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Healthcare
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Rational Use of Medicines in Children
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Rational Use of Medicines in Children

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (28 February 2019) | Viewed by 30265

Special Issue Editor

Prof. Dr. Imti Choonara

E-Mail Website
Guest Editor
Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby DE22 3DT, UK
Interests: drug toxicity; clinical trials; rational use of medicines; epidemiology of the use of medicines; inequalities in child health; access to medicines in children
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The rational use of medicines in children is one of the most important issues affecting healthcare professionals. Irrational use of medicines is responsible for significant morbidity and mortality in paediatric patients worldwide. Irrational prescribing has for too long been considered a problem only for low- and middle-income countries. It is a problem in all countries. This Special Issue of Healthcare is focused on the “Rational Use of Medicines in Children”. We welcome research articles dealing with any aspect of the rational use of medicines in children.

Prof. Imti Choonara
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • child health
  • drug therapy
  • rational prescribing
  • guidelines

Published Papers (5 papers)

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Research

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10 pages, 1444 KiB  
Article
Impact of Electronic Health Record Systems on Prescribing Errors in Pediatric Clinics
by Brooke L. Gildon, Michelle Condren and Christine C. Hughes
Healthcare 2019, 7(2), 57; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare7020057 - 05 Apr 2019
Cited by 8 | Viewed by 6327
Abstract
Medication errors are commonly reported in the pediatric population. While evidence supports the use of e-prescribing to prevent certain errors, prescribing with an electronic health record (EHR) system is not devoid of errors. Furthermore, the majority of EHRs are not equipped with functionalities [...] Read more.
Medication errors are commonly reported in the pediatric population. While evidence supports the use of e-prescribing to prevent certain errors, prescribing with an electronic health record (EHR) system is not devoid of errors. Furthermore, the majority of EHRs are not equipped with functionalities addressing pediatric needs. This study analyzes three unique EHRs in three pediatric clinics. It describes the functionality of each system and identifies errors found in e-prescribed prescriptions. Finally, the study estimates the proportion of e-prescribing errors that could have been avoided if those EHRs had met requirements set by the American Academy of Pediatrics (AAP). The number of prescriptions reviewed for Clinics 1, 2, and 3, respectively, were: 477, 408, and 633 with total error rates of 13.2%, 8.8%, and 6.6%. The clinic EHRs included 21%, 26%, and 47% of the AAP pediatric requirements for safe and effective e-prescribing for children. If all AAP elements had been included in the EHRs, over 83% of errors in the examined e-prescriptions could have been prevented. This study demonstrates that EHR systems used by many pediatric clinic practices do not meet the standard set forth by the AAP. To ensure our most vulnerable population is better protected, it is imperative that medical technology tools adequately consider pediatric needs during development and that this is reflected in selected EHR systems. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)
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15 pages, 273 KiB  
Article
Modifying a Paediatric Rational Prescribing Tool (POPI) for Use in the UK
by Fenella Corrick, Imti Choonara, Sharon Conroy and Helen Sammons
Healthcare 2019, 7(1), 33; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare7010033 - 20 Feb 2019
Cited by 8 | Viewed by 4747
Abstract
Rational prescribing tools can be used by individual prescribers, organisations, and researchers to evaluate the quality of prescribing for research and quality improvement purposes. A literature search showed that there is only one tool for evaluating rational prescribing for paediatric patients in hospital [...] Read more.
Rational prescribing tools can be used by individual prescribers, organisations, and researchers to evaluate the quality of prescribing for research and quality improvement purposes. A literature search showed that there is only one tool for evaluating rational prescribing for paediatric patients in hospital and outpatient settings. The Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) tool was developed in France and comprises 105 criteria. The aim of this study was to modify this tool to facilitate its use in paediatric practice in the United Kingdom (UK). POPI criteria were compared to relevant UK clinical guidelines from the National Institute for Health and Care Excellence, the Scottish Intercollegiate Guideline Network and the British National Formulary for Children. Where guidelines differed, criteria were modified to reflect UK guidance. If there were no relevant guidelines or directly contradictory guidelines, criteria were removed. Overall, no change was made to 49 criteria. There were 29 modified to concord with UK guidelines. Four criteria were reduced to two criteria due to being linked in single guidelines. Twenty-three criteria were omitted, due to the absence of relevant UK guidance or directly conflicting UK practice, including one entire clinical category (mosquitos). One category title was amended to parallel UK terminology. The modified POPI (UK) tool comprises of eighty criteria and is the first rational prescribing tool for the evaluation of prescribing for children in hospital and outpatient settings in the UK. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)

