EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.

This article presents the results of a qualitative study examining how social stigmatization made the lives of young people in gay and lesbian stepfamilies more complex. The study focused primarily on the young people's viewpoint, which has until now rarely been taken into consideration in studies of gay and lesbian families. Eleven semi-structured interviews were conducted with adolescents and young adults from 15 to 29 years old. The results showed that these young people experienced social stigmatization because of the family they lived in, which in turn had repercussions on their personal, family, and interpersonal lives.

Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug-related events (ADREs) in elder patients presenting to the emergency department (ED). Methods: This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review. Results: A total of 161 patients were enrolled in the study. Thirty-seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class. Conclusions: EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed. Key words: emergency department; adverse drug-related events; drug-related morbidity; physician performance. ACADEMIC EMERGENCY MEDICINE 2005; 12:197-205. Adverse drug-related events (ADREs) are unfavorable medical events related to the use and misuse of overthe-counter and prescription medications. ADREs have emerged as important health risks, especially in elders, who tend to consume the most medications. ADREs may account for up to 28% of emergency department (ED) visits 1-3 and 30% of hospital admissions 4-6 and significantly inflate hospital expenditures. In 1998, ADREs were identified as the sixth leading cause of in-hospital mortality in the United States. 7,8 In an attempt to reduce drug-related morbidity and mortality, researchers have begun to study clinicians' ability to detect and treat ADREs. Large-scale studies have shown that clinicians taking care of inpatients detect only 5%-15% of drug-related events in hospitals without systematic surveillance systems.9,10 In contrast, reports from intensive care settings indicate that the presence of a pharmacist on rounds decreases the rate of preventable ADREs by helping intercept errors as well as unrecognized events.11 These studies have served as the basis for justifying the cost of a pharmacist present on intensive care unit and medical ward rounds in many institutions.The few published studies that have documented the significance of ADREs in the ED setting 1-3,12 have not

Second marriages are known to be more fragile than first marriages. To better understand the factors that contribute to this fragility, this qualitative study compared stepfamilies that stayed together with those that separated by collecting interview data from one adult in each of the former (n = 31) and latter (n = 26) stepfamilies. Data were analyzed using a general inductive approach. The analysis allowed us to identify key processes that contributed to stepfamilies staying intact or breaking up. We found that the way in which families approached problems and the strategies they employed had more influence on stepfamily survival than the nature, number, or intensity of these problems. We also outlined the role of certain elements related to family context, such as the custody of children from former unions, intrafamily communication, and each person's particular characteristics. With regard to practitioner intervention, the results highlight the importance of examining the way in which couples deal with their problems, the strategies they employ, and the effectiveness of the strategies.In the United States, it is estimated that more than two thirds of women and three quarters

Prescription psychostimulant use among young adults is anchored in contemporary normativity and cannot be separated from the developing performance ethic within North-American and other Western societies. We suggest that pharmaceuticalization and Actor-Network Theory are useful conceptual tools to frame future research efforts.