JAMA : the journal of the American Medical Association
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A population-based case-control study of soft-tissue sarcoma (STS), Hodgkin's disease (HD), and non-Hodgkin's lymphoma (NHL) in Kansas found farm herbicide use to be associated with NHL (odds ratio [OR], 1.6; 95% confidence interval [CI], 0.9, 2.6). Relative risk of NHL increased significantly with number of days of herbicide exposure per year and latency. Men exposed to herbicides more than 20 days per year had a sixfold increased risk of NHL (OR, 6.0; 95% CI, 1.9, 19.5) relative to nonfarmers. ⋯ Neither STS nor HD was associated with pesticide exposure. This study confirms the reports from Sweden and several US states that NHL is associated with farm herbicide use, especially phenoxyacetic acids. It does not confirm the case-control studies or the cohort studies of pesticide manufacturers and Vietnam veterans linking herbicides to STS or HD.
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Medical control is an essential component of a prehospital care system. It is a method of ensuring quality and accountability of the care provided and thus provides a method of risk management for the system. Politicians, fire departments, ambulance companies, physicians, and others are struggling for control of prehospital emergency care. ⋯ Medical control includes three phases: prospective, immediate, and retrospective. The incorporation of medical control in a specific EMS system will be dependent on that system's characteristics; nevertheless, proper medical control is essential to ensure a high quality of prehospital care. Further studies will be necessary to evaluate medical control and determine the best mechanism for providing quality assurance in prehospital care.
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As part of a major patient safety/risk management effort, the Department of Anaesthesia of Harvard Medical School, Boston, has devised specific, detailed, mandatory standards for minimal patient monitoring during anesthesia at its nine component teaching hospitals. Such standards have not previously existed, and resistance to the concept was anticipated but not seen. ⋯ Early detection of untoward trends or events during anesthesia will result in prevention or mitigation of patient injury; this, in turn, may also help counter the explosive increases in anesthesia-related malpractice actions, settlements, judgments, and insurance premiums. The committee process used is applicable to the promulgation of standards of practice for all medical specialties and any organized group of medical practitioners.