bluuebunny/crossref_metadata_2025_split huggingface dataset:
28 Paediatric medication error prevention (PMEP) a tripartite alliance working together
Authors: Vallabhaneni Pramodh , Ahmad Aamina , Issac Rachel , Fitchett Nicola , Patel Bhavee 
Published: May 2023

Prescribing and medication administration errors are common themes in Paediatrics. We observed an increasing trend of errors in our ward and assessment area. We undertook an audit to quantify errors within our department as per the EQUIP criteria suggested by the General medical council. A zero-tolerance approach was undertaken, and all errors from minor to severe were recorded. An alarming 90% of admissions within the audit period had minor to significant errors recorded in the initial audit. With the zero-tolerance approach, minor errors with no harm to life were also recorded.Previous research has suggested that good quality care depends upon different professions working together. We created a tripartite alliance involving nursing, pharmacy and medical teams. Our primary aim was to reduce medication prescription and administration errors by at least 10%. The small incremental change target was made in line with the quality improvement principles. We placed education at the heart of the change process, and the programme involved no costs apart from the time invested by the team.As a result, medication errors have been substantially reduced over the last five years, and education has been at the heart of the change process. The group has achieved change that is sustainable and prudent in design. We aligned staff, method and delivery to minimise avoidable harm and promoted co-production with patient involvement in educating staff about the impact of such errors. Working together as a team involving all three disciplines has helped us understand and modify practices that have led to an overall reduction in medication errors. We would like to share our change model that has influenced consistent and reliable results over several audit cycles.
31 The impact of paediatric dose range checking software
Authors: Rybka Elena , Neame Matthew , Moss James , Saez Dominguez Jordi , Gill Andrea , Barnes Nik , Hawcutt Daniel 
Published: May 2023

Dosing errors can cause significant harm in paediatric healthcare settings.Our objective was to investigate the effects of paediatric dose range checking (DRC) clinical decision support (CDS) software on overdosing-related outcomes.A before-after study and a semi-structured survey of prescribers was conducted across inpatient wards (excluding intensive care) in a regional children’s hospital. DRC CDS software linked to a paediatric drug formulary was integrated into an existing electronic prescribing system.The main outcome measures were; the proportion of prescriptions with overdosing errors; overdosing-related clinical incidents; severity of clinical incidents; and acceptability of the intervention.The prescription overdosing error rate did not change significantly following the introduction of DRC CDS software: in the pre-intervention period 12/847 (1.4%) prescriptions resulted in prescription errors and in the post-intervention period there were 9/684 (1.3%) prescription overdosing errors (n=21, Pearson χ2 value=0.028, p=0.868).However, there was a significant trend towards a reduction in the severity of harm associated with reported overdosing incidents (n=60, Mann-Whitney U value=301.0, p=0.012).Prescribers reported that the intervention was beneficial and they were also able to identify factors that may have contributed to the persistence of overdosing errors.DRC CDS software did not reduce the incidence of prescription overdosing errors in a paediatric hospital setting but the level of harm associated with the overdosing errors may have been reduced. Use of the software seemed to be safe and it was perceived to be beneficial by prescribers.
33 Off-label use of drugs in paediatric (specialised) outpatient clinics – what has changed between 2009 and 2019?
Authors: Toni Irmgard , Hupfer Jutta , Neubert Antje 
Published: May 2023

