129 research outputs found
International paediatric drug safety studies
No full textThere are limited data on incidences of drug related problems (DRPs) including adverse drug reactions (ADRs) in children. The aim of this thesis is to increase knowledge of the incidence of ADRs and other DRPs and to enhance the understanding of risk factors for ADRs across several countries. This should facilitate the development of appropriate prevention strategies. Two large prospective cohort studies were conducted; ADVISE" recruited patients from five countries to investigate the incidence and characteristics of ADRs. Multivariable regression analysis was conducted to identify risk factors associated with ADRs in hospitalised children. The second study investigated DRPs in children attending the A&E department and/or admitted to a hospital in the Kingdom of Saudi Arabia (KSA) and the UK. ADRs and other DRPs were identified using intensive chart review. In the ADVISE study, 1278 children were included (Australia n=149, Germany n=376, UK n=313, HK n=143, Malaysia n=300). The overall ADR incidence was 18.5% (95% Cl, 16.3- 20.9). There was significant variation in incidence between countries (p<0.001), the highest was in the UK (34.9%). The use of ~five low risk drugs per patient or ~three high risk drugs (e.g. opioids) were strong predictors for ADRs (OR 4.7,95% CI, 2.4-9.3; OR 6.5,95% CI, 2.7-16.0; respectively, p<0.001). In the second study, 990 children were included (KSA n=507, UK n=483). The overall incidence of DRPs was 39.2% (95% Cl, 36.1-42.3). Incidence was highest in the paediatric intensive care units (59.7%; 95% CI, 47.0-71.5). Dosing problems were the most frequent DRP (n=303, 55.5%).80.0% (n=437) of DRPs were preventable. Using standardised methods in both studies enabled comparison of incidences of ADRs and DRPs between countries. The variation between countries was considered to be mainly due to differences in treatment strategies. These studies indicated that improvements to current procedures could reduce DRPs and hence improve patients' health. Also, a focus on paediatric pharmacology and pharmacotherapy within paediatric medical education is important to improve prescribing practices and paediatric patient safety.EThOS - Electronic Theses Online ServiceGBUnited Kingdo
Real-world management, resource use, patient-reported outcomes and adherence in patients receiving direct oral anticoagulants for first stroke attributed to non-valvular atrial fibrillation in secondary care: A UK mixed-methods observational study.
No full textCopyright: © 2025 Uprichard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This real-world study investigated the patient-related factors, characteristics, and outcomes of adult patients with non-valvular atrial fibrillation (NVAF) receiving a direct oral anticoagulant (DOAC) for secondary stroke prevention. This was a multi-centre, mixed-methods, non-interventional study conducted in 8 UK secondary care National Health Service centres. The study included adult patients who presented with first ischaemic stroke associated with NVAF without previous anticoagulants. Group 1 included all patients. Group 2 is comprised of prospectively enrolled patients who were initiated on apixaban (n = 49), edoxaban (n = 39) or rivaroxaban (n = 5) post-first stroke from Group 1. The primary objective (Group 1) was to describe patients' demographics, clinical characteristics, and medical history, stratified by the anticoagulant prescribed. The secondary objectives (Group 2) were to describe the patient management pathways, hospital resource use and clinical assessments associated with DOAC treatment, and the patient-reported satisfaction and experience of DOAC treatment. 234 patients were recruited from 8 centres (Group 1). Baseline CHA2DS2-VASc risk scores ranged from 2-7; 70% (157/224) had a score of ≥4. 86% (n = 202/234) of patients presented with stroke at accident and emergency. For Group 2, the median time from stroke to first DOAC dose was 6 (IQR, 2.0-10.2; n = 88) days; 50% patients had ≥ 1 outpatient visit recorded related to AF or DOACs. At 3 and 6 months, 73% (46/63) and 83% (43/52) had high (score of 8) Morisky Medication Adherence Scale score (MMAS-8), respectively. No patients reported being dissatisfied at 3 or 6 months post-DOAC initiation. The study findings demonstrate high levels of adherence, persistence, and treatment satisfaction in the 6 months post-initiation of DOAC after first stroke attributable to NVAF in patients. The presented results provide clinicians with valuable insights into the experience of post-stroke patients with NVAF receiving treatment with a DOAC for secondary prevention of stroke during the 6 months post-stroke
Trends, geographical variation and factors associated with melatonin prescribing in general practices in England: A practice‐level analysis
