Extended-duration hospital shifts, medical errors and patient mortality.

A meta-analysis was undertaken to study the association between extended medical shifts and consequences for patients. In six studies, the meta odds ratio was increased for mortality and for serious medical errors, but not for preventable medical errors and for physicians who slept >6 hours.

Incidentalomas revealed by abdominopelvic computed tomography scans performed in body packers.

BACKGROUND: Body packing is the transport of internally concealed narcotic substances. These may take the form of pellets or sachets, ingested or inserted per anus or per vagina. In France, abdominopelvic scanning without contrast-medium injection is used to check the complete evacuation of ingested narcotics. This sometimes leads to the discovery of incident pathologies, also known as "incidentalomas." OBJECTIVE: Our study described incidentaloma detected by abdominopelvic computed tomography (CT) scanning in body packers. This monocentric prospective study concerned 100 CT scan images from body packers managed in our secure medical unit between September 2009 and April 2010. RESULTS: Thirty-one incidentalomas were discovered on 18 abdominopelvic CT scans, including 2 women. Ten CT scan examinations revealed 1 suspect image, 5 scans included 5 suspect images, 2 scans included 3 suspect images, and 1 scan included 5 suspects images. Once the complete evacuation of all foreign bodies is confirmed, and in the absence of any surgical or medical emergency, incidentaloma management is entrusted to the prison doctors.

Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study.

OBJECTIVE: To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT). METHODS: Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination. RESULTS: Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4-58.1) and 100.0 % (95 % CI: 97.0-100.0) for reader 1 and 35.7 % (95 % CI: 12.8-64.9) and 97.6 % (95 % CI: 93.1-99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance. CONCLUSION: Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers. KEY POINTS: • Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. • Ten per cent of body packers had residual packets despite two packet-free stools. • Seventy per cent of these residual packets were missed on AXR. • No patient or packet characteristics predicted residual packets or AXR false negativity. • CT is necessary to ensure safe medical discharge of body packers.

[Methods of use and behavior of cocaine addicts consulting medical-legal emergency units in Paris. Clinical aspects and urinary toxicology profile]. / Modes d'usage et comportements du cocaïnomane consultant aux urgences médico-judiciaires de Paris. Aspect clinique et profil toxicologique urinaire.

OBJECTIVE: Establish the epidemiological characteristics and urinary toxicological profiles of a population of cocaine addicts under police custody. METHOD: A series of 60 cocaine addicts consulting the medico-legal emergency unit of the Hôtel-Dieu hospital in Paris was studied prospectively on the following elements: clinical characteristics, method of cocaine administration and association with other licit or illicit substances. Urinary toxicological analysis, using immuno-chemistry and chromatography linked to a mass spectrometer was systematically proposed to each patient. RESULTS: Half of the 17 to 26 year-old patients declared having consumed cocaine for the past 2 to 5 years. Inhalation of the vapours and the intravenous route were used more than the cigarette or nasal route. The majority of 26 to 35 year-olds were multi-drug addicted, generally associating cocaine, heroine and tobacco. Analysis of the urine provided an objective assessment of the cocaine consumption of these persons under police custody in Paris. CONCLUSION: Screening for urinary toxicity gives better knowledge on the consumption of addictive products by the person in whom urine was sampled. This study was conducted in cocaine addicts under police custody, and for the majority were social misfits. In this population, the consumption of crack by inhalation predominated.