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Smart pumps or intelligent infusion pump systems are increasingly becoming available. Such pumps incorporate sophisticated computer technologies for storing drug information, for example, a drug library with doses, pre-programmed concentra tions, automating calculations and checking information entered against agreed administration parameters. The initial stages involve developing a drug library for the specific needs of the population, and setting hard and soft limits for each drug. The needs of a neonatal unit will be different from that of a paediatric intensive care unit. Beginning to build a library requires input from clinicians as well as pharmacists and can seem like a lot of hard work. No one size fits all in term of drug libraries, particularly in a population of neonatal patients whose weight can vary from less than 500g to over 5kg. A major perceived barrier is that of possible fluid overload particularly in lower weight patients or in those whose overall fluids are restricted for clinical reasons. Interventions to reduce dosing errors in children: a systematic review of the literature. Drug name confusion: evaluating the effectiveness of capital (Tall Man) letters using eye movement data. The effect of proximity, tall man lettering, and time pressure on accurate visual perception of drug names. Standard concentrations of high-alert drug infusions across paedi atric acute care. Writing a hospital prescription Comprehensive guidance on how to write up (or transcribe) a prescription is given for those working in the United Kingdom in the introduction to the British National Formulary, but many of the points in this bear repetition. While the formal constraints that operate in the community do not apply in a hospital setting (see p. A poorly written prescription is, at best, discourteous to nurses and pharmacists who may have to spend time checking what has been written. Approved names: these should always be used to ensure consistency between vials, ampoules, bottles and other labels. Proprietary names (trade names) should only be used for compound preparations when a generic name does not exist. Avoid abbreviations and contractions other than those universally used and recognised. The dose: this should be given in grams (g), milligrams (mg), micrograms or, excep tionally, nanograms.

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In the cant proportion of children (70), and withholding mesial tem Cleveland Clinic series (3), 2 of 149 patients (1. Mortality may be slightly higher for infants, in part because of their Seizure Outcome after Epilepsy Surgery small blood volumes. These to compare owing to the inclusion of patients with diverse results emphasize the need to reserve surgery for infants with pathologic conditions, use of different evaluation and surgical severe epilepsy. Risk may be reduced by a dedicated team of techniques, and variable definitions of postoperative outcome pediatric anesthesiologists, intensivists, and surgeons. Good postoperative outcomes with rare or no At any age, the mortality from epilepsy surgery must be seizures occur with similar frequencies at all ages, according weighed against the mortality from uncontrolled seizures to recent series in infants, children, adolescents, and adults, treated medically. Nashef and associates (61) found this risk despite age-related differences in causes and surgery types to be 1:295 per year in children and adolescents with severe (1,3,11,28,71,72). In a population-based come postoperatively does not diminish significantly, even in cohort study in children (62) (1 to 16 years of age) who devel infancy. These results compare favorably with those achieved oped epilepsy between 1977 and 1985, 26 (3. The majority (13/26) who died the rate of responders (at least 50% improvement in seizure had secondarily generalized seizures. Neurologic deficit was frequency) was 20% to 40% and seizure freedom was fairly the only independent factor that determined mortality. More recent studies show only modest chances of study, mortality in children with comorbid neurologic deficits seizure freedom (5%) after failure of two antiepileptic med (15/1000 person-years) was higher than in those without any ications and report no difference between established and deficits (0. Mortality in the children newer antiepileptic drugs used as initial monotherapy (74). These epidemiologic data (3), this outcome was significantly more common in patients reinforce consideration for early surgical intervention, as chil who had temporal resection (78%) than in those who had dren with catastrophic partial epilepsy who are candidates for extratemporal or multilobar resection (54%). However, this surgery often have neurologic deficits and secondarily general difference based on surgery type disappeared when results ized seizures. The increased long-term mortality from epilepsy were analyzed by etiologic factors. Significantly more patients in children can also be seen in outcome studies of epilepsy with low-grade tumor (82%) than patients with malformation Chapter 89: Special Considerations in Children 1005 of cortical development (52%) were seizure free, regardless of 6. Temporal and extended tem poral resections for the treatment of intractable seizures in early childhood. Duchowny and colleagues (1) noted that it infantile spasms: neuroimaging perspectives. Predictors of outcome in pediatric seizure outcome appears similar to that in adults.

