International Journal of Risk & Safety in Medicine - Volume 4, issue 3
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: Twenty-one of 6327 (0.33%) patients undergoing cardiac catheterisation via the femoral artery had an acute vascular complication requiring surgical intervention. The complication rate was 0.1% after coronary angiography, 2% after PTCA and 6% after aortic ballon dilatation. The size of the catheter and the duration of catheterisation were found to be risk factors. Most commonly simple arterial repair and/or thrombectomy was performed. No mortality was observed. Only in one case was blood transfusion necessary. The outcome of surgery was in all cases a good revascularisation of the leg. Registration and evaluation of vascular injuries following diagnostic and therapeutic invasive interventions…could have a self limitating effect on the complication rate.
Abstract: Several aspects of Hg release from dental amalgam tooth fillings were examined both in vivo and in vitro. Using light microscopy, Hg globules (diameter =1−2μm) were observed on amalgam surfaces. Hg vapour was measured in exhaled air before and after 5 min of gum chewing in three groups of subjects with varying numbers of dental amalgams. Group 1 had symptoms similar to those of chronic low-dose Hg exposure, N=22; Group 2 had no apparent symptoms and were considered healthy, N=20; Group 3 were controls having no amalgam fillings; N=10. Groups 1 and 2 both demonstrated a significant 3-fold increase in…Hg vapour levels after chewing, while levels in controls remained undetectable. A mouth rinse with hot water (55°C) in Group 2 resulted in a further increase in Hg vapour levels. Saliva samples (1 ml) from 17 subjects in Group 2, collected before and after chewing, showed a significant 8-fold increase in Hg concentration after chewing. In a fourth group Hg absorption by the oral mucosa was studied, Group 4, N=10. A 50% degree of absorption was found after 3 min. It is concluded that dental amalgam should be considered an unsuitable alloy resulting in long-term Hg exposure and that it is therefore toxicologically unsuitable as a dental filling material.
Keywords: Mercury globules, Mercury vapor, Mercury exposure, Chewing, Temperature
Abstract: To evaluate the risk of addiction after prescription of a strong analgesic, we followed 90 patients during the year after they had received a prescription for a strong analgesic for the first time in September 1989 in North Jutland County, Denmark. The study was based on copies of all prescriptions of strong analgesics; these are sent to the National Health Service, which is responsible for the control of the prescribing of strong analgesics. Seven patients were excluded because the data registration was incomplete, while there was valid data on the remaining 83 patients, 12 of whom had cancer. All the…cancer patients and 14 other patients died during the follow-up period. Of the remaining 57 patients, seven were still being treated (12.3%; 95 confidence limits: 5.1–23.7%) with strong analgesics. Addiction was not suspected by their general practitioners in any of these seven as the main reason for continued treatment with strong analgesics. We therefore conclude that addiction is rare after a first prescription of strong analgesics.
Keywords: Analgesic, Follow-up, Addiction, Family practice
Abstract: Indomethacin was utilized in 89 patients in preterm labor; the mean gestational age at the start of indomethacin therapy was 25.4 weeks (± 4.1), mean duration of indomethacin treatment was 43.9 days (± 31.3), mean gestational age at delivery was 33.6 weeks (± 3.2). Long-term ( > 48 h) indomethacin tocolysis evoked serious maternal side effects in 30.3% of patients studied. These side effects included exaggerated hypertensive responses in patients treated concomitantly with beta-blockers, gastric erosion and bleeding, fever, interstitial nephritis and postpartum hemorrhage.
Keywords: Long-term indomethacin tocolysis, Side effects, maternal
Abstract: Car accidents are the leading causes of death and handicap among adolescents and young adults. Thirty-six pupils from the last class in high school (in the age group 17–18 years) have attended lectures with explanations concerning the consequences of car accidents by physicians of rehabilitation centers. They also were taken on a one-day visit to such a center. They have seen and talked with persons who were severely handicapped because of car accidents, and have followed the physical therapists and occupational healing therapists throughout their work day. The pupils completed the Rotter and Montag Internality-Externality Scale questionnaire before and after…the meeting and staging with the handicaps, and the results showed an increase of 10.28% in their Internal focus of control. The conclusion is that confrontation of young future drivers with handicaps as a result of car accidents in rehabilitation centers should be a routine and regular habit during the last classes of high school.
Keywords: Car accidents, High school pupils, Focus of control, Prevention