bluuebunny/crossref_metadata_2025_split huggingface dataset:
AUDIT OF OXYGEN PRESCRIBING IN A CHILDREN'S HOSPITAL
Authors: Wheeler Lucy , James Janet , Byrne Sarah , Forton Julian 
Published: August 2016

AimTo audit oxygen prescribing in a children's hospital following the introduction of a new paediatric medication chart, which incorporates an oxygen prescription section.MethodIn June 2015 a 1-day snapshot audit was carried out across all wards in the children's hospital. All patients receiving oxygen on that day were included:▸ The audit was repeated in July 2015.▸ The standards for the audit were set at 100% in accordance with our local guidelines.1
▸ All patients receiving oxygen should have a prescription. Of these:▸ All patients should have target saturations identified.▸ All patients should have an administration device identified.▸ All patients should have a nurse signature on the chart within the last 12 hrs.ResultsIn June, 13 patients were receiving oxygen on the audit day. 0/14 had a prescription.In July, 18 patients were receiving oxygen on the audit day. (14 critical care, 4 medicine).4/18 had an oxygen prescription (22%). These were all medical patients. Of these, 4 patients had a target saturation identified (100%), 1 had a device prescribed (25%), and 4 had a nurse signature within the last 12 hrs (100%).ConclusionThe initial audit showed no compliance with either local or national guidance for oxygen prescribing.1 2 The re-audit showed improved prescribing on the medical wards but not within critical care. The new paediatric medication chart was launched early in 2015, along with a training package for doctors, nurses and pharmacists. This was in response to the National Patient Safety Agency (NPSA) rapid response report on oxygen safety in hospitals.3
There was a gap between the training and the new charts being available which may have led to the poor results in the first audit. Increased awareness of the charts and the initial audit results probably helped improve prescribing in the re-audit. For medical patients, prescribing and monitoring was good, although device was infrequently prescribed. Critical care have not engaged with the new chart and oxygen prescription process. Although the British Thoracic Society guidelines indicate that oxygen for adult patients must be prescribed, these do not currently cover critical care or children under 16 years.2 There are guidelines for children in development which are likely to advocate the same. This could be another reason why there is no prescribing in critical care.Patient numbers were small in this snapshot audit which could limit its validity. Future work will include re-audit in our hospital and audit across the whole region where the new charts have been introduced.
ASSESSING THE BENEFITS THAT COMMUNITY PHARMACIES CAN HAVE ON CHILDHOOD ASTHMA OUTCOMES
Authors: Lilley Andrew 
Published: August 2016

IntroductionThe local Clinical Commissioning Group has funded an innovative one-year pilot project to assess the value of providing specialist paediatric pharmacist and physiotherapist support direct to families and health care professionals (GP's, community pharmacists, practice nurses etc.) regarding asthma in the primary care setting. Community pharmacies are the one service that asthmatic children come in contact with in order to pick up their medications it was decided to encourage staff to provide interventions at the point of collection.Methods22 large chain, small chain and independent community pharmacy branches were included in the pilot (out of 152 within CCG area) with a total of 31 pharmacists and 67 assistants trained to provide the service. The plan was to provide ‘back to basics’ leaflets on collection of prescription to help improve education on the medications being used; provide inhaler technique counselling on the collection of all prescriptions for children; encourage pharmacist's to perform medicines use reviews and the new medicines service in asthmatic children of high school age (for which they could collect the standard NHS fee). In order to assess the benefits of this, the pharmacist or assistant would first perform the standard asthma control test, marked out of 25 with the parent/patient completing an online version one month later to assess any improvement in symptom management. In order to trace the number of MURs, NMS, inhaler counselling sessions and leaflets given out a tally chart was completed each month by the branches involved.ResultsUnfortunately of the 22 branches that signed up to the pilot only 15 returned tally charts to the team. Over a six month period 23 MUR's, 3 NMS and 32 inhaler technique sessions were performed with 67 leaflets distributed. Of a possible 55 asthma control tests (MURs and inhaler technique counselling sessions) only 23 patients completed the four week post intervention online form. Of those completed the average asthma control test score increased by 7 points (30% increase). In particular feedback from the pharmacists involved was that the inhaler counselling sessions were of particular benefit to parents/patients.Feedback from the pharmacy teams in general was positive with many stating it was good to be more involved in the care of children's conditions; however many stated in order for the service to roll out to a wider audience the scheme would have to provide a financial incentive for the large chains to take part.ConclusionsIt is clear that interventions performed by the community pharmacy teams can help improve symptom control in asthmatic children. In particular ensuring patients are using their medications correctly appears to be key to symptom control. Encouraging pharmacists to provide child friendly MURs should be investigated further to prove the benefit of this service further. It should be noted that ensuring patients are using their medications correctly is already part of the essential service contract for pharmacies.
STARTING A NEW MEDICINE STUDY
Authors: Aston Jeff , Wilson Keith , Terry David 
Published: August 2016

