In this issue:

  Errors in Administration of Liquid Medications

Electronic News Affecting Medicine

Vitamin C Linked to Lower Death Rates

Tidbits of Trivia-With a Bit of Humor

Web Sites of Possible Interest

Quotable Quotes

ERDOCS listserv

How to get in touch with us; questions; sponsorship

Errors in Administration of Liquid Meds

Almost three-quarters of caregivers surveyed in a recent study use regular flatware teaspoons to measure medicines. Household teaspoons hold from 2 to 10 milliliters of liquid. But a measuring teaspoon holds 5 milliliters of liquid. So if you measure your liquid medications with a regular teaspoon, chances are you either getting too much or too little medicine.

The American Academy of Pediatrics has been recommending for 25 years that accurate dosing devices like oral dosing syringes, medicine cups, and calibrated medicine droppers and spoons should be used to give liquid medications. But there have been few studies that look at how often or how well these devices are actually used by parents.

Physicians Diane J. Madlon-Kay and Frederick S. Mosch of Regions Hospital in St. Paul, Minn., and the University of Minnesota Medical School in Minneapolis designed a study to find out.
They surveyed people in the waiting areas of three primary care clinics to see which dosing devices caregivers use, and how accurately they measure medications. The research is reported in "Liquid Medication Dosing Errors" in the August 2000 issue of the Journal of Family Practice, Vol. 49, No.1.

Seventy-three percent of the 130 people surveyed reported using a household teaspoon for measuring medicines at least some of the time, but most could also use more accurate devices correctly. The participants were able to measure the proper amount of liquid using an oral dosing syringe more than 90% of the time. The authors note that the oral dosing syringe is felt to be the best device for administering liquid medications. These are relatively inexpensive and are available in a variety of sizes, but only one third of the survey participants reported having one of these at home.

Medicine cups (like the ones that come with a bottle of cough syrup) were misread by more than 10% of the participants. People confused the teaspoon and tablespoon markings on the cup, or thought that one entire cupful was the standard dose. When interpreting dosing instructions, survey participants were usually correct when the instructions called for taking medicine three or four times a day. But in many cases, they misinterpreted instructions calling for a dose every six hours. People tended to assume that medicine should be given in six-hour intervals while awake, resulting in three daily doses, rather than the prescribed four a day. While under-dosing is less serious than overdosing, the authors note that this phenomenon could be responsible for failed treatment in some cases.

Another common error arose when the pediatric dosing chart on the medicine package was misinterpreted. In cases where a particular child did not fit into one of the age-weight categories listed on the chart, it was commonly assumed that age was the best factor in determining dosage, but the researchers stress that weight is the important criterion, not age.

Based on these survey results, the researchers encourage clinicians to promote the use of accurate dosing implements, especially oral dosing syringes. They also suggest that medication instructions should indicate the dosing interval as the number of doses per day, rather than as the number of hours between doses.

Reprinted with permission of the Medical College of Wisconsin / MCW HealthLink http://healthlink.mcw.edu

DISCLAIMER NOTICE: MCW HealthLink is provided for educational purposes. Individuals should consult their physician regarding the applicability of any opinions or recommendations with respect to their own symptoms or medical condition. Moreover, medical knowledge changes rapidly. In view of the possibility of human error or changes in medical science, neither the authors, nor the editors, nor the Medical College of Wisconsin, nor any other party who has been involved in the preparation or publication of this work represents that the information contained in MCW HealthLink is, in every
respect, accurate or complete. They also are not responsible for any errors or omissions or for the results obtained from the use of this information. Readers are also encouraged to confirm the information contained in MCW HealthLink with other sources.

Electronic News Affecting Medicine 

FBI Warns of Cyber-Vulnerability

Ronald Dick, the new head of the FBI's cyber-crime unit, the National Infrastructure Protection Center (NIPC), warned that federal facilities, electric power plants, hospitals, and more  than 5,000 other sites that together form the U.S.'s infrastructure are extremely vulnerable to computer-based attacks. Dick introduced a new NIPC team consisting of representatives from the CIA and the Defense Department, was quoted as saying that there are currently 1,400 active investigations into cyber-crime, and at least 50 computer viruses are generated weekly. While concern continues regarding terrorist threats, he cited the number one problem for companies was a lack of safeguards to block former employees from accessing and attacking computer systems considered vital to commerce systems. The NIPC staffs about 100 people and has ties with 946 representatives from corporations and other entities that have joined its information-sharing network. (from the Washington Post, March 21, 2001)

Medical Journals Online and Free for Researchers

Online medical research is a boon to schools such as the University of Zimbabwe, where resources are drying up--their number of subscriptions have fallen from more than 600 journals to only 170. To compensate, students and teachers now log on to computers to conduct their research using the British Medical Journal, which displays its publication online. The medical journal industry now straddles divergent directions for researchers---putting publications online for free, as an electronic subscription, or to continue conventional print formats. Revenue, of course, is a major concern for publishers. Another source, PubMed Central, a project of the National Institutes of Health, solicits free articles from medical journals, offering the companies a secure place to put their articles
on the Web. (from the New York Times, March 20, 2001)

Human Genetic Code Available Online

Celera Genomics Group will publish an analysis of the human genome, which it finished decoding last year, in the journal "Science" and will make the data supporting that analysis available on the company's Web site. The arrangement between Celera and "Science" is significant as it marks the alliance of research science's two competing wings: the academic and the corporate. The online data will be available to any academic researcher, but researchers must first agree not to share the data with other firms that have similar databases. Celera will let researchers use the data to support and patent their own projects. However, researchers from drug firms will not be allowed to use the data for commercial projects. Celera CEO J. Craig Venter explains that, while the company does want to adhere to the long tradition of data sharing among the research community, it must take steps to protect its data from piracy, which does not fall under any current U.S. copyright laws. Not all of Celera's genome database will be available online. Researchers, with written approval from a university official, may order the complete database on DVD or CD optical disks. Although some researchers have criticized the agreement between Celera and "Science," many say it is a reasonable precaution to protect data.

