Establishing a Telephone Medication Order Policy and Protocol for a Small Private Hospital in Jamaica.

OBJECTIVE: To institutionalize an evidence-based policy/protocol adapted from the Agency for Healthcare Research and Quality (AHRQ) national medication standards for managing telephone medication orders (TMO) and to determine the impact of the policy/protocol on the number of telephone medication errors (TME) on two medical units of a small private hospital in Jamaica. METHODS: Kotter's Eight-step Change Model was used to facilitate organizational change among nurses and physicians by teaching and implementing the TMO policy/protocol adapted from AHRQ standards and collecting pre-policy and post-policy frequency of TMEs. A convenience sample of 80 nurses and physicians participated in training about the policy/protocol, took post-instructional tests and participated in the implementation of the policy/protocol. Chart audits over six weeks monitored adherence to the policy/protocol. The annual monthly mean of TMEs for the prior year was compared with the number of TMEs just prior to implementation of policy/protocol and at the end of the first six weeks of implementation. RESULTS: One hundred per cent of the convenience sample of 80 nurses and doctors passed the post-instructional test; the workforce adhered fully to the protocol during six weeks of implementation, and there was a 100% reduction in TMEs between the prior year and six weeks after policy/protocol implementation. CONCLUSIONS: Kotter's eight-step framework of organizational change was a successful strategy in institutionalizing and sustaining adherence to the TMO policy/protocol, reducing the number of TMEs and positively influencing the organizational culture.

Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery.

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) equations were derived from a heterogeneous general surgical population and have been used successfully as audit tools to provide risk-adjusted operative mortality rates. Their applicability to high-risk emergency colorectal operations has not been established. METHODS: POSSUM variables were recorded for 1017 patients undergoing major elective (n = 804) or emergency (n = 213) colorectal surgery in ten hospitals. Subgroup analysis was performed to investigate the predictive capability of POSSUM and P-POSSUM in emergency and elective surgery and in patients in different age groups. RESULTS: The overall operative mortality rate was 7.5 per cent (POSSUM-estimated mortality rate 8.2 per cent; P-POSSUM-estimated mortality rate 7.1 per cent). In-hospital deaths increased exponentially with age. Both scoring systems overpredicted mortality in young patients and underpredicted mortality in the elderly (P < 0.001). Death was underpredicted by both systems for emergency cases, significantly so at a simulated emergency caseload of 47.9 per cent (P < 0.05). CONCLUSION: There is a lack of calibration of POSSUM and P-POSSUM systems at the extremes of age and high emergency workload. This has important implication in clinical practice, as consultants with a high emergency workload may seem to underperform when these scoring systems are applied. Recalibration or remodelling strategies may facilitate the application of POSSUM-based systems in colorectal surgery.

The effectiveness of humor in persuasion: the case of business ethics training.

In this study, persuasion theory was used to develop the following predictions about use of humor in persuasive messages for business ethics training: (a) cartoon drawings will enhance persuasion by creating liking for the source, (b) ironic wisecracks will enhance persuasion by serving as a distraction from counterarguments, and (c) self-effacing humor will enhance persuasion by improving source credibility. Canadian business students (N = 148) participated in 1 of 4 versions of "The Ethics Challenge," a training exercise used by the Lockheed Martin Corporation. Three versions were modified by adding or removing cartoon drawings (of cartoon characters Dilbert and Dogbert) and humorous responses (Dogbert's wisecracks). Removing the cartoon drawings had little effect on persuasiveness. Removing ironic wisecracks had more effect, and interfering with the self-effacing combination of cartoons and wisecracks had the strongest effect. The results suggest that researchers should ground their predictions in existing theory and that practitioners should differentiate among humor types.

Fibre-optic links eliminate distances separating specialists, patients.

New types of telemedicine links are being tested in Ottawa and the definition they provide is so good that cardiologists can treat patients several hundred kilometres away. Dr. Wilbert Keon says this technology should not be seen as an expensive frill but as a needed advance that will make health care more efficient.

Issues concerning ethical conduct and genetic mapping raised at Montreal meeting.

Ethical concerns about the Human Genome Diversity Project were discussed in Montreal last year during the 1st International Conference on DNA Sampling and Banking. This article, the second in a 2-part series, looks at the potential for misuse and commercialization of DNA samples and discusses some of the ethical concerns surrounding genetic mapping.

Is informed consent possible in the rapidly evolving world of DNA sampling?

