Science.gov

Sample records for current medical legal

  1. Medical photography: current technology, evolving issues and legal perspectives.

    PubMed

    Harting, M T; DeWees, J M; Vela, K M; Khirallah, R T

    2015-04-01

    Medical photographic image capture and data management has undergone a rapid and compelling change in complexity over the last 20 years. This is because of multiple factors, including significant advances in ease of photograph capture, alongside an evolution of mechanisms of data portability/dissemination, combined with governmental focus on health information privacy. Literature to guide medical, legal, governmental and business professionals when dealing with issues related to medical photography is virtually nonexistent. Herein, we will address the breadth of uses of medical photography, device properties/specific devices utilised for image capture, methods of data transfer and dissemination and patient perceptions and attitudes regarding photography in a medical setting. In addition, we will address the legal implications, including legal precedent, copyright and privacy law, informed consent, protected health information and the Health Insurance Portability and Accountability Act (HIPAA), as they pertain to medical photography.

  2. Medical marijuana: legal considerations.

    PubMed

    Schouten, J T

    1999-01-01

    In 1998, Washington State passed a law, Initiative 692 (I-692), that gives individuals who are charged with possession of marijuana for medical purposes a possible affirmative defense. The law lets these individuals provide a note from their doctor or a copy of their medical records stating they have a condition that may benefit from the use of marijuana. I-692 does not legalize the medical use of marijuana and does not affect Federal law, which makes obtaining, possessing, and growing marijuana illegal. The Washington law limits the amount of marijuana a patient can possess to a 60-day supply and defines the conditions for which medical marijuana may be used. These conditions include HIV, cancer, multiple sclerosis, and epilepsy.

  3. Legal and Regulatory Challenges Currently Facing Diabetes Treatment Providers and Related Durable Medical Equipment Suppliers

    PubMed Central

    Liles, Robert

    2013-01-01

    It has been estimated that 24 million Americans have diabetes, many of whom are Medicare beneficiaries. These individuals carefully monitor their blood glucose levels primarily through the use of in-home blood glucose testing kits. Although the test is relatively simple, the cumulative expense of providing glucose test strips and lancets to patients is ever increasing, both to the Medicare program and to uninsured individuals who must pay out-of-pocket for these testing supplies. This article discusses the diabetes durable medical equipment (DME) coverage under Part B Medicare, the establishment and role of DME Medicare administrative contractors, and national and local coverage requirements for diabetes DME suppliers. This article also discusses the federal government’s ongoing concerns regarding the improper billing of diabetes testing supplies. To protect the Medicare Trust Fund, the federal government has contracted with multiple private entities to conduct reviews and audits of questionable Medicare claims. These private sector contractors have conducted unannounced site visits of DME supplier offices, interviewed patients and their families, placed suppliers on prepayment review, and conducted extensive postpayment audits of prior paid Medicare claims. In more egregious administrative cases, Medicare contractors have recommended that problematic providers and/or DME suppliers have their Medicare numbers suspended or, in some instances, revoked. More serious infractions can lead to civil or criminal liability. In the final part of this article, we will examine the future of enforcement efforts by law enforcement and Medicare contractors and the importance of understanding and complying with federal laws when ordering and supplying diabetes testing strips and lancets. PMID:23566989

  4. Medical marijuana: Legal and regulatory considerations.

    PubMed

    Kaplan, Louise

    2015-10-16

    Nearly half of the United States has legalized medical marijuana. Advanced practice registered nurses (APRNs) in six states can authorize patients for medical marijuana use. Knowledge of legal and regulatory aspects of medical marijuana laws will protect an APRN's license and the public.

  5. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy

    PubMed Central

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-01-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation – ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and

  6. Adoption: medical and legal aspects.

    PubMed

    Bhalla, C K

    1978-06-01

    The problem of abandoned children is of great magnitude in India. Placement of these children in a family environment is essential for their physical, mental, and emotional development. Adoption must be approached from the child welfare perspective. The pediatrician can play an important role in the adoption process. The pediatrician should perform a thorough medical examination of infants to be adopted, both to ensure the child's welfare and to give adoptive parents an assessment of the child's health. Information should be collected on the medical history of the child's biologic parents to aid in the evaluation process. Adoptive parents should also undergo medical and pyschological examinations. Pediatricians can additionally work with social welfare departments in establishing criteria for matching children with adoptive parents. Adoptions in India are currently governed by provisions or the 1956 Hindu Adoptions and Maintenance Act. Since this legislation excludes groups such as Muslims, Christians, and Parsis from its purview, there has been a demand for national legislation providing a uniform adoption law for all the communities in India. The Union Government introduced such a comprehensive bill in 1972, the Adoption of Children Bill; however, no action was ever taken. It is urged that this legislation be reactivated, and that the restriction on the removal of children for adoption outside India be lifted. PMID:721273

  7. [Medical-legal issues of physical and pharmacological restraint].

    PubMed

    Gómez-Durán, Esperanza L; Guija, Julio A; Ortega-Monasterio, Leopoldo

    2014-03-01

    The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients' fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients' rights and the appropriate legal safety in the activity of practitioners.

  8. [Medical-legal issues of physical and pharmacological restraint].

    PubMed

    Gómez-Durán, Esperanza L; Guija, Julio A; Ortega-Monasterio, Leopoldo

    2014-03-01

    The use of physical and pharmacological restraint is controversial but is currently accepted as inevitable. It is indicated for controlling behavioral disorders and psychomotor agitation that put patients and third parties at risk. Its indication should be medical, and we should opt for the least restrictive measure. Restraints represent a possible infringement of patients' fundamental rights and require understanding and strict respect for the medical-legal precepts by physicians and other practitioners involved in its application. This article reviews the current legal framework, as well as the medical-legal premises and aspects of applying restraints, with the objective of ensuring maximum respect for patients' rights and the appropriate legal safety in the activity of practitioners. PMID:24913750

  9. [Legal position of non-medical personnel in hospitals].

    PubMed

    Kirschner, M H; Nebendahl, M; Russo, S G; Tecklenburg, A; Bauer, M

    2013-05-01

    There are currently many assistant professions in the German healthcare system which have either a more nursing or a more medical character. All these assistant professions have in common that as yet they do not require uniform training criteria but members of these professions undertake some aspects of medical activities. At the center lies the difficulty of more political than legal discussion on whether members of these assistant professions and also nursing personnel are allowed to or should undertake medical activities. This article illuminates the legal status quo.

  10. [Current legal problems of sterilization].

    PubMed

    Eser, A; Koch, H G

    1982-06-01

    Voluntary sterilization has not yet acquired comprehensive legal formulation. Thus there is a legal vacuum which physicians have attempted to fill by relying on their internal professional regulations. These provide for sterilization on an indication; however, an offense against this rule is not punishable in the courts. There is a prohibition, in particular, against so-called "courtesy sterilization," but this is of little significance today when so many social indications for sterilization can be found. But in general these professional regulations provide no useful assistance in deciding when a sterilization is permitted. In criminal law sterilization done by free will is not punishable nor is any indication required. The law deals in detail with the meaning and definition of the "free will" of the person being sterilized. This involves: capacity to have a free will, what to do about persons lacking that capacity (especially minors), and necessity to ensure that that woman understands all the consequences of sterilization. The civil courts have much more to do with sterilization than the criminal ones. One ground for suit is that the sterilization was "contrary to accepted morality," although the courts will generally hold that the woman herself cannot assert this claim. Another ground is lack of consent by the woman. Another ground is improper performance by the physician, i.e., malpractice. Thus the physician has to fear most the charges of no valid consent or malpractice. Questions of insurance law are also pertinent, since an insured person can be compensated for sterilization only if the procedure is legal.

  11. Physician's error: medical or legal concept?

    PubMed

    Mujovic-Zornic, Hajrija M

    2010-06-01

    This article deals with the common term of different physician's errors that often happen in daily practice of health care. Author begins with the term of medical malpractice, defined broadly as practice of unjustified acts or failures to act upon the part of a physician or other health care professionals, which results in harm to the patient. It is a common term that includes many types of medical errors, especially physician's errors. The author also discusses the concept of physician's error in particular, which is understood no more in traditional way only as classic error in acting something manually wrong without necessary skills (medical concept), but as an error which violates patient's basic rights and which has its final legal consequence (legal concept). In every case the essential element of liability is to establish this error as a breach of the physician's duty. The first point to note is that the standard of procedure and the standard of due care against which the physician will be judged is not going to be that of the ordinary reasonable man who enjoys no medical expertise. The court's decision should give finale answer and legal qualification in each concrete case. The author's conclusion is that higher protection of human rights in the area of health equaly demands broader concept of physician's error with the accent to its legal subject matter.

  12. Legal Issues for the Medical Director.

    PubMed

    Trulove, William G

    2015-09-01

    The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. PMID:25492255

  13. Legal Issues for the Medical Director

    PubMed Central

    2015-01-01

    The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles—nephrology practice and the leadership of a dialysis clinic—may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. PMID:25492255

  14. Legal Issues for the Medical Director.

    PubMed

    Trulove, William G

    2015-09-01

    The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment.

  15. [Legal aspects of networking of medical activities].

    PubMed

    Preissler, Reinhold

    2005-04-01

    Medical networks lack a legal definition. From the viewpoint of social law, this term means a form of organization of joint-service providers in a non-specified composition for the undertaking of medical care activities; from the point of view of occupational law, this consists of a loose form of joint practice. Such medical network can conclude treatment contracts with the patients and exchange patients' medical records. A practice network can take over services as contract partner of hospitals or other institutions, in the interest of improved competition chances within the integrated care system. The joining of a third partner is basically left open by the MBO, however according to SGB V this is possible only after approval by all contract partners. In advance of a planned medical care center, is it recommended to found a physician network as starting model. Before single practices fuse into a single enterprise, management-, tax-, legal-, as well as psychological aspects must be considered. PMID:15957655

  16. Medical marijuana for HIV-associated sensory neuropathy: legal and ethical issues.

    PubMed

    Larriviere, Daniel G

    2014-10-01

    The number of states legalizing medical marijuana is increasing. Medical marijuana is possibly effective therapy for HIV-associated sensory neuropathy. Despite legalization at the state level, however, the current and contradictory federal drug enforcement policy creates the risk that physicians who recommend medical marijuana to their patients will lose their ability to prescribe medications. The federal-state tension has legal and ethical implications for neurologists who receive a request for medical marijuana from their patients since neurologists must strive to both relieve suffering and obey relevant laws. Recommendation of medical marijuana by neurologists to their patients is ethically permissible but is not ethically mandatory.

  17. [Current issues in medical liability].

    PubMed

    Kaatsch, H J

    1987-01-01

    Currently, liability discussions are being dominated by AIDS and the legal problems associated with birth and death. The introduction of routine AIDS tests without the knowledge of those concerned is disputed heatedly and, in fact, may well constitute bodily assault and render those responsible liable to prosecution. In AIDS cases, the apparent breach of the Hippocratic oath of secrecy by Physicians can be justified on the grounds of both the extraordinary circumstances prevailing and conflicting duties. The transmission of AIDS could give rise to prosecution for causing bodily injury or manslaughter. The drawing up of a law to protect embryos is designed to establish legal constraints in the fields of reproduction and gene technology. In reframing section 168 StGB, which provides protection to the dead embryo, legislators assume that the head of a medical clinic is the lawful custodian of the corpse of a person who has died in his institution. This should help to resolve many of the problems arising from post-mortem examinations. The questions of euthanasia and medical assistance in cases of suicide were raised at the 1986 Conference of German Lawyers. Whereas medical treatment that could be considered as interference with the natural process of dying may be withdrawn in the case of irreversible terminal suffering, active euthanasia, i.e. the deliberate killing of a terminal patient, was rejected. With regard to noninterference in a suicide attempt by a third party, the free decision of the person wishing to commit suicide should be respected. In general, however, the maxim in dubio pro vita should be respected and where any doubt exists, an attempt should be made to save the person's life.

  18. Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership.

    PubMed

    Murphy, Johnna S; Lawton, Ellen M; Sandel, Megan

    2015-10-01

    Many of the social determinants of health are rooted in legal problems. Medical-legal partnerships (MLPs) have the potential to positively change clinical systems. This change can be accomplished by integrating legal staff into health care clinics to educate staff and residents on social determinants of health and their legal origins. When the MLP team works directly with patients to identify and address legal needs that improve health outcomes, and incorporate legal insights and solutions into health care practice where the patient population is overwhelmingly impacted by social conditions, outcomes are beneficial to children and families.

  19. [[Selected legal aspects related to medical practice].

    PubMed

    Szewczyk, M

    1998-01-01

    The question of the physician's liability, both that of civil as well as penal law nature--is always emotionally approached. Dynamic development of medical and biological sciences as well as technics is the cause of progress but it also gives rise to the increase of hazards or abuses in medical therapy. If we speak of the therapeutic intervention being originally legal we mean that it is carried out in compliance with the principles of medical art. In such circumstances, even though the intervention resulted in negative effects, the intervening physician cannot be made penally liable. Civil law liability, in its turn, may have either ex contractu or ex delictu basis. When the general prerequisites of this kind of liability are present, the intervening physician (Art. 353 or 415 of Civil Code) or the State Treasury (Art. 417 of Civil Code) may be made liable for causing damage, joint and several liability of the physician and the Treasury being also possible (Art. 420 of Civil Code). The carrying out of therapeutic intervention without the law required consent of the patient may lead--on the basis of Polish law--to the physician's civil law liability for the infringement of the patient's personal interests even though the intervention ended in success (Articles 23 and 24 of Civil Code). From the point of view of Polish penal law such situation may cause the physician's penal liability for the offence against freedom (Art. 192 of Penal Code). The euthanatic homicide should be, and in Polish law, is an offence. Considering the potential abuses arising from making the euthanasia legal, penal law whose major function is that of the guarantee nature, must ensure safeguards vis-à-vis life to the utmost limit. Polish Legislator shows, however, full understanding of the extremely difficult and conflict-generating situation in which the individual committing euthanatic homicide may find himself. Hence, in section 2 of Art. 150 of Penal Code the Legislator declared that "in

  20. Developments in legal and medical practice regarding the unborn child and the need to expand prenatal legal protection.

    PubMed

    Dorscheidt, Jozef H H M

    2010-12-01

    Developments in legal and medical practice in the Netherlands give rise to questions regarding the legal position of the unborn child. This article provides an overview of these developments and argues--in view of developments in other countries--that current Dutch legislation regarding the unborn child is not up to date. In effect, the article challenges the idea that the actual legal protection of the unborn child under positive Dutch law can be considered proportionate, even sufficient. To support this view the author will show that abortion is not the only matter in which clarity as to the legal protection of the viable unborn child is required. This signalisation provides good cause to reconsider the Dutch perspective on the matter, thus offering a point of reference to countries with a similar interpretation of what constitutes an appropriate legal protection of the unborn child.

  1. Developments in legal and medical practice regarding the unborn child and the need to expand prenatal legal protection.

    PubMed

    Dorscheidt, Jozef H H M

    2010-12-01

    Developments in legal and medical practice in the Netherlands give rise to questions regarding the legal position of the unborn child. This article provides an overview of these developments and argues--in view of developments in other countries--that current Dutch legislation regarding the unborn child is not up to date. In effect, the article challenges the idea that the actual legal protection of the unborn child under positive Dutch law can be considered proportionate, even sufficient. To support this view the author will show that abortion is not the only matter in which clarity as to the legal protection of the viable unborn child is required. This signalisation provides good cause to reconsider the Dutch perspective on the matter, thus offering a point of reference to countries with a similar interpretation of what constitutes an appropriate legal protection of the unborn child. PMID:21133241

  2. Medical-Legal Partnerships: Addressing Competency Needs Through Lawyers

    PubMed Central

    Paul, Edward; Fullerton, Danya Fortess; Cohen, Ellen; Lawton, Ellen; Ryan, Anne; Sandel, Megan

    2009-01-01

    Background Many low- and moderate-income individuals and families have at least one unmet legal need (for example, unsafe housing conditions, lack of access to food and/or income support, lack of access to health care), which, if left unaddressed, can have harmful consequences on health. Eighty unique medical-legal partnership programs, serving over 180 clinics and hospitals nationwide, seek to combine the strengths of medical and legal professionals to address patients' legal needs before they become crises. Each partnership is adapted to serve the specific needs of its own patient base. Intervention This article describes innovative, residency-based medical-legal partnership educational experiences in pediatrics, internal medicine, and family medicine at 3 different sites (Boston, Massachusetts; Newark, New Jersey; and Tucson, Arizona). This article addresses how these 3 programs have been designed to meet the Accreditation Council for Graduate Medical Education's 6 competencies, along with suggested methods for evaluating the effectiveness of these programs. Training is a core component of medical-legal partnership, and most medical-legal partnerships have developed curricula for resident education in a variety of formats, including noon conferences, grand rounds, poverty simulations and day-long special sessions. Discussion Medical-legal partnerships combine the skill sets of medical professionals and lawyers to teach social determinants of health by training residents and attending physicians to identify and help address unmet legal needs. Medical-legal partnership doctors and lawyers treat health disparities and improve patient health and well-being by ensuring that public programs, regulations, and laws created to benefit health and improve access to health care are implemented and enforced. PMID:21975996

  3. [Medical data security in medico-legal opinioning].

    PubMed

    Susło, Robert; Swiatek, Barbara

    2005-01-01

    Medical data security can be approached in medico-legal opinioning in three main situations: security of medical data, on which the opinion should be based, opinioning itself and whether the medical data security was properly ensured and ensuring medical data security during medico-legal opinion giving. The importance of medical data security, during collecting, processing and storing, as well in medical as in legal institutions, is of major importance for the possibility of providing a proper medico-legal opinion. Theoretically speeking, it is possible to give a proper medico-legal opinion using incorrect data, but the possibility is low. When the expert is given improper, unreadable, incomplete or even bogus in part or in the whole medical data it is extremely possible, that he fails in giving his opinion. The term "medical data" was defined and subsequently there was a brief review of medical data storing methods made and specific threats bound with them, based on modern literature. The authors also pointed out possible methods of preventing the threats. They listed Polish as well as international regulations and laws concerning the problem, accenting the importance of preserving medical data for the purposes of medico-legal opinioning.

  4. Medical and legal considerations in managing patients with musculoskeletal tumors.

    PubMed

    Morris, Carol D; Bal, B Sonny; D'Elia, Elizabeth M; Benevenia, Joseph

    2014-01-01

    At some point in their careers, many orthopaedic surgeons will have to navigate the legal system as it pertains to medical malpractice. An orthopaedic surgeon will find it helpful to review information on the basic legal elements of medical malpractice law along with suggestions on how he or she can assist the legal defense team if a lawsuit is filed. Surgeons who face litigation within the context of managing patients with musculoskeletal tumors should be aware of the common pitfalls in managing these patients. Knowledge of complementary strategies can provide good patient care and reduce legal risks when caring for patients with musculoskeletal neoplasms.

  5. Medical marijuana users continue to experience legal barriers.

    PubMed

    Betteridge, Glenn

    2006-04-01

    Four recent developments highlight that people continue to face significant legal and administrative barriers to using marijuana for medical purposes--despite the existence of the Marihuana Medical Access Regulations (MMAR), enacted by the federal government, as a result of court rulings, to enable people who require marijuana for medical purposes to exercise their constitutional right to such medicine. PMID:16805005

  6. The changing purpose of mental health law: From medicalism to legalism to new legalism.

    PubMed

    Brown, Jennifer

    2016-01-01

    The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.

  7. Affirmative action in medical education: a legal perspective.

    PubMed

    Helms, L B; Helms, C M

    1998-03-01

    The use of affirmative action programs as part of the effort to increase the presence of minorities in medical education and the physician workforce has come under greater legal scrutiny. The authors describe the history of the legal theory behind affirmative action, giving examples from the evolving case law and from Department of Education guidelines. They identify legal pitfalls in the areas of admission and financial aid, including the categorization of students by race, racially disproportionate financial aid awards after accounting for need, racially disproportionate amounts of scholarships as opposed to loans, and, for public medical schools, differential treatment of out-of-state students based on race. Medical schools should be aware of this legal framework so that they can construct affirmative action programs that comply with the law while maintaining momentum toward diversification. PMID:9526449

  8. Review of the medical and legal literature on restraint chairs.

    PubMed

    Castillo, Edward M; Coyne, Christopher J; Chan, Theodore C; Hall, Christine A; Vilke, Gary M

    2015-07-01

    Use of restraint chairs by law enforcement for violent individuals has generated controversy and a source of litigation because of reported injuries and deaths of restrained subjects. The purpose of this study is to review the available medical and legal literature and to allow the development of evidence-based, best practice recommendations to inform the further development of restraint chair policies. This is a structured literature review of four databases, two medical and two legal. The medical review focus was on the restraint chair with additional review of materials regarding other restraint methods and options. The legal review focused on litigation cases involving the restraint chair. The review of the medical literature revealed 21 peer-reviewed studies investigating the physiological or psychological effects of using a restraint chair on humans or primates. Of these studies, 20 were performed on primates. The single human study revealed no clinically significant effects from the restraint chair on test subjects. The legal literature review revealed very few cases where the restraint chair was either a major or minor focus. The overall issues relating to the restraint chair cases involved deviations from set protocols and rarely involved issues with the chair itself. The available medical literature reveals that the restraint chair poses little to no medical risk. Additionally, when used appropriately, the restraint chair alone carries little legal liability. With proper monitoring and adherence to set protocols, the restraint chair is a safe and appropriate device for use in restraining violent individuals.

  9. [Patient information in urology: current legal situation with particular emphasis on the codification of the contract governing medical treatment in the German Civil Code (BGB)].

    PubMed

    Fischer, C; Petersilie, F

    2014-12-01

    The extent and specification of patient information have so far been defined by case law. Henceforth, the rules of patient information are included in a new type of contract, a contract governing medical treatment (Behandlungsvertrag), codified in §§630a-630e of the German Civil Code (BGB). The main conclusions of the case law are now governed by law; however, some new requirements, such as the obligation to inform patients about treatment errors or the stipulation to deliver copies of undersigned documents have been added. This article gives an overview of the codification of patient information, explains how to inform patients, particularly in urology and illustrates where it is still likely that law courts will be concerned with questions of interpretation. Correct patient information is crucial for declarations of informed consent.

  10. Current Illinois Legal Issues. Second Edition.

    ERIC Educational Resources Information Center

    Kopecky, Frank J., Ed.; Wilkin, Rebecca S., Ed.

    Designed as supplementary reading in American government or social studies courses, this compilation of articles is intended to help students gain a better understanding of the judiciary's role in the Illinois legal system. The first of three sections contains articles about judges and the court system. The second section examines the criminal…

  11. Medical findings and legal outcomes in sexually abused children.

    PubMed

    Hansen, Lene Aagaard; Mikkelsen, Søren Johan; Sabroe, Svend; Charles, Annie Vesterby

    2010-01-01

    A previous study published in 2000 on a small group of children concluded that the medical examination in cases of sexual child abuse seldom provided legal proof of sexual abuse [J Forensic Sci 45(2000):115-7]. The present consecutive study included children referred to the police for a forensic medical examination. A colposcope was used to evaluate the anogenital findings which were classified as normal, nonspecific, and abnormal. Four hundred and eighty-two children were included. Abnormal anogenital findings were found in 38% of the girls and 20% of the boys, but there was no relation between abnormal anogenital findings and the two legal outcomes: "appearing in court" and "being convicted." However, the age of the child turned out to be a more important factor in relation to legal outcome than the physical findings. The results of this study suggest that the child's statement and not the physical findings were important for legal outcome.

  12. Legalization of marijuana for non-medical use: health, policy, socioeconomic, and nursing implications.

    PubMed

    Durkin, Anne

    2014-09-01

    The legalization of marijuana is a controversial issue with implications for health care providers, policy makers, and society at large. The use of marijuana for medical reasons is accepted in many states. However, legal sale of the drug for non-medical use began for the first time on January 1, 2014, in Colorado, following a relaxation of marijuana restrictions that is unprecedented worldwide. News reports have indicated that sales of the drug have been brisk. Marijuana-infused food products have been unexpectedly popular, exceeding sales projections. Marijuana use is associated with numerous physical and mental disorders and could result in addiction. Evidence suggests its potency has increased since the 1980s. Colorado has established regulations regarding the sale of marijuana for non-medical use, but concerns still exist. The current article offers a discussion of the health, public policy, socioeconomic, and nursing implications of the legalization of marijuana for non-medical use.

  13. Legalization of marijuana for non-medical use: health, policy, socioeconomic, and nursing implications.

    PubMed

    Durkin, Anne

    2014-09-01

    The legalization of marijuana is a controversial issue with implications for health care providers, policy makers, and society at large. The use of marijuana for medical reasons is accepted in many states. However, legal sale of the drug for non-medical use began for the first time on January 1, 2014, in Colorado, following a relaxation of marijuana restrictions that is unprecedented worldwide. News reports have indicated that sales of the drug have been brisk. Marijuana-infused food products have been unexpectedly popular, exceeding sales projections. Marijuana use is associated with numerous physical and mental disorders and could result in addiction. Evidence suggests its potency has increased since the 1980s. Colorado has established regulations regarding the sale of marijuana for non-medical use, but concerns still exist. The current article offers a discussion of the health, public policy, socioeconomic, and nursing implications of the legalization of marijuana for non-medical use. PMID:25082163

  14. [Current issues in legal cases of compensation for healthcare malpractice].

    PubMed

    Heiner, Tamás; Barzó, Tímea

    2014-09-21

    dogmatic and practical problems related to this topic. Another important area of current analysis is the institution of injury fees, which replaced the reimbursement of non-pecuniary damages. The mere fact of infringement allows setting injury fees. Taking into consideration the current resources in staff and equipment available in healthcare, this regulation may promote claims for injury fees impartial. Consequently, courts will have to apply other criteria when judgment in 'trivial cases', which might not require legal assessment, is delivered.

  15. [Medical and legal considerations in whiplash injury].

    PubMed

    Castillo-Chávez, Miguel Angel

    2013-01-01

    Whiplash injury usually occurs in people who suffered an automobile accident, but also occurs as a result of physical assault and other mechanisms. Diagnosis and initial management of the patient by the emergency physician or orthopedist, and prescribing indications, are taken into account by two forensic intervention specialists. One of these is the medical officer, who, through analysis of the injury mechanism, establishes a cause-effect relationship and concludes whether the accident suffered by a worker it is related to work or not, determines how long the worker will remain disabled and if the injury caused permanent disability under Federal Labor Law. The medical examiner by injury classification assists the Public Ministry so that it can frame the crime of injury to the Criminal Code of Federal District. For these reasons a review of medical information about the mechanism of injury, diagnosis, treatment and healing time was performed to help both specialists to standardize their approach in their daily activities.

  16. [Medical and legal considerations in whiplash injury].

    PubMed

    Castillo-Chávez, Miguel Angel

    2013-01-01

    Whiplash injury usually occurs in people who suffered an automobile accident, but also occurs as a result of physical assault and other mechanisms. Diagnosis and initial management of the patient by the emergency physician or orthopedist, and prescribing indications, are taken into account by two forensic intervention specialists. One of these is the medical officer, who, through analysis of the injury mechanism, establishes a cause-effect relationship and concludes whether the accident suffered by a worker it is related to work or not, determines how long the worker will remain disabled and if the injury caused permanent disability under Federal Labor Law. The medical examiner by injury classification assists the Public Ministry so that it can frame the crime of injury to the Criminal Code of Federal District. For these reasons a review of medical information about the mechanism of injury, diagnosis, treatment and healing time was performed to help both specialists to standardize their approach in their daily activities. PMID:23883460

  17. Sexual harassment in the medical profession: legal and ethical responsibilities.

    PubMed

    Mathews, Ben; Bismark, Marie M

    2015-08-17

    Sexual harassment of women in medicine has become a subject of national debate after a senior female surgeon stated that if a woman complained of unwanted advances her career would be jeopardised, and subsequent reports suggest that sexual harassment is a serious problem in the medical profession. Sexual harassment of women in the medical profession by their colleagues presents substantial legal, ethical and cultural questions for the profession. Women have enforceable legal rights to gender equality and freedom from sexual harassment in the workplace. Both individual offenders and employers face significant legal consequences for sexual harassment in every Australian state and territory, and individual medical practitioners and employers need to understand their legal and ethical rights and responsibilities in this context. An individual offender may be personally liable for criminal offences, and for breaching anti-discrimination legislation, duties owed in civil law, professional standards and codes of conduct. An employer may be liable for breaching anti-discrimination legislation, workplace safety laws, duties owed in contract law, and a duty of care owed to the employee. Employers, professional colleges and associations, and regulators should use this national debate as an opportunity to improve gender equality and professional culture in medicine; individuals and employers have clear legal and ethical obligations to minimise sexual harassment to the greatest extent possible.

  18. Sexual harassment in the medical profession: legal and ethical responsibilities.

    PubMed

    Mathews, Ben; Bismark, Marie M

    2015-08-17

    Sexual harassment of women in medicine has become a subject of national debate after a senior female surgeon stated that if a woman complained of unwanted advances her career would be jeopardised, and subsequent reports suggest that sexual harassment is a serious problem in the medical profession. Sexual harassment of women in the medical profession by their colleagues presents substantial legal, ethical and cultural questions for the profession. Women have enforceable legal rights to gender equality and freedom from sexual harassment in the workplace. Both individual offenders and employers face significant legal consequences for sexual harassment in every Australian state and territory, and individual medical practitioners and employers need to understand their legal and ethical rights and responsibilities in this context. An individual offender may be personally liable for criminal offences, and for breaching anti-discrimination legislation, duties owed in civil law, professional standards and codes of conduct. An employer may be liable for breaching anti-discrimination legislation, workplace safety laws, duties owed in contract law, and a duty of care owed to the employee. Employers, professional colleges and associations, and regulators should use this national debate as an opportunity to improve gender equality and professional culture in medicine; individuals and employers have clear legal and ethical obligations to minimise sexual harassment to the greatest extent possible. PMID:26268291

  19. Rape Survivors' Agency within the Legal and Medical Systems

    ERIC Educational Resources Information Center

    Greeson, Megan R.; Campbell, Rebecca

    2011-01-01

    Many rape survivors seek help from the legal and medical systems post-assault. Previous studies have examined how social system personnel treat survivors, but less attention has been paid to how survivors attempt to shape their interactions with these systems. The purpose of this qualitative study was to examine rape survivors' agency--the active…

  20. Educating Medical Students about Law and the Legal System.

    ERIC Educational Resources Information Center

    Williams, Peter C.; Winslade, William

    1995-01-01

    It is argued that the medical school curriculum should include content on jurisprudence to empower physicians to use the law and their legal colleagues to serve patients and promote public welfare. Developing practitioners' skills and changing attitudes are seen as more important than imparting information about particular doctrines and laws. (MSE)

  1. Disposal of medical waste: a legal perspective.

    PubMed

    Du Toit, Karen; Bodenstein, Johannes

    2013-09-03

    The Constitution of the Republic of South Africa provides that everyone has the right to an environment that is not harmful to their health and well-being. The illegal dumping of hazardous waste poses a danger to the environment when pollutants migrate into water sources and ultimately cause widespread infection or toxicity, endangering the health of humans who might become exposed to infection and toxins. To give effect to the Constitution, the safe disposal of hazardous waste is governed by legislation in South Africa. Reports of the illegal disposal of waste suggest a general lack of awareness and training in regard to the safe disposal of medical waste. 

  2. Learning from the Legal History of Billing for Medical Fees

    PubMed Central

    Schneider, Carl E.

    2008-01-01

    INTRODUCTION When patients pay for care out-of-pocket, physicians must balance their professional obligations to serve with the commercial demands of medical practice. Consumer-directed health care makes this problem newly pressing, but law and ethics have thought for millennia about how doctors should bill patients. Historical Background At various points in European history, the law restricted doctors’ ability to bill for their services, but this legal aversion to commercializing medicine did not take root in the American colonies. Rather, US law has always treated selling medical services the way it treats other sales. Yet doctors acted differently in a crucial way. Driven by the economics of medical practice before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardization of fees. Current Practice Today, encouraged by Medicare rules and managed care discounts, providers use a perverse form of a sliding scale that charges the most to patients who can afford the least. Primary care physicians typically charge uninsured patients one third to one half more than they receive from insurers for basic office or hospital visits, and markups are substantially higher (2 to 2.5 times) for high-tech tests and specialists’ invasive procedures. CONCLUSION Ethical and professional principles might require providers to return to discounting fees for patients in straitened circumstances, but imposing such a duty formally (by law or by ethical code) on doctors would be harder both in principle and in practice than to impose such a duty on hospitals. Still, professional ethics should encourage physicians to give patients in economic trouble at least the benefit of the lowest rate they accept from an established payer. PMID:18414955

  3. [Assisted suicide - medical, legal, and ethical aspects].

    PubMed

    Bosshard, G

    2012-02-01

    Unlike in most European countries, assisted suicide is not illegal in Switzerland. The number of assisted suicides procured by right-to-die organisations such as Exit or Dignitas has sharply increased in the last twenty years. Central part of the doctor's involvement is the prescription of a lethal dose of sodium pentobarbital. In doing so, the doctor has to apply to the rules of medical due care. A proper examination of the patient is required, who must be informed about his diagnosis, about the expected prognosis, and about different treatment options. Verification of the patient's decisional capacity is crucial. In general, a staff member of the organisation but not the doctor is present during suicide. Following death, the assisted suicide has to be reported to the police as an extraordinary death case.

  4. [Assisted suicide - medical, legal, and ethical aspects].

    PubMed

    Bosshard, G

    2012-02-01

    Unlike in most European countries, assisted suicide is not illegal in Switzerland. The number of assisted suicides procured by right-to-die organisations such as Exit or Dignitas has sharply increased in the last twenty years. Central part of the doctor's involvement is the prescription of a lethal dose of sodium pentobarbital. In doing so, the doctor has to apply to the rules of medical due care. A proper examination of the patient is required, who must be informed about his diagnosis, about the expected prognosis, and about different treatment options. Verification of the patient's decisional capacity is crucial. In general, a staff member of the organisation but not the doctor is present during suicide. Following death, the assisted suicide has to be reported to the police as an extraordinary death case. PMID:22294304

  5. Legalization of medical marijuana and marijuana use among youths

    PubMed Central

    Friese, Bettina; Grube, Joel W.

    2012-01-01

    Aims This study examined the relationship of youth marijuana use and perceived ease of access with the number of medical marijuana cards at the county-level, and marijuana norms as indicated by percent of voters approving legalization of medical marijuana in 2004. Methods Survey data from 17,482 youths (ages 13 – 19) in Montana and county-level archival data, including votes for the legalization of medical marijuana and the number of medical marijuana cards were analyzed using hierarchical linear modeling. Findings Living in a county with more medical marijuana cards was not related to lifetime or 30 day marijuana use. However, voter approval of medical marijuana was positively related to lifetime and 30 day use. Perceived ease of access to marijuana was positively related to medical marijuana cards, but this relation became non-significant when voter approval was controlled. Among marijuana users, marijuana cards and voter approval were positively related to perceived ease of access. Conclusions The relation between medical marijuana cards and youth use may be related to an overall normative environment that is more tolerant of marijuana use. Interventions to prevent youth marijuana use should focus on adult norms regarding use by and provision of marijuana to youths. PMID:23641127

  6. [Guidelines on medically assisted reproduction: legal issues and professional liability].

    PubMed

    Molinelli, A; Motroni Gherardi, S M; Picchioni, D M; Ventura, F

    2007-08-01

    The authors analyze the legal and medico-legal issues deriving from the recent Law No. 40 of February 19, 2004 concerning the Medically Assisted Reproduction. In particular, they analyze the contrasting points between the dispositions of Law No. 40/2004 and those of Law No. 194/1978 on the voluntary interruption of pregnancy, and they analyze the guidelines about the procedures and the techniques of the Medically Assisted Reproduction, issued by the Ministry of Health with D.M. of July 21, 2004. The Guidelines, as well as some sentences of several courts, lead to some reflections also about the consent and the professional liability, in particular considering the various moments of the medical action, from the first interview to the carrying out of the assisted reproduction techniques. PMID:17923834

  7. [Guidelines on medically assisted reproduction: legal issues and professional liability].

    PubMed

    Molinelli, A; Motroni Gherardi, S M; Picchioni, D M; Ventura, F

    2007-08-01

    The authors analyze the legal and medico-legal issues deriving from the recent Law No. 40 of February 19, 2004 concerning the Medically Assisted Reproduction. In particular, they analyze the contrasting points between the dispositions of Law No. 40/2004 and those of Law No. 194/1978 on the voluntary interruption of pregnancy, and they analyze the guidelines about the procedures and the techniques of the Medically Assisted Reproduction, issued by the Ministry of Health with D.M. of July 21, 2004. The Guidelines, as well as some sentences of several courts, lead to some reflections also about the consent and the professional liability, in particular considering the various moments of the medical action, from the first interview to the carrying out of the assisted reproduction techniques.

  8. [Psychiatric medication as restraint: between autonomy and protection, is there place for a legal framework?].

    PubMed

    Bernheim, Emmanuelle

    2010-01-01

    The use of chemical restraint has been regulated for the past ten years in Quebec. However, clinical, ethical and legal issues, sometimes contradictory, have not really been considered during the legislative process leading to consolidation in its current form. The author supports that, because of the absence of consent and the effects of medication, a specific legal framework to the use of medication is necessary in a context of unplanned intervention to protect both patients and medical staff. This framework would prescribe good practice, take into account the non-medical aspects of consent to care and formalize the practice as an exception to the rule. In addition, the symbolism of law, through which social solidarity can be expressed, must not be underestimated.

  9. [Harm related to medical device use - legal and organisational risks].

    PubMed

    Hölscher, U M

    2014-12-01

    The effectiveness of the risk management systems established by medical device manufacturers and health-care facilities is clearly mitigated by European and national legal provisions. Laws, regulations and authorities prevent the systematic exchange of much safety-relevant information. The obligation to report adverse events is suspended for many relevant risks associated with medical device use. Reporting into the vigilance system is of little avail for users. Reporting even may endanger the information provider. The federal fragmentation of the German vigilance system poses a risk for patients. Risk management in health-care facilities without risk policy is dangerously incomplete.

  10. [Harm related to medical device use - legal and organisational risks].

