Highlights of this issue [CMAJ - November 16, 1999]

Highlights of this issue

CMAJ 1999;161:1225

Violence in the emergency department

Violence in the emergency department: a survey of health care workers [Evidence]

Abuse of emergency department workers: An inherent career risk or a barometer of the evolving health care system? [Editorial]

Christopher Fernandes and colleagues surveyed emergency department employees working at a hospital in downtown Vancouver in 1996 to obtain estimates of the extent and effects of violence in their workplace. Ninety percent of the 106 respondents reported experiencing verbal abuse at least once a week, and 57% reported experiencing physical assault in 1996. The occupations with the highest proportion of respondents experiencing physical assault were nurses and protection services personnel. As a result of violence in the emergency department 73% reported some fear of patients and 38% had considered a job outside of health care. Because victims sought support most often from colleagues, the acquisition of debriefing skills by emergency department staff is recommended. In an accompanying editorial Laurie Morrison considers strategies to dowse this "emotional fire."

Paramedic response to DNR requests

Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma [Evidence]

Dignified death or legislated resuscitation? [Editorial]

Ontario paramedics are bound by a duty to initiate aggressive life-support measures when responding to 9-1-1 cardiac arrest calls; however, this duty may conflict with the expressed wishes of patients with terminal illnesses. Veena Guru and colleagues reviewed the ambulance call reports of 144 terminally ill patients who were experiencing cardiac arrest. In 34 of those cases paramedics did not follow the regulations mandating resuscitation; although the presence (90 [62.5%] of the 144 patients) or absence of a do-not-resuscitate (DNR) request did not appear to influence the decision to resuscitate, paramedics were more likely to withhold full advanced cardiac life support in the presence of a DNR request. In their commentary Grant Innes and Karen Wanger find fault with physicians who fail to educate patients and their families about these issues and discuss the policy of the British Columbia Ambulance Service to honour a valid DNR form.

Intraoperative MRI: a moving magnet

Intraoperative MRI: a moving magnet [Education]

Magnetic resonance imaging (MRI) scanners generate exquisitely detailed images of the anatomy and pathology of the brain and spinal cord. Garnette Sutherland and Deon Louw describe the advent of intraoperative MRI scanners and the potential for minimalist surgery with maximum technical outcome. Although expensive ($23 million), costs can be offset by using the equipment for conventional diagnostic imaging when it is not required in the neurosurgical operating room. The authors predict that within a decade intraoperative MRI will become the standard of care in neurosurgery.

Statins and myopathy

Drug interactions and the statins [Education]
Drugdrug interactions: How scared should we be? [Editorial]

The incidence of muscle disorders (e.g., myopathy and rhabdomyolysis) can increase 10-fold when statins are combined with certain other drugs. Robert Herman provides a helpful review of the literature and the pharmacology of statins. Caution is warranted with lovastatin and simvastatin in particular because of their propensity toward a marked elevation in concentration if they are taken with a drug that inhibits first-pass metabolism. Lori Shapiro and Neil Shear discuss the role of the prescribing physician in detecting and reporting drug interactions and toxicities.