Nina Fokter

The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty

BackgroundAdverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study.MethodsThe study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study.ResultsThe established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the departments specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria.ConclusionADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients.

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix

To evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix.

New International federation of gynecology and obstetrics (FIGO) staging system of gynecological cancers

Background: The revised FIGO staging system for carcinoma of the vulva, cervix uteri, and endometrium, which had been previously revised in 1988, 1994, and 1988, respectively, was approved by the International Federation of Gynecology and Obstetrics (FIGO) in September 2008. In addition to the revisions of previously existing staging systems, a new staging system for uterine sarcomas was introduced at the same time. Conclusions: The changes mostly addressed the prognostic disproportions between certain (sub) stages that had been shown in numerous statistical analyses. Vulvar cancer staging has undergone the greatest changes.

Hip Fracture in the Elderly: Partial or Total Arthroplasty?

The growing number of femoral neck fractures will have a large impact on health economics of developed countries in the coming decades. Great numbers of patients are already hospitalised yearly due to femoral neck fractures. These numbers are expected to augment importantly in the future years as the life expectancy and osteoporosis incidence increase in the ageing population. In the past, conservation of femoral head was supposed to be the ideal treatment for dislocated femoral neck fractures. However, conservation of femoral head with internal fixation has shown a high incidence of aseptic necrosis and non-union. Therefore, this treatment is now mostly applied to younger patients without osteoporosis and arthritis. In this chapter we review the topic of management of displaced femoral neck fractures in the elderly from a historical, surgical, and economical perspective. The emphasis is placed on the treatment rationale, surgical technique, and long-term clinical results. The authors’ preferred choice of treatment of these sometimes difficult cases is also presented and illustrated.