bluuebunny/crossref_metadata_2025_split huggingface dataset:
P26 Pharmacy discharge service to facilitate early discharges and to improve the quality of electronic discharge letters (EDL’s)
Authors: Ladani Sonal , AbouDaya Mohammed , Thornhill William , Christiansen Nanna 
Published: August 2020

AimThe current discharge process on the paediatric wards involves transcribing medications from one electronic system to another, this has led to errors and compromises patient safety. Discharges are also sometimes delayed due to patients waiting for their medications. The newly implemented discharge service involves pharmacists working closely with the medical team to identify patients for discharge as early as possible and to accurately transcribe medications onto the electronic patient record (EPR).MethodThe pharmacist would attend the consultant-led morning handover or would liaise with the nurse in charge on the ward to establish discharges and transfers for that day or over the weekend if on a Friday. The most urgent discharges and any complex patients were prioritised. The EPR system would be used to generate the EDL’s, transcribe the medicines for discharge and add any other relevant written information. Any medication related issues would be clarified with the medical team. The prescription would be handed over to the medical team to be reviewed and signed. This would then be dispensed and checked by the pharmacy team. The patient/parent or carer would be counselled on their medications. Data was collected from November 2018 – March 2019, this included time informed about discharge, time EDL started, time EDL printed and time EDL completed. Other data collected included if any additional written information was provided to the GP and if any amendments were required after the doctor had reviewed the prescription. The data was inputted into an Excel spreadsheet and was compared against August – October 2018.Results152 discharge prescriptions were included in the service. The data was compared to the data from August – October 2018 which showed more than double of the prescriptions were completed in the morning between 9am-12noon (compared to 12noon-5.30pm) since the service started. Less prescription needed amendments at the point of screening and more prescriptions included additional medication related information. The quality of the prescriptions had improved and completing prescriptions earlier meant timely discharges, improved bed utilisation and improved patient quality. Positive feedback was given by patients, doctors and nurses as well as the rest of the ward teams.ConclusionCommunication has improved between the hospital and community care, as well as patient satisfaction and bed availability. A future development would be to introduce prescribing pharmacists within medical teams to streamline the discharge prescription process further, freeing up medical time and increasing the focus on medicines optimisation for all patients.
P46 Dose-banding limits for commonly prescribed medications for children in the UK
Authors: Rashed Asia N , Tomlin Stephen 
Published: August 2020

AimCurrently, majority of prescribed medication doses are calculated according to a child’s body weight without considering the available drug products for administration or the therapeutic range of the drug. This can lead to lack of consistency in dosing and drug administration errors, which affects many children of all ages treated with medicines.1 There are no established standards for dose-banding in national or international healthcare systems. This project aimed to establish dose-banding limits for paediatric medicines, to be used for prescribing and administering accurate, safe, and effective drug doses.MethodA list of the most common oral prescribed medications was established from the medication dispensing database of four hospitals in the UK. Then the evidence for safe and effective dose ranges for each drug on the list was identified from paediatric reference books, Summary of Product Characteristics (SPC) and published literature. After using these data to develop dose bands based on body weight, we used a Delphi process to achieve healthcare professionals’ consensus about the suggested dose bands for each drug on the list.ResultsA total of 45 drugs for 45 specific indications were included. Four categories of dose-banding limits were established; drugs with 2-weight bands; 3-weight bands; 4-weight bands and 5-weight bands. Overall, for 53.3% (24/45) of the included drug, all their suggested dose-banding limits reached consensus after two rounds of Delphi. For 92% (22/24) of them, consensus was achieved on all their suggested bands in the first round. Only for 2 drugs the agreement was achieved after the second round. For the drugs included in 2-weight band and 5-weight band categories, all their suggested dose-banding limits received total consensus after round 1 of the Delphi process. For 9 drugs included in the 4-weight bands category, the agreement was achieved only on either one or two of their suggested dose bands. For 12 drugs, no agreement was reached on any of their suggested bands.ConclusionThe study results provide healthcare professionals with a set of recommended dose-banding limits for commonly prescribed drugs in the UK. These recommended limits could establish the basis for change in clinical practice to improve health care provided for children.AcknowledgementThis work is part of a larger project funded by the Neonatal and Paediatric Pharmacists Group.ReferenceRashed AN, Tomlin S, Arenas-Lópes S, et al. Evaluation of the practice of dose-rounding in paediatrics. Int J Pharm Pract 2019 May 29. doi:10.1111/ijpp.12549. [Epub ahead of print]
P50 Time and motion study to assess workload versus staffing at in paediatric hospital chemotherapy manufacturing unit
Authors: Samrin-Balch Lamia , Laxaman Jessica 
Published: August 2020

