Introduction of “international syringe labelling” in the Republic of Ireland

Introduction  Medication errors are a preventable cause of patient injury. In May 2003, as a result of a joint initiative by the Royal College of Anaesthetists, the Association of Anaesthetists of Great Britain and Ireland, the Intercollegiate Faculty of Accident and Emergency Medicine and the Intensive Care Society, a new colour code chart for syringe labelling was introduced. The introduction of the new system has not been uniform in the Irish Republic with no national guidelines or time scale in place. Methods  A questionnaire was administered to doctors working in Anaesthesia in two Dublin teaching hospitals. Results  As much as 23% had administered an incorrect medication and 53% admitted to a near miss as a result of the introduction of the new label. Discussion  Future action should focus on practical, common sense interventions including techniques such as those that reduce reliance on memory, standardization, the use of protocols and checklists, and the elimination of look-alike products.     

An Evaluation of a Mixed-Gender Sexual Assault Prevention Program

This study evaluated the short-term effectiveness of a mixed-gender sexual assault prevention program developed for college students. Program participants (n = 177) were compared to non-program participants (n = 132) prior to the program and during a 2-week follow-up period on measures of rape myths, victim empathy, perceived negative consequences and estimated likelihood of committing rape, sexual communication, sexual assault awareness, and risky dating behavior. The prevention program was effective at increasing men’s victim empathy and decreasing their adherence to rape myths but ineffective at changing women’s assault-related knowledge, participation in risky dating behaviors, and sexual communication strategies. Limitations of the study and directions for future research in sexual assault prevention are addressed. Editors’ Strategic Implications: This study provides an important example of the limitations of a single session prevention programming approach (even if it is well designed and executed) in addressing a systemic and pervasive problem like sexual assault on college campuses.     

Mortality rate after hip hemiarthroplasty: analysis of risk factors in 299 consecutives cases

Abstract The femoral neck fracture is actually the most important traumatic event in the elderly, because of its high rate and terrible complications. We reviwed clinical records of 314 patients treated in our institution with a bipolar implant for femoral neck fracture. At a mean follow-up of 5 years, 15 patients (4.8%) were lost to followup so data for 299 patients was studied to identity factors associated with mortality. Ten predictor variables were examined: age, sex, waiting time for surgery, pulmonary dysfunction, fracture etiology, and comorbidity with ischemic heart disease, and heart failure, hypertension, cerebrovascular disease, and chronic renal failure. Cumulative mortality rate during the first 6 months was 19% (55 of 299 patients) and in the first year it was 25% (76 of 299). At logistic regression analysis, mortality was associated with age, male gender, waiting period for surgery and presence of neoplastic disease or pathological fracture. Waiting for surgery was a significant factor for mortality at 6, 12 and 24 months: patients surgically treated in the first 24 hours had lower mortality than those who waited longer. The risk of mortality in the first 6 months doubled for an age increase of 12 years, while mortality within 2 years doubled for an age increase of 9 years. Although the motality rate after surgery for femoral neck fracture was high in the first year (25%), it dropped off in successive years to levels observed in a healthy population. Thus, we agree with the literature that femoral fracture is a risk factor for survival only in the first year after trauma, above all in the elderly.     

Head and Neck Histoplasmosis—A Nightmare for Clinicians and Pathologists! Experience at a Tertiary Referral Cancer Centre

Histoplasmosis is a rarely reported deep mycotic infection in the Indian context. Oral or oropharyngeal manifestation can occur as an isolated symptom or as part of a disseminated process associated with immunosuppression especially with HIV and diabetes. Five cases of head and neck histoplasmosis accrued over 6 years in a tertiary referral cancer institute were reviewed. All these patients presented clinically as cancer. In three patients, the marked pseudoepitheliomatous hyperplasia led to a mistaken biopsy diagnosis of malignancy following which definitive surgical treatment was performed. The subsequent excision revealed typical features of histoplasmosis. Isolated oral presentation of histoplasmosis can mimic malignancy both clinically as well as pathologically, leading to potentially disastrous consequences. A high index of suspicion in those with overt or hidden immunosuppression and a deep wedge biopsy to demonstrate the organisms in the subepithelial tissue is recommended. This work has been presented in the “Slide seminar on Infections and Infestations” in the IAP-ID pre conference CME in APCON 2006.     

Mortality risk associated with ejection fraction differs across resting nuclear perfusion findings

Background  Left ventricular ejection fraction (LVEF) is a significant predictor of morbidity and death. The nuclear summed rest score (SRS) measures myocardial perfusion defects and provides prognostic information, but its effects on long-term outcomes are not fully established. Moreover, information regarding the potential interaction between these 2 covariates is limited. The purpose of this study was to determine whether the mortality risk associated with LVEF is the same across all values of SRS in a population undergoing evaluation for ischemic heart disease. Methods and Results  We examined 3,187 patients who underwent cardiac catheterization and perfusion single photon emission computed tomography imaging with a maximum follow-up of 8.1 years and median follow-up of 3.1 years. Cox proportional hazards modeling showed that increasing nuclear SRS and decreasing LVEF were independently associated with a higher long-term mortality rate, with a clinically significant interaction between them (P=.032). Patients with a normal LVEF and a high SRS (greater perfusion abnormality) have a prognosis similar to those with a reduced LVEF. Conclusions  Resting perfusion studies provide prognostic information for long-term survival and significantly impact the interpretition of mortality risk associated with changes in LVEF. Patient prognostication, risk stratification, and future research using these variables should take this interaction into account. Supported by a grant from the Tom & Lynn Royster Foundation. Durham, NC, and a National Institutes of Health Research Fellowship Grant (T5 GM08679-04), Bethesda, Md.