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Study Objectives:Postoperative respiratory complications (PRCs) are common among children with obstructive sleep apnea (OSA) after adenotonsillectomy. We analyzed postoperative admission guidelines...

The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy.Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining.Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P.001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P.001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so.Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

The use of Triton X surfactants in developing 1,1'-oxalylimidazole chemiluminescent enzyme immunoassays (ODI CEIs) with extended linear response range for the quantification of unconjugated estriol (uE3), alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) is reported for the first time. The wider linear dynamic range in ODI CLEIA results from Triton X series (e.g., Triton X-100, -114, -405, -705) acting as an inhibitor in the interaction between Amplex Red (hydrophobic substrate) and horseradish peroxidase (hydrophilic enzyme) to produce resorufin (hydrophobic fluorescent dye). Triton X-100 acts as the appropriate inhibitor in ODI CLEIA. The maximum concentrations of AFP and hCG quantified with sandwich ODI CLEIA in the presence of Triton X-100 were 8 times higher than when analyzed with the same system in the absence of Triton X-100. In addition, the lowest concentration of uE3 determined using competitive ODI CLEIA in the presence of Triton X-100 was 20 times lower than that measured with competitive ODI CLEIA in the absence of Triton X-100. These results indicate that rapid quantification of AFP, uE3, and hCG using cost effective and highly sensitive ODI CLEIAs in the presence of Triton X-100 can be applied as an accurate, precise, and reproducible method to diagnose genetic disorders (e.g., trisomy 18 and trisomy 21) in fetuses.

In order to rapidly and simultaneously quantify and screen trace levels of multiple biomarkers in a single sample, rapid 1,1'-oxalyldiimidazole chemiluminescence (ODI CL) was applied as a biosensor of immunoassays using various enzymes such as alkaline phosphatase (ALP) and horseradish peroxidise (HRP). (1) Fluorescein was formed from the reaction of fluorescein diphosphate (FDP) and immuno-complex conjugated with ALP. (2) Resorufin was formed from the reaction between Amplex Red and H(2)O(2) in the presence of immuno-complex conjugated with HRP. When ODI CL reagents (H(2)O(2) in isopropyl alcohol, ODI in ethyl acetate) were injected in a test tube or strip-well containing fluorescein and resorufin formed from above two reactions a bright CL emission spectrum having two peaks (518 nm for fluorescein and 602 nm for resorufin) was observed. The two peaks can be independently quantified with an appropriate statistical tool capable of deconvoluting multiple emission peaks. In conclusion, we expect that ODI chemiluminescent enzyme immunoassays (CLEIAs) using a couple of enzymes conjugated with antigen or antibody and substrates can rapidly and simultaneously quantify and screen multiple biomarkers in a single sample.

Introduction Right heart catheterizations (RHC) remains the gold standard for pulmonary hypertension (PH) diagnosis, and a key component to heart failure (HF) risk assessment and in advanced heart failure planning. Many patients with HF and PH require anticoagulation (AC) which cannot be safely held without enoxaparin bridging, due to mechanical heart valves, left ventricular assist devices (LVAD), or chronic thromboembolic pulmonary hypertension (CTEPH). While it is increasingly common to perform RHC without interruption of warfarin AC, no studies have analyzed complication rates in this population. RHC in patients on AC with elevated INR does not lead to more frequent adverse events. Methods We performed a retrospective analysis of patients over 18 years old with PH and/or HF who underwent RHC at the University of Maryland Medical Center during 2013 calendar year to determine the complication rate and assess for potential pre-procedural predictors of complications. Those with heart transplants undergoing surveillance endomyocardial biopsy were excluded. Results A total of 270 right heart catheterizations were reviewed . There were 41 heart transplants that were excluded. Of the remaining 229 cases, 163 (71%) patients had heart failure—110 (48%) with reduced ejection fraction. There were 170 (74%) patients with pulmonary hypertension and 9 patients with an LVAD. Of these cases, 80 (34%) had an INR >1.5 with 27 (12%) having an INR >2 . There were 62 (78%) patients on warfarin. The most common indication for AC was atrial fibrillation/flutter—37 (60%)—with 8 (13%) requiring AC for cardiac thrombus, 7 (11%) for pulmonary embolism/deep vein thrombosis, 4 (6%) for valvular pathology, and 3 (5%) for LVAD. A majority of cases, 179 (78%) gained access via the right internal jugular vein. Micro-puncture kit was used 3 cases. There were no reported cases of hematoma, major bleeding (hemoglobin drop >2gm/dL), pulmonary hemorrhage, or cardiac tamponade. Two patients reported site discomfort—neither had an elevated INR. Conclusion RHC can be safely performed in patients with an elevated INR. In light of a growing population of LVAD's, and increasing awareness of CTEPH, a growing population of patients with advanced cardiopulmonary disease requires uninterrupted AC. If confirmed on a larger patient population, these findings would improve patient comfort and significantly reduce health care costs by eliminating the need for enoxaparin bridging or hospital admission for intravenous unfractionated heparin.

BACKGROUND:Prescription errors are among the most common types of iatrogenic errors. Because of a previously reported 82% error rate in handwritten discharge narcotic prescriptions, we developed a computerized, web-based, controlled substance prescription writer that includes weight-based dosing log

Examines the planning and scheduling systems in an integrative framework for a dual resource constrained (DRC) job shop. Models a bottleneck shop environment which represents a common situation in practice. Research on workload smoothing mechanisms which integrate the planning and scheduling systems is sparse. Simulates 13 smoothing rules (utilizing aggregate workload and bottleneck information), three despatching rules and two order review/release rules. The results of this study indicate that workload smoothing by the planning system has a significant effect on the performance of the DRC job shop. Pulling work ahead in valley periods improved the tardy measures of performance, while pushing jobs back in peak periods usually deteriorated shop performance. Suggests that combining a planning system effectively with order review/release can improve mean tardiness, percentage tardy and mean flowtime measures of performance.

Among the many changes required in implementing a just-in-time (JIT) production system, the change from batch to level production was the most difficult part in a consumer electronics company in Korea Simulation was used to persuade workers of the importance of level production by comparing the performance of batch production to level production. This article describes how simulation was used to convince workers to change and later to show them the improvements resulting from that change.