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Influenza is a contagious respiratory virus that causes high rates of morbidity and mortality and is associated with life-threatening complications. Despite the wide availability of a highly effective influenza vaccine, nurses are reluctant to receive influenza vaccination and vaccination rates among them are low. The purpose of this study was to generate a substantive theory/theoretical model regarding the phenomenon of influenza vaccination uptake by registered nurses (RNs). The study used grounded theory to develop a deeper understanding of RNs' decision-making regarding the acceptance or refusal to be vaccinated against influenza in Nova Scotia, Canada. Data were collected from 11 RNs using an unstructured and conversational interview format and analysed using the constant comparative method. The primary finding of this study is that nurses consider getting vaccinated to be a personal decision (the core variable). Their decisions are based on sources of information (including formal education, continuing education and the media); personal knowing (personal philosophy, perceived risks and benefits and personal experience); and personal modifiers (the availability and accessibility of the vaccine). The process of making a personal decision defined in this study provides a framework for creating more effective influenza immunization education and delivery programs.

Influenza seriously impacts the health and well-being of individuals and communities and has significant implications for the health care system. Despite known benefits of influenza vaccination, inoculation rates among health care providers remain low. Close proximity to patients, the potential to act as an infection vector and their role in patient education has focussed attention on how health care professionals make personal vaccination decisions. This commentary explores the inherent complexity of vaccination decision-making and offers suggestions for a multiple intervention approach to address health care providers' vaccination uptake needs. Directions for future research are also discussed.

Sulpiride is a new and chemically different neuroleptic. In a study of 16 severely ill schizophrenic patients, this compound displayed definite evidence of antipsychotic activity while producing few adverse reactions. The relative absence of extrapyramidal side effects may indicate that sulpride has a low potential for producing tardive dyskinesia. Two patients who did not develop significant increases in prolactin levels did show a definite therapeutic response to sulpiride. Thus it appears that central dopaminergic blockade in the hypothalamic area is not a prerequisite for antipsychotic activity.

In recent years, an increased use of antidepressant medications has resulted in a heightened incidence of drug overdose. Because of this increased use, more types of antidepressant agents have become available. Therefore, emergency-room physicians not only have to recognize the overdose patient (often unwilling or unable to communicate with the physician), but also, identify the overdose agents if possible, and initiate early and appropriate treatment. Recognizing overdose signs and symptoms associated with various antidepressant agents is essential in choosing the appropriate treatment. Tricyclic agent overdoses account for most of the hospital admissions and deaths due to antidepressant therapy; a majority of these deaths are attributable to cardiac complications. In contrast, trazodone, one of the safest drugs when taken in overdose, is not associated with cardiac arrhythmias. Thus, trazodone-overdose patients generally require only emesis and/or gastric lavage, and minimal supportive therapy, whereas tricyclic antidepressant overdoses often require more aggressive intervention.

Sulpiride is a new antipsychotic agent chemically different from recognized psychotropic compounds. The animal profile and the rapid urinary excretion without metabolism also distinguishes this drug from other neuroleptics. Previous studies have indicated therapeutic efficacy and few side effects. Sulpiride was evaluated in 10 hospitalized, chronic schizophrenic patients over a 10 week period. The overall findings support those studies reporting neuroleptic activity. Although no side effects were encountered, a mild leukocytosis was observed in one patient and broadening and flattening of T-waves was observed in another when each received high doses. Toxic levels appear to be well beyond the therapeutic range.

In 1972, a drug incidence survey was conducted at a private southern university. Pooled results of this random survey of 1,032 students revealed that on at least one occasion, 90% of the students had tried alcohol, 70% had used tobacco, and 61% had experimented with marijuana. Use of amphetamines (38%), hallucinogens (28%), barbiturates (19%), and cocaine (10%) was much lower. To evaluate the apparent change in trends of drug usage, a follow-up study was undertaken in 1986 at the same school. The results showed a decline in amphetamine and barbiturate use. The greatest differences were seen in the nearly fourfold increase in one-time use of cocaine between 1972 and 1986 and the sixteenfold increase in students who used cocaine more than 10 times. It was noteworthy that one-third of the students who used marijuana had done so by the 9th grade. Similar early experimentation was noted with a majority of the other drugs.

Support systems and psychosocial techniques in the outpatient care of schizophrenia are discussed. Such approaches as social skills training, behavior modification, major role therapy, and family management can be used in both the public and private sectors to foster treatment adherence and increase patients' ability to function in the community. Steps in establishing an effective aftercare program are outlined, and it is suggested that the development of community coordination centers can enhance efforts to reduce rehospitalization and improve vocational and social functioning.