Medical Inspection – Health Blog

Survey of Current BC Residency Coordinators

The coordinators of the 2004 BC residency programs were also surveyed by e-mail. A total of 8 coordinators (representing the 6 BC programs in operation at the time) were surveyed. The survey consisted of 17 multiple-choice questions. It solicited demographic information such as current job title, practice setting (teaching or nonteaching hospital), years of experience as a program coordinator, whether the pharmacy department trained undergraduate students during the residency year, whether any learning sessions conducted by pharmacists involved both undergraduate students and residents, and the department’s perceptions on training residents as preceptors.

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Survey of Recent Graduates of the British Columbia Residency Program

A written survey was sent to pharmacists who had recently graduated from the British Columbia Residency Program. The Faculty of Pharmaceutical Sciences at the University of British Columbia (UBC) assisted in compiling the names and e-mail addresses of pharmacists who had completed a residency in British Columbia in 2002, 2003, or 2004. A total of 55 graduates of the 6 residency programs offered in British Columbia during that period were identified and contacted by e-mail. The e-mail correspondence consisted of a letter describing the purpose of the survey and inviting participation. At 2 and 4 weeks after the initial e-mail distribution, a follow-up message was sent to those who had not responded, indicating that their responses had not yet been received and that their input would be valuable and requesting a response.

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INTRODUCTION

In 2003, Moy and Musing reported the results of a sur­vey of 137 pharmacists who had recently graduated from Canadian hospital pharmacy residency programs. The survey was designed as a learning needs assessment of the pharmacy practice residency from the perspective of recent residents, to determine if the program was meeting their needs. The results of the survey provided valuable information and revealed strong resident satisfaction with the program. However, in that study, as well as in previous studies of US-based pharmacy residency programs, residents identified teaching skills as an area they wished to develop through more exposure and practice.

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To the authors’ knowledge, this study represents the largest case series on the use of IV ethanol therapy for the management of methanol or ethylene glycol poisoning. Despite difficulty in achieving target serum ethanol concentrations, treatment with IV ethanol therapy and hemodialysis was associated with favourable patient outcomes. Of the 27 patients, 25 (93%) survived, and the 2 deaths occurred in patients with evidence of severe central nervous system damage who presented late after ingestion. Only one patient was discharged with renal dysfunction induced by ethylene glycol, and this patient may have had pre-existing kidney disease. No visual disturbances associated with methanol were reported.

Brent and others recently published 2 case series describing the results of treatment of methanol and ethylene glycol poisoning with fomepizole. The patient characteristics in those studies, including demographic characteristics, severity of intoxication, and use of hemodialysis, were similar to those in the study reported here. The outcomes of treatment were also similar. Among patients with ethylene glycol poisoning, 1 (9%) of 11 in the current series and 3 (16%) of 19 patients in one of the fomepizole studies were discharged with elevated serum creatinine concentration. Overall survival was 93% in the current study and 90% (27/30) in the 2 fomepizole studies.

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Adverse Effects

Because this was a retrospective study that depended on information available in the medical record, the incidence of hypoglycemia was the only adverse effect evaluated. Of the 162 serum glucose determinations during the IV ethanol infusions, none had a value below 4 mmol/L.

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Of 32 cases of potential methanol or ethylene glycol poisoning that were identified, 5 patients were excluded for the following reasons: 2 patients with confirmed ingestion had received ethanol infusions of less than 6 h duration; for 2 patients there was insufficient documentation of the initiation and discontinuation times of the ethanol infusion, which made it impossible to accurately assess treatment duration; and 1 patient did not meet the laboratory- based entry criteria (serum methanol concentration undetectable, arterial pH 7.34, serum bicarbonate concentration 15.8 mmol/L, and osmolal gap 6 mmol/kg). All of the excluded patients survived, and 4 did not experience any visual disturbances or renal dysfunction. One excluded patient (who had ethylene glycol poisoning) experienced an elevation in serum creatinine concentration, from 109 pmol/L on admission to 571 pmol/L on discharge. This patient presented with severe acidosis (pH 7.08) and serum ethylene glycol concentration of 3 mmol/L, which suggested a substantial delay between ingestion and presentation. One patient had ingested methanol and ethylene glycol simultaneously; this patient’s baseline characteristics were included in the analyses for both groups, but were counted only once in the analysis of the overall group and the ethanol administration data.

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Experimental Design

For this retrospective study, patients admitted to The Ottawa Hospital—General Campus, an adult tertiary-care hospital, for methanol or ethylene glycol poisoning between January 1995 and February 2002 were identified by screening the hospital’s medical records for specified codes from the International Classification of Diseases, 9th revision, and their medical records were reviewed. The study was approved by the Research Ethics Board of The Ottawa Hospital.

Patients

Patients were defined as having methanol poisoning if they had an initial serum concentration of methanol of at least 6.2 mmol/L or 2 of the following laboratory findings: arterial pH less than 7.3, serum bicarbonate concentration less than 20 mmol/L, or serum osmolal gap greater than 10 mmol/kg.

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