Jejuno-ileal diverticulosis : a review of literature.

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. The majority of cases are discovered incidentally during radiological investigations. Based on a case of a 77 year old woman with jejunal diverticulitis, the current literature about small bowel diverticulosis is reviewed. A jejunoileal diverticulum is usually uncomplicated and can be treated conservatively. Serious complications that require surgery can occur. Abdominal CT is the preferred diagnostic tool.

Drug-drug interactions in the intensive care unit: Do they really matter?

PURPOSE: To describe prevalence and patterns of potential drug-drug interactions (pDDIs) in the intensive care unit (ICU), occurrence of adverse drug events (ADEs), and agreement between different compendia and intensivists' perceptions. METHODS: A cross-sectional study. Drug profiles of all adult patients from 2 academic ICUs were screened on day 3 upon admission. We identified pDDIs using 3 compendia (Stockley's, Micromedex, and Epocrates) and documented their mechanism of action, clinical consequences, severity, level of evidence, and management. Medical records were searched to identify ADEs potentially related to major pDDIs. Agreement between information sources (compendia, intensivists) was evaluated. RESULTS: We identified 1120 pDDIs among 275 patients. Median number of pDDIs per patient was 3.0 (interquartile range, 1-6), with 79% of patients presenting with at least 1 pDDI. Major pDDIs were detected in 18% of patients, with potentially related to ADEs in 4% of patients. Only 13% of all pDDIs were documented simultaneously in all 3 compendia. Different information sources (compendia, clinicians) showed "no" to "fair" agreement. CONCLUSIONS: Potential drug-drug interactions occurred in most ICU patients, contrasting with low rates of potentially related ADEs, which may have been underestimated. Sources of information are inconsistent, challenging the identification of pDDIs.

Predictors of clinicians' underuse of daily sedation interruption and sedation scales.

PURPOSE: The purpose of the study is to identify predictors of underuse of sedation scales and daily sedation interruption (DSI). METHODS: We surveyed all physicians and seven nurses in every Belgian intensive care unit (ICU), addressing practices and perceptions on guideline recommendations. Underuse was defined for sedation scales as use less than 3× per day and for DSI as never using it. Classification trees and logistic regressions identified predictors of underuse. RESULTS: Underuse of sedation scales and DSI was found for 16.6% and 32.5% of clinicians, respectively. Strongest predictors of underuse of sedation scales were agreeing that using them daily takes much time and being a physician (rather than a nurse). Further predictors were confidence in their ability to measure sedation levels without using scales, for physicians, and nurse/ICU bed ratios less than 1.98, for nurses. The strongest predictor of underuse of DSI among physicians was the perception that DSI impairs patients' comfort. Among nurses, lack of familiarity with DSI, region, and agreeing DSI should only be performed upon medical orders best predicted underuse. CONCLUSIONS: Workload considerations hamper utilization of sedation scales. Poor familiarity, for nurses, and negative perception of impact on patients' comfort, for physicians, both reduce DSI utilization. Targeting these obstacles is essential while designing quality improvement strategies to minimize sedative use.

Added value of pharmacist-acquired drug histories in an orthopaedic ward.

In Belgian hospitals, drug histories of patients taken on admission are generally collected by medical trainees, physicians and nurses. As errors in drug histories may lead to medication errors and adverse drug events, we aimed at comparing the data obtained by a clinical pharmacist with those obtained by the nurses in a surgical orthopaedic ward. In this four months study, 50 patients, with a mean age of 66 years, were included. Out of these 50 drug histories, 107 differences were found when comparing the data gathered by the nurses with the data of the pharmacist. On average, there were 2.1 discrepancies per patient. Omission of a drug and incorrect or unknown dose accounted for 80.3% of the discrepancies, while allergy and/or intolerance, incorrect frequency and addition of a drug accounted for respectively 11.2%, 4.8% and 3.7%. Interestingly, six drug categories represented almost 55% of the drug-related discrepancies.These were, in order of importance: anxiolytic and neuroleptics, antacids and proton pump inhibitors (PPI's), painkillers, antidepressants, aspirin and eye drops. Finally, 27% of the discrepancies concerned "over the counter" drugs. From this study we were able to conclude that the clinical pharmacist performed more complete and more accurate drug histories than nurses in the surgical orthopaedic care unit, especially in patients taking multiple drugs. These results suggest that drug histories taken by a pharmacist may lead to a reduction of potential adverse drug events during hospitalisation.