Survey of forensic pathologists

A survey of board-certified forensic pathologists (from a list of board-certified forensic pathologists supplied by the American Board of Pathology) was conducted to determine their current practice situations. The purpose of the survey was to provide information useful to the public in general and to those organizations that represent forensic pathologists in particular to better understand and meet the needs of the forensic pathology community. A total of 773 surveys were mailed, and 18 were returned as undeliverable. There were 337 replies (45%). Responses were as follows: In terms of age, 7% were in their 30s; 32% were in their 40s; 29% were in their 50s; 19% were in their 60s; and 13% were 70 years of age or older. In terms of gender, 79% were male and 21% were female. For pathology practice status, 72% worked more than 30 hours per week; 11% between 5 and 30 hours per week; 5% less than 5 hours per week; and 12% no longer practice pathology. For percentage of pathology practice that is forensic pathology, 69% of respondents were more than 80%; 6% were 50%-80%; 5% were 25%-50%; 8% were 5%-25%; and 12% were less than 5%. In terms of forensic pathology practice setting, 54% were employed by medical examiner or coroner systems; 13% worked under contract to medical examiner or coroner systems; 27% worked in private practice or consultation; and 6% responded as "other."     

A systematic review of suicide rating scales in schizophrenia

In spite of a substantial number of suicides in patients with schizophrenia, this area of research has until very recently been the Cinderella of schizophrenia research. Both clinical and research practices have been hampered by a lack of assessment tolls specifically designed to measure suicidality in patients with schizophrenia. This has partly been because of uncertainty about what constitutes reliable risk factors for suicide in schizophrenia. A literature search following evidence-based guidelines was carried out. A number of relevant articles were found, which were then critically reviewed. The majority of rating scales used for patients with schizophrenia were actually based--at least partly--on patients with other diagnoses than schizophrenia (affective conditions, schizoaffective disorder). This procedure could result in misleading conclusions as a result of the heterogeneity of the different mental illnesses. We conclude that, at present, only one rating scale measuring suicidality specifically designed for patients with schizophrenia (the InterSePT-scale) is based on both sound methodology and has clinical relevance. Suicide in patients with schizophrenia remains a pressing problem in the treatment of this high-risk group.     

Efforts to improve patient safety in large,capitated medical groups: description and conceptual model

Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak for want of information and market power. Big purchasers' demands, however, quickly influence the internal environment of medical groups, helping managers advance quality safety toward the top of groups' congested decision-making "queues."     

Problem-solving training with a multiply distressed abusive and neglectful mother: Effects on social insularity,negative affect,and stress

Multiple sources of stress and deficient problem-solving skills have been identified among maltreating parents. In the present study, a problem-solving intervention was evaluated with a multiply distressed, abusive and neglectful mother. Problem-solving skills were trained sequentially in a multiplebaseline design. Training focused on improving judgments related to child care and managing daily stress. The impact of training was examined in relation to problem-solving skill improvements, as well as social insularity, affect, and stress which appeared to compromise child care abilities. Problem-solving training resulted in a substantial increase in generation of alternative solutions and in the quality of plans to implement solutions on both training and generalization vignettes. Moreover, training resulted in positive changes in social insularity, negative affect, and self-reported stress and anxiety. Most of these gains were maintained at 1- and 5-month follow-ups. There were no further reports of child maltreatment during the 21 months following intervention.     

Glycogenated squamous epithelial cells as a marker of foreign body penetration in sexual assault

Nonconsensual insertion of a foreign object into the vagina, anus, or mouth in some judicial jurisdictions is synonymous with rape, and elsewhere may constitute some degree of sexual assault or battery. Few techniques, however, are available to assist the criminalist in determining whether an object has been criminally inserted. Glycogenated epithelial cells have been used as a marker for vaginal epithelium, and as such, may indicate vaginal insertion if recovered from an object. This hypothesis was tested by studying orally and vaginally inserted objects from 42 volunteers and 20 rectally inserted objects recovered from cadavers. Glycogen positivity was assayed from smears of object swabbings stained with the periodic acid-Schiff (PAS) technique. More than 75 glycogen positive cells were recovered from 39 of 42 vaginally inserted objects. Glycogenated cells were recovered from 8 of 20 rectally inserted objects (5 with more than 100 positive cells). Of 42 orally inserted objects, 32 also contained glycogen positive cells, but none with more than 28 positive cells. No glycogen positive cells were seen in skin exposed but not inserted objects. Large numbers of glycogen cells were seen in dried saliva drops. Amylase activity was not seen on 5 of 20 orally inserted shields, and thus the possibility of noninsertional saliva contamination could not be ruled out with shields yielding only small numbers of positive cells. Recovery of large numbers of glycogenated cells from foreign objects is strongly suggestive of either vaginal or anal insertion assuming amylase negativity. Glycogen positive cells are not seen secondary to glabrous skin exposure.     

Economic performance and U.S. Senate elections: Reply

Major criticisms made by Chressanthis and Shaffer (C-S) are addressed: the authors' failure to include noneconomic variables in the regression model, the inclusion of open elections in the sample, and the use of variables other than the state unemployment rate as economic performance measures. Errors in C-S's interpretations are noted. Additional regression results are reported using modifications of the authors' original model. These suggest that the change (notrelative change as in C-S) in state unemployment rate is superior, and that the authors' model yields a stronger effect of state economic performance on election outcomes than does the C-S model.John Beck contributed helpful comments.