Review

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8 pages, 224 KiB  
Review
Studying the Evolving Knowledge of Adverse Drug Reactions in Order to Facilitate the Rational Use of Medicines in Paediatric Patients
by Kristina Star and Imti Choonara
Healthcare 2019, 7(2), 55; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare7020055 - 02 Apr 2019
Cited by 2 | Viewed by 6645
Abstract
Pharmacovigilance, which is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems, generates knowledge to facilitate the rational use of medicines. When a medicine is first marketed, there is limited information [...] Read more.
Pharmacovigilance, which is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems, generates knowledge to facilitate the rational use of medicines. When a medicine is first marketed, there is limited information on adverse drug reactions (ADRs), especially in paediatrics, where medicines are less likely to have been extensively studied. Knowledge in drug safety is built up over time when more (in number, and more heterogeneous) patients are treated than were studied in the randomised controlled trials preceding the marketing of a medicine. Previously not recognised ADRs are often initially described in case reports and case series. Prospective cohort studies are useful in determining the incidence and risk factors of common ADRs. Case series and pharmacovigilance reporting systems have been useful in identifying previously unknown uncommon ADRs and risk factors for specific ADRs. This brief review provides examples that illustrate how various study designs and data sources contribute to the evolving knowledge of ADRs that is essential to help develop guidelines and improve the rational use of medicines. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)
12 pages, 473 KiB  
Review
Rational Use of Antibiotics in Neonates: Still in Search of Tailored Tools
by John van den Anker and Karel Allegaert
Healthcare 2019, 7(1), 28; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare7010028 - 16 Feb 2019
Cited by 16 | Viewed by 6691
Abstract
Rational medicine use in neonates implies the prescription and administration of age-appropriate drug formulations, selecting the most efficacious and safe dose, all based on accurate information on the drug and its indications in neonates. This review illustrates that important uncertainties still exist concerning [...] Read more.
Rational medicine use in neonates implies the prescription and administration of age-appropriate drug formulations, selecting the most efficacious and safe dose, all based on accurate information on the drug and its indications in neonates. This review illustrates that important uncertainties still exist concerning the different aspects (when, what, how) of rational antibiotic use in neonates. Decisions when to prescribe antibiotics are still not based on robust decision tools. Choices (what) on empiric antibiotic regimens should depend on the anticipated pathogens, and the available information on the efficacy and safety of these drugs. Major progress has been made on how (beta-lactam antibiotics, aminoglycosides, vancomycin, route and duration) to dose. Progress to improve rational antibiotic use necessitates further understanding of neonatal pharmacology (short- and long-term safety, pharmacokinetics, duration and route) and the use of tailored tools and smarter practices (biomarkers, screening for colonization, and advanced therapeutic drug monitoring techniques). Implementation strategies should not only facilitate access to knowledge and guidelines, but should also consider the most effective strategies (‘skills’) and psychosocial aspects involved in the prescription process: we should be aware that both the decision not to prescribe as well as the decision to prescribe antibiotics is associated with risks and benefits. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)
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9 pages, 251 KiB  
Review
Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives
by Karel Allegaert
Healthcare 2018, 6(3), 115; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6030115 - 14 Sep 2018
Cited by 11 | Viewed by 4981
Abstract
A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported [...] Read more.
A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported by robust evidence in neonates. This is at least in part due to the extensive variability in pharmacokinetics and subsequent effects of medicines in neonates. Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation. We illustrate these aspects using data on drugs for gastroesophageal reflux, analgesics or anti-epileptic drugs. Areas for additional research are drug-related exposure during breastfeeding (exposure prediction) and how to assess safety (tools to assess seriousness, causality, and severity tailored to neonates) since both efficacy and safety determine rational drug use. To further improve rational medicines use, we need more data and tools to assess efficacy and safety in neonates. Moreover, we should facilitate access to such data, and explore strategies for effective implementation. This is because prescription practices are not only rational decisions, but also have psychosocial aspects that may guide clinicians to irrational practices, in part influenced by the psychosocial characteristics of this population. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)
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