ObjectivesIn order to improve efficiency of the staff workload in the Paediatric Hospital Chemotherapy Manufacturing Unit, tasks conducted by the pharmacy staff were evaluated with their expected roles. The aims of this study were to establish an understanding of the workload at this unit and to develop a proposal for the unit to become technician-led.MethodsThe time taken to perform a pre-determined list of tasks by the senior pharmacy technician was recorded, collated, and compared to tasks performed by the pharmacist. This established the key activities that could be delegated from the pharmacist and the senior pharmacy technician to other members of staff. The findings were discussed with a focus group to establish the efficiency of the manufacturing unit and enable a proposal to be formed.Key findingsA substantial part of the pharmacist’s and senior pharmacy technician’s time was spent on activities which could be delegated to other members of staff of a lower pay band. The financial implication of this estimated that there would be a reduction of around £8,696.70 with the correct utilisation of the staff members. The pharmacists leading this manufacturing unit were spending most of their time on computing and training, therefore reducing the time available for them to focus on patient-facing clinical activities.ConclusionsThe current skill mix was highlighted as being inefficient, due to a lack of delegation from the pharmacists and senior pharmacy technician. A technician-led manufacturing unit can improve the focus of pharmacists on clinical tasks while reducing the cost of activities.ReferencesLord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: unwarranted variations. An independent report for the Department of Health 2016; 10–11: 34–40.Willett MS BK, Rich DS, Ereshefsky L. Prospectus on the economic value of clinical pharmacy services. A position statement of the American College of Clinical Pharmacy. Pharmacotherapy 1989; 9:45–50.Barnett MJ, et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009;15:18–31.Napier P, et al. Introducing a checking technician allows pharmacists to spend more time on patient-focused activities. Res Social AdmPharm 2018;14:382–386.
P58 Managing access to ‘Out Of Hours‘ medications in a tertiary paediatric hospital
Authors: Worrall Mary , Devlin Elizabeth , Howlett Moninne 
Published: August 2020

AimsMany UK and Irish hospitals provide a Monday to Friday pharmacy service; automated dispensing cabinets and hospital-wide information systems remain uncommon. Locating and accessing out of hours (OOH) medications can be a significant workload for nursing staff. In an Irish 230-bed tertiary paediatric hospital processes involve: nursing staff contacting other wards by telephone to source items; completion of an ‘Out of Hours Requisition’; and either transferring stock between wards or contacting nursing administration staff (NAS) to access stock from the Pharmacy Department. A quality improvement project was undertaken to: measure current levels of OOH medications; identify areas for improvement; implement and assess impact of new processes.Methods‘Out of Hours Requisition’ data were entered into a custom-built database and analysed for the period January - December 2018. The findings were discussed with nursing staff and NAS. Improving processes for locating medications was identified as a key area for improvement. The ‘Out of Hours Requisition’ form was amended to provide clearer instructions for completion. Using data from clinical area stock lists, a searchable Medicines Locator Database was developed and made accessible to all staff in the pharmacy department, clinical areas and the NAS office in December 2018 enabling staff to remotely identify the location of all medications stocked in the hospital. Data for ‘Out of Hours Requisitions’ for the period January - May 2019 were collated, analysed and compared with data from the same time period in 2018 (January - May). Microsoft Excel® was used for data collection, analyses and development of the Medicines Locator Database.ResultsA total of 1747 OOH medications were accessed by NAS from pharmacy in 2018, 746 during the period January - May 2018. Anti-microbial agents (36%) were most common, with requests originating from 16 clinical areas. Request from the paediatric intensive care units (36%) and the surgical/orthopaedic ward (36%) were most frequent. 515 medications were accessed in the first 5 months after the introduction of the Medicines Locator Database (January - May 2019). This represents a 35% reduction in the number of medications dispensed in the same time period in 2018. No changes to the types of medications were identified, but some differences in clinical areas were found.ConclusionThis significant reduction (35%) in numbers of medications accessed out of hours, and the corresponding reduction in workload for NAS, demonstrates the benefits of reviewing medication management processes. Further substantial time savings for nursing staff locating stock at ward level are likely. Readily-available technology can be successfully employed to improve processes in the absence of more sophisticated technological solutions. A staff survey is planned to evaluate awareness and usability of the database and identify further areas for improvement.
P65 Advanced neonatal nurse practitioner (ANNP) review of neonatal antibiotics in 36hours to improve antibiotics stewardship
Authors: Bilkhoo Charon , Gray Jim , Patel Mitul , Holder Gemma , Perry Michelle 
Published: August 2020

