Epidemic of Polypharmacy and Suggestions to Control It

1988 ◽  
Vol 9 (7) ◽  
pp. 207-208
Author(s):  
Gunnar B. Stickler
Keyword(s):  
Drug Therapy ◽  
Family Physician ◽  
Private Practice ◽  
Surgical Patients ◽  
Ambulatory Setting ◽  
Medical Patients ◽  
Children's Hospital ◽  
Pediatric Hospitals ◽  
Children’S Hospital

The term "polypharmacy" is used to describe the excessive use of drug therapy. In 1980, I reviewed the evidence of a continuing epidemic of polypharmacy.1 In 1975, there were 1.7 billion visits per year to physicians in private practice.2 Such visits to a family physician resulted in the prescription of medications to 73% of the patient contacts; in 63% of the patient visits, medications were suggested by a pediatrician. Do two thirds of our patients require medication when seen in an ambulatory setting? Pediatric hospitals did not fare much better. Of 993 patients admitted to a children's hospital, 36.7% received antibiotics.3 Using strict criteria, these authors concluded that 38% of medical patients received antibiotics inappropriately and 78% of the surgical patients did not require antibiotics.

scholarly journals A Retrospective Study Evaluating the Effectiveness of an Asthma Clinical Pathway in Pediatric Inpatient Practice

2008 ◽  
Vol 13 (4) ◽  
pp. 233-241
Author(s):  
Elisa Edwards ◽  
Kristie Fox
Keyword(s):  
Drug Therapy ◽  
Hospital Stay ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Readmission Rates ◽  
Asthma Education ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Pediatric Inpatient

OBJECTIVE To determine if the asthma clinical pathway implemented at Wolfson Children's Hospital reduces the length of hospital stay. To determine if pathway use affected the use of asthma education, the use of appropriate discharge medications based on asthma classification, and readmission rates. METHODS A list of patients aged 2 to 18 years discharged from Wolfson Children's Hospital between September 1, 2004 and August 31, 2006 with the diagnosis of asthma was generated. Medical records of eligible patients were reviewed for demographic information, asthma pathway use, duration of hospital stay in days, readmission rates, receipt of asthma education, and medications prescribed upon discharge. Patients placed on the asthma clinical pathway were compared to a control group with asthma who were matched based on age and discharge date. Length of stay was averaged for each group. Asthma education, discharge medications, and readmission rates were compared between the two groups. RESULTS Forty-three patients placed on the asthma clinical pathway were compared to a 43 patients in the control group that were matched for age and discharge date. Use of the asthma clinical pathway reduced hospital stay by 0.372 days (P = .0373). Receipt of asthma education (P = .3864), the use of appropriate drug therapy prescribed upon discharge (P = .1398), and readmission rates (P = .5486) were unaffected by pathway use. CONCLUSIONS The asthma clinical pathway used at Wolfson Children's Hospital reduces length of hospital stay, but has no bearing on receipt of asthma education, use of appropriate drug therapy upon discharge, or readmission rates.

Flaws in Study of Management of Children with Febrile Illness

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 866-867
Author(s):  
JOURNAL CLUB
Keyword(s):  
General Practitioner ◽  
General Hospital ◽  
General Practitioners ◽  
Family Physician ◽  
Journal Club ◽  
Febrile Illness ◽  
Emergency Rooms ◽  
Children's Hospital ◽  
Children’S Hospital

To the Editor.— Our residency's journal club recently reviewed your October issue and the article on management of febrile illness.1 We found it to be misleading and inconclusive for the following reasons. First, the study presented itself as a comparison of the management of fever in children by pediatricians and "general practitioners." Based on introductory statements the term "general practitioner" implies family physician, but this is not clearly stated. As the article progresses, we find the data collected are based on experience in emergency rooms at a children's hospital v a "general" hospital, each staffed by residents or interns.

Private Practice

2016 ◽  
pp. 35-42
Author(s):  
Donald W. Winnicott
Keyword(s):  
Public Health ◽  
Child Psychiatry ◽  
Private Practice ◽  
Child Psychology ◽  
Children's Hospital ◽  
Health Clinics ◽  
Children’S Hospital ◽  
The Face ◽  
Public Health Clinics

In this essay, Winnicott expresses his opinion that it would be a tragedy if private practice in child psychiatry were to disappear in the face of public health clinics. Winnicott describes his own contribution to the field of child psychology through his work at Paddington Green Children’s Hospital and states his belief that private practice provides an economical psychiatric method when compared with ordinary clinic results.

AUDIT OF OXYGEN PRESCRIBING IN A CHILDREN'S HOSPITAL

2016 ◽  
Vol 101 (9) ◽  
pp. e2.30-e2 ◽  
Author(s):  
Lucy Wheeler ◽  
Janet James ◽  
Sarah Byrne ◽  
Julian Forton
Keyword(s):  
Critical Care ◽  
British Thoracic Society ◽  
Medical Patients ◽  
Children's Hospital ◽  
National Guidance ◽  
National Patient ◽  
Children’S Hospital ◽  
Medical Wards ◽  
Future Work ◽  
Medication Chart

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.

