P39 Establishment of the swiss database for dosing medicinal products in pediatrics

BackgroundDrug therapy in children is challenging. Due to the lack of licensed drugs for paediatric use, off-label or unlicensed prescription is frequent. To improve quality and safety of prescription of medicinal products for children in Switzerland, the requirement to create and continuously run a national database was added in the revision of the therapeutic products act (TPA Art. 67a). The task of operating the database was given to SwissPedDose, an association representing eight Swiss children’s hospitals, the Swiss Society of Paediatrics (SGP) and the Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA).MethodsSubstances used in three therapeutic areas ‘general paediatrics’, ‘infectious diseases’ and ‘neonatology’ are selected according to their frequency of use in the eight participating hospitals. Dosage data of substance-indication pairs are requested from the hospital pharmacists. Based on these data and literature review a dosage suggestion consisting of substance, indication, route of administration, dose, daily repetitions and, if applicable, additional remarks is then elaborated by a specialised pharmacist of SwissPedDose. This suggestion is then discussed by experienced physicians delegated from the eight clinics. The elaboration, discussion and agreement on a national dosage recommendation takes place and is documented in an online platform specially programmed for this structured harmonisation process. Once an agreement has been achieved, the national dosage recommendation is sent to the eight participating clinics and published in a free accessible public database.ResultsAs of December 31st 2018, 195 dosage recommendations for children including 87 indications and 54 substances have been harmonised and published and are available for medical professionals on https://swisspeddose.ch/database.ConclusionThe goal of published recommendations for 100 substances by March 2021 is feasible to reach due to interprofessional collaboration. SwissPedDose may thus contribute to a more efficient and safe use of drugs prescribed to children in Switzerland.Disclosure(s)Source of Funding: Project funded by the Federal Office of Public Health. Conflict of interest: None, for all listed authors.

PENGARUH KOMBINASI NUTRISI ANORGANIK DAN PUPUK HAYATI TERHADAP POPULASI Azotobacter sp, KANDUNGAN KLOROFIL, SERAPAN N, DAN HASIL TANAMAN TOMAT PADA SISTEM HIDROPONIK

Budidaya hidroponik belum efisien untuk digunakan, salah satu penyebabnya adalah tingginya kebutuhannutrisi. Pemanfaatan pupuk hayati diharapkan bias mengefisiensikan penggunaan nutrisi dan meningkatkanproduktivitas tanaman tomat Tujuan penelitian ini untuk mengetahui pengaruh kombinasi nutrisi anorganik danpupuk hayati terhadap populasi Azotobacter sp, serapan N, kandungan klorofil, dan hasil tanaman tomat padasistem hidroponik. Penelitian ini dilakukan pada bulan Agustus – November 2017 di Rumah Kaca KebunPercobaan Ciparanje Universitas Padjadjaran, Jatinangor, Kabupaten Sumedang, Jawa Barat. Metode penelitianini menggunakan rancangan acak kelompok (RAK). Kombinasi perlakuan terdiri atas rekomendasi nutrisianorganik dengan konsentrasi 100%, 75%, dan 50% dan rekomendasi pupuk hayati 100%, 75%, 50%, dan 25%.Variabel yang diamati meliputi populasi Azotobacter sp, kandungan klorofil, serapan N, jumlah buah tomat danbobot buah tomat. Hasil penelitian ini menunjukkan bahwa tidak terdapat pengaruh nyata pemberian nutrisianorganik dan pupuk hayati terhadap populasi Azotobacter sp, kandungan klorofil, serapan N, serta hasil tanamantomat. Pemberian perlakuan 50% nutrisi Anorganik + 100% pupuk hayati dapat meningkatkan bobot buah sebesar40% dibandingkan pemberian 100% nutrisi anorganik.Kata kunci: Azotobacter sp., klorofil, nutrisi anorganik, hydroponik, tomatABSTRACTHydroponic cultivation is not efficient because of its high demand for nutrients. Therefore, the utilizationof inorganic nutrients and biofertilizer is expected to improve the efficiency of nutrients uptake and increase theproductivity. The aim of research was to determine the effect of combination of inorganic nutrient dosage andbiofertilizer on the population of Azotobacter sp, N uptakes, chlorophyll content, and yield of tomatoes plantinhydroponic systems. This experiment was conducted on August - November 2017 at GreenhouseExperimentGarden Ciparanje Padjadjaran University, Jatinangor, Sumedang Regency, West Java. This research methodused Randomized Block Design (RBD). The treatment combination consisted of dosage recommendation ofinorganic nutrition with 100%, 75% and 50% concentrations, and 100%, 75%, 50%, and 25% of biofertilizer. Thevariables observed included the population of Azotobacter sp, chlorophyll content, N uptake, number of tomatoesand weight of tomatoes. The result of this study indicated that the effect of application both, inorganic nutrientsand biofertilizer did not significantly affect the population of Azotobacter sp, chlorophyll content, N uptakes, andyield of tomatoes. The application of 50% Inorganic nutrition + 100% of biofertilizer increased fruit weight by40% compared to 100% of inorganic nutrients.Keywords: Azotobacter sp., chlorophyll, biofertilizer, hydroponic, tomato