AimTo ensure neonates in transitional care and postnatal wards are receiving antibiotics appropriately. NICE CG1491 advises to consider stopping antibiotics at 36 hours in babies given antibiotics because of risk factors for infection or clinical indicators of possible infection where:the blood culture is negative,the levels and trends of C-reactive protein (crp) concentration are reassuring andno clinical indicators of possible infectionNeonatal unit was excluded from this study; since daily clinician led ward rounds to review antibiotics already occur. Antibiotics not reviewed in the 36 hour time frame were due to delays in receiving the second crp level. Daily ward rounds to review antibiotics in neonates were not happening on transitional care and postnatal wards, thus to ensure regular care, advanced neonatal nurse practitioner led reviews were implemented.MethodA crp sample should be taken after delivery and in babies given antibiotics because of possible infection, the crp concentration is measured again 18–24 hours after presentation. The role of the ANNP is to ensure both crp levels are checked and the blood culture is negative, with the aim of stopping antibiotics at 36 hours before the second dose of gentamicin is due. In summary neonates that do not need antibiotics should have only had approximately 3 doses of benzylpenicillin and 1 dose of gentamicin. Audits were carried out on neonates in transitional care and postnatal wards who were receiving antibiotics. The initial base line audit was done over 3 months to assess if antibiotics were reviewed in 36 hours. This was deduced by a signature from the ANNP either stating on the drug chart that antibiotics would continue for 5 days until crp has decreased or the antibiotic would be discontinued if the crp was low. This audit was repeated a year later.ResultsDuring the first 3 months audit the proportion of babies having their antibiotics reviewed within 36 hour time frame rose from 3% in month 1 to 25% and 50% in months 2 and 3 consecutively. During the second 3 month audit, the proportion of babies having their antibiotics reviewed was 78% in month 1 and 80% in the following two months. The first audit showed a rapid improvement, whereas the second audit showed an significant improvement compared to the end of the first audit, which was sustained throughout the full three months.ConclusionThe ANNP was a simple and no cost solution in ensuring antibiotic stewardship was consistent throughout neonates, reducing the length of stay of neonates and their mothers. The 20% of babies who are still not having a 36 hour review may be because of delays in blood cultures reaching the laboratories to commence incubation.ReferenceNeonatal infection (early onset): antibiotics for prevention and treatment. NICE CCG149 2012.
Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial
Authors: Roddy Edward , Ogollah Reuben O , Oppong Raymond , Zwierska Irena , Datta Praveen , Hall Alison , Hay Elaine , Jackson Sue , Jowett Sue , Lewis Martyn , Shufflebotham Julie , Stevenson Kay , van der Windt Danielle A , Young Julie , Foster Nadine E 
Published: August 2020

Objectives
To compare the clinical effectiveness of (1) physiotherapist-led exercise versus an exercise leaflet, and (2) ultrasound-guided subacromial corticosteroid injection versus unguided injection for pain and function in subacromial pain (formerly impingement) syndrome (SAPS).