The Challenge of Starting Hand Therapy in Uruguay

1998 ◽  
Vol 3 (3) ◽  
pp. 18-18
Author(s):  
Jeanine Harreau
Keyword(s):  
United States ◽  
Private Practice ◽  
Physical Therapist ◽  
The United States ◽  
Hand Therapy ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
To Come

In 1983 I was awarded a Fullbright scholarship to come to the United States, up until then I had been working as a Paediatric Physical Therapist in a Children's Hospital and in private practice.

scholarly journals Addressing Pain With Inpatient Integrative Medicine at a Large Children’s Hospital

2019 ◽  
Vol 58 (7) ◽  
pp. 738-745 ◽  
Author(s):  
Sanghamitra M. Misra ◽  
Evelyn Monico ◽  
Grace Kao ◽  
Danielle Guffey ◽  
Esther Kim ◽  
...  
Keyword(s):  
Side Effects ◽  
Integrative Medicine ◽  
Guided Imagery ◽  
Inpatient Setting ◽  
Consult Service ◽  
Children's Hospital ◽  
Pediatric Hospitals ◽  
Pain Scores ◽  
Children’S Hospital ◽  
Integrative Therapies

Background. Pediatric integrative medicine (IM) includes the use of therapies not considered mainstream to help alleviate symptoms such as pain and anxiety. These therapies can be provided in the inpatient setting. Methods. This 10-week study involved the integration of acupuncture, biofeedback, clinical hypnotherapy, guided imagery, meditation, and music therapy to address pain in children admitted to a large US children’s hospital. Results. Of 51 patients enrolled, 60% of the patients, 66% of their mothers, and 56% of their fathers used CAM (complementary and alternative medicine) in the preceding 1 year. Although 51 families requested integrative therapies, only 18 patients received them because of inadequate provider availability. All recorded pain scores improved with integrative therapies. One parent reported a possible side effect of irritability in the child after clinical hypnotherapy while 5 children reported opiate side effects. All participating families interviewed responded that IM services helped their child’s pain and helped their child’s mood, and that our hospital should have a permanent IM consult service. Conclusion. Integrative therapies can be helpful to address pain without significant side effects. Further studies are needed to investigate the integration, cost, and cost-effectiveness of integrative therapies in pediatric hospitals.

scholarly journals Maintenance of Elective Patient Care at Berlin University Children's Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 9 ◽  
Author(s):  
Nicolas Terliesner ◽  
Alexander Rosen ◽  
Angela M. Kaindl ◽  
Uwe Reuter ◽  
Kai Lippold ◽  
...  
Keyword(s):  
Rt Pcr ◽  
Admission Process ◽  
Children's Hospital ◽  
Pediatric Hospitals ◽  
Increased Risk ◽  
Elective Treatment ◽  
Children’S Hospital ◽  
Hospital Resources ◽  
Second Wave ◽  
Inpatient Case

Background: In Germany, so far the COVID-19 pandemic evolved in two distinct waves, the first beginning in February and the second in July, 2020. The Berlin University Children's Hospital at Charité (BCH) had to ensure treatment for children not infected and infected with SARS-CoV-2. Prevention of nosocomial SARS-CoV-2 infection of patients and staff was a paramount goal. Pediatric hospitals worldwide discontinued elective treatments and established a centralized admission process.Methods: The response of BCH to the pandemic adapted to emerging evidence. This resulted in centralized admission via one ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatment during the first wave, but maintenance of elective care and decentralized admissions during the second wave. We report numbers of patients treated and of nosocomial SARS-CoV-2 infections during the two waves of the pandemic.Results: During the first wave, weekly numbers of inpatient and outpatient cases declined by 37% (p < 0.001) and 29% (p = 0.003), respectively. During the second wave, however, inpatient case numbers were 7% higher (p = 0.06) and outpatient case numbers only 6% lower (p = 0.25), compared to the previous year. Only a minority of inpatients were tested positive for SARS-CoV-2 by RT-PCR (0.47% during the first, 0.63% during the second wave). No nosocomial infection of pediatric patients by SARS-CoV-2 occurred.Conclusion: In contrast to centralized admission via a ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatments, maintenance of elective care and decentralized admission allowed the almost normal use of hospital resources, yet without increased risk of nosocomial infections with SARS-CoV-2. By this approach unwanted sequelae of withheld specialized pediatric non-emergency treatment to child and adolescent health may be avoided.

Childhood Ecology and Child Development—As Training for Pediatric Practice

PEDIATRICS ◽  
1969 ◽  
Vol 43 (2) ◽  
pp. 306-306
Author(s):  
H. E. Thelander
Keyword(s):  
Child Development ◽  
San Francisco ◽  
Private Practice ◽  
Medical Schools ◽  
Pediatric Practice ◽  
Children's Hospital ◽  
Development Section ◽  
Children’S Hospital

At the meeting of the Child Development Section of the Academy of Pediatrics in October 1968, one of the physicians asked why medical schools and pediatric departments failed to prepare pediatricians for the private practice of their specialty. When I was chief of the department of Children's Hospital in San Francisco, two special exercises were introduced to remedy this deficiency. One of these was a weekly seminar in childhood ecology. It started in July of each year with discussion of fetology, perinatal problems, and the newborn; from there on we "grew up," as it were, with the child during the year, and by June we were discussing the adolescents.

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