Treatment of Depression in Voluntary Versus Mandated Physicians

Few if any publications discuss the effectiveness of voluntary versus mandated treatment for impaired physicians. This retrospective case-control study compared the recovery rates of physicians whose treatment was mandated or coerced by either licensure boards or employers (mandated physicians) with the rates for physicians admitted voluntarily (voluntary physicians) to the Menninger Clinic's Professionals in Crisis program from 2009 through 2012. Beck Depression Inventory (BDI)-II scores served as the primary outcome measure. At the time of admission, voluntary physicians were more depressed, but the improvement rates in the voluntary and mandated groups did not differ significantly. In addition, the two groups differed neither in rates of return to the healthy range of BDI-II scores, nor in whether BDI-II scores had decreased by at least two standard deviations by the time of discharge. These findings suggest that state physician health programs can continue to mandate physicians into treatment despite concerns that mandatory treatment may be less efficacious than voluntary treatment.

The Prevalence of Physicians Who Have Been Stalked: A Systematic Review

It has been suggested that physicians are particularly vulnerable to being stalked. Our goal was to examine the prevalence of physicians who have been stalked and the associated consequences for the victims. We conducted multiple searches of PubMed and PsycINFO for articles in English from 1950 to 2013, using the terms stalker, stalking, aggression, assaults, patient, physician, resident, registrar, intern, and trainee. Reference lists of relevant articles were also searched. We developed and used a five-point evaluation tool for critical appraisal of the articles. We found 12 prevalence studies on the stalking of physicians, of which 8 were national surveys and 4 were focused exclusively on stalking. The studies varied in their methodological quality with common limitations including the lack of a national sample, the lack of construct validity of the survey tool and of the provision of a formal definition of stalking, and low response rates. Prevalence rates ranged from 2 to 25 percent, although one study found a prevalence rate of 68.5 percent. Information on the physical and psychological consequences of having been stalked was also limited. Although a substantial minority of physicians reported having been stalked, there remains a dearth of high-quality studies on the topic.

Prevalence and treatment of frotteurism in the community: a systematic review

This article describes a systematic review of prevalence studies on frotteurism. We searched the following databases for previously published, peer-reviewed studies that used suitable diagnostic methods in adult nonclinical samples: Ovid MEDLINE, PsycINFO, Pubmed, AccessMedicine, Cochrane Library, Books@Ovid, DynaMed, Micromedex, Science Direct, and SciVerse Scopus. We conducted multiple searches using the following terms: frotteu*, frottage, frotteurism, paraphilia, paraphilic, courtship disorder, prevalence, treatment, diagnosis, and chikan, and we evaluated the articles by using a six-point epidemiologic quality tool. We identified four prevalence studies, all of which were of limited methodological quality. Limitations included small sample sizes, the use of local rather than national samples, the failure to apply DSM or ICD-9 diagnostic criteria, and the lack of assessment regarding the reliability of diagnostic tools. One small study, a statistical outlier, reported a prevalence of 35 percent. In the three other studies, the prevalence of frotteurism was 7.9 percent, 9.1 percent, and 9.7 percent. We found no studies addressing treatment that met our inclusion criteria. Our findings reveal a need to develop more rigorous research on this topic.

Rediscovery of insulin pump treatment of childhood type 1 diabetes

Currently, goals for the treatment of children and adolescents with type 1 diabetes mellitus are to achieve near normal glycemia; minimize the risks of severe hypoglycemia and excessive weight gain; optimize psychosocial functioning and quality of life (for children and their families); and prevent or delay long-term microvascular complications. Continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, provides a treatment option that can assist in the attainment of all of these goals in all ages of children. Insulin pump therapy provides the opportunity for greater flexibility in meal timing and content due to the convenience of its bolus delivery of insulin. Insulin pump therapy can potentially reduce the risk of exercise-related and nocturnal hypoglycemia, through the use of programmable variable basal infusion rates. In pediatric patients, usage of CSII has been demonstrated to reduce both glycosylated hemoglobin levels and frequency of severe hypoglycemia, without sacrifices in safety, quality of life, or weight gain, particularly in conjunction with the use of new insulin analogs and improvements in pump technology. Clinical studies of safety and efficacy of CSII in children and the use of continuous glucose monitoring to optimize insulin pump therapy are reviewed.