Utilization of a poison control center by critical access hospitals-one state's experience.

PURPOSE: Critical access hospitals (CAH) are an important source of exposures for poison control centers (PCC), yet there is a paucity of literature on how these calls differ from larger, more urban hospitals (UH). This study aimed to compare call characteristics from CAH and UH received by a regional PCC. METHODS: This retrospective chart review used the Toxicall® database of the Kansas PCC. All cases involving calls from a health care facility from 1 January 2012 to 31 December 2017 were identified. Cases were then identified as either from a CAH or from one of the four largest UH in Kansas for comparison. CAH were defined using the criteria from the Centers for Medicare & Medicaid Services. All information was de-identified in REDCAPS and analyzed in Microsoft Excel. FINDINGS: A total of 12,469 unique patient cases were identified, including 6392 CAH and 6077 UH cases. Patients at UH were more likely to have longer duration of medical effects and experience more severe medical effects. Significant differences in the unique exposures, rates of intentional overdose, routes, and number of exposures were found. Patients at CAH were more likely to receive activated charcoal, flumazenil, and be transferred to another healthcare facility, but were less likely to have been referred by the PCC, need an ICU admission, or require consultation with a toxicologist. CONCLUSIONS: PCC calls from CAHs were common and resulted in significant differences when compared to UH calls. Future research is warranted to optimize PCC services for rural hospitals.

Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity.

ABSTRACT: Ketamine is a dissociative anesthetic commonly used for procedural sedation owing to its perceived favorable safety profile. Despite its frequent use, overdoses of ketamine are rarely reported, and no cases with serum levels of ketamine or its metabolite have previously been reported. We report a case of an iatrogenic pediatric ketamine 20 mg/kg intramuscular overdose with serial ketamine and norketamine levels that resulted in minimal toxicity.

Comparison of Medication History Accuracy Between Nurses and Pharmacy Personnel.

PURPOSE:: To evaluate the differences in medication history errors made by pharmacy technicians, students, and pharmacists compared to nurses at a community hospital. METHODS:: One hundred medication histories completed by either pharmacy or nursing staff were repeated and evaluated for errors by a fourth-year pharmacy student. The histories were analyzed for differences in the rate of errors per medication. Errors were categorized by their clinical significance, which was determined by a panel of pharmacists, pharmacy students, and nurses. Errors were further categorized by their origin as either prescription (Rx) or over the counter (OTC). The primary outcome was the difference in the rate of clinically significant errors per medication. Secondary outcomes included the differences in the rate of clinically insignificant errors, Rx errors, and OTC errors. Differences in the types of errors for Rx and OTC medications were also analyzed. Additionally, the number of patients with no errors was compared between both groups. RESULTS:: The pharmacy group had a lower clinically significant error rate per medication (0.03 vs 0.09; relative risk [RR] = 0.66; 95% confidence interval [CI]: 0.020-0.093; P = .003). For secondary outcomes, the pharmacy group had a lower total error rate (0.21 vs 0.36, RR = 0.58; 95% CI: 0.041-0.255; P = .007), Rx error rate (0.09 vs 0.27, RR = 0.44; 95% CI: 0.071-0.292; P = .002), and OTC error rate (0.24 vs 0.46; RR = 0.52; 95% CI: 0.057-0.382; P = .009) per medication. The pharmacy group completed 20% more medication histories without Rx errors ( P = .045) and 25% more histories without OTC errors ( P = .041). CONCLUSION:: This study demonstrated that expanded use of pharmacy technicians and students improves the accuracy of medication histories in a community hospital.

Methionine sulfoxide reductase A affects ß-amyloid solubility and mitochondrial function in a mouse model of Alzheimer's disease.

Accumulation of oxidized proteins, and especially ß-amyloid (Aß), is thought to be one of the common causes of Alzheimer's disease (AD). The current studies determine the effect of an in vivo methionine sulfoxidation of Aß through ablation of the methionine sulfoxide reductase A (MsrA) in a mouse model of AD, a mouse that overexpresses amyloid precursor protein (APP) and Aß in neurons. Lack of MsrA fosters the formation of methionine sulfoxide in proteins, and thus its ablation in the AD-mouse model will increase the formation of methionine sulfoxide in Aß. Indeed, the novel MsrA-deficient APP mice (APP(+)/MsrAKO) exhibited higher levels of soluble Aß in brain compared with APP(+) mice. Furthermore, mitochondrial respiration and the activity of cytochrome c oxidase were compromised in the APP(+)/MsrAKO compared with control mice. These results suggest that lower MsrA activity modifies Aß solubility properties and causes mitochondrial dysfunction, and augmenting its activity may be beneficial in delaying AD progression.