Using a novel patient medication list for ambulatory pediatric patients within a hospital-based complex care program.

BACKGROUND: Medication errors are common in the pediatric outpatient setting, and children with multiple prescriptions are at increased risk. Little is known about medication reconciliation's application in the ambulatory setting. Caregivers' perceptions of a patient medication list (PML), created for children with complex health needs, were assessed. METHODS: Caregivers of children followed by a tertiary care hospital ambulatory complex care program from February through December 2009 were enrolled in the study. An electronic PML software was nested within a clinical database. At the clinic visit, the medications were updated in the database by a nurse practitioner, and a PML was created and printed for the caregivers. Caregivers were asked to complete a pre-questionnaire before using the PML and a post-questionnaire 12 weeks later. RESULTS: The pre-questionnaire demonstrated that 19 (68%) of 28 caregivers expected the PML to be very helpful. After a mean of 19.3 weeks, on the post-questionnaire, 14 (50%) of the 28 caregivers reported that the PML was very helpful, 10 (40%) of 25 caregivers used the PML at every follow-up clinic visit, and 18 (67%) of 27 caregivers were satisfied with the PML. Five (18%) of 28 caregivers strongly agreed that the PML increased their knowledge of the child's medications, and 3 (11%) of 28 caregivers strongly agreed that the PML helped them remember to give the child's medications at home. CONCLUSIONS: A subset of caregivers in a complex care program reported that a PML was helpful during interactions with their medical team. Yet in general, caregivers did not find the PML helpful in increasing their medication knowledge or reminding them to administer their child's medications.

The long-term outcomes of pediatric pleural empyema: a prospective study.

OBJECTIVE: To describe the long-term outcomes of pediatric pleural empyema. DESIGN: Prospective observational study from October 2008 to October 2011. SETTING: Tertiary care children's hospital. PARTICIPANTS: Children with pleural empyema (loculations and/or septations identified on radiologic imaging or frank pus on thoracentesis). MAIN OUTCOME MEASURES: Children were seen 1, 6, and 12 months postdischarge. Outcome measures included symptoms and signs of respiratory disease, child and parental impact, radiographic resolution, spirometry, and health-related quality of life (Pediatric Quality of Life Inventory score). Analysis was based on the last observation carried forward for missing data. RESULTS: Eighty-two of 88 patients (93%) eligible were recruited. Fifty-four percent were male and mean (SD) age was 4.5 (3.4) years. Outcome data was obtained in 100% at 1 month, 90% at 6 months, and 72% at 1 year. Seventy-one percent had effusions occupying a quarter or more of the hemithorax and 62% of effusions were drained. Fever, cough, parental work loss, child school loss, radiographic abnormalities, and abnormal spirometry results were common in the first month and then declined. By the last observation, 2% of patients had abnormal radiographs (aside from pleural thickening), 6% had mild obstruction on spirometry, and Pediatric Quality of Life Inventory scores were better than for children with asthma (P < .001). Patients with abnormal outcomes in 1 measure had normal outcomes in all other clinical measures. CONCLUSIONS: Clinically important phenomena persist in the short-term, but virtually all children with pleural empyema have no long-term sequelae.

Child vs adult randomized controlled trials in specialist journals: a citation analysis of trends, 1985-2005.

OBJECTIVE: To compare secular trends in the age representation of published randomized controlled trials (RCTs) in specialty journals during a period of 20 years. DATA SOURCE: A validated electronic search strategy using Ovid MEDLINE was conducted to identify RCTs published in the years 1985 through 2005. STUDY SELECTION: The publications retrieved were subdivided into age-specific groups: adults, children, both adults and children, and studies with no age group identified. Within 31 specialties, we chose up to 5 specialty journals and 5 pediatric specialty journals. MAIN OUTCOME MEASURE: Number of RCTs targeting children compared with adults over time. Linear trends were identified using regression modeling, and an interaction term was included to compare rates of increase between age groups. RESULTS: A total of 174 unique journals with 43 326 unique RCTs with age-specific categorization were included. Adult RCTs increased by 90.5 RCTs per year (95% confidence interval [CI], 78-103), which was significantly higher than either pediatric RCTs, which rose by 16.9 RCTs per year (95% CI, 12-22) or RCTs involving both children and adults, which rose by 22.7 RCTs per year (95% CI, 10-35). Twenty-four of 31 specialties (77%) demonstrated a greater rise in the number of published RCTs per year involving adults than those enrolling children. CONCLUSION: Adult RCT publications are increasing at a faster rate than pediatric RCTs in almost all specialties.