AimTo identify the experiences of patients, parents or carers when a child/young person is prescribed a new long-term medicine.MethodPatients' prescribed a new long-term (>6 weeks) medicine were recruited from a single UK paediatric hospital out-patient pharmacy.A semi-structured questionnaire was administered to participants, via telephone, 6 weeks after the dispensing of their medicine. The questionnaire included the following themes: information requirements, resources used to seek further information, medicine administration issues, new concerns or questions that have arisen, adverse effects, arranging repeat supplies and an assessment of adherence.The results were analysed using Microsoft Excel 2013 and NVivo Version 10.ResultsFifty patients consented and were included in the study. Eighteen (36%) participants had undertaken further research prior to taking/administering their new medicine. 13 (72%) of these used the internet for further information. Participants had further concerns/questions in 18 (36%) cases with 7 (38.9%) contacting the hospital team for further advice. Thirteen (26%) participants experienced difficulty administering/taking the medicine. Sixteen (36%) believed that they had experienced an adverse effect. Eight (16%) participants experienced difficulties when obtaining further supplies. With regard to adherence, 17 (34%) participants had forgotten a dose on at least one occasion and 4 (8%) found it difficult to keep to the medication regimen.ConclusionThis research has demonstrated that paediatric patients, parents and carers experience a wide range of issues during the first few weeks after starting a new medicine. This is in accordance with a recent review of non-adherence in paediatric long-term medical conditions.1 The New Medicines Service (NMS) offered through community pharmacists is designed to support patients' who have recently been prescribed a medicine to manage a long-term condition.2 However, this is not readily available to children/young people or their carers. The main barriers being the targeted conditions included in the service, consent and exclusion of undertaking an NMS consultation with a carer. Further research is required to establish and evaluate a paediatric specific medication review service for children/young people and their parents/carers when a new long-term medicine has been prescribed. This research will support the recent research recommendation of the National Institute of Health and Care Excellence.3
SETTING UP OF A HOMECARE SYSTEM FOR HIGH COST NEBULISERS IN A PAEDIATRIC CYSTIC FIBROSIS CENTRE
Authors: Chorro-Mari Veronica , Christiansen Nanna 
Published: August 2016

AimDue to national changes to the commissioning process of high cost nebulisers (HCN) for Cystic Fibrosis (CF) patients, CF centres have to repatriate the prescribing of the HCN to the tertiary care centres.1 The following nebulisers will no longer be prescribed by primary care: Cayston® (Aztreonam); Colomycin®, Pomixin®, Clobreathe® (Colistimethate); Pulmozyme® (Dornase alfa); Tobi®, Tobi Podhaler ®, Bramitob® (Tobramycin).This abstract explains how the Royal London Hospital (RLH) Paediatric Pharmacy recruited over 100 paediatric (CF) patients smoothly within a period of 4 months and set up a homecare system to avoid patients and families having to travel large distances to obtain their medication.MethodsA number of homecare companies were evaluated initially. Parameters looked at were reports of customer satisfaction, delivery cost, turn-around time once the prescription was received and availability of same day delivery service.In order to capture existing patients we met with CF Specialist Nurses to establish the total number of patients on HCN, what nebulised treatment they were on and their respective doses. We prioritised patients that had known problems with GP prescribing and anybody newly starting on HCN.To communicate the change to parents, a letter was sent to all parents explaining the changeover to homecare delivery and tertiary prescribing. In addition a section in the parent bulletin was dedicated to the topic as well. Following this we contacted parents via phone and in clinic to request consent and explain the process.Up to 10 patients were contacted weekly (average of 7); the consent form and registration form were then faxed to the Homecare company for patient registration. In parallel to this prescriptions were requested for the patients that had been set up in the previous week, ensuring that prescribing was spread out over time to avoid having peak times for repeat prescriptions.In addition to the letter to parents GP surgeries were also informed in writing about the changes in commissioning and planned repatriation of HCN. This information was also included on discharge prescriptions for patients on any of the HCNs as part of the pharmacy screening process.A system for follow up prescriptions as repeat was set up between the team so we would not have unexpected urgent requests and we could avoid missed doses, urgent delivery charge or stress in the team. In order to manage the prescriptions and ease communication across the team a database was developed.ResultsFrom March to July 2014 (16 weeks) one hundred and four patients were successfully repatriated to tertiary care.ConclusionA planned method and agreed standard operation procedure was key to effectively capture and repatriate all patients while at the same time keeping the increase on workload for the pharmacy team to a minimum. The fact of having a strong pharmacy presence as part of the multidisciplinary team attending CF clinics and ward rounds was vital in making this work.
INVOLVING CHILDREN AND THEIR PARENTS IN RESEARCH DESIGN
Authors: Hibberd Suzannah 
Published: August 2016

