bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF FIXED CONCENTRATIONS SEDATION INFUSIONS ON FLUID OVERLOAD IN CRITICALLY ILL CHILDREN
Authors: Sutherland Adam , Jemmett Elizabeth , Playfor Stephen 
Published: August 2016

IntroductionFluid overload of 10% at 48 hrs (100 ml/kg additional fluid) is strongly associated with morbidity in critically ill children.1 Contributors include fluid resuscitation, acute kidney injury, and administration of intravenous drugs. Acute Kidney Injury has been observed to be more prevalent in infants.2 Drug infusions are historically prepared according to bodyweight to run at large volumes to facilitate end-of-bed calculation and administration. We report the impact of using standardised concentrations on fluid overload in critically ill children in a tertiary general PICU.MethodsAdministration of sedation infusions was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained. Infusion volumes were calculated in ml/kg/day for different weight groups – 0–5 kg, 5–20 kg and <20 kg – and compared with equivalent volumes for weight-based infusions.Results33 patients received sedation infusions over a 5 week period. Overall drug volumes were reduced by 50.3%(41.3 to 58.7%) from 5.19 ml/kg to 2.65 ml/kg. Greatest reduction was seen in the smallest patients (total reduction 68% (16.72 ml/kg vs 5.36 ml/kg). Midazolam volumes in patients >20 kg was observed to increase (0.75 ml/kg vs. 0.95 ml/kg) but this did not have an impact on overall fluid burden.ConclusionsWeight based sedation infusions may contribute to fluid overload related morbidity, especially in infants. An infant on morphine and midazolam at standard doses (20 mcg/kg/hr and 90 mcg/kg/hr respectively) will receive 16.7 ml/kg/day (33.4% of critical fluid overload at 48 hrs) when using weight-based infusions. Using standard concentrations reduces this volume to 5.36 ml/kg/day (10.7% of critical fluid overload at 48 hrs).
IMPACT OF A COMPUTERISED OUTPATIENT PRESCRIPTION PRINTING SYSTEM (COPPS) ON MELATONIN PRESCRIBING IN A COMMUNITY CHILD HEALTH CLINIC
Authors: Webb Liz , Skingle Jum 
Published: August 2016

AimCOPPS is a computerised outpatient prescription printing system for WP10 prescriptions. It aims to improve the quality and safety of service, as patients will be provided with a legible, complete prescription to take to a community pharmacy of their choice. Patients requiring specialist medicines will have their medicines dispensed more promptly by the hospital pharmacy or medicines home care provider. The software ensures prescriptions contain all the required information to allow safe dispensing, reducing frequency of delays. Hospital pharmacy staff have more time to explain their medicines to patients, promoting shared decision making and improved adherence leading to better health outcomes and reduced waste and harm; provide information at the time of prescribing to increase adherence to agreed care pathways and prescribing practice. It facilitates attribution of prescribing, improves governance and is more easily audited and reported; capture the costs of medicines dispensed for out-patients which will be measured using information from the hospital pharmacy computer system and CASPA.The aim of this audit was to evaluate the effect the introduction of COPPS has had on compliance with the UHB formulary, local melatonin pathway and its impact on expenditure for melatonin within the community child health clinic. The pathway states that the starting dose is 2 mg Circadin® tablet or liquid melatonin 1 mg/1 ml if necessary for individual patients.MethodCommunity Child Health prescribing data shows their highest expenditure is on melatonin. This was therefore chosen to test the impact of COPPS for a pilot study.Six months prescribing data (September 14–March 15) was obtained from COPPS. This was compared to data obtained for WP10's from hospital forms analysis for the same months the previous year (September 13–March 14)ResultsA 55% reduction was seen in the prescribing of non-formulary melatonin and a reduction in expenditure on melatonin by 18% or £16,000. The estimated annual reduction is £23,000.There was also a significant increase in adherence to the agreed medication pathway for melatonin.ConclusionCOPPS provides information for establishment of a robust and expediated audit of medication costs and pathway compliance as shown by the melatonin results. It encourages prescribers to pick medicines from the UHB formulary and provides information that can be used to assess compliance to agreed pathways. In addition pharmacies are provided with accurate legible prescriptions and the patient receives printed copy of the prescription for the GP. A similar approach will now be used to assess the data for Attention Deficit Hyperactivity Disorder (ADHD). COPPS has recently been rolled out to another UHB community child health clinic and the local special schools and further outpatient clinics will follow. A patient satisfaction survey in the outpatient clinics will be developed and audited.
LONG-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN
Authors: Aljebab Fahad , Choonara Imti , Conroy Sharon 
Published: August 2016

