\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Puking less per pound, for acute wheezers: quality improvement in a
Pediatric Emergency Department}



\author[1]{Gail Davison}%
\author[1]{Josh Ruddell}%
\author[1]{Michelle Trouton}%
\author[2]{Roisin McDonald}%
\author[3]{Ben  Kennedy}%
\author[1]{Vikki O'Neill}%
\author[2]{Joseph McCann}%
\author[2]{Brigitte Bartholome}%
\author[2]{Heather  Steen}%
\author[4]{Mike Shields}%
\author[2]{Stephen  Mullen}%
\affil[1]{Queen's University Belfast}%
\affil[2]{Royal Belfast Hospital for Sick Children}%
\affil[3]{Royal Victoria Hospital}%
\affil[4]{Queens University Belfast}%


\vspace{-1em}



  
  \date{June 09, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Background \& local problem: Acute wheezing attacks are a leading cause
of Pediatric Emergency Department (PED) attendances and inpatient
admissions and are a considerable burden on the healthcare providers.
Almost one-third of children vomit prednisolone in the PED, requiring
anti-emetics and repeat dosing. Aim: This quality improvement (QI)
intervention aimed to improve oral corticosteroid (OCS) tolerability,
reduce emergency department length of stay (LOS), and reduce OCS drug
costs for acute wheeze attendances in a PED, while not adversely
affecting admissions, re-attendance, or mortality rates. QI
Interventions: Included (1) a departmental protocol and (2) modification
of the OCS type and dosage from prednisolone (3-day course of 1 mg/kg)
to dexamethasone (600 mcg/kg, then single dose 300 mcg/kg). Methods: The
study team reviewed the evidence and implemented the interventions. To
assess the scale of improvement, we retrospectively collected data on
attendance records for patients aged 2-14 years with acute wheeze
requiring OCS. We collected data on 100 children who attended the PED
between October and December for each year (2016, 2017, and 2018). We
then assessed OCS tolerability, LOS, OCS drug costs, and, admission,
re-attendance, and mortality rates. Results: Over a 48-month period, we
increased OCS tolerability by 67.2\% and achieved an 85.8\% reduction in
OCS drug costs (saving \selectlanguage{ngerman}£41,553.14). There was no change in the LOS,
admission, re-attendance, and mortality rates. Conclusions: Improved
tolerability and substantial cost savings can be achieved by
implementing a structured acute pediatric wheeze protocol and modifying
the OCS to single-dose dexamethasone (300 mcg/kg).%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-3/Figure-3}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

