A prospective observational study of medication errors in a pediatric emergency department.

We present a prospective, observational study evaluating the incidence of medication errors (ME) in a university hospital pediatric emergency department and describe their characteristics and determinants. A systematic analysis of the handwritten prescriptions was conducted by a clinician and pharmacist. Of 11,573 consecutively studied prescriptions in children under 15 years of age, the ME incidence was 0.9% (n=102). The incidence of errors found was statistically significantly higher in children older than 5 years (OR=2.05; P=0.026). There was no significant difference regarding the time of admission (P=0.544), the day of the week (P=0.940), or the affluence of people in attendance at the emergency department. The errors observed were all prescription errors. Most errors were related to analgesic (51%) and antibiotic (30%) treatments. No serious errors were reported. CONCLUSION: We found a low incidence of medication errors in this study. The validation of prescriptions by a senior multidisciplinary staff could contribute to limited medication errors. Measures should be continued to further reduce the incidence of drug errors by calling the attention of prescribers to the most common situations at risk of ME.

Comparative analysis of enzymatically digested kappa-carrageenans, using liquid chromatography on ion-exchange and porous graphitic carbon columns coupled to an evaporative light scattering detector.

Enzymatically digested kappa (A-G4S)-carrageenans, apart from their biological activities in plants, could be used as 'model' molecules to elucidate potential problems in nuclear magnetic resonance spectroscopy of carrageenans. Thus, oligosaccharides obtained from kappa-carrageenan by enzymatic digestion using kappa-carrageenase have been separated on silica and polymeric based ion-exchange and porous graphitic carbon (PGC) columns, coupled to an evaporative light scattering detector. Oligomers were separated on ion-exchange columns using a gradient of ammonium acetate as a developing ion, while analysis on PGC column presented an additional adjacent peak next to each main one, using a gradient of ammonium acetate in water/acetonitrile as a mobile phase. The phenomenon can be attributed to different retention mechanisms that govern the PGC surface. Furthermore, it has been demonstrated that acetonitrile can regulate the selectivity between the peaks raising hopes for preparative chromatography.

[Medical, cognitive and affective status of four-year-old very premature babies without severe disability. A case-control study]. / Devenir médical, cognitif et affectif à l'âge de quatre ans des prématurés indemnes de handicap sévère. Etude prospective cas-témoins.

AIM: To determine cognitive performances and affective development of a cohort of very premature babies at the age of 4 years. POPULATION AND METHODS: Longitudinal case-control study. Newborns less than 33 weeks gestation were included from 1992 to 1994 and were matched with two full-term newborns. At 4 years of age, they have been evaluated for medical status, cognitive functions with the K-ABC test and affective condition with the PSA and Conners' tests. RESULTS: The preterm group was significantly different from the controls for: a smaller height, (P < 0.01), a lower socioeconomic level (P = 0.027), a lower nursery school level (44% versus 27,6%, P = 0.05), the incapacity to draw "a bonhomme" (55,3% versus 93%, P < 0.001), lower performances for the K-ABC and PSA tests, a pathologic Conners score (20.4% versus 2.4%, P < 0.001). Multivariate analysis by logistic regression showed a similar neuropsychological results: a lower score of K-ABC (< 80, P = 0.0006, odds-ratio = 33.2), and a lower social competence score of PSA (< 45, P = 0.004, odds-ratio = 35.9). CONCLUSION: Follow-up of premature babies is required, and measures to prevent or minimize cognitive and social disabilities are mandatory.

Study of the attachment of Na+ on glucose and on some of its methylated derivatives.

The mechanism of attachment of Na(+) on glucose, methyl-alpha-D-glucose, methyl-beta-D-glucose, 3-O-methylglucose, tetra-O-methylglucose, and also on galactose and methyl-beta-D-galactose, was studied. For this we measured the ion yields for the complex [sugar-Na(+)] formed by ionisation by matrix-assisted laser desorption/ionisation (MALDI) and ionspray. These data were compared with the relative volatilities and hydrophobicities of the sugars, measured by evaporative light scattering and reversed-phase liquid chromatography, respectively. Some formation enthalpies for the complexes [sugar-Na(+)], starting from the sugar and the cation, were obtained by ab initio calculations. No simple correlations could be observed between the ion yields and the parameters studied, so that the cationisation mechanism of the sugars remains unclear.

[Severe infections in children with sickle cell disease: clinical aspects and prevention]. / Infections graves chez l'enfant drépanocytaire: aspects cliniques et prévention.

Sickle-cell disease (SCD) is associated with frequent and often severe infections as a result of immune function impairment and functional asplenia. Also, infection can trigger a vasoocclusive crisis. Pneumonococcal bacteremia and meningitis due to S. pneumoniae are often lethal and justify the penicillin prophylaxis, which has provided a dramatic decrease in early mortality bacterial pneumonia is common in patients younger than four years, with most cases being due to S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae. Acute chest syndrome is both a difficult differential diagnosis and a common concomitant of bacterial pneumonia, because they are often intricated. Osteomyelitis is generally due to Salmonella, most often S. enteritidis. Multiple foci are common and treatment is difficult, with some patients developing chronic osteomyelitis with sequestration. Osteomyelitis is less frequent in developed countries and must been differentiated with bone infarction by use of bone scintigraphy. Parvovirus B19 infection causes acute erythroblastopenias. Malaria does not result in cerebral malaria, but can lead to severe anaemia or vasoocclusive crisis, and should therefore be effectively prevented. Antimicrobials are generally selected for efficacy against pneumococci (septicemia, meningitis), Salmonella (osteomyelitis, meningitis), and M. pneumoniae (pneumonia). Prophylactic therapy is of paramount importance and relies on long-term or lifelong penicillin therapy started at three months of age and no closely-spaced immunizations, most notably against peumococci, hepatitis B virus, S. typhi and H. influenzae. Resistant pneumococcal strains have not been reported to cause prophylactic treatment failures. New conjugated pneumococcal vaccines are effective in protecting very young infants and should therefore be used in sickle cell patients.