    PubMed

    Hölscher, U M

    2014-12-01

    The effectiveness of the risk management systems established by medical device manufacturers and health-care facilities is clearly mitigated by European and national legal provisions. Laws, regulations and authorities prevent the systematic exchange of much safety-relevant information. The obligation to report adverse events is suspended for many relevant risks associated with medical device use. Reporting into the vigilance system is of little avail for users. Reporting even may endanger the information provider. The federal fragmentation of the German vigilance system poses a risk for patients. Risk management in health-care facilities without risk policy is dangerously incomplete. PMID:24824355

  11. Voluntary and involuntary sterilization: medical, ethical, legal and religious aspects.

    PubMed

    Fasouliotis, S J; Schenker, J G

    1999-08-01

    Surgical voluntary sterilization has become one of the most widely used methods of contraception, with vasectomy and tubal sterilization being the most commonly employed techniques, associated with a low failure, morbidity, mortality, and long-term sequelae rate. As sterilization is related with the elimination of the possibility for procreation, a number of ethical, legal and religious issues have arisen, leading often to personal misjudgements, legal disputes, and failures in applying family planning. Involuntary sterilization is currently not practiced, except in cases of severely mentally retarded people, who are unable to appreciate the consequences of their acts or care for their children and who may have a high likelihood of propagating hereditary disease.

  12. The medical-legal responsibilities of a dialysis unit medical director.

    PubMed

    Vaqar, Sarosh; Murray, Brian; Panesar, Mandip

    2014-01-01

    The specialty of Nephrology, by virtue of its relationship with the dialysis procedure, is highly vulnerable to litigation. As is the case with all nephrologists, a dialysis unit medical director is not immune to medical malpractice suits, and can be held liable for any act of perceived or potential harm to any dialysis patient, regardless of the director's level of involvement. The medical director, per the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, accepts the responsibilities, accountability, and consequent legal liabilities of the quality of the medical care provided to every dialysis patient in the unit. This review is a synopsis of lawsuits filed against medical directors of dialysis units in the past forty years. Six categories of legal actions were noted; medical malpractice, fraudulent claims, self-referral and Stark Law, discrimination, negligence, and violation of patient autonomy and dignity.

  13. Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of Medical Cannabis Legalization.

    PubMed

    Troutt, William D; DiDonato, Matthew D

    2015-01-01

    Many advances have been made toward understanding the benefits of medical cannabis. However, less is known about medical cannabis patients themselves. Prior research has uncovered many important patient characteristics, but most of that work has been conducted with participants in California, who may not represent medical cannabis patients throughout the United States. Furthermore, it is unknown if medical cannabis legalization, which typically imposes strict regulations on cannabis cultivation and sale, impacts patients' experiences acquiring and using cannabis. The goal of this study was to address these limitations by (1) examining the characteristics, perceptions, and behaviors of medical cannabis patients in Arizona; and (2) questioning participants with a history of cannabis use regarding their experiences with cannabis before and after legalization. Patients in Arizona share many characteristics with those in California, but also key differences, such as average age and degree of cannabis consumption. Participants also had positive perceptions of the effect of medical cannabis legalization, reporting that feelings of safety and awareness were higher after legalization compared to before. The results are discussed in relation to evidence from patients in other states and in terms of their potential policy implications. PMID:26317379

  14. Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of Medical Cannabis Legalization.

    PubMed

    Troutt, William D; DiDonato, Matthew D

    2015-01-01

    Many advances have been made toward understanding the benefits of medical cannabis. However, less is known about medical cannabis patients themselves. Prior research has uncovered many important patient characteristics, but most of that work has been conducted with participants in California, who may not represent medical cannabis patients throughout the United States. Furthermore, it is unknown if medical cannabis legalization, which typically imposes strict regulations on cannabis cultivation and sale, impacts patients' experiences acquiring and using cannabis. The goal of this study was to address these limitations by (1) examining the characteristics, perceptions, and behaviors of medical cannabis patients in Arizona; and (2) questioning participants with a history of cannabis use regarding their experiences with cannabis before and after legalization. Patients in Arizona share many characteristics with those in California, but also key differences, such as average age and degree of cannabis consumption. Participants also had positive perceptions of the effect of medical cannabis legalization, reporting that feelings of safety and awareness were higher after legalization compared to before. The results are discussed in relation to evidence from patients in other states and in terms of their potential policy implications.

  15. Legal considerations of medical-practice employee selection.

    PubMed

    Solomon, R J

    1994-03-01

    This article reviews the legal requirements that physicians face as employers, including Title VII of the Civil Rights Act of 1964, the Americans With Disabilities Act of 1990, and the Age Discrimination in Employment Act of 1967, as well as the preservation of at-will rights. It also describes the various employment methods that medical practices can use, including structured interviews, tests, work samples, simulations, references, drug tests, and application forms. Finally, the physician's role as supervisor of the employment process is discussed.

  16. Legal issues in medical management of violent and threatening patients.

    PubMed

    Dickens, B M

    1986-11-01

    The responsibility of professionals in the medical management of violent and threatening patients is discussed using the Tarasoff case (American) and the Lawson case (Canadian) as landmark cases influencing subsequent jurisprudence. It is becoming increasingly important to be aware of the court's interpretations in such areas as confidentiality, predictions regarding dangerousness, the duty to warn, and the legal duty to strangers to the therapist/patient relationship. A number of other issues relating to the risks involved in management of patients potentially dangerous as a result of the use of drugs are also discussed.

  17. Sexual Abuse of the Mentally Retarded Patient: Medical and Legal Analysis for the Primary Care Physician

    PubMed Central

    Morano, Jamie P.

    2001-01-01

    The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Since the current national trend is to integrate citizens with mental retardation into the community away from institutionalized care, it is essential that all physicians have a basic understanding of the unique medical and legal ramifications of their clinical diagnoses. As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse. Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active. Legal codes adjudicating sexual abuse cases of the mentally retarded often offer scant protection and vague terminology. Thus, medical documentation and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. PMID:15014610

  18. [Electronic medical records: medical and legal aspects, privacy, safety, and legal validity].

    PubMed

    Ravizza, P; Pasini, E

    2001-03-01

    Medical records must collect all data concerning in-hospital management of patients: data have to be verified and easily retrievable. Clinicians are responsible for both format and content of medical records. Respect of patient's privacy must be made sure both during on-line management and long-term storage of records. Computerization can offer many advantages to clinicians, but needs some significant adjustments: training and motivation of operators, arrangement of clinical processes and of administrative rules to technological developments. Nevertheless, some important results can be afforded: standardization of procedures, distribution of univocal, verified and ubiquitous data to all concerned operators, protection against undesired retrieval, reliability of effective reports. Preliminary condition is a clinical local area network, widespread into the institution. Database implementation must follow well accepted methodology: flow chart design of data dictionary, standardization of data coding, input of verified data, effective reporting. Access to data must be controlled by sophisticated and sure password system. Back-up of data must be automatically available with adequate timing and methodology. Respect of rules on patient's privacy must be realized whenever possible. Complex clinical records should be made available, containing data, signals and images (both single frames and dynamic sequences), due to continuous technical progress of diagnostic tools. Medical records must be available for long periods of time: database engine and managing tools must be selected among well accepted and largely available producers; informatic assistance must be assured for management and evolution of systems over the years.

  19. [Delegation of medical responsibilities to non-medical personnel. Options and limits from a legal viewpoint].

    PubMed

    Ulsenheimer, K

    2009-05-01

    Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.

  20. [Delegation of medical responsibilities to non-medical personnel. Options and limits from a legal viewpoint].

    PubMed

    Ulsenheimer, K

    2009-11-01

    Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.

  1. Reefer madness: legal & moral issues surrounding the medical prescription of marijuana.

    PubMed

    Barnes, R E

    2000-01-01

    California, Arizona, and several other states have recently legalized medical marijuana. My goal in this paper is to demonstrate that even if one grants the opponents of legalization many of their contentious assumptions, the federal government is still obligated to take several specific steps toward the legalization of medical marijuana. I defend this claim against a variety of objections, including the claims: that marijuana is unsafe, that marijuana cannot be adequately tested or produced as a drug, that the availability of synthetic THC makes marijuana superfluous, and especially that legalizing medical marijuana will increase recreational use by 'sending the wrong message.' I then go on to argue that given the intransigent position of the federal government on this issue, state governments are justified in unilaterally legalizing medical marijuana as an act of civil disobedience. A large portion of this paper consists of an extensive response to the objection that legalizing medical marijuana will 'send the wrong message'--which I take to be the primary impediment to legalization. This objection basically claims that the consequences of withholding legalization (especially preventing increased recreational use) are superior to those of legalizing medical marijuana. I argue that legalization is justified even if one were to grant both that the harms of legalization outweighed its benefits and that utilitarianism is true. This requires a subtle and somewhat extended discussion of utilitarian moral and political theory.

  2. [The notion of occupational skin disease. Medical and legal aspects].

    PubMed

    Elsner, P; Schliemann, S

    2015-03-01

    The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers

  3. [The notion of occupational skin disease. Medical and legal aspects].

    PubMed

    Elsner, P; Schliemann, S

    2015-03-01

    The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers

  4. French Current Plans for a National Space Legal Framework

    NASA Astrophysics Data System (ADS)

    Clerc, Philippe

    2002-01-01

    France bears the international obligation to authorise and supervise space activities under its jurisdiction and can be liable for damage caused by space objects launched from Kourou (French Guiana) and/or by companies registered in France. The current national framework for the activities carried by Arianespace, Starsem, Eutelsat and for the Ariane European launcher operated from the Guiana Space Centre (CSG) is adequately regulated on the basis of relevant programmatic, contractual and administrative legal regime. But in consequence of the liberalisation of the telecommunications market, of the privatisation of international organisations and State owned companies and of the increasing private demands to access CSG facilities, further regulations could be needed. In this context, the French Ministry of Research's Space Department has convened in 1999, during 2 years, more than 100 technical and legal experts organised in several working groups to propose an upgraded national legal framework for space activities. This constituted working groups dealt with: launching (to implement a licence procedure, considering the responsibility of France and international competition rules), earth observation (for licensing and data policy), telecommunications and navigation, and space objects property and security regime (linked to the registration convention and the Unidroit Space Protocol). Th report of this work named "Space Law Evolution in France Study" was presented to the Minister of Research by the beginnings of this year. The present author has driven the overall study on behalf of the French Research Ministry's Space Department. This paper presents the report's general content with following actions regarding the French national space legal framework.

  5. Medical error disclosure and patient safety: legal aspects.

    PubMed

    Guillod, Olivier

    2013-12-01

    Reducing the number of preventable adverse events has become a public health issue. The paper discusses in which ways the law can contribute to that goal, especially by encouraging a culture of safety among healthcare professionals. It assesses the need or the usefulness to pass so-called disclosure laws and apology laws, to adopt mandatory but strictly confidential Critical Incidents Reporting Systems in hospitals, to change the fault-based system of medical liability or to amend the rules on criminal liability. The paper eventually calls for adding the law to the present agenda of patient safety. Significance for public healthThe extent of preventable adverse events and the correlative need to improve patient safety are recognized today as a public health issue. In order to lower the toll associated with preventable adverse events, the former culture of professionalism (based on the premise that a good physician doesn't make mistakes) must be replaced by a culture of safety, which requires a multi-pronged approach that includes all the main stakeholders within the healthcare system. A number of legal reforms could help in prompting such a change. This contribution stresses the need to include legal aspects when trying to find appropriate responses to public health issues.

  6. Medical Error Disclosure and Patient Safety: Legal Aspects

    PubMed Central

    Guillod, Olivier

    2013-01-01

    Reducing the number of preventable adverse events has become a public health issue. The paper discusses in which ways the law can contribute to that goal, especially by encouraging a culture of safety among healthcare professionals. It assesses the need or the usefulness to pass so-called disclosure laws and apology laws, to adopt mandatory but strictly confidential Critical Incidents Reporting Systems in hospitals, to change the fault-based system of medical liability or to amend the rules on criminal liability. The paper eventually calls for adding the law to the present agenda of patient safety. Significance for public health The extent of preventable adverse events and the correlative need to improve patient safety are recognized today as a public health issue. In order to lower the toll associated with preventable adverse events, the former culture of professionalism (based on the premise that a good physician doesn’t make mistakes) must be replaced by a culture of safety, which requires a multi-pronged approach that includes all the main stakeholders within the healthcare system. A number of legal reforms could help in prompting such a change. This contribution stresses the need to include legal aspects when trying to find appropriate responses to public health issues. PMID:25170502

  7. [Prevention of medico-legal conflicts in medical practice].

    PubMed

    Minossi, José Guilherme

    2009-02-01

    Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped

  8. Integrating Social Workers into Medical-Legal Partnerships: Comprehensive Problem Solving for Patients

    ERIC Educational Resources Information Center

    Colvin, Jeffrey David; Nelson, Brooke; Cronin, Katie

    2012-01-01

    Medical-legal partnerships (MLPs) integrate legal services into the health care setting to resolve legal issues that have a negative impact on patient health. These partnerships between attorneys and health care professionals have traditionally focused on physicians. Despite early success and expansion of the MLP model, the literature is only…

  9. [Compulsory treatment under legal uncertainty: part 1: the current legal situation on compulsory treatment of patients with psychiatric disorders incapable of consenting].

    PubMed

    Müller, S; Walter, H; Kunze, H; Konrad, N; Heinz, A

    2012-09-01

    A series of recent court decisions have been concerned with the compulsory treatment of patients with mental disorders who are incapable of giving consent. This article describes the current legal situation on compulsory treatment for different cases to achieve the aim of internment, endangerment to third parties, self-endangerment, for intercurrent diseases and to achieve the aim of therapy. The verdicts contribute on the one hand to strengthen patient autonomy against governmental or medical paternalism. On the other hand the verdicts have effected a substantial legal uncertainty with the undesired indirect consequence that fixation will probably be used more often. PMID:22911322

  10. [Medical and legal aspects of inability to participate in legal proceedings and the execution of imprisonment resulting from mental illness].

    PubMed

    Teleśnicki, Stanisław M; Bolechała, Filip

    2004-01-01

    A mental disorder of the criminal can be the cause of reprieving penal conduct or the execution of imprisonment. In the present study the matter of ability to take part in legal proceedings and arrest in preliminary custody were considered. The possibility and propriety of staying in conditions of imprisonment mentally ill persons was also considered. Legal settlements relating to this problem were submitted. We paid attention to medical circumstances in which judicial experts should act in such cases.

  11. [Legal principles for participation of medical service in vocational guidance and education].

    PubMed

    Balster, W

    1989-02-01

    Dealt with is the medical profession's legal status in the vocational education and vocational retraining centres. The legal basis for the medical doctor's activities in this type of facilities is clarified, drawing on the legislational history of various rehabilitation-related laws.

  12. The legal authority of mature minors to consent to general medical treatment.

    PubMed

    Coleman, Doriane Lambelet; Rosoff, Philip M

    2013-04-01

    The nature and scope of mature adolescents' legal authority to consent to general medical treatment without parental involvement is often misrepresented by commentators. This state of affairs is further complicated by the law itself, which has developed a broad "mature minor exception" to the general requirement of parental consent in abortion cases and which has additionally carved out numerous specific status-based and condition-based exceptions to that requirement. In these circumstances, it is not always a simple matter for physicians and other medical professionals who treat adolescents to ascertain the applicable law. In this article, we discuss the underlying differences between medical ethics and law, which have caused some of the confusion in this area, and we set out the most current legal rules governing adolescent decision-making authority in general medical settings. A comprehensive analysis of both statutory and common law demonstrates that in such settings, parental consent continues to be required by most jurisdictions, even when the minor can be considered cognitively "mature."

  13. Cross-border issues in the development of medical tourism in Malaysia: legal challenges and opportunities.

    PubMed

    Nemie, Puteri; Kassim, Jahn

    2009-08-01

    Strategically located at the crossroads of Asia, Malaysia has become one of the key players in the fast-growing and lucrative market for health care services in Asia. Medical travel across international boundaries has been made possible through affordable airfares and the favourable exchange rates of the Malaysian ringgit has contributed to the rise of the "medical tourism phenomenon" where medical travel is combined with visiting popular tourist destinations in Malaysia. Further, competitive medical fees and modern medical facilities have also made Malaysia a popular destination for medical tourists. Nevertheless, the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues. Presently, there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries. The economic benefits of medical tourism must be based upon a solid legal regulatory framework and strong ethical standards as well as upon high-quality medical and health care services. It is therefore important to assess the existing legal framework affecting the development of medical tourism in Malaysia in order to explore the gaps, deficiencies and possibilities for legal and regulatory reform. PMID:19771987

  14. Cross-border issues in the development of medical tourism in Malaysia: legal challenges and opportunities.

    PubMed

    Nemie, Puteri; Kassim, Jahn

    2009-08-01

    Strategically located at the crossroads of Asia, Malaysia has become one of the key players in the fast-growing and lucrative market for health care services in Asia. Medical travel across international boundaries has been made possible through affordable airfares and the favourable exchange rates of the Malaysian ringgit has contributed to the rise of the "medical tourism phenomenon" where medical travel is combined with visiting popular tourist destinations in Malaysia. Further, competitive medical fees and modern medical facilities have also made Malaysia a popular destination for medical tourists. Nevertheless, the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues. Presently, there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries. The economic benefits of medical tourism must be based upon a solid legal regulatory framework and strong ethical standards as well as upon high-quality medical and health care services. It is therefore important to assess the existing legal framework affecting the development of medical tourism in Malaysia in order to explore the gaps, deficiencies and possibilities for legal and regulatory reform.

  15. [Current status of medical education in Chile].

    PubMed

    2009-05-01

    The Chilean Academy of Medicine published a "Report on the Current Status of Medical Education in Chile". This report reviews the history of medical education in this country and its close relationship with the Health Care System, public and private; highlights the main changes that took place during the last 25 years in superior and medical education; provides information on the 26 currently existing Medical Schools; refers to the availability of medical doctors and specialists; discusses the mechanisms that control the quality of institutions involved and their programs; and summarizes the results of the Annual National Medical Examination. The members of the Committee on Superior Education of the Academy provided a critical analysis of medical education in Chile and recommendations on how to improve it.

  16. Affirmative Action in Medical Education: A Legal Perspective.

    ERIC Educational Resources Information Center

    Helms, Lelia B.; Helms, Charles M.

    1998-01-01

    Describes history of legal theory behind affirmative action, with examples from case law and Department of Education regulations, identifying legal pitfalls in admissions and financial aid, including categorization of students by race, racially disproportionate financial aid awards after accounting for need, racially disproportionate scholarship…

  17. Medical diagnosis of legal culpability: the impact of early psychiatric testimony in the 19th century English criminal trial.

    PubMed

    Toole, Ciara J

    2012-01-01

    Fast-paced developments in psychiatry, neuroscience and emerging neuroimaging technologies place continual pressure on the legal recognition of mental illness and disease across jurisdictional boundaries. Nevertheless, the Canadian legal definition of exculpatory mental disease in the context of criminal liability has remained largely static, sheltered from the immediate influence of medical theory and advancements. In order to effectively reflect on the intersection of mental health and criminal justice systems in this area, it is important to understand its historical development and the English common law origins of the current approach. Specifically turning to the early 19th century, documented history and accounts of early medical witness testimony on the mental state of the accused provide a unique opportunity to understand the initial collision between fundamental concepts of moral and legal culpability and new scientific understandings of mental function and disease. In this article, I suggest that early psychiatric testimony to the accused's mental state challenged the evolving criminal law of 19th century England to reconcile its restrictive definition of "insanity" with expanding scientific reasoning and accounts of mental disease. The trial of Edward Oxford, an attempted royal assassination case of 1840, is examined as a symbolic height in this conflict prior to the first common law pronouncement of the current approach in 1843. As debate continues on the role of medical advancement in the identification of exculpatory medical disorders in law, this historical perspective may serve as a touchstone in balancing the enforcement of legal culpability with our society's greater appreciation for mental illness.

  18. Foundations of Refugee Rights: How Legal Language Reflects Current Trends.

    ERIC Educational Resources Information Center

    Goldsmith, Andrew

    1996-01-01

    Addresses the recent anti-immigrant sentiment in the United States and examines the forces causing it. The article examines legal language and opinion in court cases showing shifting anti-immigrant sentiment, including the language used in California's Proposition 187, and argues that this legal language in which court decisions and legislation…

  19. Serving the Newly Legalized: Their Characteristics and Current Needs.

    ERIC Educational Resources Information Center

    Martin, Susan Forbes; And Others

    The Immigration Reform and Control Act of 1986 (IRCA) provides for the legalization of undocumented aliens through several programs. IRCA established the State Legalization Impact Assistance Grants (SLIAG) "to alleviate the financial impact on States and local governments that may result from the adjustment of immigrant status" through the…

  20. Legal and ethical issues in neuroimaging research: human subjects protection, medical privacy, and the public communication of research results.

    PubMed

    Kulynych, Jennifer

    2002-12-01

    Humans subjects research entails significant legal and ethical obligations. Neuroimaging researchers must be familiar with the requirements of human subjects protection, including evolving standards for the protection of privacy and the disclosure of risk in "non-therapeutic" research. Techniques for creating veridical surface renderings from volumetric anatomical imaging data raise new privacy concerns, particularly under the federal medical privacy regulation. Additionally, neuroimaging researchers must consider their obligation to communicate research results responsibly. The emerging field of neuroethics should strive to raise awareness of these issues and to involve neuroimaging researchers in the legal, ethical, and policy debates that currently surround human subjects research.

  1. [Medical and legal aspects of teleradiology in Germany].

    PubMed

    Rosenberg, C; Langner, S; Rosenberg, B; Hosten, N

    2011-09-01

    In teleradiology, imaging data are transferred over a distance. This service is provided for the purpose of consulting or teleradiological reading in the narrower sense. Once a justification has been proposed in the latter, the examination is performed under the responsibility of a radiologist who is not present on site. The need for teleradiology services often derives from sparsely populated areas, a shortage of doctors, or the need for cost-efficient provision of radiological examinations. The providers and recipients of teleradiology services enter into an agreement specifying conditions for data transfer. The German ionizing radiation (medical exposure) regulations demand that the teleradiologist holds radiation protection qualifications and is able to reach the examination site within 45 - 60 minutes. In Germany, teleradiology services are still limited to nights, weekends, and vacations, although the German regulations allow an expansion under certain circumstances. Efforts to fundamentally change radiology in favor of teleradiology are putting the status of a radiological medical act as well as current teaching models at risk, thereby indirectly sustaining physician shortage. Transnational teleradiology services offer the possibility of cost reduction, taking advantage of out-of-hour reading and wage fluctuation. At the same time, such services are associated with deficits in quality and availability of personnel as well as the quality of medical services. In the long-term teleradiology concepts will fundamentally change radiology. Smaller radiology units will concentrate on daily business and fast reporting. Larger units also providing academic teaching can use teleradiology networks to offer specialized readings. PMID:21442556

  2. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.

    PubMed

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-11-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide

  3. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.

    PubMed

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-11-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide

  4. [Medical, ethical and legal issues in cryopreservation of human embryos].

    PubMed

    Beca, Juan Pablo; Lecaros, Alberto; González, Patricio; Sanhueza, Pablo; Mandakovic, Borislava

    2014-07-01

    Embryo cryopreservation improves efficiency and security of assisted reproduction techniques. Nonetheless, it can be questionable, so it must be justified from technical, legal and ethical points of view. This article analyses these perspectives. Embryo cryopreservation maximizes the probability of pregnancy, avoids new ovary stimulations and reduces the occurrence of multiple gestations. There is consensus that the in vitro embryo deserves legal protection by its own, although not as a newborn. Very few countries prohibit embryo cryopreservation based on the legal duty to protect human life since fecundation. Those countries that allow it, privilege women's reproductive rights. In Chile and in Latin America, no laws have been promulgated to regulate human assisted reproduction. The moral status of the embryo depends on how it is considered. Some believe it is a potential person while others think it is just a group of cells, but all recognize that it requires some kind of respect and protection. There is lack of information about the number of frozen embryos and their final destination. As a conclusion the authors propose that women or couples should have the right to decide autonomously, while institutions ought to be clear in their regulations. And the legislation must establish the legal status of the embryo before its implantation, the couples' rights and the regulation of the embryo cryopreservation. Personal, institutional or legal decisions must assume a concept about the moral status of the human embryo and try to avoid their destruction or indefinite storage.

  5. A medico-legal review of some current UK guidelines in orthodontics: a personal view.

    PubMed

    Jones, J W

    1999-12-01

    This article is a critical analysis from a medico-legal perspective of some current authoritative UK clinical guidelines in orthodontics. Two clinical guidelines have been produced by the Royal College of Surgeons of England and four by the British Orthodontic Society. Each guideline is published with the analysis immediately following it. Following recent UK case law (Bolitho v City & Hackney Health Authority, 1997) which allows the courts to choose between two bodies of responsible expert medical opinion where they feel one opinion is not 'logical', it is likely that the UK courts will increasingly turn to authoritative clinical guidelines to assist them in judging whether or not an appropriate standard of care has been achieved in medical negligence cases. It is thus important for clinicians to be aware of the recommendations of such guidelines, and if these are not followed the reasons should be discussed with the patient and recorded in the clinical case notes. This article attempts to highlight aspects of the guidelines that have medico-legal implications.

  6. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  7. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  8. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  9. Supporting transgender children: new legal, social, and medical approaches.

    PubMed

    Minter, Shannon Price

    2012-01-01

    The author, a lawyer who advocates for transgender children and youth, explores how clinical approaches to transgender children and youth are keeping pace with social and legal changes affecting these young people and with recent evidence suggesting that children are harmed by family and societal rejection as well as by attempts to change their gender identity or gender expression. The author urges providers and legal advocates to work with policymakers and the families of transgender children and youth to create a future in which these young people can reach their full potential and be embraced as fully equal, respected, and participating members of society.

  10. Operative files of legal medical emergency in Calabria: study team.

    PubMed

    Rizzo, M; D'Andrea, E; Rizzi, P; Barbaro, A; Ricci, P; Nisticò, G; Magro, G; Russo, G; Alberto, R; Calvano, R

    2004-12-01

    In Calabria, a study team form legal medicine emergency (LME) formed to initiate a Crisis Unit (CU) able to manage and deal LME with complicated operations and roles, people and technical aspects involvement. First steps are planning, scene study and organization. Everything connecting the first and second emergency to have practicable application.

  11. Legal issues related to adolescent pregnancy: current concepts.

    PubMed

    Rhodes, A M

    1986-09-01

    Adolescent pregnancies have risen in recent years. Options open to the pregnant adolescent are: terminating the pregnancy; giving birth to the child out of wedlock; keeping the baby; giving the baby up for adoption; and marriage before or after the birth of the baby. Each of these options carries certain legal ramifications, since the adolescent patients have not reached the age of majority. The state or the parents usually assume the role of decision making on behalf of the adolescent or assist in the decision making process. Court rulings since the early seventies have legalized abortion and enlarged the rights of minors seeking termination of their pregnancies. Both parents and minors have rights under the certain state laws; parent have the right to notification, minors have the right to privacy. Keeping the child, out of wedlock, might result in legal battles over custody and/or establishing financial support from the father. Some adolescent mothers give up their children for adoption. There are 2 legal procedures that have to be accomplished before a child can be adopted: termination of the rights of the natural parents and adoption proceedings. If the parents marry after the birth of the child, the child is then considered legitimate and the father does not have to go through the process of adopting the child. Other issues requiring parental or individual consent include consent to treatment, contraception, or sterilization. In the case of forcible rape or incest, the physician is required to report incidents to law enforcement officials. PMID:3602637

  12. Legal Briefing: Adult Orphans and the Unbefriended: Making Medical Decisions for Unrepresented Patients without Surrogates.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers recent legal developments involving medical decision making for incapacitated patients who have no available legally authorized surrogate decision maker. These individuals are frequently referred to either as "adult orphans" or as "unbefriended," "isolated," or "unrepresented" patients. The challenges involved in obtaining consent for medical treatment on behalf of these individuals have been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. In 2012, JCE published a comprehensive review of the available mechanisms by which to make medical decisions for the unbefriended. The purpose of this "Legal Briefing" is to update the 2012 study. Accordingly, this "Legal Briefing" collects and describes significant legal developments from only the past three years. My basic assessment has not changed. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform." Most facilities are "muddling through on an ad hoc basis." But the situation is not wholly negative. There have been a number of promising new initiatives. I group these developments into the following seven categories: 1. Increased Attention and Discussion 2. Prevention through Better Advance Care Planning 3. Prevention through Expanded Default Surrogate Lists 4. Statutorily Authorized Intramural Mechanisms 5. California Litigation Challenging the Team Approach 6. Public Guardianship 7. Improving Existing Guardianship Processes. PMID:26132070

  13. [Abortion in Colombia. Medical, legal and socioeconomic aspects].

    PubMed

    Umaña, A O

    1973-01-01

    Abortion is a social problem and criminal sanctions are very ineffective in limiting it and are seldom applied (133 legal actions vs. 65,600 cases of induced abortion in 1965). Abortion is a social disease, as are prostitution, juvenile delinquency, drug abuse, and so far has been an insoluble problem. Colombian laws should be modified to reflect reality. Sex education must be emphasized, because ignorance is one of the main causes of abortion. Leniency should be applied toward women who cooperate with the authorities in identifying the person who performed an abortion. Legalization of abortion and enforcement of strict laws against it are considered as possible solutions, but both are rejected. The former is regarded as morally unacceptable and as imposing an excessive burden on scarce health services, the latter as even worse, imposing an equivalent burden on the court system, without s olving either health or social problems. The best and probably only solution is to improve education in family planning, to promote knowledge and motivation to enable the population to make sound and responsible decisions. PMID:4804875

  14. [Transsexuality-medical and legal aspects (author's transl)].

    PubMed

    Jörgensen, G; Wiedeking, C

    1976-05-14

    Transsexuals have a subjective conviction that they belong to the opposite sex and demand a change of sex. They suffer mainly from lack of understanding in their environment. In the German Federal Republic the legal problem of transsexuals has become a legislative one through the verdict of the Bundesgerichtshof of 21.9. 1971. By contrast, pragmatical solutions have been found in the United States during the last 10 years, particularly since Gender Identity Clinics came into existence. The etiology of transsexualism is unknown. The most reliable diagnostic test is the two-year test, living practically in the desired sex. Counselling, hormonal and surgical therapy do not constitute a cure, but rehabilitation. At the present time these are the only measures to help transsexuals.

  15. The medical and legal aspects of maternal mortality.

    PubMed

    Elliott, John P

    2012-02-01

    Sudden unexpected changes in the life of a family create many different emotions in various family members. The death of a young woman during or after her pregnancy is especially difficult because of the strain it places on family dynamics. One of the consequences is that there is, commonly, a newborn, and perhaps other children, without a mother and caregiver. In families that relied on both parents working, there are financial hardships imposed by the death. There is the emotional void that is felt by her partner, parents, sisters, brothers, and extended family. This extreme stress leads to questions about the death that need to be addressed by the health care providers. If the anger that is part of the grieving process is not adequately resolved, healing cannot occur. It is then that the family may pursue the legal process to help obtain answers about what happened and, more importantly, why it happened to their loved one.

  16. Ambulatory surgery centers--current legal issues 2004 (Part 2).

    PubMed

    Becker, Scott; Szabad, Melissa; Foltushansky, Sofia

    2004-05-01

    component of the procedure performed with the equipment, and the vendor then pays the ASC a fee for its lease of ASC space to house the equipment. These types of relationships can raise several legal compliance concerns. An ASC should understand that the arrangement could jeopardize its state ASC license and its Medicare certification even though the arrangement does not involve Medicare certified procedures or Medicare patients. Furthermore, this type of business venture might not comply with state and federal self referral laws. ASCs are also increasingly facing situations where a provider performs a procedure for which there is no facility charge for the ASC, but the physician is receiving a professional fee from Medicare. In this situation, ASCs should implement a policy, similar to the example provided in this article, to avoid even the appearance of providing an inducement or reward for referrals of Medicare or Medicaid business by requiring physicians to pay the Center a fee, consistent with fair market value, for the use of the Center for non-Covered Procedures or for performing multiple procedures within the same operative session. Lastly, as touched upon by this article, in the joint venture context, ASCs must take into account several guidelines in order to steer clear from risks associated with tax-exempt entities as an investor and antitrust price fixing issues. Whether a joint venture, of which a tax exempt entity is an investor, is deemed organized and operated in furtherance of the charitable purposes of a tax-exempt partner as set forth in Section 501(c)(3) of the Code depends on the facts and circumstances of each case. Generally, a joint venture will satisfy the guidelines if the tax-exempt investor in the joint venture retains sufficient control over the joint venture to ensure that the joint venture furthers the charitable purposes of the tax-exempt investor and adequately serves the community. In the ASC physician hospital joint venture arena, the

  17. Negligence: the different focus of medical and legal concerns.

    PubMed

    Hodgson, John

    This article looks at additional areas where medical practice has been instrumental in developing the law. These cases do not involve malpractice, but do highlight how the different concerns, priorities and methodologies of medicine and law can produce problems and anomalies. One focus is on causation in relation to industrial disease, and the other on liability for negligently inflicted psychological harm.

  18. Medical legal partnership and health informatics impacting child health: Interprofessional innovations.

    PubMed

    Gilbert, Amy Lewis; Downs, Stephen M

    2015-01-01

    Dramatic differences in health are closely related to degrees of social and economic disadvantage. Poverty-induced hardships such as food insecurity, utility shut-offs, and substandard housing, all have the potential to negatively impact the health of families. In an effort to better address social determinants of health in pediatric primary health care settings using the Medical Legal Partnership (MLP) model of health care delivery, an interprofessional team of investigators came together to design an innovative process for using computerized clinical decision support to identify health-harming legal and social needs, improve the delivery of appropriate physician counseling, and streamline access to legal and social service professionals when non-medical remedies are required. This article describes the interprofessional nature of the MLP model itself, illustrates the work that was done to craft this innovative health informatics approach to implementing MLP, and demonstrates how pediatricians, social workers and attorneys may work together to improve child health outcomes.

  19. [Legal framework of data protection : current requirements in Germany and requirements in planned European Union regulations].

    PubMed

    Schütze, B

    2013-05-01

    The federal system in Germany necessitates that in addition to federal laws, country and church-specific legislations must also be considered during the evaluation of relevant legal stipulations concerning data protection. Furthermore, there are also special legal regulations for hospitals in almost every federal state which are governed by the principle of subsidiarity: special legal regulations are to be preferentially used, so that findings from one federal state are difficult to transfer to another federal state.Patient data may only be used and processed without legal regulations with informed consent of the patient. The use of patient data for purposes of quality assurance, research and further education of students and doctors is possible under the present laws according to a positive weighting of interests. Patient data can also be exchanged via online services for the purposes of patient care; however, informed consent of the patient for medical online services is almost always unavoidable.

  20. [The role and place of pathology services in ensuring and improving the quality of medical care: Organizational and legal aspects].

    PubMed

    Timofeev, I V

    2015-01-01

    The paper considers the legal and organizational issues of the activity of pathology services in improving medical care. It shows the main (diagnostic and medico-organizational) areas of pathology work to improve the quality of medical care.

  1. Medical-Legal Inferences From Functional Neuroimaging Evidence.

    PubMed

    Mayberg

    1996-07-01

    Positron emission (PET) and single-photon emission tomography (SPECT) are validated functional imaging techniques for the in vivo measurement of many neuro-phsyiological and neurochemical parameters. Research studies of patients with a broad range of neurological and psychiatric illness have been published. Reproducible and specific patterns of altered cerebral blood flow and glucose metabolism, however, have been demonstrated and confirmed for only a limited number of specific illnesses. The association of functional scan patterns with specific deficits is less conclusive. Correlations of regional abnormalities with clinical symptoms such as motor weakness, aphasia, and visual spatial dysfunction are the most reproducible but are more poorly localized than lesion-deficit studies would suggest. Findings are even less consistent for nonlocalizing behavioral symptoms such as memory difficulties, poor concentration, irritability, or chronic pain, and no reliable patterns have been demonstrated. In a forensic context, homicidal and sadistic tendencies, aberrant sexual drive, violent impulsivity, psychopathic and sociopathic personality traits, as well as impaired judgement and poor insight, have no known PET or SPECT patterns, and their presence in an individual with any PET or SPECT scan finding cannot be inferred or concluded. Furthermore, the reliable prediction of any specific neurological, psychiatric, or behavioral deficits from specific scan findings has not been demonstrated. Unambiguous results from experiments designed to specifically examine the causative relationships between regional brain dysfunction and these types of complex behaviors are needed before any introduction of functional scans into the courts can be considered scientifically justified or legally admissible. PMID:10320420

  2. Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction.

    PubMed

    Cheong, M A; Tay, S K

    2014-06-01

    In the management of complex medical cases such as a multifetal pregnancy, knowledge of the ethical and legal implications is important, alongside having competent medical skills. This article reviews these principles and applies them to scenarios of multifetal pregnancy and fetal reduction. Such a discussion is not solely theoretical, but is also relevant to clinical practice. The importance of topics such as bioethical principles and informed consent are also herein addressed.

  3. Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction

    PubMed Central

    Cheong, May Anne; Tay, Catherine Swee Kian

    2014-01-01

    In the management of complex medical cases such as a multifetal pregnancy, knowledge of the ethical and legal implications is important, alongside having competent medical skills. This article reviews these principles and applies them to scenarios of multifetal pregnancy and fetal reduction. Such a discussion is not solely theoretical, but is also relevant to clinical practice. The importance of topics such as bioethical principles and informed consent are also herein addressed. PMID:25017403

  4. Medical entrepreneurism: the current opportunity in America.

    PubMed

    Lexa, Frank James

    2004-10-01

    This article discusses both the current climate for entrepreneurial activity in the fields of biotechnology, health care services, and medical devices as well as key ideas in the process of successful innovation. Basic issues related to the nature of new medical ventures and its importance in the U.S. economy are discussed. A stepwise overview of the process of innovation is provided, starting from the initial idea, through the early and middle stages of growth, and on to an initial public offering or other alternative harvest strategy. The roles of financing sources in generating health care entrepreneurial activity are explored, and the advantages and disadvantages of each are discussed. The article focuses on venture capital investment because of its pivotal role in high-profile successes; however, alternative forms of financing are also covered as appropriate to each stage. In addition, critical nonfinancial issues that affect the success of new enterprises, such as intellectual property protection and the creation of management teams for young companies, are also covered. The magnitude of current investment in the domestic biomedical field is addressed, and future prospects for American medical innovation are briefly discussed. PMID:17411697

  5. 76 FR 54004 - Agency Information Collection (Report of Medical, Legal, and Other Expenses Incident to Recovery...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ... for Injury or Death) Activity under OMB Review AGENCY: Veterans Benefits Administration, Department of..., and Other Expenses Incident to Recovery for Injury or Death, VA Form 21-8416b. OMB Control Number... injury or death. Such award is considered as countable income; however, medical, legal or other...

  6. Psychotropic Medication Consultation in Schools: An Ethical and Legal Dilemma for School Psychologists

    ERIC Educational Resources Information Center

    Carlson, John S.; Thaler, Cara L.; Hirsch, Amanda J.

