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Study objective Evidence about the burden of disability after motor vehicle crashes has relied primarily on trauma center–based studies. We examine the impact of serious crashes on the longer-term health of car drivers, independent of natural variation, in a population-based study in Auckland, New Zealand. Methods The study population comprised 218 car drivers surviving nonfatal crashes in Auckland, in which at least 1 occupant in the vehicle was admitted to a hospital, and a representative sample of 254 car drivers in the region, recruited from roadside surveys. All participants were interviewed at recruitment (subjects reported their precrash health) and 5 and 18 months later. The drivers' changes in health were obtained with a global health transition indicator and the Short Form-36, with analyses adjusting for potential confounders. Results Compared with 7% of drivers in the comparison group, 43% of crash drivers admitted to the hospital (adjusted odds ratio 10.4; 95% confidence interval 5.5 to 19.6) and 20% of those not admitted (odds ratio 3.3; 95% confidence interval 1.4 to 8.3) reported that their overall health at 18-month follow-up was worse than at baseline (precrash). Among the drivers reporting worsened health, prospectively ascertained Short Form-36 scores revealed greater reductions in physical health in those admitted after the crash, but these scores improved from 5 to 18 months. In contrast, mental and general health scores worsened from 5 to 18 months in admitted and nonadmitted crash drivers. Conclusion A substantial proportion of drivers surviving serious crashes experience reductions in longer-term health, a burden likely to be underappreciated among those not admitted to a hospital. Emergency departments could serve as useful settings in which to develop and validate clinical decision rules that can help target services for crash survivors at increased risk of adverse outcomes.

On behalf of the Editorial Board and the editorial management staff of MDPI, it is my great pleasure to introduce this new journal Behavioral Sciences. Behavioral Sciences seeks to publish original research and scholarship contributing to our understanding of human behavior. The journal will provide a forum for work that furthers knowledge and stimulates research in the behavioral sciences. We are committed to building a diverse and methodologically rigorous literature of interest and benefit to behavioral and social scientists, as well as to clinical practitioners, educationalists, and the general public. [...]

Objectives The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue. Methods The authors searched published English-language literature using PubMed and Scopus databases using key terms including “patient,” “assaults,” “threats,” “violence,” “aggression,” and “residents.” A separate search to identify curricula used the same terms in combination with key words including “curriculum,” “didactics,” and “course.” Bibliographies of studies found by electronic searches were also searched manually. Results Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath. Conclusions Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.

We present a case of a patient who developed seizures shortly after initiating treatment with levofloxacin and to discuss the potential drug-drug interactions related to the inhibition of cytochrome P450 (CYP) 1A2 in this case, as well as in other cases, of levofloxacin-induced seizures. Several biomedical databases were searched including MEDLINE, Cochrane and Ovid. The main search terms utilized were case report and levofloxacin. The search was limited to studies published in English. Six cases of levofloxacin-induced seizures have been reported in the literature. Drug-drug interactions related to the inhibition of CYP1A2 by levofloxacin are likely involved in the clinical outcome of these cases. Clinicians are exhorted to pay close attention when initiating levofloxacin therapy in patients taking medications with epileptogenic properties that are CYP1A2 substrates.

Dear Sir,Monoamine oxidase inhibitors (MAOIs) are effectivesecond-line treatment options for depression [ 1, 2]. A recentstudy showed that tranylcypromine (TCP), a nonselectiveand irreversible MAOI, remains commonly used in standardpsychiatric clinics [ 3]. The risk of hypertensive crisis due todrug food interactions when MAOIs are prescribed iswidely known. Less well appreciated is the fact that MAOIscan cause addiction and that a particular patient populationmay be at high risk. Here we present a case of TCPdependence that brings together all signs and symptoms sofar described after TCP withdrawal, including delirium,thrombocytopenia, insomnia, and mild liver damage.CaseA 30-year-old woman diagnosed with major depressivedisorder and borderline personality disorder and with pasthistory of alcohol, marihuana, amphetamine, and cocaineabuse, presented to the emergency room. For the preceding1 2 years, she had been treated with TCP and titrated to60 mg a day, along with chlorpromazine 350 mg at nightfor “sleep. ” Two months after the initiation of TCP, shesteadily increased her dose to 170 mg a day. In order tomaintain her TCP intake, t he patient visited multiplephysicians in search for prescriptions. Three days prior toadmission,sheranoutofTCPandgraduallybecameagitated,irritable, and paranoid. When she presented to the emergencyroom, she was confused, unable to recognize her mother, andoriented to person only. She was described as responding tointernal stimuli and laughing inappropriately. On physicalexamination,she had a mild tachycardia,a severe tremor, andextensive bruising involving upper and lower extremities.Laboratory evaluation revealed a thrombocytopenia of72,000/µl.On further inpatient evaluation, her cognitive statusimproved. By the second day, her platelets had decreasedto 55,000/µl, and on the third day, these cells dropped furtherto 25,000/µl. During her third day of hospitalization, herpartial thromboplastin time (PTT) extended to 40.9 s and herliver function tests showed an aspartate transaminase (AST)of 106 IU/l. A liver ultrasound revealed fatty-acid infiltrates.On day 6, her platelets returned to normal limits. Nine daysafter admission, the patient was able to sleep 6 h without anymedication, and her tremor was completely resolved.DiscussionThis abrupt change in behavior and cognition coincideswith previously reported cases of delirium after acutewithdrawal from TCP [ 4–6]. It has been proposed thatdelirium and paranoia could result from acute removal ofthe sympathomimetic component of MAOIs on presynapticreceptors [ 7]. Under normal conditions, this presynapticeffect aims to diminish the release of catecholamines. Itis likely that when MAOIs are suddenly stopped,norepinephrine and dopamine acutely increase in thesynapse, rendering patients susceptible to psychosis anddelirium [ 6, 7].

Aim: The aim of this article is to outline best practice management strategies for nurses during the clinical application of civil commitment of mentally ill persons. Method: A thorough literature search on 'coercion' and 'civil commitment' was undertaken using MEDLINE, CINAHL and PSYCHINFO. Published and unpublished research undertaken by the authors in New Zealand on this topic was drawn upon. This research considered the use of civil commitment during admission to acute mental health services, acute forensic mental health services and community mental health services. Results: The experience of coercion by service users coincides with the degree of restriction associated with the service they are involved in. Sociodemographic factors, clinical factors and the experience of coercive events have little bearing on the amount of coercion experienced. Rather it is the pattern of communication and the use of 'procedural justice' that has the potential to ameliorate the amount of perceived coercion. Conclusions: 'Procedural justice' aligns with the emphasis placed on the therapeutic relationship in mental health nursing and is an important consideration for nurses during the clinical application of civil commitment. (author abstract)