[Second victim : Critical incident stress management in clinical medicine]

BACKGROUND Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

Nuclear medicine in Europe: education

The technical developments that have taken place in the preceding years (PET, hybrid imaging) have changed nuclear medicine. The future cooperation with radiologists will be challenging as well as positioning nuclear medicine in an European context. It can also be expected that education in nuclear medicine will undergo a harmonization process in the states of the European Union. In this paper, we describe how nuclear medicine education is organized in several European countries. We aim to stimulate constructive discussions on the future development of the specialization in nuclear medicine in Germany.

Radiopaque stomach contents in postmortem CT in suicidal oral medication intoxication: report of three cases

In clinical medicine, plane radiography is used for detecting the remains of medications in the stomach in oral medication intoxication cases. Since postmortem computed tomography (CT), performed prior to autopsy, is currently intensively entering the forensic routine, the technique was applied to three fatal cases of oral medication intoxication. Here we report CT and autopsy findings for these cases. In all three cases, hyperdense areas within the stomach content were documented. The measurement of Hounsfield Units (HU) beyond 74HU showed mean values of 338, 88 and 98HU. Postmortem CT also showed brain edema and pulmonary aspiration in one case. At autopsy, tablet remains in the stomach were detected microscopically in all three cases. The ex vivo CT scans of the ingested medicaments showed similar HU values. Despite the fact that further case studies are necessary beyond this one, and in spite of its limitations, postmortem CT was found to be a useful screening and documentation method for stomach contents in oral medication intoxication.

Ruminal drinkers: endocrine and metabolic status and effects of suckling from a nipple instead of drinking from a bucket

In ruminal drinkers (RD) ingested milk is transported into the rumen and not into the abomasum. Because this is followed by changes in digestibility and absorption, we have tested whether this is associated with postprandial metabolic and endocrine changes. Unweaned, bucket-fed calves (one RD, two controls) were studied on seven farms. On d 1, after metabolic and endocrine 12-h profiles were studied, RD and one control calf were fed for 10 d by nipple, whereas the other control calf was fed by bucket. On d 11, metabolic and endocrine 12-h profiles were again studied. On d 1, mean plasma concentrations of glucose, triglycerides, urea, insulin, insulin-like growth factor-1 (IGF-1), 3,5,3'-triiodothyronine (T3), thyroxine (T4) and leptin were significantly different between RD and controls, whereas mean concentrations of non-esterified fatty acids (NEFA), total protein, albumin, and glucagon did not differ significantly among groups. In RD concentrations of glucose, NEFA, insulin, growth hormone, IGF-1, and T4 were higher, and of urea were lower on d 11 than on d 1. Glucose and insulin concentrations increased postprandially in healthy calves on d 1, but barely in RD and remained lower than in controls, and there was no rise of NEFA and triglyceride concentrations on d 1 after the initial postprandial decrease in RD, in contrast to controls. But on d 11 postprandial responses of these four traits were similar in RD and controls and urea and T4 concentrations on d 11 became normalized. However, glucose and T3 concentrations in RD on d 11 were still lower than in one or both control groups. In conclusion, various metabolic and endocrine traits in RD differed from healthy controls. Drinking by floating nipple instead of drinking from bucket for 10 d normalized several metabolic and endocrine traits in RD.

Lawsonia intracellularis proliferative enteropathy in a filly

Proliferative enteropathy (PE) caused by the obligate intracellular bacterium Lawsonia intracellularis is a disease of high economic impact in swine worldwide. In most other species the disease occurs as a sporadic infection. This paper reports a PE caused by L. intracellularis in a 9-month-old Pura Raza Española filly with a history of profuse diarrhoea. Pathological lesions consisted of a severe proliferative enteritis associated with argyrophilic bacteria in the apical cytoplasm of proliferating crypt epithelium. Characteristic PCR products confirmed the presumptive diagnosis of L. intracellularis infection. To our knowledge this is the first report of PE in a horse in Europe caused by L. intracellularis.

Hypersensitivity reactions to quinolones

Quinolones are one of the most important classes of antimicrobial agents discovered in the recent years and one of the most widely used classes of antibiotics in clinical medicine. Their broad spectrum of activity and pharmacokinetic properties make them ideal agents for treating a variety of infections. Their clinical importance is further demonstrated by their activity against a wide range of diseases of public health importance such as anthrax, tuberculosis, bacterial pneumonia, and sexually transmitted diseases. Like other antibiotics, quinolones can cause various, sometimes dangerous hypersensitivity reactions. The underlying pathomechanisms are only poorly understood. Some are thought to be partly non-immune mediated reactions, others are considered to be IgE- or T cell-mediated reactions. This review gives an insight into the different immunological mechanisms leading to the diverse symptoms of quinolone-induced hypersensitivity reactions, with special emphasis on the role of T cells in such reactions.