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ZUSAMMENFASSUNGAntikonvulsiva haben ein großes Risikopotenzial für unerwünschte Arzneimittelwirkungen (UAW). Im ersten Abschnitt des Artikels werden die UAW-Profile in der Pädiatrie wichtiger Antikonvulsiva vorgestellt. Beispielsweise können unter Valproattherapie zwar seltene, aber potenziell lebensbedrohliche Organopathien auftreten. Bei anderen Antikonvulsiva stehen UAW im Vordergrund, die den Alltag beeinflussen können, wie etwa aggressives Verhalten bei Levetiracetam. Diese können die Lebensqualität und den Alltag pädiatrischer Patienten und deren Familien beeinträchtigen. Daher wird im zweiten Teil des Artikels auf die Wahrnehmung der Betroffenen eingegangen. Eltern befürchten eher schwerwiegende UAW wie Organversagen, pädiatrische Patienten eher neurologische und psychiatrische Symptome. Diese Symptome werden auch am häufigsten von pädiatrischen Patienten erlebt. Als besonders negativ werden die emotionale Belastung sowie erlebte Einschränkungen bei Aktivitäten in Schule und Freizeit beschrieben. Daher sollten neben der Effektivität des Arzneistoffs bei der jeweiligen Epilepsieform auch die Wünsche der pädiatrischen Patienten und deren Eltern bei der Therapieauswahl berücksichtigt werden.

Determination of the physical compatibility of acetaminophen and two different electrolyte solutions (an isotonic, balanced electrolyte solution and a hypotonic, glucose containing electrolyte solution) with drugs frequently used in routine pediatric intensive care.Analytical investigations for frequently used combinations without pre-existing data were performed. Visual and microscopic observations according to the European Pharmacopeia as well as pH measurements and ultraviolet visible spectrometry at wavelengths of 350, 410 and 550 nm were conducted to analyze physical compatibility. All measurements were performed immediately after mixing as well as 1, 4, and 24 h after.In total, 42 combinations were analyzed. Visual incompatibilities were found with pantoprazole and diazepam with both electrolyte solutions. For furosemide, a particle formation in mixture with the hypotonic glucose-containing electrolyte solution and a change in pH ≥ 0.5 after 24 h with both electrolyte solutions were observed. Ampicillin, cefuroxime, diazepam, furosemide, linezolid, meropenem, and pantoprazole showed an aberration of the absorbance ≥0.04 (350 nm/410 nm) or ≥0.01 (550 nm) in the photometric measurements with the electrolyte solutions. For acetaminophen, a physical incompatibility was observed with ampicillin, diazepam, furosemide, and pantoprazole.Most of the analyzed combinations showed no signs of physical incompatibility and may therefore be administered via the same Y-site. However, diazepam, furosemide, and pantoprazole should not be administered simultaneously with acetaminophen or both electrolyte solutions.

Background Community pharmacists play an important role in healthcare. They are the only professional point of contact for all self-medication-related matters. Little research has been done regarding the information needs of pharmacists for evidence-based self-medication counselling. Aim To explore pharmacists’ information needs in 5 predefined areas of information needs: individual needs, quality needs, utilization needs, implication needs, and access needs. Setting Community pharmacies in Germany. Method After ethical approval, we conducted a mixed-methods study in form of an exploratory, semi-quantitative, cross-sectional online survey. Members of 3 different chambers of pharmacists were invited to participate anonymously in the survey and without any incentives after giving informed consent. Main outcome measure Quantitative outcome: Frequency of relevance / importance of items within predefined information needs areas, except for access needs. Qualitative outcome: Open-text responses concerning all information needs. Results Data from a total of 823 participants, who completed the survey, were analyzed. General and specific information such as dosage (74.2 % [611/823]) and when to refer to a physician (64.6 % [532/823]) as well as an over-the-counter-product’s effectiveness according to medical guidelines (71.4 % [588/823]) were rated as very important. Participants reported to prefer digital information sources (50.5 % [416/823] strongly agreed), especially in the form of an easily accessible database (61.6 % [507/823] strongly agreed) that contains regularly updated, manufacturer independent, critically appraised, concise information. Conclusion Community pharmacists expressed distinct information needs for evidence-based self-medication counselling. Further information on essential evidence-based pharmacy knowledge may be necessary to support the correct implementation.

Purpose The standardized medication plan (MP) is a document listing the patients’ entire medication, instructions for use, and indications in a nationally defined format. However, there is currently little data on its practical implementation, comprehensibility, and use at the patient level. We aimed to investigate under routine conditions (i) patients’ competencies in using the MP, (ii) completeness and correctness of the MP including handwritten modifications, and (iii) patients’ reasons for deviating from the MP. Methods We conducted face-to-face interviews with patients in community pharmacies. Data was analyzed with qualitative and quantitative methods. Results We enrolled 288 patients (median age: 76 years, range: 27–95) with n=2,779 medications actually taken and n=2,539 medications documented on the MPs. 38.5% of the patients used their MP regularly to prepare their medication and 73.3% used it to inform their physician. (i) Overall, patients’ orientation and understanding the MP was good. (ii) No MP was correct and complete. When taking only relevant aspects into account, i.e. active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% (n=228) were incorrect or incomplete. With 25.8% of the total number of handwritten modifications (n=341) most often medications were added. (iii) Almost 60% of all patients deliberately deviated from their MP, “fear of adverse drug reactions” was the most frequently (n=50) mentioned reason. Conclusion The patients’ competence in understanding their MP was good. However, important information was often missing or incorrect; therefore, handwritten modifications were frequently added. Patients often deliberately deviated from their MP for various reasons.

Background Owing to complex treatment, critically ill children may experience alterations in their vital parameters. We investigated whether such hemodynamic alterations were temporally and causally related to drug therapy. Methods In a university pediatric intensive care unit, we retrospectively analyzed hemodynamic alterations defined as values exceeding the limits set for heart rate (HR) and blood pressure (BP). For causality assessment, we used the World Health Organization–Uppsala Monitoring Center (WHO–UMC) system, which categorizes the probability of causality as “certain,” “probable,” “possible,” and “unlikely.” Results Of 315 analyzed patients with 43,200 drug prescriptions, 59.7% experienced at least one hemodynamic alteration; 39.0% were affected by increased HR, 19.0% by decreased HR, 18.1% by increased BP, and 16.2% by decreased BP. According to drug information databases, 83.9% of administered drugs potentially lead to hemodynamic alterations. Overall, 88.3% of the observed hemodynamic alterations had a temporal relation to the administration of drugs; in 80.2%, more than one drug was involved. Based on the WHO–UMC system, a drug was rated as a “probable” causing factor for only 1.4% of hemodynamic alterations. For the remaining alterations, the probability ratings were lower because of multiple potential causes, e.g., several drugs. Conclusions Critically ill children were frequently affected by hemodynamic alterations. The administration of drugs with potentially adverse effects on hemodynamic parameters is often temporally related to hemodynamic alterations. Hemodynamic alterations are often multifactorial, e.g., due to administering multiple drugs in rapid succession; thus, the influence of individual drugs cannot easily be captured with the WHO–UMC system.