Vitamin C Linked to Lower Death Rates

Want to lessen your risk of dying of heart disease and other chronic illnesses? British researchers reiterated the importance of eating more fruits and vegetables.

New research by scientists at the University of Cambridge suggests that vitamin C may also reduce the risk of dying from chronic disorders like cardiovascular and heart disease.

Lead researcher and professor Kay-Tee Khaw, said, in the study  published in The Lancet, "Our findings suggest that an increase in dietary intake of foods rich in ascorbic acid might have benefits for cardiovascular disease and all-cause mortality in men and women." 

The researchers included nearly 20,000 men and women, aged 45-79, living in Norfolk in eastern England. Each person filled out a health and lifestyle questionnaire and they were examined at the start of the study, when concentrations of vitamin C in their blood plasma were also recorded. A four-year follow-up showed the levels of vitamin C concentrations were inversely related to deaths from all causes including cardiovascular disease. Subjects  with the highest levels of vitamin C were reported to have a 50 percent reduction in their mortality levels.

"Vitamin C coming from fruits and vegetables is the important thing. It may be that other components in fruits and vegetables are also protective," researchers reported.  Investigators were uncertain if vitamin C supplements were as beneficial as the plant sources.

The researchers concluded that consuming the equivalent to 50g of fruits and vegetables was linked with a 20 percent decrease in the risk of death.

Tidbits of Trivia-with a Bit of Humor

Carlin's Questions

Only comedian George Carlin could think of such questions; See what you think as you consider the following:
If a parsley farmer is sued, can they garnish his wages?
Would a fly without wings be called a walk?
If the police arrest a mime, do they tell him he has the right to remain silent?
Why do they put Braille on the drive-through bank machines?
How do they get the deer to cross at that yellow road sign?
Is it true that cannibals don't eat clowns because they taste funny?
What was the best thing before sliced bread?
One nice thing about egotists: they don't talk about other people.
How is it possible to have a civil war?
If one synchronized swimmer drowns, do the rest drown too?
If you try to fail, and succeed, which have you done?
Why is the alphabet in that order? Is it because of that song?

Web Sites of Possible Interest

Online Learning
http://www.utorials.com/

There's so much to know and so little time to learn at all. If you want to learn how to play a game, build a shelf, or write computer code, but don't know where to look to find the answers, Utorials is a
good place to start. A peer-to-peer site, Utorials lets you post your knowledge and experiences on the site, learn from other postings, and rate the postings you encounter. You can learn about buying a car, computers, and more. Learn from someone's hard-earned experience or just post some of your own.

Access Excellence
http://www.accessexcellence.org/

Part of the National Health Museum online (originally developed and launched by Genetech, Inc.), Access Excellence, designed for teachers, but useful for all, gives access to critical sources of new scientific information via the World Wide Web". Critical sections include news with a science update, interviews with researchers, and science news links), biotech (issues and ethics, applied biotech, a graphics gallery, careers, and a history of the biotech revolution), a resource center (math
and science, reference, health information, and teaching and student resources), activities (interactive games, mysteries, classroom activities, and exchanges with other classrooms), seminars, SciTalk discussions, and online projects. Teachers and parents may be interested in the 21st Century Classrooms page, with articles and resources on science-based learning and the use of technology in class.

Science with a Creative Edge
http://brembs.net/

Work your way around home page's Roman numerals to navigate the categories at this site. Each section is designed differently and the design is almost as much fun as the contents. Learning and memory, evolution, metabiology, as well as some lighter topics jostle together here, cheek by jowl as they say. Imaginatively designed pages add to the fun of what is at heart serious work. The easiest stuff here is at the Scientific American level and some of it is considerably more
challenging.

Quotable Quotes           

"Laughter and tears are both responses to frustration and exhaustion.... I myself prefer to laugh, since there is less cleaning up to do afterward."
Kurt Vonnegut, Jr.

"It's inexcusable for scientists to torture animals; let them make their experiments on journalists and politicians."
Henrik Ibsen

From Earl Warren, late Chief Justice, US Supreme Court:

"I always turn to the sports page first, which records people's accomplishments. The front page has nothing but man's failures."

"Everything that I did in life that was worthwhile I caught hell for."

ERDOCS e-mail group (listserv)

As a Clinician providing acute and emergency medical care, you are invited to visit and participate in our new ERDOCS group at eGroups, a free, easy-to-use email group service! You have plenty of experiences to share, questions to ask, concerns and opinions to voice, suggestions, news to post, tips to offer, etc. and can do so within this framework. this is a versatile system for posting things to be sent to a group to peruse, respond to, or simply be aware of. It eliminates conventional mail delays and allows you to review and post at your leisure. (We still have the more open-ended [any visitor can observe/post] discussion group at the ACUTE CARE, INC. web site). Our goal is to give you a variety of feedback and communication tools.

The manager/moderator for this ERDOCS egroup is the webmaster for the ACUTE CARE, INC. website (www.acutecare.com), Paul Hudson. You can subscribe by sending an e-mail indicating your wish to be included to Paul at paul@acutecare.com

As this site grows, it will feature news, calendars, links to references, resources, and other useful features. We hope you will support this effort to foster ongoing communication amongst EM providers.