BackgroundLong courses of oral corticosteroids are commonly used in children in the management of conditions such as nephrotic syndrome, leukaemia, asthma and others. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels.MethodsA literature search of several databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to March 2014. All types of studies that provided clear information on ADRs were included.Results91 relevant studies were found from 27 countries. These studies represented a total of 6653 children and contained reports of 4124 ADRs, the majority in patients with leukaemia, haemangioma and asthma. Oral prednisolone was the most commonly prescribed corticosteroid (74% of patients). The three most frequent ADRs were weight gain, Cushingoid features and growth retardation. The incidence rates of patients with these three ADRs were 22.4%, 20.6% and 18.9%, respectively. Increased susceptibility to infection was the most serious ADR. 24 children died from infections, ten from varicella zoster and the others from different microorganisms.ConclusionsWeight gain, Cushingoid features and growth retardation were the most frequent ADRs seen when long-course oral corticosteroids were given to children. In addition, increased susceptibility to infection was the most common cause of mortality.
ONCE DAILY GENTAMICIN DOSE BANDING IN NEWBORNS WITH SIGNS OF EARLY ONSET OF NEONATAL SEPSIS (EONS), BASED ON INITIAL BIRTH WEIGHT AND GESTATIONAL AGE
Authors: Windscheif Paul-Michael , Welsh Rhoda , Smith Laura , Nicoll Ian , Anthony Mark 
Published: August 2016

AimProspective assessment of safety of dose banding of once daily gentamicin in newborns with signs of EONS in their first days of life.MethodAll neonates admitted on the level-3 neonatal unit, with at least three consecutive once daily gentamicin doses, started no later than 48 hrs after birth were included. The dose was based on initial birth weight and not adjusted to daily changes of the bodyweight(W). A gentamicin trough level of 2 mg/L was permitted. Neonates with hypoxic ischaemic encephalopathy at birth were not started on a gentamicin regimen. Data was taken from a database system registered as a service evaluation.Of more than 1200 admitted neonates eighty nine (60 boys, 29 girls; born between Feb 2014 and Jul 2015) received at least three consecutive gentamicin doses for EONS soon after birth (within first 24 hrs: 96.6%), while the majority of antibiotic courses started with a gentamicin regimen were stopped within 36 hrs. 23 (25.8%) neonates with a gestational age (GA) of less than 30 weeks started on 5 mg/kg 48-hourly. Neonates 30 weeks and older started on weight based dosing range: Up to 3 kg: 48 (53.9%) neonates on 5 mg/kg 24 hourly. Between 3–3.5 kg: 13 (14.6%) at fixed 15 mg 24 hourly; between 3.5–4 kg: 5 (5.6%) neonates at fixed 17.5 mg 24 hourly. The first trough level (95.5%) was taken before the third dose. Daily weight (W) was recorded. Routine blood samples was recorded including creatinine, C-reactive protein and a routine sample was sent for investigation of bacterial growth.ResultsThe first trough level for neonates up to 30 weeks on 48 hourly regimen (GA-mean 27, range 24–29; W-mean 0.96 kg, range 0.54–1.4 kg; W-change 3.9%) was for all less than 2 mg/L (mean 0.66 mg/L, range 0.2–1.3). For neonates 30 weeks and older, up to 3 kg: (GA-mean 34, range 30–41; W-mean 2.16 kg, range 1.09–2.86 kg; W-change 2.9%) on 24 hourly regimen the level was for 37(82%) up 2 mg/L (mean 1.6 mg/L, range 0.2–2; for 3 cases no level; eight cases 2 up to 3 mg/L of which 3 results cannot be explained with change of a disease status). Neonates between 3–3.5 kg: (GA-mean 38, range 33–42; W-mean 3.3 kg, range 3–3.48 kg; W-change 0.96%) on 24 hourly regimen: all except for one less than 2 mg/L (mean 1.3 mg/L, range 0.4–2; one at 2.7 with hyperinsulinaemia). Between 3.5–4 kg: (GA-mean 39, range 36–41; W-mean 3.78 kg, range 3.6–3.9 kg; W-change 1.3%) on 24 hourly regimen: all less than 2 mg/L (mean 1.1 mg/L, range 0.4–1.7). None of the samples for 73(82%) neonates sent for bacterial investigation showed bacterial growth over 5 days.ConclusionDose banding for gentamicin in EONS is a promising safe option for dosing neonates. There needs to be a revision and re-evaluation in context of the disease profile of the population of a newborn unit as indicated by results for dosing neonates 30 weeks and older but less than 3 kg.
PAEDIATRIC STANDARDISED CONCENTRATION INFUSIONS – A NATIONAL SOLUTION
Authors: Howlett Moninne , Curtin Michael , Doherty Dermot , Gleeson Paula , Sheerin Michelle , Breatnach Cormac 
Published: August 2016