IntroductionOff-label use is still inevitable for paediatric drug treatment. The aim of this study was to analyse the licensing status of drug prescriptions in German paediatric (specialised) outpatient clinics and to determine changes over a 10-year time course.MethodsCross-sectional, retrospective, monocentric studies were conducted in 2009 and 2019 to assess drug prescriptions regarding their licensing status in 10 (one general and nine specialised) outpatient clinics in Germany. Prevalence and relative frequency of off-label prescriptions were calculated, reasons for off-label prescribing analysed and logistic regression performed to determine influencing factors.Results751 prescriptions of 296 patients in 2009 and 1438 prescriptions of 786 patients in 2019 were examined and classified according to their licensing status. Relative frequency of off-label prescriptions was around 45% without significant change over that decade. Prevalence of off-label prescriptions was 60.1% in 2009 and 53.1% in 2019 and therefore significantly higher in 2009 (p=0.037). The number of prescriptions per patient was significantly higher in 2009 (2.5 ± 2.3 vs. 1.8 ± 1.5, p<0.000), too. Comparison revealed the same high-ranking reasons in every study: off-label use due to indication, overdosing and missing paediatric information.ConclusionsOff-label prescribing still plays an important role in clinical daily routine in paediatrics. Despite numerous regulatory efforts and incentives, no substantial reduction in off-label prescribing could be determined since 2009. Further efforts are needed to generate more evidence-based knowledge about paediatric pharmacotherapy and to treat children as best as possible.
35 What is known about the pharmacology of intramuscular therapeutics in duchenne muscular dystrophy? A systematic review
Authors: Roberts Eve , Yi Gan Jia , Hawcutt Daniel , Spinty Stefan 
Published: May 2023

2Clinical Research Facility, Alder Hey Children’s HospitalIntroductionIn 2018 the Centers for Disease Control published updated Standards of Care for Duchenne Muscular Dystrophy – newly included was the recommendation for all patients with DMD who received steroids to receive prescriptions for intramuscular (IM) hydrocortisone for emergency administration at home.The aim of this systematic review was to assess the current understanding of the pharmacodynamics and kinetics of intramuscular therapies in patients affected by DMD.MethodsA systematic review was conducted according to Cochrane methodology. Medline, EMBASE and PubMed databases were searched. Two independent reviewers reviewed the abstract of each identified paper. Where there was any discrepancy in the decision to include or exclude a paper, a third reviewer arbitrated.ResultsThe search returned a total of 98 papers. 96 papers were excluded: 61 described animal or in-vitro studies, whilst the remaining studies did not study an intramuscular pharmacological intervention or were review articles.Of the two included articles, one compared the immunogenicity of intramuscular and subcutaneous administration of influenza vaccination, and the other studied ten patients with DMD who were injected with two different doses of plasmidic DNA. Neither study reported on the pharmacodynamics or kinetics of the interventions.ConclusionsThere is very limited evidence into the pharmaco-kinetics and -dynamics of IM therapies for children affected by muscular dystrophy. Given the recognised changes in the muscle structure and function, studies to explore if this causes clinically significant changes in boys with DMD are required.
37 Deprescribing long acting beta2 agonists in children and adolescents with stable asthma: a systematic review
Authors: Drozdz Wiktoria , Sinha Ian , Hawcutt Daniel 
Published: May 2023

IntroductionCurrent guidelines recommend step-down of asthma drugs once stable asthma has been achieved but there is no guidance regarding deprescribing long acting beta2 agonists (LABAs) in the paediatric population.AimTo systematically review evidence regarding deprescribing methods of LABAs in the paediatric population.MethodsSearches were undertaken in the following databases: EMBASE, Medline, PubMed and CINAHL regarding reports of deprescription or discontinuation of LABAs in children and adolescents with persistent asthma.ResultsThe search returned 168 papers following deduplication. 4 papers met the eligibility criteria including 3 randomised control trials and 1 retrospective study. Overall, LABA step down was attempted in 365 children and young people (5–18 years old). The studies had variable follow up durations once deprescribing was undertaken, from 2 to 12 weeks. Effects of withdrawal were measured using parameters such as airway hyperresponsiveness tests (3 studies), asthma control test scores (3 studies), use of rescue medication (3 studies) and lung function tests (FeNO, FEV1, FEF25–75%, peak expiratory flow rate (PEFR),% forced expiratory flow at 50% of vital capacity (%V50)) (all studies). Airway responsiveness was unchanged 2 weeks following LABA withdrawal, however decreases in%PEFR and%V50, FEV1 and asthma control test scores were observed. 2 studies assessed changes in LABA related adverse effects after deprescribing.ConclusionThere is limited and short-term evidence regarding stepping down LABAs in paediatrics. To fully implement national and international guidelines, prospective studies in this area are required.
39 KiDSafe – improving medication safety for children and adolescents: implementation and evaluation of a new form of care
Authors: Toni Irmgard , Malonga Makosi Dorothée , König Jochem , Urschitz Michael S , Rascher Wolfgang , Neubert Antje 
Published: May 2023

