Write a procedural email to employees reminding them of key components of a company policy on acceptable use of email and text messaging. The policy should address security and privacy issues and company monitoring of messages. Consider policies on appropriate message content and consequences for using company equipment to send harassing messages and a policy on the use of company system for sending personal emails. Please introduce the main idea, itemize and explain 3 to 5 key points with details and clear info about where and whom to questions should be directed. Begin statements with action verbs and use bullets to emphasize key points.
Goals: This investigation expected to decide the commonness of hypokalemia and its clinical connects in intense mental sickness among hypokalemic and normokalemic patients after acetaminophen overdose. Strategies: This is a review accomplice investigation of medical clinic confirmations for intense acetaminophen overdose led over a time of 5 years from January 1, 2004 to December 31, 2008. Statistic information and distinctive sorts of mental ailment were looked at among hypokalemic and normokalemic patients. Hypokalemia was predefined by a serum fixation < 3.5 mmol/L. SPSS 15 was utilized for information investigation. Results: Two hundred and eighty patients out of 305 affirmations were contemplated. Hypokalemia was found in 63.6% of patients with a higher commonness within the sight of mental ailment (67.7%). Hypokalemic patients were fundamentally connected with the nearness of significant sadness (P = 0.04), alteration issue (P < 0.001), uneasiness (P = 0.01), and self-destructive endeavors (P = 0.04). End: Hypokalemia was regular among patients with mental disease and intense acetaminophen overdose. Catchphrases: Acetaminophen; Hypokalemia; Overdose; Potassium; Psychiatric disease. Presentation Conscious self-harming (DSP) is perceived as a noteworthy reason for suicide around the world.1 Acetaminophen (Paracetamol) is the most widely recognized medication utilized in DSP in numerous nations, 2, 3 including Malaysia.4 Despite fantastic wellbeing in restorative dosages of acetaminophen; it is additionally one of the main sources of serious hepatic necrosis.5 Acetaminophen overdose might be joined by electrolyte aggravations including hypokalemia, and these seem, by all accounts, to be autonomous of the hepatotoxic effects.6 These electrolyte changes seem, by all accounts, to be because of the expansion in fragmentary renal discharge of potassium, however the fundamental cell components by which acetaminophen may adjust electrolyte transport are still unknown.6-9 at times, hypokalemia might be extreme, achieving a dimension of 2.3 mmol/L after detailed ingestion of 48 g of acetaminophen.8 Hypokalemia, an effectively recognizable and clinically vital condition in clinical settings, has gotten little consideration from specialists around the world. Not exclusively is hypokalemia related with continuous cardiovascular and neuromuscular inconveniences, yet its impact on mental capacity may likewise compound mental disturbances.10, 11 Both anxiety12 and serious exercise13 increment coursing epinephrine, which initiates a β2 – receptor-interceded inundation of potassium into skeletal muscle.14 As this condition might be like the intense maniacal state, it was estimated that the decrease in serum potassium focus could be related with the nearness of mental disease amid acetaminophen overdose. To enhance our insight into hypokalemia after intense acetaminophen overdose, we did a five-year, medical clinic based examination with the accompanying goals: 1) to decide the commonness of hypokalemia in patients displaying to emergency clinic after acetaminophen overdose, and 2) to research the clinical associates in intense mental ailment among hypokalemic and normokalemic patients after acetaminophen overdose. Techniques Settings and Study Design This is an observational review case audit of all patients with intense acetaminophen overdose admitted to a 1200-bed emergency clinic situated in the Northern locale of Malaysia. The medical clinic gives human services and crisis treatment for all ailments and mishaps. All parts of the examination convention, including access to and utilization of the patients' clinical data, were approved by the neighborhood wellbeing specialists before inception of this investigation. Members and Data Collection Information were gathered from January 1, 2004 to December 31, 2008. A PC produced rundown was gotten from the Hospital Record Office. We recognized our cases as indicated by the T-codes of the International Classification of Diseases-Tenth correction (ICD-10). All patients with symptomatic codes T 39.1 (acetaminophen overdose) were incorporated into the investigation. Uniquely structured information accumulation shapes were utilized to gather information concerning age, sexual orientation, conditions of overdose (inadvertent or self-destructive), expressed date and time of harming to figure the dormancy time (the season of ingestion to the time the patient was displayed at the emergency clinic), amount of acetaminophen ingested, GI cleaning, for example, stomach wash, research facility tests including serum acetaminophen fixation, and serum potassium focuses amid the primary day of affirmation and following at least 4 hours of ingestion. Information on serum acetaminophen