Women surgeons are experiencing more discomfort and treatment in their hands than male surgeons. Redesign of laparoscopic instrument handles and improvements to table height comprise the most promising solutions to these ergonomic challenges.
Background: Medication discrepancies are common between transitions in healthcare and are associated with higher healthcare utilisation and hospital readmission following discharge. Medication reconciliation is a key intervention to reduce medication list discrepancy. The transition between discharge and first outpatient appointment is critical for patient recovery. The proportion of medication discrepancies during this interval is not well characterised. Aim: The aim of this study was to evaluate the accuracy of patients' medication list between discharge from hospital or emergency department to first outpatient follow-up with their primary care physician. Methods: A cross-sectional observational study was performed between November 2015 and May 2016. A 10-question survey was designed to identify potential areas of inaccuracies in the medication lists. Results: In all, 106 patients completed the survey, of whom 67.9% (n = 72) had complete data. Eighty per cent of patients (n = 85) had a provider review their medication list prior to discharge. At the time of follow-up, 22.6% (n = 28) were not taking the listed medications; of this cohort, 35% (n = 8) had a physician instruct them to stop taking medication. Six per cent of patients (n = 6) reported incorrect medication doses. Conclusion: Medication discrepancies occur in the transition from hospital discharge to first follow-up. This poses a threat to patient safety. A standardised process of medication review is critical to prevent such errors.
Oxaliplatin is one of the most commonly used drugs for patients with colorectal cancer. It has rarely been associated with disseminated intravascular coagulation (DIC) with only 3 previously reported cases. In all those instances, the patients had started receiving oxaliplatin, developed evidence of DIC during the course of planned treatment, and recovered with supportive care. We report a case of a 71-year-old man with colorectal cancer treated successfully with an oxaliplatin-based regimen who had disease relapse after 3 years. When treated again with oxaliplatin, he developed signs of an acute hypersensitivity reaction, and eventually had signs and symptoms consistent with DIC despite appropriate management. This case is unique in that a DIC reaction evolving from a hypersensitivity reaction occurred after the patient had already tolerated the drug years earlier. It suggests a possible immune-mediated etiology to this rare occurrence that should be kept in mind while utilizing this commonly employed drug.
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