Poison Information Centers (PICs) fulfil the legal mandate to provide advice and answer inquiries from healthcare professionals and medical nonprofessionals on measures to be taken in the event of an intoxication. Medication errors might be a frequent cause of intoxication. However, hardly any data on medication errors are available from PICs.We aimed to investigate the incoming inquiries of a PIC with regard to medication errors.In the PIC database, we identified and analyzed medication errors in a retrospective analysis of inquiries from 2013 to 2020. We distinguished between medication errors committed by (i) laypersons or by healthcare professionals in (iia) medical care facilities or (iib) home care facilities. We evaluated the estimated potential risk of toxicity to assess the potential harm to the patient.From 152,149 inquiries in total, 43.5% (This study identified medication errors that were committed mainly by laypersons in almost 80% of the medication inquiries to a PIC. Medication errors caused by healthcare professionals in medical care led to a higher risk of harm to the patients.

Background In older multimorbid orthopedic and rheumatic patients, data on symptoms besides pain or reduced mobility are rarely published. Objective We investigated patients’ perspectives on their symptoms after hospital discharge. Material and methods Orthopedic and rheumatic patients aged over 70 years were asked via telephone interviews about (i) their symptoms, (ii) communication, (iii) treatment, and (iv) support. Results (i) The 60 participants (35 women and 25 men) reported a median of 6 (min-max: 1–14) different symptoms, of which 86% (356 of 415) had existed before hospitalization, (ii) patients did not communicate 28% (117) of symptoms to either healthcare professionals, family or friends and (iii) 52 (87%) patients desired improvement. Of the 280 most impairing symptoms, 19% (52) were not treated at all. (iv) Almost all patients (59; 98%) considered it easy to obtain support. Conclusion Remarkably, many symptoms were not communicated or treated despite the patients having been hospitalized.

BACKGROUND Self-medication counseling in community pharmacies plays a crucial role in healthcare. Counseling advice should therefore be evidence-based. Web-based information and databases are commonly used as electronic information sources. The EVInews-database is a self-medication related information tool, consisting of a database and monthly published newsletters for pharmacists. Little is known about the quality of pharmacists’ electronic information sources for evidence-based self-medication counseling. OBJECTIVE Our aim was to investigate the quality of community pharmacists’ web-based search results for self-medication related content in comparison to the EVInews-database, based on an adjusted quality score for pharmacists. METHODS After the approval of the ethics protocol, we performed a quantitative online survey with a search-task as a prospective, randomized, controlled and unblinded study. For the search-task, participants were instructed to search for evidence-based information to verify 6 health-related statements from 2 typical self-medication indications. Pharmacists across Germany were invited to participate by E-Mail. After written informed consent, they were automatically, randomly assigned to either use web-based information sources of their choice without the EVInews-database (Web-group) or exclusively the EVInews-database (EVInews-group). The quality of the information sources that were utilized for the search-task was then assessed by two evaluators using a quality score ranging from 100% (180 points, all predefined criteria fulfilled) to 0% (0 points, none of the predefined criteria fulfilled). In case of assessment discrepancies, an expert panel consisting of 4 pharmacists was consulted. RESULTS In total, 141 pharmacists were enrolled. In the Web-group (n=71 pharmacists), the quality score median was 32.8% (59.0 out of 180.0 points; IQR: 23.0–80.5). In the EVInews-group (n=70 pharmacists) the quality score median was significantly higher (85.3%; 153.5 points out of 180.0 points; P CONCLUSIONS The median quality score of the Web-group was poor and there was a significant difference in quality scores in favor of the EVInews-group. Pharmacists' web-based and self-medication related information sources often did not meet standard quality requirements and therefore showed a considerable variation in quality. CLINICALTRIAL

Background Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians’ perceptions on ADRs in pediatric routine care. Methods In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions. Results Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P Conclusions Physicians’ perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.

Ines Wakob,1,2 Gordian Lukas Schmid,3 Ingo Nöhring,3 Romy Elze,4 Ralf Sultzer,5 Thomas Frese,6 Susanne Schiek,1,2,&ast; Thilo Bertsche1,2,&ast; 1Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany; 2Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany; 3Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany; 4University Computer Center, Department of Research and Development, Leipzig University, Leipzig, Germany; 5Sana Geriatric Centre, Zwenkau, Germany; 6Institute of General Practice and Family Medicine, Martin-Luther-University, Halle (Saale), Germany&ast;These authors contributed equally to this workCorrespondence: Thilo Bertsche, Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, University Hospital of Leipzig and Leipzig University, Bruederstr 32, Leipzig, Germany, Tel +49 341 97 11800, Email thilo.bertsche@uni-leipzig.dePurpose: Mobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation.Methods: We performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users’ assessment of functionalities and (iii) barriers to mHealth managing ADR communication.Results: A total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = − 0.231; p < 0.001) and GPs (r = − 0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (> 60%) included “Rapid feedback on urgency of face-to-face consultations.” GPs valued information on “Patient’s difficulties in medication administration.” (iii) In free-text answers, the barrier reported most frequently by patients was “preferred personal GP contact” (6%), whereas GPs claimed, “uncomplicated use with low expenditure of time and personnel” (19%).Conclusion: Older patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs’ time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.Keywords: mHealth, adverse drug reaction, patient, general practitioner, questionnaire survey

This study aimed to compare assessment methods to determine adverse drug reactions (ADRs) at nonelective hospital admission in pediatric patients, to investigate the interrater reliability of assessment methods in pediatric care, and to analyze symptoms related to ADRs and (suicidal) drug intoxications.For 1 year, the medical records of nonelective patients admitted to a university pediatric department were evaluated for potential ADRs using 4 assessments methods by 1 experienced rater. Krippendorff α was calculated from a sample of 14 patients evaluated by 4 experienced raters to determine interrater reliability.In 1831 nonelective hospital admissions, 63.4% (1161 of 1831) of patients had received at least one drug before admission. We found a potential causal relationship between drugs and symptoms documented at admission and thus potential ADRs according to Naranjo in 23.3% (271 of 1161) of those patients, World Health Organization - Uppsala Monitoring Centre (WHO-UMC) in 22.5% (261 of 1161), Koh in 21.7% (252 of 1161), and Begaud in 16.5% (192 of 1161). The probability rating of the potential causal relationships varied considerably between the methods (Naranjo-Begaud, P0.01; Naranjo-Koh, P0.001; Koh-Begaud, P0.01; Begaud-WHO-UMC, P0.01). Acceptable interrater reliability (α ≥ 0.667) was only obtained for WHO-UMC (α = 0.7092). The most frequently identified definite ADR was sedation in 1.5% of all nonelective patients with medication before hospital admission. In 1.2% (22 of 1831) of all nonelective admissions, we found drug intoxications with suicidal intent.The assessment methods showed a high variability in the determination of a potential causal relationship between drug and documented symptom, in the classification of the probability of ADRs, and suboptimal interrater reliability. Thus, their feasibility in pediatric patients is limited.

