Chemical abuse. An intervention program for the elderly.

Although chemical dependency has been identified as a problem in the geriatric population, the literature continues to focus on issues of problem identification; few authors address the issue of providing appropriate services for the chemically dependent elderly. A goal of the Elders Health Program was to design a process of intervention using strategies employed by current chemical dependency treatment facilities, and to interface this process with knowledge and respect for normal aging changes. The intervention involved creating a unified and informed intervention team. The Elders Health Program illustrates that all elders have a network that can be employed or created in an effort to move the client into accepting the need to change. The ultimate goal is to improve the well-being of the client.

Physician at Risk Committees Re-evaluated.

Physician at risk committees have existed in some provinces for close to a decade. The major concern originally was that addicted physicians denied they suffered from an addictive illness, and so failed to seek treatment. Many provinces, including Manitoba, chose to develop an at risk committee so that an advocacy program was separate from the traditional disciplinary bodies. The rationale for the existence of such advocacy programs and the terms of reference of the physician at risk committees are reexamined in the light of eight years' experience.

Pharmacokinetics of metronidazole in patients undergoing continuous ambulatory peritoneal dialysis.

The pharmacokinetics of metronidazole, its biologically active alcohol metabolite, and its inactive acid metabolite were studied in five noninfected patients undergoing continuous ambulatory peritoneal dialysis and five patients undergoing hemodialysis. The latter were studied on off-dialysis days as a control group. Peritoneal dialysis caused insignificant changes in the apparent volume of distribution, elimination half-life, and total body clearance of metronidazole. Peritoneal dialysis clearance (4.49 +/- 0.88 ml/kg per h [mean +/- standard deviation]) accounted for only 8.9% of total body clearance (50.17 +/- 18.64 ml/kg per h). Analysis of the 24-h area under the serum concentration versus time curves and peritoneal dialysis clearance data for the two metabolites suggested a similar insignificant effect of peritoneal dialysis on their elimination. Metronidazole dialysate concentrations in the first 6-h exchange ranged from 7.6 to 11.7 micrograms/ml. This would suggest that cumulative penetration of metronidazole from the systemic circulation into the peritoneal cavity with dosing every 8 h should lead to adequate concentrations for the treatment of anaerobic peritonitis. For the treatment of systemic anaerobic infections, it would appear at present that metronidazole dosage adjustments are not necessary in patients undergoing continuous ambulatory peritoneal dialysis. The potential for metabolite accumulation was noted in this study. If further studies confirm that excessive serum metabolite concentrations are toxic, dosage reduction in this group of patients may be warranted.