IntroductionDrug therapy in paediatrics is often associated with uncertainties due to the lack of data from clinical trials, and thus the need for off-label use, but also missing paediatric dosage forms.The KiDSafe project aimed to significantly improve the existing shortfall by introducing a structured treatment procedure (PaedPharm).MethodsPaedPharm consists of three modules: 1. a digital paediatric drug information system (PaedAMIS), 2. paediatric-pharmacological quality circles (PaedZirk) and 3. a system for reporting of ADRs/MEs in the paediatric population (PaedReport). By using a stepped-wedge design, PaedPharm was implemented in 12 territorial clusters, each involving a children’s hospital and surrounding outpatient paediatricians and psychiatrists. The primary aim of the study was to reduce the prevalence of drug-related hospital admissions by one third. In addition, qualitative and quantitative analysis concerning the quality of the implementation and acceptance of the intervention was performed.ResultsA total of 41829 patient cases were recorded in the participating hospitals, of which 5101 admissions could be assigned to the participating doctors (n=152). Under control conditions, a population-based mean of 4.14% of the admissions were due to an ADR or ME. Under intervention, however, it was 3.07% (OR 0.73 (95% CI 0.39 to 1.37), p>0.05). The PaedAMIS database was well accepted and PaedZirk achieved a particular high level of acceptance.ConclusionsStructured, evidence-based drug information in combination with teaching may improve the quality of drug therapy in children.The number of participating paediatricians as well as the COVID pandemic hampered the results of this study. Thus, further studies are needed to confirm our results.
5 The perceived barriers and facilitators for model-informed dosing in pregnancy: a qualitative stakeholder analysis
Authors: Koldeweij Charlotte , Kleuskens Mirèse , Scheepers Liesbeth , Dean Franklin Bryony , Litjens Carlijn , de Wildt Saskia 
Published: May 2023

IntroductionThe lack of evidence for drug dosing in pregnancy represents a large unmet need for pregnant women and their unborn child. This study examines Dutch stakeholders’ perceptions of model-informed dosing in pregnancy as part of an effort to build a model-informed pregnancy formulary (MIPF).MethodsOnline focus groups and individual interviews were conducted with health care practitioners (HCPs) from various specialties (gynecology, pharmacy, general medicine, midwifery and other medical specialties) and with currently or recently pregnant women. The perceived barriers and facilitators for implementing a MIPF were identified using a hybrid thematic analysis.Results30 HCPs and 10 pregnant women participated in nine focus groups and three interviews. The awareness of pharmacokinetic changes in pregnancy varied across focus group participants. While a majority of HCPs and pregnant women found a MIPF to be a relevant innovation, several participants across both groups indicated that the lack of information on fetal safety constituted another important gap to address. The information needs of HCPs in order to be willing to apply model-informed dosing recommendations varied. A majority of participants indicated that they preferred model predictions to be clinically verified for the concerned drug. HCPs expressed different preferences with regards to the most appropriate website for publishing model-informed dosing advice. Several pregnant women indicated that they wanted to be informed on the evidence behind model-informed dosing recommendations.ConclusionsStakeholders’ views on the barriers and facilitators for relying on model-informed dosing in pregnancy will be further investigated through an online survey and will inform the design of a MIPF.
9 The flood of study feasibilities and the value of a centralised approach
Authors: Degraeuwe Eva , Persijn Laura , Nuytinck Lieve , Raes Ann , Turner Mark , Vande Walle Johan 
Published: May 2023