Zusammenfassung Ziel der Studie Ziel dieser Studie war es, die Empfehlungen eines etablierten ABS-Teams während der wöchentlichen Routinevisiten zu evaluieren sowie ihre Umsetzungsrate und die Gründe der Nichtumsetzung zu untersuchen. Methodik Die Visiten eines multiprofessionellen ABS-Teams (Infektiologie, Mikrobiologie, Apotheke und Krankenhaushygiene) wurden über 8 Wochen auf 9 intensivmedizinischen und peripheren Stationen eines Universitätsklinikums (1451 Betten) begleitet. Die Empfehlungen des ABS-Teams wurden prospektiv analysiert und bei fehlender Umsetzung Gründe standardisiert von den behandelnden Ärzten erfragt. Ergebnisse Während des Beobachtungszeitraums fanden bei 262 Patienten 359 ABS-Visiten statt. Im Median nahmen 4 Ärzte und 1 Apotheker (Q25/Q75: 4/6) an den ABS-Visiten teil. Bei 177/359 (49%) ABS-Visiten erfolgte mindestens eine Empfehlung zur Antiinfektivatherapie. Insgesamt wurden 210 Empfehlungen ausgesprochen. Am häufigsten waren mit 38% (80/210) Empfehlungen zur Einhaltung der festgesetzten Therapiedauer. Je mehr unterschiedliche Berufsgruppen an der ABS-Visite teilnahmen, je eher wurde eine Empfehlung ausgesprochen (p=0,016; Odds Ratio=1,018 (1,003–1,033)). 62/210 (30%) der Empfehlungen des ABS-Teams wurden vom behandelnden Arzt nicht umgesetzt. Als häufigster Grund wurde mit 32% (20/62) eine bewusst von der Empfehlung abweichende Therapieentscheidung angegeben. Schlussfolgerung Die hohe Empfehlungsrate von knapp 50% zeigt den Bedarf an Therapieoptimierung durch ABS-Teams in der Routine. Je multiprofessioneller diese besetzt sind, desto häufiger werden auch Empfehlungen ausgesprochen. Gründe für die fehlende Umsetzung von Empfehlungen sollten kritisch hinterfragt werden – sowohl seitens des ABS-Teams als auch seitens der behandelnden Ärzte auf Station.

Aim Meeting children's needs when communicating an epilepsy diagnosis can have a large impact on their treatment. We investigated children's experiences and wishes concerning their first conversation about epilepsy. Methods This prospective study was performed in the neuropaediatric departments of two German university hospitals from 2 October 2018 to 12 April 2019. The semi-structured interview contained open questions and multiple answers were allowed. Results We interviewed 101 patients (57 male) aged 6-17 (median 11) years and asked them to put themselves in the place of a physician delivering an epilepsy diagnosis. They said they would be careful and friendly and consider the children's feelings (29%), give them detailed information about their condition (29%) and reduce their fears and offer hope (26%). They would tell them the importance of always taking their medication and explain why (25%), make sure that the conversation took place in a comfortable setting (21%), explain any safety precautions (19%), keep the conversation straightforward and provide examples (16%). Conclusion Children with epilepsy provided concrete recommendations for physicians delivering an epilepsy diagnosis, with regard to the ideal setting, important topics and optimal communication. The recommendations could help physicians meet children's needs.

Children and adolescents are exposed to medicines and supplements, but only a few studies have evaluated the actual intake in routine care. Thus, we performed a pharmacoepidemiological evaluation of a longitudinal population-based pediatric cohort study (LIFE Child) conducted at the University Hospital of Leipzig between 2014 and 2019. We analyzed all visits of the participants of the LIFE Child cohort between 1 January 2014 and 31 December 2019. Participants were asked to bring their medicines and supplements to their appointments at the study center. If they had not brought the preparations with them, attempts were made to obtain the relevant information during a telephone call after the visit to the study center. Furthermore, the participants and their parents were interviewed on medicine and supplement use and on sociodemographic and socioeconomic data during their visit to the study center. Associations of medicine and supplement use with age, sex, and socioeconomic status were analyzed using multivariate binary logistic regressions to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Furthermore, the number of the respective visit was included as possible confounder in the multivariate model. We included 3602 participants who visited the study center 11,906 times. The intake of 9759 medicines and supplements was recorded. Based on the evaluation of all study visits, 49% of the children and adolescents took at least one medicine or supplement. Self-medication accounted for 28% of the medicines and supplements. The prevalence of overall intake increased from 45% in 2014 to 53% in 2019 (aOR 2.63, 95% CI 2.23, 3.09). The prevalence was the highest (77%) in children aged 0– CI 1.10, 1.28) than in males (35%), owing mainly to the intake of ibuprofen and hormonal contraceptives in adolescent females. A high socioeconomic status was a predictor of lower medicine (aOR 0.80, 95% CI 0.68, 0.95) and higher supplement (aOR 1.47, 95% CI 1.09, 1.98) use.Conclusion: Half of all children and adolescents took at least one medicine or supplement. The intake varied depending on age and sex. Furthermore, high socioeconomic status was associated with a decreased probability of medicine intake. What is Known:• Half of all children and adolescents in Germany are exposed to medicines and supplements.• Data on the actual intake are scarce as most studies focus on prescribed medicines. What is New:• The prevalence of medicine/supplement use rose from 2014 (45%) to 2019 (53%). The prevalence was age-dependent: it was the highest in children aged < 3 years, and the lowest in children aged 6–< 9 years. Females took medicines more frequently than males.• High socioeconomic status was associated with lower medicine and higher supplement use. Self-medication accounted for 28% of all preparations.

