Drinking, drugs and driving in Ireland: more evidence for action.

OBJECTIVE: To examine the prevalence of drug positivity among drivers suspected of driving under the influence of an intoxicant, and consequently apprehended by the police in Ireland. DESIGN: 2000 specimens were selected for drug analysis, 1000 with results under the limit for alcohol and 1000 over the limit. The limit for alcohol is 80 mg/100 ml in blood and 107 mg/100 ml in urine. Seven drugs/drug classes were examined; amphetamines, methamphetamines, benzodiazapines, cannabinoids, cocaine, opiates and methadone. RESULTS: 331 (33.1%) of the drivers under the legal limit for alcohol tested positive for one or more of the relevant drugs, and the corresponding figures of drivers over the limit was 142 (14.2%; p<0.001). Using weighted analysis, this corresponds to 15.7% (95% confidence interval (CI) 13.5% to 18.1%) of all tested drivers (15.8% in men and 14.5% in women). Among drivers who had minimal blood alcohol levels, 67.9% (95% CI 61.2% to 74.1%) were taking at least one type of drug. The prevalence of taking drugs reduced steadily as alcohol concentrations increased, but still remained as high as 11.1% (95% CI 8.3% to 14.6%) for drivers with blood alcohol concentrations >200 mg/100 ml. Being under the limit for alcohol, stopped in a city area, stopped between 6 am and 4 pm, or 4 pm and 9 pm, and being of a younger age were each independently associated with drug positivity. CONCLUSIONS: There are immediate implications for the evidential breath alcohol program and for checkpoints; in the event of a nil or low alcohol reading being obtained, a separate blood or urine specimen should be sought for analysis, which is currently non-routine.

Ireland: breakdown of trust between doctor and patient.

By European standards Ireland experiences a very high level of medical litigation. The possible reasons for this are numerous but not yet determined with any certainty. The consequences are quite clear with negative effects on medical practice, on the psychological health of doctors and patients alike, and on finances of the state. There are different patterns of medical litigation throughout Europe. Ireland may be merely anticipating the emerging increase in such actions elsewhere in the region. The present adversarial basis for medical litigation is not wholly without merit and has contributed to professional accountability. Nevertheless, a change in the present system ensuring accountability and fair compensation is required, together with a striving to ensure that trust is rebuilt between doctors and patients.

'Near PVS': a new medico-legal syndrome?

This paper addresses the current medico-legal issues surrounding PVS (Permanent Vegetative State), including: the lack of a unified definition of the acronym PVS, the varying criteria for diagnosis of PVS, and the issue of patients who maintain a minimal degree of consciousness and cannot be categorized as PVS patients. First, we analyse the differing medical definitions and criteria for diagnosis in vegetative conditions. We also ask what part 'consciousness' plays in treatment decisions made by the family, the healthcare team, and the courts, by analysing a unique Irish case of a patient in a state deemed by the courts as 'near PVS'. The paper demonstrates that there is now a legal dichotomy in vegetative patients. However, the manner in which the court treated these patients is the same. Underlying this discussion we hope to demonstrate how medical practice is subject to legal decisions and thus the importance of establishing uniform medical guidelines to assist the non-medical professional.

Neurosecretion of arginine vasopressin by an olfactory neuroblastoma causing reversible syndrome of antidiuresis.

A 26-year-old woman with the syndrome of inappropriate antidiuresis demonstrated complete recovery following the resection of an olfactory neuroblastoma. Tissue arginine vasopressin levels by radioimmunoassay, immunohistochemical staining of the tissue arginine vasopressin, postoperative normalization of plasma arginine vasopressin levels, and the clinical resolution are evidence in support of a neurally derived tumor being the direct source of neurosecretion of arginine vasopressin rather than neurohypophyseal secretion or secretion from non-neural tissues, as reported to date in the etiology of the syndrome of inappropriate antidiuresis.