Objectives To determine the incidence of hospital admissions for adverse events related to drug therapy, and to assess whether these drug‐related admissions (DRAs) could have been reasonably prevented. Setting A tertiary teaching hospital. Design and patients Prospective assessment of all admissions through the emergency department and resulting in a stay of more than 24 hours during 30 consecutive days in November and December 1994 to determine if the admission was related to drug therapy. Cases of intentional overdose were excluded. Main outcome measures The number, type, causality and avoidability of drug‐related admissions. Results Of 965 admissions, 55 (5.7%) were assessed as being drug‐related. Drug‐related admissions (DRAs) were designated possibly (38%), probably (46%) or definitely (16%) drug‐related; caused by prescribing factors (26%), patient noncompliance (27%) and adverse drug reactions (47%); and classified as definitely (5.5%), possibly (60.0%) and not (34.5%) avoidable. The estimated annual cost to the hospital for all DRAs was $3496956 and for unavoidable DRAs was $1629494. Conclusion The DRA rate we found lies around the middle of the range of other published rates. Few DRAs were judged definitely avoidable and over one‐third were unavoidable. Nevertheless, the largest proportion were judged possibly avoidable. As the drugs identified in this study are clearly needed in the community, efforts to reduce DRAs must concentrate on education, counselling and monitoring of drug therapy.

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ObjectiveTo assess the quality of antibiotic prescribing by Victorian general practitioners, and the effectiveness of educational intervention techniques in improving prescribing. DesignA randomised, controlled, parallel group trial. Setting and participantsIn rural and metropolitan Victoria, 182 general practitioners (78 control, 104 intervention) began and 103 (41 control, 62 intervention) completed the study. InterventionParticipants recorded their antibiotic prescribing for tonsillitis. The intervention group received an educational mailing campaign. A project pharmacist visited each doctor to discuss campaign messages. Main outcome measureThe percentages of prescriptions of antibiotics for tonsillitis complying with those recommended in Antibiotic guidelines. ResultsIn the intervention group, prescriptions consistent with recommendations in the guidelines increased from 60.5% before the campaign to 87.7% afterwards. Improvement also occurred in the control group, from 52.9% to 71.7% of prescriptions. The improvement within the intervention group was significantly greater than that within the control group. ConclusionsThe educational campaign significantly improved the prescribing of appropriate antibiotics for tonsillitis by general practitioners.

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1. A new method of studying isolated human skeletal muscle has been evaluated. This involves the incubation and electrical stimulation of strips of muscle, obtained at surgical biopsy, that are tied at the cut ends of the fibre bundles. 2. Morphological examination showed that the fibres were sealed off at the cut ends. Damage appeared to be restricted to the areas immediately adjacent to the ties. 3. Contractile properties were well maintained for several hours and measurements of tissue metabolites showed that muscle contents of the high-energy phosphate compounds were well preserved. 4. The isolated preparations were found to have the same contractile properties as human quadriceps femoris studied in vivo by the methods described in the preceeding paper. 5. Correlation was found between the relaxation speed of the isolated preparations and their fibre-type composition histochemically determined. 6. It is concluded that this technique is a valid addition to the present methods of studying the physiology and pharmacology of human skeletal muscle.