IntroductionDue to an increase in multicentric paediatric clinical trials after 2007 following the EU Paediatric Regulation, there has been a substantial increase in the number of feasibility questionnaires (FQ). Paediatric clinical trial conduct has made unique advances through the conect4children (c4c) pan-European network, funded by the Innovative Medicines Initiative (IMI2). We examined the role of a national, centralized coordination center in Belgium to pre-fill feasibility questionnaires and quality control responses from sites.MethodsThis report describes the 4-year learnings of prefilling and performing quality control for FQ by the Belgian Network representative. Additional information has been included from a broad survey sent to sites in the Belgian Network, of which 13 of the 15 sites have responded.ResultsPIs are confronted by between 10 to 50 FQ requests per year, each taking at average 60 minutes. The number of redundant questions asked by sponsors is on average 43% of the FQ. Of the 112 completed feasibilities, approximately 82% required quality control adjustments by our national coordinating center. Inconsistencies were primarily found in PIs’ report of experience, number of paediatric studies conducted, recruitment estimates and site qualifications. With a centralized and repetitive collection of FQ, a prefill of 65% of the requested information and potential corrections can be performed. A time reduction of 10 to 46% is estimated when a FQ is facilitated through the national representative.ConclusionsThe increase in paediatric clinical trials has substantially burdened sites within Belgium. Quality control and adjustments by a national central organization could be beneficial to increase feasibility quality and efficiency.
Effect of multicomponent rehabilitation on independence and functioning in elderly patients with common age-associated diseases: protocol for a scoping review (REHOLD)
Authors: Baritello Omar , Stein Hanna , Wolff Lara Luisa , Hamann Maria , Völler Heinz , Salzwedel Annett 
Published: May 2023

IntroductionElderly patients after hospitalisation for acute events on account of age-related diseases (eg, joint or heart valve replacement surgery) are often characterised by a remarkably reduced functional health. Multicomponent rehabilitation (MR) is considered an appropriate approach to restore the functioning of these patients. However, its efficacy in improving functioning-related outcomes such as care dependency, activities of daily living (ADL), physical function and health-related quality of life (HRQL) remains unclarified. We outline the research framework of a scoping review designed to map the available evidence of the effects of MR on the independence and functional capacity of elderly patients hospitalised for age-related diseases in four main medical specialties beyond geriatrics.Methods and analysisThe biomedical databases (PubMed, Cochrane Library, ICTRP Search Platform, ClinicalTrials) and additionally Google Scholar will be systematically searched for studies comparing centre-based MR with usual care in patients ≥75 years of age, hospitalised for common acute events due to age-related diseases (eg, joint replacement, stroke) in one of the specialties of orthopaedics, oncology, cardiology or neurology. MR is defined as exercise training and at least one additional component (eg, nutritional counselling), starting within 3 months after hospital discharge. Randomised controlled trials as well as prospective and retrospective controlled cohort studies will be included from inception and without language restriction. Studies investigating patients <75 years, other specialties (eg, geriatrics), rehabilitation definition or differently designed will be excluded. Care dependency after at least a 6-month follow-up is set as the primary outcome. Physical function, HRQL, ADL, rehospitalisation and mortality will be additionally considered. Data for each outcome will be summarised, stratified by specialty, study design and type of assessment. Furthermore, quality assessment of the included studies will be performed.Ethics and disseminationEthical approval is not required. Findings will be published in a peer-reviewed journal and presented at national and/or international congresses.Trial registration numberhttps://doi.org/10.17605/OSF.IO/GFK5C.
Predictors of suicidal ideation, attempts among adults living with HIV attending ART follow-ups at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: a cross-sectional study
Authors: Tesera Kendie Mikiyas , Worku Lelisa , Abebaw Ermias , Solomon Damtew , Ogeto Luke Amana , Hayilu Sisay , Bogale Eyob Ketema 
Published: May 2023

