Volume 102, Issue 12

The purpose of this study was to explore the relationship between chronic mental illness, menstrual cycle phases, and psychiatric hospitalization. A detailed menstrual history was obtained from each participating subject. Women who were pregnant, postmenopausal, or who were prescribed hormonal contraception were excluded from the study. Factors precipitating admission, such as a suicide attempt, were identified. All women had a documented history of chronic mental illness, defined in this study as two prior psychiatric hospitalizations. Based on the menstrual history, the phase of the women's cycle at time of hospitalization was calculated. Diagnoses and the reasons for admission were correlated with the menstrual cycle phase. Thirty-three women participated in the study. Seventeen (52%) of those women were admitted during the late luteal/early menstrual phase. Women with schizophrenia whose behavior precipitating the admission was characterized as nonsuicidal and nonaggressive were admitted exclusively during the postovulatory phase. On the basis of findings of this study, the authors conclude that the postovulatory phase of the menstrual cycle may be a time of increased risk for women with chronic mental illness, especially schizophrenia. Prophylactic interventions might minimize admissions.

Although postoperative fever is common after major gynecologic surgery, the majority of patients have no identifiable infectious or pathologic etiology. Traditional management has been to delay hospital discharge until the patient is afebrile. The authors evaluate the outcome of patients discharged with postoperative fever after major gynecologic surgery. In a retrospective review of 537 women undergoing major gynecologic surgery, 211 (39%) had postoperative fever. The authors identified all patients who were discharged despite having a temperature of 38 degrees C or higher (> or = 100.4 degrees F) in the preceding 12 hours. All outpatient and inpatient records for a period of 30 days were reviewed. Thirty-eight (18%) of 211 patients who were febrile postoperatively were discharged despite having a fever within the preceding 12 hours. One patient was lost to follow-up. Two (5%) of 37 patients had a documented infection (one urinary tract infection and one postoperative wound infection). Four (11%) were readmitted within 30 days for noninfectious causes. None of the patients discharged on oral antibiotics had an antibiotic-related complication. Eighty-four percent of patients discharged with a postoperative fever did not have a documented infectious or pathologic cause for the fever while at home.

This article outlines the development of learning materials to educate osteopathic medical students about biological terrorism at the American Association of Colleges of Osteopathic Medicine (AACOM). The author then poses two questions that arose from this and concurrent AACOM projects and new technologic developments in medical education, regarding what colleges of osteopathic medicine teach and how they teach it.

The authors address the need for a better understanding of the reasons for greater indebtedness among today's osteopathic medical students. In May 2000, a survey was mailed to all 219 osteopathic interns at participating institutions in Michigan. The self-administered survey contained 19 questions designed to gather basic financial information, demographic characteristics, and subjective perceptions of student debt loads from participating interns. One hundred seventy completed surveys were returned, for a response rate of 78%. The authors attempted to focus on demographic predictors of debt and found that although there is no indication that such predictors have a significant effect on a student's total debt load, financial support from the student's family remains the single most important factor in predicting low levels of student debt. The authors suggest that the higher debt rate of students entering specialty fields may reflect the fact that students incur these debts with the knowledge that those debts will be more easily repaid once the student has begun to practice medicine.

The Institute of Medicine has reported that medication errors cause an estimated 7000 deaths annually. Additionally, drug-related adverse events increase the risk of mortality by 1.88, with approximately 27% of reported adverse drug events attributed to negligence. As the healthcare system is faced with the challenge of reducing medication errors and adverse drug events, one viable solution may be to increase physician-pharmacist collaboration. According to the recent literature, increasing physicianpharmacist collaboration may result in a reduction in total drug morbidity and mortality.

The authors report a case of a 65-year-old woman with small cell lung cancer who had profound, progressive lower extremity weakness, intermittent blurred vision, a dry mouth, and orthostatic hypotension. Results of laboratory and electrodiagnostic studies were consistent with the diagnosis of Lambert-Eaton myasthenic syndrome. The patient was treated with one course of intravenous immunoglobulin and had significant improvement.