Sabrina De Winter

Autopsy protocols and microscopic slides of 56 dialyzed and 18 nondialyzed chronically uremic patients were reviewed to assess the presence, extent, and severity of extraosseous soft tissue calcification. Calcification was identified in 79% of the dialysis patients and 44% of the nondialysis patients (P iss less than .025). Soft tissue calcification most frequently involved the heart, lungs, stomach, and kidneys. Lesions were severe in 36% of the dialysis patients and, when strategically located within the myocardium, were life-threatening. The deaths of 6 dialysis patients were attributed to severe calcification of the cardiac conduction system and/or myocardium. The presence and severity of soft tissue calcification was not related to duration of dialysis, patients' age, degree of parathyroid gland hyperplasia, radiographic evidence of soft tissue calcification, serum calcium and phosphate levels, Ca X P products, or type or severity of metabolic bone disease.

BACKGROUND: Recent literature revealed that medication histories obtained by physicians and nurses are often incomplete. However, the number of patients included was often low. Study objective In this study, the authors compare medication histories obtained in the Emergency Department (ED) by pharmacists versus physicians and identify characteristics contributing to discrepancies. METHODS: Medication histories were acquired by the pharmacist from patients admitted to the ED, planned to be hospitalised. A structured form was used to guide the pharmacist or technician to ensure a standardised approach. Discrepancies, defined as any difference between the pharmacist-acquired medication history and that obtained by the physician, were analysed. RESULTS: 3594 medication histories were acquired by pharmacy staff. 59% (95% CI 58.2% to 59.8%) of medication histories recorded by physicians were different from those obtained by the pharmacy staff. Within these inaccurate medication histories, 5963 discrepancies were identified. The most common type of error was omission of a drug (61%; 95% CI 60.4% to 61.6%), followed by omission of dose (18%; 95% CI 17.6% to 18.4%). Drugs belonging to the class of psycholeptics, acid suppressors and beta blocking agents were related to the highest discrepancy rate. Acetylsalicylic acid, omeprazole and zolpidem were most commonly forgotten. CONCLUSION: This large prospective study demonstrates that medication history acquisition is very often incomplete in the ED. A structured form and a standardised method is necessary. Pharmacists are especially suited to acquire and supervise accurate medication histories, as they are educated and familiar with commonly used drugs.

Measuring the contrast sensitivity function (CSF) in the periphery of the eye is complicated. The lengthy measurement time precludes all but the most determined subjects. The aim of this study was to implement and evaluate a faster routine based on the quick CSF method (qCSF) but adapted to work in the periphery. Additionally, normative data is presented on neurally limited peripheral CSFs. A peripheral qCSF measurement using 100 trials can be performed in 3 min. The precision and accuracy were tested for three subjects under different conditions (number of trials, peripheral angles, and optical corrections). The precision for estimates of contrast sensitivity at individual spatial frequencies was 0.07 log units when three qCSF measurements of 100 trials each were averaged. Accuracy was estimated by comparing the qCSF results with a more traditional measure of CSF. Average accuracy was 0.08 log units with no systematic error. In the second part of the study, we collected three CSFs of 100 trials for six persons in the 20° nasal, temporal, inferior, and superior visual fields. The measurements were performed in an adaptive optics system running in a continuous closed loop. The Tukey HSD test showed significant differences (p < 0.05) between all fields except between the nasal and the temporal fields. Contrast sensitivity was higher in the horizontal fields, and the inferior field was better than the superior. This modified qCSF method decreases the measurement time significantly and allows otherwise unfeasible studies of the peripheral CSF.