Evaluation of age-banded dosing of oral paracetamol in hospitalised children: a retrospective analysis using clinical data in a tertiary paediatric hospital.

OBJECTIVE: To evaluate age-banded dosing in paediatric inpatients by determining the proportion of patients whose dose would fall outside the therapeutic range (by weight). DESIGN: A retrospective observational study. Weight and height measurements and details of hospital admissions were matched from the electronic patient record of a single, tertiary paediatric hospital. Dosage which would be given according to age-banded dosing was then compared with their weight. PARTICIPANTS: All children admitted to a single tertiary children's hospital aged 3 months to 16 years over a 5-year period. Data were cleaned to remove values likely to be erroneous and filtered to reduce bias due to patients who were admitted on multiple occasions. OUTCOMES: The main outcome was the proportion of patients who would receive a subtherapeutic or supratherapeutic paracetamol dose if given a dose based on their age. Secondary outcomes were to examine this in children of different ages and to examine the impact of alternative size-based dosing strategies. RESULTS: 100 047 admissions (in 68 310 patients) had a weight documented. If age-banded dosing had been used, a subtherapeutic dose (less than 10 mg/kg) would be given during 19 829 (20%) of the admissions and a supratherapeutic dose (over 18.75 mg/kg, 75 mg/kg/day in four doses) in 4289 (4.3%). The highest risk of a subtherapeutic dose occurred in infants just prior to reaching 6 months of age (83%) and in children just prior to reaching 8 years (66%). The highest risk of a supratherapeutic dose was at 12 years of age (35%). CONCLUSION: Age-banded dosing is not suitable for an inpatient paediatric population as approximately a quarter of patients receive a dose outside the recommended range of 10.0-18.75 mg/kg.

The Impact of COVID-19 on Patient Experience Within a Midwest Hospital System: A Case Study.

Patient-centered communication and patient-provider relationships directly affect patient outcomes. The purpose of this study was to compare inpatient perception of provider/nurse communication in both COVID versus non-COVID diagnoses groups. A qualitative retrospective study was conducted by performing a priori coding analysis on Hospital Consumer Assessment of Healthcare Providers and Systems surveys from 4 different hospitals for both COVID and non-COVID diagnoses. Five themes emerged from non-COVID patient data: inconsistent health care provider communication, variable patient-provider education, pandemic influenced patient satisfaction and mental health stress, inconsistent hospital services, and stable provider professionalism. Five themes arose from the COVID patient data: provider gratitude, controversial communication methods, consistent patient education, lack of quality patient care, and poor timeliness. There is evidence of shared patient perceptions between both COVID and non-COVID patients, but also differences including timeliness and quality of care. The pandemic influenced all patients by creating non-mutually exclusive themes including overall gratitude and patient satisfaction. Future research should focus on a quantitative analysis of pandemic-related patient-provider communication effects on patient outcomes.

Effects of marine overwash for atoll aquifers: environmental and human factors.

Inundation of atoll islands by marine overwash is a serious threat to fresh groundwater, which can be a critical emergency water resource after artificial storage or other water resource infrastructure has been exhausted or destroyed. In contrast to drought, which slowly exhausts water supplies and often can be forecasted in time, overwash can occur with little warning and can ruin both rain catchment storage and groundwater reserves. In this study, a SUTRA-based model is applied to estimate how groundwater contamination by overwash and subsequent recovery of fresh groundwater are influenced by geologic factors (aquifer hydraulic conductivity, dispersivity, and the presence or absence of a reef flat plate), the seasonal timing of the event (wet vs. dry), and the presence of hand-dug wells that penetrate the reef flat plate. Actual tidal and rainfall data from regions in the western Pacific are applied to simulated 30-month recovery periods for hypothetical islands with properties and conditions characteristic of the western Pacific. For all scenarios, results indicate that 12 to 16 months are required to achieve 60% recovery of fresh groundwater. However, the time required to restore useful quantities of groundwater to acceptable salt concentration at depths typical of hand-dug wells is only 3 to 6 months. Of particular interest is the influence of the reef flat plate, which acts as a barrier to infiltrating seawater, thus preserving a pocket of confined freshwater during an overwash event and the recovery, which could probably be utilized if the necessary tools and equipment are on hand.