BackgroundArticle 12 of the UN Convention on the Rights of the Child, states that children should be involved in decisions that directly affect them.1 Research involving children should ensure that the opinions and assistance of children and young people is sought at the beginning of the project as their perspectives may influence all aspects of the research design.AimTo describe the challenges recruiting paediatric patients and members of the public to consult on the design of a research project.MethodPosters were put up around the Children's Hospital including pharmacy to recruit paediatric patients and parents to review a research proposal involving children with long-term conditions.ResultsThere were two responses to the poster, a father and his 15 year old daughter, and a father with a 2 year old child. The father of the 15 year old attended the initial planning meeting, unfortunately the 15 year old and the father of the 2 year old were unable to attend on the day although both agreed to participate in the project. The meeting gave the opportunity to explain the research proposal and answer questions. It was established that the lay team would review the lay summary, participant information leaflet (PIL), and questionnaires that would be sent to the participants. It was arranged that all further contact would be via email due to travel constraints.Patient and public involvement (PPI) in research requires the individuals to be reimbursed for their time. The National Institute for Health Research rate is £18.75 per hour. The lay team members were informed of this and were reimbursed for attending the planning meeting.ConclusionsThe use of posters to recruit PPI into the research design had limited success. Since recruitment, the Children's Hospital has launched a youth partnership which may be able to assist in recruitment of lay team members in the future.The logistics of how to pay the lay team members needed to be resolved before their recruitment to ensure timely payment. A form has been created to enable timely payment.Face to face meetings allow for greater discussion between all lay members which may lead to more ideas and opinions being generated than when communicating via email. When working via email, the amount of time spent on the project can not be verified. It should be specified from the start how long the work is expected to take. An advantage of using email is that costs reimbursed do not include travel expenses.When involving young people of school age it must be remembered that meetings need to be arranged outside of school hours which may be difficult for the researcher to accommodate.The lay members of the team provided valuable feedback regarding the wording of the lay summary, PIL and research tools leading to alterations being made before submission to the ethics committee.
Palliative care evidence review service (PaCERS): a rapid systematic approach to identifying high quality evidence on palliative care
Authors: Gee Peter , Woodward Amanda , Nelson Annmarie , Mann Mala , Byrne Anthony 
Published: August 2016

IntroductionThe importance of relating clinical practice more closely to evidence, is recognised by health and social care professionals and commissioners alike. However a significant obstacle is the lack of time to locate and read the relevant literature. Additionally, the expectation to assess quality and deal with conflicting information can be challenging. Therefore, we have initiated PaCERS to support professionals and other decision makers working in palliative care.AimThe aim of this service is to conduct rapid evidence reviews on questions of current and direct importance to clinical care or service delivery, producing critically appraised summaries of available evidence, in the shortest possible timeframe. Responding directly to external clinical/organisational calls for evidence, the service will also facilitate at-pace integration of research findings into service development, and will help to embed palliative care research into clinical practice.MethodThe service will enable palliative care professionals to gain an overview of literature relevant to the topic of immediate interest in order to inform future practice/service design, confirm that current practice reflects contemporary research evidence and identify areas that require further research. A web-based repository of all reviews produced through PaCERS will be made available to palliative care decision makers.ResultsWe have held a highly productive workshop with clinical colleagues to refine our processes and achieve consensus on how best PaCERS can serve the palliative care community. One full review, which identifies best practice models for end of life and palliative care in rural areas, has been completed.ConclusionThis service will impact directly on palliative care clinicians and other decision makers, and indirectly on patients/carers in receipt of palliative care. This research evidence review service can provide guidance for a variety of palliative care issues including round the clock palliative care.
Are subcutaneous palliative medicines available and accessible: an out of hours (OOH) audit in sheffield
Authors: Miller Elizabeth , Morgan Julie D , Blenkinsopp Alison , Wong Christina 
Published: August 2016

