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    <recommendedItem id="20100101_19_392"
                     title="Parents Often Err in Dosing Kids (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Pediatrics/Parenting/tb/18290?impressionId=1265802916992"
                     
      &lt;p&gt;Adults tasked with giving their children liquid medications often gave them too much, especially when the dosing device was a cup instead of a spoon or oral syringe, researchers said.&lt;/p&gt;
&lt;p&gt;Asked to prepare a 5-mL dose for a child, adult caregivers in a study were almost always within 20% of the target when using a 5-mL syringe, according to a report in the February &lt;em&gt;Archives of Pediatric and Adolescent Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;But about 70% of the 302 parents in the trial put more than 6 mL in cups that were packaged with the medication, H. Shonna Yin, MD, of New York University, in New York City, and colleagues reported.&lt;/p&gt;
&lt;p&gt;Cups with etched markings gave the adults nearly as much trouble, the researchers found, but droppers and dosing spoons were more accurate.&lt;/p&gt;
&lt;p&gt;Yin and colleagues also found that dosing errors were nearly twice as common among caregivers who tested poorly for health literacy (adjusted OR 1.7, 95% CI 1.1 to 2.8).&lt;/p&gt;
&lt;p&gt;Given that many liquid medications come with cups, it may be necessary to reconsider how products intended for young children are packaged, the researchers suggested.&lt;/p&gt;
&lt;p&gt;&quot;Redesign of dosing devices as well as instructions for their use, with a focus on standardization and consistency, has the potential to decrease medication errors and improve safety and efficacy,&quot; Yin and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The researchers recruited adults who brought children to a pediatric clinic in New York&apos;s Bellevue Hospital in late 2008. Participants were given each of six dosing instruments in random order and asked to fill it with one teaspoon (5 mL) of acetaminophen suspension.&lt;/p&gt;
&lt;p&gt;Some 95% of participants were the children&apos;s mothers, with the remaining 5% split between fathers and legal guardians. Most were Hispanic, foreign-born, and poor, and 56% spoke Spanish as their first language. Half were not high school graduates.&lt;/p&gt;
&lt;p&gt;The instruments included the cup packaged with Children&apos;s Tylenol Suspension Liquid, which has printed markings on the side; a cup with etched markings bought from a local drugstore; a 5-mL dropper; a 10-mL dosing spoon; a 5-mL syringe; and a 5-mL syringe with bottle adapter.&lt;/p&gt;
&lt;p&gt;Mean doses actually put into the cups were 6.7 mL (SD 1.7) for those with printed markings and 7.0 (SD 3.2) for those with etched markings.&lt;/p&gt;
&lt;p&gt;Although the mean doses were similar with these devices, fewer parents made errors when using the etched cup. Some 50% of doses measured with it were in the range of 4 to 6 mL, compared with only 30.5% of doses put into the cup with printed markings.&lt;/p&gt;
&lt;p&gt;Small errors (20% to 40% more or less than the target) were also less common with the etched cup: 26.6% of doses, versus 43.7% of doses measured with the printed cup. But the rate of large errors was nearly the same with the two cups, at about 25%.&lt;/p&gt;
&lt;p&gt;With the other instruments, mean doses were close to the target, ranging from 4.6 for the oral syringe with bottle adapter to 5.5 for the spoon.&lt;/p&gt;
&lt;p&gt;From 86% to 94% of doses prepared with these devices were within 20% of the 5-mL target. When errors were made, they were usually small and on the low side of the target, Yin and colleagues found.&lt;/p&gt;
&lt;p&gt;Adjusted odds ratios for making large errors, with the oral syringe as reference, were: &lt;ul&gt; &lt;li&gt;Cup with printed markings: 7.3 (95% CI 4.1 to 13.2)&lt;/li&gt; &lt;li&gt;Cup with etched markings: 6.3 (95% CI 3.5 to 11.2)&lt;/li&gt; &lt;li&gt;Dropper: 0.8 (95% CI 0.5 to 1.5)&lt;/li&gt; &lt;li&gt;Dosing spoon: 0.3 (95% CI 0.1 to 0.9)&lt;/li&gt; &lt;li&gt;Oral syringe with bottle adapter: 0.8 (95% CI 0.5 to 1.5)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;But the spoon was more often associated with dosing errors, both small and large, than the syringe, with an adjusted odds ratio of 1.7 (95% CI 1.1 to 2.7).&lt;/p&gt;
&lt;p&gt;Adjustments included caregivers&apos; age, relationship to child, marital status, language, ethnicity, U.S. birth, socioeconomic status, presence of young child, and presence of child with a chronic medical problem.&lt;/p&gt;
&lt;p&gt;Caregivers were given the Newest Vital Sign test to evaluate their health literacy, which turned out to be a factor in dosing errors, the researchers found.&lt;/p&gt;
&lt;p&gt;Scores of 0 or 1 reflected a high likelihood of limited literacy, 2 or 3 was considered &quot;possible limited literacy,&quot; and 4 to 6 was deemed adequate literacy.&lt;/p&gt;
&lt;p&gt;About 40% of participants had scores of 0 or 1 and 38% scored in the range of 2 to 3.&lt;/p&gt;
&lt;p&gt;Both levels of low health literacy predicted dosing errors, and poor literacy was also significantly associated with increased risk of large errors.&lt;/p&gt;
&lt;p&gt;Adjusted odds ratios for any dosing error and large errors associated with poor literacy were 1.7 (&lt;em&gt;P&lt;/em&gt;=0.02) and 2.3 (&lt;em&gt;P&lt;/em&gt;=0.01), respectively.&lt;/p&gt;
&lt;p&gt;Possible limited literacy predicted any dosing error and large errors with adjusted odds ratios of 1.6 (&lt;em&gt;P&lt;/em&gt;=0.04) and 1.9 (&lt;em&gt;P&lt;/em&gt;=0.07), respectively.&lt;/p&gt;
&lt;p&gt;These findings on health literacy and medication errors have important implications for the design of dosing instruments, Yin and colleagues indicated.&lt;/p&gt;
&lt;p&gt;&quot;Provision of instruments designed to place fewer literacy demands on families is one strategy to decrease dosing errors,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Limitations to the study included its setting in a clinic, which may not reflect parents&apos; performance at home; the largely Hispanic immigrant sample with low socioeconomic status; and the use of a written test to assess health literacy, which does not measure verbal comprehension and other skills that may contribute to health literacy.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded from internal sources. Yin received partial support from the Pfizer Fellowship in Health Literacy/Clear Health Communication.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_136"
                     title="FDA Warns Against Leaky Baby Food"
                     score="-0.005"
                     href="http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/tb/17956?impressionId=1265802916992"
                     
