Abstract:
AIM:To reduce the overall expenditure on melatonin for the local health economy by working collaboratively with the CCG's. To ensure that all paediatric patients prescribed melatonin have been clinically assessed by a specialist and the most appropriate formulation is dispensed. METHOD:Evaluation of GP melatonin prescribing cost across CCG using ePACT data and extrapolation of equivalent cost of prescribing and dispensing within secondary care. This initial data was then refined to exclude patients 16 years and over on unlicensed formulations of melatonin and all patients on licensed formulations. This was used to estimate the net potential saving achieved by repatriating the prescribing of melatonin for children for the local CCG's. A six month pilot was initiated to establish if the predicted savings translated into reality for the local health economy. RESULTS:It was estimated that approximately 100 patients under 16 years were prescribed melatonin by GP's in the local CCG's, 60 of these patients were on unlicensed formulations hence eligible for the pilot. To date we have received 42 referrals from GP's to review the prescribing of melatonin unlicensed formulations. 32 patients had been initiated melatonin by the child development team or paediatric specialist 16 (50%) of whom were currently under the care of the team and being reviewed every six months. 10 of the referrals were for patients under the care of CAMHs who were happy to provide ongoing treatment to avoid duplicated appointments. From the remainder of the referrals 6 patients when contacted had advised that they were no longer using melatonin. The remaining 10 patients have an appointment to review treatment and if deemed appropriate provide ongoing prescriptions using formulations approved by pharmacy. There are still 18 patients prescribed melatonin by Gp's who have not been referred and the medicines management team are chasing. A review of ePACT data for the CCG at the end of the six month pilot compared with the recharge expenditure demonstrated that the predicted net cost of the repatriation was cost neutral for the CCG whilst delivering a predicted saving for the hospital of around £30,000 per annum. Additional savings for the CCG are anticipated once the remainder of the patients are repatriated. CONCLUSIONS:The initial assumption that all unlicensed melatonin prescribing within the local CCG's was for children with severe learning difficulties was unfounded with a number of GP's prescribing these formulations for adults. Consequently the initial projected savings were an overestimate as only paediatric patients would be repatriated as part of this proposal.The hospital expenditure on melatonin had also increased from the original projections due to increasing patient numbers with GP's unwilling to take on the ongoing prescribing. In addition the child development team had started to use Circadin off label for older patients ensuring cost containment for GP's when patients discharged from the child health team.Despite these barriers to success the overall impact of the repatriation process was cost neutral for the CCG.
journal_name
Arch Dis Childjournal_title
Archives of disease in childhoodauthors
Haley Hdoi
10.1136/archdischild-2016-311535.49subject
Has Abstractpub_date
2016-09-01 00:00:00pages
e2issue
9eissn
0003-9888issn
1468-2044pii
archdischild-2016-311535.49journal_volume
101pub_type
杂志文章abstract::Six children with congenital heart disease are described in whom poor growth was found to be due to small-bowel villous atrophy; none was in heart failure and only one was severely cyanosed. Growth improved in all 6 on a gluten-free diet. Gluten enteropathy may be more common than is realised in children with congenit...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract:BACKGROUND:Studies on adolescent drug use are scarce as most studies do not distinguish between children and adolescents. Therefore, we assessed overall drug use in adolescents. METHODS:A retrospective cohort study was conducted using pharmacy dispensing records from 62 community pharmacies in the Netherlands. Dispens...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/archdischild-2017-314692
更新日期:2019-08-01 00:00:00
abstract::During the 6-year period from 1 October 1971 to 30 September 1977, 13 (about 1%) of 1225 admissions to hospital with asthma developed severe ventilatory failure (peak arterial PCO 2 greater than 8 kPa). Mean age was 4.1 years (2.3--7.9), and on average each patient had been admitted to hospital on 5 occasions during t...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.53.9.714
更新日期:1978-09-01 00:00:00
abstract::A children's hospital nutritional care team prospectively monitored the frequency of sepsis in central venous catheters used for administering parenteral nutrition. During an initial study period of 12 months, 26/58 (45%) of catheters were removed because of proved sepsis. The possible causes of this alarmingly high r...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.66.3.335
更新日期:1991-03-01 00:00:00