Chiral supercritical fluid chromatography on porous graphitic carbon using commercial dimethyl beta-cyclodextrins as mobile phase additive.

Using dimethylated-beta-cyclodextrin mixtures (MeCD) as chiral selectors in CO2-polar modifier mobile phase and porous graphitic carbon as solid-phase, chiral supercritical (or subcritical) fluid chromatography was performed. The adsorbed quantity of MeCD onto the porous graphitic carbon (Hypercarb) was measured for various chiral selector concentrations using the breakthrough method with evaporative light scattering detector. The effects of MeCD concentration in the mobile phase, the nature of the polar modifier, the outlet pressure, the column temperature and the nature of the commercial MeCD mixture on the retention and the enantioselectivities were studied. For a given solute, the enantioselectivity is greatly dependent on the commercial MeCD mixture used. The retention mechanism was also studied. From the data, we find that the dominant mechanism for the chiral discrimination is the diastereoisomeric complexation in the mobile phase.

[Sickle cell disease: from childhood to adolescence. Management in 2001]. / La drépanocytose: de l'enfant à l'adolescent. Prise en charge en 2001.

Sickle cell anaemia is a chronic disease which evolves on the background of a basal state punctuated by critical periods, often with complications requiring overall treatment. The management of both periods must be well integrated into the treatment programme. In order to treat occlusive crisis, medical staff must be well trained and equipped for the complicated clinical diagnoses involved in drepanocytosis: bone infarction or osteomyelitis, pneumonia or acute chest syndrome, multifocal crisis or severe infectious disease. Neonatal diagnosis is the best way for early treatment by preventing severe pneumococcal diseases, ensuring sufficient hydration and appropriate surveillance, as well as providing family education. Much progress has been made over the last decade in the early treatment of retinitis, biliary lithiasis, and aseptic hip necrosis. It is also important to ensure accurate prescriptions for hydroxyurea. Specialised centres for drepanocytosis treatment are now a growing necessity and should be encouraged in order to provide treatment for dispersed patients against a relatively little known disease.

[Diagnostic value of physical examination and electrocardiogram in the initial evaluation of heart murmurs in children]. / Valeur diagnostique de l'examen clinique et de l'électrocardiogramme dans l'évaluation initiale d'un souffle cardiaque de l'enfant.

OBJECTIVE: To investigate the diagnostic value of the physical examination and electrocardiogram in the evaluation of heart murmur in new patients referred to the pediatric cardiologist. METHOD: From 1 April to 30 September 1998, all consecutive patients referred to the pediatric cardiology clinic for evaluation of heart murmur were included. They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical examination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiography was systematically performed. RESULTS: In 120 children aged four days to 14 years (median: ten months), 72 (60%) showed abnormalities on doppler-echocardiography and 48 (40%) no heart disease. After physical examination, 52 patients were categorized with no heart disease: 45 patients had a normal doppler-echocardiography; in three of them, the diagnosis was incorrectly modified to possible heart disease on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed minor (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspected of having possible heart disease, no diagnosis was modified after analysis of the electrocardiogram and six had normal doppler-echocardiography; 49 patients were correctly diagnosed as having definite heart disease. The sensibility of the physical examination was 90.3%, the specificity was 93.8%, the positive predictive value 95.6% and the negative predictive value 86.5%. CONCLUSION: The electrocardiogram is of no help in the discrimination between heart disease and no heart disease in children referred to the pediatric cardiologist for a cardiac murmur. The physical examination is able to differentiate children with or without heart disease in most of the cases.

Structure elucidation of methylidene malonate 2.1.2 cyclic trimers with mass spectrometry, liquid chromatography and nuclear magnetic resonance investigations.

The anionic polymerization of methylidene malonate 2.1.2. is able to yield four different molecule types. The major product obtained at pH 5.5 corresponds to a trisubstituted cyclohexanone formed by a back-biting reaction. A mixture of four diastereoisomer couples due to the presence of three asymmetric carbon atoms was produced in the same proportion. These results were deduced from mass spectrometry (MS), liquid chromatography MS (LC-MS) and 1H nuclear magnetic resonance (NMR) investigations.

Electrospray mass spectrometry and supercritical fluid chromatography of methylated beta-cyclodextrins.

Five commercial dimethylated beta-cyclodextrin (DM-beta-CD) samples were analysed by electrospray (or ionspray) mass spectrometry (ESI-MS) and supercritical fluid chromatography (SFC) with evaporative light scattering detection. A silica and a nitro-bonded silica were selected using CO2-methanol-acetonitrile-water and CO2-methanol as mobile phase, respectively. An extensive optimisation scheme was performed for mobile phase selection. Both SFC systems were used for analyses of complex DM-beta-CD samples. Peak identifications were made using off-line ESI-MS. Commercial DM-beta-CDs are impure mixtures of homologues and isomers and analysis reveals that every manufacturer produces a different mixture.