bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW WELL DO OUTPATIENT PRESCRIPTIONS ADHERE TO GOOD ANTIMICROBIAL STEWARDSHIP?
Authors: Ubhi Hirminder , Patel Mitul , Ludwig Lisa 
Published: August 2016

AimAims of the study included evaluation of outpatient antibiotic prescribing practices relating to good Antimicrobial Stewardship1 focusing on documentation of indication and duration.MethodPrescriptions dispensed at the Outpatient Pharmacy over a 6 week were evaluated. Data collected include patient's hospital identification in full, the antibiotic prescribed, duration of treatment, indication (in a specifically allocated area on the prescription) and route of administration, prescriber speciality and grade. Data were entered onto Microsoft Excel and reviewed by a committee that included a medical microbiologist and antimicrobial pharmacist.ResultsFive hundred and six antimicrobial prescriptions were reviewed. Therapeutic antibiotics accounted for 484/506 (95.6%) and the remaining 22/506 (4.4%) were prophylactic therapy. Indications were documented in 186/506 (36.8%) cases and 465/506 (91.9%) documented duration of therapy. By speciality, adherence with indication and duration, respectively, for oral medication, were as follows: Haematology 2/55 (3.6%) and 12/55 (21.8%), General paediatrics 26/42 (61.9%) and 41/42 (97.6%), Oncology 4/37 (10.8%) and 34/37 (91.9%), Dermatology 12/35 (34.3%) and 35/35 (100%), Nephrology 24/30 (80%) and 30/30 (100%), Ear Nose and Throat (ENT) 9/31 (29%) and 31/31 (100%). Oral route of administration was the most frequently prescribed 391/506 (77.3%), with topical and eye/ear drops prescribed in 63/506 (12.4%) and 50/506 (9.9%) respectively. Nebulised therapy accounted for only 2/506 (0.4%) prescriptions. Most commonly prescribed antibiotics were Co-amoxiclav 83/391 (21.2%), Flucloxacillin 50/391 (12.8%), Penicillin 35/391 (9.0%), Azithromycin 27/391 (6.9%) and Trimethoprim 26/391 (6.6%). Adherence to antibiotic guidelines was seen to be appropriate with 496/506 (98%).From the ten prescriptions that did not adhere, Azithromycin accounted for 8/10 (80%) with 50% of these used for prophylaxis, with lack of clear documentation.ConclusionA designated area on the Outpatient Pharmacy prescription for indication and duration can aid better Antimicrobial Stewardship. Duration of therapy was better documented than indication, however it is postulated that this was to ensure adequate supply on outpatient dispensing and not always through following good antimicrobial prescribing practice. On the whole, the most commonly prescribed antibiotics were predominantly prescribed by the specialities within the antibiotic guidelines. Azithromycin, which is restricted to respiratory team, was prescribed outside of the policy by other specialties. This study helped prioritise which specialities require further input to improve adherence with Antimicrobial Stewardship in the outpatient setting. As dermatology and ENT had 100% compliance with specifying duration, we are now reviewing their prescribing education which can be used to enhance the practice of the other specialities.
APPROPRIATE DOSE ROUNDING OF CYTOKINE MODULATORS FOR PAEDIATRIC RHEUMATOLOGY INPATIENTS
Authors: Paget Chris 
Published: August 2016

