Development of pneumonia after stroke was associated with mortality at 30 days and 1 year, longer length of stay, and dependency at discharge. Patients who received more inpatient stroke services had reduced mortality after pneumonia.

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Since the mid-1990s, there has been a growing number of unconfirmed reports of assailants surreptitiously using prescription and nonprescription drugs to induce disinhibition, sedation and amnesia to facilitate rape. 1 This type of victimization is most commonly referred to as drug-facilitated sexual assault. Although flunitrazepam, in particular, has been maligned as a "date rape drug," 2 many other easily accessible substances have reportedly been used to facilitate sexual assault, including alcohol and alprazolam, chloral hydrate, gamma-hydroxybutyrate, ketamine, lorazepam, ziploclone and zolpidem. 1,3 Few studies have systematically measured the occurrence of drug-facilitated sexual assault. Because there is no agreedupon definition of the phenomenon, 4 comparisons across studies are difficult. In a large population-based telephone survey focused on rape in the United States, 2.3% of adult women reported that they had been deliberately incapacitated with drugs or alcohol and sexually assaulted. 5 According to the 2001 British Crime Survey, among adult female victims of rape, 5.0% reported that they had been "drugged in some way."6 Rates of suspected drug-facilitated sexual assault derived from chart reviews of sexual assault victims presenting to specialized sexual assault services have ranged from 6.3% to 17.5%. 1,[7][8][9] One such study demonstrated that the incidence of hospital-reported drug-facilitated sexual assault had shown a marked and continuing increase since 1999. 10Little is known about the victims of drug-facilitated sexual assault and how they may differ from victims of other forms of sexual assault. 1,5 In a retrospective analysis of sexual assaults in the city of Vancouver, British Columbia, McGregor and colleagues 1 found that, compared with other victims, those who suspected that they had been drugged waited longer before presenting to a hospital sexual assault service. In addition, this group had a lower occurrence of genital and extragenital injuries. Women aged 15-19 years had the highest risk of experiencing this type of sexual assault.10 Testa and colleagues, 11 working in the United States, compared 48 incidents of rape while incapacitated with 65 other rape incidents. They found that rapes involving incapacitation were less likely than other types of rape to result in injury and were also less likely to involve a perpetrator with whom the victim had had previous sexual intercourse. Rapes involving incapacitation were more likely to have occurred following time spent CMAJ ResearchBackground: There has been little systematic investigation of widespread reports of drugging and sexual assault. We sought to determine the prevalence of and factors associated with suspected drug-facilitated sexual assault. Methods:Between June 2005 and March 2007, a total of 977 consecutive sexual assault victims underwent screening for suspected drugging at 7 hospital-based sexual assault treatment centres. We defined victims of drugfacilitated sexual assault as those who presented to a centre within ab...

ObjectiveDespite widespread interest in many jurisdictions in monitoring and improving the quality of stroke care delivery, benchmarks for most stroke performance indicators have not been established. The objective of this study was to develop data-derived benchmarks for acute stroke quality indicators.DesignNine key acute stroke quality indicators were selected from the Canadian Stroke Best Practice Performance Measures Manual.ParticipantsA population-based retrospective sample of patients discharged from 142 hospitals in Ontario, Canada, between 1 April 2008 and 31 March 2009 (N = 3191) was used to calculate hospital rates of performance and benchmarks.InterventionThe Achievable Benchmark of Care (ABC™) methodology was used to create benchmarks based on the performance of the upper 15% of patients in the top-performing hospitals.Main Outcome MeasuresBenchmarks were calculated for rates of neuroimaging, carotid imaging, stroke unit admission, dysphasia screening and administration of stroke-related medications.ResultsThe following benchmarks were derived: neuroimaging within 24 h, 98%; admission to a stroke unit, 77%; thrombolysis among patients arriving within 2.5 h, 59%; carotid imaging, 93%; dysphagia screening, 88%; antithrombotic therapy, 98%; anticoagulation for atrial fibrillation, 94%; antihypertensive therapy, 92% and lipid-lowering therapy, 77%. ABC™ acute stroke care benchmarks achieve or exceed the consensus-based targets required by Accreditation Canada, with the exception of dysphagia screening.ConclusionsBenchmarks for nine hospital-based acute stroke care quality indicators have been established. These can be used in the development of standards for quality improvement initiatives.

Background: Premenstrual mood symptoms are considered common in women, but such prevailing attitudes are shaped by social expectations about gender, emotionality and hormonal influences. There are few prospective, community studies of women reporting mood data from all phases of the menstrual cycle (MC). We aimed (i) to analyze daily mood data over 6 months for MC phase cyclicity and (ii) to compare MC phase influences on a woman’s daily mood with that attributable to key alternate explanatory variables (physical health, perceived stress and social support). Method: A random sample of Canadian women aged 18–40 years collected mood and health data daily over 6 months, using telemetry, producing 395 complete MCs for analysis. Results: Only half the individual mood items showed any MC phase association; these links were either with the menses phase alone or the menses plus the premenstrual phase. With one exception, the association was not solely premenstrual. The menses-follicular-luteal MC division gave similar results. Less than 0.5% of the women’s individual periodogram records for each mood item showed MC entrainment. Physical health, perceived stress and social support were much stronger predictors of mood (p < 0.0001 in each case) than MC phase. Conclusions: The results of this study do not support the widespread idea of specific premenstrual dysphoria in women. Daily physical health status, perceived stress and social support explain daily mood better than MC phase.

These subjective data suggest that women perceived a wide range of external, usually interpersonal, influences as relevant to their mood, however menstrual cycle was rarely mentioned. Perceptions of influences on mood are statistically related to frequency of moods. In addition, ethnicity and paid employment are independently associated with positive mood.

Research suggests that students experience high levels of sexual assault, but studies addressing how they differ in their experiences from other sexual assault victims are virtually nonexistent. To address this gap, information was collected from consecutive individuals, aged 16 years or older, presenting to one of 7 hospital-based sexual assault treatment centers in Ontario from 2005 to 2007. Of the 882 victims seen during the study period, 32% were students. Relative to other sexual assault victims, students were more likely to be aged 16 to 18 years and 19 to 24 years versus 25 years and older. They were more likely to be living alone, with family of origin, a partner or spouse, or a nonrelative than on the street or in a shelter or institution. They were also more likely to report having consumed over-the-counter medication in the 72 hours prior to examination. Student victims were less likely than nonstudent victims to report having a disability and having used street drugs. Implications for research, education, and practice are discussed.