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Regardless of health care utilization, a majority of respondents want full disclosure of medical error and wish to be informed of error immediately upon its detection. Respondents support reporting of errors to government agencies, the state medical board, and hospital committees focused on patient safety. Teaching physicians error disclosure techniques, honesty, and compassion were endorsed as a priority for educators who teach error management.

Introduction Annually, 500,000 episodes of alcohol withdrawal syndrome (AWS) are severe enough to require clinical attention. A symptom-triggered lorazepam regimen remains the standard of care for the management of hospitalized AWS patients. However, phenobarbital has also been shown to be an effective adjunctive therapy for severe AWS, reducing benzodiazepine use in the emergency department (ED) and the intensive care unit (ICU). The purpose of this study is to compare hospital length of stay (LOS) for AWS patients using phenobarbital-based versus lorazepam-based treatment protocols as monotherapy for management of AWS on general medical units. Methods This is a retrospective cohort study over a two-year period (March, 2016 to March, 2018), conducted at three hospitals within the St. Joseph Mercy Health System. We included 606 patients with a primary diagnosis of AWS or alcohol intoxication who met our inclusion criteria (543 in the lorazepam cohort and 63 in the phenobarbital cohort). Adjusted comparisons were done using propensity scoring methods. Hospital LOS was set as the primary outcome. Secondary outcomes included all-cause 30-day readmission, alcohol-related 30-day readmission, 30-day ED visits after discharge, and need for ICU transfer during hospital stay. Results Patients who received phenobarbital had a statistically significant shorter hospital LOS as compared to patients who received lorazepam (2.8 versus 3.6 days, P < 0.001). Furthermore, the phenobarbital treatment group had statistically significant lower rates of all-cause 30-day readmission (11.11% versus 14.18%, P = 0.020) and 30-day ED visits after discharge (11.11% versus 18.6%, P = 0.015). No statistical significance was detected for alcohol-related 30-day readmission and the need for ICU transfer between the treatment groups. Conclusion This study suggests that phenobarbital may be a reasonable alternative to lorazepam in the management of AWS patients admitted to general medical units. Larger scale, well-executed, and adequately powered prospective studies and randomized controlled trials are needed to corroborate these findings.

In 1974 a questionnaire was mailed to the nation's local health officers. Responses were received from 1,345, at least 68 per cent of all local health departments. The present paper presents selected summary data from respondents concerning the health departments, their jurisdictions, organization, finance, functions, staffing, and about the training, salaries, and other characteristics of local health officers.Health departments are extensively involved in rendering health services, including direct personal Current data about local health departments are not readily available. In 1966 a survey questionnaire was conducted of all local health units, and from that survey a report on their medical care activities was published in 1968.1 The Department of Health, Education, and Welfare once maintained a registry of local health departments but this was abandoned after 1971.Interest in the real or potential roles for local health departments has increased. Published reports have emphasized the importance of local governments and their health departments with regard to health planning, monitoring and regulation of health services, provision of personal health care, maintenance of community health services, and other functions.2-6 These reports with few exceptions have focused on policy analysis that has not benefited from up-to-date data on the actual structure and function of local health departments. MethodIn 1973 a group of investigators associated with the University of North Carolina developed plans for a study of lo- Addressees: For purposes of addressing and mailing the questionnaires, the rosters that were provided by the state health departments were used. The rosters presented difficulties in several states where many hundreds of "local health officers" were listed. Further inquiry revealed that the title "local health officer" in these states was conferred on physicians in private practice as well as non-professional persons in order to honor their functions in reporting vital statistics. The titles in these instances have nothing to do with authority over an administrative or service unit that is traditionally regarded as a local health department. In states where the number of local health officers exceeded 200 a spe-*Available on request to authors.

[940][941][942][943][944][945] 1977) sibilities to state health agencies, which may be empowered to write regulations that further delegate these responsibilities to local health agencies; statutes that grant powers to other governmental units, especially at the local level such as county governments, which then enact regulations that define the work of local health agencies; appropriations that carry authorizations through any of the previously identified channels. Developing a full understanding of the scope of responsibilities and authorizations that are granted to any local health agency through all of these processes would be an awesome undertaking. Not surprisingly, data are not available that enable generalizations to be made about the authorizations for all local health departments.This report presents data on the authorizations that are granted to local health departments through only one of the processes of delegation: state statutes that specifically designate local health departments and are identifiable in the portions of statute books that are codified in health or public health chapters.A previous paper in this series reviewed the services that are rendered by local health departments as reported by about two-thirds of the nation's local health officers.2 The present report seeks to examine the nature and scope of services that the nation's local health departments are authorized to render by the various tates' health codes and statutes. A comparison is made between what local health departments are authorized to do, and what they are in fact reported to be doing with relation to selected personal health services.