Summary Background Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. Methods A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses’ interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. Results (i) We found 424 adverse events with a median of 4 per patient (range 1–14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0–11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as “doubtful,” in 218 (51.2%) as “possible,” in 7 (1.7%) as “probable,” and in 1 (0.2%) adverse event as a “definitive” cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. Conclusion Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

Background Little is known about children's perspectives and attitudes towards their long-term and rescue anticonvulsant medication. Methods We interviewed paediatric patients aged 6–18 years in two university hospitals concerning their anticonvulsant treatment based on a structured questionnaire. We also asked them to draw a picture titled “Me and my medication”. Results We interviewed 100 patients with anticonvulsant long-term medication. 87/100 patients considered their medication to be helpful. 66/100 patients gave an explanation on why a regular medication intake is important, e.g. “Reduction/prevention of seizures”, “Otherwise I have to go to hospital”, “I don't want to die” or “Kill the virus which is causing epilepsy”. Of 92 patients with a prescribed rescue medication, 22 (24%) did not know about it. Of the remaining 70, 39 (56%) stated they always carry it with them. When asked to imagine being the physician and to inform about the medication, the children would use illustrative (e.g. brochures) or demonstration material (e.g. “real tablets”) to aid their consultation (47/100). 55/100 would stress the necessity of a regular intake. 52 participants drew a picture related to the given topic. Of those, only 1 depicted rescue medication. Conclusion Paediatric patients mostly have a positive attitude towards their medication. However, misconceptions exist and participants expressed the desire for more interactive support in the medical counselling. Children are not sufficiently aware of their rescue medication in everyday life. Consequently, physicians should consider the children's needs in their consultations and put more focus on potentially life-saving rescue medication.

Background Providing evidence-based care is recognized as a key competence for all healthcare professionals. In order to support community pharmacists in evidence-based self-medication counseling, the umbrella organization of German pharmacists initiated the development of a nationwide concept. The key element of the concept was a professional newsletter that should help pharmacists incorporate research findings into their daily counseling practice. Objective To develop, implement and evaluate the professional newsletter concept. Setting German community pharmacies. Method Clinical pharmacists from a German university compiled and synthesized clinical trial data in a professional newsletter that would supply community pharmacists with evidence-based information on common over-the-counter medicines as well as instructions for searching and appraising scientific literature. The electronic newsletter was offered to interested community pharmacists free of charge, once or twice a month, after they signed up for a subscription. About one year after the publication of the first newsletter issue, the subscribers were invited to take part in an anonymous cross-sectional online survey. In all, 21 newsletter issues were published through the end of the survey period. Main outcome measure Perceived value of the professional newsletter with 10 predefined objectives. Results A total of 1975 persons subscribed to the professional newsletter. Of those, 150 persons working in community pharmacies completed the survey. Most of them perceived the synthesized information as ‘useful’ (81–95%). They attributed positive changes in knowledge (89%), skills (87–91%), awareness (85%), and motivation (67–77%) to the newsletter. However, almost half of them (43%) found it difficult to incorporate reading the newsletter in their everyday working life. Free-text feedback suggested that further modifications should be considered to facilitate a better integration of the newsletter into everyday pharmacy practice. Conclusion A nationwide provided professional newsletter can play a vital part in supporting pharmacists in evidence-based self-medication counseling. However, the practicability of such a newsletter needs to be further improved and the newsletter should be accompanied by additional measures.

A diagnosis of epilepsy substantially influences the lives of affected children and adolescents, and concealing the diagnosis can generate additional stress. However, little is known about whether children and adolescents communicate their diagnosis to their friends. We performed a survey at two German university hospitals. Epilepsy patients aged 6–18 years were asked why they did or did not disclose their condition to their friends. A total of 101 patients (44 female, 57 male) were interviewed. Twenty-one (21%) informed all their friends about their epilepsy, 63 (62%) informed only certain friends, and 3 (3%) did not specify. Fourteen (14%) did not inform any friends. Their reasons for informing their friends were trust in friends (47/87; 54%); questions from friends, e.g., about missed school days (29/87; 33%); a wish for friends to be informed in case of an emergency (15/87; 17%); and a desire to live openly with the condition (8/87; 9%). The reasons for not informing friends were fear of stigmatization/shame (4/14; 29%), discouragement from parents (3/14; 21%), and a wish for confidentiality (3/14; 21%).Conclusion: Most children and adolescents inform their friends about their epilepsy. Fear of stigmatization is the main reason for not informing friends about this condition. What is Known• An epilepsy diagnosis is a life-changing event for affected children and adolescents.• Having to conceal the diagnosis can be very stressful. What is New• Most pediatric epilepsy patients informed at least some close friends about their diagnosis motivated by trust in friends; questions from friends, e.g., about missed school days; and a wish for friends to be informed in case of an emergency.• Fear of stigmatization/shame, discouragement from parents, and a wish for confidentiality were the motivations for concealing the disease.

Anticonvulsant drugs have a high risk of adverse drug events. Little is known about the perception of those events by pediatric patients. We performed a survey in the neuropediatric departments of two university hospitals. Using a questionnaire, we interviewed patients aged 6–18 years with current anticonvulsant treatment regarding (i) their fears about potential adverse drug events, (ii) experienced adverse drug events, and (iii) perceived burden of experienced adverse drug events. One hundred patients took part in the interview. (i) 40 (40%) expressed fears that the medication could harm them. Eighteen of 40 (45%) named fears concerning specific adverse drug events. Of those, 12/18 (67%) feared neurologic or psychiatric symptoms. (ii) 37 (37%) of children described altogether 60 experienced adverse drug events. Of those, 38 (63%) concerned neurologic or psychiatric symptoms. (iii) 32/37 (82%) children who experienced adverse drug events felt bothered by the experienced event. Among others, they described an emotional burden (11/37, 30%), and restrictions in school performance (8/37, 22%) and favorite leisure activities (4/37, 11%).Conclusion: School-aged children are well able to describe adverse drug events of their anticonvulsant medication. Almost two thirds of the described events concern neurologic or psychiatric symptoms that cause an emotional burden and restrictions according to the patients. What is Known:• Anticonvulsants have a high potential of adverse drug events.• In an earlier survey, parents expressed fears of severe adverse drug events such as liver failure, which seldom occur, and reported a high number of neurological and psychological adverse drug events. What is New:• Many children fear that their anticonvulsants could harm them, and they fear and experience neurological and psychological adverse drug events.• According to the children, adverse drug events cause an emotional burden and restrictions in school performance and favorite leisure activities.

Metamizole can sterically inhibit aspirin (ASA) from binding to cyclooxygenase 1 (COX1). It is recommended that ASA should be taken 30 min prior to metamizole to maintain the irreversible inhibition of arachidonic acid (AA)–induced platelet aggregation. We aimed to analyse the inhibitory effect of ASA and metamizole on AA-induced platelet aggregation over the course of the day. We analysed hospitalized patients who ingested ASA at least 30 min prior to metamizole (recommended dosing group, n = 15), metamizole prior or simultaneously with ASA (not recommended dosing group, n = 16) and patients with unknown or mixed intake (mixed dosing group, n = 5). AA-induced light transmission (LTA) and impedance aggregometry (IA) were measured before, 1–2 and 5–6 h after the intake of ASA ± metamizole. Maximum AA-induced LTA prior to the intake of ASA was significantly lower and the rate of high on treatment platelet reactivity (HTPR) higher in the recommended compared with the not recommended dosing group (19.6% vs. 46.9%, p = 0.011 and 4/15 vs. 12/16 patients, p = 0.017). There was no difference when IA was used. Maximum AA-induced LTA after the intake of ASA ± metamizole was lower in patients in the not recommended but not in the recommended dosing group. All patients with HTPR in the recommended dosing group had regular inhibition of AA-induced LTA after discontinuation of metamizole. Co-medication of ASA and metamizole significantly influences platelet inhibition with variations during the day and can cause HTPR in patients taking ASA prior to metamizole or simultaneously.

