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Month: July 2017

The Urgent Case for Immediate Treatment of Propofol as a Controlled Substance in All Clinical Settings

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Propofol has been reported as a drug of abuse amongst anesthesia providers since 1992. As an uncontrolled substance, propofol is seldom kept in locked storage, nor is it inventoried or counted similar to other potential drugs of abuse found in most operating rooms. Ease of access has been shown to be a factor in the incidence of propofol abuse. Most concerning is the high rate of accidental fatal outcomes reported in individuals who abuse propofol. The Peer Assistance Advisors of the AANA urgently recommend that all institutions, anesthesia departments, out-patient surgery centers, office anesthesia locations, and each clinical setting in which propofol is administered, adopt and apply the inventory and control methods currently in use for Schedule III substances, despite the lack of scheduled status, to their handling of the drug propofol. Propofol has become the most widely used IV induction agent for general anesthesia (1) because of its attractive properties of quick recovery (2) and minimal side effects. (3) (4)As such, it is commonly...

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The Long-term Psychological Effects of Daily Sedative Interruption on Critically Ill Patients

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Critically ill patients often receive sedatives, which may delay liberation from mechanical ventilation and intensive care unit discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is unknown. We compared psychological outcomes of intensive care unit patients undergoing daily sedative interruption (intervention) with those without this protocol (control). Assessments using (1) the Revised Impact of Event Scale (evaluates signs of posttraumatic stress disorder [PTSD]), (2) the Medical Outcomes Study 36 item short-form health survey, (3) the State-Trait Anxiety Inventory, (4) the Beck Depression Inventory-2, (5) and the Psychosocial Adjustment to Illness score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3, p  0.02), a trend toward a lower incidence of PTSD (0% vs. 32%, p  0.06), and a trend toward a better total Psychosocial Adjustment to Illness score (46.8 vs. 54.3, p  0.08). We conclude that...

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Introduction to Forensic Pathology | Gross

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Forensic pathology is the subspecialty area of pathology that is specifically involved in the investigation of sudden, unexpected, and/or violent deaths. Thus, the practice of forensic pathology involves applying forensic scientific and pathological techniques to the investigation of lethal episodes. In a more general sense, forensic pathology can also be considered part of the somewhat larger discipline of forensic medicine that applies forensic sciences to medical issues.

The main role for most forensic pathologists is to perform medicolegal autopsies; however, the nature of the practice is very variable depending on jurisdictions. In certain countries, such as Australia, forensic pathologists will only perform autopsies at the direction of the State Coroner, who is a lawyer and a judicial officer. In some jurisdictions in the United States, such as certain county-based medical examiners systems and most coroner systems, the official, legally mandated responsibility for the...

Additional Resource: Introduction to Forensic Pathology

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Melanie McGuire Trial

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McGuire, now 44, was convicted on April 23, 2007, of murder, possession of a weapon for unlawful purpose, desecration of of human remains and perjury in connection with the death of her husband, whose body parts were recovered from a set of matching black and green Kenneth Cole "Reaction" suitcases pulled from Chesapeake Bay near Virginia Beach in May 5, 2004, just days after he had allegedly gone missing from the couple's Woodbridge home. Days earlier, the couple had purchased a $500,000 home in Warren County.

William McGuire died from two gunshots wounds — one to the head and one to the chest. Melanie McGuire was charged with his murder in June 2005, more than a year after her husband's remains had been found.

Following a televised trial and conviction, she was sentenced to life in prison and must serve 85 percent before becoming eligible for parole.

McGuire sought post-conviction relief in 2014, claiming in court papers that she was denied effective representation by famed attorney Joseph Tacopina.

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Eyewitness Evidence A Guide for Law Enforcement

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The legal system always has relied on the testimony of eyewitnesses, nowhere more than in criminal cases. Although the evidence eyewitnesses provide can be tremendously helpful in developing leads, identifying criminals, and exonerating the innocent, this evidence is not infallible. Even honest and well-meaning witnesses can make errors, such as identifying the wrong person or failing to identify the perpetrator of a crime. To their credit, the legal system and law enforcement agencies have not overlooked this problem. Numerous courts and rule making bodies have, at various times, designed and instituted special procedures to guard against eyewitness mistakes. Most State and local law enforcement agencies have established their own policies, practices, and training protocols with regard to the collection and handling of eyewitness evidence, many of which are quite good.

