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Cases & Commentaries: SEPTEMBER 2008

Medicine

Pediatrics

Medicine

	Delirium or Dementia? SPOTLIGHT CASE An elderly woman hospitalized for pneumonia becomes disoriented during hospitalization. Even though the patient was never confused at baseline, doctors attribute it to "senile dementia" and place her in restraints.
	Commentary by James L. Rudolph, MD, SM
	CME/CEU available

	Vial Mistakes Involving Heparin Hospitalized for an elective procedure, a patient is given heparin in an incorrect concentration—off by a factor of 100.
	Commentary by Tim Vanderveen, PharmD, MS

	Missing Trauma After an hour of failed resuscitative efforts, a woman who collapsed in a market is pronounced dead in the emergency department (ED). Only later do the paramedics and physician discover a small bullet in the patient's chest.
	Commentary by Gregory J. Jurkovich, MD


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Perspectives on Safety

	This month: The Business Case for Improving Safety

	•	In Conversation with... William B. Weeks, MD, MBA Listen to podcast (.MP3 \| 3.6 MB \| 7:52)

	•	Patient Safety: A Perspective from Office Practice Richard J. Baron, MD

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Patient Safety Network

What's New: Study presents new conceptual model for patient safety in ambulatory chronic disease care.

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Did You Know?

Disruptive behaviours

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