Medications brought into the Emergency Department by Ambulance: Does this impact on the accuracy of prescribing on admission?

This journal suppl. entitled: Abstracts of the Annual Scientific Meeting of the Australasian College for Emergency Medicine 2006Aims: We hypothesize that the accuracy of medication prescribing is improved when the patients’ own medications (POM) are brought to the Emergency Department (ED). We aimed to: • determine the frequency with which paramedics bring POM to ED, • compare the incidence of admission medication chart errors when POM are brought to the ED and when they are not. Methods: Patients were enrolled if they were adult, brought to ED by ambulance, taking four or more regular medications, admitted to hospital and not referred to a pharmacist prior to the admission medication chart being written. ED pharmacists determined patients’ regular medications and details of medications brought in by ambulance. Medication charts were assessed for discrepancies related to medications taken prior to presentation. These were recorded as errors if a change was made to the medication chart after a pharmacist’s discussion with the prescriber. Results: 100 patients were enrolled: mean age 71.8 ± 14.7 years, 63% were male, mean number of regular medications 8.0 ± 3.7. Paramedics brought all, some and none of a patient’s POM to ED in 30%, 37% and 33% of cases, respectively. Among the 428 POM brought to ED there were 56 (13.1%) prescribing errors on admission medication charts. Among the 372 POM not brought to the ED there were 95 (25.5%) prescribing errors – a highly significant difference (p < 0.001). Conclusion: When ambulance paramedics bring POM to ED for use by prescribers, significantly fewer prescribing errors occur on admission medication charts. An intervention encouraging paramedics to bring POM to ED is planned.link_to_subscribed_fulltextThe Annual Scientific Meeting of the Australasian College for Emergency Medicine, 2006. In Emergency Medicine Australasia, 2007, v. 19 n. S1, p. A25-A2

Experimental murine mycobacteriosis: evaluation of the functional activity of alveolar macrophages in thalidomide- treated mice

Thalidomide is a selective inhibitor of tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in mycobacterial death mechanisms. We investigated the role of this drug in the functional activity of alveolar macrophages in the presence of infection induced by intranasal inoculation of Mycobacterium avium in thalidomide-treated and untreated adult Swiss mice. Sixty animals were inoculated with 5 x 10(6) M. avium by the respiratory route. Thirty animals received daily thalidomide (30 mg/kg mouse) and 30 received water by gavage up to sacrifice. Ten non-inoculated mice were used as a control group. Lots of animals from each group were evaluated until 6 weeks after inoculation. Infection resulted in an increased total number of inflammatory cells as well as increased activity of pulmonary macrophages. Histologically, intranasal inoculation of bacilli resulted in small mononuclear infiltrates located at the periphery of the organ. Culture of lung fragments revealed the presence of bacilli only at the beginning and at the end of the experimental period. Thalidomide administration did not affect the microbiological or histological features of the infection. Thalidomide-treated and untreated animals showed the same amount of M. avium colonies 3 weeks after infection. Although it did not affect bacillary clearance, thalidomide administration resulted in a decreased percent of spread cells and release of hydrogen peroxide, suggesting that factors other than TNF-alpha play a role in the killing of mycobacteria by alveolar macrophages. Thalidomide administration also reduced the number of spread cells among resident macrophages, suggesting a direct effect of the drug on this phenomenon