      &lt;p&gt;WASHINGTON  --  The FDA is warning consumers about two brands of baby food recalled because of leaking and swollen packaging that may indicate bacterial contamination.&lt;/p&gt;
&lt;p&gt;Nurture recalled plastic pouches of its 3.5 oz HAPPYBABY Stage 1 and Stage 2 and 4.22 oz HAPPYTOT Stage 4 baby food products because of the defects. Consuming the product could cause illness if the baby food is contaminated.&lt;/p&gt;
&lt;p&gt;Although no cases have been reported so far, the FDA asked the company to test its manufacturing processes after receiving complaints of and testing for swollen or leaking food pouches.&lt;/p&gt;
&lt;p&gt;Included in the recall are the following products, with expiration dates from October 2010 to January 2011: &lt;ul&gt; &lt;li&gt;HAPPYTOT Green bean, pear &amp;amp; peas, UPC 8 52697 00127 9&lt;/li&gt; &lt;li&gt;HAPPYTOT Sweet potato, carrot, apple &amp;amp; cinnamon, UPC 8 52697 00128 6&lt;/li&gt; &lt;li&gt;HAPPYTOT Spinach, mango &amp;amp; pear, UPC 8 52697 00129 3&lt;/li&gt; &lt;li&gt;HAPPYTOT Butternut squash &amp;amp; apple, UPC 8 52697 00130 9&lt;/li&gt; &lt;li&gt;HAPPYTOT Banana, peach, coconut &amp;amp; prunes, UPC 8 52697 00131 6&lt;/li&gt; &lt;li&gt;HAPPYTOT Banana, peach &amp;amp; mango, UPC 8 52697 00132 3&lt;/li&gt; &lt;li&gt;HAPPYBABY Mango, UPC 8 52697 00134 7&lt;/li&gt; &lt;li&gt;HAPPYBABY Apricot sweet potato, UPC 8 52697 00136 1&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Any poorly-packaged, swollen, or leaking pouches of HAPPYBABY Stage 1 or Stage 2 or HAPPYTOT Stage 4 should be discarded immediately in a way that will prevent people and pets from acquiring them, the FDA recommended.&lt;/p&gt;
&lt;p&gt;Parents of affected children or other consumers who have eaten the product and become ill should contact a healthcare professional immediately and report the incident to the FDA district office and the company, the agency said.&lt;/p&gt;

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