Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

The effects of drought on human nutrition in an Ethiopian province

In mid 1974 the authors conducted a survey of Harerghe Province, Ethiopia in order to verify reports of serious effects of drought six months earlier. Information was obtained on anthropometric nutritional status, mortality, livestock, and market prices from a random sample of 62 villages in four ecological zones - the highlands, the northern and southern rangelands and an intermediate zone of mixed economy. The rangelands and intermediate areas had experienced heavy human and livestock losses during the drought but this had not occurred in the highlands. Although a high prevalence of malnutrition was found in every area studied, the geographical and height distribution of malnutrition within population groups suggested that this could only be clearly attributed to the effects of unusual food shortage in one part of the southern rangelands.

Accumulation of somatic mutations in proliferating T cell clones from children treated for leukemia

There is continued controversy as to the sequential steps and mechanism(s) responsible for the in vivo acquisition of multiple mutations during neoplastic transformation. We investigated the in vivo clonality and mutational spectra of hypoxanthine-guanine phosphoribosyltransferase (HPRT) mutations in T cells from children with acute lymphocytic leukemia (ALL) to gain insight into the mutagenic mechanisms associated with leukemogenesis. We observed several instances of multiple, independent HPRT mutations accumulating in vivo in T cell receptor (TCR) gene defined clones that had undergone extensive pre- and/or post-thymic expansion following chemotherapy. In addition, we also detected the accumulation of multiple unique single mutations within distinct expanding post-thymic T cell clones. This pattern of clonally restricted hypermutability is compatible with extensive cell proliferation and selection alone without postulating genomic instability. These observations provide a paradigm for a continuum of cellular events that eventually results in the clonal accumulation of mutations in selected populations of cells in vivo and may provide insight into the primary genetic events associated with leukemogenesis, as well as the development of second malignancies and drug resistance following chemotherapy.

The use of male or female voices in warnings systems: a question of acoustics

Speech warnings and communication systems are increasingly used in noisy, high workload environments. An important decision in the development of such systems is the choice of a male or a female speaker. There is little objective evidence to support this decision, although there are many misconceptions and misunderstandings on this topic. This paper suggests that both acoustic and non-acoustic differences (such as social attributions towards speakers of different sexes) between male and female speakers is negligible, therefore the choice of speaker should depend on the overlap of noise and speech spectra. Female voices do however appear to have an advantage in that they can portray a greater range of urgencies because of their usually higher pitch and pitch range. An experiment is reported showing that knowledge about the sex of a speaker has no effect on judgements of perceived urgency, with acoustic variables accounting for such differences.

History of successful ballot initiatives--Arizona

In this article, the author, a key architect of the successful tobacco control program in Arizona, examines the stages of preparing an initiative campaign and the major issues in recruiting hospital associations to antitobacco campaigns. The article provides important lessons for coalitions and hospital associations, potential key players in other statewide campaigns.

Extent of vascularization as a prognostic indicator in thin (< 0.76 mm) malignant melanomas

Angiogenesis in malignant melanoma (MM) was evaluated by comparing mean vessel number (MVN) in Spitz's nevi (SN), thick and thin MMs that metastasized, and thick and thin MMs with > or = 10-year survival. Vessels were identified with antibodies against factor VIII-related antigen (FVIII) and CD34 in 37 MMs (17 < or = 1.9 mm and 20 > or = 4.0 mm) with > or = 10-year follow-up and 10 SN from children (< or = 9 years old). Fields (x250) with the highest vessel density were counted by independent observers blinded to clinical outcome. There were no differences in MVN between SN versus MMs (P = 1.0), but the distribution of vessels was much more uniform in SN. Seven MM pairs (> or = 5.5 mm) and five pairs (< or = 0.75 mm) were matched by sex, age, site, stage, and primary treatment (paired t-test). In the pairs > or = 5.5 mm, there was no correlation with MVN with either metastasis or death (FVIII P = 0.98; CD34 P = 0.85). Among the thin paired lesions, high MVN (FVIII = 46, CD34 = 39) was significantly related not only to metastasis (FVIII P = 0.04, CD34 P = 0.03) but also to death (FVIII P = 0.04, CD34 P = 0.05). MVN does not separate SN versus MM nor predict outcome in thick (> or = 4.0 mm) MMs; however, high MVN (> or = 42 average) is predictive of metastasis and death in MMs < or = 0.75 mm. Larger matched studies are indicated to confirm this observation.