JAMA : the journal of the American Medical Association
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To determine incidence and outcome of reentry into anesthesiology training programs by residents with histories of substance abuse, a survey was sent to the 159 US anesthesiology training programs. One hundred thirteen (71%) responded, with 82 (73%) submitting at least one case report of substance abuse. A total of 180 case reports were submitted, including 26 in which the resident died as a result of substance abuse. ⋯ There were 14 cases of suicide or lethal overdose among trainees who were allowed to reenter anesthesiology training. Death as the initial relapse symptom occurred in 16% (13/79) of the parenteral opioid abusers who were allowed to reenter anesthesiology training. This study suggests that drug rehabilitation followed by redirection into another specialty may be the most prudent course for the anesthesiology trainee who abuses parenteral opioids.
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Comparative Study
Frequency of hypomagnesemia and hypermagnesemia. Requested vs routine.
This study was designed to assess the effectiveness of identifying serum magnesium abnormalities by comparing physician-initiated requests for this analyte with routine magnesium determinations. Because magnesium abnormalities frequently accompany other electrolyte abnormalities, we measured magnesium in 1033 serum specimens submitted for electrolyte analyses. Physician-initiated requests for magnesium measurements were received for 81 (7.4%) of these specimens. ⋯ Only 10% of the hypomagnesemic patients (48/487) and 13% of the hypermagnesemic patients (7/59) were identified by physician-initiated requests for this analyte. Fifty-three patients were both hypomagnesemic/hypokalemic and 30 patients were both hypomagnesemic/hyponatremic, but only 8 (15%) and 3 (10%), respectively, had physician-initiated requests for magnesium. Because magnesium abnormalities in significant numbers of patients are not being detected, we recommend routine measurement of this analyte when analyses of electrolytes are required for the care of patients.