Post discharge follow up of children on long term medication

Background: There have been no published studies observing what happens to children post hospital discharge and if medication discrepancies occurred between the hospital and General Practitioner (GP) interface.1 Objectives: To identify the type of discrepancies between hospital discharge prescription and the patient's medicines after their first GP prescription. Method: Over a 3 month period (March–June 2012) across two London NHS hospital sites, parents of children on long term medications aged 18 years and under, were approached and consented prior to discharge from the ward. The patients were followed up 21 days after discharge by telephone call or home visit depending on their preference. The parent was asked if they had contacted their GP for further medications during the follow up, and if not the follow up was rescheduled. The parents were interviewed to find out if there were any discrepancies that occurred post discharge by comparing the patient's hospital discharge letter and medication at follow up. All this information was captured on a data collection form. Results: Eighty-eight patients were consented and 60 patients (68%; 60/88) were followed up by telephone call 21 days post discharge. A total of 317 medications were ordered at discharge among the 60 patients. Of the 60 that were followed up, nine were lost to follow up, one died post discharge, one was excluded from the study, and 11 had not contacted the GP and were to be followed up at a later date. Of the 38 patients who were followed up, 254 medications were ordered. Of the 38 patients there were 12 (32%) patients who had discrepancies that occurred between the discharge letter and GP, 19 (50%) had no issues, and seven (18%) mentioned issues to do with post discharge that were not discrepancies. Of the 12 patients who had at least one medication discrepancy (total 34 medications, range 1–7 discrepancies per patient), six patients had GP discrepancies, four had discrepancies resulting from a hospital outpatient appointment, one related to the discharge letter order and one was a complex discrepancy. An example: a patient was discharged on amiodarone liquid 16.5 mg daily as opposed to 65 mg daily of amiodarone from the GP. Upon interview the parent used volume units to communicate dose as opposed to the actual dose itself and the strengths of liquid had changed. Conclusions: The preliminary results from the study have shown that discrepancies due to several causes occur when paediatric patients leave hospital.

Epidemiology of medication discrepancies upon hospital admission in children - a systematic review

Objectives: NICE/NPSA excluded children under 16 from their guidance concerning medicines reconciliation (MR) upon admission.1 Our aims and objectives of conducting the literature review was to identify the epidemiology of medication discrepancies upon admission, transfer and discharge in children, and if they require MR. Method: Six bibliographical databases (Medline, Embase, CINAHL, International Pharmaceutical Abstracts, Web of Science and Biosis Previews) and selected key words were used to find epidemiological studies on medication discrepancies in children upon hospital admission, transfer and discharge (key words included ‘medication discrepancy’; ‘medication reconciliation’; ‘hospital admission’; ‘hospital discharge’; ‘hospital transfer’); studies where the data for children could be extracted were included. Results: From the 1239 articles found (in May 2011), eight of the articles had extractable paediatric information, (five from Canada, two from USA, one from UK). Five of the studies involved discrepancies on admission, one involved discrepancies on admission and transfer, one involved discrepancies at transfer and one considered discharge. The reference point used to compare against the admission, transfer and the discharge order differed in each of the studies. Four studies used a rating scale to assess the clinical significance of the discrepancies to demonstrate the potential adverse clinical outcome of patients in the absence of clinical intervention. Two studies2 3 used a rating scale that was used in adults.4 A study of paediatric neurosurgical patients found that initial hospital prescriptions for children differed from the preadmission prescriptions in 39% of occasions and 50% of all prescribing variations had the potential to cause moderate or severe discomfort or clinical deterioration.2 A study by Coffey et al in general paediatric admissions in Canada showed 22% of patients experienced at least one discrepancy and 29% of the discrepancies had the potential to cause moderate or severe discomfort or clinical deterioration.3 By comparison an epidemiological study in discrepancies in adults on admission had 38.6% of the discrepancies identified with a potential to cause moderate or severe discomfort or clinical deterioration.4 All the studies involved small samples or specific patient groups such as medically complex patients. However all of the studies demonstrated that discrepancies occurred among paediatric populations during transitions in care settings and mentioned MR as an intervention. Conclusion: The results have shown that discrepancies of medication upon hospital admission, transfer and discharge occur regularly in children. With only one published study in the UK looking at hospital admission in children, and no published articles on the incidence and epidemiology of medication discrepancies upon hospital transfer or discharge further research is required in a wider paediatric population. Further work is also required to define the required interventions to improve practice.

Collective excitability, synchronization, and array-enhanced coherence resonance in a population of lasers with a saturable absorber

In this article we present a numerical study of the collective dynamics in a population of coupled semiconductor lasers with a saturable absorber, operating in the excitable regime under the action of additive noise. We demonstrate that temporal and intensity synchronization takes place in a broad region of the parameter space and for various array sizes. The synchronization is robust and occurs even for a set of nonidentical coupled lasers. The cooperative nature of the system results in a self-organization process which enhances the coherence of the single element of the population too and can have broad impact for detection purposes, for building all-optical simulators of neural networks and in the field of photonics-based computation.