Idiopathic central serous chorioretinopathy--a physical complication of stress?

The adverse psychological sequelae of stress are well recognized by occupational health specialists. Potential adverse physical effects, such as ischaemic heart disease, are more contentious but are biologically plausible. This report outlines a case of idiopathic central serous chorioretinopathy (ICSC), an uncommon but potentially sight-threatening condition, which is widely accepted amongst ophthalmologists to be stress related. The condition is not referred to in standard occupational health texts or databases. The report includes a brief review of the ophthalmological literature on which the connection between ICSC and stress has been made, and a need for further research promoted.     

Voriconazole plasma monitoring.

AIMS: Very little information is available regarding the use of voriconazole drug monitoring in children with invasive fungal infections. The purpose of this study was to report the cases of five paediatric patients treated with voriconazole, in which plasma levels were used to monitor therapy. METHODS: Five children treated with voriconazole were included in this case series. Voriconazole plasma levels were determined using either a bioassay or liquid chromatography-tandem mass spectrometry. RESULTS: The patients' ages ranged from 2 to 10 years old (mean 6.2 years). Three patients had acute leukaemia and two had suffered severe burn injuries. Doses administered varied from 3.4 mg/kg every 12 h to 8.1 mg/kg every 8 h. Plasma voriconazole concentrations were unpredictable for these paediatric patients. Subtherapeutic levels were frequently observed, despite progressive increments in dosage. For others, voriconazole levels markedly increased after a small increment in dosage. Phenobarbitone caused important drug interactions with voriconazole for two of the patients. CONCLUSIONS: The dose administered did not correlate with exposure as measured by plasma levels of voriconazole. While the optimal dosage for voriconazole in children is still unknown, drug monitoring seems warranted to ensure adequate exposure, and after dose increments to prevent excessive exposure. Drug interactions significantly altered exposure.     

General practitioners' reactions to non-compliant patients

Objective - To examine how general practitioners (GPs) respond to patients who are non-compliant with medical advice and who doctors believe act irresponsibly towards their health. Design - Quantitative analysis of responses to questionnaire with case histories. Setting and subjects - 93 questionnaires completed by a random stratified sample of Norwegian GPs. Main outcome measures - Scores relating to GPs' feelings and choice of main and sub-strategies for further treatment of patients. Results - The respondents typically felt discouraged or unaffected by non-compliant patients, younger doctors more often felt helpless while older ones were more content, and female doctors more often than male doctors felt irritated or angry. The main strategy preferred was to give the patient a new appointment. The young, the inexperienced, and females tended more often to ask a colleague for advice or refer to a specialist. Patient-centred sub-strategies were generally preferred, especially by younger doctors. Conclusion - GPs' feelings towards and strategies for dealing with non-compliant patients vary, and the doctor's age, sex and clinical experience are central variables.