Methods
This was a single-blind 2×2 factorial randomised trial. Adults with SAPS were randomised equally to one of four treatment groups: (1) ultrasound-guided corticosteroid injection and physiotherapist-led exercise, (2) ultrasound-guided corticosteroid injection and an exercise leaflet, (3) unguided corticosteroid injection and physiotherapist-led exercise and (4) unguided corticosteroid injection and an exercise leaflet. The primary outcome was the Shoulder Pain and Disability Index (SPADI), collected at 6 weeks, 6 and 12 months and compared at 6 weeks for the injection interventions and 6 months for the exercise interventions by intention to treat.

Results
We recruited 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months. Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months (adjusted mean difference −8.23; 95% CI −14.14 to -2.32). There were no significant differences between the injection groups at 6 weeks (−2.04; −7.29 to 3.22), 6 months (−2.36; −8.16 to 3.44) or 12 months (1.59; −5.54 to 8.72).

Conclusions
In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection.

Trial registration number

ISRCTN42399123
.
Expression of clock geneDbpin omental and mesenteric adipose tissue in patients with type 2 diabetes
Authors: Ushijima Kentaro , Suzuki Chisato , Kitamura Hiroko , Shimada Ken , Kawata Hirotoshi , Tanaka Akira , Horie Hisanaga , Hosoya Yoshinori , Imai Yasushi , Yamashita Chikamasa , Fujimura Akio 
Published: August 2020

IntroductionWe previously reported in ob/ob mice, one of animal models of human type 2 diabetes mellitus (DM2), that (i) acetylation of histone H3 lysine 9 (H3K9) at the promoter region of clock geneDbpand DBP mRNA expression are reduced in epididymal adipose tissue, (ii) binding of DBP to the promoter region of peroxisome proliferator-activated receptor (Ppar)-γand mRNA expression of PPAR-γ1sv were decreased in preadipocytes and (iii) adiponectin secretion was decreased, leading to the impaired insulin sensitivity.Research design and methodsThe present study was undertaken to evaluate whether such the changes in visceral adipose tissue were detected in patients with DM2. We obtained omental and mesenteric adipose tissue during surgery of lymph node dissection for gastric and colorectal cancers, and investigated these variables in adipose tissue (omental from gastric cancer; 13 non-DM, 12 DM2: mesenteric from colorectal cancer; 12 non-DM, 11 DM2).ResultsAcetylation of histone H3K9 at the promoter region ofDbpand DBP mRNA expression in omental, but not in mesenteric adipose tissue were significantly lower in DM2 than in patients without DM. PPAR-γ mRNA expression in omental adipose tissue was also lower in patients with DM2, but not in mesenteric adipose tissue.ConclusionsThe changes in DBP-PPAR-γ axis observed in mice with diabetes were also detected in patients with DM2. Because adiponectin secretion is reported to be enhanced through the PPAR-γ-related mechanism, this study supports the hypothesis that omental adipose tissue is involved in the mechanism of DM2.
Endoscopic full-thickness resection and its treatment alternatives in difficult-to-treat lesions of the lower gastrointestinal tract: a cost-effectiveness analysis
Authors: Kuellmer Armin , Behn Juliane , Beyna Torsten , Schumacher Brigitte , Meining Alexander , Messmann Helmut , Neuhaus Horst , Albers David , Birk Michael , Probst Andreas , Faehndrich Martin , Frieling Thomas , Goetz Martin , Thimme Robert , Caca Karel , Schmidt Arthur 
Published: August 2020