Ethical concerns about the human genome diversity project were discussed in Montreal last year during the 1st International Conference on DNA Sampling and Banking. This, the first article in a 2-part series on the conference, examines issues related to informed consent.

Mandatory CPR training for students may improve cardiac-arrest survival rate, MDs say.

A mandatory cardiopulmonary resuscitation (CPR) program that started as a pilot project in Ottawa-area high schools is expanding to other Canadian schools. Besides CPR techniques, Grade 9 students are being taught about healthy lifestyles and how to recognize cardiac arrest. Emergency physician Justin Maloney, the program's principal architect, believes that in a decade this mandatory training will translate into increased bystander-initiated CPR and improved chances of survival for victims of cardiac arrest.

Canadian patient played key role in uncovering secrets about early-onset Alzheimer's disease.

Last June, the University of Toronto announced that Canadian scientists and a team of international researchers had discovered the gene responsible for most cases of early-onset Alzheimer's disease. One of the key players in that discovery had died just 3 months earlier. Frances Hodge, who participated in a battery of tests for the 20 years she lived with the disease, helped lead researchers to gene S182--and an ember of hope for future generations.

Canadian military physician one of many who tried to help Rwandans cope with a "world of hurt".

Lieutenant-Commander Colin Harwood was part of a team from the Canadian Forces Medical Service (CFMS) that was sent to Rwanda in the wake of that country's bloody civil war. The Ottawa-based officer says the CFMS personnel helped ease many serious medical problems during the 10 weeks they spent there, although the sheer numbers of wounded, diseased and orphaned people sometimes seemed overwhelming. The Canadian personnel helped more than 22,000 patients during their stay.

Subsets of T lymphocytes in relation to T lymphocyte function in multiple sclerosis.

T lymphocyte control of Epstein-Barr virus (EBV) infection of autologous B lymphocytes was examined in parallel to the enumeration of subpopulations of mononuclear cells in 22 multiple sclerosis (MS) patients and in 22 healthy individuals. All were seropositive for EBV. The incidence of lack of T cell control was significantly higher in patients than in controls, confirming previous published work. In the present study, we have shown in addition a significantly reduced proportion of OKT8+ cells and a significantly increased ratio of OKT4/OKT8 cells in the group of patients with lack of control. The findings point to abnormal immunoregulation in MS.

Tumor morphometry as prognostic factor in T1 and T2 bladder cancer.

Cytologic features indicative of malignancy were related to the subsequent rate of tumor recurrence in 50 patients with T1 and T2 transitional cell carcinoma (TCC) of the bladder. All patients with T1 disease in whom frequent recurrences developed had more than 15 per cent malignant-looking (ML) cells in their original biopsy. In patients with less than 15 per cent ML cells recurrences developed infrequently. All patients with T2 disease who had more than 15.5 per cent ML cells subsequently had a poor prognosis, whereas those with less than 15.5 per cent ML cells had a good prognosis.

Primary squamous carcinoma of the proximal large bowel. Report of a case and review of the literature.

A patient with primary squamous carcinoma of the proximal colon, who also had a previous adenocarcinoma of the large bowel, is described along with a review of the literature. Clinical features, etiologic factors, and possible pathogenesis are discussed.

Intersphincteric excision of the rectum.

Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements. Fifty-three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.

Carotid artery thrombosis, encephalitis, myelitis and optic neuritis associated with rubella virus infections.

The clinical, virological and pathological findings in 5 patients with neurological complications associated with rubella virus infection are described. The neurological illnesses began four to ten days after the rubella illnesses. The patients were all males aged between 6 and 17 years and were diagnosed during one non-epidemic year in a population of 1-5 million people. All the patients had rubella specific IgM in their sera. Two patients had no rash. In one of the patients who died, left internal carotid artery thrombosis and cerebral infarction were found at post-mortem. Rubella virus antigen and particles resembling rubella virus were found in the brain together with IgG and IgM in the same areas. This patient also had extensive liver necrosis. The other patient had a severe meningomyelitis and radiculitis and he recovered completely after two years. His serum rubella antibody rose significantly and was shown to leak into CSF during the acute stage of his illness. Three patients had a rash. Two of these patients had encephalitis: one recovered completely and the other had residual disability. The third patient had bilateral optic neuritis from which he recovered completely. Rubella specific IgM was, however, present in his serum for the abnormally long time of twenty-eight weeks indicating possible persistence of rubella virus.