Background Hepatic insufficiency can affect patient safety and should therefore be considered during drug therapy. Hospital admission offers an ideal point to screen for patients at risk and to adjust drug therapy accordingly. Objective To assess the number of patients admitted to hospital with clinically elevated liver parameters. To identify high-risk patients in need of potential drug therapy adjustment to liver function by calculation of liver scores. Finally, to investigate whether pre-hospital medication needed adjustment to liver function. Setting Patients admitted to surgical wards of a tertiary teaching hospital. Method Surgical patients were included in a 3-month retrospective study. A pharmacist-led screening process, including recording of elevated liver parameters and calculation of liver scores (Child-Pugh-score, Model of End-stage Liver Disase [MELD], MELDNa), was used to assess frequency of hepatic insufficiency and patients potentially needing medication adjustment. Additionally, pre-hospital medication was checked for contraindications and correct dosage with regard to liver function. Main outcome measure Percentage of surgical patients with clinically elevated liver parameters at admission, percentage of patients with hepatic insufficiency potentially needing drug therapy adjustment, and percentage of pre-hospital drug intakes not adjusted to liver function. Results Of 1200 patients, 130 (11%) had at least one clinically relevant elevated liver parameter at hospital admission. Of these, need for drug adjustment to liver function was found for 16-36%, depending on the liver score used (equivalent to 2-4% of all patients), with the highest number of patients detected by the MELD- and MELDNa-score. Pre-hospital medication concerned 719 drug intakes and was contraindicated in 2%, dosage not adjusted in 3%, and evaluation not possible in 44% of all drug intakes due to lack of information on the drug. Conclusion A significant proportion of patients admitted for surgery have clinically elevated liver parameters and potentially need medication adjustment. A pharmacist-led screening already at hospital admission can support the identification of patients with clinically relevant elevated liver parameters and patients at risk by calculating liver scores under routine conditions. Evaluation of drug adjustment to liver function is challenging, since no data are available in routine resources for a considerable number of drugs.

Prejudices can impair social participation of people with epilepsy.From 2019 to 2020, we invited people with epilepsy and their relatives across Germany to fill in a questionnaire.Two hundred and thirty people with epilepsy (PWE, median age: 40 years; min./max.: 19/83; 66% female) and 103 relatives (REL, median age: 42 years; min./max. 23/70; 83% female) took part in the survey. 44% PWE and 40% REL said prejudices against PWE had not declined in recent years. Of PWE, 64% reported they had experienced prejudices themselves. In an open question with multiple answers possible, 71% of the PWE described concrete prejudices against PWE, 62% of the REL did so. The reported prejudices concerned symptoms of epilepsy (37% PWE; 23% REL), academic or occupational performance (47% PWE; 38% REL), social or family life (27% PWE, 29% REL), and other topics (7% PWE, 4% REL). Of PWE, 88% said all or almost all relatives knew about their condition, 74% stated this applied to all or almost all friends, and 48% told all or almost all colleagues about their epilepsy. Of PWE, 94% would want to know if a relative had epilepsy, 87% would like to know about a friend's epilepsy, 70% about a colleague's epilepsy. Fear of stigmatization was a reason for not always communicating the condition according to 20% PWE and 63% REL. None of PWE and 16% of REL named shame as a reason.People with epilepsy still experience prejudices and fear of stigmatization hinders an open communication about the condition.

Febrile seizures (FS) in children are common, but little is known about parents’ perceptions and knowledge of FS. We interviewed parents of children aged 6 months to 6 years affected by FS (FS group, 65 parents) or unaffected (control group, 54 parents). In the FS group, 32% said they knew their child had an FS when the first event occurred, and 89% described fear when the child had a seizure, with a median intensity of 10/10 (Q25/Q75: 9/10). Related to follow-up, 77% in the FS group (will) observe their child more carefully after the first seizure happened, and 63% (will) give antipyretics earlier at a median temperature of 38.2 °C (100.8 °F). In the FS group, 62% were unaware of FS before the first event (54% of control group did not know about FS thus far, n.s.). In the FS group, 20% would put a solid object in the mouth of a child having a seizure (control group, 39%, p = 0.030), and 92% would administer an available anti-seizure rescue medication (control group, 78%, p = 0.019). In the FS group, 71% feared that children with FS might suffocate (control group, 70%, n.s.).Conclusion: Information about FS and their management should be more available to improve parents’ coping and patient safety. What is Known:• Febrile seizures in children are common.• The prognosis of children suffering from febrile seizures is usually rather good. What is New:• Over half of parents had not informed themselves about febrile seizures so far; and only 32% of parents realized their child had a febrile seizure when it occurred.• Most parents described own fear with a median intensity of 10/10; and 63% (will) give antipyretics earlier at a median temperature of 38.2 °C (100.8 °F).

BACKGROUND Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices. PURPOSE We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients. METHODS An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge. RESULTS Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide. CONCLUSIONS We found that education on inhalation procedures including practical training is required to increase patient safety.

Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0–5-year-old children and (ii) 6–17-year-olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) 46 parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) 65% of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g. liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6–17-year-old children and their parents matched in 43% to 66%. Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children’s needs might remain unmet.

Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0–5-year-old children and (ii) 6–17-year olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) Forty-six parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned with the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) Sixty-five percent of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g., liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6–17-year-old children and their parents matched in 43 to 66%. Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children’s needs might remain unmet. What is Known:• Pediatric drug administration is complex and therefore error-prone.•Experiences and expectations of children and their parents should be considered. What is New:•Most pediatric patients and their parents have already experienced drug-handling problems.• Expectations concerning the ideal pediatric drug are highly heterogeneous. Parents are often insufficiently aware of those expectations in their children.