BackgroundCytokine modulators (adalimumab, infliximab, etanercept, anakinra, canakinumab, rituximab, tocilizumab and abatacept) are high-cost biologics used primarily in paediatrics to treat patients with juvenile idiopathic arthritis.1 Funding mechanisms are unreliable and inconsistent hence appropriate dose rounding is a key cost-saving measure.2 However, there is a lack of evidence-based guidance for dose rounding in paediatrics.3
Aims and objectivesDetermine if 100% of inpatient cytokine modulator prescriptions in rheumatology are dose rounded up or down to the nearest whole vial, pen or syringe if within 5 or 10% of the dose for patients less or more than 10 kg respectively.Establish financial impact of drug wastage due to failures in dose rounding.MethodRetrospective data collection of electronic prescriptions for all cytokine modulators prescribed for rheumatology inpatients from January 2011 to December 2014. Prescriptions analysed using a five step process to determine if doses could have been rounded to nearest whole dose unit. Cost of waste resulting from failure to dose round also calculated.ResultsOnly 35% (380/1100) of prescriptions rounded to the nearest whole dose unit therefore audit standard not met. 97% (698/720) of all prescriptions not dose rounded were for tocilizumab and infliximab with approximate annual wastage of £11,000. Unexpected and significant unavoidable wastage identified due to lack of paediatric-friendly dose unit sizes, particularly for canakinumab (approximately £740,000/year).DiscussionAppropriate dose rounding does not appear to be common practice. Raising awareness and educating rheumatology and pharmacy teams as well as establishing local dose banding or rounding guidelines may improve future results. Tocilizumab is available in 80 mg, 200 mg and 400 mg vials therefore there is scope for flexibility in dose rounding if combinations are used appropriately. Unavoidable waste may be reduced through use of pharmacy central intravenous additive service (CIVAS) for preparation or use of biosimilars.
TOLERABILITY OF PREDNISOLONE AND DEXAMETHASONE IN CHILDREN IN SAUDI ARABIA
Authors: Aljebab Fahad , Alanazi Mofadhi , Choonara Imti , Conroy Sharon 
Published: August 2016

BackgroundCorticosteroids are used to treat a variety of medical conditions including acute asthma and croup where they are often given in short-courses. Epidemiological studies in Saudi Arabia show an increasing prevalence of respiratory diseases such as asthma in the past three decades.1 This study aimed to evaluate the tolerability and palatability of oral prednisolone and dexamethasone in children in Saudi Arabia. Both drugs are available in different formulations from different pharmaceutical companies.MethodsProspective observational and interview study. The palatability of the oral corticosteroids was evaluated by asking children and their parent's opinions of the taste and acceptability of the medication soon after drug administration. Children were asked to point at the appropriate face on a 10-cm visual analogue scale depicting five degrees of pleasure: 1 ‘dislike very much, 2 ‘dislike a little’, 3 ‘not sure’, 4 ‘like a little’ and 5 ‘like very much’.2 The tolerability of the drugs, in particular nausea, vomiting and abdominal pain was also evaluated by direct questioning of the parent/patients after each drug administration, and at the end of the course. Data was collected over three months, February to April 2015. Patients aged 2–18 years with any condition being treated with oral prednisolone or dexamethasone in hospital were approached to participate.Results122 patients (89 with asthma and 33 with croup) age range 2–11 years (mean=4.3) were recruited. 52 patients were given prednisolone base tablets, 37 patients were given prednisolone sodium phosphate syrup and 33 patients dexamethasone oral solution.The palatability score was lowest for the prednisolone base tablet (Mean rating=1.12), (prednisolone sodium phosphate group, Mean=1.62, 95% CI −0.75, −0.26; P=0.000001) (dexamethasone group, Mean=1.97, 95% CI −1.11, −0.6; P=0.000001). Dexamethasone was rated the most palatable (prednisolone sodium phosphate, 95% CI 0.08, 0.62; P=0.012). Nausea and vomiting occurred only in patients given prednisolone base tablets (24 and five patients respectively). Both were statistically more frequent when compared with the prednisolone sodium phosphate group (only four patients had nausea) (95% CI 0.19, 0.52; P=0.000001 and 95% CI 0.1, 0.18; P=0.024 respectively). In the dexamethasone group only two patients had nausea. Abdominal pain was reported in 13 patients given prednisolone sodium phosphate syrup compared to eight patients in the prednisolone tablet group (95% CI 0.02, 0.38; P=0.032). In the dexamethasone group eight patients had abdominal pain.ConclusionsDexamethasone was the most palatable preparation though it did cause abdominal pain in nearly one quarter of patients. Prednisolone base tablets were rated the least palatable preparation and were also the least well tolerated.
OPINIONS OF USERS OF PHARMACY SERVICE PROVIDED TO PICU
Authors: Isaac Rhian , Gerrard Astrid , Bazaz Kevin 
Published: August 2016