ObjectiveTo assess the magnitude of suicidal ideation, attempts and associated factors among adults living with HIV attending antiretroviral therapy follow-ups at Tirunesh Beijing General Hospital, Addis Ababa.DesignHospital-based observational, descriptive, cross-sectional study was conducted.SettingA study was conducted in Tirunesh Beijing General Hospital, Addis Ababa from 8 February 2022 to 10 July 2022.ParticipantsTwo hundred and thirty-seven HIV-positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview was used to assess suicide. Patient Health Questionnaire-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. Bivariate and multivariate logistic regressions were computed to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at p value <0.05.ResultsThe finding of the study revealed magnitude of suicide ideation and suicide attempt was 22.8% and 13.5%, respectively. Disclosure status (adjusted odd ratio (AOR)=3.60, 95% CI 1.44 to 9.01), history of using substances (AOR)=2.86, 95% CI 1.07 to 7.61), living alone (AOR=6.47, 95% CI 2.31 to 18.10) and having comorbidity or other opportunistic infection (AOR=3.74, 95% CI 1.32 to 10.52) are factors associated with suicide ideation while disclosure status (AOR=5.02, 95% CI 1.95 to 12.94), living arrangement (AOR=3.82, 95% CI 1.29 to 11.31) and depression history is a factor associated with suicide attempts (AOR=3.37, 95% CI 1.09 to 10.40).ConclusionThe finding of the study indicated the magnitude of suicide ideation and attempt is high among the subjects included in this study. Disclosure status, history of using substances, living alone and having comorbidity or other opportunistic infection are factors associated with suicide ideation while disclosure status, living arrangement and depression history are factors associated with a suicide attempt.
Half-metallicity from CrCoSi and MnCoSi half-Heusler alloys to their derivative double half-Heusler CrMnCo2Si2
Authors: Elarabi Hiba , Khelfaoui Friha , Boudia Keltouma , Labani Fatima , Hamlat Mama , Sadouki Ouafaa , Belkharroubi Fadila , Faid Fares , Bouhemadou Abdelmadjid , Deghfel Bahri 
Published: May 2023

The structural, elastic, electronic, and magnetic properties of the CrCoSi, MnCoSi parent half-Heusler (HH) alloys, and their CrMnCo2Si2 derivative double half-Heusler (DHH) compound are studied, utilizing the augmented plane wave method, which is based on density functional theory and implemented in the WIEN2k code. The stability of HH structure of the CrCoSi and MnCoSi alloys has been checked for their non-magnetic and ferromagnetic phases, leading to that the latter phase of the type I arrangement is the most stable. The CrMnCo2Si2 DHH alloy, derivative from the found structural and magnetic ground states of CrCoSi and MnCoSi HH alloys, is constructed and investigated. This DDH as well as its CrCoSi parent HH are found to be resistant to deformation and can be classified as ductile materials, whereas the MnCoSi compound is brittle. By the gradient generalized approximation (GGA), the electronic structures of CrCoSi, MnCoSi, and CrMnCo2Si2compounds exhibit a metallic behavior in the spin-up channel and a semiconducting behavior in the spin-dn channel, with band gaps (half-metallic gaps) of 0.851(0.020), 0.852(0.021), and 0.531(0.002) eV, respectively. The half-metallicity of CrMnCo2Si2 DHH is retained with smaller (larger) band gap (half-metallic gap) of 0.38(0.106) eV than that of GGA, using GGA + U approximation. In addition, the total magnetic moments are found to be 1, 2, and 3 µB for CrCoSi, MnCoSi, and CrMnCo2Si2, respectively. Therefore, these alloys can be good candidates for spinitronic applications due to their half-metallicity.
Cosmic neutrons at ground: new spectral measurements at 3480 m a.s.l. and benchmarking of the cascade component as a function of the elevation at around 45° geomagnetic latitude
Authors: Bedogni R. , Fontanilla A. , Calamida A. , Campoy A. I. Castro , Russo L. , Monti V. , Mafucci E. , Vigorito C. , Vernetto S. , Pietropaolo A. 
Published: May 2023

AbstractWithin the INFN-based project SAMADHA, environment neutron spectrum measurements were performed at 3480 m a.s.l. on the Italian western Alps. An extended range Bonner Sphere Spectrometer was used, that was especially designed to operate unattended and to discriminate genuine neutron events from spurious ones. In addition to the measurements of neutron fluence rate, its energy distribution and the related ambient dose equivalent, as well as the arrival time distribution of the events were also studied. The high-energy component of the neutron fluence rate was compared to literature data measured with the same technique at similar latitudes as a function of the elevation, in turn being fitted with an exponential curve and compared to the results from EXPACS code. As the cascade component is not influenced by the materials surrounding the measurement site, this curve can be regarded as “universal” at the studied latitudes.