Older people's experiences of changed medication appearance : a survey

This report details a survey of older people's experiences of changed medication appearance. The aims of the study were: • To develop a questionnaire in partnership with older people to survey older people’s views on fluctuating medication appearance • To elicit older people’s experiences of medication that changed appearance due to ‘generic prescribing’ and ‘parallel import’ practices and its impact on their medication taking practices. These common pharmacy practices mean that the same tablet medication can be issued to older people in different colours, sizes and shapes to their previous prescriptions. Older people from a local User/Carer Forum highlighted these problems to the research team and asked that we investigate to explore the extent of the problem. An eight-item questionnaire was developed and distributed to 2000 older people (50 years+) across participating PCTs in Greater Manchester in 2008. A 29% response rate was achieved. The data was analysed using the SPSS statistical package. Findings include: •63.3% experienced a change in the appearance of their tablet medications. •74.1% did not seek advice regarding the change in the appearance of their tablet medications. •Older people noted changes to the actual tablets, tablet packaging and written information that accompanies tablets. Changes are occurring to the colour, size and shape of tablets more than changes to packaging and written information. The majority of respondents had experienced changes in the appearance of their prescribed tablet medication in the previous two years which were not due to change in medication or dose etc. Worryingly, for some respondents, these changes prompted negative experiences such as anxiety, confusion and upset. Of particular concern was that a small number omitted the affected tablet medications and did not seek help or advice from GPs, pharmacists or relatives. Six older people have been study advisors from inception to dissemination of this study and significantly added to its quality. The study demonstrates substantive public engagement / user involvement in research. The findings suggest nurses and others have a role to play in promoting better medicines management and identifying those most at risk from changed appearance of medications

An interesting case of suicidal poisoning

Aconite is one of the most poisonous known herbs. It has been known to be used as a homicidal poison from long time in history. However this is rarely known to be used as suicidal poison. Poisoning with aconite is usually fatal and death commonly occurs due to arrhythmias and cardiotoxicity. We report a case of attempted suicidal poisoning by aconite where patient survived in spite of documented cardiotoxic effects of the poison

Costochondral Grafts in the treatment of Temporomandibular joint ankylosis: a Clinical Study

Background: Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic block (arthroplasty) without interposing any material (gap arthroplasty) or interpositional arthroplasty using autogenous or alloplastic materials. The objective of this paper was to note the potential of the costochondral graft (CCGs) as an interpositional material and to see whether they induce normal growth potential in the reconstructed mandible. Materials and method: The ankylosed temporomandibular joint was reached by a preauricular incision with or without angulation and exposed. In the first 4 cases, arthroplasty was done using a bur. The bony mass was detached of its muscle attachments and removed. In the 5th case, condylectomy was performed. In all cases, this was followed by immediate costochondral grafting. Results: The maximal incisal opening in the pre-operative period ranged from 0- 2mm and in the immediate post- operative period from 15- 20mm. at the end of the follow up period it ranged from 20- 35 mm. The increase in SNB angle, SND angle, ramus length and mandibular body length all showed linear growth of mandible on the side where costochondral grafting was done. Conclusion: The articular reconstruction with costochondral grafts for the treatment of TMJ ankylosis is efficient in relation to post- operative maximal incisal opening, recurrence and articular function