Epilepsiepatienten stehen im Schulalter vor besonderen Herausforderungen. Die Epilepsie selbst und unerwunschte Arzneimittelwirkungen von Antikonvulsiva wie Mudigkeit und Verhaltensanderungen konnen den Schulerfolg und die soziale Teilhabe negativ beeinflussen. Dabei konnen Schuler mit Epilepsie ihre Anfalle oft gut beschreiben und schildern den Kontrollverlust als entscheidendes Kriterium. In Bildern werden oft Notfallsituationen und haufig auch Schulsituationen gezeichnet. Um die Situation fur die Kinder mit Epilepsie zu verbessern, sollten Lehrer und Erzieher in der Lage sein, bei einem Anfall adaquat zu reagieren. Schulungen leisten einen wichtigen Beitrag zur Verbesserung der Patientensicherheit, indem das Wissen der Betreuungspersonen verbessert und die Bereitschaft der Lehrer und Erzieher erhoht wird, ein verschriebenes Notfallmedikament auch anzuwenden. Zudem steigen die Kenntnisse uber notwendige Vorsichtsmasnahmen zur Pravention von Unfallen im Rahmen eines Anfalls. Gleichzeitig kann die Teilhabe verbessert werden, indem Kinder nicht mehr unnotig von Aktivitaten ausgeschlossen werden. Spezifische Forderung oder Masnahmen wie ein Nachteilsausgleich konnen die Situation zusatzlich verbessern. Arztliche Masnahmen wie die Optimierung der Epilepsietherapie, um eine optimale Wirksamkeit bei individuell moglichst vertretbaren unerwunschten Arzneimittelwirkungen zu erreichen, stellen dabei die Grundlage all dieser Strategien dar.

Background For a safe drug therapy, outpatients have to self-administer their medications correctly. However, these procedures are known as error-prone. In community pharmacies, the pharmaceutical staff has to recognize patients’ counseling needs and to use adequate strategies to prevent possible handling errors. Objective Assessing the experiences and opinions of pharmaceutical staff on counseling patients on practical drug handling. Setting Community pharmacies in a German city and surrounding area. Method Descriptively evaluating a self-administered questionnaire to be completed by members of the pharmaceutical staff involved in patient counseling. Main outcome measures Estimated counseling needs of patients, current counseling strategies and limitations of counseling. Results 520 staff members of 119 pharmacies (59.8%, 199 invited) participated. The majority prioritized counseling on dosage over counseling on practical drug handling. Participants saw a particular need when medication was dispensed for the first time compared to repeated use (all medication types, each p

To evaluate recommendations of an antibiotic stewardship (ABS) team during routine weekly visits and to analyse their implementation and reasons for non-implementation by the ward physicians.Multiprofessional ABS Rounds (members: infectiology, microbiology, pharmacy and hospital epidemiology) were accompanied by an observer in nine intensive and peripheral wards of a university hospital (1451 beds) for eight weeks. The recommendations of the ABS team were prospectively analysed, and when these were not implemented, ward physicians in charge were asked to give reasons for non-implementation.A total of 262 patients were visited in the course of 359 ABS visits. A median of four physicians and one pharmacist (Q25/Q75: 4/6) participated in the ABS rounds. In 177/359 (49%) of visits, at least one recommendation for anti-infective therapy was given; the total number of recommendations made was 210. The most frequent (38%, 80/210) recommendations were related to the prescribed therapy duration. The more different the professional groups participating in the ABS rounds, the larger was the number of recommendations given (p=0.016; odds ratio=1.018 (1.003-1.033)). 62/210 (30%) of the ABS recommendations were not implemented by the ward physicians in charge. The most frequent reason (32%: 20/62) for this was the deliberate decision by the physicians to deviate from the recommended therapy.The high recommendation rate of 50% demonstrates the need for optimizing therapy by the ABS teams in routine practice. The larger the number of different specialists participating in single visits, the larger was the number of recommendations. Reasons for the lack of implementations need to be critically examined by both the ABS team and the ward physicians in charge.Ziel dieser Studie war es, die Empfehlungen eines etablierten ABS-Teams während der wöchentlichen Routinevisiten zu evaluieren sowie ihre Umsetzungsrate und die Gründe der Nichtumsetzung zu untersuchen.Die Visiten eines multiprofessionellen ABS-Teams (Infektiologie, Mikrobiologie, Apotheke und Krankenhaushygiene) wurden über 8 Wochen auf 9 intensivmedizinischen und peripheren Stationen eines Universitätsklinikums (1451 Betten) begleitet. Die Empfehlungen des ABS-Teams wurden prospektiv analysiert und bei fehlender Umsetzung Gründe standardisiert von den behandelnden Ärzten erfragt.Während des Beobachtungszeitraums fanden bei 262 Patienten 359 ABS-Visiten statt. Im Median nahmen 4 Ärzte und 1 Apotheker (Q25/Q75: 4/6) an den ABS-Visiten teil. Bei 177/359 (49%) ABS-Visiten erfolgte mindestens eine Empfehlung zur Antiinfektivatherapie. Insgesamt wurden 210 Empfehlungen ausgesprochen. Am häufigsten waren mit 38% (80/210) Empfehlungen zur Einhaltung der festgesetzten Therapiedauer. Je mehr unterschiedliche Berufsgruppen an der ABS-Visite teilnahmen, je eher wurde eine Empfehlung ausgesprochen (p=0,016; Odds Ratio=1,018 (1,003–1,033)). 62/210 (30%) der Empfehlungen des ABS-Teams wurden vom behandelnden Arzt nicht umgesetzt. Als häufigster Grund wurde mit 32% (20/62) eine bewusst von der Empfehlung abweichende Therapieentscheidung angegeben.Die hohe Empfehlungsrate von knapp 50% zeigt den Bedarf an Therapieoptimierung durch ABS-Teams in der Routine. Je multiprofessioneller diese besetzt sind, desto häufiger werden auch Empfehlungen ausgesprochen. Gründe für die fehlende Umsetzung von Empfehlungen sollten kritisch hinterfragt werden – sowohl seitens des ABS-Teams als auch seitens der behandelnden Ärzte auf Station.

Although pharmaceutical staff consider guideline-compliant information exchange during self-medication consultations as crucial, they have not fully integrated it into practice. It is unclear what prevents pharmaceutical staff from implementing their positive intentions into their actual everyday practice. To improve the information exchange during the current consultation practice, a deeper understanding of its implementation is needed.The aim was to evaluate the factors influencing information exchange during self-medication consultations in German community pharmacies.We performed a non-participant observation of real-life consultations with post-consultation interviews of pharmaceutical staff in 10 pharmacies. The information exchanged during self-medication consultations was evaluated via 7 guideline-recommended information parameters in 2 stages of information exchange: (a) 'information gathering' and (b) 'provision of information'. Directly after each observed consultation, pharmaceutical staff's opinion about the consultation, the customer's interest and their own performance was questioned. Factors associated with the observed extent of information exchange were analysed by Poisson regression analysis.In the 379 self-medication consultations with 46 pharmaceutical staff members, 454 different customer enquiries were addressed, and 483 medications were dispensed. In median, 2 predefined information parameters (First-/Third quartile: 1/4) were fulfilled during an enquiry and 2 parameters (First-/Third quartile: 1/3) were fulfilled for a dispensed medication. Pharmaceutical staff were satisfied with 85% of their consultations and perceived 76% of them as easy to handle. In both information stages, information exchange increased when 'customers were perceived to be interested in counselling' (p 0.001) and decreased when customers had a 'specific medication request' (p 0.001).Information exchange in pharmacies needs to be better integrated into daily practice. Strategies to encourage information exchange should also include pharmaceutical staffs' perception of their own counselling technique. Ongoing patient-centred trainings should facilitate strategies to engage uninterested customers or costumers with specific medication requests in consultations.