    2006-01-01

    Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the…

  7. Insulin Administration in Catholic Schools: A New Look at Legal and Medical Issues

    ERIC Educational Resources Information Center

    Huggins, Mike

    2015-01-01

    Anecdotal evidence indicates that more students with type 1 diabetes are enrolling in Catholic schools across the United States. Meeting the medical needs of these students appears to be a significant challenge--legally and logistically--for many Catholic schools. District officials, school leaders, and school staff need support to understand the…

  8. Inclusion of Medical-Legal Issues in Entry-Level Occupational and Physical Therapy Curricula.

    ERIC Educational Resources Information Center

    Ekelman, Beth A.; Goodman, Glenn; Dal Bello-Haas, Vanina

    2000-01-01

    Directors of 47 occupational therapy (OT) and 65 physical therapy (PT) accredited entry-level programs responded to a survey by indicating their support for inclusion of medical-legal issues in the curriculum. Only 40% of OT and 52% of PT directors believed lawyers should deliver instruction; most felt their faculty were qualified to teach these…

  9. Medication-Related Practice Roles: An Ethical and Legal Primer for School Psychologists

    ERIC Educational Resources Information Center

    Shahidullah, Jeffrey D.

    2014-01-01

    Given the prevalence of school-age children and adolescents who are prescribed with and are taking psychotropic medications, a critical issue that school psychologists may likely encounter in contemporary practice is providing both quality and continuity of care to these students in the context of relevant legal and ethical parameters. With a…

  10. Ethical and legal aspects in medically assisted human reproduction in Romania.

    PubMed

    Ioan, Beatrice; Astarastoae, Vasile

    2008-01-01

    Up to the present, there have not been any specific norms regarding medically assisted human reproduction in Romanian legislation. Due to this situation the general legislation regarding medical assistance (law no. 95/2006, regarding the Reform in Health Care System), the Penal and Civil law and the provisions of the Code of Deontology of the Romanian College of Physicians are applied to the field of medically assisted human reproduction. By analysing the ethical and legal conflicts regarding medically assisted human reproduction in Romania, some characteristics cannot be set apart because they derive from religious, cultural and socio-economic aspects. In this article the authors identify the development stages of medically assisted human reproduction in Romania, beginning from these characteristics and insisting upon the failure of the legal system in this specific field. The authors consider that the law regarding medically assisted human reproduction cannot be effective because it did not take into account the ethical and cultural aspects that might appear. Furthermore, in this framework of the legal process, no public debate involving the representatives of civil society was undertaken although the Council of Europe Oviedo Convention approved by our country according to law no. 17/2001 stipulated exactly this working method.

  11. The diversion of stimulant medications among a convenience sample of college students with current prescriptions.

    PubMed

    Gallucci, Andrew R; Martin, Ryan J; Usdan, Stuart L

    2015-03-01

    Diversion is defined as the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace. Persons with legal prescriptions often give away or sell their medications to others. The misuse of prescription stimulant medications continues to be a problem on college campuses and a need to understand how students are obtaining stimulant medications exists. The object of the study was to identify the prevalence, correlates, and motivations associated with diversion of prescription stimulants among current prescription holders. A large sample of undergraduates (n = 1,022) between the ages of 18 and 24 enrolled at a large public university in the southeastern United States completed an in class questionnaire. Among those respondents, we identified 151 current stimulant prescription holders and analyzed the prevalence, motivations, and correlates associated with lifetime and current diversion. Overall, 58.9% of current prescription holders had given away or sold their stimulant medication during their lifetime. Those with a history of nonmedical use of prescription stimulants were almost 5 times more likely to divert their medication during their lifetime. The majority of those engaging in lifetime and current diversion medication did so infrequently. The most common motivations reported for both lifetime and current diversion were "to make extra money" and to "help during a time of high academic stress." Students who reported a history of prescription misuse were also more likely to engage in current diversion. Diversion-related behaviors should be explored further and programs aimed at the reducing these behaviors should be considered. PMID:25134041

  12. The diversion of stimulant medications among a convenience sample of college students with current prescriptions.

    PubMed

    Gallucci, Andrew R; Martin, Ryan J; Usdan, Stuart L

    2015-03-01

    Diversion is defined as the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace. Persons with legal prescriptions often give away or sell their medications to others. The misuse of prescription stimulant medications continues to be a problem on college campuses and a need to understand how students are obtaining stimulant medications exists. The object of the study was to identify the prevalence, correlates, and motivations associated with diversion of prescription stimulants among current prescription holders. A large sample of undergraduates (n = 1,022) between the ages of 18 and 24 enrolled at a large public university in the southeastern United States completed an in class questionnaire. Among those respondents, we identified 151 current stimulant prescription holders and analyzed the prevalence, motivations, and correlates associated with lifetime and current diversion. Overall, 58.9% of current prescription holders had given away or sold their stimulant medication during their lifetime. Those with a history of nonmedical use of prescription stimulants were almost 5 times more likely to divert their medication during their lifetime. The majority of those engaging in lifetime and current diversion medication did so infrequently. The most common motivations reported for both lifetime and current diversion were "to make extra money" and to "help during a time of high academic stress." Students who reported a history of prescription misuse were also more likely to engage in current diversion. Diversion-related behaviors should be explored further and programs aimed at the reducing these behaviors should be considered.

  13. Federal legal preparedness tools for facilitating medical countermeasure use during public health emergencies.

    PubMed

    Courtney, Brooke; Sherman, Susan; Penn, Matthew

    2013-03-01

    Preparing for and responding to public health emergencies involving medical countermeasures (MCMs) raise often complex legal challenges and questions among response stakeholders at the local, state, and federal levels. This includes concerns about emergency legal authorities, liability, emergency use of regulated medical products, and regulations that might enhance or hinder public health response goals. In this article, lawyers from the U.S. Department of Health and Human Services' (HHS) Office of the General Counsel (OGC), Centers for Disease Control and Prevention (CDC), and Food and Drug Administration (FDA) discuss federal legal tools that are critical to enhancing MCM legal preparedness for public health emergencies, with an emphasis on the legal mechanisms that can be used to facilitate the emergency use of countermeasures. Specifically, the authors describe the Public Readiness and Emergency Preparedness (PREP) Act and Emergency Use Authorization (EUA) authority, outlining the conditions under which these tools can be utilized and providing examples of how they have supported both pre-event (e.g., doxycycline mass dispensing preparedness for anthrax) and intra-event (e.g., 2009 H1N1 influenza pandemic response) activities.

  14. Evolving medical service in the information age: a legal analysis of applying telemedicine programs in Taiwan.

    PubMed

    Wu, Hsing-Hao

    2008-12-01

    In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI). PMID:19202856

  15. Legal considerations on the liability of damage compensation in medical accidents in China.

    PubMed

    Shen, Xiuqin; Chen, Xiaoyang

    2008-12-01

    In the past years, there has been an increasing number of medical accidents in various places around the country. Some of them often led to medical litigations. The responsibility of medical accident compensation is the key factor, which involves either the harmony between physician-patient relationship, or the realization of patients' rights. Though relevant legal provisions on the responsibility of medical accidents have been made in national law, regulation and some judicial interpretation, there exist so many problems in reality, such as the uniformity of law application, compensational rate and the deficiency of compensational scope and method. Therefore, in this article, the author tries to analysis the attribute of medical accident compensation, relevant laws and regulations and the problems in practical life, and to put forward advice on how to perfect medical accident legislation.

  16. Current trends in medical ethics education in Japanese medical schools.

    PubMed

    Kurosu, Mitsuyasu

    2012-09-01

    The Japanese medical education program has radically improved during the last 10 years. In 1999, the Task Force Committee on Innovation of Medical Education for the 21st Century proposed a tutorial education system, a core curriculum, and a medical student evaluation system for clinical clerkship. In 2001, the Model Core Curriculum of medical education was instituted, in which medical ethics became part of the core material. Since 2005, a nationwide medical student evaluation system has been applied for entrance to clinical clerkship. Within the Japan Society for Medical Education, the Working Group of Medical Ethics proposed a medical ethics education curriculum in 2001. In line with this, the Japanese Association for Philosophical and Ethical Research in Medicine has begun to address the standardization of the curriculum of medical ethics. A medical philosophy curriculum should also be included in considering illness, health, life, death, the body, and human welfare.

  17. INFORMED CONSENT: THE MEDICAL AND LEGAL CHALLENGE OF OUR TIME

    PubMed Central

    Séllos Simões, Luiz Carlos

    2015-01-01

    Objective: To assess the real importance of obtaining informed consent, through an appropriate form, and its role in the outcome from civil liability claims. Methods: The wordings of the current Brazilian law and jurisprudence were compared with rulings from the State Court of the State of Rio de Janeiro, in 269 civil liability claims against healthcare professionals and hospitals. Results: Favorable and unfavorable outcomes (i.e. acquittals and convictions) were compared, and possible variations in the verdicts were discussed in relation to whether informed consent forms had been filled out or not. Conclusions: Obtaining informed consent, by means of appropriate forms, is still not a widespread practice in the Brazilian healthcare or judicial systems. It is recommended that this practice be adopted in the manner described in this paper, since this is prescribed in Brazilian law. PMID:27022541

  18. Key Considerations for an Economic and Legal Framework Facilitating Medical Travel.

    PubMed

    Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

    2016-01-01

    Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel.

  19. Key Considerations for an Economic and Legal Framework Facilitating Medical Travel

    PubMed Central

    Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

    2016-01-01

    Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel. PMID:27066467

  20. Key Considerations for an Economic and Legal Framework Facilitating Medical Travel.

    PubMed

    Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

    2016-01-01

    Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel. PMID:27066467

  1. Consumers devise drug cost-cutting measures: medical and legal issues to consider.

    PubMed

    Ganguli, Gouranga

    2003-01-01

    Health care costs in general, and prescription drug costs in particular, are rapidly rising. Between 1996 and 2007 the average annual per capita health care cost is projected to increase from dollar 3,781 to dollar 7,100. [AQ1] The single leading component of health care cost is the cost of prescription drugs (currently 10% of total health care spending, projected to become 18% in 2008). The average cost per drug increased 40% during the 1993-1998 period. Forty-one million Americans have no health insurance, and those who have, have inadequate prescription drug coverage. [AQ2] To cope with this situation, many consumers are trying to economize by doing without the prescriptions or the appropriate doses, buying generics or medicines from Canada or Mexico, or splitting pills of higher doses to take advantage of the pricing policy of drug manufacturers. Some of these approaches are medically and/or legally acceptable, while some are dubious. Most adversely affected are the seniors and poor; for certain groups of seniors prescription drugs account for 30% of their health care spending. The problem must receive prompt concerted attention from consumers, insurers, pharmaceutical companies, and lawmakers before it gets out of hand.

  2. [Compliance with psychiatric legal ordinance section 63 STGB. Legal principles--current status--treatment concepts--perspectives].

    PubMed

    Nedopil, N; Müller-Isberner, R

    1995-11-01

    According to German law, delinquents who are considered either not fully responsible or not responsible at all for their actions because of a mental disorder receive no punishment or a lesser degree of punishment in criminal trials. They may, however, be sentenced to psychiatric treatment either in a psychiatric hospital or in an addiction centre, if the risk of them committing such offenses in the future is considered to be high. This article reviews the current situation of mentally ill offenders in hospitals and explores possible developments in forensic psychiatry. It outlines the legal framework, and the current and developing treatment strategies, and finally raises the question of whether these developments will lead to further specialization of forensic psychiatry or to a reintegration of forensic knowledge into general psychiatry.

  3. [Current approaches in vocationally oriented medical rehabilitation].

    PubMed

    Röckelein, E; Lukasczik, M; Neuderth, S

    2011-04-01

    Stressors and demands related to changes in work environment may result in impairments of employees' health and ability to work. In the context of the German statutory pension insurance's inpatient medical rehabilitation, these aspects are increasingly taken into account within the concept of vocationally oriented medical rehabilitation (VOMR). Nonetheless, a comprehensive implementation of diagnostic and therapeutic concepts in rehabilitative practice has not yet been realized. In this article, a profile of requirements for VOMR which has been developed by the German pension insurance is introduced that shall contribute to aligning rehabilitative measures for patients with work-related problems with occupational demands. Moreover, approaches for implementing vocationally oriented measures in diagnostics (e.g., screenings) and therapy (e.g., job training) as well as good practice examples are presented. In addition, user-oriented media (handbook, homepage) which enable researchers and clinicians to learn about the current state of research in this area are highlighted. Starting points for further development of vocational orientation in rehabilitation are discussed. PMID:21465399

  4. [Surgery and transfusion in Jehovah's witness patient. Medical legal review].

    PubMed

    Loriau, J; Manaouil, C; Montpellier, D; Graser, M; Jarde, O

    2004-06-01

    The religious convictions of the witnesses of Jehovah leads them to refuse transfusion of blood, of its major components and of blood sparing procedures breaking the physical contact between the patient and his blood. We recall the rules of good practice in case of elective surgery concerning exhaustive information of the patient within multidisciplinary team associating anesthetist and surgeon advised by the forensic pathologist. This consultation must, to our point of view, be concluded by a report which summarizes what is accepted or not by the patient. This report will be initialed by the patient. This consultation can never lead the physician to swear to never use a transfusion whatever the circumstances. In case of emergency if and only some conditions are met (everything was made to convince the patient, vital emergency, no therapeutic choice, therapeutic care adapted to the patient heath status), the physician can be brought to overpass the patient's will to not receive blood transfusion. Current jurisprudence has, to date, never recognized as faulty the physicians having practiced such transfusions whenever they took place within a precise framework. PMID:15220098

  5. Medical, psychologic, and legal aspects of child custody disputes.

    PubMed

    Duncan, J W

    1978-07-01

    An increasing number of children seen in pediatric practice are children of divorce. The child is often involved in the conflict between his parents in regard to custody and visitation. The physician will want to be familiar with the historical background of child custody decisions and the present guidelines the courts are using in determining custody and visitation, together with the newer and controversial proposals concerning the elusive concept of "best interests of the child." It is important that the pediatrician recognize the usual phenomenology of the young child's response to family disruption, lest he ascribe it to some fault on the part of the current caretaker. Some children respond to disruption in the family with symptoms that warrant intervention directed toward helping the child. All cases warrant intervention designed to enhance the parenting ability of the custodial parent and to enlist the cooperation of the noncustodial parent to minimize adverse influences on the child's developmental agenda. The physician should be well prepared if he participates in court procedures regarding custody and visitation controversy.

  6. Medical paternalism or legal imperialism: not the only alternatives for handling Saikewicz-type cases.

    PubMed

    Buchanan, A

    1979-01-01

    In 1977, the Supreme Judicial Court of Massachusetts held in the Saikewicz case that the probate court is the proper tribunal for making decisions whether to give or withhold "life-prolonging treatment" for terminally ill incompetent patients. This ruling provoked debate in the medical and legal communities. Dr. Arnold Relman, Editor of The New England Journal of Medicine, argues that Saikewicz encroaches on existing sound medical practice and requires decision-making machinery that is impractical and inhumane. Relman contends that treatment decision for terminally ill incompetents in Saikewicz-type cases should be made by the physician in consultation with the patient's family. Law professor Charles Baron, in contrast, defends Saikewicz's judicialization approach, arguing that such decision must bemade in an adversary framework that approximates the ideal of the rule of law. In the present Article, Professor Buchanan argues that Relman's criticism of Saikewicz rests on a defective, medical paternalist view of the physician-patient relationship, and that Baron's support of Saikewicz is based on an unjustifiable, legal imperalist view of decision making for incompetents. In Buchanan's view, Relman's approach fails to distinguish appropriately between the making of medical judgments and the making of moral judgments and wrongly assumes that the patient's family typically cannot understand the elements of the decision, while Baron's approach unjustifiably extends the sphere of the legal process by ignoring the special moral relationship that usually exists between the family and its incompetent member. Buchanan proposes an alternative decision-making approach that he believes incorporates the merits, while remedying the defects, of both Baron's and Relman's approaches. The alternative is based on three propositions. (1) The proper presumption in Saikewicz-type cases is that the family of an incompetent is to make decisions concerning treatment. (2) This presumption of

  7. Differences in the medical and legal viewpoint illustrated by R v Hardie [1984].

    PubMed

    Weller, M; Somers, W A

    1991-04-01

    The case of R. v Hardie [1984] creates an important precedent and is cited in the current edition of Archbold (1989). It is argued that the pharmacological issues discussed therein contain errors that seem to go to the heart of the judgment, which illustrates the differences between the legal and scientific viewpoint.

  8. Medical malpractice and the professional legal responsibility of the sports physician.

    PubMed

    Verzeletti, Andrea

    2013-09-01

    As with other medical specialties, litigation in sports medicine appears to be on the increase. In most countries, the applicable legal standard is "good medical practice" as identified with reference to the physician's own field of specialisation: what is commonly done by physicians in the same specialty generally serves as the standard by which a physician's conduct is measured. To enhance the quality of sports medicine practice, medical societies have been issuing guidelines for use by sports physicians, and a number of courts have recognised guidelines as evidence of good medical practice. One potential field of malpractice in sports medicine relates to privacy issues: an athlete should be asked to fill in a consent form if the medical information needs to be shared with other parties. Another relevant field is doping: for any act of drug prescription to be legally sound, sports physicians have to be aware of the requirements of the World Anti-Doping Agency Code and its international standards. Ultimately, the best way for sports physicians to avoid sources of liability is for them to keep up to date with the latest research and to act in a careful and diligent manner.

  9. Is there any legal and scientific basis for classifying electronic cigarettes as medications?

    PubMed

    Farsalinos, Konstantinos E; Stimson, Gerry V

    2014-05-01

    The rapid growth in the use of electronic cigarettes has been accompanied by substantial discussions by governments, international organisations, consumers and public health experts about how they might be regulated. In the European Union they are currently regulated under consumer legislation but new legislation will regulate them under the Tobacco Products Directive. However, several countries have sought to regulate them under medicines regulations. These claims have been successfully challenged in 6 court cases in European states. Under European legislation a product may be deemed to be a medicine by function if it is used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis. It is a medicine by presentation if it is presented (e.g. by a manufacturer or distributor) as having properties for treating or preventing disease in human beings. We assess the legal and scientific basis for the claim that electronic cigarettes should be regulated as medicines. We conclude that they are neither medicine by function nor necessarily by presentation The main reason for their existence is as a harm reduction product in which the liking for and/or dependence on nicotine is maintained, and adoption of use is as a substitute for smoking and not as a smoking cessation product. In reality, they are used as consumer products providing pleasure to the user. They are not used to treat nicotine addiction or other disease, but to enable continued use of nicotine. Their use is adjusted individually by each consumer according to his or her perceived pleasure and satisfaction. Gaps in current regulation regarding safety and quality can be met by tailored regulations.

  10. Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan

    PubMed Central

    2011-01-01

    Background A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. Methods We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. Results When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. Conclusion These findings may be useful in improving physician-patient communication in the medical setting. PMID:21510891

  11. The Current State of Medical Education in Chinese Medical Schools

    ERIC Educational Resources Information Center

    Kosik, Russell Oliver; Huang, Lei; Cai, Qiaoling; Xu, Guo-Tong; Zhao, Xudong; Guo, Li; Tang, Wen; Chen, Qi; Fan, Angela Pei-Chen

    2014-01-01

    Today's doctor is as much a humanist as a scientist. Medical schools have responded to this change by introducing a variety of courses, most notably those concerning the humanities and ethics. Thus far, no one has examined the extent of use of these subjects in Chinese medical schools. The goal of this study is to determine how many and in…

  12. The "amnesty" aftermath: current policy issues stemming from the legalization programs of the 1986 Immigration Reform and Control Act.

    PubMed

    Baker, S G

    1997-01-01

    "The 1986 Immigration Reform and Control Act (IRCA) created two one-time only legalization programs affecting nearly 3 million undocumented immigrants. Legalization has produced important changes among immigrants and in immigration policy. These changes include new patterns of immigrant social and economic adaptation to the United States and new immigrant flows through family ties to IRCA-legalized aliens.... This article combines data from a longitudinal survey of the IRCA-legalized population with qualitative field data on current immigration issues from key informants in eight high-immigration metropolitan areas. It reviews the political evolution and early implementation of legalization, the current socioeconomic position of legalized aliens, and changes in the immigration ¿policy space' resulting from legalization."

  13. Current Issues and the Veterinary Medical Library

    ERIC Educational Resources Information Center

    Nault, Andre J.

    2010-01-01

    Veterinary medical libraries and librarians are unique. There are now 33 veterinary colleges in North America, and in accordance with American Veterinary Medical Association accreditation, each has a library managed by an accredited librarian. Colleges with veterinary programs often maintain specialized branch libraries to support the degree,…

  14. [Legal regulation of clinical drug trials for the use in military-medical organisations].

    PubMed

    Ivchenko, E V; Ivanov, V S; Shustov, S B

    2015-06-01

    The authors identified problematic issues of legal regulation of clinical drug trials for medical use, and proposed possible solutions. It has been established that the conduction of clinical trials, of medicinal products is based on the norms of various branches of law embodied in the Constitution of the Russian Federation, the norms of international law, the Civil Code of the Russian Federation and federal laws and subordinate legislations regulating health and pharmaceutical activity. According to the authors, the norms of bioethics can be attributed to the sources of legal doctrine. It is proposed to oblige executives of clinical trials to make a report about effectiveness and safety of drugs and pass the results to the customer, in his/her turn the customer is obliged to accept the results of these trials and pay for them. PMID:26442317

  15. Industry-sponsored medical education--in the quest for professional integrity and legal certainty.

    PubMed

    Buchner, Benedikt

    2007-12-01

    Industry-sponsored medical education is a much disputed issue. So far, there has been no regulatory framework which provides clear and definite rules as to whether and under what circumstances the sponsorship of medical education is acceptable. State regulation does not exist, or confines itself to a very general principle. Professional regulation, even though applied frequently, is rather vague and indefinite, raising the general question as to whether self-regulation is the right approach at all. Certainly, self-regulation by industry cannot and should not replace other regulatory approaches. Ultimately, advertising law in general and the European Directive 2001/83/EC specifically, might be a good starting point in providing legal certainty and ensuring the independence of medical education. Swiss advertising law illustrates how the principles of the European Directive could be implemented clearly and unambiguously. PMID:18431976

  16. Medical devices for the anesthetist: current perspectives.

    PubMed

    Ingrande, Jerry; Lemmens, Hendrikus Jm

    2014-01-01

    Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use. PMID:24707188

  17. Current medical diagnosis and treatment 1987

    SciTech Connect

    Krupp, M.A.; Schroeder, S.A.; Tierney, L.M.

    1987-01-01

    This book contains 33 chapters. Some of the titles are: Medical genetics; Poisoning; Disorders due to physical agents; Malignant disorders; Immunologic disorders; Breast; Gynecology and obstetrics; and Genitourinary tract.

  18. Current medical diagnosis and treatment 1986

    SciTech Connect

    Krupp, M.A.; Chatton, M.J.; Tierney, L.M.

    1986-01-01

    This book contains 33 chapters. Some of the titles are: Nervous system; Psychiatric disorders; Medical genetics; Endocrine disorders; Introduction to infectious diseases; Disorders due to physical agents; and Anti-infective chemotherapeutic and antibiotic agents.

  19. Medical devices for the anesthetist: current perspectives

    PubMed Central

    Ingrande, Jerry; Lemmens, Hendrikus JM

    2014-01-01

    Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use. PMID:24707188

  20. Interpreting risk as evidence of causality: lessons learned from a legal case to determine medical malpractice.

    PubMed

    Mercuri, Mathew; Baigrie, Brian S

    2016-08-01

    Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing "biological plausibility" of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context.

  1. [Medico-legal opinionating in cases of insobriety in medical personnel].

    PubMed

    Jurek, Tomasz; Swiatek, Barbara; Drozd, Radosław

    2009-01-01

    The authors analyzed the medico-legal opinions in cases of insobriety in medical personnel. The studies were based on the results of 157 medico-legal evaluations in criminal cases performed in the years 2005-2007. Expert appraisals included: correctness of medical management, degree of exposure to direct danger of death or grave detriment to health associated with alcohol intoxication of a physician, regardless of his activities being correct in their merits, as well as influence of insobriety on personnel behavior. Penal responsibility is implemented in case of exposing the patient to direct danger to life or severe detriment to health. The necessary analysis should include activities that have been or should have been performed by a physician with respect to his patients, their health status (degree of danged to life or health) and the effect of the physician's alcohol intoxication on his abilities to perceive and assess the reality, make decisions and perform his duties. The Polish law in force lacking the equivalent of Article 147 found in the Polish penal code of 1969 causes problems in penalization of insobriety in medical personnel.

  2. Self-medication: A current challenge.

    PubMed

    Bennadi, Darshana

    2013-12-01

    Self-medication is a global phenomenon and potential contributor to human pathogen resistance to antibiotics. The adverse consequences of such practices should always be emphasized to the community and steps to curb it. Rampant irrational use of antimicrobials without medical guidance may result in greater probability of inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen resistance and increased morbidity. This review focused on the self-medication of allopathic drugs, their use, its safety and reason for using it. It would be safe, if the people who are using it, have sufficient knowledge about its dose, time of intake, side effect on over dose, but due to lack of information it can cause serious effects such as antibiotic resistance, skin problem, hypersensitivity and allergy. There is need to augment awareness and implement legislations to promote judicious and safe practices. Improved knowledge and understanding about self-medication may result in rationale use and thus limit emerging microbial resistance issues. Articles which were published in peer reviewed journals, World Self-Medication Industry and World Health Organization websites relating to self-medication reviewed. PMID:24808684

  3. Undergraduate medical students' empathy: current perspectives.

    PubMed

    Quince, Thelma; Thiemann, Pia; Benson, John; Hyde, Sarah

    2016-01-01

    Empathy is important to patient care. It enhances patients' satisfaction, comfort, self-efficacy, and trust which in turn may facilitate better diagnosis, shared decision making, and therapy adherence. Empathetic doctors experience greater job satisfaction and psychological well-being. Understanding the development of empathy of tomorrow's health care professionals is important. However, clinical empathy is poorly defined and difficult to measure, while ways to enhance it remain unclear. This review examines empathy among undergraduate medical students, focusing upon three main questions: How is empathy measured? This section discusses the problems of assessing empathy and outlines the utility of the Jefferson Scale of Empathy - Student Version and Davis's Interpersonal Reactivity Index. Both have been used widely to assess medical students' empathy. Does empathy change during undergraduate medical education? The trajectory of empathy during undergraduate medical education has been and continues to be debated. Potential reasons for contrasting results of studies are outlined. What factors may influence the development of empathy? Although the influence of sex is widely recognized, the impact of culture, psychological well-being, and aspects of undergraduate curricula are less well understood. This review identifies three interrelated issues for future research into undergraduate medical students' empathy. First, the need for greater clarity of definition, recognizing that empathy is multidimensional. Second, the need to develop meaningful ways of measuring empathy which include its component dimensions and which are relevant to patients' experiences. Medical education research has generally relied upon single, self-report instruments, which have utility across large populations but are limited. Finally, there is a need for greater methodological rigor in investigating the possible determinants of clinical empathy in medical education. Greater specificity of context

  4. Undergraduate medical students’ empathy: current perspectives

    PubMed Central

    Quince, Thelma; Thiemann, Pia; Benson, John; Hyde, Sarah

    2016-01-01

    Empathy is important to patient care. It enhances patients’ satisfaction, comfort, self-efficacy, and trust which in turn may facilitate better diagnosis, shared decision making, and therapy adherence. Empathetic doctors experience greater job satisfaction and psychological well-being. Understanding the development of empathy of tomorrow’s health care professionals is important. However, clinical empathy is poorly defined and difficult to measure, while ways to enhance it remain unclear. This review examines empathy among undergraduate medical students, focusing upon three main questions: How is empathy measured? This section discusses the problems of assessing empathy and outlines the utility of the Jefferson Scale of Empathy – Student Version and Davis’s Interpersonal Reactivity Index. Both have been used widely to assess medical students’ empathy. Does empathy change during undergraduate medical education? The trajectory of empathy during undergraduate medical education has been and continues to be debated. Potential reasons for contrasting results of studies are outlined. What factors may influence the development of empathy? Although the influence of sex is widely recognized, the impact of culture, psychological well-being, and aspects of undergraduate curricula are less well understood. This review identifies three interrelated issues for future research into undergraduate medical students’ empathy. First, the need for greater clarity of definition, recognizing that empathy is multidimensional. Second, the need to develop meaningful ways of measuring empathy which include its component dimensions and which are relevant to patients’ experiences. Medical education research has generally relied upon single, self-report instruments, which have utility across large populations but are limited. Finally, there is a need for greater methodological rigor in investigating the possible determinants of clinical empathy in medical education. Greater

  5. Undergraduate medical students' empathy: current perspectives.

    PubMed

    Quince, Thelma; Thiemann, Pia; Benson, John; Hyde, Sarah

    2016-01-01

    Empathy is important to patient care. It enhances patients' satisfaction, comfort, self-efficacy, and trust which in turn may facilitate better diagnosis, shared decision making, and therapy adherence. Empathetic doctors experience greater job satisfaction and psychological well-being. Understanding the development of empathy of tomorrow's health care professionals is important. However, clinical empathy is poorly defined and difficult to measure, while ways to enhance it remain unclear. This review examines empathy among undergraduate medical students, focusing upon three main questions: How is empathy measured? This section discusses the problems of assessing empathy and outlines the utility of the Jefferson Scale of Empathy - Student Version and Davis's Interpersonal Reactivity Index. Both have been used widely to assess medical students' empathy. Does empathy change during undergraduate medical education? The trajectory of empathy during undergraduate medical education has been and continues to be debated. Potential reasons for contrasting results of studies are outlined. What factors may influence the development of empathy? Although the influence of sex is widely recognized, the impact of culture, psychological well-being, and aspects of undergraduate curricula are less well understood. This review identifies three interrelated issues for future research into undergraduate medical students' empathy. First, the need for greater clarity of definition, recognizing that empathy is multidimensional. Second, the need to develop meaningful ways of measuring empathy which include its component dimensions and which are relevant to patients' experiences. Medical education research has generally relied upon single, self-report instruments, which have utility across large populations but are limited. Finally, there is a need for greater methodological rigor in investigating the possible determinants of clinical empathy in medical education. Greater specificity of context

  6. Independent medical review: expanding legal remedies to achieve managed care accountability.

    PubMed

    Berman-Sandler, Leatrice

    2004-01-01

    Author Leatrice Berman-Sandler reports on independent medical review (IMR), a state-based statutory remedy used to resolve disputes over coverage between patients and their health plans. Ms. Berman-Sandler explores the connection between ERISA preemption and IMR, and opines that in light of recent Supreme Court decisions, the stage has been set for expansion of IMR. Accordingly, Ms. Berman-Sandler concludes that there are strong legal and policy reasons for state legislatures to broaden the application of IMR and for the Court to continue to narrow ERISA preemption in order to increase accountability in the managed care arena.

  7. Current trend of robotics application in medical

    NASA Astrophysics Data System (ADS)

    Olanrewaju, O. A.; Faieza, A. A.; Syakirah, K.

    2013-06-01

    The applications of robotics in recent years has emerged beyond the field of manufacturing or industrial robots itself. Robotics applications are now widely used in medical, transport, underwater, entertainment and military sector. In medical field, these applications should be emphasized in view of the increasing challenges due to the variety of findings in the field of medicine which requires new inventions to ease work process. The objective of this review paper is to study and presents the past and on-going research in medical robotics with emphasis on rehabilitation (assistive care) and surgery robotics which are certainly the two main practical fields where robots application are commonly used presently. The study found that, rehabilitation and surgery robotics applications grow extensively with the finding of new invention, as well as research that is being undertaken and to be undertaken. The importance of medical robot in medical industry is intended to offer positive outcomes to assist human business through a complicated task that involves a long period, accuracy, focus and other routines that cannot be accomplished by human ability alone.

  8. Outsourcing Medical Data Analyses: Can Technology Overcome Legal, Privacy, and Confidentiality Issues?

    PubMed Central

    2013-01-01

    Background Medical data are gold mines for deriving the knowledge that could change the course of a single patient’s life or even the health of the entire population. A data analyst needs to have full access to relevant data, but full access may be denied by privacy and confidentiality of medical data legal regulations, especially when the data analyst is not affiliated with the data owner. Objective Our first objective was to analyze the privacy and confidentiality issues and the associated regulations pertaining to medical data, and to identify technologies to properly address these issues. Our second objective was to develop a procedure to protect medical data in such a way that the outsourced analyst would be capable of doing analyses on protected data and the results would be comparable, if not the same, as if they had been done on the original data. Specifically, our hypothesis was there would not be a difference between the outsourced decision trees built on encrypted data and the ones built on original data. Methods Using formal definitions, we developed an algorithm to protect medical data for outsourced analyses. The algorithm was applied to publicly available datasets (N=30) from the medical and life sciences fields. The analyses were performed on the original and the protected datasets and the results of the analyses were compared. Bootstrapped paired t tests for 2 dependent samples were used to test whether the mean differences in size, number of leaves, and the accuracy of the original and the encrypted decision trees were significantly different. Results The decision trees built on encrypted data were virtually the same as those built on original data. Out of 30 datasets, 100% of the trees had identical accuracy. The size of a tree and the number of leaves was different only once (1/30, 3%, P=.19). Conclusions The proposed algorithm encrypts a file with plain text medical data into an encrypted file with the data protected in such a way that

  9. Current perspectives in medical image perception

    PubMed Central

    Krupinski, Elizabeth A.

    2013-01-01

    Medical images constitute a core portion of the information a physician utilizes to render diagnostic and treatment decisions. At a fundamental level, this diagnostic process involves two basic processes: visually inspecting the image (visual perception) and rendering an interpretation (cognition). The likelihood of error in the interpretation of medical images is, unfortunately, not negligible. Errors do occur, and patients’ lives are impacted, underscoring our need to understand how physicians interact with the information in an image during the interpretation process. With improved understanding, we can develop ways to further improve decision making and, thus, to improve patient care. The science of medical image perception is dedicated to understanding and improving the clinical interpretation process. PMID:20601701

  10. Accommodating the medical use of marijuana: surveying the differing legal approaches in Australia, the United States and Canada.

    PubMed

    Bogdanoski, Tony

    2010-02-01

    While the scientific and medical communities continue to be divided on the therapeutic benefits and risks of cannabis use, anecdotal evidence from medical users themselves suggests that using cannabis is indeed improving their quality of life by alleviating their pain and discomfort. Notwithstanding the benefits anecdotally claimed by these medical users and the existence of some scientific studies confirming their claims, criminal drug laws in all Australian and most United States jurisdictions continue to prohibit the possession, cultivation and supply of cannabis even for medical purposes. However, in contrast to Australia and most parts of the United States, the medical use of cannabis has been legal in Canada for about a decade. This article reviews these differing legal and regulatory approaches to accommodating the medical use of cannabis (namely, marijuana) as well as some of the challenges involved in legalising it for medical purposes.

  11. The nude in medical photography: a historical perspective, with modern legal ramifications.

    PubMed

    Burns, S B

    1996-01-01

    Taking medical photographs of nude patients was common in the nineteenth century and was related to the diagnostic promises of photography. Nude photography today, while just as diagnostically important, is a carefully thought out practice fraught with serious legal ramifications especially when dealing with children and adolescents. As members of the human race, we are diverse in our practices and not only on a country wide but a regional level. What is acceptable in New York is not necessarily acceptable in central Kansas. Unfortunately, in many circumstances, it is difficult to measure intent. Vintage medical photographs have become valued as art, as well as historic and cultural documents. Nude vintage medical photographs fully expose the human condition and have become among the most valued of historic medical photographs. The implications for the future treatment of nude medical photography is well established. The passage of time, nostalgia, and, most importantly, the attempt to learn the secrets of life and means of death in past epochs will result in preserving and valuing these most important clinical photographs.

  12. Latin American women’s experiences with medical abortion in settings where abortion is legally restricted

    PubMed Central

    2012-01-01

    Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used. Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades. This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal. Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support. Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and

  13. [The new federal law in the light of forensic medical and legal proceedings].

    PubMed

    2016-01-01

    The objective of the present study was the article by article analysis of the Code of administrative legal proceedings of the Russian Federation with special reference to the judicial-expert procedures with a view to enhancing the awareness of the readers with the new directions of activities of forensic medical experts in the law-courts. It is emphasized that a number of provisions of the Code have not been properly elaborated, nor have they been adequately coordinated with the standard regulatory acts concerning the analogous or related issues. It is concluded that the provisions of the Code pertaining to the activities of the forensic medical experts remain to be widely discussed in the public domain to provide a basis for the development of recommendations for the legislative correction of the selected articles of the Code. PMID:27529106

  14. [Legal framework of the medical profession and of the neurology speciality].

    PubMed

    Gil Díaz, C

    2004-12-01

    The law on the general organization of Health Care Professionals (GOHCP) and the Framework Statute make up a new regulatory framework for the practice of medicine, which is completed with the legal debate on the obligatory association to the medical college, pending in the Constitutional Court based on certain regional legal developments. The GOHCP defines the functions of the different professions according to degree, establishes a public registry of physicians, converts the obligation of practicing according to the state of the art into law and updates the training, introduces the Resident core training program and opens the door to superspecialities. It also regulates the professional career, in order to establish a common body of four grades to which the health services can add a fifth one with previous character. Among the novelties of the Framework Statute, there is extensive updating of the offences and sanctions -- that include aspects such as work harassment and adaptation of the workday to the European guidelines, so that the maximum workday is established in 48 hours per week and the complementary (having a voluntary character) cannot exceed 150 hours per year. Lowering retirement age to 65 years foreseen in this guideline will require planning of human resources and has already generated suits in the courts. The obligatory nature of belonging to the medical college has also been modified, this time by some guidelines on the regional level. They would require a decision by the Constitutional Court on whether the college members can be exempted in some cases.

  15. [Current problems of hospital health including the AIDS problem. "Protection of patients and staff--legal status"].

    PubMed

    Gallwas, H U

    1989-01-01

    The prevention of HIV infection in hospital, if at all possible, is a general legal obligation. For that reason, special preventive measures against infection are required for blood transfusions, transplantations or semen donations. On the other hand, comprehensive information on the risks of infection and the permanent reminder of hygienic directions are considered to be sufficient for the protection of physicians and nursing staffs. However, the arguments for such a careless handling are not convincing. HIV testing of patients for the protection of the medical staff must not be relinquished. However, the current jurisdiction does not permit to carry out HIV tests without the patients' consent following comprehensive information; furthermore, the consequences resulting from a positive as well as a negative test have to be explained to the patients. In case of established infection further transmission must be prevented by all means.

  16. Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making.

    PubMed

    Jahn Kassim, Puteri Nemie; Alias, Fadhlina

    2016-02-01

    Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.

