Measurement-based care in forensic psychiatry.

Measurement-based care (MBC) is the systematic evaluation of a patient's symptoms or factors before or during an encounter. It is used to inform treatment and behavioral health interventions. This article argues that MBC is the natural consequence flowing from evidence-based practice. In this article, MBC is defined and explained in detail. Barriers to the implementation of MBC are presented and methods of selecting a measurement tool are evaluated. The article describes areas where MBC can be applied in forensic settings, and specific risk assessment tools are presented and evaluated, including the HCR-20v3, DASA-IV, DUNDRUM, and CGIC. The article emphasizes how imperative it is that physicians use MBC and discusses why forensic practice is ideally suited to MBC.

Risk factors for acquisition of endemic blastomycosis.

BACKGROUND: Blastomycosis is potentially fatal, but environmental risk factors for acquiring blastomycosis are not well established. METHOD: Matched cross-sectional questionnaire of 112 patients with history of blastomycosis and 118 control subjects in Manitoba and northwestern Ontario. RESULTS: The most common tissues involved with blastomycosis were pulmonary, skin and soft tissues, and bone. A significantly greater proportion of patients with blastomycosis than control subjects were involved in outdoor occupations. A significantly greater percentage of patients with blastomycosis were immunosuppressed either from collagen vascular disease or immunosuppressive therapy, or had hypothyroidism. A significant association between canine and human blastomycosis was not observed. CONCLUSIONS: Independent risk factors for development of blastomycosis included immunosuppression for any reason (including drugs or disease), collagen vascular disease, being an outdoor worker, and having a coworker with blastomycosis. Canine blastomycosis was not a risk factor for human disease in dog owners.