The management of atopic diseases such as severe asthma, severe atopic dermatitis, and severe food allergy in childhood is challenging. In particular, there are safety concerns regarding the use of high-dose corticosteroids. The recent development of biologicals and their approval for the treatment of children offer a new, very promising, and more personalized therapy option. Omalizumab, mepolizumab, and dupilumab are currently approved as add-on treatments of severe asthma in children and have been shown to be effective in improvement of asthma control and reduction of exacerbations. Dupilumab is the only biological approved for the treatment of atopic dermatitis in adolescents so far. It has been demonstrated to significantly improve symptoms of atopic dermatitis.However, safety data for biologicals used in atopic diseases in children and adolescents are still very limited. Biologicals are generally considered to be safe in adults. These data are often extrapolated to children. Additionally, data for long-term use are lacking. Thus, the safety profiles of those biologicals cannot yet be conclusively assessed.

Zusammenfassung Einleitung Veränderungen der Arzneimitteltherapie an intersektoralen Schnittstellen können zu klinisch relevanten arzneimittelbezogenen Problemen führen. Ziel dieser Studie war ein Vergleich der Kontinuität in der Arzneimittelverordnung von Patienten mit und ohne Medikationsplan (MP) bei Krankenhausaufnahme. Methoden Nach Erhalt des Ethikvotums wurden in 6 Krankenhäusern in Sachsen von November 2011 bis Januar 2012 konsekutiv Patienten einer gesetzlichen Krankenversicherung (GKV) nach schriftlicher Einwilligung aufgenommen. Für Patienten mit und ohne MP bei Krankenhausaufnahme wurden diese Daten ausgewertet: (1) die am Tag der Krankenhausaufnahme vom Krankenhausarzt verordneten Arzneimittel aus der Patientenkurve, (2) die Arzneimittel des Krankenhausentlassungsbriefes. Diesen Daten wurden patientenbezogene ambulante Arzneimittelverordnungsdaten einer GKV für den Zeitraum 6 Monate vor und nach der stationären Therapie zugeordnet (Datenlinkage). Ergebnisse Bei 173 (62 %) der 279 Studienteilnehmer lag ein MP bei Krankenhausaufnahme vor. Patienten mit MP hatten ein statistisch signifikant höheres Lebensalter, eine höhere Anzahl an Arzneimitteln und Diagnosen und wurden bei diesem Krankenhausaufenthalt seltener als Notfallbehandlung aufgenommen. Bei Krankenhausaufnahme weitergeführt wurden 53 % der Arzneimittel bei Patienten mit mitgebrachtem MP und 40 % bei Patienten ohne MP (p Diskussion Noch vor der gesetzlich vorgesehenen Einführung des MP besaßen bei Krankenhausaufnahme fast zwei Drittel der Patienten einen MP. Dieser war allerdings in vielen Fällen vom Patienten selbst erstellt worden. Das Vorliegen eines MP kann einen Einfluss auf die Kontinuität der Arzneimittelverordnung im Krankenhaus nehmen, jedoch nicht auf die Weiterverordnung bei Krankenhausentlassung.

Objective Parents of children with epilepsy are at risk of committing high-risk handling errors with a high potential to harm the patient when administering anticonvulsant rescue medication. We developed a training concept addressing identified high-risk handling errors and investigated its effects on parents' skills. Study design In a controlled prospective intervention study, parents of children with epilepsy were asked to demonstrate their administration of rescue medication by using dummy dolls. A clinical pharmacist monitored rectal or buccal administration and addressed errors in the intervention group with training and information sheets. Three to 6 weeks later, intervention's sustainability was assessed at a home visit. Results One hundred sixty-one parents completed full study assessment: 92 in the intervention group and 69 in the control group. The number of processes with at least one handling error was reduced from 96.4% to 56.7% in rectal tube administration and from 66.7% to 13.5% in buccal administration (both p Conclusion A one-time intervention for parents significantly and sustainably reduced high-risk handling errors. Dummy dolls and information sheet were adequate for an effective and feasible training to support the correct administration of anticonvulsant rescue medication.

A developmental disorder of a child has a major impact on the affected families' lives. However, data about the parents' perception of the revealing of the diagnosis is scarce.Parents of children with developmental disorder treated as outpatients in a university hospital were interviewed about the initial medical consultation concerning the diagnosis of their child.Parents of 210 children agreed to take part in the study. 35/210 (17%) had to be excluded from the study as they were not able to remember the initial medical consultation, or claimed there was either no initial medical consultation or they did not attend it. The diagnosis of developmental disorder was made in median 4 months (Q25/Q75: 0/12; min/max: 0/63) after the parents had noticed the first symptoms. According to the parents, options to support the development of the child were the most frequently addressed topic in the initial medical consultation (119/175, 68%). Some parents wished more empathy (19/175, 11%), and less medical terminology (12/175, 7%). 114/175 (65%) of parents rated the initial medical consultation as "very good" or "good". After their initial medical consultation, 66/175 (38%) of the parents had open questions mainly concerning the prognosis of the disease. Sources of information that were used after the consultation were most often the treating physician (150/175, 86%) and the internet (133/175, 76%).Generally, parents perceive the initial medical consultation on the developmental disorder of their child well. Nevertheless, many parents state that they had unanswered questions after the consultation. The internet is one of the main sources parents use to answer those questions.Die Entwicklungsverzögerung eines Kindes hat einen erheblichen Einfluss auf das Leben betroffener Familien. Es gibt jedoch kaum Daten darüber, wie Eltern die Diagnoseeröffnung erleben.Eltern, deren Kinder ambulant in einer Universitätsklinik behandelt wurden, wurden zum ärztlichen Erstgespräch zur Diagnose ihres Kindes befragt.Eltern von 210 Kindern stimmten der Teilnahme zu. 35/210 (17%) mussten ausgeschlossen werden, weil sie sich entweder nicht an das Erstgespräch erinnern konnten oder angaben, dass ein solches Gespräch nie stattgefunden habe oder sie nicht daran teilgenommen haben. Die Diagnose Entwicklungsverzögerung wurde im Median 4 Monate (Q25/Q75: 0/12; min/max: 0/63), nachdem die Eltern die ersten Symptome beobachtet hatten, gestellt. Laut Eltern wurden im Erstgespräch insbesondere Unterstützungsmöglichkeiten für die Entwicklung des Kindes besprochen (119/175, 68%). Einige Eltern wünschten sich mehr Empathie (19/175, 11%) und weniger medizinische Fachausdrücke (12/175, 7%). 114/175 (65%) der Eltern bewerteten das Gespräch als „sehr gut“ oder „gut“. Nach dem Erstgespräch hatten 66/175 (38%) der Eltern offene Fragen, insbesondere bezüglich der Prognose der Erkrankung. Als Hauptinformationsquellen nach dem Erstgespräch dienten der behandelnde Arzt (150/175, 86%) und das Internet (133/175, 76%).Im Allgemeinen empfinden Eltern das Erstgespräch zur Entwicklungsverzögerung ihres Kindes positiv. Dennoch geben viele Eltern an, dass sie nach dem Erstgespräch offene Fragen hatten. Das Internet ist eine der Hauptinformationsquellen, die Eltern zur Beantwortung dieser Fragen nutzen.