focus estimations were acquired from the emergency clinic's restorative medication checking lab administration. Furthermore, information identified with the nearness of mental ailment were acquired. mental sickness was characterized as the nearness of any aggravation of passionate balance, as showed in maladaptive conduct and impeded working, brought about by hereditary, physical, substance, organic, mental, or social and social factors, for example, gloom, uneasiness, alteration issue, incautious practices and stress responses, either enthusiastic or conduct; these causes were noted by the medical clinic mental expert report. Hypokalemia was characterized as a serum potassium dimension of under 3.5 mmol/L.11 Patients with hypokalemia were arranged into three gatherings dependent on potassium levels: (1) gentle/grade 1 (3.0 – 3.4 mmol/L), (2) moderate/grade 2 (2.5 – 2.9 mmol/L) and, (3) serious/grade 3 (< 2.5 mmol/L).15 The outlines of all patients recognized through the inquiry were audited and the information gathered. Diagrams were barred from examination for the accompanying reasons: (1) pattern potassium focuses were not estimated, (2) if patients had taken acetaminophen however the reason for ingestion was obscure or dubious, (3) the season of ingestion was not known or (4) the patients were on customary endorsed medications that lead to hypokalemia, for example, furosemide, and (5) the patients were youngsters under 13 years old. Outlines of patients who had research center tests at or over 4 hours post-ingestion were separated for further examination. Measurable examination Information were entered and broke down utilizing the Statistical Package for Social Sciences program form 15 (SPSS). Information were communicated as mean ± SD for constant factors and as recurrence for all out factors. The Chi square or Fischer's definite test, as fitting, was utilized to test the centrality between unmitigated factors. The autonomous examples t-test was utilized to think about methods for nonstop factors. Factors were tried for typicality utilizing the Kolmogorov-Smirnov test. Factors that were not ordinarily dispersed were communicated as a middle (lower – upper quartiles). Measurable noteworthiness was considered at P < 0.05. Results Three hundred and five instances of acetaminophen overdose were recognized. Of these, 25 patients (8.2%) were barred. Benchmark potassium focuses were not estimated in eight patients, one patient was given furosemide at affirmation, five patients were under 13 years of age, the reason for ingestion was obscure or dubious in 11 patients, and along these lines, the investigation populace comprised of 280 patients (45 male and 235 female patients with a mean time of 23.4 ± 7.1, giving a female: male proportion of 5.22: 1). The greater part (72.1%) of instances of acetaminophen ingestion were displayed inside eight hours. The middle (interquartile run) amount of acetaminophen ingested was 10 g (6 – 15 g). Introductory administration included stomach wash, which was performed in 181 (64.6%) cases. Initiated charcoal was given while patients were in the Accident and Emergency office; it was given as single or numerous dosages in 173 cases (61.8%). Intravenous N-acetylcysteine (NAC) was given to 140 patients (half) after acetaminophen levels were evaluated. The middle (interquartile extend) serum acetaminophen fixation was 55.6 mg/L (14 – 120 mg/L). Amid the examination time frame, 63.6% (178 patients; 33 guys and 145 females) had potassium dimensions of under 3.5 mmol/L. For the hypokalemic patients, the mean potassium level was 3.1 ± 0.26 mmol/L, while that for the normokalemic patients was 3.76 ± 0.35 mmol/L. The majority of the patients (129) were in gentle stage hypokalemia and 45 patients were in moderate stage hypokalemia. Hardly any patients (4) were in serious stage hypokalemia. Mentally sick subjects were found to have hypokalemia, and the pervasiveness was higher than that in non-mentally sick subjects (67.7% versus 43.8%; individually, P = 0.002) (Figure 1). The most widely recognized clinical analysis among therapeutically treated suicide attempters was alteration issue (45.7%) trailed by indiscreet conduct (24.3%), real sadness (10.7%), and nervousness (2.1%). Hypokalemia was essentially connected with the nearness of real sadness (P = 0.04), change issue (P < 0.001), nervousness (P = 0.01), and self-destructive endeavors (P = 0.04). Nonetheless, normokalemia was altogether connected with incautious conduct (P < 0.001), the nonappearance of mental sickness (P = 0.002), and the nearness of incidental overdose (P = 0.04) (Table 1). One hundred and twelve patients with change issue and six patients with nervousness were found to have hypokalemia, and the pervasiveness of hypokalemia among these patients was higher than that in the general investigation populace and in patients with other mental scatters (100% and 87.5%, separately). Correspondingly, their mean potassium level was lower than that of the general examination populace (3.16 ± 0.41 and 3.2 ± 0.21 mmol/L, individually) (Table 2). Eight hypokalemic patients (4.5%) were enhanced with oral potassium prescription, and 85 hypokalemic patients (47.8%) were treated with intravenous potassium chloride, and their potassium levels were standardized in the following blood test. Also, a large portion of the treated patients (59) were in mellow stage>