  17. Current medical treatment strategies concerning fracture healing.

    PubMed

    Giannotti, Stefano; Bottai, Vanna; Dell'osso, Giacomo; Pini, Erica; De Paola, Gaia; Bugelli, Giulia; Guido, Giulio

    2013-05-01

    The morbidity and socioeconomic costs associated with bone healing are considerable. A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, post-menopausal women, and in people with malnutrition. The biologic process of fracture healing is complex and impacted by multiple factors. Some of them, such as the nutritional and health conditions, are patient-dependent, while others depend on the trauma experienced and stability of the fracture. Fracture healing disorders negatively affect the patient's quality of life and result in high health-care costs, as a second surgery is required to stabilize the fracture and stimulate bone biology. Future biotechnologies that accelerate fracture healing may be useful tools, which might also prevent the onset of these disorders. We list the characteristics of the drugs used for osteoporosis, but we point out in particular the use of strontium ranelate and teriparatide in our clinical practice in elderly patients, especially females, who reported fractures with risk of nonunion. This medical treatment could impaired fracture healing however, most of the evidence is obtained in animal studies and very few studies have been done in humans. Thus one could hypothesize the possibility of a medical treatment both as a preventive and as support to the synthesis. However, no clinical studies are available so far, and such studies are warranted before any conclusions can be drawn. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research. PMID:24133528

  18. Current medical treatment strategies concerning fracture healing.

    PubMed

    Giannotti, Stefano; Bottai, Vanna; Dell'osso, Giacomo; Pini, Erica; De Paola, Gaia; Bugelli, Giulia; Guido, Giulio

    2013-05-01

    The morbidity and socioeconomic costs associated with bone healing are considerable. A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, post-menopausal women, and in people with malnutrition. The biologic process of fracture healing is complex and impacted by multiple factors. Some of them, such as the nutritional and health conditions, are patient-dependent, while others depend on the trauma experienced and stability of the fracture. Fracture healing disorders negatively affect the patient's quality of life and result in high health-care costs, as a second surgery is required to stabilize the fracture and stimulate bone biology. Future biotechnologies that accelerate fracture healing may be useful tools, which might also prevent the onset of these disorders. We list the characteristics of the drugs used for osteoporosis, but we point out in particular the use of strontium ranelate and teriparatide in our clinical practice in elderly patients, especially females, who reported fractures with risk of nonunion. This medical treatment could impaired fracture healing however, most of the evidence is obtained in animal studies and very few studies have been done in humans. Thus one could hypothesize the possibility of a medical treatment both as a preventive and as support to the synthesis. However, no clinical studies are available so far, and such studies are warranted before any conclusions can be drawn. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research.

  19. Urethral catheters and medical malpractice: a legal database review from 1965 to 2015

    PubMed Central

    Osterberg, E. Charles; Chang, Helena; Gaither, Thomas W.; Alwaal, Amjad; Fox, Ryan; Breyer, Benjamin N.

    2016-01-01

    Background Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications. Methods The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms “urethral catheter” or “Foley catheter” in combination with “medical malpractice”, “negligence”, “medical error”, and “trauma”. Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case. Results Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000–$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000–$325,000). Conclusions Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses. PMID:27785434

  20. Current medical treatment strategies concerning fracture healing

    PubMed Central

    Giannotti, Stefano; Bottai, Vanna; Dell’Osso, Giacomo; Pini, Erica; De Paola, Gaia; Bugelli, Giulia; Guido, Giulio

    2013-01-01

    Summary The morbidity and socioeconomic costs associated with bone healing are considerable. A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, post-menopausal women, and in people with malnutrition. The biologic process of fracture healing is complex and impacted by multiple factors. Some of them, such as the nutritional and health conditions, are patient-dependent, while others depend on the trauma experienced and stability of the fracture. Fracture healing disorders negatively affect the patient’s quality of life and result in high health-care costs, as a second surgery is required to stabilize the fracture and stimulate bone biology. Future biotechnologies that accelerate fracture healing may be useful tools, which might also prevent the onset of these disorders. We list the characteristics of the drugs used for osteoporosis, but we point out in particular the use of strontium ranelate and teriparatide in our clinical practice in elderly patients, especially females, who reported fractures with risk of nonunion. This medical treatment could impaired fracture healing however, most of the evidence is obtained in animal studies and very few studies have been done in humans. Thus one could hypothesize the possibility of a medical treatment both as a preventive and as support to the synthesis. However, no clinical studies are available so far, and such studies are warranted before any conclusions can be drawn. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research. PMID:24133528

  1. Medical Management of Uveitis – Current Trends

    PubMed Central

    Babu, Kalpana; Mahendradas, Padmamalini

    2013-01-01

    Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis. PMID:23803479

  2. [The scope of expert competence for the evaluation of non-compliance with the requirements of the departmental normative legal acts in the course of forensic medical panel examinations concerning "medical practice" in the criminal legal procedures].

    PubMed

    Kovalev, A V; Pletianova, I V; Fetisov, V A

    2014-01-01

    This article is devoted to the analysis of the problem of expert competence for the evaluation of non-compliance with the requirements of the departmental normative legal acts in the course of forensic medical panel examinations concerning "medical practice" in the criminal legal procedures. The approaches to the solution of his problem are exemplified by forensic medical expertise of selected cases from obstetric and gynecological practice. It is demonstrated that investigations into non-compliance events arising in the work of medical facilities must include the analysis of the departmental normative legal acts that govern the organizational and diagnostic processes. These documents should be regarded as pertaining to an additional direct object and considered to be one of the constituent elements of.the offence to be identified during forensic medical expertise. Such documents are very specific in terms of their content and can not be properly interpreted by independent specialists possessing juristic knowledge alone. Therefore, the expert judgments concerning these issues must include well-reasoned arguments and solidly established evidence of normative legal character.

  3. [Factors forming opnion on marijuana legalization in Poland among group of students from medical and technical college faculty].

    PubMed

    Suwała, Małgorzata; Gerstenkorn, Andrzej; Szewczyk, Anna

    2015-01-01

    Marijuana is the most popular illegal drug in the world. In 2010 17.6% of polish adult population (age 15-64) and 37.3% of youth (age 17-18) declared use of marijuana at least once in their lifetime. Recent years in Poland brought back public discussion regarding decriminalization and legalization of marijuana. The main goal of the study was to reveal the opinion about legalization of marijuana in Poland among students of medical and technical faculty in correlation with chosen socio-demographic factors, college major, attitude to tobacco smoking, use of drugs and religious practice. Study included 230 students (110 from Medical University of Lodz and 120 from Technical University of Lodz). Women consisted on 56.1% of surveyed and men on 43.9%. Study used audit survey as a research method. Results. 40.4% of students considered marijuana as "soft" drug and in majority (65.7%) are convinced that it is not addictive. The main part of studied group (83%) claimed that marijuana is easily accessible in Poland. The majority of the group (38.75%) was against marijuana legalization, a little bit less (35.2%) approved its legalization in Poland and 26.1% had no opinion. Type of college faculty had not been detected as a factor influencing support for legalization. Important factors influencing positive opinion on legalization was: living in the city, tobacco smoking, socializing with legalization supporters, lack of regular religious practice, drug use. CONCLUSION. Young people's diversified opinion regarding legalization of marijuana in Poland should encourage further discussion. Educational and preventive activities within different social groups are necessary to form a conscious opinion on legalization of marijuana in Poland based on the knowledge of actual scientific facts.

  4. [Factors forming opnion on marijuana legalization in Poland among group of students from medical and technical college faculty].

    PubMed

    Suwała, Małgorzata; Gerstenkorn, Andrzej; Szewczyk, Anna

    2015-01-01

    Marijuana is the most popular illegal drug in the world. In 2010 17.6% of polish adult population (age 15-64) and 37.3% of youth (age 17-18) declared use of marijuana at least once in their lifetime. Recent years in Poland brought back public discussion regarding decriminalization and legalization of marijuana. The main goal of the study was to reveal the opinion about legalization of marijuana in Poland among students of medical and technical faculty in correlation with chosen socio-demographic factors, college major, attitude to tobacco smoking, use of drugs and religious practice. Study included 230 students (110 from Medical University of Lodz and 120 from Technical University of Lodz). Women consisted on 56.1% of surveyed and men on 43.9%. Study used audit survey as a research method. Results. 40.4% of students considered marijuana as "soft" drug and in majority (65.7%) are convinced that it is not addictive. The main part of studied group (83%) claimed that marijuana is easily accessible in Poland. The majority of the group (38.75%) was against marijuana legalization, a little bit less (35.2%) approved its legalization in Poland and 26.1% had no opinion. Type of college faculty had not been detected as a factor influencing support for legalization. Important factors influencing positive opinion on legalization was: living in the city, tobacco smoking, socializing with legalization supporters, lack of regular religious practice, drug use. CONCLUSION. Young people's diversified opinion regarding legalization of marijuana in Poland should encourage further discussion. Educational and preventive activities within different social groups are necessary to form a conscious opinion on legalization of marijuana in Poland based on the knowledge of actual scientific facts. PMID:26946562

  5. [Cartography of psychoactive heterotopias: a look at the medical, legal and social discourses regarding drug use].

    PubMed

    Massó, Paloma

    2015-09-01

    This article traces a map of the social control of drugs through the politics of space, according to the Foucaultian concept of "heterotopia." Firstly, a brief genealogy of the use of psychotropic substances in different times and cultures is described, up to the introduction of the prohibitionist paradigm. Attention is paid to the way in which power has marked, separated and enclosed certain rituals and uses of pleasure in physical and symbolic sites. The itinerary is focused on the Spanish context to establish a dialogue between the various policies of space that have come into being and have overlapped in the construction and management of a problem which has been rendered an object to the gazes, mechanics and discourses of the medical, legal, and social fields. In this way, the intersections between the liminal spaces of drug use and the harm reduction paradigm are analyzed, including therapeutic strategies with prescribed drugs, from methadone programs to the new heroin programs.

  6. Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

    PubMed

    Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

    2016-03-01

    As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. PMID:27256135

  7. Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

    PubMed

    Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

    2016-03-01

    As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed.

  8. [Cartography of psychoactive heterotopias: a look at the medical, legal and social discourses regarding drug use].

    PubMed

    Massó, Paloma

    2015-09-01

    This article traces a map of the social control of drugs through the politics of space, according to the Foucaultian concept of "heterotopia." Firstly, a brief genealogy of the use of psychotropic substances in different times and cultures is described, up to the introduction of the prohibitionist paradigm. Attention is paid to the way in which power has marked, separated and enclosed certain rituals and uses of pleasure in physical and symbolic sites. The itinerary is focused on the Spanish context to establish a dialogue between the various policies of space that have come into being and have overlapped in the construction and management of a problem which has been rendered an object to the gazes, mechanics and discourses of the medical, legal, and social fields. In this way, the intersections between the liminal spaces of drug use and the harm reduction paradigm are analyzed, including therapeutic strategies with prescribed drugs, from methadone programs to the new heroin programs. PMID:26418094

  9. Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium.

    PubMed

    Bilsen, Johan; Vander Stichele, Robert; Broeckaert, Bert; Mortier, Freddy; Deliens, Luc

    2007-08-01

    Changes in medical practices during transitions in regulating healthcare are rarely investigated. In this study, we investigated changes in medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) that occurred during the legalization process of euthanasia in Belgium. We took representative random samples from deaths reported to registries in Flanders, Belgium in 1998 (n=3999) at the beginning of the process and in 2001 (N=5005), at the end of the process. The reporting physicians received an anonymous mail questionnaire about possible ELDs preceding the death involved. We found no significant shifts in the epidemiology of diseases between 1998 and 2001. The overall incidence of ELDs did not change. The incidence decreased for euthanasia, administering life-ending drugs without patient's explicit request, and alleviation of pain and symptoms with life-shortening co-intention. Incidence increased for alleviation of pain and symptom without life-shortening intention, and remained stable for non-treatment decisions. All decisions in 2001 were more often discussed with patients, their relatives and nurses. In 2001, continuous deep sedation was reported in 8.3% of deaths. We can conclude that physicians' end-of-life practices have substantially changed during the short but tumultuous legalization process of euthanasia in Belgium. Although follow-up research is needed to investigate the continuance of these changes, it is important for policy makers to keep in mind that social factors related to transitions in healthcare regulation may play an important role in the physicians' actual behaviour.

  10. Focus: current issues in medical ethics.

    PubMed Central

    Davis, A; Horobin, G

    1977-01-01

    The current debates about seat belts in motor cars and the evils of smoking may only be straws in the wind if the scenario sketched in this paper were translated into a social, political programme. Then 'illness would increasingly be seen as a failure to keep healthy and thus culpable. The failures [the patients] ... must either be irresponsible and hence punishable at least by the imposition of financial penalties or insane and thus in need of corrective therapy.' If this sounds like 1984 the reader must read the whole argument set out in this paper and make his own judgment. He may not be encouraged by what he reads but he will be forewarned. There is no answer to the question, What shall I do, if this prophecy is true? PMID:926128

  11. [Mental state and the criminal responsibility--legal regulations and medical criteria in Poland and other countries].

    PubMed

    Bolechała, Filip

    2009-01-01

    In contemporary civilized legal systems, sanity is a prerequisite for criminal responsibility of the perpetrator. Thus, insanity resulting from certain psychiatric and psychological disorders is a circumstance excluding the guilt. General assumptions of insanity criteria are close and similar in legal systems of the majority of countries; however, certain essential differences appear in details of their interpretation and acceptance. These differences in particular appear among systems of continental European states as opposed to these, in which the judiciary system is derived from the English law. The paper presents and discusses in detail the legal and medical considerations of insanity defense in Poland, as well as outlines the legal foundations of this issue in other countries of Europe, North America and Australia.

  12. [The legal frameworks and organizational forms of the work of a forensic medical expert participating in group investigation activities].

    PubMed

    Kachina, N N

    2013-01-01

    The problems pertaining to the modern organization of group investigation activities and the role of a forensic medical expert involved in them are discussed. It is shown that the variety of such groups formed in accordance with departmental and interdepartmental guidelines and regulations can be reduced to two major types, viz. investigation teams (brigades) and alert operational investigations groups. Either type can and some must include a forensic medical expert although neither legal nor institutional frameworks has been formulated for his participation.

  13. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS GENERAL CLAIMS REGULATIONS Military Claims Act § 750.54 Payment of costs, settlements,...

  14. The Americans with Disabilities Act and Family and Medical Leave Act: Legal Requirements, Negotiations and Policy Considerations.

    ERIC Educational Resources Information Center

    Juengart, Laurie S.

    The Americans with Disabilities Act (ADA) and Family and Medical Leave Act (FMLA) are two major pieces of social legislation that impact private and public employers, including school districts. Public school employers must have thorough awareness of the legal requirements of both laws and must analyze the ways in which those requirements…

  15. [Withdrawal of artificial nutrition and hydration in severe stroke: medical, legal and ethical considerations].

    PubMed

    Tannier, C; Crozier, S; Zuber, M; Constantinides, Y; Delezie, E; Gisquet, E; Grignoli, N; Lamy, C; Louvet, F; Pinel, J-F

    2015-02-01

    In the majority of cases, severe stroke is accompanied by difficulty in swallowing and an altered state of consciousness requiring artificial nutrition and hydration. Because of their artificial nature, nutrition and hydration are considered by law as treatment rather basic care. Withdrawal of these treatments is dictated by the refusal of unreasonable obstinacy enshrined in law and is justified by the risk of severe disability and very poor quality of life. It is usually the last among other withholding and withdrawal decisions which have already been made during the long course of the disease. Reaching a collegial consensus on a controversial decision such as artificial nutrition and hydration withdrawal is a difficult and complex process. The reluctance for such decisions is mainly due to the symbolic value of food and hydration, to the fear of "dying badly" while suffering from hunger and thirst, and to the difficult distinction between this medical act and euthanasia. The only way to overcome such reluctance is to ensure flawless accompaniment, associating sedation and appropriate comfort care with a clear explanation (with relatives but also caregivers) of the rationale and implications of this type of decision. All teams dealing with this type of situation must have thoroughly thought through the medical, legal and ethical considerations involved in making this difficult decision.

  16. [Medical-legal conduct with individuals in judicial or police custody].

    PubMed

    Medallo Muñiz, Jordi; Martín-Fumadó, Carles; Nuno Vieira, Duarte

    2014-03-01

    The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities.

  17. [Medical-legal conduct with individuals in judicial or police custody].

    PubMed

    Medallo Muñiz, Jordi; Martín-Fumadó, Carles; Nuno Vieira, Duarte

    2014-03-01

    The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities. PMID:24913748

  18. Relationship between Prior Legal Involvement and Current Crisis for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Lunsky, Yona; Raina, Poonam; Jones, Jessica

    2012-01-01

    Background: Individuals with intellectual disability (ID) and legal involvement are a unique population with complex needs. To date, there has been limited research exploring the demographic and clinical profiles of individuals with ID and legal involvement that are in crisis and how they differ to individuals with ID without legal involvement.…

  19. Legal implications for failure to comply with advance directives: an examination of the incompetent individual's right to refuse life-sustaining medical treatment.

    PubMed

    Perry, Sherynn J

    2002-01-01

    Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an incompetent individual to refuse life-sustaining medical treatment. The article examines advance directives along with various judicial decision-making standards for incompetent individuals and explores the sociobehavioral and legal rationale for compliance with incompetent individual's rights to make end-of-life decisions. Finally this article concludes (i) that advance directives allow competent individuals to state the medical treatment they would prefer in the event they should later become incompetent and (ii) that when advance directives are properly executed in a detailed manner, under laws currently in effect in some jurisdictions, the preferences stated in the directive bind health care providers.

  20. Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership.

    PubMed

    Tobin-Tyler, Elizabeth; Teitelbaum, Joel

    2016-06-01

    For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH's effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical-legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities.

  1. Ethics, privacy and the legal framework governing medical data: opportunities or threats for biomedical and public health research?

    PubMed

    Coppieters, Yves; Levêque, Alain

    2013-01-01

    Privacy is an important concern in any research programme that deals with personal medical data. In recent years, ethics and privacy have become key considerations when conducting any form of scientific research that involves personal data. These issues are now addressed in healthcare professional training programmes. Indeed, ethics, legal frameworks and privacy are often the subject of much confusion in discussions among healthcare professionals. They tend to group these different concepts under the same heading and delegate responsibility for "ethical" approval of their research programmes to ethics committees. Public health researchers therefore need to ask questions about how changes to legal frameworks and ethical codes governing privacy in the use of personal medical data are to be applied in practice. What types of data do these laws and codes cover? Who is involved? What restrictions and requirements apply to any research programme that involves medical data?

  2. Current & future medical costs of childhood obesity in Alaska.

    PubMed

    Guettabi, Mouhcine

    2014-09-01

    This study examines the medical costs of childhood obesity in Alaska, today and in the future. We estimate that 15.2 percent of those ages 2 to 19 in Alaska are obese. Using parameters from published reports and studies, we estimate that the total excess medical costs due to obesity for both adults and children in Alaska in 2012 were $226 million, with medical costs of obese children and adolescents accounting for about $7 million of that total. And those medical costs will get much higher over time, as today's children transition into adulthood. Aside from the 15.2 percent currently obese, another estimated 20 percent of children who aren't currently obese will become obese as adults, if current national patterns continue. We estimate that the 20-year medical costs--discounted to present value--of obesity among the current cohort of Alaska children and adolescents will be $624 million in today's dollars. But those future costs could be decreased if Alaskans found ways to reduce obesity. We consider how reducing obesity in several ways could reduce future medical costs: reducing current rates of childhood obesity, rates of obese children who become obese adults, or rates of non-obese children and adolescents who become obese adults. We undertake modest reductions to showcase the potential cost savings associated with each of these channels. Clearly the financial savings are a direct function of the obesity reductions and therefore the magnitude of the realized savings will vary accordingly. Also keep in mind that these figures are only for the current cohort of children and adolescents; over time more generations of Alaskans will grow from children into adults, repeating the same cycle unless rates of obesity decline. And finally, remember that medical costs are only part of the broader range of social and economic costs obesity creates.

  3. The Current Status of Medical Marijuana in the United States

    PubMed Central

    2014-01-01

    Medical marijuana is currently a controversial issue in medicine. There are strong pro and con opinions but relatively little scientific data on which to base medical decisions. The unfortunate scheduling of marijuana in class I has limited research and only serves to fuel the controversy. This article will review the history of laws to regulate drugs in the United States in the 20th century to provide context for the current status of medical marijuana. It will include the rationale for opposing medical marijuana laws and the problem of the Schedule I inclusion of marijuana as well as other drugs. It will examine the problems associated with smoking raw marijuana and review other routes of administration. Finally, it examines the inadvisability of medicine's promotion of smoked marijuana. PMID:24765557

  4. Medical surveillance of the lead exposed worker. Current guidelines.

    PubMed

    Hipkins, K L; Materna, B L; Kosnett, M J; Rogge, J W; Cone, J E

    1998-07-01

    1. The "lead standards" established by OSHA for general industry in 1978 and the construction industry in 1993 require employers and clinicians to follow very specific guidelines for protecting lead exposed workers. Depending on the level of exposure, medical surveillance may be legally required. 2. Lead affects multiple body systems and can cause permanent damage. Low level exposures that in the past were thought safe are now considered hazardous as new information emerges about the toxicity of lead. 3. Lead poisoning, if undetected, often results in misdiagnosis and costly care. Adults are exposed to lead in many different workplace settings. All clinicians caring for lead exposed workers need to be informed about the health effects of lead, employer and physician responsibilities, and worker rights. 4. Occupational and environmental health nurses can help identify workers at risk and prevent lead poisoning by education and early intervention through collaboration with the workers, the employer, the company physician, and other health and safety professionals.

  5. Words Can Be Deceiving: A Review of Variation Among Legally Effective Medical Marijuana Laws in the United States

    PubMed Central

    Pacula, Rosalie Liccardo; Hunt, Priscillia; Boustead, Anne

    2014-01-01

    When voters in two US states approved the recreational use of marijuana in 2012, public debates for how best to promote and protect public health and safety started drawing implications from states’ medical marijuana laws. However, many of the discussions were simplified to the notion that states either have a medical marijuana law or do not; little reference was made to the fact that legal provisions differ across states. This study seeks to clarify the characteristics of medical marijuana laws in place since 1990 that are most relevant to consumers/patients and categorizes those aspects most likely to affect the prevalence of use, and consequently the intensity of public health and welfare effects. Evidence shows treating medical marijuana laws as homogeneous across states is misleading and does not reflect the reality of medical marijuana lawmaking. This variation likely has implications for use and health outcomes, and thus states’ public health. PMID:25657828

  6. Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

    PubMed

    Tuladhar, H; Risal, A

    2010-06-01

    World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

  7. What the History of Drugs Can Teach Us About the Current Cannabis Legalization Process: Unfinished Business.

    PubMed

    Adrian, Manuella

    2015-01-01

    Over time, there have been considerable changes in the variety, availability, production, distribution, and use and user(s) of psychoactive substances, the meaning of substance use and its impact on users and their social or physical environment(s). This article reviews the mechanisms of introduction of psychoactive substances such as alcohol, tobacco, coffee, tea and cannabis to populations and communities that did not have them before. It considers the historical tension between early adopters who greet new substances with various levels of enthusiasm in their eagerness to enjoy what they believe to be the benefits of using these substances, and those focused on what they believe to be the negative aspects of use, who decry these new substances with horror. With more nonusers than users in the population, social policies tend to be directed at preventing, restricting, or punishing selected use, users and .drugs., using controls and interventions such regulation, incarceration, death sentence, treatment, prevention, legalization, taxation, among others. Whatever their intent or wished-for impact, all had consequences that produced additional, unplanned for, and (often) negative effects. This paper will consider some of these sequences as they occurred historically with other substances in light of the current shift to legalization and normalization of cannabis, noting the mechanisms of use, controls, and consequences of some types of formal interventions and give some attention to how and what we can learn from our experiences in order to plan ahead and become better prepared to successfully deal with the 'unexpecteds' of that well-known 'hell' paved with good intentions. PMID:26361906

  8. What the History of Drugs Can Teach Us About the Current Cannabis Legalization Process: Unfinished Business.

    PubMed

    Adrian, Manuella

    2015-01-01

    Over time, there have been considerable changes in the variety, availability, production, distribution, and use and user(s) of psychoactive substances, the meaning of substance use and its impact on users and their social or physical environment(s). This article reviews the mechanisms of introduction of psychoactive substances such as alcohol, tobacco, coffee, tea and cannabis to populations and communities that did not have them before. It considers the historical tension between early adopters who greet new substances with various levels of enthusiasm in their eagerness to enjoy what they believe to be the benefits of using these substances, and those focused on what they believe to be the negative aspects of use, who decry these new substances with horror. With more nonusers than users in the population, social policies tend to be directed at preventing, restricting, or punishing selected use, users and .drugs., using controls and interventions such regulation, incarceration, death sentence, treatment, prevention, legalization, taxation, among others. Whatever their intent or wished-for impact, all had consequences that produced additional, unplanned for, and (often) negative effects. This paper will consider some of these sequences as they occurred historically with other substances in light of the current shift to legalization and normalization of cannabis, noting the mechanisms of use, controls, and consequences of some types of formal interventions and give some attention to how and what we can learn from our experiences in order to plan ahead and become better prepared to successfully deal with the 'unexpecteds' of that well-known 'hell' paved with good intentions.

  9. Forensic implications and medical-legal dilemmas of maternal versus fetal rights.

    PubMed

    Mohaupt, S M; Sharma, K K

    1998-09-01

    The purpose of this paper is to review the issue of fetal rights from primarily a legal perspective, with consideration of morals and professional ethics. The practice of medicine is fraught with numerous bioethical dilemmas. These dilemmas often leave the physician wondering if he has made the correct decision. A physician's morals and professional ethics may influence his or her decision in resolving bioethical dilemmas. The case example is a 34-year-old female with a 41-week intra-uterine pregnancy. The mother was refusing induction of labor. Without the labor induction, the fetus may die. Despite this risk, the mother desired to pursue a vaginal delivery. The AMA's ethics state that a competent, pregnant mother's wishes should prevail and the court should not be involved unless there are unusual circumstances. The mother in the case example was competent and informed consent was provided. Case law does not specifically address the dilemma of the case example. However, there is case law regarding court-ordered cesarean sections which reveals different opinions. The difference in court opinion encompasses the relative degree of weight given to the fetus's right to be born healthy and alive versus the mother's privacy rights. Some courts describe this "balancing test," whereas others state that the mother's privacy rights prevail unless there are exceptional circumstances, which will be extremely rare. The fetus has acquired rights in other areas of the law; for example, abolishment of the intra-family immunity doctrine and the definition of murder in most states. In considering the legal arena of fetal versus maternal rights, a decision tree is presented to assist physicians in assessing cases of a pregnant mother refusing medical treatment. There is no precise demarcation in assessing fetal and maternal rights. The greater the degree of fetal viability, the greater degree of fetal rights. Consideration must also be given to the relative degree of invasiveness to

  10. Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence

    PubMed Central

    Cerdá, Magdalena; Wall, Melanie; Keyes, Katherine M; Galea, Sandro; Hasin, Deborah

    2011-01-01

    Background Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence. Methods We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ (n=34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of ~68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence. Results In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% CI: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% CI: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% CI: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use. Conclusions States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use. PMID:22099393

  11. Current status and future trends of medical physics in Mexico

    NASA Astrophysics Data System (ADS)

    Azorin Nieto, J.

    2015-01-01

    Medical Physics is an area that applies the principles of physics to medicine, particularly in the prevention, diagnosis and treatment of diseases using ionizing and nonionizing radiation. The main attractive of medical physics is that it has a direct impact on the quality and safety of medical care in humans; this social component with direct implications for the population is of high value for Mexico. This paper describes the concepts of medical physics, trends and the current status of this discipline as a profession, which is directly related to the efforts of clinical research. It is also described what is, in my opinion, the future of medical physics in Mexico, emphasizing the fact that this field requires a substantial boost from universities and hospitals to recruit highly qualified young medical physicists and the support from government agencies such as Secretaria de Salud, Instituto Mexicano del Seguro Social and Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado through clinical research projects that allow the necessary evolution of medical physics into the hospital setting.

  12. How to Use Current Medical Literature and APA Format Style.

    ERIC Educational Resources Information Center

    Peek, Robin

    Directives and guidance in obtaining current medical literature are provided in this publication with special emphasis given to locating material in the Portland, Oregon area. The uses and types of periodical indexes are identified and periodical index citation examples are indicated. Explanations are offered on: (1) how to conduct an effective…

  13. Principles over principals? How innovation affects the agency relationship in medical and legal practice.

    PubMed

    Polaris, Julian J Z

    2014-01-01

    This Note outlines a conceptual framework for defining and analyzing innovation in the professional practice of medicine and law. The two professions have structural and historical similarities, and both are organized around the principal-agent relationship. Some types of professional activity adhere to the traditional agency model of principal-centered practice, but innovative professionals who develop novel tools and techniques often deviate from the agency model in interesting ways. This Note explores how that distinction plays out by identifying examples from academic medicine, public interest "cause lawyering", and corporate law. The field of medicine is governed by a regulatory regime that strictly differentiates routine practice from the experimental activities of clinical research, but the legal profession is governed by a monolithic code of conduct that does not explicitly acknowledge the types of innovation described here. Certain key events in the twentieth century help to explain why the government has chosen to tightly regulate innovation in medicine but not in law, and it turns out that innovators in both fields have found ways to stretch or bend the rules. These observations shed light on each profession's unique culture and can inform current debates over regulatory reform. PMID:25508846

  14. Principles over principals? How innovation affects the agency relationship in medical and legal practice.

    PubMed

    Polaris, Julian J Z

    2014-01-01

    This Note outlines a conceptual framework for defining and analyzing innovation in the professional practice of medicine and law. The two professions have structural and historical similarities, and both are organized around the principal-agent relationship. Some types of professional activity adhere to the traditional agency model of principal-centered practice, but innovative professionals who develop novel tools and techniques often deviate from the agency model in interesting ways. This Note explores how that distinction plays out by identifying examples from academic medicine, public interest "cause lawyering", and corporate law. The field of medicine is governed by a regulatory regime that strictly differentiates routine practice from the experimental activities of clinical research, but the legal profession is governed by a monolithic code of conduct that does not explicitly acknowledge the types of innovation described here. Certain key events in the twentieth century help to explain why the government has chosen to tightly regulate innovation in medicine but not in law, and it turns out that innovators in both fields have found ways to stretch or bend the rules. These observations shed light on each profession's unique culture and can inform current debates over regulatory reform. PMID:25486715

  15. Automatisms--the current legal position related to clinical practice and medicolegal interpretation.

    PubMed

    Beran, R G

    1992-01-01

    The interface between medicine and the law is an area which demands further investigation. There can be no criminal capability for an act unless the perpetrator had both the will to so act and the capacity to differentiate and choose whether or not to conform the particular behaviour to that dictated by the law. The capacity for choice must remain the fundamental issue. The range of conditions which can raise volition as a defence include: Somnambulism; post-traumatic syndromes; epilepsy; arteriosclerosis; or acts secondary to cerebral neoplasia. There is need to differentiate between reflex actions and automatisms and it is imperative that terms such as automatism or automatic behaviour are not perverted to allow an excuse for that which is inexcusable. Cases such as that of Cogdon, who was acquitted of murdering her daughter; Ramsbottom who was found guilty of causing a traffic accident despite having a stroke; Dennison in which a driver was found guilty despite epilepsy or Jenkins where the driver was initially found innocent of dangerous driving because of the unpredictable nature of diabetes are discussed. Special attention will be focused upon the case of Sullivan, a landmark in consideration of automatism in epilepsy. The paper examines insane verses non-insane automatism and the Australian legal system as it affects modern neurological practice. Suggestions are proffered as to how the law should be modified to better reflect justice as required within the context of modern medical knowledge. 'The social and psychological pressures that shape our criminals also shape-those who make and remake the laws which aim to control, punish or rehabilitate them, and those who try to change their behaviour.'

  16. Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports

    PubMed Central

    Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V.; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H.; Plazzi, Giuseppe

    2014-01-01

    Objective: To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). Search Methods: We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Selection Criteria: Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Data Extraction and Analysis: Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Results: Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. Conclusion: SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority. Citation: Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014;10(8):927-935. PMID:25126042

  17. The medical-legal quandary of healthcare in capital punishment: an ethical dilemma for the anesthesia provider.

    PubMed

    Johnson, Kevin W

    2008-12-01

    The case of Brase v Rees was presented before the US Supreme Court to consider the constitutionality of death by lethal injection as practiced in the state of Kentucky. The 3-drug combination of sodium thiopental, pancuronium bromide, and potassium chloride is a key aspect in question. Capital punishment conflicts with medical and nursing code of ethics preventing providers who are skilled at difficult intravenous (IV) access, assessment of appropriate sedation, and involvement without fear of disciplinary action. Therefore, untrained or undertrained personnel from the prison have been delegated these duties. Cases in which failure to establish or maintain IV access has led to executions lasting up to 90 minutes before the execution was complete. Participation by skilled medical personnel has been a debate between the medical and legal communities since the inception of lethal injection. Healthcare should reevaluate the ethical and moral principle of beneficence as the legal system attempts to evaluate the constitutionality of lethal injection. Can a nurse or doctor step out of the role of medical professional, use knowledge and skill to make death by lethal injection more humane, and not violate the ethical principle of "do no harm"?

  18. ["Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time].

    PubMed

    Lindner, Christina; Lindner, Gregor; Exadaktylos, Aristomenis K

    2013-12-11

    Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law.

  19. Reducing legal fees in medical group practices. The role of health care alternative dispute resolution.

    PubMed

    Joseph, D M

    1995-01-01

    Conflict is a growth industry, particularly in an increasingly complex health care system. Litigation is the most common, and most costly, method of settling health care disputes. Highly adversarial, the process of litigation often generates as much, if not more, hostility than the original dispute. In addition, satisfaction with the outcome is very low. The challenge that has arisen is to manage the conflicts so that the underlying needs and interests of all the parties can best be met. Often the techniques and processes of alternative dispute resolution (ADR) can be successfully used in resolving these sorts of conflicts quickly, cheaply and with greater satisfaction for all parties. Various applications of ADR are currently being used or tested in a variety of health care disputes in the United States and Canada. Tremendous success has been achieved in mediating medical malpractice claims, medical staff disputes, economic credentialing conflicts, insurer relations issues and denial of coverage disputes. Professional relations and departmental staff disputes, partnership and employee conflicts, and organizational disputes within clinics, HMOs and large group practices have all been found particularly amenable to ADR. These are all situations in which everyone benefits from quick, non-hostile resolutions and on-going relationships can continue. PMID:10144247

  20. The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits.

    PubMed

    Park, Bo Young; Pak, Ji-Hyun; Hong, Seung-Eun; Kang, So Ra

    2015-12-01

    This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit.

  1. The Current State of Medical Malpractice in Urology.

    PubMed

    Sherer, Benjamin A; Coogan, Christopher L

    2015-07-01

    Medical malpractice can present an unwelcome professional, emotional, and economic burden to the practicing urologist. To date, there is a paucity of data specific to urologic malpractice in the literature. We performed a comprehensive literature search to identify and evaluate recent studies related to urologic malpractice. We also analyzed 6249 closed urologic claims from the largest available specialty-specific data set gathered by Physician Insurers Association of America from 1985 to 2012. The resulting comprehensive review seeks to raise awareness of current trends in the malpractice environment specific to urologic surgery while also helping urologists identify opportunities for risk management and improved patient care.

  2. Current legal and institutional issues in the commercialization of phosphoric acid fuel cells

    NASA Technical Reports Server (NTRS)

    Nimmons, J. T.; Sheehy, K. D.; Singer, J. R.; Gardner, T. C.

    1982-01-01

    Legal and institutional factors affecting the development and commercial diffusion of phosphoric acid fuel cells are assessed. Issues for future research and action are suggested. Perceived barriers and potential opportunities for fuel cells in central and dispersed utility operations and on-site applications are reviewed, as well as the general concept of commercialization as applied to emerging energy technologies.

  3. Current Legal Trends Regarding Abortions for Minors: A Dilemma for Counselors.

    ERIC Educational Resources Information Center

    Talbutt, Lou Culler

    1983-01-01

    Reviews court cases dealing with abortion and the counselor's legal responsibility to both the student and parents. Provides practical recommendations on abortion counseling with minors and suggests that counselors urge minors to discuss abortion plans with parents. Counselor should consider local mores and be knowledgeable about appropriate…

  4. Emergency contraception over-the-counter: the medical and legal imperatives.

    PubMed

    Grimes, D A; Raymond, E G; Scott Jones, B

    2001-07-01

    Requiring a physician's prescription for hormonal emergency contraceptive pills makes no sense. Unintended pregnancies remain endemic in the United States, and wider use of emergency contraceptive pills could substantially help. However, the prescription requirement poses an unnecessary barrier to prompt, effective use of this preventive therapy. According to the Durham-Humphrey Amendment of 1951, the default option for all new drugs is, in principle, over-the-counter, unless a drug is addictive or dangerous when self-administered. Clearly, hormonal emergency contraception is neither of these. Emergency contraceptive pills meet all the customary criteria for over-the-counter use: low toxicity, no potential for overdose or addiction, no teratogenicity, no need for medical screening, self-identification of the need, uniform dosage, and no important drug interactions. The Food and Drug Administration is authorized, and, by its own regulations, should be required to switch hormonal emergency contraception to over-the-counter status without delay. The current prescription requirement is not only gratuitous but also harmful to women's health because it impedes access to this important therapy. PMID:11430974

  5. Variation in Acceptable Child Discipline Practices by Child Age: Perceptions of Community Norms by Medical and Legal Professionals.