BackgroundPressures to open pharmacy services 7 days a week, with no financial input for these extra resources, has knock on effects that may dilute accessibility to clinical pharmacists in specialist areas.AimsThe aim of this survey was to assess opinions of the users of the current pharmacy services to PICU and the planned extended hours provision.MethodAn e-survey was sent to PIC Consultants, Advanced Nurse Practitioners, and Senior Nursing Staff following a six month period of increased clinical pharmacists time allocation to PIC. Free-text area was added to each multiple choice question.ResultsTwenty-four staff responded, 14 prescribers and 10 senior nursesPresence of PICU trained clinical pharmacist on morning ward rounds was considered essential by 19 (79%) respondents and desirable by 4 (17%). Attendance on the afternoon round was deemed essential by 14 (59%) and desirable by 8 (33%) of respondents.Comments on the benefits of pharmacists on ward rounds included:“Enabling a second professional review of the patient overall—it prevents forced direction from the consultant and the pharmacists are empowered to ask us to reconsider. Very useful to have this safety and reality check.”“Essential for the guidance of drug usage and drug chart review which improves safety, benefit of advice for use with specialist patients, best cost approach, multiple benefits.”Roles expected as routine from the clinical pharmacist included patient safety (100%), managing parenteral nutrition (80%), advice on intravenous therapy e.g. compatibility (100%), education of the multidisciplinary team (96%), management of long term medicines e.g. sedation withdrawal (83%), and therapeutic drug monitoring control (83%).Only 6 respondents felt the PICU patient would benefit from extending access to dispensary only over weekends, 11 felt that there was no benefit, and 6 respondent unsure.Provision of the pharmacy on call service which involves both supply and clinical advice, was felt sufficient to the requirements of the PICU patient by less than a third of repondents,56% feeling the current service insufficient. Comments on the on call service included.“difficult to get experienced advice on weekends”“need access to pic pharmacists officially.”“we may direct queries to the on call pharmacy staff but 9 times out of 10 theses queries are redirected to our PICU pharmacists. Our questions are answered at any time of the weekend”Ninety one percent answered positively to the final question asked about extending the current clinical pharmacy service from 5 to 7 days per week. Comments included.“PICU is a 24 hr, 7 day a week service…how we can provide adequate care to children if this valuable service is only provided 5 days a week.”ConclusionPharmacy is a valued service on PICU, where the service users support increased access and attendance on certain ward rounds by specifically PICU trained pharmacist.
AN AUDIT TO ASSESS THE TIMINGS OF TTAS AND INPATIENT ORDERS IN PAEDIATRICS; FROM WRITING, TO SCREENING, TO DISPENSING, AND TO LEAVING DISPENSARY
Authors: Hale Ami , Christiansen Nanna , Calvert Heather 
Published: August 2016

