Objectives: To determine the incidence and preventability of unplanned admissions to a State acute care general teaching hospital caused by adverse medication-related events (AMREs). Methods: A cohort study of consecutive unplanned admissions to the Repatriation General Hospital Daw Park over three weeks in April and May 1996. Medication details were obtained by patient interview, referral letters and review of medical notes. If an AMRE was suspected, all investigators met and collaboratively assessed whether an AMRE had occurred. Results: Of 172 unplanned admissions, 31 (18%) possibly involved an AMRE as a primary cause. Nearly one-third were considered potentially preventable. The most common events were adverse drug reactions (58%), patients receiving too much of the correct medication (16%), and patients not receiving the prescribed medication (16%). AMREs were assessed as the probable cause of hospitalisation in 29% of all cases, possible in 58%, and unassessable in 13%. Cardiovascular and central nervous system medications were most commonly implicated. Conclusion: AMREs were significant contributors to hospitalisation in this study of an older than average population. Aust J Hosp Pharm 1999; 29: 84-7.
I was raised in North America - a culture and society in which the education emphasizes knowledge about science, its methods and its principles. The scientific method of understanding, coupled with the rudimentary knowledge that I was taught in high school biology, resulted in my conceptualization of pain as an objective truth. Pain, as I believed for a long time, was a bodily sensation with an expression that was more or less universal; to me, pain was simply the sensation that the brain experiences as a response to noxious stimuli. The pain sensation protects us from things that can hurt us; it is a warning sign that something in us is physically amiss. Thus, everybody physically reacts to the touch of a flame or experiences abdominal pain when there is appendicitis. Even now, in medical school, the pain education that I have received so far has only involved the physiology or mechanics of pain. Pain, as a physiological condition, operates independent of cultural context. However, in considering the experience of pain that my grandmother has endured, I realize that pain is much more than a mechanical bodily sensation effected by the nervous system in response to stimulus. Pain is a human experience, and as such, it is highly individualized and subjective. The proper diagnosis, care and treatment of pain necessitate a holistic understanding of pain, its physiology and its context (1).
Clinical experience suggests higher occurrence of carbapenem‐associated seizures in the elderly than what is reported in the available literature (range between 0.2% and 0.7%). An audit of 1345 patients with age 60 years or older, who received imipenem, ertapenem or meropenem during their acute hospitalisation found 32 (2.4%) subjects developed seizures. Subjects with more than one central nervous system disorders were 11.6 times more likely to develop seizures (odds ratio 11.61, P < 0.001) and subjects with prior history of seizures is associated with four times greater risks (odds ratio 4.02, P = 0.005). Physicians should exercise caution when prescribing carbapenems in elderly, especially those with known epilepsy and a high number of intracranial pathologies.
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