    PubMed

    Block, Stephanie D; Poplin, Ashlee Burgess; Wang, Eric S; Widaman, Keith F; Runyan, Desmond K

    2016-01-01

    Mandated child abuse reporters may judge specific disciplinary practices as unacceptable for young children, whereas child law professionals arbitrating allegations may be less inclusive. Do the views of these groups diverge, by child age, regarding discipline? Judgments of community norms across a wide range of children's ages were obtained from 380 medical and legal professionals. Because the Parent-Child Conflict Tactics Scale (PC-CTS) can be used to assess the epidemiology of child disciplinary behaviors and as a proxy to examine the incidence or prevalence of child abuse, the disciplinary practices described on the PC-CTS were presented as triggers for questions. Significant child age effects were found for disciplinary practices classified as "harsh." The consistencies between legal and medical professionals were striking. Both groups reflected changes in United States norms, as non-physical approaches were the most approved. We conclude that instruments estimating the prevalence of child maltreatment by parent-report should consider modifying how specific disciplinary practices are classified. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27117603

  6. Study of the Types of Domestic Violence Committed Against Women Referred to the Legal Medical Organization in Urmia - Iran

    PubMed Central

    Aghakhani, Nader; Sharif Nia, Hamid; Moosavi, Ehsan; Eftekhari, Ali; Zarei, Abbas; Bahrami, Nasim; Nikoonejad, Ali Reza

    2015-01-01

    Background: Today, domestic violence against women is a growing epidemic that can be observed in many countries. Objectives: This study was carried out to determine the types of domestic violence against women who were referred to the Legal Medical Organization of Iran in Urmia, Iran in 2012. Materials and Methods: The descriptive survey included demographic information, abuse screening, and items regarding partner involvement. Data was gathered using face-to-face structured interviews. The study population included 300, women 18 years of age or older, and data was collected about their demographic characteristics and the types of domestic violence they experienced. SPSS software version 16 was used for the analyses. Results: The majority of participants were in the 25 – 30 age group, and 83% of them were battered by their husbands in various ways. No significant relationships were observed between violence and unemployment, increasing age, and home ownership. Conclusions: The prevalence of abuse reported by women in this population suggests that many women that are referred to the Legal Medical Organization of Iran may have a history of abuse. Abused women may have different reasons for seeking a divorce. If routine screening for abuse is included in counseling, health providers will have the opportunity to develop a safety plan and initiate appropriate referrals. PMID:26834806

  7. Should performance-enhancing drugs in sport be legalized under medical supervision?

    PubMed

    Wiesing, Urban

    2011-02-01

    This review examines the question of whether performance-enhancing drugs should be permitted in sport under the control of physicians, and evaluates the expected outcomes of such a scenario. Such a change in regulation would need to be tightly controlled because of the risks involved. The results of legalizing performance-enhancing drugs in competitive sport would be either unhelpful or negative, and the unwanted aspects of doping control would not disappear. Athletes, including children and adolescents who wanted to pursue competitive sports, would be forced to take additional, avoidable health risks. The 'natural lottery' of athletic talents would be compensated for only partially by use of performance-enhancing agents. It would also be complemented by another 'natural lottery' of variable responses to doping measures, combined with the inventiveness of doping doctors. There would be no gain in 'justice' (i.e. fairer results that reflected efforts made) for athletes as a result of legalizing doping. Legalization would not reduce restrictions on athletes' freedom; the control effort would remain the same, if not increased. Extremely complicated international regulations would have to be adopted. The game of the 'tortoise and the hare' between doping athletes and inspectors would remain because prohibited but not identifiable practices could still provide additional benefits from use of permissible drugs. Audience mistrust, particularly toward athletes who achieved outstanding feats, would remain because it would still be possible that these athletes were reliant on illegal doping practices. Doping entails exposing the athletes to avoidable risks that do not need to be taken to increase the appeal of a sport. Most importantly, the function of sport as a role model would definitely be damaged. It is not necessary to clarify the question of what constitutes the 'spirit of sport' and whether this may be changed. From a practical point of view, a legalization of

  8. Should performance-enhancing drugs in sport be legalized under medical supervision?

    PubMed

    Wiesing, Urban

    2011-02-01

    This review examines the question of whether performance-enhancing drugs should be permitted in sport under the control of physicians, and evaluates the expected outcomes of such a scenario. Such a change in regulation would need to be tightly controlled because of the risks involved. The results of legalizing performance-enhancing drugs in competitive sport would be either unhelpful or negative, and the unwanted aspects of doping control would not disappear. Athletes, including children and adolescents who wanted to pursue competitive sports, would be forced to take additional, avoidable health risks. The 'natural lottery' of athletic talents would be compensated for only partially by use of performance-enhancing agents. It would also be complemented by another 'natural lottery' of variable responses to doping measures, combined with the inventiveness of doping doctors. There would be no gain in 'justice' (i.e. fairer results that reflected efforts made) for athletes as a result of legalizing doping. Legalization would not reduce restrictions on athletes' freedom; the control effort would remain the same, if not increased. Extremely complicated international regulations would have to be adopted. The game of the 'tortoise and the hare' between doping athletes and inspectors would remain because prohibited but not identifiable practices could still provide additional benefits from use of permissible drugs. Audience mistrust, particularly toward athletes who achieved outstanding feats, would remain because it would still be possible that these athletes were reliant on illegal doping practices. Doping entails exposing the athletes to avoidable risks that do not need to be taken to increase the appeal of a sport. Most importantly, the function of sport as a role model would definitely be damaged. It is not necessary to clarify the question of what constitutes the 'spirit of sport' and whether this may be changed. From a practical point of view, a legalization of

  9. Historical perspective and current trends in the legal process of divorce.

    PubMed

    Katz, S N

    1994-01-01

    Over the past 30 years, the legal status of husbands and wives in marriage has undergone major changes with the result that wives are now beginning to have more of an independent legal identity than in the past and, to some extent, more of an equal relationship with their husbands although full equality has not yet been achieved. At the same time, divorce laws and policies have consistently moved toward a view of marriage as an economic partnership and away from the concept of marriage as a status totally regulated by the state and dominated by the husband. This trend has produced significant changes in the statues, which have, to a certain extent, limited judicial discretion regulating the assignment of marital property and the awarding of alimony upon divorce. These changes have given more consideration to the contribution of wives to the marital enterprise and to the financial needs of children. In addition, recently there has been a movement toward legislating how couples divorce, particularly with regard to their ability--with or without the assistance of counsel--to conclude their divorce with minimal official action. This article explores the trends toward the equality and legal autonomy of husbands and wives in marriage and in the divorce process with particular emphasis on methods of allocating marital property and on new and simplified procedures for divorce.

  10. Dispensing death, desiring death: an exploration of medical roles and patient motivation during the period of legalized euthanasia in Australia.

    PubMed

    Street, A; Kissane, D W

    A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's cort, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia. PMID:12578011

  11. Good cop, bad cop: federal prosecution of state-legalized medical marijuana use after United States v. Lopez.

    PubMed

    Newbern, A E

    2000-10-01

    The Supreme Court's recent decisions in United States v. Lopez and United States v. Morrison articulate a vision of federalism under which Congress's regulatory authority under the Commerce Clause is severely limited in favor of returning traditional areas of state concern, particularly criminal law enforcement, to local or state control. The Court's decisions in these cases coincide with ballot initiatives legalizing the medical use of marijuana garnering a majority of the vote in California, Arizona, Alaska, Colorado, Nevada, Oregon, Washington, Maine, and Washington D.C. Those who use marijuana for medical purposes under sanction of state law, however, still face the threat of federal prosecution under the Controlled Substances Act. Medical marijuana proponents have traditionally, and unsuccessfully, contested federal prosecution using individual rights arguments under theories of equal protection or substantive due process. This Comment argues that after Lopez and Morrison, the federal government's authority to regulate intrastate use of marijuana for medicinal purposes is not the foregone conclusion it once was. The author suggests that proponents of medical marijuana use should invoke the federalism arguments of Lopez and Morrison and argue for state legislative independence from the federal government on this issue.

  12. Legal Issues in School Health Services and School Psychology: Guidelines for the Administration of Medication

    ERIC Educational Resources Information Center

    Mazur-Mosiewicz, Anna; Pierson, Eric E.; McIntosh, David E.

    2009-01-01

    The use of psychoactive medications to augment behavioral and psychosocial interventions in schools has significantly increased within the last few decades. Yet, advising, administrating, and supervising the dispensation of medication (including psychostimulants and psychoactive substances) tend to be some of the most risky tasks of school…

  13. Medical telerobotic systems: current status and future trends.

    PubMed

    Avgousti, Sotiris; Christoforou, Eftychios G; Panayides, Andreas S; Voskarides, Sotos; Novales, Cyril; Nouaille, Laurence; Pattichis, Constantinos S; Vieyres, Pierre

    2016-01-01

    Teleoperated medical robotic systems allow procedures such as surgeries, treatments, and diagnoses to be conducted across short or long distances while utilizing wired and/or wireless communication networks. This study presents a systematic review of the relevant literature between the years 2004 and 2015, focusing on medical teleoperated robotic systems which have witnessed tremendous growth over the examined period. A thorough insight of telerobotics systems discussing design concepts, enabling technologies (namely robotic manipulation, telecommunications, and vision systems), and potential applications in clinical practice is provided, while existing limitations and future trends are also highlighted. A representative paradigm of the short-distance case is the da Vinci Surgical System which is described in order to highlight relevant issues. The long-distance telerobotics concept is exemplified through a case study on diagnostic ultrasound scanning. Moreover, the present review provides a classification into short- and long-distance telerobotic systems, depending on the distance from which they are operated. Telerobotic systems are further categorized with respect to their application field. For the reviewed systems are also examined their engineering characteristics and the employed robotics technology. The current status of the field, its significance, the potential, as well as the challenges that lie ahead are thoroughly discussed. PMID:27520552

  14. Modeling past, current, and future time in medical databases.

    PubMed Central

    Kouramajian, V.; Fowler, J.

    1994-01-01

    Recent research has focused on increasing the power of medical information systems by incorporating time into the database system. A problem with much of this research is that it fails to differentiate between historical time and future time. The concept of bitemporal lifespan presented in this paper overcomes this deficiency. Bitemporal lifespan supports the concepts of valid time and transaction time and allows the integration of past, current, and future information in a unified model. The concept of bitemporal lifespan is presented within the framework of the Extended Entity-Relationship model. This model permits the characterization of temporal properties of entities, relationships, and attributes. Bitemporal constraints are defined that must hold between entities forming "isa" hierarchies and between entities and relationships. Finally, bitemporal extensions are presented for database query languages in order to provide natural high-level operators for bitemporal query expressions. PMID:7949941

  15. The right to die and physician-assisted suicide medical, legal, and ethical aspects (Part I).

    PubMed

    Wecht, C H

    1998-01-01

    Part 1 of this paper examines the issue of the "Right to Die", and its relationship to the discipline of Bioethics and the doctrine of Informed Consent. The discussion underlines the role and rights of the patient. A number of relevant judgments are quoted, with their implications. Part 2, to be published in our next issue, continues the discussion, with emphasis on the subject of physician-assisted suicide and the activities of Dr. Kevorkian. Further legal cases are quoted with relevant analysis, together with proposed legislation under the title "Death with Dignity". Finally, the author points to possible future developments in this controversial issue.

  16. Restricted career paths for overseas students graduating from Australian medical schools: legal and policy considerations.

    PubMed

    Elkin, Katie J; Studdert, David M

    2010-05-01

    A sharp increase in the number of students graduating from Australian medical schools over the next few years looks set to outpace available intern positions. Graduating overseas students will be the first to miss out. While this treatment of overseas students is unlikely to be found unlawful, questions of fairness remain. From a policy standpoint, the bottleneck in intern places could be quite damaging as: it encourages Australian-trained medical graduates with high-quality training and culturally-relevant skills to leave; and it extinguishes a valuable opportunity to steer some of these graduates into geographical areas with the greatest medical workforce needs.

  17. Restricted career paths for overseas students graduating from Australian medical schools: legal and policy considerations.

    PubMed

    Elkin, Katie J; Studdert, David M

    2010-05-01

    A sharp increase in the number of students graduating from Australian medical schools over the next few years looks set to outpace available intern positions. Graduating overseas students will be the first to miss out. While this treatment of overseas students is unlikely to be found unlawful, questions of fairness remain. From a policy standpoint, the bottleneck in intern places could be quite damaging as: it encourages Australian-trained medical graduates with high-quality training and culturally-relevant skills to leave; and it extinguishes a valuable opportunity to steer some of these graduates into geographical areas with the greatest medical workforce needs. PMID:20438428

  18. [Current legal initiative to integrated care - effects of outpatient care in hospitals].

    PubMed

    Wohlgemuth, W A; Mayer, J; Nagel, E; Bohndorf, K

    2004-04-01

    The strict separation of the out-patient and hospital-based health care delivery sectors in Germany leads to deficits in effectiveness and efficiency. Newly introduced legal initiatives to overcome this separation, namely "Ambulantes Operieren" (section 115 b SGB V), "Ambulante Behandlung durch Krankenhäuser" and Disease Management Programs (sections 116a-b SGB V) are described in detail in this article. Their impact on hospital-based health provision for out-patients is discussed. The aim of a better integration of different sectors with a better quality and a more efficient use of resources seems to be the target of these initiatives.

  19. [Current legal initiative to integrated care - effects of outpatient care in hospitals].

    PubMed

    Wohlgemuth, W A; Mayer, J; Nagel, E; Bohndorf, K

    2004-04-01

    The strict separation of the out-patient and hospital-based health care delivery sectors in Germany leads to deficits in effectiveness and efficiency. Newly introduced legal initiatives to overcome this separation, namely "Ambulantes Operieren" (section 115 b SGB V), "Ambulante Behandlung durch Krankenhäuser" and Disease Management Programs (sections 116a-b SGB V) are described in detail in this article. Their impact on hospital-based health provision for out-patients is discussed. The aim of a better integration of different sectors with a better quality and a more efficient use of resources seems to be the target of these initiatives. PMID:15088171

  20. Hunger strikers: ethical and legal dimensions of medical complicity in torture at Guantanamo Bay.

    PubMed

    Dougherty, Sarah M; Leaning, Jennifer; Greenough, P Gregg; Burkle, Frederick M

    2013-12-01

    Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO. PMID:24073786

  1. Hunger strikers: ethical and legal dimensions of medical complicity in torture at Guantanamo Bay.

    PubMed

    Dougherty, Sarah M; Leaning, Jennifer; Greenough, P Gregg; Burkle, Frederick M

    2013-12-01

    Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO.

  2. Medical-legal issues in headache: penal and civil Italian legislation, working claims, social security, off-label prescription.

    PubMed

    Aguggia, M; Cavallini, M; Varetto, L

    2006-05-01

    Primary headaches can be considered simultaneously as symptom and disease itself, while secondary headaches are expressions of a pathological process that can be systemic or locoregional. Because of its subjective features, headache is often difficult to assess and quantify by severity, frequency and invalidity rate, and for these reasons it has often been implicated in legal controversies. Headache has seldom been considered in the criminal law, except when it represents a typical symptom of a disease whose existence can be objectively assessed (i. e. raised intracranial pressure). Therefore, in civil legislation it is not yet coded to start claiming for invalidity compensation. In particular, one of the most debated medical-legal questions is represented by headaches occurring after head injury. Headache is often the principal symptom at the beginning of several toxic chronic syndromes, with many implications, especially in working claims, and, more recently, it may be referred to as one of the most frequent symptoms by victims of mobbing (i. e. psychological harassment in the workplace). The National Institute for Industrial Accident Insurance (INAIL) scales (instituted by the law 38/2000) mention the "Subjective cranial trauma syndrome" and give an invalidity rate evaluation. With reference to other headache forms, no legislation really exists at the present time, and headache is only considered as a symptom of a certain coded disease. Requests for invalidity social pension and the question of off-label prescriptions (drug prescription for a disease, without formal indication for it) are other controversial matters.

  3. Protection of genetic data in medical genetics: a legal analysis in the European context.

    PubMed

    Romeo-Malanda, Sergio; Nicol, Dianne

    2007-01-01

    This article is based in three ideas, namely: 1. All the questions in the field of "privacy" and "confidentiality" derived from genetic tests only must be taken into account if we deal with "personal data". 2. When we are dealing with personal genetic data, two aspects must be especially guaranteed: a) the freedom and autonomy of the individual; and b) the duty of secrecy in order to protect the privacy of the person. 3. Some conflicts can appear between these two aspects and we have to deal with them. The author analyses the supranational European legislation referring to this topic, according to with, genetic privacy must be guarantee. He also notes how Genetic medicine can give rise to a variety of conflicts of interests, and points out how the different legal texts object of study deal with this issue.

  4. [Myocardial infarction as work-related accident: medical and legal problems].

    PubMed

    Szozda, Ryszard; Procek, Marek

    2002-01-01

    An accident is a work-related event caused by an external factor. Therefore, myocardial infarction is also considered, in specific conditions, as a work-related accident. The aim of this study was to present the cause-effect relationship between myocardial infarction and working conditions in the context of a work-related accident characterized by: urgency of event, external factor and relation with working conditions. The attitude of the Supreme Court to the question of certification, highlighting the key issues and facilitating the understanding of the problem and opinions of legal experts on this matter is also discussed. Myocardial infarction as a work-related accident is an issue involving both law and medicine, particularly occupational medicine, that will have to tackle and solve this problem in its several dimensions, including periodical examinations.

  5. [Advance Directives - Not a Lot of Margin for Error - The Surgeon's View of a Complex Medical-Legal Topic].

    PubMed

    Slotta, J E; Schilling, M K; Ghadimi, M; Kollmar, O

    2015-08-01

    Since September 1st, 2009, the most recent version of the German "Betreuungsrechtsänderungsgesetz" has been validated by the legislators. It precisely sets out how physicians and nursing staff have to deal with a written declaration of a patient's will. This new law focuses in a special way on advance directives, describes the precise rules for the authors of an advance directive and shows both its sphere of action and its limitations. This article aims to give an overview on the legal scope of advance directives, and to illustrate potential limitations and conflicts. Furthermore, it shows the commitments and rights of the medical team against the background of an existing advance directive.

  6. The ethical and legal implications of Jaffee v Redmond and the HIPAA medical privacy rule for psychotherapy and general psychiatry.

    PubMed

    Mosher, Paul W; Swire, Peter P

    2002-09-01

    The 1996 Jaffee v Redmond US Supreme Court decision established a privilege for psychotherapeutic communications in the federal courts. The new privilege has both substantive and symbolic importance. In its strongly worded opinion in Jaffee v Redmond, the US Supreme Court made clear that confidentiality in psychotherapy takes precedence over certain other important societal goals. The new Health Insurance Portability and Accountability Act (HIPAA) medical privacy rule promulgated by the Department of Health and Human Services relies on Jaffee v Redmond in providing additional legal protections for confidential psychotherapy. Both the US Supreme Court's Jaffee v Redmond ruling and the HIPAA rule support the ethical protection of confidentiality of conversations between psychiatrists and patients. PMID:12232971

  7. [Intravitreal injections of medications in Germany. Contract situation and legal conditions].

    PubMed

    Ziemssen, F; Wiedemann, P; Kampik, A; Holz, F; Bartz-Schmidt, K U

    2009-05-01

    Despite the increasing application of both approved and off-label drugs for intravitreal administration, the German health system still does not provide an accounting code for the procedure of intravitreal injections. Health insurances and politicians are exerting pressure in order to limit the expected increase in the number of medications and costs due to demographic factors. Although the price for the drug can be determined by the manufacturer, a standing committee has to agree on the fee to be charged for the medical service of injection and subsequent examinations. Until the missing arrangement has been made, each individual surgeon can balance accounts with the patients who have claim for reimbursement. Many contracts have recently been made in order to regulate the extent of performance and charges for the application of medications and follow-up examinations to reduce administration costs. Due to medical liability and ethical code, physicians are obliged to provide a cost-effective and adequate treatment as well as a comprehensive preoperative patient education including efficacy, potential complications, limited prescription and free choice of a medical practitioner. It also appears prudent to explain relevant terms such as 'off-label' and 'level of evidence'. To prevent any suspicion of personal advantage, patients should be informed if placed contracts do not allow equal reimbursement for the same treatment or similar drugs. PMID:19408003

  8. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.

    PubMed

    Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini

    2015-01-01

    Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care.

  9. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.

    PubMed

    Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini

    2015-01-01

    Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care. PMID:26322648

  10. Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

    PubMed

    Richmond, Melissa K; Pampel, Fred C; Rivera, Laura S; Broderick, Kerryann B; Reimann, Brie; Fischer, Leigh

    2015-01-01

    With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users. PMID:25715066

  11. Sickle Cell Screening: Medical, Legal, Ethical, Psychological and Social Problems; A Sickle Cell Crisis.

    ERIC Educational Resources Information Center

    Bowman, James E.

    In recent years, sickle cell screening programs have been initiated by community groups, health centers, hospitals, medical schools, health departments, school systems, city and State governments, various branches of the Federal Government, fraternal and social clubs, and other organizations. Problems have resulted from mass sickle cell screening,…

  12. Patient-centered medical home cyberinfrastructure current and future landscape.

    PubMed

    Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew

    2011-05-01

    The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

  13. Improvised explosive devices: pathophysiology, injury profiles and current medical management.

    PubMed

    Ramasamy, A; Hill, A M; Clasper, J C

    2009-12-01

    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

  14. [Current problems of information technologies application for forces medical service].

    PubMed

    Ivanov, V V; Korneenkov, A A; Bogomolov, V D; Borisov, D N; Rezvantsev, M V

    2013-06-01

    The modern information technologies are the key factors for the upgrading of forces medical service. The aim of this article is the analysis of prospective information technologies application for the upgrading of forces medical service. The authors suggested 3 concepts of information support of Russian military health care on the basis of data about information technologies application in the foreign armed forces, analysis of the regulatory background, prospects of military-medical service and gathered experience of specialists. These three concepts are: development of united telecommunication network of the medical service of the Armed Forces of the Russian Federation medical service, working out and implementation of standard medical information systems for medical units and establishments, monitoring the military personnel health state and military medical service resources. It is noted that on the assumption of sufficient centralized financing and industrial implementation of the military medical service prospective information technologies, by the year 2020 the united information space of the military medical service will be created and the target information support effectiveness will be achieved.

  15. The current medical education system in the world.

    PubMed

    Nara, Nobuo; Suzuki, Toshiya; Tohda, Shuji

    2011-07-04

    To contribute to the innovation of the medical education system in Japan, we visited 35 medical schools and 5 institutes in 12 countries of North America, Europe, Australia and Asia in 2008-2010 and observed the education system. We met the deans, medical education committee and administration affairs and discussed about the desirable education system. We also observed the facilities of medical schools.Medical education system shows marked diversity in the world. There are three types of education course; non-graduate-entry program(non-GEP), graduate-entry program(GEP) and mixed program of non-GEP and GEP. Even in the same country, several types of medical schools coexist. Although the education methods are also various among medical schools, most of the medical schools have introduced tutorial system based on PBL or TBL and simulation-based learning to create excellent medical physicians. The medical education system is variable among countries depending on the social environment. Although the change in education program may not be necessary in Japan, we have to innovate education methods; clinical training by clinical clerkship must be made more developed to foster the training of the excellent clinical physicians, and tutorial education by PBL or TBL and simulation-based learning should be introduced more actively.

  16. [Medico-legal assessment of selected cases of perinatal complications resulting in death of the woman during childbirth. Medical error or therapeutic failure?].

    PubMed

    Chowaniec, Małgorzata; Chowaniec, Czesław; Jabłoński, Christian; Nowak, Agnieszka

    2005-01-01

    Medico-legal estimation of therapeutic management in cases of perinatal complications, especially those resulting in death of the women during childbirth is usually very difficult. The authors have investigated medical documentation supported by the results of autopsies of cases chosen from the casuistry of the Forensic Medicine Department, Medical University of Silesia, Katowice. Considering the limits of professional liability and legal responsibility of physicians, close attention was paid to standard therapeutic management and increased risk in treatment with regard to that relating to typical salubrious complications. The presented cases of deaths of women during childbirth can be the succeeding opinion in broad discussion on medical errors as well as an attempt to standardise and differentiate the medical error from therapeutic failure which occurred within the reach of risk in the undertaken treatment.

  17. Children sold for transplants: medical and legal aspects. Amnesty International--Danish Working Group for Children.

    PubMed

    Fasting, U; Christensen, J; Glending, S

    1998-11-01

    Over the last few decades there has been a substantially higher percentage of successful organ transplants but also a significant imbalance between the demand for and the supply of organs, creating the basis for a highly profitable black market trade in human organs. Sometimes there are reports that children have been kidnapped, only to reappear later lacking one kidney, or that they simply disappear and are subsequently killed to have all their transplantable organs removed for profit. The European Union feels that there is a need for action and that it has a duty to act in this field, especially for ethical reasons. There is now established close co-operation between the various European transplant organizations. The legal protection of children with regard to organ transplantation is not specifically mentioned in the existing conventions because this issue was not foreseen at the time of their preparation. However, the issue is covered in a broader sense by more general provisions. There are endless rumours surrounding this area. Members of various organizations who travel in the suspected countries say that the trafficking in children who are sold for transplantation is well known, but it is too difficult and very dangerous to catch the people involved. We have to conclude that it has been impossible to prove or disprove the rumours, but they are consistent and we all, especially in the health care professions, have an obligation to be keenly aware of how and where organs are obtained.

  18. Children sold for transplants: medical and legal aspects. Amnesty International--Danish Working Group for Children.

    PubMed

    Fasting, U; Christensen, J; Glending, S

    1998-11-01

    Over the last few decades there has been a substantially higher percentage of successful organ transplants but also a significant imbalance between the demand for and the supply of organs, creating the basis for a highly profitable black market trade in human organs. Sometimes there are reports that children have been kidnapped, only to reappear later lacking one kidney, or that they simply disappear and are subsequently killed to have all their transplantable organs removed for profit. The European Union feels that there is a need for action and that it has a duty to act in this field, especially for ethical reasons. There is now established close co-operation between the various European transplant organizations. The legal protection of children with regard to organ transplantation is not specifically mentioned in the existing conventions because this issue was not foreseen at the time of their preparation. However, the issue is covered in a broader sense by more general provisions. There are endless rumours surrounding this area. Members of various organizations who travel in the suspected countries say that the trafficking in children who are sold for transplantation is well known, but it is too difficult and very dangerous to catch the people involved. We have to conclude that it has been impossible to prove or disprove the rumours, but they are consistent and we all, especially in the health care professions, have an obligation to be keenly aware of how and where organs are obtained. PMID:9856069

  19. Medicalization: Current Concept and Future Directions in a Bionic Society

    PubMed Central

    Maturo, Antonio

    2012-01-01

    The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other “engines” of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a “bionic society”. PMID:22654387

  20. Medical education in India: current challenges and the way forward.

    PubMed

    Solanki, Anjali; Kashyap, Surender

    2014-12-01

    Medical education in India is suffering from various shortcomings at conceptual as well as implementation level. With the expansion in medical education, the doctor to patient ratio has increased but these numbers do not align well with the overall quality of medical care in the country. To address this issue, a comprehensive analysis of various associated factors is essential. Indian medical education is suffering from a maldistribution of resources, unregulated growth in the private sector, lack of uniform admission procedures and traditional curricula lacking innovative approaches. To achieve higher standards of medical education, our goal should be to re-evaluate each and every aspect; create an efficient accreditation system; promote an equal distribution of resources, redesign curricula with stricter implementation and improved assessment methodologies; all of which will generate efficient medical graduates and consequently better health care delivery, and resulting in desired change within the system.

  1. RUSA Guidelines. Guidelines for Liaison Work in Managing Collections and Services; Guidelines for Medical, Legal, and Business Information Service Responses; Guidelines for the Preparation of a Bibliography.

    ERIC Educational Resources Information Center

    Reference & User Services Quarterly, 2001

    2001-01-01

    Presents guidelines developed by RUSA (Reference and User Services Association), a division of the American Library Association, regarding collection development with user liaisons; meeting user needs for medical, legal, or business information; and bibliography preparation that includes a variety of formats such as nonprint materials and Web…

  2. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 2. Equipment, Safe Driving Practices, Legal Aspects, Controlling the Situation, Action Evaluation Conference. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the second in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains five sections that cover the following course content: ambulance equipment, safe driving practices for emergency vehicle drivers, legal aspects of the EMT's job, how to maintain control at an accident scene…

  3. Bilingual Encounters: Spanish-English Medical and Legal Dialogues. A Practical Resource for Educators and Students of Interpreting. Interpreting and Translation Publications Series, No. 1.

    ERIC Educational Resources Information Center

    Hale, Sandra

    Thirty-eight dialogues are presented, each illustrating a common, real-life interpreting situation involving medical and/or legal issues and terminology. Each involves both Spanish and English languages, and the situations are specific to New South Wales, Australia. They are designed to be used as a resource in teaching interpreting. The…

  4. Chronic pain management: legal and licensure issues.

    PubMed

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Legal and licensure issues are an inevitable aspect of treating patients with chronic pain. Clinicians need to ensure compliance with state medical board and federal guidelines. Prescription drug abuse continues to be a significant problem. Despite the legalization of medical marijuana in some states, there is currently no medical indication for prescribing marijuana; the exceptions are dronabinol and nabilone. These are approved by the Food and Drug Administration for chemotherapy-induced nausea and vomiting, and dronabinol also is approved for anorexia in patients with AIDS or cancer. Other legal issues concern establishment of chronic pain as a basis for disability status. Clinicians often are asked to provide a letter or assessment, such as a functional capacity evaluation, for documenting disability. Referral to a physical medicine and rehabilitation subspecialist or physical therapist for this evaluation should be considered. Balancing legal and licensure issues with the best interests of the patient can be challenging for clinicians. PMID:25970871

  5. Neurologists' Views of Current Medications: Spasticity and Athetosis

    ERIC Educational Resources Information Center

    Obringer, S. John; Coffey, Kenneth

    2008-01-01

    Medications to treat individuals with cerebral palsy have increased significantly over the last few decades. The purpose of this article was to randomly survey practicing neurologists on a national level to determine prescribing patterns for both spasticity and athetosis. The results indicated that the most frequently prescribed medication for…

  6. What is Wrong With the Current Psychiatric Medication?

    PubMed Central

    Kubacki, Andrew

    1973-01-01

    Some common aspects of the misuse of psychotropic drugs are discussed against the background of disparate development of psychiatric and medical sciences. Particular attention is granted the anxiolytic agents, antidepressants, and neuroleptic drugs, and the related psychiatric conditions are considered correspondingly. Popular errors in applying psychiatric medication are thus discussed with their adverse consequences. PMID:20469001

  7. Medical malpractice lawsuits and the value of skilled and diverse legal counsel.

    PubMed

    Lapuyade, Keith D; Sorkin, Alison C

    2013-12-01

    Medical malpractice claims against dermatologists and dermapathologists arise mostly out of claims for negligence--when a patient claims a provider owed a duty to a patient, breached that duty, and caused damages to the patient. When a health care provider files a claim with his or her insurance company, the insurance company will usually retain and pay an attorney for the health care provider. It is important to understand the role the attorney retained by the insurance company plays to evaluate whether a health care provider should seek the advice of independent or "personal" counsel. PMID:24800431

  8. Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions.

    PubMed

    Lelario, M; Ciuffreda, P; Lupo, P; Bristogiannis, C; Vinci, R; Stoppino, L P; De Filippo, M; Macarini, L

    2013-08-01

    To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.

  9. Rights of persons with conditions associated with disability: current legal framework.

    PubMed

    Moya, Graciela

    2016-08-01

    The objective of this review study is to promote the dissemination of the legislation in force in Argentina for the protection of the rights of persons with conditions that might cause disability. Articles of bills and laws that protect the rights of these families are reviewed, so that health care providers assisting them have better access to them. Argentina has a wide range of laws and regulations dedicated to protecting them, but they are generally not clearly recognized by citizens. The aim is to disseminate this information in the medical setting so that health care providers can help patients recognize their rights through empowerment.

  10. [Medical and legal aspects of genital mutilation and circumcision part I: female genital mutilation (FGM)].

    PubMed

    Dettmeyer, Reinhard; Laux, Johannes; Friedl, Hannah; Zedler, Barbara; Bratzke, Hansjürgen; Parzeller, Markus

    2011-01-01

    Female genital mutilation (FGM) is considered to be against the law and against morality not only in Western countries, although a woman of age and able to consent may sometimes think differently. The procedure may have serious physical and emotional consequences for the girl or woman. Nevertheless there are attempts to justify the procedure with medical and hygienic pseudoarguments, ideology, freedom of religion, cultural identity and social adequacy. Outside the Western world, some people claim that religion and culture alone justify the practice. In Germany, parents can lose the right to determine the residence of their daughter, if she is faced with the risk of genital mutilation in order to prevent that the child or girl is taken to her home country. Genital mutilation as a gender-specific threat is recognized as a reason to grant asylum or prevent deportation. Proposals to make genital mutilation a separate punishable offence are presently discussed by the legislator.

  11. The Role of Educators in the AIDS Epidemic: Medical, Legal, and Psychoeducational Responsibilities.

    ERIC Educational Resources Information Center

    Ford, Harriett H.; Russo, Charles J.

    1997-01-01

    Provides educators with current information on HIV/AIDS epidemiology, transmission, and prevention; the educational rights of HIV-infected children; neurodevelopmental sequelae in school-age infected children; relevant case law; results of empirically based studies on youngsters' HIV/AIDS-related knowledge, attitudes, and behaviors; and school…

  12. [Update on current care guidelines: Self-medication, Current Care Guideline].

    PubMed

    2016-01-01

    Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication. PMID:27483629

  13. [Update on current care guidelines: Self-medication, Current Care Guideline].

    PubMed

    2016-01-01

    Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication.

  14. [Current situation and countermeasures of medical damage risk sharing system in China].

    PubMed

    Wen, Xuebin; Cao, Yanlin; Tian, Yongquan; Wei, Zhanying; Gao, Xinqiang; Zheng, Xueqian

    2015-01-01

    Although medical damage risks really exist, an effective medical risk sharing system is still not available in China right now. By analyzing the status quo of Chinese medical damage risks sharing system, the authors put forward the following suggestions to improve the current system: Upgrading the preventive strategy for medical disputes, establishing multi-level and multi-channel comprehensive medical damage risks sharing system, promoting the effective cooperation between insurance relief systems and mediation system for medical disputes, and constructing highly effective pathways to resolve the medical disputes.

  15. [The state of forensic medical expertise of civil cases concerning medical disputes].

    PubMed

    Barinov, E Kh; Romodanovskiĭ, P O

    2013-01-01

    It is concluded that the current state of forensic medical expertise of civil cases concerning disputable issues, such as causing harm to health in medical practice, does not meet the requirements of the relevant legal procedures.

  16. Targeting Oral and Cultural Proficiency for Medical Personnel: An Examination of Current Medical Spanish Textbooks

    ERIC Educational Resources Information Center

    Hardin, Karol

    2012-01-01

    Demand for medical Spanish courses has grown with the rising needs of Spanish-speaking patients in the United States, but while there is no shortage of beginning medical Spanish textbooks, very few target the intermediate level. This article examines eighteen medical Spanish texts published in the last twenty years with respect to seven factors:…

  17. Cost-shifting in the current medical environment

    NASA Astrophysics Data System (ADS)

    Gruber, William H.

    1994-12-01

    `Cost shifting' occurs when there is not a fair or accurate match of the payment and use of medical services. A common `cost shifting' occurs when an insured patient is charged more to cover free services provided to an uninsured patient. This paper documents the multiple negative consequences of the many categories of cost shifting, reviews forces which are leading both to an increase and decrease in the magnitude of cost shifting, and evaluates the consequences of cost shifting on the goals of U.S. health care reform and investment in medical technology. Policy to minimize the negative consequences of cost shifting is recommended.

  18. [Project Shared Medical Record in Catalonia, Spain: legal framework and enforcement of rights of access, rectification, cancellation and opposition (ARCO)].

    PubMed

    Borrás-Pascual, Maria Josep; Busquets-Font, Josep Maria; García-Martínez, Anna; Manent-González, Martí

    2010-02-01

    The Constitution and especially the Constitutional Court's jurisprudence have recognized the so-called right of habeas data, providing legal protection at the highest level of personal data. Health information, falls within the scope of protection, but we see that there are peculiarities in the health and development legislation that compels us to treat such information with special characteristics. This article will review the citizen's rights to access to health information, taking into account both the protection of personal data such as regulating access to specific health information and tools that have been developed for the exercise of these rights under the "Shared Medical Record" project developed by the Department of Health of the Generalitat of Catalonia. In particular the rights that are discussed are: the right of access to information, the right of correction, the right of cancellation. The right of access to information enables anyone to know if their personal data are processed, the purpose of treatment and the available information on the origin of personal data. In addition the law also allows to know whether the data have been disclosed to a third party. The right of rectification gives -concerned in this case the patient- the right to correct any data that contain errors. The cancellation right is restricted to situations where it really is exercising a right of correction against information. Finally, the right to object is for patients to be able to oppose their health data is consulted by various health care facilities to generate them.

  19. Worth its weight in gold: Legal analysis of the current appraisal of coal property in West Virginia

    SciTech Connect

    1997-11-01

    The legacy of out-of-state coal barons buying up the vast wealth of our natural resources continues to echo through West Virginia. Much has been written of the continuing controversy between labor and the owners of the state`s coal mines. Indeed, one can hardly grow up in West Virginia without perceiving the subtle indoctrination about the injustice and the implicit class struggle that underlies the history of the Appalachian coal fields. This study begins with a historical review of natural resource property appraisal in West Virginia and then looks at the recent attempt being made to change tax department policy and application of the current regulations. One recent attempt to achieve this end has been a series of cases brought by citizen taxpayers against the tax department to declare current methodology unconstitutional and to have the courts mandate corrective action to bring the tax department`s appraisals in line with the constitutional mandate of equal taxation. Then, the analysis turns to the duty of the tax commissioner to appraise coal property, potential solutions to the current debate, and a conclusory look at why this issue should be brought to the attention of not only the legal community, but to the entire state.

  20. [Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].

    PubMed

    Vadász, Gábor

    2010-10-24

    Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation.

  1. Medical necessity: is current documentation practice and payment denial limiting access to inpatient rehabilitation?

    PubMed

    Granger, Carl V; Carlin, Marsha; Diaz, Pedro; Dorval, Jane; Forer, Steve; Kessler, Corby; Melvin, John L; Miller, Lawrence S; Riggs, Richard V; Roberts, Pamela

    2009-09-01

    Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, "Medical necessity?! That's what I was taught to know!" PMID:19487918

  2. Efficacy and safety of currently marketed anti-osteoporosis medications.

    PubMed

    Reginster, J Y; Neuprez, A; Dardenne, N; Beaudart, C; Emonts, P; Bruyere, O

    2014-12-01

    During the past 2 decades, many interventions were proven effective in the management of postmenopausal osteoporosis. The objective of an anti-osteoporosis treatment is to reduce fracture rates, ideally at all skeletal sites (i.e. spine, hip, and other non-spine). The armamentarium against osteoporosis includes anti-resorptive agents (i.e. bisphosphonates, selective estrogen receptor modulators and denosumab), bone-forming agents (i.e. peptides from the parathyroid hormone family) and one agent with a dual mechanism of action (i.e. strontium ranelate). All these medications combine antifracture efficacy with a reasonable benefit/risk profile. However, the choice of a particular chemical entity, in one individual patient is based on the knowledge and expertise of the physician. Prioritization of drugs should be based on the individual profile of the patient, the severity of osteoporosis and the specific contraindications, warnings and precautions of use of the various available medications. PMID:25432354

  3. Review of the Italian Current Legislation on Research Biobanking Activities on the Eve of the Participation of National Biobanks' Network in the Legal Consortium BBMRI-ERIC

    PubMed Central

    Calzolari, Alessia; Napolitano, Mariarosaria

    2013-01-01

    The ethical-legal framework of research biobanking activities is still scarcely defined in Italy, and this constitutes a major obstacle to exploit the potential benefits of existing bioresource patrimony at the national and international levels. Biobanking and Biomolecular Resources Research Infrastructure (BBMRI), which aims to become a major interface between biological samples and data and top-level biological and medical research, is undertaking the crucial transformation to the ERIC (European Research Infrastructure Consortium) legal entity. In this scenario, there is a need to address the national legal and ethical concerns that are strictly correlated with the use of human biosources in research across European countries participating (and not) in BBMRI. In this perspective, this article aims to review the legal framework applying to research biobanking in Italy, including both “soft” nonbinding instruments and binding regulations. Since ethical and societal aspects impact biobanking research activities, the article discusses both the critical ethical and legal open issues that need to be implemented at the national level. PMID:23840925

  4. Review of the Italian current legislation on research biobanking activities on the eve of the participation of national biobanks’ network in the legal consortium BBMRI-ERIC.

