EDICAL STUDENTS EXPERIence depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training. [1][2][3][4][5][6] Medical students have a higher risk of suicidal ideation 7 and suicide, 8 higher rates of burnout, 6,9 and a lower quality of life than age-matched populations. 5,10 Burnout and depressive symptoms have been associated with suicidal ideation. 4,6,9,10 Medical students are less likely than the general population to receive appropriate treatment despite seemingly better access to care. [11][12][13] Students may engage in potentially harmful methods of coping, such as excessive alcohol consumption, and, despite their training, may fail to recognize that depression is a significant illness that requires treatment. 11 Stigma associated with depression and the use of mental health care services may represent a barrier to seeking treatment. 2,[12][13][14] One study identified stigma as an explicit barrier to the use of mental health services by 30% of first-and second-year medical students experiencing depression. In addition, 37% identified lack of confidentiality and 24% cited fear of documentation in their academic record as barriers to treatment. 2 Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, 2,12,13 and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications. 15,16 The fear of professional sanctions may lead to inappropriate and possibly dangerous approaches to seeking care such as selfprescription of antidepressants. 17 No studies to our knowledge have addressed in more specific detail the perceptions of stigma by depressed medical students that may serve as barriers to receiving appropriate mental health care.We conducted a study of medical students at the University of Michigan Medical School to assess the prevalence of self-reported depression and suicidal ideation and to assess the per-See also pp 1173 and 1231.

Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. Improvements in hazard intervention are needed.

The accuracy of external cause of injury codes (E codes) for work-related and non-work-related injuries in Massachusetts emergency department data were evaluated. Medical records were reviewed and coded by a nosologist with expertise in E coding for a stratified random sample of 1000 probable workrelated (PWR) and 250 probable non-work-related (PNWR) cases. Cause of injury E codes were present for 98% of reviewed cases and accurate for 65% of PWR cases and 57% of PNWR cases. Place of occurrence E codes were present in less than 30% of cases. Broad cause of injury categories were accurate for about 85% of cases. Non-specific categories (not elsewhere classified, not specified) accounted for 34% of broad category misclassifications. Among specified causes, machinery injuries were misclassified most often (39/60, 65%), predominantly as cut/pierce or struck by/against. E codes reliably identify the broad mechanism of injury, but inaccuracies and incompleteness suggest areas for training of hospital admissions staff, providers, and coders.A knowledge of the external causes of injuries is critical to be able to adequately direct injury prevention efforts. In large administrative databases, this information can be obtained through the International Classification of Disease (ICD) external cause of injury codes (E codes). Many injury prevention experts and organizations have advocated submission of these codes for inclusion in acute care hospital databases.1 However, few studies have looked at the overall accuracy of E codes for injury surveillance. 2-5As a part of a feasibility study of using electronic emergency department (ED) data for occupational injury surveillance, we evaluated the completeness and accuracy of E codes for workrelated and non-work-related injuries reported to a statewide Emergency Department Injury Surveillance System (EDISS). In addition, we conducted a qualitative analysis of the most common E code errors in order to identify potential areas for training hospital personnel. METHODSEDISS collected ED data from a sample, stratified by geography and patient volume, of 12 Massachusetts acute care hospitals. Electronic administrative data were collected on all non-fatal, non-admitted visits that were assigned an ICD Ninth Revision Clinical Modification (ICD-9-CM) diagnostic code (in any of six fields) in the range 800-999, and/or any ICD-9-CM E code in the range of E800-E999. The ICD-9-CM codes in EDISS were assigned by trained coders at the hospitals. The information reported included patient demographics, diagnostic codes, E codes, payer source, and the presence and content of an injuryat-work field. Probable work-related (PWR) cases were defined as those visits with either workers' compensation designated as payer or an injury-at-work value of ''yes'', or both. If neither of these criteria were met, the cases were considered probable non-work-related (PNWR).A study sample of PWR and PNWR cases was drawn from patients aged 14 through 75 years reported to EDISS during the period 1 March 1999 through...

he transition to practice can be a challenging and anxiety-provoking time for the novice NP. One way to ease the transition and provide a foundation for success in a new advanced practice role is through mentorship. A considerable learning curve exists for the novice NP. Mentorship is a recognized concept applicable in a wide variety of personal and professional circumstances which can be particularly valuable to the healthcare workforce. Mentoring can provide a supportive relationship to increase success in the advanced practice role and alleviate stress associated with the transition to professional practice. 1 Specifi cally,