What is barbiturate dependence and who is at risk?

The dependence on drugs today, particularly by young people, must concern many - doctors and nurses, social workers, lawyers and the police, and parents. The writers of the group of papers which follow, although inevitably overlapping in some respects, attempt to examine the questions raised from the particular point of view of each. When does taking a drug (generally a barbiturate) become a state of dependence is the question posed and answered by Dr Connell. He begins by setting out the series of offical definitions of addiction, habituation and dependence formulated by the World Health Organization and in Britain by the Interdepartmental Committee (the Brain Committee). With these definitions as a framework he examines barbiturate dependence and abuse in the setting of current medical practice.     

When patient care is shared, who is the most responsible physician?

Ottawa lawyer Karen Capen examines the case of five Ontario physicians who faced charges of professional misconduct after a patient they cared for died in 1988. The investigation, which focused on the concept of "most responsible physician," serves as a cautionary tale for all doctors who share the care of a patient with colleagues.     

Characteristics of distractions in the intensive care unit: how serious are they and who are at risk?

INTRODUCTION

Distractions and interruptions of doctor’s work, although common and potentially deleterious in the intensive care unit (ICU), are not well studied.

METHODS

We used a simple observational method to describe the frequency, sources and severity of such distractions, and explore at-risk situations in the ICU. Independent paired observers separately shadowed eight residents and three fellows for 38 sessions (over 100 hrs) in a 20-bed medical ICU.

RESULTS

In total, 444 distractions were noted. Interobserver agreement was excellent at 99.1%. The mean number of distractions/doctor/hr was 4.36 ± 2.27. Median duration of each distraction was 2 mins (interquartile range 2–4 mins; range 1–20 mins). The top three initiators of distractions were other doctors (35.1%), nurses (30.4%) and oneself (18.7%). Of the 444 distractions, 107 (24.1%) were prolonged (lasting ≥ 5 mins), 210 (47.3%) led to a complete pause of current activity and 85 (19.1%) led to complete abandonment of the current activity. On multivariate analysis, physician seniority, time of session and day of week did not predict frequency of distraction. After adjusting for time of session, day of week and type of current activity, urgent distractions (to see another patient, perform immediate procedures or administer medications) and physician juniority were associated with major distractions (complete interruption or termination of current activity), while only urgent distractions were associated with prolonged distractions.

CONCLUSION

Distractions are common in the ICU and junior doctors are particularly susceptible to major distractions.     

Chinese children at higher risk for diabetes

A medical statistic showed that the ratio of Chinese children suffering from diabetics among total population under 14 years has nearly tripled over the past 25 years.[第一段]     

Surgery in the elderly: is age a risk factor?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.