ZusammenfassungFür die Diagnostik von Epilepsien im Kindes- und Jugendalter und deren Behandlung mit Antikonvulsiva ist Expertise in unterschiedlichen Bereichen nötig. Der Patient profitiert dabei vom Zusammenwirken verschiedener Berufsgruppen. Risiken müssen reduziert und die in klinischen Studien gezeigte Wirksamkeit auch in eine möglichst gute Effektivität unter Routinebedingungen umgesetzt werden. Dabei sollten zunächst Aspekte der Arzneimittelverschreibung durch den Arzt berücksichtigt werden, wie etwa die Auswahl, Kombination und Dosierung der Antikonvulsiva. Dabei sollte die Arzneimittelanwendung nicht vergessen werden. Erst, wenn ein Antikonvulsivum richtig angewendet wird, kann der vom verordnenden Arzt gewünschte Therapieerfolg auch erreicht werden. Dabei sollten sich Maßnahmen nicht nur auf den Pflegedienst, sondern auch auf die Eltern, die Kinder und Jugendlichen selbst sowie Betreuer in Schulen und Kindertageseinrichtungen erstrecken. Durch theoretische Schulungen, praktische Übungen und regelmäßige Einbindung von Apothekern ins interdisziplinäre Behandlungsteam wird vermeidbaren arzneimittelbezogenen Problemen, die zu mangelnder Effektivität und dem Auftreten erhöhter Risiken führen können, vorgebeugt. Auf diese Weise wird nicht nur die Arzneimittel(therapie)sicherheit qualitativ verbessert, sondern auch die Teilhabe und Lebensqualität der Patienten und deren Familien positiv beeinflusst.

Problem Pharmacists can have a large impact on attitude, acceptance and adherence in patients with long-term conditions. They should be able to give appropriate advice. Methods We invited pharmacists in Mecklenburg-Vorpommern and Saxony, Germany, to complete a questionnaire mainly containing multiple-choice-questions. Results Overall, 238 pharmacists took part in the survey. 199 (84%) said they were insecure counselling people with epilepsy or had no experience at all. 205 (86%) rightly assumed a seizure can result in death. Concerning an acute seizure, administration of a rescue medication was considered as possible useful measure by 127 (53%) participants. Of the participants, 206 (87%) stated a physician should be consulted for every first afebrile seizure, 188 (79%) for every first febrile seizure. Exanthema as especially clinically relevant adverse drug event was rightly chosen for carbamazepine by 18 (8%) and for lamotrigine by 12 (5%) participants. 60 (25%) rightly chose liver toxicity for valproate. The increase of carbamazepine plasma concentration when adding erythromycin was chosen by 66 (28%) of pharmacists. 13 (5%) knew about the reduction of effectiveness of lamotrigine when adding hormonal contraceptives. For valproate, 201 (84%) stated that it is important to counsel patients concerning contraception. Conclusion Pharmacists are insecure counselling people with epilepsy. Some of them would not suggest to seek medical advice for every first seizure. This can lead to reduced patient safety. The adverse drug events of valproate are well known, important adverse drug events and interactions of other anticonvulsants are less present to the pharmacists and should be regularly addressed in training courses.

Purpose Attitudes concerning epilepsy improved over the last few decades, but children with epilepsy still suffer from stigmatisation. Data about unaffected children's knowledge of and attitudes about epilepsy is scarce. Methods We developed a questionnaire regarding epilepsy for high school students attending 8th–10th grade. The survey was performed from October 2015 to March 2016 in 5 different federal states of Germany. Results 1092 students [mean age (Q25/75): 14.5 (14/15) years] participated. 542/1092 (50%) of the respondents knew that people could die from a seizure. 216/1092 (20%) thought emotional strain could cause epilepsy. Asked for measures they would perform in case of a seizure, 235/1092 (24%) participants would hold the person to the ground, and 182/1092 (19%) would put a solid object into the person's mouth. 28/1092 (3%) would not like to be friends with a person with epilepsy, and 237/1092 (22%) would not like to go on a date with a person with epilepsy. Answers of 342/1092 (31%) students of a school located nearby a specialised epilepsy centre differed in some questions. The latter students were more familiar with epilepsy and showed better knowledge concerning causes, symptoms and treatment of epilepsy. In a question about special characteristics of people with epilepsy, 63/342 (18%) [other schools: 52/750 (11%)] answered people with epilepsy were friendlier and 76/342 (22%) [other schools: 49/750 (11%)] answered they were more sociable compared to people without epilepsy. Conclusion To improve knowledge and attitudes and reduce misconceptions further education seems necessary.

Prolonged seizures can cause severe harm and even death. For seizures lasting longer than 5min, an administration of rescue medication is therefore recommended. Caregivers such as preschool teachers should be able to administer correctly anticonvulsive rescue medication to children.A training concept for preschool teachers on seizure management focussing on practical skills was developed. To assess the success of the training, a structured interview on attitudes relating to rescue medication administration was conducted. The number of committed errors during administration of a rectal/buccal rescue medication to dummy dolls was compared before and after training.210 teachers from 115 preschools participated while all teachers from 303 preschools had been invited. The self-reported level of confidence in their own skills to administer anticonvulsive rescue medication increased from 5 to 8 on a scale from 1 to 10 (p0.001). The number of participants who agreed to administer rescue medication rose from 195/210 (92.8%) before training to 209/210 (99.5%, p0.001) after training for the rectal route, and from 173/210 (82.4%) to 209/210 (99.5%, p0.001) for the buccal route. For teachers who administered rescue medication before and after training, the number of administrations without any administration errors rose from 1/195 (0.5%) to 117/195 (60.0%, p0.001) for the rectal route, and from 13/173 (7.5%) to 95/173 (54.9%, p0.001) for the buccal route.A training for preschool teachers boosted the level of self-confidence relating to administration of anticonvulsive rescue medication. Teachers also committed fewer errors when administering rescue medication to dummy dolls.