Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

The fact of metafiction in nineteenth-century children's literature : Nathaniel Hawthorne's A Wonder Book and Elizabeth Stoddard's Lolly Dinks's Doings

This article examines two American books for children: Nathaniel Hawthorne’s A Wonder Book for Girls and Boys (1851) and Elizabeth Stoddard’s Lolly Dinks’s Doings (1874). In both books, fairy tales or myths are framed by a contemporary American setting in which the stories is told. It is in these realistic frames with an adult storyteller and child listeners that metafictional features are found. The article shows that Hawthorne and Stoddard use a variety of metafictional elements. So, although metafiction has been regarded as a postmodernist development in children’s literature, there are in fact instances of metafiction in nineteenth-century American children’s literature.

Children's Literature and Brazilian identity of black children

This article aims to analyze how the black child is characterized in relation to the stereotypes created around the black, in the course of Brazilian history in children's narratives, from a sociological approach to the literary text and the assumptions of comparative literature. To this end, we selected some childish narratives that feature characters black children, and you can see that these works reveal the transformations that occurred in Brazilian society with regard to black. This work is based on the theoretical support in the works of Rosangela Malachias and Florestan Fernandes, among others. The analysis was organized to observe the difficulties of identifying the black child before the European cultural dictates about the standard model of beauty. In general, one can observe that the production of works whose characters are black children intensified after the 1988 Constitution and the Law 10.639/2003. The literary discourse aimed at children, so undergoes changes before changes in society and shows a new socio-historical context in which minorities gain more space, but respect for differences yet to occur effectively in social relations that the black is really valued.

SPACE CONFIGURATION IN THE CHILDREN'S LITERATURE OF MIA COUTO

The main objective of this research is to analyze the the spatial configuration in the children's literature of Mia Couto. It is intended to show that the space outlined in these books reveals many aspects of the social and human reality of Mozambique. Therefore, the books O gato e o escuro (“The cat and the dark”) and O beijo da palavrinha (“The kiss of the little word”) will be analyzed from the perspective of the space’s studies – a research method that survey the spatial configuration in the literature. The fictional space created by Mia Couto delineates a cultural landscape and reveals the human and ethical values that we need to teatch to children. As the author's work is marked by a keen aesthetic sense, the space of the world soon becomes the space of the language.  

Children's Fiction About 9/11: Ethnic, Heroic and National Identities

In this study, Lampert examines how cultural identities are constructed within fictional texts for young people written about the attacks on the Twin Towers. It identifi es three significant identity categories encoded in 9/11 books for children:ethnic identities, national identities, and heroic identities,arguing that the identities formed within the selected children’s texts are in flux, privileging performances of identities that are contingent on post-9/11 politics. Looking at texts including picture books, young adult fiction, and a selection of DC Comics, Lampert finds in post-9/11 children’s literature a co-mingling of xenophobia and tolerance; a binaried competition between good and evil and global harmony and national insularity; and a lauding of both the commonplace hero and the super-human. The shifting identities evident in texts that are being produced for children about 9/11 offer implicit and explicit accounts of what constitutes good citizenship, loyalty to nation and community, and desirable attributes in a Western post-9/11 context. This book makes an original contribution to the field of children’s literature by providing a focused and sustained analysis of how texts for children about 9/11 contribute to formations of identity in these complex times of cultural unease and global unrest.

'We just make the pictures...?' How work is portrayed in children's feature length films

This article explores how adult paid work is portrayed in 'family' feature length films. The study extends previous critical media literature which has overwhelmingly focused on depictions of gender and violence, exploring the visual content of films that is relevant to adult employment. Forty-two G/PG films were analyzed for relevant themes. Consistent with the exploratory nature of the research, themes emerged inductively from the films' content. Results reveal six major themes: males are more visible in adult work roles than women; the division of labour remains gendered; work and home are not mutually exclusive domains; organizational authority and power is wielded in punitive ways; there are avenues to better employment prospects; and status/money is paramount. The findings of the study reflect a range of subject matters related to occupational characteristics and work-related communication and interactions which are typically viewed by children in contemporary society.

Gender Dilemmas in Children's Fiction

Gender Dilemmas in Children's Fiction examines how fictional texts – picture books, novels, and films – produced for children and young adults are responding to the tensions and dilemmas that arise from new gender relations and sexual differences. The book discusses a diverse range of international children's fiction published between 1990 and 2008. Some of the key dilemmas that emerge are around the texts' treatment of romance, beauty, cyberbodies, queer, and comedy.