abstract::The prevalence of thyroid disease in 134 children, adolescents, and young adults with diabetes mellitus beginning in childhood is described. Clustering of a family history of thyroid disease and the presence of thyrogastric antibodies in some patients supports the concept of familial autoimmunity. In 4 children a diag...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.57.8.622
更新日期:1982-08-01 00:00:00
abstract:AIMS:To examine the disease burden and epidemiology of community acquired rotavirus gastroenteritis in Austrian children treated in a paediatric practice. METHODS:A prospective, population based, multicentre study in four paediatric practices and two children's hospitals (Innsbruck and Leoben). Children = 48 months ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,多中心研究
doi:10.1136/adc.84.5.393
更新日期:2001-05-01 00:00:00
abstract::Persistent daytime incontinence is a fairly uncommon but important problem. Videourodynamic studies were carried out in 215 children presenting with this problem in whom there were no neurological signs and who had not responded to simple measures. Over 90% of symptomatic children were shown to have an abnormality, of...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.62.2.128
更新日期:1987-02-01 00:00:00
abstract:AIMS:To investigate how parents report children's respiratory sounds on video compared to a clinical "gold standard". METHODS:Five clinicians agreed on 10 video clips of children with audible breathing. These responses were the "gold standard". The clips were shown to parents of children: (a) with asthma/wheeze; (b) w...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.84.1.31
更新日期:2001-01-01 00:00:00
abstract::The utility of point-of-care lung ultrasound in neonatology is rapidly expanding. This review summarises current evidence of a diagnostic, procedural and observational tool valuable in the management of newborns requiring intensive care. Approaching a patient, probe in-hand with focused clinical question is essential,...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,评审
doi:10.1136/archdischild-2017-314538
更新日期:2019-09-01 00:00:00
abstract::There was much speculation about the potential impact of the Human Rights Act 1998 on established principles of health care practice. Now the statute has been "bedded in", predictions that existing good practice would not fall foul of the legislation provided it was demonstrable, have proved to be broadly accurate. Th...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,评审
doi:10.1136/adc.2003.037218
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:To assess the natural history of respiratory symptoms not labelled as asthma in primary schoolchildren. DESIGN:Repeat questionnaire survey of subgroups identified from a previous questionnaire survey after a two year delay. SUBJECTS:The original population of 5321 Sheffield children aged 8-9 years yielded 4...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.75.5.385
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:To define better the adult phenotype and natural history of Noonan syndrome. DESIGN:A prospective observational study of a large cohort. RESULTS:Data are presented for 112 individuals with Noonan syndrome (mean age 25.3 (range 12-71) years), who were followed up for a mean of 12.02 years. Mutations in PTPN1...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2006.104547
更新日期:2007-02-01 00:00:00
abstract::The transport characteristics of the placenta, which favour higher phenylalanine concentrations in the fetus than in the mother, and regression data of head circumference at birth against phenylalanine concentration at conception in maternal phenylketonuria (PKU), suggest that treatment of maternal PKU should ideally ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.66.11.1346
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:There are no objective ambulatory studies on the temporal relationship between reflux and cough in children. Commercial pHmetry loggers have slow capture rates (0.25 Hz) that limit objective quantification of reflux and cough. The authors aimed to evaluate if there is a temporal association between cough and ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2009.177733
更新日期:2011-05-01 00:00:00
abstract::Necrotising pneumonia in young, previously healthy patients due to Panton-Valentine leucocidin (PVL) producing Staphylococcus aureus has been increasingly recognised. PVL pneumonia is often associated with influenza co-infection and high mortality. This case report describes the successful management of the first docu...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2009.175281
更新日期:2010-04-01 00:00:00
abstract::In 20 children needing treatment for symptomatic sick sinus syndrome, the average age at presentation was 7.1 years and ranged from 9 months to 18 years. Symptoms were never precise but, in retrospect, 5 children had syncope, 7 had a rapid heart action, 6 had dyspnoea or tachypnoea, 2 had nonspecific chest pains, 2 ha...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.50.11.879
更新日期:1975-11-01 00:00:00
abstract:OBJECTIVE:Investigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability. DESIGN:Multicentre, single-blind, randomised controlled trial. SETTING:Recruitment through neurodisability teams; treatment by parents. PARTICIPANTS:Ninety childr...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/archdischild-2017-313763
