Manipulation of drugs to achieve the required dose is intrinsic to paediatric practice but is not supported by guidelines or evidence

Background: A lack of age-appropriate formulations can make it difficult to administer medicines to children. A manipulation of the dosage form may be required to achieve the required dose. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice.Method: A structured, undisguised observational study and postal survey. The observational study investigated drug manipulations occurring in clinical practice across three sites. The questionnaire, administered to a sample of paediatric nurses throughout the UK, surveyed manipulations conducted and nurses' experiences and views.Results: The observational study identified 310 manipulations, of which 62% involved tablets, 21% were intravenous drugs and 10% were sachets. Of the 54 observed manipulations 40 involved tablets with 65% of the tablets being cut and 30% dispersed to obtain a smaller dose. 188 manipulations were reported by questionnaire respondents, of these 46% involved tablets, 12% were intravenous drugs, and 12% were nebuliser solutions. Manipulations were predominantly, but not exclusively, identified in specialist clinical areas with more highly dependent patients. Questionnaire respondents were concerned about the accuracy of the dose achieved following manipulations and the lack of practice guidance.Conclusion: Manipulations to achieve the required dose occur throughout paediatric in-patient settings. The impact of manipulations on the efficacy of the drugs, the accuracy of the dose and any adverse effects on patients is not known. There is a need to develop evidence-based guidance for manipulations of medicines in children

Internet, Web, what's next?

9:45 Peter Kirstein, pioneer of the Internet, will give an overviewof how the network was created 10:45 Jean-Fran?ois Abramatic, World Wide Web Consortium (W3C) Chairman,will explain the role of the global Web Consortium 11:00 Tim Berners-Lee, inventor of the World Wide Web and W3C Director , will explain how the Web came to be and give his views on the future 14:00 Robert Verrue, Director General of the DGXIII of the European Commission, responsible for telecommunications in Europe, will present the approach taken by the European Commission towards the developments of global network 14.45 Mark Bernstein, Vice President of the CNN Interactive, will describe theimpact of the Web on world media and predict what we can expect as the next the developments 16:00 Mr. Jan Visser, Director General UNESCO, will talk about "Learning without Frontiers in the Information Age" 17:00 End of conferenceJan Visser's talk "Learning without frontiers in the information age"Llewellyn Smith's talk on the discoveries made at CERN and Peter T. Kirstein's talk on the background to the InternetMark Bernstein, Vice President of the CNN Interactive, describes the impact of the Web on world media and predicts what we can expect as the next the developmentsPeter T. Kirstein answering the questions after his talkRobert Verrue, Director General of the DGXIII of the European Commission, responsible for telecommunications in Europe, presents the approach taken by the European Commission towards the developments of global networ