementation of the above strategies, there was a 33% reduction in the number of prescribing errors recorded by the Paediatric Pharmacist daily intervention log from 2017/2018 to 2018/2019. There were 163 prescribing errors for 2017/2018 compared to 110 for 2018/2019.ConclusionThe formation of the PMEP group and implementation of strategies to reduce paediatric prescribing errors has positively impacted on reducing the error rate at the hospital. It has also raised awareness of the necessity to report all errors and actively find ways to prevent these from re-occurring. Further work is required to reduce these errors to zero including targeting non paediatric teams prescribing on paediatrics and implementing Pharmacists prescribing on consultant ward rounds. Future work would also include replicating this model in other specialities e.g. neonatal intensive care to achieve the same success rate in reducing medication errors.ReferenceDavis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91. Accessed via http://adc.bmj.com on 2/4/19.
P40 A qualitative study on the supply of specialist medication in children at the interface of care
Authors: Camie Ng Ka Mei , Thoong Hong 
Published: August 2020

AimTo explore the views and experiences of healthcare professionals in primary care around the supply of specialist medication after a child is discharged from a specialist paediatric centre and suggest ways to improve it.MethodA qualitative study conducted with semi-structured interview via telephone was carried out to explore the views of primary pharmaceutical advisors on the supply of specialist medicine in children. Participants were identified by reviewing outpatient prescriptions from 19 November 2018 to 30 November 2018. Telephone interviews were recorded on interview forms, as the form of data. Framework analysis was used to analyse the data.ResultsA total of 109 outpatient prescriptions with 56 Clinical Commissioning Groups (CCGs) were identified. 8 CCG pharmaceutical advisors were recruited. Four key themes were identified.Theme 1: In order to overcome issues around the supply of specialist medicines, it is important to understand different supplying considerations in primary care. Factors including patient clinical status, GP’s expertise and confidence in prescribing and shared care agreement.Theme 2: Actions that are untaken by primary care to solve supplying issues include drug alternatives, direct communication between clinicians and the clinical input of pharmacists.Theme 3: Views on current shared care arrangements were generally negative. For example, participant 2 expressed: ‘Good principle… but they are too wordy, they are 10 pages long’.Theme 4: Views on improvement in continual medicines supply included participants explaining the lack of understanding between GP and Specialist. Participant 1 commented, ‘Specialist has to understand we lack the expertise to prescribe the drug. It is not just about money…’.ConclusionCurrently there is a lack of an integrated system in medicines supply at the tertiary to secondary/primary care interface. In order to deliver continuity of patient care, there is a need for different healthcare professionals to break down preconceptions and understand the pathway and policy involved in different care setting. A shared care should involve patient and carers, GP and the hospital consultant when making decision on the child’s health. Moreover, pharmacists in different settings have an active role in medicine optimisation and it is important to value their opinions to improve the continuation of specialist medicines supply.
Effects of food policy actions on Indigenous Peoples’ nutrition-related outcomes: a systematic review
Authors: Browne Jennifer , Lock Mark , Walker Troy , Egan Mikaela , Backholer Kathryn 
Published: August 2020

IntroductionIndigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap.MethodsEight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework.ResultsWe identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples’ diets, health or well-being.ConclusionBoth targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
Mixed-method estimation of population-level HIV viral suppression rate in the Western Cape, South Africa
Authors: Mukonda Elton , Hsiao Nei-Yuan , Vojnov Lara , Myer Landon , Lesosky Maia 
Published: August 2020

IntroductionThere are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from antiretroviral therapy (ART) programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates.MethodsVL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test-level and individual-level VS rates were based on test VL values <1000 cps/mL, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived midyear population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data.ResultsApproximately 1.9 million VL test results between 2008 and 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed VL testing coverage and population HIV prevalence.ConclusionWhile validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.
Effect of exposure to PM10on child health: evidence based on a large-scale survey from 184 cities in India
Authors: Mahapatra Bidhubhusan , Walia Monika , Avis Wiliam Robert , Saggurti Niranjan 
Published: August 2020

