Emergency Physician Recognition of Adverse Drug-related Events in Elder Patients Presenting to an Emergency Department

Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug‐related events (ADREs) in elder patients presenting to the emergency department (ED). Methods: This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review. Results: A total of 161 patients were enrolled in the study. Thirty‐seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class. Conclusions: EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.     

SKIN DISEASES AMONG ADOLESCENT BOYS IN ABHA, SAUDI ARABIA

Background. Adolescence is characterized by a sensitivity to issues of attractiveness. With dermatologic conditions, this may adversely affect early detection and compliance. Methods. A cross-sectional study was carried out on a multistage stratified random sample of 647 adolescent schoolboys in Abha, Saudi Arabia, to determine the prevalence of skin diseases. The age of the boys ranged from 11 to 19 years with an average of 15.3 ± 1.9 years. Results. It was found that 19.8% of the children were affected by one form or another of transmissible skin diseases (TSD). The most common types were: pediculosis capitis (9.6%), verruca vulgaris (3.9%), and tinea pedis (1.9%). The prevalence of TSD increased significantly as the age decreased and as the crowding index increased. As for nontransmissible skin diseases, acne vulgaris was the most prevalent disease (56.3%). The prevalence and severity of acne increased significantly as the age increased. Conclusions. The findings indicate the need to develop regional intervention programs at the school level. Appropriate continuing medical education programs for school health workers in the region are mandatory to achieve this goal.     

MORPHOMETRIC ANALYSIS OF PULMONARY DEVELOPMENT IN THE SHEEP FOLLOWING CREATION OF FETAL DIAPHRAGMATIC HERNIA

Congenital diaphragmatic hernia (CDH) in humans is relatively common and associated with high mortality attributed mainly to pulmonary hypoplasia. Previous animal models have induced CDH late in gestation, in contrast to the human situation, and only limited morphometric analyses have been reported. We undertook early surgical creation of CDH in fetal lambs, days 72-74 of gestation (n 8), with unoperated lambs (n 8) as controls. At 143 days (term 145-149) a cesarean section was performed and the lungs were obtained, inflation fixed, divided into lobes, and processed for morphometry. In the CDH group the total lung volumes (51.3 mL compared to 223.8 mL) and gas exchange surface areas (5.85 m2 versus 26.43 m2) were less than one quarter of control values. Capillary loading was reduced from 0.3 mL m2 in controls to 0.12 mL m2 in CDH and parenchymal volume reduced from 77 in controls to 57 in CDH. Within parenchyma, gas exchange tissue volume was increased in CDH (66 ) compared with controls (50 ). CDH lungs had primitive air sacs alveoli that were smaller (perimeter 83 mu m) and more numerous (1321 per mm2) than in controls (perimeter 132 mu m, 504 per mm2). The left lung and left upper lobe were affected most. Induction of CDH in the lamb at this early age results in quantifiable, reproducible pulmonary hypoplasia from which comparisons can be made with the human condition.     

Pediculosis Capitis

Pediculosis capitis is a worldwide public health concern. Infestation occurs most commonly in children, with a peak incidence between 5 to 11 years of age. The condition is more common in girls and less common in Black children. Direct head-to-head contact is the most common mode of transmission. Pruritus is the most common symptom of infestation. The gold standard for diagnosing pediculosis capitis is finding a live louse or nymph in the scalp or viable egg in the scalp hair. Pediculicides are the most effective treatment. All household members and close contacts should be examined and treated concurrently if infested. The child should be allowed to return to school or to a child care facility after proper treatment. The child should be discouraged from close, direct head contact with others or from sharing items that have come in contact with the hair.     

The Impact of Specialized Oncology Nursing on Patient Supportive Care Outcomes

Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world. Despite significant improvements in the organization of medical care of patients with cancer, numerous surveys of cancer populations demonstrate that significant proportions of patients fail to have their supportive care needs met. One possible solution is the introduction of a care coordinator role using oncology nursing to help ensure that patients’ physical, psychological, and social support needs are addressed. Although having face validity, there is little empirical evidence on the effects of nurse-led supportive care coordinator roles on patient reported supportive care outcomes. In this article the authors present the results of a prospective longitudinal cohort study of 113 patients referred to a community-based specialist oncology nursing program. Using validated instruments they found significant improvements in patient-reported outcomes in key supportive care domains: unmet needs, quality of life, and continuity of care, as well as a shift in patterns of health resource utilization from acute care settings to the community over the course of the intervention. The results of this study are important in supporting the design and development of controlled trials to examine provider roles in the coordination of supportive cancer care.