AimTo assess the time it takes for paediatric TTA and inpatient orders to be dispensed and sent to ward. This is to establish if the Trust is meeting an operational Key Performance Indicator (KPI).Standards (KPIs)▸ 85% of urgent items (TTAs) dispensed within 1 hour.▸ 85% of non-urgent items (most inpatient orders) dispensed within 3 hrs.MethodTo audit the time it takes for TTAs and inpatient orders to be screened, sent to dispensary, labelled, dispensed, checked, and leave dispensary. Data collection took place over 5 days and focused on TTAs and inpatient orders coming from high turnover paediatric wards.Data was collected on: time to verify, time logged into dispensary, time for labelling, time for checking, and time to leave dispensary.Exclusion criteria: TTAs/ inpatient orders that contain controlled drugs, requires a dosette box, or is ordered out of hours.ResultsTTA results:The time from writing to screening of TTAs averages 1 hour 34 minutes. However, this may be inaccurate as it requires the doctor to select ‘sign and send to pharmacy’. If not selected, the clock has started, but the TTA is not visible to pharmacy.It took on average 2 hrs for all items from being logged in to being checked (n=12). The standard is 1 hour. The rate limiting steps were time to screen and time to label (each of which took approx. 1 hour 30 mins).The majority of the dispensing time is spent labelling, with an average time from logging in to labelling being 1 hour 25 minutes. The dispensing and checking was quick with an average of 36 minutes.Inpatient resultsInpatient orders took on average 5 hrs 51 minutes for the items to leave dispensary after they had been logged in (n=22). The standard for non-urgent work is 3 hrs.Time to screen was not recorded as the doctors do not record the time of prescribing on the inpatient drug chart. There is only a 6 minute delay between faxing orders and it being logged in, therefore no problem identified at that stage.The majority of time was spent labelling, with an average time from logging in to labelling being 1 hour 56 minutes.ConclusionStandards are not being met. The rate limiting steps appears to be labelling in dispensary.Proposals▸ Additional staff labelling at peak times▸ Slow dispensing system, liaise with IT to see if improvements can be made▸ Unable to have more labelling terminals as the robot only has three shoots▸ Induction teaching to include importance of sending TTAs to pharmacy after writing▸ Re-audit in 3 monthsLimitationsLack of dataThe screening time for TTAs is misleading as it captures the time from writing (rather than time of sending to pharmacy), until the time screened.No data on time taken for items to arrive back onto the ward, or if medicines collected or delivered by porter.
OPTIMISATION OF PHARMACY CONTENT IN PAEDIATRIC ONCOLOGY AND HAEMATOLOGY CLINICAL TRIAL PROTOCOLS. EXPERIENCE OF CHEMOTHERAPY PHARMACY ADVISORY SERVICE (CPAS) FROM 2011 TO PRESENT
Authors: Greer Rachel , Harvey Sally 
Published: August 2016

AimClarity and accuracy of the pharmacy aspects of cancer clinical trial protocols is essential. Inconsistencies and ambiguities in protocols have the potential to delay research and jeopardise both patient safety and the collection of credible data. The Chemotherapy and Pharmacy Advisory Service (CPAS) was established in 2007 by the UK National Cancer Research Network, currently known as National Institute for Health Research Clinical Research Network, to improve the quality of pharmacy-related content in cancer clinical trial protocols. This abstract describes the scope of CPAS, its methodology of mandated protocol review and an analysis of the issues found and reported in paediatric oncology and haematology trials.MethodAll paediatric oncology and haematology clinical trial protocols from 2011 to present were included in this study. A review checklist was developed by CPAS and used by the review panel, consisting of pharmacists, doctors and nurses, to standardise the evaluation of all protocols. Once completed, all reviews were collated and any queries and inconsistencies were fed back to Chief Investigators and study sponsors. The most common remarks made at protocol review were summarised and categorised through retrospective analysis. It is at the discretion of the study Sponsor and Chief Investigator to accept any recommendations or amendments based on the findings. In order to evaluate the impact of the service, Chief Investigators were asked to respond to queries made at protocol review and make appropriate changes to their protocols. Responses from Chief Investigators have been collated and acceptance rates determined.ResultsA total of 13 paediatric protocols were reviewed during this period. The mean number of comments per protocol was 32 and these mainly concerned the drug regimen, support medication, dose calculation, drug information and administration. Eleven of the Chief investigators returned responses to their protocols reviews. All responses were positive with an overall acceptance rate of 82% of the proposed protocol changes.ConclusionReview by CPAS of pharmacy content of paediatric oncology and haematology clinical trial protocols prior to final approval is feasible and exposes many undetected clinically relevant issues that could hinder efficient trial conduct and/or patient safety. This analysis has highlighted that the majority of suggestions were deemed clinically significant and effectively incorporated into the final protocols. The refinement of existing and development of further pharmacy-related guidance documents by CPAS might support more effective and safer clinical research.
Utility of wireless motility capsule and lactulose breath testing in the evaluation of patients with chronic functional bloating
Authors: Triadafilopoulos George 
Published: August 2016