IntroductionAir pollution is increasingly becoming a serious global public health concern. Prior studies examining the effect of air pollution on health have ignored the role of households’ hygienic practices and socioeconomic condition, which are key determinants of the health status of a country like India. This study examines the effects of air pollution, measured in levels of particulate matters of size below 10 µg/m3(PM10), on child-health outcomes after adjusting for hygiene practices.MethodsHealth data from the National Family Health Survey-4 (NFHS-4) and PM10levels provided by the Central Pollution Control Board were matched for 184 Indian towns/cities. Child health outcomes included neonatal mortality, post-neonatal mortality, premature births, children with symptoms of acute respiratory infections (ARI) and low birth weight. Multilevel mixed-effects models were used to estimate the risk associated with exposure to PM10.ResultAnalyses based on 23 954 births found that every 10-unit increase in PM10level, increased the risk of neonatal mortality by 6% (adjusted RR (95% CI): 1.02 (1.02 to 1.09)), and the odds of symptoms of ARI among children by 7% (adjusted OR (95% CI): 1.07 (1.03 to 1.12)), and premature births by 8% (adjusted OR (95% CI): 1.08 (1.03 to 1.12)). There was no statistically significant difference in the effect of PM10on child health regardless of household’s hygienic practices. Effects of PM10on child health outcomes remained similar for cities whether or not they were part of the National Clean Air Program (NCAP).ConclusionExposure to PM10, regardless of hygienic practices, increases the risk of adverse child health outcomes. Study findings suggest that the focus of mitigating the effects of air pollution should be beyond the towns/cities identified under NCAP. Given the increasing industrialisation and urbanisation, a systemic, coherent approach is required to address the issue of air pollution in India.
Identifying and prioritising technical procedures for simulation-based curriculum in paediatrics: a Delphi-based general needs assessment
Authors: Thim Signe , Nayahangan Leizl Joy , Paltved Charlotte , Jensen Rune Dall , Konge Lars , Hertel Niels Thomas , Balslev Thomas 
Published: August 2020

ObjectivesTo identify and prioritise technical procedures that should be integrated in a curriculum of simulation-based procedural training in paediatrics using the Delphi method.Study designNational general needs assessment using a Delphi process was completed among 93 key opinion leaders in paediatrics in Denmark. Delphi round 1 identified technical procedures. Round 2 explored frequency of procedures, number of paediatricians performing the procedures, risks and/or discomfort for patients and feasibility for simulation-based training. Round 3 included final elimination and reprioritisation.ResultsResponse rates in the Delphi rounds were 73%, 71% and 72%. We identified 37 procedures in Delphi round 1, preprioritised in round 2, resulting in a final list of 19 procedures in round 3. Strong correlation between the prioritisation from the second and third Delphi rounds was identified, Spearman’s r of 0.94 (p<0.0001). Top five on the final list were acute neonatal airway management, acute non-neonatal airway management, non-neonatal peripheral intravenous and intraosseous access, neonatal vascular access and advanced heart lung resuscitation.ConclusionWe identified and prioritised 19 technical procedures in paediatrics that are suitable for simulation and may be used as a guide for the development of simulation-based curriculum in paediatrics.
Improving safety and reducing error in endoscopy (ISREE): a survey of UK services
Authors: Ravindran Srivathsan , Bassett Paul , Shaw Tim , Dron Michael , Broughton Raphael , Griffiths Helen , Keen Dimple , Wood Eleanor , Healey Chris J , Green John , Ashrafian Hutan , Darzi Ara , Coleman Mark , Thomas-Gibson Siwan 
Published: August 2020

BackgroundThe Joint Advisory Group on Gastrointestinal Endoscopy (JAG) ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy was developed in 2018. In line with the strategy, a survey was conducted within the JAG census in 2019 to gain further insights and understanding of key safety-related areas within UK endoscopy.MethodsQuestions were developed using the ISREE strategy as a guide and adapted by key JAG stakeholders. They were incorporated into the 2019 JAG census of UK endoscopy services. Quantitative and qualitative statistical methods were employed to analyse the results.ResultsThere was a 68% response rate. There was regional variability in the provision of out-of-hours GIB services (p<0.001). Across 1 month, 1535 incidents were reported across all services. There was a significantly higher proportion of reported incidents in acute services compared with others (p<0.001). Technical and training incidents were likely to be reported significantly differently to all other incident types. 74% of services have an endoscopy-specific sedation policy and 42% have a named sedation or anaesthetic lead for endoscopy. Services highlighted a desire for more anaesthetic-supported lists. Only 66% of services stated they have an effective strategy for supporting upskilling of endoscopists. Across acute services, 56% have access to human factors and endoscopic non-technical skills (ENTS) training. Patient feedback is used in several ways to improve services, develop training and promote shared learning among endoscopy users.ConclusionsThe census provides a benchmark for key safety-related characteristics of endoscopy services. These results have highlighted key areas to develop, guided by the ISREE strategy.
Novel platform leveraging electronic medical record (EMR) to triage patients admitted with high-grade immune-related adverse events (irAEs) to the immune-toxicity (ITOX) service
Authors: Abu-Shawer Osama , Singh Prabhsimranjot , Yenulevich Eric , Brito Amanda , Ni Jian , Abdulnour Raja-Elie E , Grover Shilpa , Manos Michael , Bowling Peter , LeBoeuf Nicole R , Ott Patrick , Stephen Hodi F , Jacobson Joseph , Rahma Osama 
Published: August 2020