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Timing of referral to subspecialists may be a major determinant for access to adequate treatment. Kidney transplantation is the preferred modality of renal replacement therapy (RRT) in children. In adults, delayed referral from general physicians to nephrologists reduced access to kidney transplantation. Thi...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.2009.174581
更新日期:2010-08-01 00:00:00
abstract::Production of platelet thromboxane B2, a stable metabolite of thromboxane A2, was measured in seven newborn infants with pulmonary hypertension during the first day of life. Platelet thromboxane B2 production was significantly lower than in 12 healthy controls but did not correlate with simultaneous blood gas values. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.62.2.195
更新日期:1987-02-01 00:00:00
abstract::A 9 month old boy presented with acute respiratory distress and was found to have a left pleural effusion. The chylous nature of the effusion, multiple bony lytic lesions, and splenic cysts lead to the diagnosis of congenital lymphangiomatosis with chylothorax. Surgical intervention including pleurectomy was required ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.64.7.1058
更新日期:1989-07-01 00:00:00
abstract::Since its first description optic nerve hypoplasia has been identified with increasing frequency, and a range of associated problems have been described. The major neurological and endocrine associations are well established, but those factors that predispose to the development of optic nerve hypoplasia remain unclear...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.65.1.103
更新日期:1990-01-01 00:00:00
abstract::We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.88.4.330
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Acute respiratory infections (ARI) cause 3 million deaths in children worldwide each year. Most of these deaths occur from pneumonia in developing countries, and hypoxaemia is the most common fatal complication. Simple and adaptable indications for oxygen therapy are important in the management of ARI. The c...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,评审
doi:10.1136/adc.2008.138362
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVES:To determine the incidence of insulin dependent diabetes mellitus (IDDM) among children aged up to 16 years residing in the city of Karachi, Pakistan, during the five years from 1989 to 1993. DESIGN:Retrospective study of incidence using hospital and clinic records. SETTING:The city of Karachi, Pakistan. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.76.2.121
更新日期:1997-02-01 00:00:00
abstract:AIMS:To review the results of long term high dose intravenous immunoglobulin treatment. METHODS:162 treatment years in 18 patients with hypogammaglobulinaemia who received intravenous immunoglobulin treatment between 1973 and 1993 were reviewed. RESULTS:A mean dose of 0.42 g/kg immunoglobulin resulted in a mean troug...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.74.6.527
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:Poor condition at birth may impact on IQ, although its effect on other measures of neurodevelopment is unclear. The authors' aim was to determine whether infants receiving resuscitation after birth have reduced scores in measures of attention, memory and language skills or the need for educational support at ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章,多中心研究
doi:10.1136/adc.2009.176065
更新日期:2011-01-01 00:00:00
abstract::Samples from the pharynx, stomach, duodenum or jejunum, and faeces were collected on 7 days between 1st and 28th day from neonates weighing less than 1.5 kg at birth who were fed by transpyloric tube. These were cultured on selective and non-selective media, and the results were expressed in a semi-quantitative manner...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.58.2.115
更新日期:1983-02-01 00:00:00
abstract::We report two children with ruptured, multiple hydatid cysts treated with mebendazole. Long term follow up has confirmed the success of this treatment. ...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.59.9.894
更新日期:1984-09-01 00:00:00
abstract::Respiratory timing was studied in 100 babies ventilated for respiratory distress syndrome (RDS) during a brief period of continuous positive airway pressure. For the 76 spontaneously breathing babies the mean (SD) inspiratory and expiratory times were 0.31 (0.06) and 0.41 (0.12) seconds. Respiratory rate was predomina...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/adc.67.4_spec_no.446
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Phenobarbital (PB), commonly used as the preferred treatment for neonatal seizure, is a drug that requires careful dose adjustments based on therapeutic drug monitoring. It has been reported that PB metabolism was affected by cytochrome P450 (CYP)2C19 polymorphisms in adults requiring dose adjustment. AIM:T...
journal_title:Archives of disease in childhood
pub_type: 杂志文章
doi:10.1136/archdischild-2011-300538
更新日期:2012-06-01 00:00:00