AimWide scale implementation of paediatric standardised concentration infusions (SCIs) and the use of smart pump technology has been slow despite international safety agency recommendations. Implementation rates in European hospitals fall far below those in the United States, where for the last decade accreditation has been linked to implementation.1 2 Multidisciplinary collaboration is essential, with pharmacy input and the creation of a smart pump drug library recognised as often being limiting, yet crucial factors, to implementation.3 Following on from the successful development and implementation of a paediatric drug library of standardised concentrations in the paediatric intensive care unit (PICU), operating theatres and cardiac ward of a large tertiary children's hospital, a project was set up to further develop this library for use across multiple sites including paediatric acute transport services.MethodPost-implementation of the original SCI drug library in the single site paediatric hospital in 2012, a database was created to record proposals for amendments and expansion of that library. A cross-site multidisciplinary collaborative working group was established with representation from PICU pharmacists, intensivists, nursing and clinical engineering to progress multisite adoption of a standardised drug library. Differences in practices across sites were identified and resolved by consensus where possible. Unresolved differences were overcome by omission or ‘hiding’ of particular drug lines at individual sites until consensus could be reached for future updates. Legally binding agreements were drawn up between sites, in conjunction with the infusion pump vendors, to prevent any future deviations from the master library.ResultsCross-site collaboration over a number of months facilitated the successful amendment and extension of the original drug library to create a new master drug file. Individual site versions of this library, and the supporting documentation were created and disseminated. A change control management plan was developed and agreed upon.ConclusionCross-site collaboration is achievable in supporting the increased implementation of standardised concentration infusions. The standardisation of practices across sites maximises both human and financial resources, and has the potential to reduce medications errors as both patients and medical staff transfer across sites.
Association between human resources and risk of hospitalisation in end-stage renal disease outpatients receiving haemodialysis: a longitudinal cohort study using claim data during 2013–2014
Authors: Choi Hoon-Hee , Han Kyu-Tae , Nam Chung Mo , Moon Ki Tae , Kim Woorim , Park Eun-Cheol 
Published: August 2016

ObjectiveThe number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit.SettingWe used data from National Health Insurance (NHI) claims during October 2013 to September 2014.ParticipantsThese data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis.InterventionsNo interventions were made.Outcome measureWe performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD.ResultsAmong 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients.ConclusionsOur findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD.
“What makes it worth the investment to say it?” – Care experiences of lesbian, gay, bisexual and/or trans* people facing life-limiting illness: a qualitative interview study
Authors: Bristowe Katherine , Hodson Matthew , Wee Bee , Almack Kathryn , Daveson Barbara , Koffman Jonathan , McEnhill Linda , Johnson Katherine , Harding Richard 
Published: August 2016