No full textAn overview of melatonin prescribing trends and variation in England is described in this study. Prescription reimbursement data for melatonin in England were extracted from publicly available primary care datasets between 2008–2019. Melatonin prescribing rates, cost and product license status were described over time. Potential factors associated with melatonin prescribing were investigated using Poisson regression. Melatonin prescribing increased from 2.0 to 19.9 per 1000 people between 2008 and 2019. While prescriptions for licensed products increased from 6.5% to 88.2%, spending on unlicensed products was £10 million and accounted for 23.3% of the total prescription cost in 2019. Practices with a higher proportion of children and older people and those serving more deprived patient populations were associated with a higher rate of prescribing (rate ratio = 1.51, 1.66 and 1.59, respectively). Melatonin prescribing in England has increased exponentially over the last decade, with substantial spending on unlicensed products of unknown quality. Patient-level analysis research is needed.</p
Establishing dose bands for commonly prescribed oral medications for children in the UK: Results of a Delphi study
No full textObjective: To establish weight-based dose bands for commonly used oral medicines, given in liquid forms, for children in the UK that could be used for prescribing and administering accurate and safe drug doses. Methods: A list of commonly prescribed, oral liquid medications was established from the medication dispensing database of four UK hospitals and a primary care database. The evidence base of currently used dose regimens for each drug was identified from paediatric reference books, summary of product characteristics and the literature. Then, weight-based dose bands were developed and a modified Delphi process was used to achieve healthcare professional consensus about the suggested dose bands for each drug. Results: Forty-six experts in paediatric medicines participated in the Delphi process (mean years of experience 17.3 ± 9.4 [standard deviation]) and assessed 45 oral liquid drugs in total. Four categories of weight-based dose bands were established: drugs with two dose bands (17.8%, 8/45), drugs with three dose bands (64.4%, 29/45), drugs with four dose bands (15.6%, 7/45) and drugs with five dose bands (2.2%, 1/45). The 46 participants reached consensus on all the suggested dose bands for 53.3% (24/45) of the drugs. Consensus was reached in the first round of the Delphi process for 91.7% (22/24) of the drugs and after two rounds for two drugs. No agreement was achieved on any of the suggested dose bands for 26.7% (12/45) of the drugs. Conclusion: This study provides healthcare professionals with a set of recommended weight-based dose bands for commonly prescribed oral liquid drugs for children. These bands could establish the basis for change in clinical practice to reduce dosing errors and improve healthcare for children.</p
A NOTE ON AN EXTENDED NUMERATION METHOD FOR SOLVING FREE DISPOSAL HULL MODELS IN DEA
No full text This note identifies and corrects an error in Keshvari, A and N Dehghan Hardoroudi (2008). Asia-Pacific Journal of Operational Research, 25, 689–696. </jats:p
A NOTE ON AN EXTENDED NUMERATION METHOD FOR SOLVING FREE DISPOSAL HULL MODELS IN DEA
No full textThis note identifies and corrects an error in Keshvari, A and N Dehghan Hardoroudi (2008). Asia-Pacific Journal of Operational Research, 25, 689–696.Data envelopment analysis, free disposal hull (FDH), dominant units, efficiency
An Investigation into Emergency Planning Requirements and Challenges of Disaster Management in the Kingdom of Saudi Arabia
No full textEvery year, the Kingdom of Saudi Arabia (KSA) is exposed to different natural hazards. However, flash floods have been the most common hazard during the previous few decades. Between 2000 and 2020, over 1,000 people lost their lives from flash floods, resulting in an economic loss amounting to billions of US dollars. By focusing on flash floods, a systematic review of the extracted data was conducted. They were analyzed based on the suitability of their content and data for emergency planning requirements and disaster management challenges in the KSA. A total of 104 articles, papers, and plans were reviewed, of which only 18 complete papers met the inclusion criteria, including one plan and the General Directorate of Civil Defense (GDCD) website. The author has concluded that: 1) the essential requirements for emergency planning in the KSA include: conducting studies that show potential natural hazards, their locations, and their implications, and taking appropriate measures that reduce the possible causes of natural hazards; 2) The challenges facing the disaster management in the KSA are: lack of policies; the ambiguity of legislation and plans; poor coordination between stakeholders; lack of databases. This is the first investigation into emergency planning requirements and challenges of disaster management in the KSA. Furthermore, a scientific consensus predicts an increase in the frequency and magnitude of flash floods in the KSA. Therefore, the gaps need to be addressed in order to reduce the impact on inhabitants and infrastructure
L'analyse diophantienne au Xe siècle : l'exemple d'al-Khäzin.