Obstetrical Management of an Extremely Overweight Pregnant Woman (184 kg bw) with Special Attention on Thromboprophylaxis

The 27-year-old pregnant woman has been overweight since her childhood. Endocrinological assessments did not confirm hormonal disease. Her pregnancy was without complication. A signs of intrauterine distress were observed and elective caesarean section was performed under heparin protection because of anatomy unsuitable for delivery per vias naturals. The mother’s bodyweight was 184 kg. By monitoring the change in fX activity LMWH treatment (Enoxaparin) initiated with a dose of 120 mg twice daily and then the dose was gradually elevated to 200 mg twice daily thereby achieving the lower range of the desired therapeutic effect. Apart from mild disorder of wound healing, the recovery was free of complication. The patient suffered from thrombophilia (extremely overweight, pregnant, thrombophlebitis under the knee, surgery, and postoperative immobilization). In case of quite extreme bodyweight there is no dosage recommendation or clinical practice for LMWH. Because of the extreme overweight and the therapeutic dose titration test of heparin, monitoring of fX activity by measurement of inhibition, dosage of heparin other than the recommended (abdominal wall instead of upper arm SC), and the very fluctuating heparin dosage which is well correlating with clinical practice, it is reasonably expected that this case will take interest.

A Terapêutica na Terceira Idade e o Uso Racional de Medicamentos

Resumo: O envelhecimento é um processo biológico e muitas doenças se desenvolvem nesta época da vida, devido à suscetibilidade natural do organismo. Existe uma falsa crença de que os medicamentos podem “curar” tudo, inclusive a velhice. A terapia medicamentosa, quando realmente necessária ao tratamento de algum estado patológico do paciente idoso, deve ser aplicada com restrições e de forma individualizada, pois a metabolização dos fármacos pode estar bastante diversa do esperado quando comparada à de adultos jovens. Ao contrário desta lógica, vemos um excesso de prescrições destinadas aos idosos, quando a prevenção das doenças seria mais coerente, mais saudável e menos onerosa. Além disto, outros elementos intrínsecos ao paciente idoso e ao seu comportamento são determinantes na terapêutica da terceira idade. A pesquisa sobre a utilização de fármacos (tipo, dose, indicação e uso) por parte desta população é necessária a fim de estabelecer a racionalização e otimização destes. Desta forma, o objeto central deste trabalho é fazer uma breve reflexão sobre os aspectos envolvidos na terapêutica da terceira idade, buscando com isto promover o uso racional de medicamentos por esta faixa da população. Palavras-chave: Medicamento. Terapêutica. Uso racional. Terceira idade. Abstract: The aging is a biological process and many illnesses appear in this time of life, due to the body natural susceptibility. There is a false belief that medicine can “cure” everything, including the old age. The medicinal therapy should be used with constraints and on an individualized way when it is really necessary to treat some pathologic conditions in an old patient since the drugs metabolism can be very diverse from the expected when compared to young adults. On the other hand, we see an excessive number of prescriptions to elderly, while the prevention to the diseases would be more coherent, healthier and less expensive. Besides, there are more intrinsic elements of the old patient as well as his behaviour which are crucial to the third age therapy. The research about the use of drugs (type, dosage, recommendation and usage) by this part of the population is necessary to establish their rationalization and optimization. Therefore this paper does a brief reflection about the aspects in the third age therapy trying to promote the rational use of drugs by these people. Keywords: Drugs. Therapy. Third age.