IntroductionNICE quality standards (2011) state palliative care drugs should be fully accessible 24/7. National drug shortages, insufficient local stockholdings and prescriptions for items not on the recommended palliative list can make this problematic especially out of hours (OOH). There is little research on referral patterns for accessing subcutaneous medicines OOH.ObjectivesDetermine if subcutaneous palliative medicines are fully available OOH Investigate whether supplies vary between hospital and community pharmaciesUnderstand referral patterns to access medicationMethodA 12 month retrospective audit of GP OOH supplies from a hospital pharmacy with a prospective 4 week audit and carer survey in a large community pharmacy providing OOH supplies.ResultsLocally derived standards from commissioned service set at 100% (n = 68 in GP OOH/hospital, n = 21 in community pharmacy).100% of core subcutaneous medicines were available 24/7. Use of midazolam, diamorphine and hyoscine butylbromide similar across both settings; however levomepromazine was more common in the community following a national shortage of haloperidol. See table 1.29% of community pharmacy issues were for formulations not on the recommended palliative list.80% (4/5) patient referrals were made to the community pharmacy; 20% (1/5) going to more than one pharmacy.Abstract 61 Table 1Subcutaneous palliative care drug suppliesDrug nameGP OOH/hospital pharmacy suppliesNo. (%)Community pharmacy suppliesNo. (%)Midazolam Injection (various strengths)19 (28)5 (24)Diamorphine Injection (various strengths)17 (25)8 (38)Haloperidol Injection 5 mg5 (7)1 (5)Hyoscine Butylbromide Injection 20 mg13 (19)4 (19)Levomepromazine Injection 25 mg1 (1)3 (14)Morphine Injection 10 mg3 (4)0 (0)Oxycodone Injection (various strengths)6 (9)0 (0)Other Injections4 (6)0 (0)Total6821ConclusionSubcutaneous palliative care drugs are fully available in the OOH setting however further research should be undertaken to assess referral patterns.ReferenceNational Institute for Health and Care Excellence (NICE). Quality Standard 13 End of life care for adults. London: NICE; 2011
Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review
Authors: Crocker-Buque Tim , Edelstein Michael , Mounier-Jack Sandra 
Published: August 2016

BackgroundIn high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents).MethodsWe searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015.ResultsThe 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group.ConclusionsLocally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.
Three-body quantum Coulomb problem: Analytic continuation
Authors: Turbiner A. V. , Lopez Vieyra J. C. , Olivares Pilón H. 
Published: August 2016

The second (unphysical) critical charge in the three-body quantum Coulomb system of a nucleus of positive charge [Formula: see text] and mass [Formula: see text], and two electrons, predicted by Stillinger has been calculated to be equal to [Formula: see text] and [Formula: see text] for infinite and finite (proton) mass [Formula: see text], respectively. It is shown that in both cases, the ground state energy [Formula: see text] (analytically continued beyond the first critical charge [Formula: see text], for which the ionization energy vanishes, to [Formula: see text][Formula: see text][Formula: see text][Formula: see text][Formula: see text]) has a square-root branch point with exponent 3/2 at [Formula: see text] in the complex [Formula: see text]-plane. Based on analytic continuation, the second, excited, spin-singlet bound state of negative hydrogen ion H[Formula: see text] is predicted to be at −0.51554 a.u. (−0.51531 a.u. for the finite proton mass [Formula: see text]). The first critical charge [Formula: see text] is found accurately for a finite proton mass [Formula: see text] in the Lagrange mesh method, [Formula: see text].
Norm resolvent approximation of thin homogeneous tubes by heterogeneous ones
Authors: de Oliveira César R. , Verri Alessandra A. 
Published: August 2016

We study the operator [Formula: see text] restricted to a waveguide [Formula: see text], with heterogeneous function [Formula: see text] constant in the longitudinal direction. The purpose is to obtain an effective operator, in the norm resolvent sense, when the diameter of [Formula: see text] tends to zero with heterogeneity approaching a homogeneous situation (i.e. a constant function [Formula: see text]). The effective operator presents a potential that, besides the traditional dependence on waveguide geometric properties, there is also a contribution from [Formula: see text] which results, when combined with the curvature, for example, in the possibility of a repulsive interaction.