Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Morgan BW[original query] |
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Circumstances involved in unsupervised solid dose medication exposures among young children
Agarwal M , Lovegrove MC , Geller RJ , Pomerleau AC , Sapiano MRP , Weidle NJ , Morgan BW , Budnitz DS . J Pediatr 2020 219 188-195 e6 OBJECTIVE: To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention. STUDY DESIGN: From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children </=5 years. Study participants answered contextually directed questions about exposure circumstances. RESULTS: Sixty-two percent of eligible callers participated. Among 4496 participants, 71.6% of SDM exposures involved children aged </=2 years; 33.8% involved only prescription medications, 32.8% involved only over-the-counter (OTC) products that require child-resistant packaging, and 29.9% involved >/=1 OTC product that does not require child-resistant packaging. More than one-half of exposures (51.5%) involving prescription medications involved children accessing medications that had previously been removed from original packaging, compared with 20.8% of exposures involving OTC products (aOR, 3.39; 95% CI, 2.87-4.00). Attention deficit hyperactivity disorder medications (49.3%) and opioids (42.6%) were often not in any container when accessed; anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic agents (30.8%) were often transferred to alternate containers. Grandparents' medications were involved in 30.7% of prescription medication exposures, but only 7.8% of OTC product exposures (aOR, 3.99; 95% CI, 3.26-4.87). CONCLUSIONS: Efforts to reduce pediatric SDM exposures should also address exposures in which adults, rather than children, remove medications from child-resistant packaging. Packaging/storage innovations designed to encourage adults to keep products within child-resistant packaging and specific educational messages could be targeted based on common exposure circumstances, medication classes, and medication intended recipients. |
Case files of the Emory University Medical Toxicology Fellowship: inhalational mercury toxicity from a traditional Vietnamese product
Pandalai SL , Morgan BW . J Med Toxicol 2011 7 (4) 295-305 A 41-year-old woman attempted to treat her sinus congestion with a complementary and alternative medicine (CAM) product consisting of dime-size white pellets originally purchased in Vietnam by a family member who brought it with her to the USA. The remedy was obtained from one of her relatives who stated that treatment with these pellets had alleviated similar symptoms of other persons from her hometown in Vietnam. The patient was advised to heat the pellets on an electric stove for 2–3 days at various times, and inhale the fumes that were produced. After using the product for 2 days, she developed generalized malaise, dry skin, and poor appetite. She was later informed by a family member in Vietnam that the remedy may contain mercury and lead. She presented to her primary care clinic for metal testing, where initial total blood mercury (organic plus inorganic) and total blood lead concentrations were found to be 409 μg/L (normal, ≤10 μg/L) and 1 μg/L (normal, <10 μg/L), respectively. Her physician advised her to discontinue this treatment and was subsequently referred to the authors’ toxicology clinic. | The patient’s initial evaluation in our toxicology clinic was approximately 4 weeks after her initial exposure to the CAM product, and she continued to describe overall malaise and dry skin. She also complained of depressed mood and poor appetite. On physical examination, the patient was in no distress and her vital signs included a temperature of 36.9°C, heart rate of 109 beats per minute, blood pressure of 125/81 mmHg, and respiratory rate of 18 breaths per minute. Her oral exam showed mild erythema of the tongue, but no evidence of gingivostomatitis (which may occur with mercury toxicity). Her mini-mental status examination including orientation to person, place, time, attention, immediate and delayed recall, naming, repetition, reading, writing and copying was normal. She was able to follow a three-stage command with no difficulty. No other abnormalities were noted on the remainder of her neurological examination, which included gross cranial nerve testing, deep tendon reflexes, muscle strength, gait, cerebellar function, and sensation to pin-prick testing. Her skin exam was notable for generalized dryness of the extremities. |
Public health partnerships in medical toxicology education and practice
Schier JG , Rubin C , Schwartz MD , Thomas JD , Geller RJ , Morgan BW , McGeehin MA , Frumkin H . Am J Prev Med 2010 38 (6) 667-74 In December 2002, the medical toxicology sub-board, which consists of representatives from emergency medicine, preventive medicine, and pediatrics, released revised core content for medical toxicology, aiming to better meet the academic challenges imposed by the continually expanding knowledge base of medical toxicology. These challenges included the addition of relatively new areas of interest in medical toxicology, including population health, while simultaneously ensuring that a structural framework existed to accommodate future areas of interest. There is no evidence readily available to assess how well the educational curricula of existing fellowship programs are meeting these needs. In an effort to address this, the authors describe a medical toxicology fellowship program that consists of a partnership among the Emory University School of Medicine, the Georgia Poison Control Center, and the CDC, as well as the results of a reorganization of its academic curriculum that occurred in 2006. To the best of the authors' knowledge, this is the first published report describing such a curriculum redesign. Suggestions and potential resources proposed as enhancements for the public health-associated education of medical toxicology fellows are discussed. The authors also seek to initiate a discussion among programs about how to optimally meet the new challenges developed by the medical toxicology sub-board. |
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