In the past, these procedures have not integrated the growing body of psychological knowledge regarding eyewitness evidence with the practical demands of day-to-day law enforcement. In an effort to bring together the perspectives...

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Intelligence Community’s use of Mind-Control and Thought- Manipulation

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The preceding briefing is to educate the reader on the Intelligence Community’s use of Mind-Control and Thought- Manipulation that may be implemented today, as well as a few actual case scenarios of successful operations conducted by the Central Intelligence Agency, The Office of Naval Intelligence, and, in some limited capacity, Intelligence Support Activities units.

The senarios described in this briefing have been selected for their recognition factor for members of intelligence teams as “well known” events in recent history and for their direct involvements with various U.S. Intelligence agencies and selected operations connected to these events.

These manipulations and degrees of control are easily achieved after years of intensive research by both the CIA and the Office of Naval Intelligence. The methods cover the range of actual hypno-programming, through either overt or covert methods as utilized by the agency concerned in the use of R.H.I.C., U.S.I.C. , E.E.O.M. and E.D.O.M. techniques.

Ultrasound technology is most frequently used by the lesser intelligence agencies in their various

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Woman Savagely Stabbed, Raped

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File:# 72-12184

DEPARTMENT OF CHIEF MEDICAL EXAMINER-CORONER

Date: November 16,1972    Time: 1000 Hours

I performed an autopsy on the body of KATHLEEN LA CHANCE
at Office of Chief Medical Examiner-Coroner, 1104 N. Mission Rd.,
Los Angeles and from the anatomic findings and pertinent history I ascribe the death to:

MASSIVE HEMORRHAGE

DUE TO:   MULTIPLE STAB WOUNDS OF CHEST
FINAL: November 16, 1972

ANATOMICAL SUMMARY

           1. Multiple stab wounds
DESCRIPTION OF STAB WOUNDS AND INJURIES

Note:    For the purpose of identification the wounds are labeled numerically, however, this does not imply the order in which the wounds were inflicted. The descriptions that follow are made using the anatomic

There appears to be twelve stab wounds, ten located in the back within an area 12 inches and 19 ½ inches from the top of the head and 3 ½ inches to the left of the midline of the back and 3 ½ inches to the right of the midline of the back. Two additional stab wounds are...

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Infowar and Disinformation: From the Pentagon to the Net

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In 1967, a satire was published under the title “Report From Iron Mountain on the Possibility and Desirability of Peace.” This analysis soberly reflected, in think-tank style, on the importance to society of waging war. Leonard Lewin, who pretended that the secret report was leaked and did not claim authorship until five years later, argued forcefully that war provides a type of social and psychological glue, without which society cannot function.

“Roughly speaking,” Lewin writes, “the presumed power of the 'enemy' sufficient to warrant an individual sense of allegiance to a society must be proportionate to the size and complexity of the society. Today, of course, that power must be one of unprecedented magnitude and frightfulness.”[1] Lewin's tongue-in- cheek premise is that before peace breaks out, it becomes urgent to find substitutes for war.

They say that life imitates art. Almost 30 years later, Lewin's claim of authorship is lost amid the general enthusiasm over the manuscript. Dog-eared copies of “Report from Iron Mountain”

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Indoctrination in Psychotherapy and Psychoanalysis:

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Indoctrination in Psychotherapy and Psychoanalysis:

The Double Whammy, Interrogation and Other Methods of Covert Control

Theodore L. Dorpat

In treatment, the psychotherapist is in a position of power. Often, this power is unintentionally abused. While trying to embody a compassionate concern for patients, therapists use accepted techniques that can inadvertently lead to control, indoctrination, and therapeutic failure. Contrary to the stated tradition and values of psychotherapy, they subtly coerce patients rather than respect and genuinely help them. The more gross kinds of patient abuse, deliberate ones such as sexual and financial exploitation, are expressly forbidden by professional organizations. However, there are no regulations discouraging the more covert forms of manipulation, which are not even considered exploitative by many clinicians. In this book, noted psychiatrist Theo. L. Dorpat strongly disagrees. Using a contemporary interactional perspective Dorpat demonstrates the destructive potential of manipulation and indoctrination in treatment.