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In addition, armed confict and natural disasters is a woman or that afects women disproportionately. It often exacerbate discrimination and inequalities, further includes acts that infict physical, mental or sexual harm impeding progress towards gender equality and the full or sufering, threats of such acts, coercion and other de enjoyment by women of their human rights. The International Criminal Tribunals ian assistance and protection during armed conficts and for the former Yugoslavia and Rwanda have prosecuted natural disasters should contribute to achieving equality crimes of sexual violence, thereby providing legal prece and womens human rights. The involvement of men and dents for protecting women and combating impunity for boys as partners in empowering women and girls and violations of their rights. The Rome Statute of the Interna achieving gender equality is also of crucial importance. The 1993 Declara parties shall provide all appropriate assistance to chil tion on the Elimination of Violence against Women fur dren for their physical and psychological recovery and thermore emphasized that violence against women and their social reintegration. The 1995 Beijing World the 1997 Mine Ban Treaty, the 1951 Refugee Convention, Conference on Women included strategic objectives to the1967 Protocol protecting refugee children and sev address the impact of armed confict on women. It furthermore called on all parties to armed confict of child soldiers and other violations against children af to fully respect international law applicable to the rights fected by armed confict. The Convention Protection needs and the methods to address them may recognizes childrens right to be free from abuse and ne be diferent for girls and boys. A gender analysis is there glect, sexual exploitation, trafcking, abduction, torture, fore critical to designing and implementing appropriate deprivation of liberty and other forms of maltreatment child protection programmes. In many conficts, gender-based and classifes rape and other forms of sexual violence, violence against women and girls is endemic. Girls who recruitment or use of children under the age of 15 into have been recruited and used by armed forces and groups armed groups and attacks against schools as war crimes. Girls may be forced to provide sexual services, vention 182 declares child soldiering to be one of the which is a less common problem for boys. Girls may also worst forms of child labour and prohibits forced or com take on other roles in armed forces or groups, for example pulsory recruitment of children under the age of 18 in as fghters, cooks, porters or spies. Girls are shipwrecked and captured combatants, and which regu also more likely to be ignored or excluded from advocacy lates the means and methods of warfare. It is applicable in and other initiatives to secure childrens return to civilian international and non-international armed conficts and life. Proactive measures therefore are required to ensure is binding on States, armed opposition groups and troops the full involvement and inclusion of girls in all aspects participating in multilateral peacekeeping and peace of prevention, release and reintegration; services pro enforcement operations if they take part in the hostilities.

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One response to this problem is to between virus and host, or to unveil some mysteries fund the search for generic methods of boosting innate of the viruses themselves have simultaneously proven immunity to provide increased resistance to most or the ease with which bioactive and sometimes harmful all infectious agents. Even if medical benign until a mouse poxvirus (ectromelia virus) ren countermeasures were nominally available, however, dered more virulent by its modification to coexpress both genetically engineered and conventional agents a molecule of the immune system (interleukin-4) was could cause great localized harm and widespread reported. Still others 596 Emerging Infectious Diseases and Future Threats may be common commensals that have acquired Future threats are difficult to predict but will cer virulence factors (eg, toxins) or antimicrobial resis tainly include the increasingly complex challenges of tance genes though natural or unnatural (ie, genetic foodborne and waterborne diseases, the threat of an engineering) means. What new diseases remain the leading cause of death worldwide and will be encountered in the next 20 years Will other infectious agents from the past, in dramatic example of a new infectious disease that addition to the 1918 influenza virus, be resurrected Vaba, Haiza, Kholera, Foklune or Cholera: in any language still the disease of seven pandemics. Classification of the Legionnaires disease bacterium: Legionella pneumophila, genus Novum, species nova, of the family Legionellaceae, familia nova. Legionnaires disease: isolation of a bacterium and demonstration of its role in other respiratory disease. Legionnaires disease associated with cooling towers-Massachusetts, Michigan, and Rhode Island, 1993. Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Le gionella micdadei. Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations. A survey of Campylobacter and other bacterial contaminants of pre-market chicken and retail poultry and meats, King County, Washington. The role of poultry and meats in the etiology of Campylobacter jejuni/coli enteritis. The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli. Grain feeding and the dissemination of acid-resistant Esch erichia coli from cattle.

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