The status of paediatric medicines initiatives around the world-what has happened and what has not?

Purpose: This review was conducted to examine the current status of paediatric medicines initiatives across the globe. Methods: The authors made a non-systematic descriptive review of current world situation. Results: Two regions, the United States (US) and the European Union (EU), and the World Health Organization (WHO) have introduced strong paediatric initiatives to improve children's health through improving access to better paediatric medicines. The experience from the US initiative indicates that it is possible to stimulate development and study of paediatric medicines and provide important new information for improvement of paediatric therapy. The early results from the EU initiative are similarly encouraging. In Canada, Japan, Australia and other developed countries, specific paediatric medicines initiatives have been less extensive and weaker, with modest results. Disappointingly, current evidence suggests that results from clinical trials outside the US often do not benefit children in the country in which the trials were largely conducted. Pharmaceutical companies that have derived a financial benefit commensurate with the cost of doing the paediatric trials in one country do not seem to be making the results of these trials available to all countries if there is no financial incentive to the company. The WHO campaign 'make medicines child size' has produced substantive accomplishments in building improved foundations to improve mechanisms that will enhance children's access to critical medicines in resource-limited settings. However, practically all of this work has been performed using an amalgamation of short-term funding from a variety of sources as opposed to a sustained, programmatic commitment. Conclusions: Although much still needs to be done, it's clear that with concerted efforts and appropriate resources, change is possible but slow. Retaining and fostering public and political interest in paediatric medicines is challenging, but pivotal for success.Fil: Hoppu, Kalle. Helsinki University Central Hospital; FinlandiaFil: Anabwani, Gabriel. Botswana-Baylor Children’s Clinical Centre of Excellence; BotsuanaFil: Garcia Bournissen, Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Gazarian, Madlen. University of New South Wales; Australia. Sydney Children’s Hospital; AustraliaFil: Kearns, Gregory L.. The Children’s Mercy Hospital; Estados Unidos. University of Missouri; Estados UnidosFil: Nakamura, Hidefumi. National Center for Child Health and Development; JapónFil: Peterson, Robert G.. University of British Columbia; CanadáFil: Sri Ranganathan, Shalini. University Of Colombo. Faculty Of Medicine; Sri LankaFil: De Wildt, Saskia N.. Sophia Children’s Hospital; Países Bajo

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

Background: Acute paracetamol poisoning is a rapidly increasing problem in Sri Lanka. The antidotes are expensive and yet no health economic evaluation has been done on the therapy for acute paracetamol poisoning in the developing world. The aim of this study is to determine the cost effectiveness of using N-acetylcysteine over methionine in the management of acute paracetamol poisoning in Sri Lanka. Methods:Economic analysis was applied using public healthcare system payer perspective. Costs were obtained from a series of patients admitted to the National Hospital of Sri Lanka with a history of acute paracetamol overdose. Evidence on effectiveness was obtained from a systematic review of the literature. Death due to hepatotoxicity was used as the primary outcome of interest. Analysis and development of decision tree models was done using Tree Age Pro 2008. Results: An affordable treatment threshold of Sri Lankan rupees 1,537,120/death prevented was set from the expected years of productive life gained and the average contribution to GDP. A cost-minimisation analysis was appropriate for patients presenting within 10 hours and methionine was the least costly antidote. For patients presenting 10-24 hours after poisoning, n-acetylcysteine was more effective and the incremental cost effectiveness ratio of Sri Lankan rupees 316,182/life saved was well under the threshold. One-way and multi-way sensitivity analysis also supported methionine for patients treated within 10 hours and n-acetylcysteine for patients treated within 10-24 hours as preferred antidotes.Conclusions: Post ingestion time is an important determinant of preferred antidotal therapy for acute paracetamol poisoning patients in Sri Lanka. Using n-acetylcysteine in all patients is not cost effective. On economic grounds, methionine should become the preferred antidote for Sri Lankan patients treated within 10 hours of the acute ingestion and n-acetylcysteine should continue to be given to patients treated within 10-24 hours

What information and the extent of information research participants need in informed consent forms: a multi-country survey

Background: The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. Methods: This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Results: Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be \u27moderately important\u27 to \u27very important\u27 for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively). Conclusions: Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF

Evaluation of critical success factor in implementing ISO 14001 using Analytical Hierarchy Process (AHP) in Pulau Pinang

