ObjectivesLack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy.MethodsMedline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of “polypharmacy” and “children”. Data were extracted about study characteristics, polypharmacy terms and definitions from qualifying studies, and were synthesized by disease conditions.ResultsOut of 4,398 titles, we included 363 studies: 324 (89%) provided numeric definitions, 131 (36%) specified duration of polypharmacy, and 162 (45%) explicitly defined it. Over 81% (n = 295) of the studies defined polypharmacy as two or more medications or therapeutic classes. The most common comprehensive definitions of pediatric polypharmacy included: two or more concurrent medications for ≥1 day (n = 41), two or more concurrent medications for ≥31 days (n = 15), and two or more sequential medications over one year (n = 12). Commonly used terms included polypharmacy, polytherapy, combination pharmacotherapy, average number, and concomitant medications. The term polypharmacy was more common in psychiatry literature while epilepsy literature favored the term polytherapy.ConclusionsTwo or more concurrent medications, without duration, for ≥1 day, ≥31 days, or sequentially for one year were the most common definitions of pediatric polypharmacy. We recommend that pediatric polypharmacy studies specify the number of medications or therapeutic classes, if they are concurrent or sequential, and the duration of medications. We propose defining pediatric polypharmacy as “the prescription or consumption of two or more distinct medications for at least one day”. The term “polypharmacy” should be included among key words and definitions in manuscripts.

BackgroundPolypharmacy can be either beneficial or harmful to children. We conducted a scoping review to examine the concept of pediatric polypharmacy: its definition, prevalence, extent and gaps in research. In this manuscript, we report our transdisciplinary scoping review methodology.MethodsAfter establishing a transdisciplinary team, we iteratively developed standard operating procedures for the study’s search strategy, inclusion/exclusion criteria, screening, and data extraction. We searched eight bibliographic databases, screened abstracts and full text articles, and extracted data from included studies using standardized forms. We held regular team meetings and performed ongoing internal validity measurements to maintain consistent and quality outputs.ResultsWith the aid of EPPI Reviewer collaborative software, our transdisciplinary team of nine members performed dual reviews of 363 included studies after dual screening of 4398 abstracts and 1082 full text articles. We achieved overall agreement of 85% and a kappa coefficient of 0.71 (95% CI 0.68–0.74) while screening full text articles. The screening and review processes required about seven hours per extracted study. The two pharmacists, an epidemiologist, a neurologist, and a librarian on the review team provided internal consultation in these key disciplines. A stakeholder group of 10 members with expertise in evidence synthesis, research implementation, pediatrics, mental health, epilepsy, pharmacoepidemiology, and pharmaceutical outcomes were periodically consulted to further characterize pediatric polypharmacy.ConclusionsA transdisciplinary approach to scoping reviews, including internal and external consultation, should be considered when addressing complex cross-disciplinary questions.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0560-4) contains supplementary material, which is available to authorized users.

There is growing recognition and concern that too many of the 20,000 foster youth who age out of the child welfare system each year 1 in this country do so without the basic necessities of housing, education, employment, and health care. The purpose of this article is to outline the problems facing foster youth as they leave care and to detail, as a case study, the steps taken by KidsVoice, a Pittsburgh legal services organization representing almost 5,000 dependent children each year, to help youth in foster and substitute care transition more successfully to adulthood and independent living.

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Pediatric polypharmacy, the practice of administering or taking multiple medications among children, is known to be a source of both benefits and harms. Yet, despite the importance of understanding its effects, research to date has been inconsistent in the way polypharmacy in children is defined and measured. This makes measuring prevalence and outcomes across different patient groups and clinical specialties challenging. This poster will introduce the work of a transdisciplinary scoping review team that is mapping the relevant literature to produce a standardized definition of pediatric polypharmacy. The findings, which will be informed by applied library and information science (LIS), will benefit research and clinical practice in pharmacy, medicine, pediatrics, neurology and other fields.