Ritalin: drug of abuse. Two case reports of intra-arterial injection.
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Adult↗
Biomedical subjects
A Still
Publications and source records attributed to A Still.
Cellular potassium depletion predisposes to hypokalaemia after oral sodium phosphate.
BACKGROUND: Oral sodium phosphate has become an attractive alternative to polyethylene glycol for colonic cleansing preparatory to elective colorectal surgery. Its use, however, has been associated with hypokalaemia. The authors of the present study tested the hypothesis that patients with cellular depletion of potassium are at significant risk for hypokalaemia with oral sodium phosphate bowel preparation. METHODS: In 23 patients, total body potassium was measured by whole-body counting and intracellular water volume was measured by bioimpedance analysis before oral sodium phosphate bowel preparation. Patients were divided into those whose serum potassium fell to 3.5 mmol/L or lower (Group 1) and those whose did not after sodium phosphate treatment (Group 2). RESULTS: The fall in serum potassium concentration over the period of oral sodium phosphate administration was significantly negatively correlated with intracellular potassium concentration measured prior to administration (r = -0.65, P = 0.0009). In Group 1, serum potassium concentration fell from 4.1+/-0.1 (standard error of the mean (SEM)) mmol/L to 3.2+/-0.1 mmol/L (P < 0.0001) while in Group 2 there was no significant change in this concentration (4.0+/-0.1 vs 3.9+/-0.1 mmol/L) as a result of sodium phosphate treatment. Intracellular potassium concentration prior to administration of sodium phosphate was significantly lower in Group 1 (117+/-9 mmol/L vs 143+/-7 mmol/L, P < 0.05). CONCLUSIONS: Caution should be exercised when treating patients with oral sodium phosphate who are considered to be cellularly depleted of potassium. These patients are at risk of hypokalaemia after this treatment.
Administration, Oral↗
General practitioners' strategies and tactics of communication with the terminally ill.
Interviews with 22 randomly selected general practitioners (GPs) investigated their communication with terminally ill patients. In interview analysis a conceptual distinction was drawn between objectives, strategies and tactics. When treating terminal patients, GPs expressed the objectives of keeping the patient comfortable, painfree, happy and maintaining dignity. A strategy is a plan and mode of approaching patients existing over an extended time period. Three strategies were described by GPs for use when interacting with terminally ill patients. These are characterized as 'try to disclose', 'let the patient decide' and 'avoid disclosing'. Tactics refer to behaviours used within a single consultation, as part of a strategy. Six tactics are described: evasion, denial, uncertainty, hints and prompts, euphemism and reassurance. Different strategies imply quite different forms of consultation. Thus to understand a consultation we must place it into the context of the series.
Attitude to Death↗
Homicide offenders in Auckland, New Zealand.
In the 14-year period from 1976 to 1989, 183 homicide offenders have been recorded in Auckland, New Zealand. Data accessed from police files show that Maori and Polynesians made up the majority of the offenders. Almost all offenders were male, and the largest proportion was between 20 and 24 years of age. Racial differences were noted in the methods used to commit the homicide, in the offender-victim relationship, and in whether the offender acted alone. The majority of offenders were not convicted of murder, but were convicted on lesser charges.
Adolescent↗
Child passenger fatalities and restraint use in Auckland.
AIMS: To determine the proportion of children killed as passengers in car crashes who were unrestrained and to estimate the reduction in mortality that might result from increasing child restraint utilisation. METHODS: All children killed as passengers in car crashes, over the period 1980-90, were identified from the Auckland coroners records. Data were recorded on sex, age, use and type of restraint, position within the motor vehicle, pattern of injuries and place of death. RESULTS: There were 49 children (25 male, 24 female) killed as passengers in car crashes over the study period (2.14/100,000/year). The median age was eight years (range 0-14 years). Of the 38 children for whom restraint use could be determined, 31 (81.6%) were unrestrained and seven (18.4%) were restrained. None of the children aged 0-2 years were restrained. Thirty-five children (71.4%) died at the scene of the crash, three (6.2%) died during transport to hospital, and 11 (22.4%) died in hospital. CONCLUSIONS: Based on overseas reports of the efficacy of child restraints, close to half (49%) of all child passenger deaths in Auckland could have been prevented with appropriate child restraint use.
Accidents, Traffic↗
Death certification in Auckland.
AIMS: to investigate the reasons behind general practitioner referral of cases of natural death to the coroner, and also the understanding of general practitioners of the relevant legislation. METHODS: as cases of natural death were referred to the coroner over a seven month period, the deceased's general practitioner was contacted by telephone and questioned regarding his/her knowledge of the death and willingness to sign a cause of death certificate. Based upon this interview, cases were divided according to whether their general practitioner could have signed the death certificate or not. RESULTS: there were 314 cases where there was a contactable general practitioner. In 257 instances, the general practitioner would not have signed the death certificate: 183 found the death unexpected, and 74 had not seen the patient recently enough. In 57 instances the general practitioner would have signed the death certificate, but did not because: 23 were unaware of the death, 13 could not be contacted, 14 did sign a death certificate but this was rejected by the medical referee, and seven would have signed but did not for miscellaneous reasons. CONCLUSION: a disturbing finding was the general lack of understanding of certification legislation in particular the concept that the patient must have been seen in their last illness to be able to sign the death certificate. When signing death certificates, doctors should be thinking in terms of last illness rather than a vague period of time between two weeks and three months.
Cause of Death↗
Differences between terminally ill patients who know, and those who do not know, that they are dying.
Four GPs each selected 6 patients, 2 terminally ill with knowledge of diagnosis and prognosis, 2 terminally ill without knowledge, and 2 chronically ill. Semi-structured interviews were conducted with the patients, and the transcripts' content was analyzed. There were large group differences in the predicted direction in frequency of utterances that indicated knowledge, which both validated the content analysis and verified the GPs' capacity to categorize patients according to knowledge. Terminally ill patients with knowledge produced significantly longer transcripts than the other two groups. Groups did not differ significantly on state or trait anxiety scales. Differences due to demographic variables could not account for the main effects. There were significant associations that involved age, anxiety, and the dependent variables of the content analysis, especially among the terminally ill patients without knowledge.
Age Factors↗
Police enquiries in sexual offences.
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Adolescent↗