Torres Strait Island parents' involvement in their children's mathematics learning : a discussion paper

This paper is a beginning point for discussing what the literature states about parents’ involvement in their children’s mathematics education. Where possible it will focus on Torres Strait Islander Peoples. Little is known about how Torres Strait Islander parents approach their children’s learning of mathematics and how important early mathematics is to mothers. What is known is that is they are keen for their children to receive an education that provides them with opportunities for their present and future lives. However, gaining access to education is challenging given that the language of instruction in schools is written to English conventions, decontextualised and disconnected from the students’ culture, community and home language. This paper discusses some of the issues raised in the literature about what parents are confronted with when making decisions about their children’s education.

Treadmill adaptation and verification of self-selected walking speed : a protocol for children

The term self-selected (i.e., individual or comfortable walking pace or speed) is commonly used in the literature (Frost, Dowling, Bar-Or, & Dyson, 1997; Jeng, Liao, Lai, & Hou, 1997; Wergel-Kolmert & Wohlfart, 1999; Maltais, Bar-Or, Pienynowski, & Galea, 2003; Browning & Kram, 2005; Browning, Baker, Herron, & Kram, 2006; Hills, Byrne, Wearing, & Armstrong, 2006) and is identified as the most efficient walking speed, with increased efficiency defined by lower oxygen uptake (VO^sub 2^) per unit mechanical work (Hoyt & Taylor, 1981; Taylor, Heglund, & Maloiy, 1982; Hreljac, 1993). [...] assessing individual and group differences in metabolic energy expenditure using oxygen uptake requires individuals to be comfortable with, and able to accommodate to, the equipment.

The neuro-muscular and musculo-skeletal characterization of children with joint hypermobility

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

Young Children and the Environment : Early Learning for Sustainability

This world-first text book on early childhood edcuation for sustainabilty tackles one of the biggest contemporary issues of our times - the changing environmment - and demonstrates how early education can contribute to sustainable living. An essential text for students in early childhood teacher education and a practcial resource for child care practitioners and primary school teachers, it is designed to promote edcuation for sustainabilty from birth to eight years. the text refers to national and international initiatives such as 'sustainable Schools', 'Child Friendly Cities' and 'Health Promoting Schools' and explores their existing and potential links with early childhood education. Groundbreaking content draws on recent literature in the areas of organisational, educational and cultural chnage, and environmental sustainabilty. Specific chapters explore ethical challenges and the use of ICT to advance learning. Case studies and vignettes exemplify leadership in practice and 'provocations' are integrated throughout to inspire new ways of thinking about the environment, the wider world, young children and the transformative power of early edcuation.

Migrant and refugee children, their families, and early childhood education

One of the effects of globalization is the increasing movement of people around the globe. Transnational migration brings demographic changes that produce challenges for education and social services. While there is a growing body of literature about educational concerns associated with migrant and refugee children, young migrant children are not often included in this research because it concentrates on secondary and primary schooling. In this chapter we review the literature that relates to young migrant and refugee children, their families and early childhood education. More specifically, we synthesize the state of knowledge relating to curriculum, parents and teacher education. Following the analysis of recent research, the chapter concludes with some suggestions for further research, policy makers and practitioners.

Controversies of prophylactic hypothermia and the emerging use of brain tissue oxygen tension monitoring and decompressive craniectomy in traumatic brain-injured children

Background Despite being the leading cause of death and disability in the paediatric population, traumatic brain injury (TBI) in this group is largely understudied. Clinical practice within the paediatric intensive care unit (PICU) has been based upon adult guidelines however children are significantly different in terms of mechanism, pathophysiology and consequence of injury. Aim To review TBI management in the PICU and gain insight into potential management strategies. Method To conduct this review, a literature search was conducted using MEDLINE, PUBMED and The Cochrane Library using the following key words; traumatic brain injury; paediatric; hypothermia. There were no date restrictions applied to ensure that past studies, whose principles remain current were not excluded. Results Three areas were identified from the literature search and will be discussed against current acknowledged treatment strategies: Prophylactic hypothermia, brain tissue oxygen tension monitoring and decompressive craniectomy. Conclusion Previous literature has failed to fully address paediatric specific management protocols and we therefore have little evidence-based guidance. This review has shown that there is an emerging and ongoing trend towards paediatric specific TBI research in particular the area of moderate prophylactic hypothermia (MPH).