The British journal of general practice : the journal of the Royal College of General Practitioners
-
Methaemoglobinaemia may be caused by ingestion of a number of drugs, among them nitrites, some of which are remarkably toxic. This was tragically highlighted by the death of a 17 year old dental nurse after taking a single 1 g tablet of sodium nitrite. ⋯ The toxicity of this chemical should be more widely recognized and its storage made correspondingly more secure. Methaemoglobinaemia should be considered as a diagnosis in any patient with significant central cyanosis in whom there is no obvious cardiorespiratory cause.
-
A random sample of referral letters from general practitioners to outpatient departments of general medicine, dermatology, neurology, and gastroenterology at an Amsterdam teaching hospital were analysed together with the specialists' replies for 144 referrals. The pairs of letters were judged by a panel of four general practitioners and four specialists. ⋯ The judges were also asked to assess whether in their opinion the letters were of value in teaching or were discourteous. Though in general intraobserver agreement on what constitutes a good letter was low, deficiencies were revealed in the quality of letters and there were delays in transmission and missed educational opportunities.