ISO 14001 has engaged with all industries, international firms and governments around the world and outlines to assist the organizations to reduce the impact of operation towards environment as well as to construct a systematic managing process to improve environmental performance. The main objectives that can be derived from this study is to identify the challenges in implementing ISO 14001 and to identify the benefits of ISO 14001 standards implementation as well as to analyse the critical success factors of ISO 14001 execution in Pulau Pinang using analytic hierarchy process (AHP). Besides that, increase in bureaucracy and demand for more and unneeded certification has made the organization to consider about the EMS execution. The sampling method used in this research was a purposive sampling which based on objective of study. The survey was conducted by distributing the questionnaire to all the 13 companies that certify with the ISO 14001 standards in Pulau Pinang. An empirical study using the analytic hierarchy process (AHP) was carried out to find the relative weights and priorities of these critical success factors and benefits. The findings of the study indicate that the critical success factors in the order of importance are as follows management approach (0.2694), organizational change (0.2477), external and social aspects (0.2457) and technical aspects (0.2373). The findings of this empirical study specify which elements an organization should ponder for effective execution of ISO 14001. The research model proposed in this study offers methodology to analyse and recognize the critical success factor and the advantages due to ISO 14001 execution. Even though the study was done in manufacturing and electronics sector in Pulau Pinang but the proposed research model can be utilized in other sector as well

Background

This article focuses on two main areas viz. the process of rational prescribing and the difficulties encountered in practising rational prescribing in paediatrics

Determination of arsenic in acid mine drainage and river water in Ranau, Sabah

The colorimetric analysis of arsenic (As) in aqueous solution according to the molybdenum blue method was investigated. Maximum absorbance reading can be obtained at λ =880 nm at least 20 minutes after addition of molybdate reagent to the arsenate, As(V) solution. The absorbance-concentration relationship obeyed the Beer- Lambert law at low arsenate concentrations (≤5 µgmL⁻¹) but showed a negative deviation at high (>5 µgmL⁻¹) concentrations. At fixed arsenate concentration, the presence of phosphate ion gave a higher absorbance reading, which increased with the increase in phosphate concentration. Analysis of river water and acid mine drainage( AMD) samples gave total As concentration in the range of 0.013-0.019 µgmL⁻¹ (Mean=0.016f0.003 µgmL⁻¹) and 0.012-0.024 µgmL⁻¹ (Mean=0.017±0.005 µgmL⁻¹), respectively. These values are higher than the WHO guideline value (0.01 µgmL⁻¹) for arsenic concentration in water. Arsenite, As(III), and arsenate, As(V), is dominant in river water and AMD, respectively

The medically complex pregnant patient

In our contemporary society, where medical advancements occur daily, many women with complex medical conditions are becoming pregnant and successfully carrying pregnancies to term. We report a case of a complicated, unplanned pregnancy in a newly initiated haemodialysis patient. The patient presented with breathlessness and was discovered to be 13 weeks pregnant while also being diagnosed with bilateral pulmonary embolisms. Unfortunately, she later developed pregnancy-induced complications that required her to remain hospitalised throughout her entire pregnancy. This case illustrates the complex care needed to manage a pregnant woman with multiple co-morbidities. It emphasises the importance of pre-pregnancy counselling and optimizing care among women of childbearing age who have complex medical backgrounds. Such awareness is crucial for both physicians and obstetricians

Hybrid power generation forecasting using CNN based BILSTM method for renewable energy systems

ABSTRACTThis paper presents the design of a grid-connected hybrid system using modified Z source converter, bidirectional converter and battery storage system. The input sources for the proposed system are fed from solar and wind power systems. A modified high gain switched Z source converter is designed for supplying constant DC power to the DC-link of the inverter. A hybrid deep learning (HDL) algorithm (CNN-BiLSTM) is proposed for predicting the output power from the hybrid systems. The HDL method and the PI controller generate pulses to the proposed system. A closed loop control framework is implemented for the proposed grid integrated hybrid system. A 1.5 Kw hybrid system is designed in MATLAB/SIMULINK software and the results are validated. A prototype of the proposed system is developed in the laboratory and experimental results are obtained from it. From the simulation and experimental results, it is observed that the ANN controller with SVPWM (Space vector Pulse width Modulation) gives a THD (Total harmonic distortion) of 2.2% which is within the IEEE 519 standard. Therefore, from the results, it is identified that the ANN-SVPWM method injects less harmonic currents into the grid than the other two controllers

Administration of oral dosage forms of medicines to children in a resource limited setting.

BackgroundThere are many paediatric specific challenges such as lack of age-appropriate dosage forms, inability of young children to swallow tablets and capsules and poor acceptability, during administration of oral dosage forms of medications to children. Parents adopt various methods which they consider best to circumvent this problem. The objective of this study was to describe the administration practice by parents when giving oral dosage forms of medications to children.MethodsA descriptive cross-sectional study was conducted to assess the administration practice of 1800 oral dosage forms of medications administered to children under the age of 12 years using validated indicators. A pre-tested interviewer-administered questionnaire given to parents or caregivers was used to collect the necessary data. The data were analysed using descriptive statistics.ResultsData from 1800 oral dosage forms was obtained from 663 children. Of the 1287 solid dosage forms, almost one-third were manipulated by parents at the time of giving the medications to children. They were crushed and dissolved in water given to children. In about 17% of instances safety of water was questionable. In 92% of instances, measuring device was found to be inappropriate.ConclusionAdministration of oral dosage forms of medications to children is far from ideal and hinders successful use of medications in children