BackgroundThe incidence of high-grade immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICIs) is increasing due to the rapid expansion of indications for their use. There is an urgent need for a feasible approach of identifying patients with high-grade irAEs to ensure early detection and proper management of this unique set of toxicities.MethodsWe established one of the first inpatient services that are specifically devoted to mitigating irAEs. The service uses a multidisciplinary approach with consulting service from experts in managing irAEs. We are leveraging the electronic medical record (EMR) to triage patients who are admitted to the hospital and have received or are currently receiving ICIs. A list of patients with ICI exposure is generated daily by EMR and then curated manually to identify patients with potential irAEs.ResultsA total of 129 patients with high-grade irAEs were admitted between June 2018 and June 2019. The most common irAEs were colitis (32%), pneumonitis (30%), and hepatitis (14%). Eighty five per cent of the patients had grade 3 irAEs and 15% had grade 4–5. About half of the patients had received ICI monotherapy; 30% had received combination of ICIs and non-ICIs; and 19% had received a combination of ICIs. Only 9% of patients had steroid-refractory irAEs requiring other immunosuppressive agents. The average length of stay for irAE-related admission was 11 days with a readmission rate due to recurrent irAEs of 26% within a year.ConclusionWe demonstrated the feasibility of using the EMR to accurately triage patients with suspected irAEs to a dedicated immune-toxicity service. Our model is adaptable in major academic centers and could have a major impact on quality of care and future clinical research addressing irAEs.
A history of smoking does not reduce long-term benefits of cardiac rehabilitation on cardiorespiratory fitness in men and women with cardiovascular disease
Authors: Noguchi Kenneth Shinkichi , Pryzbek Mike , Moncion Kevin , McQuarrie Angelica , MacDonald Maureen Jane , Tang Ada 
Published: August 2020

Smoking is an important risk factor for cardiovascular disease and all-cause mortality. Cardiac rehabilitation (CR) is effective for reducing the risk of recurrent cardiac events through improving cardiorespiratory fitness (CRF). Little is known about the influence of smoking on CRF throughout long-term CR. The purpose of this analysis was to compare CRF trajectories among individuals with positive and negative smoking history enrolled in long-term CR. Participants had a positive smoking history if they currently or formerly smoked (Smoke+, n = 55, mean age = 64.9 ± 9.0 years) and had a negative history if they never smoked (Smoke–, n = 34, mean age = 61.4 ± 9.0 years). CRF (peak oxygen uptake) was measured at baseline and annually thereafter for 6 years. The Smoke+ group had lower CRF compared with the Smoke– group over enrollment (β = −3.29 (SE = 1.40), 95% confidence interval (CI) −6.04 to −0.54, p = 0.02), but there was no interaction of smoking history and enrollment (β = 0.35 (SE = 0.21), 95% CI: −0.06 to 0.77, p = 0.10). Moreover, trajectories were not influenced by pack-years (β = 0.01 (SE = 0.01), 95% CI: −0.01 to 0.04, p = 0.23) or time smoke-free (β = −0.002 (SE = 0.01), 95% CI: −0.02 to 0.02, p = 0.80). Although the trajectories of CRF do not appear to be affected by smoking behaviour, individuals without a history of smoking maintained higher CRF throughout enrollment. Novelty: The benefits of long-term exercise-based cardiac rehabilitation on cardiorespiratory fitness are similar between those who have smoked and those who have never smoked. Neither the number of pack-years nor the length of time spent smoke-free influence cardiorespiratory fitness trajectories following long-term cardiac rehabilitation.
First limits on double beta decays in $$^\mathbf{232}$$Th
Authors: Laubenstein M. , Lehnert B. , Nagorny S. S. 
Published: August 2020

AbstractAs one of the primordial radioactive isotopes, $$^{232}\mathrm{Th}$$232Th mainly undergoes $$\alpha $$α-decay with a half-life of $$1.402\cdot 10^{10}$$1.402·1010 years. However, it is also one of 35 double beta decay candidates in which the single $$\beta $$β-decay is forbidden or strongly suppressed. 181 mg of thorium contained in a gas mantle were measured in a HPGe well-detector at the Gran Sasso Underground Laboratory with a total exposure of 3.25 g$$\times $$×d.We obtain half-life limits on all double beta decay modes of $$^{232}\mathrm{Th}$$232Th to excited states of $$^{232}\mathrm{U}$$232U on the order of $$10^{11-15}$$1011-15 years. For the most likely transition into the 0$$^+_1$$1+ state we find a lower half-life limit of $$6.7\cdot 10^{14}$$6.7·1014 years (90% C.I.). These are the first constraints on double beta decay excited state transition in $$^{232}\mathrm{Th}$$232Th.
Upper bounds on the compactness at the innermost light ring of anisotropic horizonless spheres
Authors: Peng Yan 
Published: August 2020

AbstractIn the background of isotropic horizonless spheres, Hod recently provided an analytical proof of a bound on the compactness at the innermost light ring with the dominant energy condition. In this work, we extend the discussion of isotropic spheres to anisotropic spheres. With the dominant energy and non-negative trace conditions, we prove that Hod’s bound also holds in the case of anisotropic horizonless spheres.