ObjectiveEndoscopic full-thickness resection (EFTR) has shown efficacy and safety in the colorectum. The aim of this analysis was to investigate whether EFTR is cost-effective in comparison with surgical and endoscopic treatment alternatives.DesignReal data from the study cohort of the prospective, single-arm WALL RESECT study were used. A simulated comparison arm was created based on a survey that included suggested treatment alternatives to EFTR of the respective lesions. Treatment costs and reimbursement were calculated in euro according to the coding rules of 2017 and 2019 (EFTR). R0 resection rate was used as a measure of effectiveness. To assess cost-effectiveness, the average cost-effectiveness ratio (ACER) and the incremental cost-effectiveness ratio (ICER) were determined. Calculations were made both from the perspective of the care provider as well as of the payer.ResultsThe cost per case was €2852.20 for the EFTR group, €1712 for the standard endoscopic resection (SER) group, €8895 for the surgical resection group and €5828 for the pooled alternative treatment to EFTR. From the perspective of the care provider, the ACER (mean cost per R0 resection) was €3708.98 for EFTR, €3115.10 for SER, €8924.05 for surgical treatment and €7169.30 for all pooled and weighted alternatives to EFTR. The ICER (additional cost per R0 resection compared with EFTR) was €5196.47 for SER, €26 533.13 for surgical resection and €67 768.62 for the pooled rate of alternatives. Results from the perspective of the payer were similar.ConclusionEFTR is cost-effective in comparison with surgical and endoscopic treatment alternatives in the colorectum.
Profiling of gastric cancer cell-surface markers to achieve tumour–normal discrimination
Authors: Toh Judith , Hoppe Michal Marek , Thakur Teena , Yang Henry , Tan Kar Tong , Pang Brendan , Ho Sharmaine , Roy Rony , Ho Khek Yu , Yeoh Khay Guan , Tan Patrick , Sundar Raghav , Jeyasekharan Anand 
Published: August 2020

BackgroundDifferentiating between malignant and normal cells within tissue samples is vital for molecular profiling of cancer using advances in genomics and transcriptomics. Cell-surface markers of tumour–normal discrimination have additional value in terms of translatability to diagnostic and therapeutic strategies. In gastric cancer (GC), previous studies have identified individual genes or proteins that are upregulated in cancer. However, a systematic analysis of cell-surface markers and development of a composite panel involving multiple candidates to differentiate tumour from normal has not been previously reported.MethodsWhole transcriptome sequencing (WTS) of GC and matched normal samples from the Singapore Gastric Cancer Consortium (SGCC) was used as a discovery cohort to identify upregulated putative cell-surface proteins. Matched WTS data from the The Cancer Genome Atlas (TCGA) was used as a validation cohort. Promising candidates from this analysis were validated orthogonally using multispectral immunohistochemistry (mIHC) with automated quantitative analysis using the Vectra platform. mIHC was performed on a tissue microarray containing matched normal, marginal and tumour tissues. The receiver-operating characteristic (ROC) curves were analysed to identify markers with the highest diagnostic validity independently and in combination.ResultsAnalysis of putative membrane protein transcripts from the SGCC discovery cohort WTS data (n=15 matched tumour and normal pairs) identified several differentially and highly expressed candidates in tumour compared with normal tissues. After validation with TCGA data (n=29 matched tumour and normal pairs), the following proteins were selected for mIHC analysis: CEACAM5, CEACAM6, CLDN4, CLDN7, and EpCAM. These were compared with established glycoprotein markers in GC, namely CA19-9 and CA72-4. Individual ROC curves yielded the best performance for CEACAM5 (area under the ROC curve (AUC)=0.80), CEACAM6 (AUC=0.82), EpCAM (AUC=0.83), and CA72-4 (AUC=0.76). Combined multiplexed imaging of these four markers revealed improved specificity and sensitivity for detection of tumour from normal tissue (AUC of 4-plex=0.91).ConclusionCEAMCAM5, CEACAM6, EpCAM, and CA72-4 form a versatile set of markers for robust discrimination of GC from adjacent normal tissue. As cell-surface markers, they are compatible with both IHC and live imaging approaches. These candidates may be exploited to improve automated identification of tumour tissue in GC.