Emergency department medication lists are not accurate.

BACKGROUND: Medication errors are a common source of adverse events. Errors in the home medication list may impact care in the Emergency Department (ED), the hospital, and the home. Medication reconciliation, a Joint Commission requirement, begins with an accurate home medication list. OBJECTIVE: To evaluate the accuracy of the ED home medication list. METHODS: Prospective, observational study of patients aged > 64 years admitted to the hospital. After obtaining informed consent, a home medication list was compiled by research staff after consultation with the patient, their family and, when appropriate, their pharmacy and primary care doctor. This home medication list was not available to ED staff and was not placed in the ED chart. ED records were then reviewed by a physician, blinded to the research-generated home medication list, using a standardized data sheet to record the ED list of medications. The research-generated home medication list was compared to the standard medication list and the number of omissions, duplications, and dosing errors was determined. RESULTS: There were 98 patients enrolled in the study; 56% (55/98, 95% confidence interval [CI] 46-66%) of the medication lists for these patients had an omission and 80% (78/98, 95% CI 70-87%) had a dosing or frequency error; 87% of ED medication lists had at least one error (85/98, 95% CI 78-93%). CONCLUSION: Our findings now add the ED to the list of other areas within health care with inaccurate medication lists. Strategies are needed that support ED providers in obtaining and communicating accurate and complete medication histories.

Pyoderma gangrenosum: dermatologic application of hyperbaric oxygen therapy.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of skin and subcutaneous tissue. The current accepted theory is that PG is an immunologic-based phenomenon. Several therapies have been used to control this disease, including corticosteroids, antibiotics, immunotherapy, dapsone, and hyperbaric oxygen therapy. This article will review the application of hyperbaric oxygen (HBO) therapy in patients with PG. Information for this manuscript was derived from multiple searches of MEDLINE and the National Baromedical Service literature collection. HBO therapy has been shown to effectively treat PG ulcers and reduce pain associated with PG in several case studies. Evidence from the studies cited herein help to establish a foundation for further research to investigate the role of HBO therapy as an adjuvant therapy in the treatment of PG.

Topical therapy for actinic keratoses, I: 5-Fluorouracil and imiquimod.

Actinic keratoses (AKs) are evolving, malignant cutaneous neoplasms. AKs can be treated with physical or destructive methods and with topical therapies. This article is the first in a 2-part series that will review current topical therapeutic options for AKs. Several topical treatment options offer some significant benefit for the alleviation of these lesions. Therapies include 5-fluorouracil, imiquimod, diclofenac, colchicine, and retinoids. The first part of this review will focus on topical 5-fluorouracil and imiquimod.

Topical therapy for actinic keratoses, II: Diclofenac, colchicine, and retinoids.

Actinic keratoses (AKs) are evolving, malignant cutaneous neoplasms. AKs can be treated with physical or destructive methods and by topical therapies. This article is the second in a 2-part series of current topical therapeutic options for AKs and discusses topical diclofenac, colchicine, and retinoids. The first part focused on topical 5-fluorouracil and imiquimod.

Physician vs patient assessment of dyspnea during acute decompensated heart failure.

This study assessed agreement between physician and patient self-reported measures of dyspnea severity during acute decompensated heart failure (ADHF). Both the physician and patient measured the change in dyspnea severity over 1 hour using 2 methods: (1) the difference of two static dyspnea measures (STATIC) and (2) a single transitional measure (TRANS). Likert scales and visual analog scales (VASs) were used. Data on 112 patients were analyzed. The mean difference between physician and patient VAS scores was 1 mm (limits of agreement: -54 to 56 mm) using the STATIC data. For TRANS data, the mean difference was 5 mm (limits of agreement: -75 to 86 mm). For the Likert scales, the weighted kappa was 0.13 and 0.23 for STATIC and TRANS data, respectively. The wide limits of agreement restrict our ability to substitute physician assessment for patient self-assessment of dyspnea in patients with ADHF.

Assessing validity by comparing transition and static measures of dyspnea in patients with acute decompensated heart failure.

This study assessed the convergent validity of 2 dyspnea measures, the transition measure and the change measure, by comparing them with each other in patients admitted to the hospital with acute decompensated heart failure. Static measures of dyspnea were obtained at baseline (pre-static measure) and at time 1 hour and 4 hour (post-static measures). The change measure was calculated as the difference between the pre-static and post-static measures. Transition measures were obtained at time 1 hour and 4 hour. Visual analog scales and Likert scales were used. Both physicians and patients measured the dyspnea independently. A total of 112 patients had complete data sets at time 0 and 1 hour and 86 patients had complete data sets at all 3 time points. Correlations were calculated between the transition measures and static measures (pre-static, post-static, and change measure). Bland-Altman plots were generated and the mean difference and limits of agreement between the transition measures and the change measures were calculated. In general, short-term dyspnea assessment using transition measures and serial static measures can not be used to validate each other in this population of patients being admitted with acute decompensated heart failure.

Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry.

OBJECTIVE: The aim of this study was to determine the prevalence of life-threatening arrhythmias in monitored ED patients while in the radiology suite. METHODS: This is a retrospective analysis at a tertiary care hospital with an ED census of 52,000 visits. The patient population consisted of 3,051 adult ED patients with a chief complaint of chest pain, who were monitored with telemetry while they were sent to the radiology suite, and who were ultimately admitted to the hospital. RESULTS: Of a total of 3,051 consecutive patients with a cardiac presentation who received a nonportable chest x-ray, no patients were found to have incurred a life-threatening arrhythmia while in the radiology suite. CONCLUSION: The prevalence of a cardiac arrhythmia occurring during transport or while within the radiology suite in our study was zero. We conclude that stable patients can probably be transported to radiology safely without the use of bedside telemetry.

False memories are hard to inhibit: differential effects of directed forgetting on accurate and false recall in the DRM procedure.

Directed forgetting research shows that people can inhibit the retrieval of words that they were previously instructed to forget. The present research applied the directed forgetting procedure to the Deese/Roediger and McDermott (DRM) recall task to determine if directed forgetting instructions have similar or different effects on accurate and false memory. After studying lists of semantically related words, some participants were told to forget those lists, whereas other participants were not. All participants were then shown additional lists to remember. Following study, all participants were asked to free recall as many of the studied words as possible, including those they were previously instructed to forget. Directed forgetting instructions inhibited the accurate recall of studied words, but not the false recall of nonstudied critical words, whether measured by a within-participant or between-participants design. Contrary to an implicit activation hypothesis, false memories survived instructions to forget. These findings were reviewed in terms of fuzzy trace theory and the activation/monitoring approach to false memory.