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PubMed2005

Folie a trois in a multilevel security forensic treatment center: forensic and ethics-related implications.

Shared (Induced) Delusional Disorder commonly occurs in close relationships and involves a varying number of participants who may be nonconsanguineous. The disorder has been associated with forensic and fatal consequences. Its occurrence in three nonrelated, incarcerated individuals is described in this article. This case of folie à trois has forensic implications and raises several questions of ethics that relate to autonomy, confidentiality, safety, and risk estimation. The presentation, management, and outcome of the patients suggest that a high index of suspicion is needed to detect cases in similar settings. The report concludes that the rarity of the disorder in a forensic mental health population may be the result of underdetection, given that conditions are conducive to the development of the disorder. Telltale signs of its manifestation are hypothesized as being responsible for some events in incarcerated populations. Physical separation and antipsychotic medications remain the mainstay of treatment.

Adult↗
PubMed1992

Preemployment drug screening. The epidemiologic issues.

Deciding to test applicants for employment for drugs raises complex, legal, moral, economic, and technical issues. However, we focus here on three epidemiologic issues germane to this decision. In one industry, the United States Postal Service, two recent studies suggest associations between positive preemployment drug screens and turnover, absenteeism, accidents, injuries, and discipline, but these associations are weaker than had been assumed. Cost-benefit analyses show that whether drug screening saves money depends both on the costs associated with adverse outcomes such as accidents and on the prevalence of drug use in the population screened. Finally, the predictive value of a positive drug screen also depends crucially on the prevalence of drug use. In populations with low prevalence of drug use, a large proportion of the positives may be false positives.

Absenteeism↗
PubMed2005

Bioterrorism and its aftermath: dealing individually and organizationally with the emotional reactions to an anthrax attack.

From September 2001 through April 2004, the United States Postal Service (USPS) dealt, for the first time, with bioterrorism resulting in employee deaths and the closure of a large mail processing plant in Washington, D.C. The Employee Assistance Program (EAP) partnered with the USPS throughout this tumultuous time to meet the multiple and evolving behavioral health needs of the employees and facilitate the employees' emotional preparedness for their return to work at the closed facility. This paper discusses the reactions manifested by the employees during this extended period, as well as the EAP activities in the recovery process.

Adaptation, Psychological↗
PubMedDate not supplied

Emergency preparedness curriculum in nursing schools in the United States.

With concern about bioterrorism and inadequacies in responding to mass casualty events, health care professionals have been placed in the category of first responders. The International Nursing Coalition for Mass Casualty Education (INCMCE) was established to plan strategically to address the educational needs of the nation's nurses. This study sought to determine the types and levels of disaster preparedness curricula being delivered or in development in nursing programs at all levels. INCMCE surveyed 2,013 deans or directors of nursing schools as to curricula for emergency preparedness prior to September 11, 2001, and during the two following academic years. Initial requests were sent via email and the US postal service. Respondents were invited to answer the online survey so data could be directly entered into a database for purposes of data analysis. Responses were received from 348 schools of nursing. Curriculum plans, followed by competency lists, were selected as most helpful for teaching content in disaster preparedness. The survey results validated the general assumption that nursing programs provide limited curricula in this area. The mean number of hours of disaster preparedness content provided, approximately four hours, did not change significantly over three academic years. The study also showed that 75 percent of respondents thought that nurse faculty were inadequately prepared in the area of disaster management. The study established a baseline for future curricular growth.

Bioterrorism↗
PubMed2006

[Changes in diabetic retinopathy and visual acuity in patients with end-stage diabetic nephropathy after the introduction of hemodialysis].

PURPOSE: To study the diabetic retinopathy (DR) and visual acuity in patients with end-stage diabetic nephropathy in the predialysis period and the changes after the initiation of hemodialysis at Tokyo Postal Service Agency Hospital (TPSAH). METHODS: We retrospectively analyzed the systemic conditions and the stage of DR and visual acuity in the medical records, of 24 patients 48 eyes (male: female=20 : 4) with diabetic nephropathy, who were started on hemodialysis between June 1994 and August 2003 at TPSAH, and were followed ophthalmologically more than 6 months after the start of hemodialysis. RESULTS: At the start of hemodialysis, 46 of 48 eyes (95.8%) had already been treated by retinal photocoagulation. The DR activity was assessed as "low" in 62.5% of the patients at the start of hemodialysis, but 6 months later, over 95% of the patients were assessed as having "low-activity". At the start of hemodialysis visual acuity was less than 0.1 in 21% of the eyes, and over 0.7 in 42% of the eyes, and the ratio was stable in the follow-up period. In 2 eyes the stage of diabetic retinopathy became worse by more than one grade in Fukuda's grading of diabetic retinopathy, and in 4 eyes more than a 2 grade alteration in visual acuity was observed. CONCLUSIONS: After the start of hemodialysis, DR became less active relatively early, and only a few eyes became worse in visual acuity and DR.

Adult↗
PubMed1991

Dog bites.

Although our canine companions can provide us with many hours of unyielding love and faithfulness, it is important to remember that these same loving creatures inflict 500,000 to one million bites per year, accounting for one percent of all emergency room visits nationwide. Ten percent of these injuries require suturing, one to two percent require hospitalization, and approximately one-third of dog bite injuries cause lost time from work or school. The United States Postal Service spends more than $250,000 annually just for prevention and treatment of dog bite injuries involving letter carriers! Still think that adorable pooch is harmless? Read on.

Animals↗
PubMed1990

Choices in prescription-drug benefit programs: mail versus community pharmacy services.

Pharmaceutical price increases and greater coverage of outpatient prescription medications have stimulated interest in containing drug benefit-program costs. While mail pharmacy services (MPS) may achieve savings through volume purchasing, high usage of generic drugs, and dispensing larger quantities of medication per prescription, efforts are also underway to adapt community-pharmacy-based services to keep costs down in these areas. No controlled studies document a difference in quality between the two types of services. Third-party administrators and benefit managers need to consider factors such as providing information to patients, monitoring drug therapy, dispensing patients' correct medication, and cost-control incentives when assessing MPS's role in prescription drug programs.

Community Pharmacy Services↗
PubMed1995

Financial viability of screening for drugs of abuse.

Urine drug testing is now a common practice in the American workplace; a recent survey indicated that > 90% of companies with > 5000 employees have some type of testing program. These programs have indeed reduced the rate of drug-positive test results; for example, recent data from the Federal Aviation Agency show that the rate for 1993 was 0.82% compared with 0.95% for 1992. Many corporations have stated that urine drug testing, as a component of a substance abuse policy, results in significant savings, e.g., from decreased absenteeism and turnover. The United States Postal Service recently completed a longitudinal study on the economic benefits and found that, over the average tenure of an annual intake of employees, there were savings of more than $100 million. Although this study clearly demonstrates the financial benefits of preemployment drug testing, the decision to test is not based solely on this but also on the regulatory environment and on the potential impact of a major accident attributable to the use of drugs or alcohol in the workplace.

Cost-Benefit Analysis↗
PubMed1998

Mail-order pharmacy. Teaching your patients to use it safely.

People of all ages are discovering the convenience and savings of mail-order pharmacy use. On the surface, this option seems like a commonsense way to save money on healthcare, but the use of mail-order pharmacy among the elderly may increase the risk of unintentional medication noncompliance. This article discusses the advantages and risks of using this service and presents guidelines that can maximize the safety of mail-order pharmacy.

Drug Interactions↗