    PubMed

    Calzolari, Alessia; Napolitano, Mariarosaria; Bravo, Elena

    2013-04-01

    The ethical-legal framework of research biobanking activities is still scarcely defined in Italy, and this constitutes a major obstacle to exploit the potential benefits of existing bioresource patrimony at the national and international levels. Biobanking and Biomolecular Resources Research Infrastructure (BBMRI), which aims to become a major interface between biological samples and data and top-level biological and medical research, is undertaking the crucial transformation to the ERIC (European Research Infrastructure Consortium) legal entity. In this scenario, there is a need to address the national legal and ethical concerns that are strictly correlated with the use of human biosources in research across European countries participating (and not) in BBMRI. In this perspective, this article aims to review the legal framework applying to research biobanking in Italy, including both "soft" nonbinding instruments and binding regulations. Since ethical and societal aspects impact biobanking research activities, the article discusses both the critical ethical and legal open issues that need to be implemented at the national level.

  5. [History and current status of medical treatment for stroke].

    PubMed

    Yagita, Yoshiki

    2016-04-01

    In the last few decades, medical treatment for stroke has made progress greatly. Effective and safe antihypertensive drug dramatically reduced incidence of hemorrhagic stroke Although intravenous thrombolysis is effective therapeutic strategy, only limited patient can receive the benefit due to narrow time window. There are some ongoing trials to develop safer and more effective thrombolytic therapy. Antithrombotic therapy is important for prevention of recurrent stroke in the acute and chronic phase. Aspirin and warfarin have been used for a long period. Now, we can also choose clopidogrel, cilostazol and non-vitamin K antagonist oral anticoagulants. Researchers and physicians will continue effort to develop more effective strategy for management of stroke. PMID:27333740

  6. [Current trends in medical and surgical treatment of epilepsy].

    PubMed

    Ambrosetto, C; Ambrosetto, P

    1979-01-01

    The AA., after a critical review of the literature, discuss the actual problems related to the various forms of the epilepsie susceptible of an appropriate surgical treatment. The AA. consider that the modern S.E.E.G. techniques, such as the formed in the highly specialized center of Bancaud and Talairach, open new perspectives particularly for the cases resistant to medical treatment and without evidence of focalisation. The AA. discuss the criteria, justifying such limitations and auspicate the institution of a much limited number of such centers, also in Italy.

  7. The legal aspects of the termination of unwanted pregnancies and the risks faced by the medical doctor: a UK perspective.

    PubMed

    Gibson, C

    2003-03-01

    Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.

  8. The legal aspects of the termination of unwanted pregnancies and the risks faced by the medical doctor: a UK perspective.

    PubMed

    Gibson, C

    2003-03-01

    Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence. PMID:14556349

  9. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    PubMed

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. PMID:25702076

  10. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    PubMed

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system.

  11. [Current status of palliative care in medical oncology].

    PubMed

    Sasaki, Tsubasa; Ohta, Syuji; Seki, Nobuhiko; Eguchi, Kenji

    2010-06-01

    A team approach is efficient in palliative care for cancer patients. People suffered from cancer have a right to receive high-quality palliative care earlier in cancer treatment. In Japan the National Act for Strategy against Cancer was enacted in 2007. Systematic educational programs supported by the Ministry of Health Labor and Welfare has been conducted for medical staffs, home care staffs, local pharmacists, care managers etc. at core institutes in each district. Pain control is still major target for cancer palliative medicine. Recently various types of opioids can be used routinely in daily clinical setting for Japanese cancer patients. Complementary and alternative medicine (CAM) may also effective in some patients but further study for proving scientific evidence in CAM should be warranted. Tailor-maid pain control will be established in the near future with molecular based pharmacogenomics.

  12. Current perspectives of nanoparticles in medical and dental biomaterials.

    PubMed

    Mohamed Hamouda, Ibrahim

    2012-05-01

    Nanotechnology is gaining tremendous impetus due to its capability of modulating metals into their nanosize, which drastically changes the chemical, physical and optical properties of metals. Nanoparticles have been introduced as materials with good potential to be extensively used in biological and medical applications. Nanoparticles are clusters of atoms in the size range of 1-100 nm. Inorganic nanoparticles and their nano-composites are applied as good antibacterial agents. Due to the outbreak of infectious diseases caused by different pathogenic bacteria and the development of antibiotic resistance, pharmaceutical companies and researchers are searching for new antibacterial agents. The metallic nanoparticles are the most promising as they show good antibacterial properties due to their large surface area to volume ratios, which draw growing interest from researchers due to increasing microbial resistance against metal ions, antibiotics and the development of resistant strains. Metallic nanoparticles can be used as effective growth inhibitors in various microorganisms and thereby are applicable to diverse medical devices. Nanotechnology discloses the use of elemental nanoparticles as active antibacterial ingredient for dental materials. In dentistry, both restorative materials and oral bacteria are believed to be responsible for restoration failure. Secondary caries is found to be the main reason to restoration failure. Secondary caries is primarily caused by invasion of plaque bacteria (acid-producing bacteria) such as Streptococcus mutans and lactobacilli in the presence of fermentable carbohydrates. To make long-lasting restorations, antibacterial materials should be made. The potential of nanoparticles to control the formation of biofilms within the oral cavity is also coming under increasing scrutiny. Possible uses of nanoparticles as topically applied agents within dental materials and the application of nanoparticles in the control of oral infections are

  13. Platelet-rich plasma therapy for knee joint problems: review of the literature, current practice and legal perspectives in Korea.

    PubMed

    Park, Yong-Geun; Han, Seung Beom; Song, Sang Jun; Kim, Tae Jin; Ha, Chul-Won

    2012-06-01

    Platelet-rich plasma (PRP) is a concentrate extract of platelets from autologous blood, and represents a possible treatment option for the stimulation and acceleration of soft-tissue healing and regeneration in orthopedics. Currently, the availability of devices for outpatient preparation and delivery contributes to the increase in the clinical use of PRP therapy in practical setting of orthopedic fields. However, there is still paucity of scientific evidence in the literature to prove efficacy of PRP therapy for the treatment of ligament or tendon problems around the knee joint. Moreover, strong evidence from well-designed clinical trials to support the PRP therapy for osteoarthritis of the knee joint is yet scanty in the literature. Scientific studies need to be performed to assess clinical indications, efficacy, and safety of PRP, and this will require high powered randomized controlled trials. Nonetheless, some hospitals exaggeratedly advertise PRP procedures as the ultimate treatment and a novel technology with abundant scientific evidence for the treatment of knee problems. As a matter of fact, PRP protocols are currently approved only for use in clinical trials and research, and are not allowed for treatment purpose by any institutions in Korea. At present, clinical use of PRP therapy for ligament or tendon problems or osteoarthritis of knee joint is defined as illegal medical practice, regardless of whether it is performed as a sole procedure or as a part of prolotherapy, because the safety and validity are not yet approved by the Ministry of Health and Welfare and Health Insurance Review and Assessment Service. Practicing physicians should remember that injection of PRP to patients by imposing medical charge is still illegal as per the current medical law in Korea. PMID:22708106

  14. "Loss of situation awareness" by medical staff: reflecting on the moral and legal status of a psychological concept.

    PubMed

    Breakey, Hugh; van Winsen, Roel D; Dekker, Sidney W A

    2015-03-01

    This article examines the emergence of "accurate situation awareness (SA)" as a legal and moral standard for judging professional negligence in medicine. It argues that SA constitutes a status, an outcome resulting from the confluence of a wide array of factors, some originating inside and others outside the agent. SA does not connote an action, a practice, a role, a task, a virtue, or a disposition--the familiar objects of moral and legal appraisal. The argument contends that invoking SA becomes problematic when its use broadens to include professional or legally appraisable norms for behaviour, which expect a certain state of awareness from practitioners.

  15. Current status of the CBCT project at Varian Medical Systems

    NASA Astrophysics Data System (ADS)

    Matsinos, Evangelos

    2005-04-01

    Tracking and targeting the tumors are simultaneous processes in the image-guided radiotherapy (IGRT); this is expected to boost the efficiency, the reliability, and the safety in the treatment. Varian Medical Systems (VMS) has already produced and installed the first IGRT machine; the device comprises the VMS Clinac equipped with the On-Board Imager (OBI) component. Cone-beam CT (CBCT) imaging, one of the options of the OBI machine, aims at high-quality volumetric reconstruction. A number of calibrations are needed in order to operate our CT-imaging machines properly; they ensure that the machine components are properly aligned, the mechanical distortions are small, and yield important output that is used in the reconstruction of the actual scan data. The geometrical calibration is achieved by using a needle phantom. In order to increase the dynamic range of our imager (hence, to obtain reliable information simultaneously in the high- and the low-attenuation areas of the irradiated object), VMS has developed a dual-gain mode. Next on our agenda is the suppression of (ring, streak, and beam-hardening) artefacts in our reconstructed images and the further development of our detectors in order to remove patterns relating to lag and ghosting effects.

  16. Institutional and legal arrangements in the Nile river basin: suggestions to improve the current situation toward adaptive integrated water resources management.

    PubMed

    Abdalla, Khalid Mohamed El Hassan

    2008-01-01

    A comparative study was conducted in this work in order to investigate the current situation in the Nile river basin (NRB) regarding the institutional and legal arrangements needed to support the adaptive integrated water resources management (AIWRM) strategy. Two similar river basins were selected to achieve this comparison and to introduce suggestions to reform the current situation in the basin. Before that, the ideal situation is investigated to be as a yardstick for the desired situation. The study indicated that the necessary AIWRM criteria may include regulatory as well as implementation organizations that support shared-vision reaching with its all necessary features (cooperation, stakeholders' participation, subsidiarity, and information and knowledge exchange). Thus the main features of the desired situations regarding AIWRM in river basins are stakeholders' participation, learning-driven ability, quick response to risks and uncertainties, and finally a legal framework that could support these criteria. Although the AIWRM criteria seem to be satisfied in NRB, the basin lacks the necessary regulatory institutions as well as the legal framework. According to this, this study recommends to reform the current situation in NRB by creating regulator institutions (policy and decision making level) as well a legal framework to legitimate them.

  17. Bassoonists' medical problems-current state of knowledge.

    PubMed

    Dawson, William J

    2012-06-01

    Specific musical instruments can be a source of physical problems to their players. Based on reviews of the literature and personal experience, this paper summarizes current knowledge of problems affecting musicians who play instruments in the bassoon family (including the bassoon, contrabassoon, and several other instruments). Prevalence rates are higher in reports of surveys (ranging up to 86%), compared to clinical reports of patients seen and treated. Significant risk factors include young age, small body size, female gender, and use of large instruments. Problems unique to bassoonists are rare; most physical difficulties also are seen in general musculoskeletal clinical practices and in musicians playing all types of instruments. The left upper extremity is more commonly affected by overuse-related conditions in bassoonists. Non-playing-related problems are equally important for consideration (such as degenerative disorders and acute trauma), since they also affect practice and performance. Little experimental data exist to validate current and widely-held principles of treatment, rehabilitation, and prevention.

  18. Ethical and professional conduct of medical students: review of current assessment measures and controversies

    PubMed Central

    Boon, K; Turner, J

    2004-01-01

    As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems. PMID:15082823

  19. Avoiding currently unavoidable conflicts of interest in medical publishing by transparent peer review.

    PubMed

    Gleicher, Norbert

    2013-05-01

    The medical literature frequently addresses potential conflicts of interest, involving scientists and authors. Conflicts involving editorial offices of medical journals, have, however, only rarely been subject to discussion. The biggest opportunity for editorial conflicts presents during peer review. This commentary, therefore, argues in favour of changes in peer review. Improved and more transparent peer review will quite automatically avoid most potential conflicts of interest in medical publishing, including those currently widely considered unavoidable.

  20. [Exploring Current Problems and Corresponding Strategies for Evaluation of Innovative Medical Devices in China].

    PubMed

    Du, Ranran; Ouyang, Zhaolian; Li, Yang; Yang, Yuan; Yang, Guozhong; Chi, Hui

    2015-03-01

    Through the analysis of the current status and problems of innovative medical devices evaluation, tnis paper discussed the strategies of evaluation, and ultimately raises the frame of evaluation, so as to provide reference for scientific evaluation of medical devices in China.

  1. 'It begins with the goose and ends with the goose': medical, legal, and lay understandings of imbecility in Ingram v Wyatt, 1824-1832.

    PubMed

    Jackson, M

    1998-12-01

    A number of historians have recently suggested that we need to get out of the asylum if we are to fully understand attitudes to insanity in the nineteenth century. Arguing that accounts of the medicalization of madness have ignored the importance of non-medical attitudes to lunacy and idiocy, recent studies have stressed the need to explore family attitudes and responses in more detail. Unfortunately, efforts to escape the asylum have to some extent been hampered by a persistent reliance on institutional records. This institutional dependence is understandable: certificates of insanity, reception orders, case-books, and asylum registers, together with published documents, constitute the major record of historical constructions of the lunatic and idiotic mind. However, there may be more resourceful ways of exploring both medical and non-medical attitudes to idiocy. In this paper, I want to use the records from a contested will case, Ingram v Wyatt, to demonstrate that records from the ecclesiastical courts can provide access to a domain where the definitions and meanings of idiocy and imbecility were routinely considered by lawyers, lay witnesses, judges, and doctors. I shall argue that such cases constitute a fruitful site for excavating lay, professional legal, and medical attitudes to imbecility, for exploring the complex relationship between medical and non-medical understandings of capacity, and for situating those understandings within the context of professional developments in law and medicine and contemporary concerns about inheritance.

  2. Current issues result in a paradigm shift in reprocessing medical and surgical instruments.

    PubMed

    Alfa, Michelle J

    2016-05-01

    The objective of this report is to review the available scientific data on reprocessing of medical and surgical instruments and discuss the current issues related to cleaning and disinfection of flexible endoscopes and intracavitary ultrasound probes.

  3. The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform.

    PubMed

    Gupta, Amar; Sao, Deth

    2011-01-01

    The current health care crisis in the United States compels a consideration of the crucial role that telemedicine could play towards deploying a pragmatic solution. The nation faces rising costs and difficulties in access to and quality of medical services. Telemedicine can potentially help to overcome these challenges, as it can provide new cost-effective and efficient methods of delivering health care across geographic distances. The full benefits and future potential of telemedicine, however, are constrained by overlapping, inconsistent, and inadequate legal and regulatory frameworks, as well as the repertoire of standards imposed by state governments and professional organizations. Proponents of these barriers claim that they are necessary to protect public health and safety, and that the U.S. Constitution gives states exclusive authority over health and safety concerns. This Article argues that such barriers not only fail to advance these public policy goals, but are unconstitutional when they restrict the practice of telemedicine across state and national borders. Furthermore, the interstate and international nature of telemedicine calls for increasing the centralized authority of the federal government; this position is consistent with the U.S. Constitution and other governing principles. Finally, this Article observes that the U.S. experience bears some similarities to that of other nations, and represents a microcosm of the international community's need and struggle to develop a uniform telemedicine regime. Just as with state governments in the U.S., nations are no longer able to view health care as a traditional domestic concern and must consider nontraditional options to resolve the dilemmas of rising costs and discontent in the delivery of health care to their people. PMID:22145522

  4. The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform.

    PubMed

    Gupta, Amar; Sao, Deth

    2011-01-01

    The current health care crisis in the United States compels a consideration of the crucial role that telemedicine could play towards deploying a pragmatic solution. The nation faces rising costs and difficulties in access to and quality of medical services. Telemedicine can potentially help to overcome these challenges, as it can provide new cost-effective and efficient methods of delivering health care across geographic distances. The full benefits and future potential of telemedicine, however, are constrained by overlapping, inconsistent, and inadequate legal and regulatory frameworks, as well as the repertoire of standards imposed by state governments and professional organizations. Proponents of these barriers claim that they are necessary to protect public health and safety, and that the U.S. Constitution gives states exclusive authority over health and safety concerns. This Article argues that such barriers not only fail to advance these public policy goals, but are unconstitutional when they restrict the practice of telemedicine across state and national borders. Furthermore, the interstate and international nature of telemedicine calls for increasing the centralized authority of the federal government; this position is consistent with the U.S. Constitution and other governing principles. Finally, this Article observes that the U.S. experience bears some similarities to that of other nations, and represents a microcosm of the international community's need and struggle to develop a uniform telemedicine regime. Just as with state governments in the U.S., nations are no longer able to view health care as a traditional domestic concern and must consider nontraditional options to resolve the dilemmas of rising costs and discontent in the delivery of health care to their people.

  5. Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives

    PubMed Central

    Crooks, Valorie A; Turner, Leigh; Cohen, I Glenn; Bristeir, Janet; Snyder, Jeremy; Casey, Victoria; Whitmore, Rebecca

    2013-01-01

    Objectives Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism. Design We held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically. Participants Seven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated. Results Five dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making. Conclusions Concern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose

  6. [Determining the need for medical rehabilitation services of employed members of the legal pension fund. A recommendation from social medicine and social legal viewpoints].

    PubMed

    Raspe, H; Sulek, C; Héon-Klin, V; Matthis, C; Igl, G

    2001-01-01

    Assessing health care needs in populations has become a major activity of public health medicine worldwide. Its methodology has been developing mainly in the English-speaking world. Concept, methods, and techniques have not yet reached Germany though recently the national expert advisory council for the concerted action in health care (Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen) provided first "official" definitions of demand, supply, and need to identify over- and undersupply in health care. This article aims at defining, from a combined sociolegal and sociomedical perspective, the need for medical rehabilitation measures among insurees of German pension funds. According to section 15 SGB VI rehabilitation is conceived as a medically coordinated multimodal-multidisciplinary intervention with a cognitive-behavioural orientation. To objectify the need for rehabilitation a series of 9 questions was developed enquiring inter alia about the presence of a disease or disability, the extent or "amplification" of the disorder, its course pattern, the implied risk of permanent work disability and likely success of rehabilitation. Nonspecific back pain served as a paradigmatic condition. One of the main problems encountered is the presently small evidence base to arrive at the necessary prognostic and therapeutic judgements. PMID:11272866

  7. Health care professionals’ comprehension of the legal status of end-of-life practices in Quebec

    PubMed Central

    Marcoux, Isabelle; Boivin, Antoine; Arsenault, Claude; Toupin, Mélanie; Youssef, Joseph

    2015-01-01

    Abstract Objective To determine health care professionals’ understanding of the current legal status of different end-of-life practices and their future legal status if medical aid in dying were legalized, and to identify factors associated with misunderstanding surrounding the current legal status. Design Cross-sectional survey using 6 clinical scenarios developed from a validated European questionnaire and from a validated classification of end-of-life practices. Setting Quebec. Participants Health care professionals (physicians and nurses). Main outcome measures Perceptions of the current legal status of the given scenarios and whether or not the practices would be authorized in the event that medical aid in dying were legalized. Results Among the respondents (n = 271, response rate 88.0%), more than 98% knew that the administration or prescription of lethal medication was currently illegal. However, 45.8% wrongly thought that it was not permitted to withdraw a potentially life-prolonging treatment at the patient’s request, and this misconception was more common among nurses and professionals who had received their diplomas longer ago. Only 39.5% believed that, in the event that medical aid in dying were legalized, the use of lethal medication would be permitted at the patient’s request, and 34.6% believed they would be able to give such medication to an incompetent patient upon a relative’s request. Conclusion Health care professionals knew which medical practices were illegal, but some wrongly believed that current permitted practices were not legal. There were various interpretations of what would or would not be allowed if medical aid in dying were legalized. Education on the clinical implications of end-of-life practice legislation should be promoted. PMID:26052600

  8. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    PubMed Central

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. Objective This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended. PMID:26449204

  9. Medically Assisted Procreation and Fast-Moving Developments in Science and Law: Ethical and Legal Issues in Heterologous Procreation in Italy

    PubMed Central

    Delbon, Paola; Conti, Adelaide

    2015-01-01

    Significance for public health Continual scientific progress is making new applications available, with significant medical, ethical, legal and social implications, not only for the persons directly concerned. In the area of medically assisted procreation, the use of heterologous techniques is able to overcome problems of sterility or infertility for those requesting access to methods of this kind. On the other hand, legislation is required to regulate the many correlated issues, also with regard to other parties such as ova or sperm donors and the offspring resulting from the use of these techniques: the protection of the health of the offspring; the management of laboratory results obtained during donor selection tests; the protection of confidentiality; the donor-child traceability; the number of donations; and individuals’ rights to be fully informed about their biological origins are just some of the questions confirming that the implications of new procreation techniques are not restricted merely to the couples who access them. PMID:26425499

  10. [Current status and progress of medical imaging in diagnosis of gastrointestinal stromal tumors].

    PubMed

    Wang, Lingjie; Zhang, Ruiping; Li, Jianding

    2015-04-01

    Gastrointestinal stromal tumors (GISTs) are derived from non-directed differentiation of gastrointestinal mesenchymal tissue, which lack of typical clinical symptoms, and many asymptomatic GISTs are often found on physical examination. The tumor is primarily through implantation metastasis and blood metastasis. Currently, conventional medical imaging methods, such as X-ray barium meal, US, CT, MRI, PET/CT and ES, are still the main means of diagnosis of GISTs. Early diagnosis and early treatment are key factors of the prognosis in GISTs. Therefore, we need to be proficient in various medical imaging methods, then apply them to the diagnosis of GISTs, and to provide comprehensive and valuable information for clinical practice. Through retrieving and consulting literature of medical imaging associated with GISTs, this paper reviews the current status and progress of medical imaging in diagnosis of GISTs.

  11. The current format and ongoing advances of medical education in the United States.

    PubMed

    Gishen, Kriya; Ovadia, Steven; Arzillo, Samantha; Avashia, Yash; Thaller, Seth R

    2014-01-01

    The objective of this study was to examine the current system of medical education along with the advances that are being made to support the demands of a changing health care system. American medical education must reform to anticipate the future needs of a changing health care system. Since the dramatic transformations to medical education that followed the publication of the Flexner report in 1910, medical education in the United States has largely remained unaltered. Today, the education of future physicians is undergoing modifications at all levels: premedical education, medical school, and residency training. Advances are being made with respect to curriculum design and content, standardized testing, and accreditation milestones. Fields such as plastic surgery are taking strides toward improving resident training as the next accreditation system is established. To promote more efficacious medical education, the American Medical Association has provided grants for innovations in education. Likewise, the Accreditation Council for Graduate Medical Education outlined 6 core competencies to standardize the educational goals of residency training. Such efforts are likely to improve the education of future physicians so that they are able to meet the future needs of American health care.

  12. Current integration of dissection in medical education in Australia and New Zealand: Challenges and successes.

    PubMed

    Bouwer, Hope Ellen; Valter, Krisztina; Webb, Alexandra Louise

    2016-01-01

    The reduced use of dissection associated with the introduction of integrated systems problem-based learning curricula, graduate-entry programs and medical school expansion is a frequent topic of discussion and debate in modern medical training. The purpose of this study was to investigate the impact of these changes to the medical education landscape, by looking at the current utilization and integration of dissection in medical schools, in Australia and New Zealand. A survey and an invitation to participate in an interview were distributed to all Australian Medical Council-accredited medical schools. Sixteen schools (76%) responded to the survey and five interviews (24%) were conducted. Dissection was a component of the medical program in 12 of the 16 schools surveyed. The opportunity for medical students to dissect human cadavers was found to be related to whether the medical school was established pre- or post-2000 (P = 0.003) but was not significantly associated to undergraduate- or graduate-entry (P = 0.64), program length (P = 0.59) or the number of commencing students (P = 0.07). The methods used for the delivery and integration of dissection varied between schools. Despite substantial changes to the delivery of anatomy in Australian and New Zealand medical schools, a variety of approaches have been adopted to ensure dissection remains an integral component of medical student education. Based on our findings, a number of recommendations were formulated to encourage the integration of dissection, regardless of the didactics of the program, to enhance the anatomical knowledge of students. PMID:26147336

  13. WHAT ROLE SHOULD PUBLIC OPINION PLAY IN ETHICO-LEGAL DECISION MAKING? THE EXAMPLE OF SELECTING SEX FOR NON-MEDICAL REASONS USING PREIMPLANTATION GENETIC DIAGNOSIS.

    PubMed

    Fovargue, Sara; Bennett, Rebecca

    2016-01-01

    In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice.

  14. Current status of information literacy instruction practices in medical libraries of Pakistan

    PubMed Central

    Ullah, Midrar; Ameen, Kanwal

    2014-01-01

    Objectives: The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan. Methods: A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff. Results: The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used. Conclusion: IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction. Implications: Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum. PMID:25349546

  15. Legal madness in the nineteenth century.

    PubMed

    Bartlett, P

    2001-01-01

    Legal sources remain under-exploited in the history of madness, and the legal character of some documents is sometimes unrecognized. This article examines the inter-relations between legal and medical histories of madness, and discusses use and availability of nineteenth-century legal source material relating to criminal insanity, mental incapacity, and the confinement of the insane.

  16. Legal Preparedness

    PubMed Central

    Courtney, Brooke; Hodge, James G.; Toner, Eric S.; Roxland, Beth E.; Penn, Matthew S.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Christian, Michael D.; Powell, Tia

    2015-01-01

    contribute to protecting hospitals and practitioners who act in good faith from liability. Finally, to address anticipated staffing shortages during severe and prolonged disasters and pandemics, governments should develop approaches to formally expand the availability of qualified health-care workers, such as through using official foreign medical teams. CONCLUSIONS As a fundamental element of health-care and public health emergency planning and preparedness, the law underlies critical aspects of disaster and pandemic responses. Effective responses require comprehensive advance planning efforts that include assessments of complex legal issues and authorities. Recent disasters have shown that although law is a critical response tool, it can also be used to hold health-care stakeholders who fail to appropriately plan for or respond to disasters and pandemics accountable for resulting patient or staff harm. Claims of liability from harms allegedly suffered during disasters and pandemics cannot be avoided altogether. However, appropriate planning and legal protections can help facilitate sound, consistent decision-making and support response participation among health-care entities and practitioners. PMID:25144203

  17. Brief Review of Current Research in FXS: Implications for Treatment with Psychotropic Medication

    ERIC Educational Resources Information Center

    Valdovinos, Maria G.

    2007-01-01

    The purpose of this paper is to provide a brief review of current research in fragile X syndrome (FXS) with regards to the morphology and behavioral phenotype associated with FXS and the use of psychotropic medication for the treatment of behavior problems (e.g., aggression) often seen in FXS (full mutation). The lack of production of the fragile…

  18. Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment.

    PubMed

    Alempijevic, D; Beriashvili, R; Beynon, J; Duque, M; Duterte, P; Fernando, R; Fincanci, S; Hansen, S; Hardi, L; Hougen, H; Iacopino, V; Mendonça, M; Modvig, J; Mendez, M; Özkalipci, Ö; Payne-James, J; Peel, M; Rasmussen, O; Reyes, H; Rogde, S; Sajantila, A; Treue, F; Vanezis, P; Vieira, D

    2013-04-01

    In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given. PMID:23472795

  19. Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment.

    PubMed

    Alempijevic, D; Beriashvili, R; Beynon, J; Duque, M; Duterte, P; Fernando, R; Fincanci, S; Hansen, S; Hardi, L; Hougen, H; Iacopino, V; Mendonça, M; Modvig, J; Mendez, M; Özkalipci, Ö; Payne-James, J; Peel, M; Rasmussen, O; Reyes, H; Rogde, S; Sajantila, A; Treue, F; Vanezis, P; Vieira, D

    2013-04-01

    In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.

  20. Analysis - what is legal medicine?

    PubMed

    Beran, Roy G

    2008-04-01

    Legal medicine addresses the interface between medicine and law in health care. The Australian College of Legal Medicine (ACLM) established itself as the peak body in legal and forensic medicine in Australia. It helped establish the Expert Witness Institute of Australia (EWIA), the legal medicine programme at Griffith University and contributes to government enquiries. Public health, disability assessment, competing priorities of privacy verses notification and determination of fitness for a host of pursuits are aspects of legal medicine. Complementing the EWIA, the ACLM runs training programmes emphasising legal medicine skills additional to clinical practice, advocating clinical relevance. Assessment of athletes' fitness and ensuring that prohibited substances are not inadvertently prescribed represent a growing area of legal medicine. Ethical consideration of health care should respect legal medicine principles rather than armchair commentary. International conventions must be respected by legal medicine and dictate physicians' obligations. The NSW courts imposed a duty to provide emergency medical care. Migration and communicable diseases are aspects of legal medicine. Police surgeons provide a face to legal medicine (which incorporates forensic medicine) underpinning its public perception of specialty recognition. Legal medicine deserves its place as a medical specialty in its own right.

  1. Analysis - what is legal medicine?

    PubMed

    Beran, Roy G

    2008-04-01

    Legal medicine addresses the interface between medicine and law in health care. The Australian College of Legal Medicine (ACLM) established itself as the peak body in legal and forensic medicine in Australia. It helped establish the Expert Witness Institute of Australia (EWIA), the legal medicine programme at Griffith University and contributes to government enquiries. Public health, disability assessment, competing priorities of privacy verses notification and determination of fitness for a host of pursuits are aspects of legal medicine. Complementing the EWIA, the ACLM runs training programmes emphasising legal medicine skills additional to clinical practice, advocating clinical relevance. Assessment of athletes' fitness and ensuring that prohibited substances are not inadvertently prescribed represent a growing area of legal medicine. Ethical consideration of health care should respect legal medicine principles rather than armchair commentary. International conventions must be respected by legal medicine and dictate physicians' obligations. The NSW courts imposed a duty to provide emergency medical care. Migration and communicable diseases are aspects of legal medicine. Police surgeons provide a face to legal medicine (which incorporates forensic medicine) underpinning its public perception of specialty recognition. Legal medicine deserves its place as a medical specialty in its own right. PMID:18313010

  2. [Postmortem dismemberment/mutilation--medicolegal and criminalistic evaluation of the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School].

    PubMed

    Schulz, Yvonne; Mossakowski, Harald; Albrecht, Knut; Breitmeier, Dirk

    2008-01-01

    Among all the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School between 1978 and 1998. 16 cases of postmortem dismemberment/mutilation were evaluable under criminalistic and medicolegal aspects. In the present study, particular attention was paid to the psychosocial circumstances of the perpetrator's and victim's lives and also to the classification of the different types of postmortem dismemberment/mutilation illustrated by case reports. Apart from an unfavourable personal life situation at the time of the offence, essential predisposing factors were: poor integration in society and family, occupational problems, drug abuse and mental diseases. As the interactions between these factors differ in every single case and may be combined with other factors, the analysis of such homicides should always be based on the assessment of the individual case.

  3. Current and emerging medications for overweight or obesity in people with comorbidities.

    PubMed

    Fujioka, K

    2015-11-01

    Recently, the recognition of obesity as a complex disease that requires chronic management has become more widespread. There has also been a movement away from a focus on body mass index alone, and toward the management of obesity-related comorbidities as well as excess weight. This article examines the current and emerging pharmacological options for weight management in people with overweight or obesity who have, or are at a high risk of, weight-related comorbidities. In the USA, the current options for pharmacological weight management are phentermine (indicated for short-term use only), orlistat, combined phentermine/topiramate extended release, lorcaserin, naltrexone/bupropion and liraglutide 3.0 mg. Currently, orlistat, naltrexone/bupropion and liraglutide 3.0 mg are approved in Europe. All of the above-mentioned medications have shown weight-loss efficacy versus placebo. Those approved for long-term weight management have also been associated with improvements in weight-related comorbidities, such as hypertension, prediabetes, diabetes or dyslipidaemia, or related biomarkers. As with all drugs, the safety and tolerability profiles of medications for weight management should be considered alongside their efficacy to ensure correct use. Additional medications for weight management that are in clinical development include bupropion/zonisamide and beloranib. The field of obesity treatment is advancing with a number of medications being recently approved, and with other pharmacological options emerging. PMID:26040215

  4. Low current performance of the Bern medical cyclotron down to the pA range

    NASA Astrophysics Data System (ADS)

    Auger, M.; Braccini, S.; Ereditato, A.; Nesteruk, K. P.; Scampoli, P.

    2015-09-01

    A medical cyclotron accelerating H- ions to 18 MeV is in operation at the Bern University Hospital (Inselspital). It is the commercial IBA 18/18 cyclotron equipped with a specifically conceived 6 m long external beam line ending in a separate bunker. This feature is unique for a hospital-based facility and makes it possible to conduct routine radioisotope production for PET diagnostics in parallel with multidisciplinary research activities, among which are novel particle detectors, radiation biophysics, radioprotection, radiochemistry and radiopharmacy developments. Several of these activities, such as radiobiology experiments for example, require low current beams down to the pA range, while medical cyclotrons are designed for high current operation above 10 μA. In this paper, we present the first results on the low current performance of a PET medical cyclotron obtained by ion source, radio-frequency and main coil tuning. With this method, stable beam currents down to (1.5+/- 0.5 ) pA were obtained and measured with a high-sensitivity Faraday cup located at the end of the beam transport line.

  5. Implantable and ingestible medical devices with wireless telemetry functionalities: a review of current status and challenges.

    PubMed

    Kiourti, Asimina; Psathas, Konstantinos A; Nikita, Konstantina S

    2014-01-01

    Wireless medical telemetry permits the measurement of physiological signals at a distance through wireless technologies. One of the latest applications is in the field of implantable and ingestible medical devices (IIMDs) with integrated antennas for wireless radiofrequency (RF) communication (telemetry) with exterior monitoring/control equipment. Implantable medical devices (MDs) perform an expanding variety of diagnostic and therapeutic functions, while ingestible MDs receive significant attention in gastrointestinal endoscopy. Design of such wireless IIMD telemetry systems is highly intriguing and deals with issues related to: operation frequency selection, electronics and powering, antenna design and performance, and modeling of the wireless channel. In this paper, we attempt to comparatively review the current status and challenges of IIMDs with wireless telemetry functionalities. Full solutions of commercial IIMDs are also recorded. The objective is to provide a comprehensive reference for scientists and developers in the field, while indicating directions for future research.

  6. [Current status on storage, processing and risk communication of medical radioactive waste in Japan].

    PubMed

    Watanabe, Hiroshi; Yamaguchi, Ichiro; Kida, Tetsuo; Hiraki, Hitoshi; Fujibuchi, Toshioh; Maehara, Yoshiaki; Tsukamoto, Atsuko; Koizumi, Mitsue; Kimura, Yumi; Horitsugi, Genki

    2013-03-01

    Decay-in-storage for radioactive waste including that of nuclear medicine has not been implemented in Japan. Therefore, all medical radioactive waste is collected and stored at the Japan Radioisotope Association Takizawa laboratory, even if the radioactivity has already decayed out. To clarify the current situation between Takizawa village and Takizawa laboratory, we investigated the radiation management status and risk communication activities at the laboratory via a questionnaire and site visiting survey in June 2010. Takizawa laboratory continues to maintain an interactive relationship with local residents. As a result, Takizawa village permitted the acceptance of new medical radioactive waste containing Sr-89 and Y-90. However, the village did not accept any non-medical radioactive waste such as waste from research laboratories. To implement decay-in-storage in Japan, it is important to obtain agreement with all stakeholders. We must continue to exert sincere efforts to acquire the trust of all stakeholders.

  7. [Current status on storage, processing and risk communication of medical radioactive waste in Japan].

    PubMed

    Watanabe, Hiroshi; Yamaguchi, Ichiro; Kida, Tetsuo; Hiraki, Hitoshi; Fujibuchi, Toshioh; Maehara, Yoshiaki; Tsukamoto, Atsuko; Koizumi, Mitsue; Kimura, Yumi; Horitsugi, Genki

    2013-03-01

    Decay-in-storage for radioactive waste including that of nuclear medicine has not been implemented in Japan. Therefore, all medical radioactive waste is collected and stored at the Japan Radioisotope Association Takizawa laboratory, even if the radioactivity has already decayed out. To clarify the current situation between Takizawa village and Takizawa laboratory, we investigated the radiation management status and risk communication activities at the laboratory via a questionnaire and site visiting survey in June 2010. Takizawa laboratory continues to maintain an interactive relationship with local residents. As a result, Takizawa village permitted the acceptance of new medical radioactive waste containing Sr-89 and Y-90. However, the village did not accept any non-medical radioactive waste such as waste from research laboratories. To implement decay-in-storage in Japan, it is important to obtain agreement with all stakeholders. We must continue to exert sincere efforts to acquire the trust of all stakeholders. PMID:23514856

  8. Panel--Overcoming exclusion: current research and legal issues in Canadian immigration policy for people living with HIV.

    PubMed

    Bisaillon, Laura M

    2010-10-01

    This article provides summaries of presentations made during the panel. Laura Bisaillon presents findings on the activities, actions and practices newcomers undertake as a result of being tested positive for HIV during Canadian immigration medical screening. Michael Battista discusses how to challenge the "excessive demand" barrier for HIV-positive newcomers through case law and advocacy.

  9. Improving medical students’ knowledge of genetic disease: a review of current and emerging pedagogical practices

    PubMed Central

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

  10. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

    PubMed

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

  11. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

    PubMed

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics.

  12. Nanomaterials and synergistic low intensity direct current (LIDC) stimulation technology for orthopaedic implantable medical devices

    PubMed Central

    Samberg, Meghan E.; Cohen, Paul H.; Wysk, Richard A.; Monteiro-Riviere, Nancy A.

