Clinical toxicology

Flexible training opportunities in the European Union

This paper compares the opportunities for flexible (part-time) specialist training in the UK and elsewhere in the EU in the overall context of the rising numbers of women doctors across Europe. Few other EU countries appear to provide the same opportunities for flexible training as the UK, despite high percentages of women medical students and women medical graduates. There are important differences in training patterns across the EU and some reasons are proposed for why flexible training may be more difficult to implement or may not be required elsewhere in the EU. Reasons include less centralized health care systems and more rigidly structured training programmes. In the context of four main factors affecting medical manpower--medical unemployment, contracted working hours, maternity provisions and duration of training--both the health authorities' need to implement flexible training and the trainee doctors' demand for it would appear to be greater in the UK than in other EU countries.

Plant poisonings in children

1. Plant poisonings comprise 5% of all hospitalizations due to poisonings in children and plant inquiries to Poison Information Centre consist about 28% of calls concerning children. 2. A search of 71 cases of hospitalization due to plants in a 5 year period obtained from two children's hospitals in Helsinki were reviewed and 105 plant inquiries concerning poisonings among children to the Poison Information Centre in a 6 month period were studied. 3. The most frequent plant poisonings involved lily-of-the-valley, dumb cane and cotoneaster plant. Only 11% of the cases treated in hospital were evaluated to be unequivocal poisonings. 4. Mezereon, snowberry, cotoneaster plant, honeysuckle, and woody nightshade caused the most serious symptoms. Symptoms in mezereon poisoning were increased saliva excretion, haematuria and diarrhoea in a 1.2-year-old girl. Snowberries caused a semicomatose state and difficulty in urination, cotoneaster caused severe stomach ache, honeysuckle abudant gastrointestinal symptoms and muscle cramps, and nightshade led to prolonged high fever and sweating. 5. It appears that almost all plant poisonings could be treated with medical charcoal. Gastric evacuation is seldom required.

Management of drug overdoses in accident and emergency departments in the United Kingdom

A questionnaire consisting of 10 overdose scenarios was sent to 190 career accident and emergency staff in the United Kingdom, asking in each case how the respondents would treat a patient to prevent drug absorption. The responses showed lack of consensus in treatment methods. There was extensive use of both ipecacuanha induced emesis and gastric lavage despite a lack of experimental evidence to support these techniques.