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BackgroundSuicide is one of the leading causes of death worldwide, and estimates of suicide among health professionals are higher than the general population. High rates of suicide among physicians and nurses have been described previously, but there is a lack of data for suicides completed by pharmacists.ObjectiveThe purpose of this study was to quantify the incidence, means, and characteristics of pharmacist suicides in the United States.MethodsData were obtained from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) for the years 2003-2018. The dataset contained all suicides, coded by occupation, reported by medical examiners and law enforcement from 39 states and Washington DC and Puerto Rico. Suicide characteristics were compared between pharmacists and nonpharmacists. Age-adjusted rates were calculated for 2004, 2009, and 2014.ResultsDuring 2003-2018, the NVDRS contained 316 pharmacist suicides compared with 213,146 nonpharmacist suicides. The age-adjusted rates per 100,000 people were 19.6, 20.1, and 18.2 for 2004, 2009 and 2014, respectively. The most common means of suicide was firearm. Associated factors for suicide included job problems, current mental illness treatment, and suicide note.ConclusionSuicide rates among pharmacists are higher than the general population. Future research is needed to evaluate the context of job-related problems to mitigate risk. Encouraging help-seeking behaviors to identify and treat pharmacist depression is warranted.

Background: Anisocoria (unequal pupil size) has been defined using cut points ranging from greater than 0.3 mm to greater than 2.0 mm for absolute difference in pupil size. This study explored different pupil diameter cut points for assessing anisocoria as measured by quantitative pupillometry before and after light stimulus. Methods: An exploratory descriptive study of international registry data was performed. The first observations in patients with paired left and right quantitative pupillometry measurements were included. Measurements of pupil size before and after stimulus with a fixed light source were used to calculate anisocoria. Results: The sample included 5769 patients (mean [SD] age, 57.5 [17.6] years; female sex, 2558 patients [51.5%]; White race, 3669 patients [75.5%]). Anisocoria defined as pupil size difference of greater than 0.5 mm was present in 1624 patients (28.2%) before light stimulus; 645 of these patients (39.7%) also had anisocoria after light stimulus (P <.001). Anisocoria defined as pupil size difference of greater than 2.0 mm was present in 79 patients (1.4%) before light stimulus; 42 of these patients (53.2%) also had anisocoria after light stimulus (P <.001). Discussion: The finding of anisocoria significantly differed before and after light stimulus and according to the cut point used. At most cut points, fewer than half of the patients who had anisocoria before light stimulus also had anisocoria after light stimulus. Conclusion: The profound difference in the number of patients adjudicated as having anisocoria using different cut points reinforces the need to develop a universal definition for anisocoria. [ABSTRACT FROM AUTHOR]

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty‐eight subjects met these inclusion criteria. Narratives from 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: "mental health treatment," "poor general health and chronic pain," "substance use," "worsening mental health after bereavement," and "repeating a family member's suicide." Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help‐seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality.Methods: We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements.Results: Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001).Conclusion: The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units.Trial Registration: NCT02804438 , Date of Registration: June 17, 2016. [ABSTRACT FROM AUTHOR]

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Nurses are facing increased mental health issues, substance use, and even suicide since the novel coronavirus pandemic arrived in the United States. Nurses with substance use disorder (SUD) may enroll in alternative-to-discipline (ATD) programs to retain their license during initial treatment with the goal to return to practice, but this process is not without challenges. For example, previous analyses have shown that the time surrounding disciplinary/regulatory process regarding substance use disorder (SUD) by either employers or licensure boards was a trigger for nurses who died by suicide. Internet searches are a common approach to find information on health-related topics. This limited critical review sought to replicate and evaluate a simple internet search that a nurse seeking information on their state ATD program may complete. Google searches for information on ATD programs were completed on the 50 continental states and Washington, DC between April and September 2022. States with ATD programs were evaluated for evidence-based components and barriers to accessing program information. Publicly available ATD program information ranged from requirements for contact information to obtain details to websites that outline the entire program, including associated costs. While ATD programs offer a significant improvement over traditional disciplinary responses to nurse substance use, a significant barrier is program cost, which can often exclude participation. In this article, we discuss the detailed results of our critical review and offer implications for practice that include opportunities for research and a national database to track ATD program components and target outcomes to support return to practice for nurses with SUDs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to estimate the national incidence of nurse suicide., Background: Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018., Methods: This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides., Results: Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use., Conclusion: Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)