Clinical Pediatrics and Medicine

Pediatric drug development is a challenge for over the past half a century. There are quite a few childhood diseases which have significant occurrence rates in pediatric subjects but  for which there are no approved drugs. Reports say that as a result of low prioritization of pediatric drug development globally about 75% of drugs do not carry regulatory approval for use in infants or children; ~66% of medications used in children in the US are used off label, 50% in Europe and in Japan it is less than 20%. Most medications in these regions donot contain package inserts have adequate information for treating infants or children. This session will address all such issues including R&D, F&D and regulatory framework with research scientists from different pharmaceutical industries and also drug discovery researchers.

A different or modified drug delivery system is required by the pediatric patients compared to other subsets of the population due to their continuing development hence dosing and administration requirements. Conventional formulations are not designed for pediatric patients. Hence it becomes necessity to manipulate and compound the medication accordingly and this has become common practice. The pharmacokinetic and pharmacodynamic profile of a drug varies broadly depending on the factors like developmental stage of a child, necessitating dose flexibility to suit the dosing requirements etc. Excipients which are commonly regarded as safe may pose a safety risk for child group in addition to other considerations of the formulation and development of the dosage form a drug. Palatability and ease of swallowing are also considered as pivotal parametrs for the acceptability of medicines intended for children, who due to their age possess distinct preferences and swallowing abilities than other subsets of the population. New formulation design approaches like multiparticulate drug delivery systems, orodispersible tablets (ODTs), orodispersible films (ODFs), and chewable formulations are gainig importance based on their respective efficacy, PK/PD factors and patient compliances.

From the time of inception hospitalists have emerged as a fast growing group of physicians in the United States. Reports suggest that in almost 30% hospitals, wherein 55% hospitals consist beds equal to 200 or more, have hospitalists as their medical staffs. Presently, more than 12,000 hospitalists are practicing in the United States. With time if this hospitalist model continues to have expansion at the present rate, the number of hospitalists will eventually rise to 30,000 in the United States by 2019. With its success rate appreciably rising hospitalist programs are adopted in several countries outside North America, including Australia, New Zealand, Argentina, Brazil, Chile, Columbia, Spain, Sweden, and Singapore.

Most hospitalists’ time are engaged in delivering and coordinating the healthcare for a wide range of conditions affecting hospitalized children. Reports say that patients under the care of hospitalists have decreased duration of stay and lesser associated costs when compared to physicians with principally outpatient responsibilities. The range of services provided by a pediatric hospitalist group is by large dependent on the requirement of the situation and the institution. Also the ability of the group to provide these services is an important factor, which may include the following:

Consultation or short-stay observation unit services| Coordinated, family-centered interdisciplinary admission and discharge planning that includes the essential role of the primary care physician| Delivery room services| General inpatient pediatricare| Newborn nursery care| NICU and PICU coverage| Palliative care| Pediatric emergency department evaluation| Perioperative surgical and medical subspecialty care| Sedation services

In the year The Centers for Medicare and Medicaid Services (CMS) have finalized rules that prohibit Medicaid payments for the additional cost of services which result from the preventable healthcare acquired illnesses or injuries, that are generally referred to provider-preventable conditions (PPCs). Basically, there are two distinct categories of PPCs:

1.       Health Care-Acquired Conditions (HCACs)- pertaining to Medicaid inpatient hospital settings

2.       Other Provider-Preventable Conditions (OPPCs)- applying to Medicaid inpatient and outpatient health care settings.

Nosocomial infections (NI) are one of the most important causes of morbidity and mortality in pediatric hospitals. Nosocomial (hospital-acquired) infections cause a number of major complications which potent to serious illnesses. Severely ill patients pose a greater risk of acquiring nosocomial infection. This in turn implies to the problem being greatest in intensive care units. However, studies have demonstrated that nosocomial infections are largely preventable. Most Hospital-acquired infections are caused by viral, bacterial, and fungal pathogens. Most common types are bloodstream infection (BSI), pneumonia (eg, ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI).

For diagnosis of nosocomial infections the Laboratory investigations should be additionally guided by the results of detailed physical examination and clinical manifestations. Interpreting laboratory results is critical for nosocomial infections as not all bacterial or fungal growth on a culture are pathogenic. Growth on cultures may often reflect simple microbial colonization. Considering the points like *clinical presentation of the patient *reason for obtaining the test *process by which the specimen was obtained *presence of other supporting evidence of infection

Discharge from the hospital for most pediatric patients implies that the child is clinically improving, but all the same it also creates potential risk of the transition of care. In  a study, almost 49% of patients had more than 1 medication error at discharge, which potent to increase their likelihood for readmission. In other studies, approximately 10% to 20% of patients were found to have an adverse event after discharge, with about half of these events deemed to be preventable. It is because of the potential for errors and variability in the discharge process, that recently the Children’s Hospital Association (CHA) formed the first pediatric improvement collaborative to examine whether the shared improvement strategies would affect discharge-related care failures, parent-reported readiness for discharge, and readmission.

Children—they aren't just miniature adults. Children's perceptions of pediatric nursing care have not been systematically taken into account in the development of the quality of care. Their bodies function differently, absorb medications differently, and process thoughts differently. Starting a normal healthcare regimen early in life enables children to become healthy adults. Nurses, no matter where they work, come into contact with children. It's important to know that children require special handling. Developing trust is key when trying to gain the pediatric patient's cooperation. Understanding the differences in children is important to care for them safely. The family should be included in the child's care, and parent concerns should be taken seriously. Parents can be a valuable tool in assessing and caring for pediatric patients. With the correct knowledge and attitude, treating children and their families can be a wonderful experience.

Pediatric clinical conundrums are some interesting topics of discussion for clinicians around the world. More than theoretical approach a real time case study or case report is more effective to deal with critical situations arising in the hospital. This session will focus on all such case studies and real experiences of paediatricians and other physicians in the hospital. A systematic approach towards better pediatric healthcare will be the main aim of this conference session.

The Popularity of Herbal medicine over the past 20years has been instrumental in motivating much of this research. Increasing numbers of children and adolescents turn to complementary and alternative medical therapies to promote health, prevent illness, and treat acute and chronic conditions. Herbs are among the most commonly used of these therapies. In 1998, herbs and other dietary supplements were a $3.5 billion dollar industry in the United States.