Medical Inspection – Health Blog

Oral squamous cell carcinoma (OSCC) is a com­mon cancer whose significant risk factors are smoking, alcohol, betel quid use, sun exposure and immunosuppression. Recently many researchers have suggested that HPV infection is a causative factor of OSCC. While it is well known that HPV infec­tion is a significant risk factor for cervical cancer, its relationship with oral malignant tumors has not been fully characterized yet. In 1985, de Villier first detected HPV DNA in oral carcinoma, and many studies have confirmed this finding. A review of articles from 1982 to 1997 showed that the detection rate of HPV in OSCC was up to 46.5%. The most frequently detected types were HPV 16 and 18, suggesting an important role for these viruses in malignant transformation. Other various types of HPV were detected in oral cancers, although their detection rates were much lower than those of HPV- 16 and 18.

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CASE REPORT

A 77-year old Korean man presented with a fungating mass on the right aspect of his lower lip, which had been growing for 5 months. He was a non-smoker, with no history of alcohol consumption, betel quid use or excessive sun exposure. His past medical history was significant for prostate cancer and transurethral resection without additional ad­juvant chemotherapy six months before. At that time, he was also found to have latent syphilis and treated with penicillin. Read More…

Previous work suggests that prescription data­bases are an accurate means of identifying drugs dispensed to individual patients. One study has demonstrated good agreement between computerized prescription records and written prescription records from a medical clinic. Information in prescription databases is also similar to that obtained from self-administered medication-history questionnaires. However, previous work suggests that medication histories documented in hospital records are often inaccurate. Beers and others reported that 83% of medication histories recorded for persons over the age of 65 years had at least one error when compared with information obtained during a structured interview. The results presented here suggest that the completeness of medication-history information varies with the profession of the person recording the information. The pharmacists’ monitoring form, which was not a part of the health care record at St Paul’s Hospital, included the highest proportion of medications taken before admission, according to the definition used in this study, regardless of whether PharmaNet was reviewed.

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The results of the current study suggest that pharmacists may obtain more complete histories of a patient’s use of prescription medication than other health care workers. However, because the variability in the data was large, the difference was not statistically significant. Since taking medication histories is a focus of pharmaceutical care, pharmacists may spend more time obtaining medication information than other health care professionals. Also, pharmacists likely have a broader knowledge of available pharmacy products, which enables them to pose more specific drug-related questions during a patient interview.

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Of the charts for 52 patients randomly selected from the Medical Records Department list, 22 (42%) patients were seen by a clinical pharmacist during their admis­sion, and medication-history information for 6 (27%) of these 22 patients was obtained from PharmaNet.

From the charts for 66 patients in total (52 from the hospital’s Medical Records Department and 14 from the Pharmacy Department’s list), charts for 11 were excluded because there was no evidence of any prescription medications taken before admission. This left a total of 55 charts for analysis: 19 for patients who were not seen by a clinical pharmacist, 18 for patients who were seen by a clinical pharmacist and for whom no PharmaNet review was carried out, and 18 for patients who were seen by a clinical pharmacist and for whom a PharmaNet review had been conducted. The mean age of these 55 patients was 75 ±8 years, and the mean duration of their hospital stay was 13.2 ± 12.5 days. The majority (69%, 38/55 patients) of patients were male. Of those for whom a PharmaNet review was conducted, the mean time after admission until PharmaNet was accessed was 3.8 ±4.5 days.

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This study was carried out at St Paul’s Hospital in Vancouver, British Columbia, a 500-bed teaching institution, with 48 of these beds allocated to general medicine and another 11 to geriatric medicine. A list of patients over the age of 65 years admitted to St Paul’s Hospital for at least 3 days between November 1, 1999, and February 28, 2000, was generated by the hospital’s Medical Records Department. From the 1200 names on the list, patients were randomly chosen and a chart review carried out as described below.

After 52 charts had been completed, only 6 involved cases in which pharmacists had used PharmaNet to obtain medication-history information. To obtain more data about PharmaNet use, additional charts were randomly selected from a list of patients maintained by the Pharmacy Department that included only cases for which PharmaNet was used. Inclusion criteria were the same as those outlined above. Fourteen additional charts were selected for review in this manner. The sample size of 52 charts selected for the Medical Records Department list, plus 14 charts selected from thePharmacy Department list, was based on the time the pharmacy resident had available to complete the chart review. At this point, charts in which there was no evidence of patients taking medications before admission to hospital were excluded from the analysis.

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INTRODUCTION

To prescribe safely, physicians must know which medications their patients are using. However, medication histories documented in hospital medical records are often inaccurate, and these inaccuracies may be the source of drug-related problems. Since most adverse drug events are avoidable, their prevention has become a high priority for health care professionals.

Because advancing age increases the risk of chronic illness, geriatric patients are more likely to require drug treatment and often require more medications than younger patients. The greater use of medications is a risk factor for inaccurate documentation of medication history, which is reflected in the frequency with which errors are found in elderly patients’ hospital records. Further, it is well documented that seniors are at higher risk for adverse drug events. Up to 19% of hospital admissions of older people in Canada are the result of drug-related adverse patient events. As many as 15% of hospitalized elderly patients experience preventable adverse drug events.

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