Salivary cortisol is an acceptable surrogate for free serum cortisol when satisfactory salivary volumes are procured. Due to inadequate sample volumes, and contamination, it should not be generally adopted in the ICU. We identified discordance between free and total cortisol in interpreting AI, suggesting reinterpretation of seminal trials investigating physiologic corticosteroid replacement on the basis of total cortisol levels. The analysis of both free serum cortisol via ultrafiltration and salivary cortisol involved two steps: sample centrifugation followed by ELISA, suggesting consideration of widespread adoption of free serum cortisol in future investigations.
Errors resulting in adverse events in the medical care system are ubiquitous and underreported. Critical incident techniques that have been used to reduce errors in aviation have recently been applied to evaluate adverse events in the critical care arena. We report an evaluation of interrater agreement on responses to questions concerning adverse event reporting using a computer-based medical incident reporting system (MIRS). Thirty-four intensive care unit staff volunteers reviewed five fabricated test cases containing iatrogenic factors, then completed an incident report for each case using the MIRS. Interrater agreement was significant for all five cases (p < 0.01). The time required to complete a report decreased significantly from the first case to the last (p < 0.01). Overall, the MIRS was perceived as a relatively quick (< 6 minutes) and comprehensive reporting tool. The results indicate that health care providers report adverse events similarly, suggesting that the MIRS would be a useful tool in the reduction of errors (as a process improvement program) and to facilitate the continuing process of health care improvement.
As an active duty military medical officer who has been deployed several times, I wish to infuse the debate over the dual role of military physicians with a sense of the military physician's ethical responsibility to society as a whole. To do so, I summarize the concept of dual agency and raise the topic of duty. Then I develop an argument for what I consider an ethically superior, but seldom discussed, moral position: the obligation of physicians to perform military medical service in the United States. In advancing this concept, I am aware of the contradiction inherent in the notion of mandatory service in a free society. I am also aware that the American military itself generally disagrees with this opinion.
The purpose of this study was to determine if a computerized medical incident reporting system could be developed: 1) to be used by general hospital staff to report medical incidents and/or general concerns about their workplace, 2) provide data to identify, quantify, and categorize the problem areas, 3) provide detailed information that could be used to identify causal factors of system errors, and 4) recommend intervention strategies to reduce error in health care settings. A computerized system was developed, based upon critical incident methodology, to collect information pertaining to medical events. Data were collected over a 19 month test period on four types of reports (Adverse, Near-Miss, Positive, and Workplace Concern). Three hundred and forty-five reports were collected and categorized into one of seven areas: Communication, Diagnosis, Equipment, Medication, Monitoring, Procedure, and Treatment. Seventy-six percent of the problematic events were reported as preventable. Specific problem areas were identified, further analyses indicated their potential root causes, and intervention strategies were implemented for 36 system errors. Overall, the hospital staff responded favorably to the use of the computerized reporting system. Limitations of the current system and suggestions for improvement are discussed.1 Neuromuscular performance of the trunk was investigated during repetitive flexion and extension motion. Ten healthy subjects and ten low-back pain (LBP) patients with niusculoskeletal disorders were recruited for the study. Kim's protocol (1995) based upon Fitts' law (1954) was employed to examine the control capability of the trunk in terms of information processing capacip (bivsec). Electromyographic (EMG) parameters such as peak timing difference and duration of coexcitation between flexors and extensors were also defined and used as dependent measures of the neuroniuscular response of the trunk muscles. Results indicated that the control capabilie was not a significant factor to differentiate between healthy subjects and LBP patients under the current .experimental condition. On the other hand, the peak timing difference of normalized EMG signals between quadriceps and hamstrings were significantly greater (~4 . 0 1 ) in healthy subjects than LBP patients for both self-selected range of motion (ROM) and pre-determined ROM conditions. Moreover, the duration of coexcitation in rectus abdominis and erector spinae (L5) pair of muscles was significantly greater (p
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