Intravenous melatonin abuse leading to recurrent aortic valve endocarditis: a case report and discussion.

BACKGROUND: Reports of inappropriate medication use are widespread. There is a growing literature detailing abuse of drugs not typically thought to have high abuse liability. Melatonin is considered to be generally safe and is categorized by the Food and Drug Administration as a nutritional supplement. There are no known reports of intravenous melatonin abuse in the medical literature. CASE PRESENTATION: The authors report a case of a patient injecting melatonin with euphoric and then sedative effects leading to two episodes of infective endocarditis culminating in aortic valve replacement. CONCLUSION: Infective endocarditis continues to be a major potential complication of intravenous drug abuse. The proliferation of novel street drugs, resurgence in the use of older drugs and ongoing abuse of medications warrant continued research and vigilance in treating substance use disorders and attendant medical complications.

Providers' beliefs about expressing condolences to the family of a deceased patient: a qualitative and quantitative analysis.

BACKGROUND: Most providers do not receive training in expressing condolences to bereaved families, and most health care institutions do not have policies in place encouraging expression of condolences. Physicians may fail to meet the expectations of bereaved families. OBJECTIVE: Our aim was to describe providers' beliefs and practices regarding expressing condolences to families of patients who have died. METHODS: A confidential online survey was conducted. Subjects were all physicians, nurse practitioners, and physician assistants on the active and adjunct medical staff at the University of Washington Medical Center (UWMC). Using the responses to the survey questions, we measured the nature and frequency of practices surrounding condolences; qualitative analysis using grounded theory was performed for open-ended questions. RESULTS: Four hundred ninety-seven of 1063 providers (47%) responded to the survey. Of 432 respondents who provide direct patient care, 375 answered the question, "Excluding condolences offered when notifying someone of a death, how often do you express your condolences to the family after the death of [a patient]?" Two hundred eight of the 375 (55%) responded "always" or "often." Providers who only provide inpatient care were significantly less likely to express condolences than those who provide some or only outpatient care, p=0.029. In multinomial regression models, the only factor significantly associated with the likelihood of expressing condolences was number of years in practice. Providers in practice for 20 or more years were more likely to write letters than less experienced providers (p<0.05). Qualitative data suggested that respondents want institutional support for expressing condolences. CONCLUSIONS: A small majority of providers at an academic medical center usually expressed condolences to the families of patients who died. Hospitalists and less experienced providers may be less likely to express condolences and interventions should target these physicians.