Virtua Memorial Hospital

Therapeutic hypothermia appears to be effective in limiting the trauma resulting from ischemia as well as reducing reperfusion injury.

Babesiosis has not been previously associated with spontaneous splenic rupture. We describe an otherwise healthy 61-year-old man with symptomatic babesiosis whose spleen ruptured during hospitalization. Although this complication is rare, practitioners who commonly treat patients with babesiosis should be aware of its potential occurrence.

In Brief Review the recommendations for emergency cardiovascular care during special circumstances.

Clinical nurse specialists use a variety of preexisting instruments to measure and describe health-related concepts. It is important for clinical nurse specialists to know how to evaluate the content validity of potentially useful instruments. This study assessed the content validity of the Institute for Safe Medication Practice's Medication Error Worksheet. The worksheet is used as a questioning framework to guide data collection processes when beginning analysis of a medication error. Although the worksheet has been valuable to the Institute for Safe Medication Practice staff, its content validity has not been determined. Content validity methods included expert validation and a review of the related literature. Results support the validity of the Medication Error Worksheet and suggest that this worksheet is a comprehensive tool that may be helpful when exploring the circumstances of medication errors and when analyzing medication use systems. Results were shared with the Institute for Safe Medication Practice staff to improve the accuracy of the worksheet.

Gemcitabine has recently been compared favorably to 5-fluorouracil (5-FU) as the standard chemotherapy for advanced pancreas cancer. Based on phase I data that combining gemcitabine with 5-FU is safe and has evidence for clinical activity, a phase II trial was conducted by the Eastern Cooperative Oncology Group (ECOG). Patients with metastatic disease, good performance status and organ function were eligible and enrolled after providing informed consent. Patients were given gemcitabine (1,000 mg/m²) followed by 5-FU (600 mg/m²) weekly for 3 weeks of every 4. Of 37 patients enrolled over a 3-month period, 36 were eligible. Partial responses were seen in 5 patients (14%). Median survival was 4.4 months with a 1-year survival rate of 8.6%. A randomized trial of the combination of 5-FU and gemcitabine versus gemcitabine alone is currently accruing patients in ECOG.

To the Editor: — The May 1989 issue of The Journal contained a letter from Dr. Bernstein that recorded a challenge to the geriatric community for the development of a plan to reeducate primary care physicians in outpatient assessment methods. As a family physician who has conducted a private practice after completing a fellowship in geriatrics, I understand Dr. Bernstein's concerns. Practicing clinicians need to understand that there is nothing “magical” about a geriatric assessment. The process can easily be accomplished by gathering community-based resources in nursing, social work, physical therapy, et al. for a concerted effort. The evaluation of ADL function can be recorded by a paramedical observer/recorder. The physician's task becomes the coordination of services, delineation of biomedical, psychological, social, and functional problems, and the assignment of tasks to responsible parties on the team. Assessment primarily focuses on the impact of comorbidity on function. A wonderful team could be assembled within the office if one could recruit a core team of committed members and a source of financial support while Medicare deliberates on the reimbursement issues of geriatric assessment. Brief office visits with patients provide only a “slice in time” regarding their functional status; we must rely on other observers to gather data for us. A consultant geriatrician could both assist the family physician group in the assembly of such a program and also provide expertise on the physiological changes of aging and the integration of sound geriatric principles for the geriatric assessment program.