BackgroundThe precise aetiology of chronic bloating remains poorly understood and underlying gastroparesis, small bowel bacterial overgrowth and colonic inertia may, individually or collectively, play a role.AimsIn this retrospective cohort analysis of symptomatic patients with chronic persistent bloating, we determined the clinical utility of wireless motility capsule and lactulose breath test in further defining the underlying aetiology for functional bloating.MethodsConsecutive patients with chronic bloating underwent clinical assessment, wireless motility capsule testing and lactulose breath testing using standard protocols.Results52 patients qualified for inclusion in this analysis, fulfilling Rome III criteria for functional bloating. Most patients (54%) had an abnormal wireless motility capsule study; of those, 11.5% had evidence of gastroparesis, 7.7% had small bowel transit delay, 15.8% had colonic inertia, 3.8% had delayed gastric and small bowel transit, 5.6% had combined gastric and colonic transit delay, 3.8% had delayed small bowel and colonic transit, and 5.6% had delayed gastric, small bowel and colon transit times. Using clinical questionnaires the median scores for bloating, constipation and eructation were not significantly different. Neither constipation nor eructation was specific to gastroparesis or colonic inertia but bloating was numerically more prevalent and severe in patients with delayed small bowel transit. 40% of patients had positive lactulose breath test but had no distinguishing clinical characteristics.ConclusionsChronic functional bloating may reflect underlying gastroparesis, small intestinal bacterial overgrowth or colonic inertia. Wireless motility capsule and lactulose breath test are useful in the assessment of patients with bloating and should be considered during evaluation.
Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study
Authors: Garde Ainara , Zhou Guohai , Raihana Shahreen , Dunsmuir Dustin , Karlen Walter , Dekhordi Parastoo , Huda Tanvir , Arifeen Shams El , Larson Charles , Kissoon Niranjan , Dumont Guy A , Ansermino J Mark 
Published: August 2016

ObjectiveHypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission.SettingTertiary-level hospital emergency department in Bangladesh.ParticipantsChildren under 5 years (n=3374) presenting at the facility (October 2012–April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app.Primary outcomeThe need for hospitalisation based on expert physician review and follow-up.MethodsPulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping.ResultsChildren admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01 unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2of 98% and 94% (OR associated with 10 s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic of 0.76.ConclusionsObjective measurements, easily obtained using a mobile device in low-resource settings, can predict the need for hospitalisation. External validation will be required before clinical adoption.
Relationship between occupational stress and job burnout among rural-to-urban migrant workers in Dongguan, China: a cross-sectional study
Authors: Luo Hao , Yang Hui , Xu Xiujuan , Yun Lin , Chen Ruoling , Chen Yuting , Xu Longmei , Liu Jiaxian , Liu Linhua , Liang Hairong , Zhuang Yali , Hong Liecheng , Chen Ling , Yang Jinping , Tang Huanwen 
Published: August 2016

ObjectivesIn China, there have been an increasing number of migrant workers from rural to urban areas, and migrant workers have the highest incidence of occupational diseases. However, few studies have examined the impact of occupational stress on job burnout in these migrant workers. This study aimed to investigate the relationship between occupational stress and job burnout among migrant workers.DesignThis study used a cross-sectional survey.SettingThis investigation was conducted in Dongguan city, Guangdong Province, China.Participants3806 migrant workers, aged 18–60 years, were randomly selected using multistage sampling procedures.Primary and secondary outcome measuresMultistage sampling procedures were used to examine demographic characteristics, behaviour customs and job-related data. Hierarchical linear regression and logistic regression models were constructed to explore the relationship between occupational stress and burnout.ResultsDemographics, behaviour customs and job-related characteristics significantly affected on burnout. After adjusting for the control variable, a high level of emotional exhaustion was associated with high role overload, high role insufficiency, high role boundary, high physical environment, high psychological strain, high physical strain, low role ambiguity, low responsibility and low vocational strain. A high level of depersonalisation was associated with high role overload, high role ambiguity, high role boundary, high interpersonal strain, high recreation, low physical environment and low social support. A low level of personal accomplishment was associated with high role boundary, high role insufficiency, low responsibility, low social support, low physical environment, low self-care and low interpersonal strain. Compared to the personal resources, the job strain and personal strain were more likely to explain the burnout of rural-to-urban migrant workers in our study.ConclusionsThe migrant workers have increased job burnouts in relation to occupational stress. Relieving occupational stress and maintaining an appropriate quantity and quality of work could be important measures for preventing job burnout among these workers.