    2012-01-01

    Nanomaterials play a significant role in biomedical research and applications due to their unique biological, mechanical, and electrical properties. In recent years, they have been utilised to improve the functionality and reliability of a wide range of implantable medical devices ranging from well-established orthopaedic residual hardware devices (e.g. hip implants) that can repair defects in skeletal systems to emerging tissue engineering scaffolds that can repair or replace organ functions. This review summarizes the applications and efficacies of these nanomaterials that include synthetic or naturally occurring metals, polymers, ceramics, and composites in orthopaedic implants, the largest market segment of implantable medical devices. The importance of synergistic engineering techniques that can augment or enhance the performance of nanomaterial applications in orthopaedic implants is also discussed,, the focus being on a low intensity direct electric current (LIDC) stimulation technology to promote the long-term antibacterial efficacy of oligodynamic metal-based surfaces by ionization, while potentially accelerating tissue growth and osseointegration. While many nanomaterials have clearly demonstrated their ability to provide more effective implantable medical surfaces, further decisive investigations are necessary before they can translate into medically safe and commercially viable clinical applications. The paper concludes with a discussion about some of the critical impending issues with the application of nanomaterials-based technologies in implantable medical devices, and potential directions to address these. PMID:23335493

  13. An Examination to Determine the English Competencies Required of Secretaries in the Administrative, Legal and Medical Areas with a Synthesis into a Core of Common Competencies to be Used in Forming a Basis for an English Curriculum. Final Report.

    ERIC Educational Resources Information Center

    Radloff, David Maurice

    The central problem of the study was to determine the English competencies required of secretaries in the Medical, Legal and Administrative Secretarial Areas. The questionnaire/interview method was employed, utilizing 50 questionnaires and ten interviews in each of the three secretarial areas, and distributing them to imployers and employees…

  14. STUDIES ON SEXTUPOLE COMPONENTS GENERATED BY EDDY CURRENTS IN THE RAPID CYCLING MEDICAL SYNCHROTRON.

    SciTech Connect

    CARDONA,J.ABELL,D.T.PEGGS,S.

    2003-05-12

    The Rapid Cycling Medical Synchrotron is a second generation medical accelerator that it has been designed with a repetition frequency of 30 Hz. This repetition frequency is far above the typical repetition frequency used in medical accelerators. An elliptical beam pipe has been chosen for the RCMS design in order to win as much physical aperture as possible while keeping the magnet dimensions as small as possible. Rapid Cycling induces Eddy current in the magnets. Eddy currents and elliptical beam pipes generate sextupole components that might be necessary to consider. In this paper, the effects of these sextupoles components are evaluated, first by looking at the phase space of a bunch of particles that has been tracked for 62530 turns, and also by evaluating the dynamical aperture of the accelerator. The effect of the sextupoles component in the tuneshift is also evaluated. First results obtained with Marylie show that the width of a phase space ellipse of a bunch of particles is slightly affected by the sextupoles due to the Eddy currents.

  15. Avoiding the Legal “Blemish”

    PubMed Central

    Michaels, Brent D.; Momin, Saira B.

    2009-01-01

    In today’s legal environment, it is unlikely that a physician will complete a medical career without being introduced to the legal system in some way. Despite this, medical education often does not incorporate a basic teaching of general legal principles, and many physicians are left unaware of some of the important legal aspects of practicing medicine. The purpose of this article is to provide a background of the essential legal principles of a malpractice action as well as review the fundamentals of the legal process, provide published caselaw of prior dermatological pitfalls, and ultimately, provide suggestions to better prepare the dermatologist to practice medicine. PMID:20725583

  16. [Current pattern of anthracosilicosis, its complications and correlation with other diseases (evaluation of 300 legal autopsies 1977-1988)].

    PubMed

    Hartung, W; Moon, J S

    1992-10-01

    The spectrum of silicosis of coal miners has changed during the past decades. The life expectancy of the miners suffering from silicosis has been successfully adapted to that of the non-miners as a result of a consistent therapy. Morphologically, the processes involving large callosities have receded markedly; in their place, there has been an increased incidence of generalised focal dust emphysema that are difficult to differentiate clinically from the common chronic obstructive pulmonary diseases. Chronic bronchitis and emphysema are the most important concomitant pulmonary diseases; the incidence of tuberculosis is still enhanced and carcinomas of the lung are only rarely to be acknowledged as so-called carcinomas in scar tissue. Other major diseases that coincide with silicosis are seen in p.m. statistics with customary frequency of incidence (cardiovascular diseases almost 50%, malignant tumours including those of the lung about 25%, other major diseases without respiratory organs about 10%). The main problem in expertising is to differentiate the influence of these diseases from those of silicosis; expertising must employ the legally prescribed terminology. In our own investigations based on 300 postmortem expertises, death as a result of a professionally acquired disease was acknowledged in 48% of all cases of silicosis of severity grades I to III, silicosis being the sole major disease in only half of the cases and in the other cases an essential partial contributor to the cause of death. The significance of the extended generalised dust emphysema as a special type of pneumoconioses that must be classified as grave, is emphasised in contrast to previously compiled statistics.

  17. The value of postmortem experience in undergraduate medical education: current perspectives

    PubMed Central

    Bamber, Andrew R; Quince, Thelma A

    2015-01-01

    The autopsy has traditionally been used as a tool in undergraduate medical education, but recent decades have seen a sharp decline in their use for teaching. This study reviewed the current status of the autopsy as a teaching tool by means of systematic review of the medical literature, and a questionnaire study involving UK medical schools. Teachers and students are in agreement that autopsy-based teaching has many potential benefits, including a deeper knowledge of basic clinical sciences, medical fallibility, end of life issues, audit and the “hidden curriculum”. The reasons underlying the decline in teaching are complex, but include the decreasing autopsy rate, increasing demands on teachers’ time, and confusion regarding the law in some jurisdictions. Maximal use of autopsies for teaching may be achieved by involvement of anatomical pathology technologists and trainee pathologists in teaching, the development of alternative teaching methods using the principles of the autopsy, and clarification of the law. Students gain most benefit from repeated attendance at autopsies, being taught by enthusiastic teachers, when they have been effectively prepared for the esthetic of dissection and the mortuary environment. PMID:25792862

  18. Toward a more materialistic medicine: the value of authentic materialism within current and future medical practice.

    PubMed

    Leder, Drew; Krucoff, Mitchell W

    2011-09-01

    Modern medicine is often accused by diverse critics of being "too materialistic" and therefore insufficiently holistic and effective. Yet, this critique can be misleading, dependent upon the ambiguous meanings of "materialism." The term can refer to the prevalence of financial concerns in driving medical practice. Alternatively, it can refer to "mechanistic materialism," the patient viewed as a body-machine. In each case, this article shows that this represents not authentic "materialism" at play, but a focus upon high-level abstractions. "Bottom-line" financial or diagnostic numbers can distract practitioners from the embodied needs of sick patients. In this sense, medical practice is not materialist enough. Through a series of clinical examples, this article explores how an authentic materialism would look in current and future practice. The article examines the use of prayer/comfort shawls at the bedside; hospitals and nursing homes redesigned as enriched healing environments; and a paradigmatic medical device--the implantable cardioverter defibrillator--as it might be presented to patients, in contrast to current practice.

  19. The Role of Social Networks, Medical-Legal Climate, and Patient Advocacy on Surgical Options: A New Era.

    PubMed

    Tracy, Erin E; Bortoletto, Pietro

    2016-04-01

    The dissemination of information online and resultant public discourse through social media and other online channels has influenced the practice of medicine in dramatic ways. Physicians have historically worked to develop new techniques and devices for the benefit of their patients. It is only a more recent phenomenon, however, that these tools are either removed or their use is curtailed largely driven by anecdotal reports; passionate, vocal, often media-savvy advocates; and plaintiff attorneys. The use of power morcellation, hysteroscopic tubal sterilization, and mesh in urogynecologic procedures all have been victims of these societal pressures. It is important for health care professionals to be involved in the debate to ensure that public outcry does not unduly influence what we, as clinicians, are able to safely offer our patients. By being better advocates for our field, our instruments, and our patients, we can ensure medical decision-making is driven by good science and not public fervor. PMID:26959205

  20. The Role of Social Networks, Medical-Legal Climate, and Patient Advocacy on Surgical Options: A New Era.

    PubMed

    Tracy, Erin E; Bortoletto, Pietro

    2016-04-01

    The dissemination of information online and resultant public discourse through social media and other online channels has influenced the practice of medicine in dramatic ways. Physicians have historically worked to develop new techniques and devices for the benefit of their patients. It is only a more recent phenomenon, however, that these tools are either removed or their use is curtailed largely driven by anecdotal reports; passionate, vocal, often media-savvy advocates; and plaintiff attorneys. The use of power morcellation, hysteroscopic tubal sterilization, and mesh in urogynecologic procedures all have been victims of these societal pressures. It is important for health care professionals to be involved in the debate to ensure that public outcry does not unduly influence what we, as clinicians, are able to safely offer our patients. By being better advocates for our field, our instruments, and our patients, we can ensure medical decision-making is driven by good science and not public fervor.

  1. The current status of education and career paths of students after completion of medical physicist programs in Japan: a survey by the Japanese Board for Medical Physicist Qualification.

    PubMed

    Kadoya, Noriyuki; Karasawa, Kumiko; Sumida, Iori; Arimura, Hidetaka; Yamada, Syogo

    2015-07-01

    To standardize educational programs and clinical training for medical physics students, the Japanese Board for Medical Physicist Qualification (JBMP) began to accredit master's, doctorate, and residency programs for medical physicists in 2012. At present, 16 universities accredited by the JBMP offer 22 courses. In this study, we aimed to survey the current status of educational programs and career paths of students after completion of the medical physicist program in Japan. A questionnaire was sent in August 2014 to 32 universities offering medical physicist programs. The questionnaire was created and organized by the educational course certification committee of the JBMP and comprised two sections: the first collected information about the university attended, and the second collected information about characteristics and career paths of students after completion of medical physicist programs from 2008 to 2014. Thirty universities (16 accredited and 14 non-accredited) completed the survey (response rate 94 %). A total of 209, 40, and 3 students graduated from the master's, doctorate, and residency programs, respectively. Undergraduates entered the medical physicist program constantly, indicating an interest in medical physics among undergraduates. A large percentage of the students held a bachelor's degree in radiological technology (master's program 94 %; doctorate program 70 %); graduates obtained a national radiological technologist license. Regarding career paths, although the number of the graduates who work as medical physicist remains low, 7 % with a master's degree and 50 % with a doctorate degree worked as medical physicists. Our results could be helpful for improving the medical physicist program in Japan.

  2. Quality management of eLearning for medical education: current situation and outlook

    PubMed Central

    Abrusch, Jasmin; Marienhagen, Jörg; Böckers, Anja; Gerhardt-Szép, Susanne

    2015-01-01

    Introduction: In 2008, the German Council of Science had advised universities to establish a quality management system (QMS) that conforms to international standards. The system was to be implemented within 5 years, i.e., until 2014 at the latest. The aim of the present study was to determine whether a QMS suitable for electronic learning (eLearning) domain of medical education to be used across Germany has meanwhile been identified. Methods: We approached all medical universities in Germany (n=35), using an anonymous questionnaire (8 domains, 50 items). Results: Our results (response rate 46.3%) indicated very reluctant application of QMS in eLearning and a major information deficit at the various institutions. Conclusions: Authors conclude that under the limitations of this study there seems to be a considerable need to improve the current knowledge on QMS for eLearning, and that clear guidelines and standards for their implementation should be further defined. PMID:26038685

  3. [Current approaches for early detection and treatment of medication-related osteonecrosis of jaw].

    PubMed

    Janovszky, Ágnes; Vereb, Tamás; Szabó, Andrea; Piffkó, József

    2014-12-01

    Owing to the increased life expectancy, the incidence of rheumatoid disorders and oncologic cases with bone metastasis has dramatically increased. Despite the beneficial effects of the applied antiresorptive and antiangiogenic drugs (e.g. bisphosphonates), serious side effects such as jaw osteonecrosis may also develop. The aim of the authors was to summarize present knowledge about the possibilities of prevention and treatment in medication-related osteonecrosis of the jaw. Based on literature data, currently used detection methods for medication-related osteonecrosis of the jaw (including their advantages and limitations) are summarized. In addition, novel trends of surgical and adjuvant therapeutic approaches are also reviewed. The authors conclude that possibilities of prevention and efficacy of therapeutic interventions in this disorder are still limited possibly due to an incomplete knowledge of the underlying pathomechanism. An interdisciplinary cooperation for prevention and attentive monitoring in order to decrease the incidence of iatrogenic oral and maxillofacial complications seems to be particularly important.

  4. Whatever happened to the Norwegian Medical Need Clause? Lessons for current debates in EU pharmaceutical regulation.

    PubMed

    Brooks, Eleanor; Geyer, Robert

    2016-05-01

    Until 1994, pharmaceutical products seeking market authorisation in Norway were required to demonstrate a fulfilment of unmet medical need. This clause enabled the national regulator to dramatically limit the number of products on the market whilst encouraging price competition to keep drug expenditure low and was credited with encouraging the development of drugs with genuine added therapeutic value and reducing the incidence of antimicrobial resistance. Norway was forced to abandon its Medical Need Clause (MNC) when it joined the European Economic Area as it was incompatible with the acquis communautaire of the European Union. This article reviews Norway's experience with its MNC in light of contemporary debates in European health policy. It discusses the potential contribution of an MNC-style regulation to improving health, reducing illness, ensuring sustainable health systems and fostering pharmaceutical innovation. It concludes by asking how these findings can inform current European Union debates over the growing cost of prescription drugs and direction of pharmaceutical development. PMID:26564268

  5. [Teenage pregnancies, legal aspects].

    PubMed

    Rogue, Fanny

    2016-01-01

    Minor girls are legally considered as incapable, under the authority of their parents. Difficulties can arise when a minor becomes pregnant. The law takes account of this situation: under certain conditions, she can decide by herself to undertake certain actions, medical or otherwise, without the consent of her parents. These include access to contraception, abortion or anonymous birth.

  6. [Teenage pregnancies, legal aspects].

    PubMed

    Rogue, Fanny

    2016-01-01

    Minor girls are legally considered as incapable, under the authority of their parents. Difficulties can arise when a minor becomes pregnant. The law takes account of this situation: under certain conditions, she can decide by herself to undertake certain actions, medical or otherwise, without the consent of her parents. These include access to contraception, abortion or anonymous birth. PMID:27444530

  7. Euthanasia: Some Legal Considerations

    ERIC Educational Resources Information Center

    Koza, Pamela

    1976-01-01

    Several sections of the Criminal Code of Canada which are relevant to the issue of euthanasia are discussed. In addition, the value placed on the sanctity of life by the law, the failure to recognize motive in cases of euthanasia, and disparate legal and medical definitions of death are also considered. (Author)

  8. An Interdisciplinary Seminar on Legal Issues in Medicine.

    ERIC Educational Resources Information Center

    Moore, Dale L.

    1989-01-01

    A seminar on legal issues in medicine brings together medical (obstetrics/gynecology) and law students to promote mutual understanding of the legal and medical realms, their effects on each other, and the potential for cooperation. (MSE)

  9. Current status and future perspectives on the medical treatment of neurocysticercosis

    PubMed Central

    Gonzales, Isidro; Garcia, Hector H

    2012-01-01

    Neurological disease resulting from neurocysticercosis (NCC) is common in most of the world. The variability in the biology of the infection and in its clinical manifestations has led to much confusion regarding appropriate management. Therapeutic options have evolved from surgery, symptomatic measures, and steroids, to include the use of anti-parasitic drugs and minimally invasive neurosurgery. This manuscript reviews the principles of medical therapy for NCC, from discussion of the need for individualized management approaches for each type of NCC to exploration of the most likely potential additions or modifications currently under study. PMID:23265555

  10. Assessing the public health impacts of legalizing recreational cannabis use in the USA.

    PubMed

    Hall, W; Weier, M

    2015-06-01

    A major challenge in assessing the public health impact of legalizing cannabis use in Colorado and Washington State is the absence of any experience with legal cannabis markets. The Netherlands created a de facto legalized cannabis market for recreational use, but policy analysts disagree about how it has affected rates of cannabis use. Some US states have created de facto legal supply of cannabis for medical use. So far this policy does not appear to have increased cannabis use or cannabis-related harm. Given experience with more liberal alcohol policies, the legalization of recreational cannabis use is likely to increase use among current users. It is also likely that legalization will increase the number of new users among young adults but it remains uncertain how many may be recruited, within what time frame, among which groups within the population, and how many of these new users will become regular users.

  11. An overview of veterinary medical education in China: current status, deficiencies, and strategy for improvement.

    PubMed

    Yin, Jie-chao; Li, Guang-xing; Ren, Xiao-feng

    2006-01-01

    Especially in developing countries, the profession of veterinary medicine is closely tied with agriculture and government economic development, the national structure of education, and national public health. Currently, the Chinese veterinary medical educational system and accreditation standards are distinctly different from those of some more developed countries, such as the United States, Japan, or the countries of the European Union. Chinese veterinary education is still closely based on traditional Chinese education approaches and standards, which has led to some deficiencies in the Chinese system. With the development of a stronger economy in China and the growing trend toward globalization, and particularly since China joined the World Trade Organization (WTO), some important questions about China's system of veterinary education are being raised: How can veterinary science develop more rapidly in China? How can it meet the needs of the growing Chinese society? How can China bring its veterinary medical practice more in line with that of other, more advanced countries? This article describes some of the realities of veterinary medical education in China, discusses several existing problems, and puts forward some ideas for possible reforms. It is hoped that by this means those outside China may gain insight into our veterinary education program and that this, in turn, will lead to helpful input from international educators and other professionals to help improve our programs.

  12. The U.S. Forest Service's analysis of cumulative effects to wildlife: A study of legal standards, current practice, and ongoing challenges on a National Forest

    SciTech Connect

    Schultz, Courtney A.

    2012-01-15

    Cumulative effects analysis (CEA) allows natural resource managers to understand the status of resources in historical context, learn from past management actions, and adapt future activities accordingly. U.S. federal agencies are required to complete CEA as part of environmental impact assessment under the National Environmental Policy Act (NEPA). Past research on CEA as part of NEPA has identified significant deficiencies in CEA practice, suggested methodologies for handling difficult aspects of CEA, and analyzed the rise in litigation over CEA in U.S. courts. This article provides a review of the literature and legal standards related to CEA as it is done under NEPA and then examines current practice on a U.S. National Forest, utilizing qualitative methods in order to provide a detailed understanding of current approaches to CEA. Research objectives were to understand current practice, investigate ongoing challenges, and identify impediments to improvement. Methods included a systematic review of a set of NEPA documents and semi-structured interviews with practitioners, scientists, and members of the public. Findings indicate that the primary challenges associated with CEA include: issues of both geographic and temporal scale of analysis, confusion over the purpose of the requirement, the lack of monitoring data, and problems coordinating and disseminating data. Improved monitoring strategies and programmatic analyses could support improved CEA practice.

  13. Current medication choices in juvenile rheumatoid arthritis II--update of a survey performed in 1993.

    PubMed

    Brunner, H I; Kim, K N; Ballinger, S H; Bowyer, S L; Griffin, T A; Higgins, G C; Mier, R; Passo, M H; Rennebohm, R; Schikler, K; Lovell, D J

    2001-10-01

    The documentation of treatments used for Juvenile Rheumatoid Arthritis (JRA) is important to allow for the evaluation of practice patterns for future outcome studies. A survey of nine pediatric rheumatologists was performed between September 1999 and February 2000. Each of the physicians prospectively recorded demographic and treatment information on consecutively sampled JRA patients (n=395). Pauciarticular onset JRA was present in 46%, polyarticular onset JRA in 35%, and systemic onset JRA in 19% of the children. Naproxen was the most frequently prescribed medication (55% of the patients), followed by methotrexate (MTX), which was used in 39% of the patients. Folic acid supplementation (1 mg/day) was provided to 69% of the patients treated with MTX. Etanercept was used in 11% of the children. Eleven percent of the patients received corticosteroids, and 13% of children on corticosteroids took calcium supplements. Uveitis was present in 8% and had a chronic course in 79% of those cases. Although systemic medications were used in 50% of the children with uveitis to control eye inflammation, severe damage to the eyes developed in 30% of them. Fourteen percent of the patients required gastroprotective medications. Compared with findings of a similar survey performed in 1993, there was no significant change in the frequency of use of naproxen, but nabumetone is now more often prescribed, and COX-2 inhibitors have been introduced in the therapy of JRA. Changes among second-line agents used for JRA have also occurred, although there was no change in the frequency of use of MTX or corticosteroids. JRA continues to be a treatment challenge for the practicing pediatric rheumatologist. Patients often show incomplete response to the currently available medications. Therefore, new therapeutic agents need to be evaluated for their use in JRA, and the treatment of JRA associated uveitis especially needs to be improved.

  14. Preparing Medical Graduates for an Interconnected World: Current Practices and Future Possibilities for Internationalizing the Medical Curriculum in Different Contexts

    ERIC Educational Resources Information Center

    Stütz, Alexander; Green, Wendy; McAllister, Lindy; Eley, Diann

    2015-01-01

    Preparing medical graduates who are competent to work in a global environment requires broad integration of international and intercultural perspectives throughout the medical curriculum. Employing Leask and Bridge's "conceptual framework of internationalisation of the curriculum," this article first highlights the emphasis placed…

  15. Current medical research with the application of coupled techniques with mass spectrometry

    PubMed Central

    Kałużna-Czaplińska, Joanna

    2011-01-01

    Summary The most effective methods of analysis of organic compounds in biological fluids are coupled chromatographic techniques. Capillary gas chromatography/mass spectrometry (GC-MS) allows the most efficient separation, identification and quantification of volatile metabolites in biological fluids. Liquid chromatography-mass spectrometry (LC-MS) is especially suitable for the analysis of non-volatile and/or thermally unstable compounds. A major drawback of liquid chromatography-mass spectrometry is that no standard spectral libraries such as NIST and Wiley for GC-MS are available to facilitate the identification of unknown compounds. Moreover, the identification of potential new compounds, especially new biomarkers in LC-MS, is much more challenging than in GC-MS. Capillary electrophoresis coupled with mass spectrometry (CE-MS) has been widely used to characterize metabolomes. Capillary electrophoresis is a powerful technique for the separation of charged metabolites, offering high analyte resolution. The advantages of CE-MS are applicability for hydrophilic metabolites, robust separation efficiency and short duration of analysis. This review provides an overview of current chromatographic methods – gas chromatography – mass spectrometry, liquid chromatography – mass spectrometry and capillary electrophoresis-mass spectrometry – and their applications in current medical research. The focus is on the description of metabonomics research, strategies for biomarkers identification, medical diagnoses of diseases and research of drugs. PMID:21525822

  16. Impact of current video game playing on robotic simulation skills among medical students

    PubMed Central

    Öge, Tufan; Borahay, Mostafa A.; Achjian, Tamar; Kılıç, Sami Gökhan

    2015-01-01

    Objective To evaluate the impact of current and prior video game playing on initial robotic simulation skill acquisition. Material and Methods This cross-sectional descriptive study (Canadian Task Force Classification II-1) was conducted at a medical university training center. The study subjects were medical students who currently played video games (Group I) and those who had not played video games in the last 2 years (Group II). The robotic skills of both groups were assessed using simulation. Results Twenty-two students enrolled in this study; however, only 21 completed it. The median age of the participants was 23 (22–24) years and 24 (23–26) years in Groups I and II, respectively. Among the participants, 15 (71.4%) were male and 6 (28.5%) were female, and 90.4% of the students started playing video games in primary school. When the 2 groups were compared according to the completion time of each exercise, Group I finished more quickly than Group II in the Peg Board-1 exercise (p>0.05), whereas Group II had better results in 3 exercises including Pick and Place, Ring and Rail, and Thread the Rings-1. However, none of the differences were found to be statistically significant (p>.05), and according to the overall scores based on the time to complete exercises, economy of motion, instrument collision, use of excessive instrument force, instruments out of view, and master workspace range, the scores were not statistically different between Groups I and II (p>.05). Conclusion According to the basic robotic simulation exercise results, there was no difference between medical students who used to play video games and those who still played video games. Studies evaluating baseline visuospatial skills with larger sample sizes are needed. PMID:25788841

  17. A New Approach to Campus Legal Services.

    ERIC Educational Resources Information Center

    Roster, Michael; Woodward, Linda

    1996-01-01

    Stanford University (California) restructured its legal services office, for both cost containment and service improvement, by outsourcing legal work. The new system consists of a smaller in-house legal staff, for largely preventive work (academic and medical affairs, policy formation), and contracts with three outside law firms to work in…

  18. The impact of marijuana policies on youth: clinical, research, and legal update.

    PubMed

    Ammerman, Seth; Ryan, Sheryl; Adelman, William P

    2015-03-01

    This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement.

  19. The impact of marijuana policies on youth: clinical, research, and legal update.

    PubMed

    Ammerman, Seth; Ryan, Sheryl; Adelman, William P

    2015-03-01

    This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement. PMID:25624385

  20. What is legal medicine--are legal and forensic medicine the same?

    PubMed

    Beran, Roy G

    2010-04-01

    Some consider the terms "forensic" and "legal" medicine to be synonymous but this is counter to the title of the Faculty of Forensic and Legal Medicine or the dual strands for progression to fellowship of the Australian College of Legal Medicine. The paper examines a very brief historical background to legal medicine and develops a definition of the strands thereof, namely legal and forensic medicine. It demonstrates that the two are different components of the application of medical knowledge upon the legal system. Legal medicine has greater relevance to civil and tort law, impacting upon patient care, whereas forensic medicine relates to criminal law and damage to, or by, patients.

  1. Medical use of cannabis in Australia: "medical necessity" defences under current Australian law and avenues for reform.

    PubMed

    Martin, Charles

    2014-06-01

    The possession of cannabis is an offence in all Australian jurisdictions. No exception is made for medical use under any of the State and Territory Drug Acts, nor the Commonwealth's pharmaceutical regulation scheme. Nevertheless, questions remain about the scope for defences argued on the basis of necessitous medical use. More fundamentally the increasingly favourable light in which the medical use of cannabis is growing to be seen by state and national legislatures overseas raises important questions about the need for reform of Australian drug laws. This article explores those questions. PMID:25087368

  2. Management of gastroesophageal reflux disease: medications, surgery, or endoscopic therapy? (Current status and trends).

    PubMed

    Zhi, Xu-ting; Kavic, Stephen M; Park, Adrian E

    2005-01-01

    Gastroesophageal reflux disease (GERD) is a common chronic disorder in the Western world. The basic cause of GERD has been well characterized--the fundamental defect is a loss of integrity of the gastroesophageal barrier. What is less clear is the most appropriate means of addressing this reflux. GERD has a variety of symptoms, ranging from typical presentations of heartburn and regurgitation (without esophagitis) to atypical presentations, such as severe erosive esophagitis and its associated complications. Because of its symptomatic diversity, physicians may select from a variety of therapeutic approaches. Medical therapy aims at decreasing acidity by suppressing proton secretion and has been well established. Available medications include antacids and alginates, H2-receptor antagonists, motility agents, and proton pump inhibitors (PPIs). Antireflux surgery, commonly performed laparoscopically, aims at reinforcing and repairing the defective barrier through plication of the gastric fundus. The earliest performed successful procedures were the Nissen and Toupet fundoplications, to which several modifications have since been made. It has been demonstrated in preliminary studies and long-term outcomes of such open surgery and preliminary studies of such laparoscopic surgery that antireflux surgery is an effective approach, with overall outcomes superior to those achieved with medications. The precise indications for the surgical treatment of patients with GERD, however, remain controversial. In recent years, endoscopic intraluminal antireflux approaches have attracted the attention of physicians, surgeons, and commercial companies, especially after the approval of two endoscopic intraluminal methods by the United States FDA in 2000. The common element is prevention of acid reflux by construction of a functional or controlled barrier in the lower esophageal sphincter zone. Three main methods are currently employed: endoscopic intraluminal valvuloplasty, endoscopic

  3. Legal Rights

    ERIC Educational Resources Information Center

    Baril, Cecile; Couchman, Ian S. B.

    1976-01-01

    The legal processes following a rape charge mortify, denigrate and transfer guilt to the victim. Rape laws reinforce traditional sex roles and restrict the options available to women in defining their personal and sexual careers. (Author/AM)

  4. The Future of e-Learning in Medical Education: Current Trend and Future Opportunity

    PubMed Central

    2006-01-01

    A wide range of e-learning modalities are widely integrated in medical education. However, some of the key questions related to the role of e-learning remain unanswered, such as (1) what is an effective approach to integrating technology into pre-clinical vs. clinical training?; (2) what evidence exists regarding the type and format of e-learning technology suitable for medical specialties and clinical settings?; (3) which design features are known to be effective in designing on-line patient simulation cases, tutorials, or clinical exams?; and (4) what guidelines exist for determining an appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and performance-based skill practices? Based on the existing literature and a variety of e-learning examples of synchronous learning tools and simulation technology, this paper addresses the following three questions: (1) what is the current trend of e-learning in medical education?; (2) what do we know about the effective use of e-learning?; and (3) what is the role of e-learning in facilitating newly emerging competency-based training? As e-learning continues to be widely integrated in training future physicians, it is critical that our efforts in conducting evaluative studies should target specific e-learning features that can best mediate intended learning goals and objectives. Without an evolving knowledge base on how best to design e-learning applications, the gap between what we know about technology use and how we deploy e-learning in training settings will continue to widen. PMID:19223995

  5. Problems and the potential direction of reforms for the current individual medical savings accounts in the Chinese health care system.

    PubMed

    Kong, Xiangjin; Yang, Yang; Gong, Fuqing; Zhao, Mingjie

    2012-12-01

    Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China.

  6. Changing practice on confidentiality: a cause for concern. Commentary 1: Confidentiality: the dangers of anything weaker than the medical ethic.

    PubMed

    Jacob, J M

    1982-03-01

    Articles by D.J. Kenny and Derek F.H. Pheby in the same issue of the Journal of Medical Ethics suggested that expanded legal rights are needed in Great Britain to safeguard medical confidentiality and to reinforce the "ethics of virtue" of the medical profession. The author of this commentary contends that a legal rights approach would subject medical practice to greater regulation and prove less powerful than the current peer review mechanism in protecting ethical standards of confidentiality.

  7. Medical radiation countermeasures for nuclear and radiological emergencies: Current status and future perspectives

    PubMed Central

    Arora, Rajesh; Chawla, Raman; Marwah, Rohit; Kumar, Vinod; Goel, Rajeev; Arora, Preeti; Jaiswal, Sarita; Sharma, Rakesh Kumar

    2010-01-01

    Nuclear and radiological emergencies (NREs) occurred globally and recent incidences in India are indicating toward the need for comprehensive medical preparedness required both at incident site and hospitals. The enhanced threat attributed toward insurgency is another causative factor of worry. The response capabilities and operational readiness of responders (both health and non-health service providers) in contaminated environment need to be supported by advancement in R & D and technological efforts to develop prophylactics and radiation mitigators. It is essential to develop phase 1 alternatives of such drugs for unseen threats as a part of initial preparedness. At the incident site and hospital level, external decontamination procedures need to be standardized and supported by protective clothing and Shudika kits developed by INMAS. The medical management of exposure requires systematic approach to perform triage, resuscitation and curative care. The internal contamination requires decorporation agents to be administered based on procedural diagnostics. Various key issues pertaining to policy decisions, R & D promotion, community awareness, specialized infrastructure for NREs preparedness has been discussed. The present review is an attempt to provide vital information about the current status of various radiation countermeasures and future perspective(s) ahead. PMID:21829316

  8. Strategies for medical data extraction and presentation part 1: current limitations and deficiencies.

    PubMed

    Reiner, Bruce

    2015-04-01

    Data overload is a burgeoning challenge for the medical imaging community; with resulting technical, clinical, and economic ramifications. A primary concern for radiologists is the timely, efficient, and accurate extraction of imaging and clinical data, which collectively are essential in determining accurate diagnosis. In current practice, imaging data retrieval is limited by the fact that imaging and report data are de-coupled from one another, along with the non-standardized and often ambiguous free text data contained within narrative radiology reports. Clinical data retrieval is equally challenging and flawed by the lack of information system integration, paucity of clinical order entry data, and diminished role of the technologist in providing clinical data. These combined factors have the potential to adversely affect radiologist performance and clinical outcomes by diminishing workflow, report accuracy, and diagnostic confidence. New and innovative strategies are required to improve and automate data extraction and presentation, in a context- and user-specific fashion. PMID:25666903

  9. Mississippi Curriculum Framework for Business and Office and Related Technology Cluster. Office Systems Technology (CIP: 52.0401--Administrative Assistant/Secretarial). Accounting Technology (CIP: 52.0302). Medical Office Technology (CIP: 52.0404--Medical Admin. Asst./Secretarial). Microcomputer Technology (CIP: 52.0490). Court Reporting Technology (CIP: 52.0405). Paralegal Technology (CIP: Paralegal/Legal Assistant).

    ERIC Educational Resources Information Center

    Mississippi Research and Curriculum Unit for Vocational and Technical Education, State College.

    This document, which is intended for use by community and junior colleges throughout Mississippi, contains curriculum frameworks for four programs in the postsecondary-level business and office cluster (office systems, accounting, medical office, and microcomputer technologies) and two programs in the legal cluster (court reporting and paralegal…

  10. Emerging ethical, legal and social issues associated with stem cell research & and the current role of the moral status of the embryo.

    PubMed

    Zarzeczny, Amy; Caulfield, Timothy

    2009-06-01

    Since its early days, stem cell research, particularly human embryonic stem cell research, has been the focus of intense social debate, and the question of the moral status of the embryo has been a central issue in the controversy. Despite this friction, and while it has yet to obtain widespread success in clinical applications, stem cell research remains a great hope for future advances in healthcare. In this paper, we will discuss the results of our systematic literature review in which we examined recent social science, legal and biomedical discourse, as well as Canadian print media discourse, associated with stem cell research in order to assess the role the question of the moral status of the embryo currently plays in these forums, and to identify what other issues are emerging and receiving attention. This analysis will assist with recognizing the issues which are likely to inform future policy and will facilitate forecasting the probable direction of the continually developing social discourse surrounding stem cell research.

  11. [Legal aspects of toxicological care].

    PubMed

    Teijeira, R

    2003-01-01

    The care of poisoned patients in the sphere of the hospital emergency services is an increasingly frequent phenomenon. Any patient, whether or not they die, who is subjected to medical care in the course of a poisoning generates certain obligations from the medical-legal point of view. This paper reviews the most frequent causes of medical care in living patients, or in those who have died because of a poisoning, the legal obligations that care gives rise to, and the suitable form for approaching and resolving these.

  12. Legalizing Farmworkers: The 2002 Outlook.

    ERIC Educational Resources Information Center

    Martin, Philip

    2002-01-01

    Discusses proposals for a new guest worker program with Mexico, reviewing characteristics of U.S. farmworkers, the current federal H-2A program for admitting legal guest workers for farm work, major proposals being debated to turn unauthorized into legal farmworkers, and new considerations after September 11 that may affect the negotiations. (SM)

  13. Current Integration of Dissection in Medical Education in Australia and New Zealand: Challenges and Successes

    ERIC Educational Resources Information Center

    Bouwer, Hope Ellen; Valter, Krisztina; Webb, Alexandra Louise

    2016-01-01

    The reduced use of dissection associated with the introduction of integrated systems problem-based learning curricula, graduate-entry programs and medical school expansion is a frequent topic of discussion and debate in modern medical training. The purpose of this study was to investigate the impact of these changes to the medical education…

  14. Current Medications for the Treatment of Attention-Deficit/Hyperactivity Disorder

    ERIC Educational Resources Information Center

    Vaughan, Brigette S.; Roberts, Holly J.; Needelman, Howard

    2009-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is common among children. Fortunately, ADHD is highly treatable with medication. The purpose of this article is to serve as a primer on medication treatment for ADHD for school psychologists. The article discusses the available stimulant and nonstimulant medication for the treatment of ADHD.…

  15. Legal abortion: the impending obsolescence of the trimester framework.

    PubMed

    Mangel, C P

    1988-01-01

    Women who wish to terminate a pregnancy, and physicians willing to perform abortions, are subject to increasing harassment from groups which challenge the constitutional abortion right upheld by the Supreme Court in Roe v. Wade. Their vulnerability, in fact, parallels the vulnerability of the abortion right. This Article analyzes the inherent weakness and impending obsolescence of the trimester framework established in Roe. Present medical evidence of maternal health risks and fetal viability demonstrates that the trimester framework is inconsistent with current medical knowledge, and will likely be rendered obsolete by developments in medical technology. The Article suggests that adoption of an alternative constitutional basis for legal abortion is necessary to preserve the abortion right, and explores the utility of two arguments grounded in the equal protection doctrine. Finally, it discusses means of preserving legal abortion within the confines of the trimester framework established in Roe v. Wade.

  16. History and current state of neurosurgery at the Medical University of South Carolina.

    PubMed

    Krishna, Vibhor; Rauf, Yasmeen; Patel, Sunil; Glazier, Steve; Perot, Phanor; Ellegala, Dilantha B

    2011-07-01

    We review the development of neurosurgery at the Medical University of South Carolina (MUSC) and the emergence of MUSC as a leading academic neurosurgical center in South Carolina. Historical records from the Waring Historical Library were studied, former and current faculty members were interviewed, and the personal records of Dr Phanor J Perot were examined. Dr Frederick E Kredel was the first to perform cerebral revascularization in stroke patients using omental flaps and the first to culture glioma cells in artificial media. The MUSC Neurosurgery residency program was established in 1964 by its first formally trained neurosurgeon, Julian Youmans, MD. The first graduate of the program, Dr Russell Travis, went on to become the President of the American Association of Neurological Surgeons. In 1968, the longest serving chairman, Dr Perot, joined the department and conducted significant research in spinal cord injury, receiving a continuous, 20-year award from the National Institute of Neurological Disorders and Stroke. A major change in the neurosurgery program occurred in 2004 when Dr Sunil Patel accepted the chairmanship. He integrated neurosurgery, neurology, and basic neuroscience departments into a comprehensive Department of Neurosciences to provide integrated clinical care. This department now ranks second in the country in National Institutes of Health research funding. Recently, the Center for Global Health and Global Neurosurgery was established with a vision of caring for patients beyond national borders. Neurosurgery at MUSC has been influenced by Drs Kredel and Perot and the current leadership is moving forward with a uniquely integrated department with novel areas such as global neurosurgery. PMID:21368698

  17. Impact of antipsychotic medication on transcranial direct current stimulation (tDCS) effects in schizophrenia patients.