No full textSUMMARY. — First introduced in the 10th century, the Arithmetica of Diophantus contributed much to the development of mathematics in the Middle Ages. Most notably it permitted the extension of classical Diophantine analysis, which existed already, independently of the Arab translation of Diophantus, among the Arab algebrists. Less known but more original, is the contribution of the Arithmetica to the development of new research on modern Diophantine analysis, as that term was understood by Bachet de Méziriac and Fermat. The examination of two unpublished documents in this article demonstrates this fact more clearly than before. The author shows that this research, inspired by a reading of Diophantus, was however the work of mathematicians who deliberately placed themselves outside the algebraic tradition and chose a style intentionally different from that of the Arithmetica.RÉSUMÉ. — Introduites au Xe siècle, les Arithmétiques ont diversement contribué au développement des mathématiques de l'époque. Elles ont tout d'abord permis l'extension de ce qui existait déjà chez les algébristes arabes, indépendamment de la traduction arabe de Diophante : l'analyse diophantienne ancienne. Beaucoup moins connue que la précédente, la deuxième contribution est plus originale : il s'agit de l'essor de nouvelles recherches sur l'analyse diophantienne moderne, au sens où l'entendent Bachet de Méziriac et Fermat. L'analyse de deux inédits permet d'établir plus formellement ce fait. On montre ici que ces recherches, suscitées par la lecture de Diophante, sont cependant l'œuvre de mathématiciens qui se situaient délibérément hors de l'algèbre et optaient pour un style autre que celui des Arithmétiques de Diophante.Rashed Roshdi. L'analyse diophantienne au Xe siècle : l'exemple d'al-Khäzin.. In: Revue d'histoire des sciences, tome 32, n°3, 1979. pp. 193-222
Physical and Psychological Implications of Risky Child Labor: A Study in Sylhet City, Bangladesh
No full textIn Bangladesh, children are accustomed to working in industrial and manufacturing plants, small scale factories, metal works, construction, as well as in many informal sector activities. Based on a survey conducted in Sylhet city, this study found that child workers are suffering from different physical and psychological problems and that more than half of them receive their medical assistance from local health care providers who have no recognized qualifications. The study maintains that working from an early age impedes the children’s physical growth and intellectual and psychological development, which then also has negative effects on their long-term health and earning potential.risky child labor, physical health, mental health, Bangladesh
The Reflection of Sufi Influence on the Mughal Empire (1526-1857): A Spiritual and Cultural Analysis
No full textThis article examines the role of Mughal emperors in promoting Sufism and their contributions to the religious, social, and economic development of the Indian subcontinent during their nearly three-hundred-year reign from 1526 to 1857. The Mughal Empire, founded by Babur, a Turkic descendant from Central Asia, began in 1526 after defeating the Sultan of Delhi, Ibrahim Lodi, in the first Battle of Panipat. Babur laid the foundation, which was solidified during the reign of his grandson Akbar and expanded under Akbar's great-grandson Aurangzeb. Under Aurangzeb's reign, the Mughal Empire reached its most considerable territorial extent. However, by 1760, the empire's control diminished to the areas around Old Delhi, and it was formally dissolved by the British following the Indian Rebellion of 1857. During Mughal rule, Sufi philosophy enriched Indian religious thought, characterised by tolerance and inclusivity. The Mughals were patrons of art and architecture, encouraging the development of paintings, literature, textiles, and architectural styles. They contributed to Muslims' social, political, economic, and religious advancements. Several Sufis promoted Islam and socioeconomic development during the Mughal era. After Panipat, Babur visited the tombs of Nizam-ud-Din Auliya and Khwaja Moin-ud-Din Chishti, and he was a follower of Khwaja Ubaidullah Ahrar of the Naqshbandi tariqa. Humayun received the Shattariyya Tariqa's bay'ah from Syed Muhammad Ghaus. Imam Rabbani resisted Akbar's new religious doctrine, 'D & imacr;n-i Il & amacr;h & imacr;', and eradicated it during Jahangir's reign. Shah Jahan promoted Islam by building the Taj Mahal and the Jama Masjid in Delhi. Aurangzeb reformed mosques, khanqahs, and charitable institutions. Muhammad Shah supported Sufi activities. The last emperor, Bahadur Shah II, was a Sufi king and wrote several Sufi poems
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