Postdischarge problems identified by telephone calls to an advice line.

Background: Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care.

Objective: To identify opportunities for improving discharge processes by examining calls to an advice line (AL).

Design: Prospective cohort.

Treatment of chronically digoxin-poisoned patients with a newer digoxin immune fab--a retrospective study.

Context: Digoxin is used in the treatment of patients with cardiac dysfunction, though toxicity sometimes results from the use of this medication. In 1986, the US Food and Drug Administration (FDA) approved a digoxin immune Fab for the treatment of such patients. In 2001, the FDA approved a newer digoxin immune Fab, a digoxin-specific antibody (DSAb) known as DigiFab (Protherics Inc, Brentwood, Tennessee), though minimal literature exists on the clinical effects of this DSAb.

Short-term outcomes after Fab antivenom therapy for severe crotaline snakebite.

Study Objectives: We seek to determine the short-term outcomes associated with the use of Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) therapy for severe crotaline snake envenomation and to better define the incidence of hypersensitivity reactions associated with FabAV use.

Methods: We conducted a multicenter observational case series study of patients who received FabAV at 17 US hospitals in 2002 to 2004. A 7-point score incorporating local, systemic, and hematologic venom effects was used to grade envenomation severity before and after FabAV therapy.

Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review.

Background: In 2000, the United States Food and Drug Administration approved Crotalidae Polyvalent Immune Fab (Ovine) (hereafter, FabAV), "for the management of patients with minimal to moderate North American Crotalid envenomation." Because whole-IgG pit viper antivenom is no longer available in the United States, FabAV is currently the only specific treatment option available to United States clinicians treating snakebite victims of any severity. No clinical trial data are available concerning the effectiveness of FabAV for treatment of severe snakebite, but several published articles describe its use in this setting.

Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care.

Study Objective: We developed recommendations for antidote stocking at hospitals that provide emergency care.

Methods: An expert panel representing diverse perspectives (clinical pharmacology, clinical toxicology, critical care medicine, clinical pharmacy, emergency medicine, internal medicine, pediatrics, poison centers, pulmonary medicine, and hospital accreditation) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel.

Overuse of non-prescription analgesics by dental clinic patients.

Background: Many patients present to dental clinics for treatment of painful conditions. Prior to seeking treatment, many of these patients will self-medicate with non-prescription analgesics (NPA), and some will unintentionally overdose on these products. The objective of this study is to describe the use of NPA among dental patients.

Effects of clinical laboratory choice on study outcome: an interlaboratory evaluation of aminotransferase levels.

Study Objective: To determine if laboratories with disparate alanine aminotransferase (ALT) reference ranges would report different rates of elevation greater than the upper limit of reference range (ULRR) and thus have the potential to alter study results.

Design: Interlaboratory evaluation.

Setting: Research department of a poison and drug center.

Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.

Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators.

Environments, indoor air quality, and children.

This article addresses air-quality science in the indoor environments in which children and adolescents find themselves, including the home, the school, and other environments such as work and recreational situations. The home arena is covered extensively, presenting an analysis of the usual exposures such as environmental tobacco smoke and bioaerosols and also touching on discrete issues such as sudden infant death syndrome, carbon monoxide, and public housing. Recreation and work environments are covered as well.

Active surveillance of abused and misused prescription opioids using poison center data: a pilot study and descriptive comparison.

Background: Prescription opioids are abused throughout the United States. Several monitoring programs are in existence, however, none of these systems provide up-to-date information on prescription opioid abuse. This article describes the use of poison centers as a real-time, geographically specific, surveillance system for prescription opioid abuse and compares our system with an existing prescription drug abuse monitoring program, the Drug Abuse Warning Network (DAWN).

The safety profile of sustained release paracetamol during therapeutic use and following overdose.

Sustained release (SR) formulations of paracetamol (acetaminophen) have been introduced in several countries to provide lasting pain relief and reduced risk of rebound pain. However, few studies have evaluated the safety of paracetamol SR formulations. To assess the available published safety data regarding SR formulations of paracetamol, the EMBASE and MEDLINE databases were searched from 1980 to June 2003 for published worldwide human experience with paracetamol SR formulations.

Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion.

Study Objective: Repeated supratherapeutic ingestion of acetaminophen is potentially lethal but poorly described. We provide the first prospective description of the characteristics, course, and outcome of patients with repeated supratherapeutic ingestion of acetaminophen.

Methods: This was a prospective case series of consecutive patients aged 12 years and older with acetaminophen dosage greater than 4 g per 24 hours referred to our poison center.

Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs.

Objective: To explore the effect of telephone triage and advice lines in uninsured and managed care populations served by a safety net system and to document the relationship between the patient's initial plan for healthcare, the nurse recommendation, and the patient's subsequent healthcare action.

Study Design: Prospective telephone survey.

Patients And Methods: Of 1538 calls to a nurse advice line in a 28-day period, 710 (46%) callers were selected to be surveyed.

Health care facility and community strategies for patient care surge capacity.

Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for "surge capacity" must thus be made to accommodate a large number of patients.

Using respiratory-related calls to a nurse advice line to predict pediatric upper respiratory infection-related healthcare utilization.

Using Poisson regression analysis, respiratory-related calls to a nurse advice line in Denver, Colorado were used to predict pediatric upper respiratory infection (URI) outpatient and urgent care visits. Use of electronic hospital information systems and triage software allowed for the rapid identification of respiratory-related calls and URI-related utilization. Monitoring nurse advice line call volume may help increase awareness and planning for increases in healthcare utilization.

Australian tiger snake (Notechis scutatus) and mexican coral snake (Micruris species) antivenoms prevent death from United States coral snake (Micrurus fulvius fulvius) venom in a mouse model.

Background: Wyeth-Ayerst has discontinued production of Antivenin (Micrurus fulvius). Currently, there is no other approved coral snake antivenom available in the United States.

Methods: This study was a randomized, placebo-controlled and blinded determination of the ability of a Mexican Micrurus (coral snake) antivenom and an Australian Notechis (tiger snake) antivenom to prevent lethality from a United States Micrurus fulvius fulvius venom in a mouse model.