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The Effectiveness of Psychotherapy

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Abstract.

Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features...

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The Role Of Eyewitness Identification Evidence In Felony Case Dispositions

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Abstract

We addressed the question of whether felony case dispositions are associated with eyewitness identification evidence. Toward this end, 725 felony cases (rape, robbery, and assault) were randomly sampled from the archives of a District Attorney’s Office in a large south-western city in the United States. A positive identification was present more often in accepted compared to rejected cases, although the association was significant in acquaintance cases (i.e., cases in which one or more of the eyewitnesses was familiar with the defendant), not stranger cases. Additionally, suspect and crime incident factors were associated with case issuing outcomes to a larger extent than eyewitness identification evidence. Analyses further indicated that eyewitness identification evidence was stronger in prosecuted compared to rejected cases in which eyewitness testimony was the sole evidence against the defendant. Neither the presence of multiple identifications nor nonidentifications of the suspect varied across issuing outcomes. The findings are discussed in relation to additional research that is needed at the police and prosecution stages to...

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Compassion Fatigue: When Listening Hurts

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The psychological and emotional demands placed on the practitioner have never been more intense, clinicians and researchers agree. Psychologists are expected to have the broadest of shoulders, absorbing without complaint the suffering and anxiety of their clients. But who takes care of the caretaker when the stress of a clinical case load becomes too great to bear alone? Psychologists should look to their own profession for help, practitioners say, but pride and concerns about confidentiality often stand in the way. In recent years, psychologists have suffered increased stress from the demands of the changing health-care environment, said Daniel Abrahamson, PhD, a clinical psychologist and co-founder of the Traumatic Stress Institute/Center for Adult and Adolescent Psychotherapy, or TSI/CAAP, in South Windsor, Conn. Managed-care organizations and other insurance providers require therapists to document their work with each patient in excruciating detail. That leaves providers feeling they must risk breaking a patient's confidentiality to collect reimbursement, Abrahamson said.

But psychotherapy has always been challenging, even...

Additional Resource: Compassion fatigue: when listening hurts (2895 downloads )

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Shooting at Moving Targets or Shooting on the Move

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There is never enough time for all aspects of firearms training. This is an issue that has plagued law enforcement agencies forever. Reviewing the basics (marksmanship, weapon handling & presentation, reloads, malfunction clearance, etc.) is always a priority. But, sometimes there is time left over for more advanced training. So, what is considered advance firearms training? Most instructors would agree that “advance” training is simply mastering the basics. I’ll take it a step further mastering the basics under adverse conditions. So, what would your answer be if you were asked, “What you would rather spend your spare time on shooting at moving targets, or shooting on the move?” To answer that question, you have to ask this question, “Which one would you utilize more?” Shooting at Moving Targets Shooting at moving targets has always been a fun and challenging range drill. Although there are “charging man” mechanical targets systems that allow students to shoot at a target that is charging at them, most mechanical target systems are designed...

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Shooting at Moving Vehicles

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Introduction

The subject of the use of deadly force against the drivers and occupants of moving motor vehicles has become an increasingly troublesome and controversial topic. Sometimes officers have used such force when the driver was accelerating the vehicle towards or near an officer. Some high profile cases in which vehicle drivers or passengers have died or suffered substantial injuries have resulted in large civil liability awards or settlements, such as the $7 million settlement in the Sean Bell case in New York. On the other hand, there certainly have also been instances in which police officers have been seriously injured or even killed by an oncoming vehicle either ignoring the officer’s orders to halt or even intentionally targeting the officer for harm, using the vehicle as a weapon. Indeed, in the Sean Bell case, one of the officers was, in fact, struck by the vehicle driven by Bell. A number of municipal police departments have adopted policies that restrict or prohibit...

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