IntroductionPeople who identify as lesbian, gay, bisexual and/or trans* (LGBT) have increased risk of certain life-limiting illnesses. Evidence suggests they may not receive the care and support they need towards the end of life and into bereavement.1,2AimTo inform training and resources to improve care, this original study aimed to explore care experiences of LGBT people facing life-limiting illness, by eliciting experiences of: sharing identity (sexual identity/gender history) in healthcare settings; accessing services; discrimination/exclusion; and examples of good practice.MethodsIn-depth qualitative interview study. Participants were recruited across the UK (England, Wales, Scotland) via clinical teams, social media and community networks. Interviews were transcribed verbatim and analysed using thematic analysis.Results40 LGBT people were interviewed: 20 patients, 6 informal carers, 14 bereaved informal carers; 21 described cancer experiences, 16 non-cancer, 3 co-morbid cancer/non-cancer; and mean age was 60 (range 27–94).Five main themes emerged: 1) palliative care needs that may require additional or different consideration for LGBT people; 2) communicative or service level barriers and stressors, including heteronormative assumptions, and homophobic/transphobic behaviours; 3) internalised or invisible barriers and stressors, including fears, or experiences, of discrimination, 4) which shape individuals’ preferences for disclosure and exploration of identity; and 5) communicative or service level facilitators to accessing care and support.ConclusionsDespite recent legislative change for LGBT people, experiences of discrimination and exclusion in advanced disease and palliative care are still evident. A resource, co-designed with the LGBT community, is being piloted, and learning events being delivered nationally.ReferencesHarding R, Epiphaniou E, Chidgey-Clark J. Needs, experiences and preferences of sexual minorities for end-of-life care and palliative care: a systematic review.J Palliat Med2012;15:602–611Bristowe K, Marshall S, Harding R. The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: a systematic review, thematic synthesis and modelling of the literature.Palliat Med2016
UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method
Authors: Dempster Martin , McCorry Noleen , O’Connor Sean , Armour Kathy , Coast Joanna , Cohen Joachim , Donnelly Michael , Finucane Anne , Fyvie Joan , Jones Louise , Kernohan George , Leemans Kathleen , Oxenham David , Perkins Paul 
Published: August 2016

IntroductionEvaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.AimTo develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.MethodsUsing a modified version of the RAND/UCLA appropriateness method (Fitchet al.,2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.Results71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.ConclusionThe final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.ReferenceFitch K, Bernstein SJ, Aguilar MD,et al.The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001.http://www.rand.org/pubs/monograph_reports/MR1269
The chemical compatibility and stability of drug combinations administered by continuous subcutaneous infusions used in end of life care
Authors: Dickman Andrew , Roberts Ellen , Weir Phil , Mason Stephen , Ellershaw John 
Published: August 2016

IntroductionIn 2007, the National Patient Safety Agency recommended that healthcare staff need to have full technical information about compatibility of commonly used mixtures used in specialist areas only (National Patient Safety Agency 2007). In 2008, the Commission on Human Medicine (CHM) recommended that research should be commissioned to develop authoritative national advice on mixing of medicines to encompass compatibility and stability data (Commission on Human Medicines, 2008).In the UK, a continuous subcutaneous infusion (CSCI) is considered to be the preferred method of drug administration to maintain symptom management at the end of life. Despite this common practice, compatibility data are lacking. Analysis of national practice identified commonly used drug combinations administered by CSCI that were included in this study.Aims/objectivesTo determine the chemical compatibility/stability of a total of 40 commonly encountered drug combinations. A CME T34 syringe pump was used to simulate infusion of the syringe preparation over a 24 hour period. The combinations were analysed by High Performance Liquid Chromatography-Diode Array Detection (HPLC-DAD).ResultsThirty combinations were identified as compatible by HPLC-DAD. These combinations also remained clear and free from visible particulate matter and the pH remained constant over the monitored period. Four combinations will require additional analysis as variances were detected during the testing procedure.ConclusionThis research is the first step towards providing technical information required by healthcare staff for the mixing of injectable medicines in the same syringe.ReferencesCommission on Human Medicines.Outcome of the consultation exercise on proposals for regularising the position of those mixing and administering medicines in palliative care. London: MHRA; 2008.http://webarchive.nationalarchives.gov.uk/20141205150130/http://mhra.gov.uk/publications/consultations/medicinesconsultations/mlxs/con033523. Accessed June 3, 2016.National Patient Safety Agency. Promoting safer use of injectable medicines; 2007.http://www.nrls.npsa.nhs.uk/resources/?entryid45=59812. Accessed June 3, 2016.