    PubMed

    Agarwal, Sri Mahavir; Bose, Anushree; Shivakumar, Venkataram; Narayanaswamy, Janardhanan C; Chhabra, Harleen; Kalmady, Sunil V; Varambally, Shivarama; Nitsche, Michael A; Venkatasubramanian, Ganesan; Gangadhar, Bangalore N

    2016-01-30

    Transcranial direct current stimulation (tDCS) has generated interest as a treatment modality for schizophrenia. Dopamine, a critical pathogenetic link in schizophrenia, is also known to influence tDCS effects. We evaluated the influence of antipsychotic drug type (as defined by dopamine D2 receptor affinity) on the impact of tDCS in schizophrenia. DSM-IV-TR-diagnosed schizophrenia patients [N=36] with persistent auditory hallucinations despite adequate antipsychotic treatment were administered add-on tDCS. Patients were divided into three groups based on the antipsychotic's affinity to D2 receptors. An auditory hallucinations score (AHS) was measured using the auditory hallucinations subscale of the Psychotic Symptom Rating Scales (PSYRATS). Add-on tDCS resulted in a significant reduction inAHS. Antipsychotic drug type had a significant effect on AHS reduction. Patients treated with high affinity antipsychotics showed significantly lesser improvement compared to patients on low affinity antipsychotics or a mixture of the two. Furthermore, a significant sex-by-group interaction occurred; type of medication had an impact on tDCS effects only in women. Improvement differences could be due to the larger availability of the dopamine receptor system in patients taking antipsychotics with low D2 affinity. Sex-specific differences suggest potential estrogen-mediated effects. This study reports a first-time observation on the clinical utility of antipsychotic drug type in predicting tDCS effects in schizophrenia.

  18. Medico-legal issues in detecting and proving the sexual abuse of children.

    PubMed

    Indest, G F

    1989-01-01

    In this article the author reviews the scope and magnitude of the problem currently faced by medical and investigative personnel in detecting and proving the sexual molestation of children. The legal effects of poor medical records are discussed in detail. Various medical and legal issues that may present pitfalls for the unwary examining physician are identified and discussed. The admissibility of various portions of the medical examination and medical report as evidence in courts of law is reviewed as well as newly emerging forensic tests and techniques for collecting medical evidence. The author provides a comprehensive and detailed summary of steps to be followed in the physical examination of a child sex abuse victim, emphasizing the importance of a strict, thorough procedure for protecting the interests of the patient, the physician and society.

  19. The Use of Medical Marijuana in Cancer.

    PubMed

    Birdsall, Shauna M; Birdsall, Timothy C; Tims, Lucas A

    2016-07-01

    The use of medical marijuana in cancer care presents a dilemma for both patients and physicians. The scientific evidence is evolving, yet much of the known information is still insufficient to adequately inform patients as to risks and benefits. In addition, evidence-based dosing and administration information on medical marijuana is lacking. Medical marijuana is now legal, on some level, in 24 states plus the District of Columbia, yet is not legal on the federal level. This review addresses the current state of the research, including potential indications, risks and adverse effects, preliminary data on anticancer effects, as well as legal and quality issues. A summary of the clinical trials underway on medical marijuana in the oncology setting is discussed.

  20. The Use of Medical Marijuana in Cancer.

    PubMed

    Birdsall, Shauna M; Birdsall, Timothy C; Tims, Lucas A

    2016-07-01

    The use of medical marijuana in cancer care presents a dilemma for both patients and physicians. The scientific evidence is evolving, yet much of the known information is still insufficient to adequately inform patients as to risks and benefits. In addition, evidence-based dosing and administration information on medical marijuana is lacking. Medical marijuana is now legal, on some level, in 24 states plus the District of Columbia, yet is not legal on the federal level. This review addresses the current state of the research, including potential indications, risks and adverse effects, preliminary data on anticancer effects, as well as legal and quality issues. A summary of the clinical trials underway on medical marijuana in the oncology setting is discussed. PMID:27215434

  1. Minimally legally invasive dentistry.

    PubMed

    Lam, R

    2014-12-01

    One disadvantage of the rapid advances in modern dentistry is that treatment options have never been more varied or confusing. Compounded by a more educated population greatly assisted by online information in an increasingly litigious society, a major concern in recent times is increased litigation against health practitioners. The manner in which courts handle disputes is ambiguous and what is considered fair or just may not be reflected in the judicial process. Although legal decisions in Australia follow a doctrine of precedent, the law is not static and is often reflected by community sentiment. In medical litigation, this has seen the rejection of the Bolam principle with a preference towards greater patient rights. Recent court decisions may change the practice of dentistry and it is important that the clinician is not caught unaware. The aim of this article is to discuss legal issues that are pertinent to the practice of modern dentistry through an analysis of legal cases that have shaped health law. Through these discussions, the importance of continuing professional development, professional association and informed consent will be realized as a means to limit the legal complications of dental practice.

  2. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics. PMID:16822631

  3. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.

  4. Same-Sex Couples: Legal Complexities

    ERIC Educational Resources Information Center

    Oswald, Ramona Faith; Kuvalanka, Katherine A.

    2008-01-01

    In this article, the authors present a typology for organizing our current knowledge regarding same-sex couples in the United States who have and have not established legal ties between partners. This framework is complemented by a discussion of key rulings that define what is legally possible as well as the introduction of "legal consciousness,"…

  5. Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments

    PubMed Central

    Chien, Wai Tong; Yip, Annie LK

    2013-01-01

    During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients’ needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive–behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have recommended that a combination of treatment modalities be adopted to meet the complex health needs of people with schizophrenia spectrum disorders. In view of the heterogeneity of the

  6. Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

    PubMed

    Heptonstall, N B; Ali, T; Mankad, K

    2016-04-01

    This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial. PMID:26970390

  7. [Current situations and problems of quality control for medical imaging display systems].

    PubMed

    Shibutani, Takayuki; Setojima, Tsuyoshi; Ueda, Katsumi; Takada, Katsumi; Okuno, Teiichi; Onoguchi, Masahisa; Nakajima, Tadashi; Fujisawa, Ichiro

    2015-04-01

    Diagnostic imaging has been shifted rapidly from film to monitor diagnostic. Consequently, Japan medical imaging and radiological systems industries association (JIRA) have recommended methods of quality control (QC) for medical imaging display systems. However, in spite of its need by majority of people, executing rate is low. The purpose of this study was to validate the problem including check items about QC for medical imaging display systems. We performed acceptance test of medical imaging display monitors based on Japanese engineering standards of radiological apparatus (JESRA) X-0093*A-2005 to 2009, and performed constancy test based on JESRA X-0093*A-2010 from 2010 to 2012. Furthermore, we investigated the cause of trouble and repaired number. Medical imaging display monitors had 23 inappropriate monitors about visual estimation, and all these monitors were not criteria of JESRA about luminance uniformity. Max luminance was significantly lower year-by-year about measurement estimation, and the 29 monitors did not meet the criteria of JESRA about luminance deviation. Repaired number of medical imaging display monitors had 25, and the cause was failure liquid crystal panel. We suggested the problems about medical imaging display systems.

  8. Current practices for labeling medications in hospitals in Riyadh, Saudi Arabia

    PubMed Central

    Alkhani, Salma; Ahmed, Yusuf; Bin-Sabbar, Nora; Almogirah, Hailah; Alturki, Alanoud; Albanyan, Haifa; Adam, Mansour; Saleem, Fahad; Aljadhey, Hisham; Hassali, Mohamed Azmi; Vaida, Allen J.

    2013-01-01

    Background Good medication labeling practices are imperative to ensure safe medication use. Non-adherence to labeling protocols is reported as one major source of medication errors. Objective This study was intended to evaluate and compare adherence to labeling guidelines for dispensed medications among the hospitals of the five different health sectors in the city of Riyadh, Saudi Arabia. Methods A descriptive, cross-sectional analysis was conducted among 14 public hospitals in the city of Riyadh, Saudi Arabia. Labeling guidelines issued by the Institute for Safe Medication Practices were used as a standard assessment tool. A total of 218 medication labels were collected and evaluated for labeling adequacy. Descriptive statistics were used to elaborate the study findings. All analyses were performed with Microsoft Access. Results The study showed a substantial rate of adherence to the labeling guidelines. In terms of the established criteria, community and mail orders were reported to adhere strongly (90.5%), whereas injectables adhered least to the labeling guidelines. The labeling format, contents of the label, instructions on the labels, abbreviations used on the labels and drug names were also consistent with the guidelines (80.0%, 84.0%, 88.0%, 97.7% and 85.5%, respectively). Organizations belonging to the public sector reported a higher level of adherence (⩾80.0%) than the level found for private hospitals (70.0%). Conclusion In Riyadh hospitals, medication labeling following the guidelines issued by the Institute for Safe Medication Practices, is well accepted and rationally practiced. However, a nationwide study is recommended to evaluate if the guidelines are followed throughout Saudi Arabia. PMID:24227953

  9. IEC80001 and Future Ramifications for Health Systems not currently classed as Medical Devices

    NASA Astrophysics Data System (ADS)

    Harrison, Ian

    Traditionally a medical device is viewed as a standalone hospital system with a carefully segregated private network running on specialist bespoke equipment, managed by highly skilled medical technicians. The regulations in force implementing the Medical Devices Directive support this view. The emerging reality in the modern health organisation is a patient-centric shared electronic record, networked over the organisation's local area network, with medical devices hanging as endpoints off that shared network and contributing to the central pool of patient data - all the time reliant on the shared network services. The IEC80001 standard has been developed to provide guidance on the measures that the medical devices community considers are required best practice in order to ensure that the integrity and safety of the interconnected medical device is not compromised. This in itself is both a laudable and pragmatic action. The question that it immediately prompts for those left with the new and very real task of 'compliance' with the new standards - primarily the over worked health organisation's IT department, is 'what impact does this have on me?'. A number of papers exist prepared from a health-system-supplier standpoint. This paper is principally focused on examining the ramifications of IEC80001 from a health organisation stand point. This paper seeks to identify the areas where a health organisation may expect to have their business-as-usual IT processes impacted, and offers a simple framework to address these challenges.

  10. Medico-legal issues in detecting and proving the sexual abuse of children.

    PubMed

    Indest, G F

    1989-01-01

    This article reviews the problem currently faced by medical and investigative personnel in detecting and proving the sexual molestation of children. The legal consequences of poor medical records are discussed. Various medical and legal issues that may present pitfalls for the examining physician are identified. The admissibility of various portions of the medical examination and report as evidence in courts of law is reviewed as well as newly emerging forensic tests and techniques for collecting medical evidence. A comprehensive summary of steps to be followed in the physical examination of a child sex abuse victim, emphasizing the importance of a strict, thorough procedure for protecting the interests of the patient, the physician and society is provided.

  11. The current provision of community-based teaching in UK medical schools: an online survey and systematic review

    PubMed Central

    Lee, Sandra W W; Clement, Naomi; Tang, Natalie; Atiomo, William

    2014-01-01

    Objective To evaluate the current provision and outcome of community-based education (CBE) in UK medical schools. Design and data sources An online survey of UK medical school websites and course prospectuses and a systematic review of articles from PubMed and Web of Science were conducted. Articles in the systematic review were assessed using Rossi, Lipsey and Freeman's approach to programme evaluation. Study selection Publications from November 1998 to 2013 containing information related to community teaching in undergraduate medical courses were included. Results Out of the 32 undergraduate UK medical schools, one was excluded due to the lack of course specifications available online. Analysis of the remaining 31 medical schools showed that a variety of CBE models are utilised in medical schools across the UK. Twenty-eight medical schools (90.3%) provide CBE in some form by the end of the first year of undergraduate training, and 29 medical schools (93.5%) by the end of the second year. From the 1378 references identified, 29 papers met the inclusion criteria for assessment. It was found that CBE mostly provided advantages to students as well as other participants, including GP tutors and patients. However, there were a few concerns regarding the lack of GP tutors’ knowledge in specialty areas, the negative impact that CBE may have on the delivery of health service in education settings and the cost of CBE. Conclusions Despite the wide variations in implementation, community teaching was found to be mostly beneficial. To ensure the relevance of CBE for ‘Tomorrow's Doctors’, a national framework should be established, and solutions sought to reduce the impact of the challenges within CBE. Strengths and limitations of this study This is the first study to review how community-based education is currently provided throughout Medical Schools in the UK. The use of Rossi, Lipsey and Freeman's method of programme evaluation means that the literature was analysed

  12. [Estimation of incapacity to work in medico-legal opinions given by clinicians and forensic medicine specialists from the Department of Forensic Medicine, Medical University of Silesia, Katowice--comparative analysis].

    PubMed

    Chowaniec, Czesław; Jabłoński, Christian; Kobek, Mariusz; Chowaniec, Małgorzata

    2005-01-01

    After amending the rules obligatory for decision making about the incapacity to work and social insurance in district courts observed in the practice of the Department of Forensic Medicine Medical University of Silesia, Katowice. Our Department is usually appointed for a second opinion in legal pension proceedings. In the first place courts appoint physicians being experts in particular fields of clinical medicine. Irrespective of all differences in the accepted conclusion a comparative analysis of medico-legal opinions given by forensic medicine specialists or groups of experts from the Department of Forensic Medicine, Medical University of Silesia, Katowice, showed flaws in the way opinions were handed down by individual experts relating to the lack of the state of general health estimation in people contesting for pensions as well as ignorance of the obligatory rules and procedures when deciding about incapacity to work in pension proceedings. It is known that physicians appointed by the court establish only whether the examined person can work or not, but do not give any information about the character of incapacity and do not consider the possibility of therapeutic rehabilitation within the extent of the pension prevention by the Social Insurance Department nor a chance to change ones profession due to the incapacity to work in the present occupation. While presenting their opinions, physicians very often suggest the need of additional opinions given by other physicians being experts in particular fields of clinical medicine. On the basis of the above mentioned remarks the authors show the necessity for greater control over all medico legal opinions and by the court decision making process as well as the verification of experts qualifications taking into consideration of economy and the need to make the proceedings shorter.

  13. Current and future directions for hospital and physician reimbursement. Effect on the academic medical center.

    PubMed

    Petersdorf, R G

    1985-05-01

    Profound changes are occurring in the health care system, including a surfeit of physicians, cost containment, and competition. This article addresses the effects of these changes on the academic medical center. It recommends that the faculty of the future will be of two types--clinician-teachers and researcher-teachers--and outlines the qualifications of these faculties. It recommends a proper reward system for clinician-teachers, the reintroduction of part-time faculties, and careful retrenchment in medical school class size and house staff. It calls for teaching hospitals to improve their physical plants and control costs by phasing out programs that are not cost-effective. Universities should consider divesting themselves of university-owned teaching hospitals. Most importantly, local, state, and federal governments and the public must develop a more supportive attitude toward the needs of medical education.

  14. Strategies and methods for aligning current and best medical practices. The role of information technologies.

    PubMed Central

    Schneider, E C; Eisenberg, J M

    1998-01-01

    Rapid change in American medicine requires that physicians adjust established behaviors and acquire new skills. In this article, we address three questions: What do we know about how to change physicians' practices? How can physicians take advantage of new and evolving information technologies that are likely to have an impact on the future practice of medicine? and What strategic educational interventions will best enable physicians to show competencies in information management and readiness to change practice? We outline four guiding principles for incorporating information systems tools into both medical education and practice, and we make eight recommendations for the development of a new medical school curriculum. This curriculum will produce a future medical practitioner who is capable of using information technologies to systematically measure practice performance, appropriateness, and effectiveness while updating knowledge efficiently. PMID:9614787

  15. Attitudes to legalizing cannabis use.

    PubMed

    Williams, Jenny; van Ours, Jan C; Grossman, Michael

    2016-09-01

    In this paper, we investigate the relationship between cannabis use and attitudes to legalizing the use of cannabis. Predictions from theory provide a means of learning about the roles of information, self interest and regret in explaining differences in attitudes to legalization between those who currently use, those who have used in the past and those who have never used. Our empirical investigation suggests that users have a greater awareness of cannabis not being as harmful as abstainers think it is. This may explain why individuals are more inclined to be in favor of legalizing cannabis once they have used it themselves. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Physiologists at US Medical Schools: Education, Current Status, and Trends in Diversity.

    ERIC Educational Resources Information Center

    Matyas, Marsha Lakes; Frank, Martin

    1995-01-01

    Analyzes data concerning the status of faculty at American medical schools who hold Ph.D. degrees in physiology and faculty members with appointments in departments of physiology. Data show a decline in numbers of Ph.D.s in animal and human physiology awarded to Americans since 1980. Discusses programs and initiatives to increase student interest…

  17. Sexual Health Curricula in U.S. Medical Schools: Current Educational Objectives

    ERIC Educational Resources Information Center

    Galletly, Carol; Lechuga, Julia; Layde, Joseph B.; Pinkerton, Steven

    2010-01-01

    Objective: The authors identify the explicit and implicit objectives that shape decisions about what medical schools teach regarding human sexuality. Methods: The authors reviewed relevant articles in journals, physician licensing examinations, and publications by professional organizations to identify learning objectives for human sexuality in…

  18. The medical device industry and the biomedical engineer: current status and future trends.

    PubMed

    Farley, B E

    1989-01-01

    The role of new and existing technology in the development of medical devices is examined. The impact of competition and economic and regulatory pressures is assessed. The identification of clinical needs is discussed. These include the needs to reduce liability, find less invasive alternatives to surgery, improve the quality of life, and prevent disease. Career opportunities are considered in some detail.

  19. The urgent need to change the current medical approach on tobacco cessation in Latin America.

    PubMed

    Ponciano-Rodríguez, Guadalupe

    2010-01-01

    Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers.

  20. The urgent need to change the current medical approach on tobacco cessation in Latin America.

    PubMed

    Ponciano-Rodríguez, Guadalupe

    2010-01-01

    Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers. PMID:21243210

  1. Does current provision of undergraduate education prepare UK medical students in ENT? A systematic literature review

    PubMed Central

    Ferguson, Gary R; Bacila, Irina A; Swamy, Meenakshi

    2016-01-01

    Objective To systematically identify and analyse all published literature relating to the provision of undergraduate education for preparedness in ear, nose and throat (ENT) surgery, as perceived by medical students and clinicians in the UK. Design Systematic literature review. Data sources 5 major databases were searched: MEDLINE, EMBASE, ERIC, Cochrane and Web of Science. The literature search was conducted from February to April 2015. Eligibility criteria for selecting studies Primary research or studies that report on the provision of undergraduate education for preparedness in ENT, from the perspective of medical students and clinicians in the UK. The timescale of searches was limited from 1999 onwards (ie, the past 15 years). Data extraction The literature search was conducted by 2 independent reviewers. Search terms used involved the combination and variation of 5 key concepts, namely: medical student, clinician, ENT, undergraduate medical education and UK. A data extraction form was designed for and used in this study, based on guidelines provided by the UK National Health Service (NHS) Centre for Reviews and Dissemination. Textual narrative synthesis was used for data analysis. Results A total of 7 studies were included in the final review. 4 main themes were identified: confidence in managing patients, teaching delivery, student assessment and duration of rotations. A consistent finding in this review was that the majority of final year medical students and junior doctors did not feel adequately prepared to practise ENT. Important factors influencing preparedness in ENT included the duration of clinical rotations, the opportunity for hands-on learning and formal assessment. Conclusions The findings of this review suggest the need for further development of the ENT undergraduate curricula across the UK. However, there is insufficient evidence from which to draw strong conclusions; this in itself is beneficial as it highlights a gap in the existing

  2. ‘E-learning’ modalities in the current era of Medical Education in Pakistan

    PubMed Central

    Jawaid, Masood; Aly, Syed Moyn

    2014-01-01

    There are a number of e-Learning modalities, some or all of which may be used throughout a medical, dental, nursing or any other health related undergraduate curriculum. The purpose of this paper is to briefly describe what e-learning is along with some of the modalities, their common advantages and limitations. This publication ends with practical implications of these modalities for Pakistan. PMID:25225547

  3. Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems

    PubMed Central

    Schiff, G D; Amato, M G; Eguale, T; Boehne, J J; Wright, A; Koppel, R; Rashidee, A H; Elson, R B; Whitney, D L; Thach, T-T; Bates, D W; Seger, A C

    2015-01-01

    Importance Medication computerised provider order entry (CPOE) has been shown to decrease errors and is being widely adopted. However, CPOE also has potential for introducing or contributing to errors. Objectives The objectives of this study are to (a) analyse medication error reports where CPOE was reported as a ‘contributing cause’ and (b) develop ‘use cases’ based on these reports to test vulnerability of current CPOE systems to these errors. Methods A review of medication errors reported to United States Pharmacopeia MEDMARX reporting system was made, and a taxonomy was developed for CPOE-related errors. For each error we evaluated what went wrong and why and identified potential prevention strategies and recurring error scenarios. These scenarios were then used to test vulnerability of leading CPOE systems, asking typical users to enter these erroneous orders to assess the degree to which these problematic orders could be entered. Results Between 2003 and 2010, 1.04 million medication errors were reported to MEDMARX, of which 63 040 were reported as CPOE related. A review of 10 060 CPOE-related cases was used to derive 101 codes describing what went wrong, 67 codes describing reasons why errors occurred, 73 codes describing potential prevention strategies and 21 codes describing recurring error scenarios. Ability to enter these erroneous order scenarios was tested on 13 CPOE systems at 16 sites. Overall, 298 (79.5%) of the erroneous orders were able to be entered including 100 (28.0%) being ‘easily’ placed, another 101 (28.3%) with only minor workarounds and no warnings. Conclusions and relevance Medication error reports provide valuable information for understanding CPOE-related errors. Reports were useful for developing taxonomy and identifying recurring errors to which current CPOE systems are vulnerable. Enhanced monitoring, reporting and testing of CPOE systems are important to improve CPOE safety. PMID:25595599

  4. What emergency physicians should know about informed consent: legal scenarios, cases, and caveats.

    PubMed

    Moore, Gregory P; Moffett, Peter M; Fider, Cyril; Moore, Malia J

    2014-08-01

    The basic concept of obtaining informed consent is familiar to emergency physicians, and many consider themselves well versed on the topic; however, lack of obtaining proper informed consent is a frequent source of lawsuits. The legal definitions and nuances of informed consent might surprise even the most experienced physician. This article will detail the historical legal evolution of the concept of informed consent. It will also report defining and recent court cases that illustrate the current medical-legal status of informed consent. Special scenarios, caveats, and documentation recommendations are discussed. After reading this article the emergency physician will know how to practice and document the appropriate aspects of informed consent in emergency medicine, as well as understand available legal defenses if a lawsuit should arise.

  5. The Ethical and Legal Framework for the Decision Not to Resuscitate

    PubMed Central

    Lee, Melinda A.; Cassel, Christine K.

    1984-01-01

    Practicing physicians are frequently faced with the question of whether or not to institute cardiopulmonary resuscitation in case of cardiac or respiratory arrest in a patient in hospital. Medical training has usually not included any systematic analysis of this issue from either an ethical or a legal standpoint. Many physicians may be unaware that ethical and legal principles, as well as professional guidelines, exist to guide such decision making. In practice, physicians make this decision without the benefit of training in ethical analysis. The problem is especially acute in teaching hospitals when young physicians unacquainted with formal ethics or the law must often make decisions emergently. Studies show some discrepancy between ethical and legal principles and the actual decision making by physicians. For this reason, we recommend an approach that will enable physicians to make and implement decisions not to resuscitate that are consistent with current ethical and legal standards. PMID:6702189

  6. What emergency physicians should know about informed consent: legal scenarios, cases, and caveats.

    PubMed

    Moore, Gregory P; Moffett, Peter M; Fider, Cyril; Moore, Malia J

    2014-08-01

    The basic concept of obtaining informed consent is familiar to emergency physicians, and many consider themselves well versed on the topic; however, lack of obtaining proper informed consent is a frequent source of lawsuits. The legal definitions and nuances of informed consent might surprise even the most experienced physician. This article will detail the historical legal evolution of the concept of informed consent. It will also report defining and recent court cases that illustrate the current medical-legal status of informed consent. Special scenarios, caveats, and documentation recommendations are discussed. After reading this article the emergency physician will know how to practice and document the appropriate aspects of informed consent in emergency medicine, as well as understand available legal defenses if a lawsuit should arise. PMID:25156698

  7. Complementary and Alternative Medicine: Comparison of Current Knowledge, Attitudes and Interest among German Medical Students and Doctors

    PubMed Central

    Münstedt, Karsten; Harren, Hildegard; von Georgi, Richard; Hackethal, Andreas

    2011-01-01

    Although it has been agreed that complementary and alternative medicine (CAM) should be included in the German medical curriculum, there is no consensus on which methods and how it should be taught. This study aimed to assess needs for CAM education by evaluating current knowledge, attitudes and interests of medical students, general physicians and gynecologists. Two instruments based on established and validated questionnaires were developed. One was given to seventh semester medical students and the other to office-based doctors. Data were analyzed by bivariate correlation and cross-tabulation. Altogether 550 questionnaires were distributed—280 to doctors and 270 to medical students. Completed questionnaires were returned by 80.4% of students and 78.2% of doctors. Although 73.8% (160/219) of doctors and 40% (87/217) of students had already informed themselves about CAM, neither group felt that they knew much about CAM. Doctors believed that CAM was most useful in general medicine, supportive oncology, pediatrics, dermatology and gynecology, while students believed that dermatology, general medicine, psychiatry and rheumatology offered opportunities; both recommended that CAM should be taught in these areas. Both groups believed that CAM should be included in medical education; however, they believed that CAM needed more investigation and should be taught “critically". German doctors and students would like to be better informed about CAM. An approach which teaches fundamental competences to students, chooses specific content based on evidence, demographics and medical conditions and provides students with the skills they need for future learning should be adopted. PMID:19098296

  8. Legal considerations when making a practice change.

    PubMed

    Armon, Bruce D; Bayus, Karilynn

    2014-07-01

    Changes in medical practice, such as retiring, selling a practice, and switching employment, have significant legal impacts on physicians. These decisions should be carefully analyzed prior to being made. Physicians who do not make decisions in a well-considered manner may face economic penalties, licensure sanctions, and/or other legal issues. This article explores some key legal issues including (1) timing, (2) patient care continuity, (3) medical records retention, (4) licensure and board certification, (5) professional liability insurance, and (6) postemployment restrictions on practice. Within these topics, sources of physicians' legal and ethical obligations are examined, including possible resolutions to identified issues. Not all changes affect physicians in the same manner. This article further considers how these important legal issues may impact differently situated physicians, such as retiring physicians vs transitioning physicians and physicians employed by groups or hospital systems vs physicians in solo practice.

  9. [Legal aspects of ritual circumcision].

    PubMed

    Schreiber, M; Schott, G E; Rascher, W; Bender, A W

    2009-12-01

    Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out - be it for medical or ritual reasons - without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.

  10. How Current Are Leading Evidence-Based Medical Textbooks? An Analytic Survey of Four Online Textbooks

    PubMed Central

    2012-01-01

    Background The consistency of treatment recommendations of evidence-based medical textbooks with more recently published evidence has not been investigated to date. Inconsistencies could affect the quality of medical care. Objective To determine the frequency with which topics in leading online evidence-based medical textbooks report treatment recommendations consistent with more recently published research evidence. Methods Summarized treatment recommendations in 200 clinical topics (ie, disease states) covered in four evidence-based textbooks–UpToDate, Physicians’ Information Education Resource (PIER), DynaMed, and Best Practice–were compared with articles identified in an evidence rating service (McMaster Premium Literature Service, PLUS) since the date of the most recent topic updates in each textbook. Textbook treatment recommendations were compared with article results to determine if the articles provided different, new conclusions. From these findings, the proportion of topics which potentially require updating in each textbook was calculated. Results 478 clinical topics were assessed for inclusion to find 200 topics that were addressed by all four textbooks. The proportion of topics for which there was 1 or more recently published articles found in PLUS with evidence that differed from the textbooks’ treatment recommendations was 23% (95% CI 17-29%) for DynaMed, 52% (95% CI 45-59%) for UpToDate, 55% (95% CI 48-61%) for PIER, and 60% (95% CI 53-66%) for Best Practice (χ 2 3=65.3, P<.001). The time since the last update for each textbook averaged from 170 days (range 131-209) for DynaMed, to 488 days (range 423-554) for PIER (P<.001 across all textbooks). Conclusions In online evidence-based textbooks, the proportion of topics with potentially outdated treatment recommendations varies substantially. PMID:23220465

  11. Current Trends on Medical and Pharmaceutical Applications of Inkjet Printing Technology.

    PubMed

    Scoutaris, Nicolaos; Ross, Steven; Douroumis, Dennis

    2016-08-01

    Inkjet printing is an attractive material deposition and patterning technology that has received significant attention in the recent years. It has been exploited for novel applications including high throughput screening, pharmaceutical formulations, medical devices and implants. Moreover, inkjet printing has been implemented in cutting-edge 3D-printing healthcare areas such as tissue engineering and regenerative medicine. Recent inkjet advances enabled 3D printing of artificial cartilage and skin, or cell constructs for transplantation therapies. In the coming years inkjet printing is anticipated to revolutionize personalized medicine and push the innovation portfolio by offering new paths in patient - specific treatments. PMID:27174300

  12. Evolving medical knowledge: moving toward efficiently answering questions and keeping current.

    PubMed

    McConaghy, John R

    2006-12-01

    The information needs of clinicians are many and varied; however, these information needs remain largely unmet. This likely diminishes the quality of patient care. Although it is important that physicians be proficient in critically evaluating the medical literature, it is more important that they become proficient in the "applied science of information management." Clinicians must learn the techniques and skills to find, evaluate, and use relevant and valid information both in the care of patients and in their careers of lifelong learning. Clinicians need sources for rapid retrieval of valid information at the point of care.

  13. [Current problems of metrological support for medical laboratory technology for microanalysis].

    PubMed

    Anufriev, Iu A; Pashkevich, E V; Kuznetsov, A D; Mochalov, V S; Galushkin, A N

    1986-01-01

    Consideration is given to current concepts and general problems of metrological support for clinical microanalytical laboratory instrumentation. The impact of varying environmental conditions is evaluated with due regard to transition to microdoses. PMID:3784863

  14. A time to step in: legal mechanisms for protecting those with declining capacity.

    PubMed

    Arias, Jalayne J

    2013-01-01

    Current estimates approximate that the population over sixty-five years of age will increase from 40 million in 2010 to 72.1 million by 2030. As society ages, the number of elderly with cognitive deficits that impair decision-making abilities will also increase. This will place additional burdens on families and probate courts seeking to balance individual autonomy with necessary protections. A legal determination of incompetency is a prerequisite to a judicial order appointing a guardianship or other protective mechanism. The current legal-medical model for competency determinations fails to reflect the complexities of declining capacity in an aging population. A global structure for competency determinations leaves a critical gap between competent and incompetent. The gap between competence and incompetence not only raises concerns about how to classify those that fall between the two, but also highlights the lack of legal protections for those within the gap. A revised model is needed to provide protections to individuals who do not yet meet the threshold for incompetence but require additional protections for their personal or financial welfare. This Article provides an unprecedented examination of the legal model for determining competence through a comparison of the medical model for evaluating capacity. While a number of legal scholars have examined the appointment and oversight of guardians, fewer articles have critically examined the process by which individuals are declared incompetent. This Article presents a comprehensive overview of competency and clinical capacity determination procedures, legal mechanisms available to protect individuals with declining capacity, and policy recommendations for improving legal protections in light of inefficiencies related to legal competency determinations. PMID:23678789

  15. Retention in care and medication adherence: current challenges to antiretroviral therapy success.

    PubMed

    Holtzman, Carol W; Brady, Kathleen A; Yehia, Baligh R

    2015-04-01

    Health behaviors such as retention in HIV medical care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g., mental illness, substance abuse), patient-enabling factors (e.g., social support, reminder strategies, medication characteristics, transportation, housing, insurance), and healthcare environment factors (e.g., pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include (1) systematic monitoring of clinic attendance and ART adherence; (2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; (3) optimization of ART regimens and pharmaceutical supply chain management systems; (4) provision of reminder devices and tools; (5) general education and counseling; (6) engagement of peer, family, and community support groups; (7) case management; and (8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the healthcare environment. PMID:25792300

  16. Retention in Care and Medication Adherence: Current Challenges to Antiretroviral Therapy Success

    PubMed Central

    Holtzman, Carol W.; Brady, Kathleen A.; Yehia, Baligh R.

    2015-01-01

    Health behaviors, such as retention in HIV medical care and adherence to antiretroviral therapy (ART), pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g. mental illness, substance abuse), patient enabling factors (e.g. social support, reminder strategies, medication characteristics, transportation, housing, insurance), and health care environment factors (e.g. pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include 1) systematic monitoring of clinic attendance and ART adherence; 2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; 3) optimization of ART regimens and pharmaceutical supply chain management systems 4) provision of reminder devices and tools; 5) general education and counseling; 6) engagement of peer, family, and community support groups; 7) case management; and 8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the health care environment. PMID:25792300

  17. [Current status of the development of wireless sensors for medical applications].

    PubMed

    Moor, C; Braecklein, M; Jörns, N

    2005-01-01

    Wireless near-field transmission has been a challenge for scientists developing medical sensors for a long time. Here, instruments which measure a patient's ECG, oxygen saturation, blood pressure, peak flow, weight, blood glucose etc. are to be equipped with suitable transmission technology. Application scenarios for these sensors can be found in all medical areas where cable connections are irritating for the doctor, patient and other care personnel. This problem is especially common in sport medicine, sleep medicine, emergency medicine and intensive care. Based on its beneficial properties with regard to power consumption, range, data security and network capability, the worldwide standard radio technology Bluetooth was selected to transmit measurements. Since digital data is sent to a receiving station via Bluetooth, the measurement pre-processing now takes place in the patient sensor itself, instead of being processed by the monitor. In this article, a Bluetooth ECG, Bluetooth pulse oximeter, Bluetooth peak flow meter and Bluetooth event recorder will be introduced. On the one hand, systems can be realized with these devices, which allow patients to be monitored online (ECG, pulse oximeter). These devices can also be integrated in disease management programs (peak flow meter) and can be used to monitor high-risk patients in their home environment (event recorder).

  18. Emerging legal concerns with chronic diseases in the Australian workplace: pre-employment medicals, functional capacity evaluations, workers' compensation and disability discrimination.

    PubMed

    Guthrie, Robert; Westaway, Jennifer

    2009-05-01

    Although considerable attention is paid to injury and disease sustained or contracted through work causes, by far the most prolific cause of diminished health in the Australian workplace is chronic illness, which is not caused by work but which may have significant effects upon the work environment. Employers' concerns in relation to loss of productivity through poor health are reflected in a number of practices such as pre-employment screening, on-the-job drug testing and other health and safety requirements. In turn, workers' concerns regarding discrimination, workers' compensation and privacy are frequently raised in relation to discussions on workplace fitness for work. This article reflects on the issues of chronic illness and the legal issues which arise through the interaction of employers' obligations for safety and efficiency and workers' concerns with fairness and privacy. PMID:19554861

  19. Survey and analysis of the current state of residency training in medical-school-affiliated hospitals in China

    PubMed Central

    2014-01-01

    Background Since the global standards for postgraduate medical education (PGME) were published in January 2003, they have gained worldwide attention. The current state of residency training programs in medical-school-affiliated hospitals throughout China was assessed in this study. Methods Based on the internationally recognized global standards for PGME, residents undergoing residency training at that time and the relevant residency training instructors and management personnel from 15 medical-school-affiliated hospitals throughout China were recruited and surveyed regarding the current state of residency training programs. A total of 938 questionnaire surveys were distributed between June 30, 2006 and July 30, 2006; of 892 surveys collected, 841 were valid. Results For six items, the total proportions of “basically meets standards” and “completely meets standards” were <70% for the basic standards. These items were identified in the fields of “training settings and educational resources”, “evaluation of training process”, and “trainees”. In all fields other than “continuous updates”, the average scores of the western regions were significantly lower than those of the eastern regions for both the basic and target standards. Specifically, the average scores for the basic standards on as many as 25 of the 38 items in the nine fields were significantly lower in the western regions. There were significant differences in the basic standards scores on 13 of the 38 items among trainees, instructors, and managers. Conclusions The residency training programs have achieved satisfactory outcomes in the hospitals affiliated with various medical schools in China. However, overall, the programs remain inadequate in certain areas. For the governments, organizations, and institutions responsible for PGME, such global standards for PGME are a very useful self-assessment tool and can help identify problems, promote reform, and ultimately standardize PGME

  20. Representing Medical Knowledge in the Form of Structured Text: The Development of Current Disease Descriptions*

    PubMed Central

    Nelson, Stuart J.; Sherertz, David D.; Erlbaum, Mark S.; Tuttle, Mark S.

    1989-01-01

    As part of the Unified Medical Language System (UMLS) initiative, some 900 diseases have been described using “structured text.” Structured text is words and short phrases entered under labelled contexts. Vocabulary is not controlled. The contexts comprise a template for the disease description. The structured text is both manipulable by machine and readable by humans. Use of the template was natural, and only a few problems arose in using the template. Instructions to disease description composers must be explicit in definitions of the contexts. Diseases to be described are chosen, after clustering related diseases, according to the distinctions that physicians practicing in the area under question believe are important. Limiting disease descriptions to primitive observations and to entities otherwise described within the corpus appears to be both feasible and desirable.

  1. Impulsive Aggression, Delay Discounting, and Adolescent Suicide Attempts: Effects of Current Psychotropic Medication Use and Family History of Suicidal Behavior

    PubMed Central

    Reynolds, Brady; McBee-Strayer, Sandra M.; Sheftall, Arielle H.; Ackerman, John; Stevens, Jack; Mendoza, Kristen; Campo, John V.; Brent, David A.

    2015-01-01

    Abstract Objective: Impulsive-aggressive behaviors have been consistently implicated in the phenomenology, neurobiology, and familial aggregation of suicidal behavior. The purpose of this study was to extend previous work by examining laboratory behavioral measures of delayed reward impulsivity and impulsive aggression in adolescent suicide attempters and never-suicidal comparison subjects. Methods: Using the Point Subtraction Aggression Paradigm (PSAP) and the Delay Discounting Task (DDQ), the authors examined delay discounting and impulsive aggression in 40 adolescent suicide attempters, ages 13–18, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Results: Overall, suicide attempters and comparison subjects performed similarly on the PSAP and DDQ. There was a significant group by current psychotropic medication use interaction (p=0.013) for mean aggressive responses on the PSAP. Group comparisons revealed that attempters emitted more aggressive responses per provocation than comparison subjects, only in those not on psychotropic medication (p=0.049), whereas for those currently treated with psychotropic medication, there were no group differences (p>0.05). This interaction effect was specific to current antidepressant use. Among all subjects, family history of suicidal behavior (suicide or suicide attempt) in first degree relatives was significantly correlated with both delay discounting (r=−0.22, p=0.049), and aggressive responding (r=0.27, p=0.015). Family history of suicidal behavior was associated with delay discounting, but not with aggressive responding on the PSAP, after controlling for relevant covariates. Conclusions: In this study, impulsive-aggressive responding was associated with suicide attempt only in those not being treated with antidepressants. Future work to replicate and extend these findings could have important therapeutic implications for the treatment of depressed suicide attempters, many of whom are

  2. Model VESL Program Guide, Office Information Systems, International: One Semester Intensive Training Certificate of Achievement Programs in General, Medical, and Legal Office.

    ERIC Educational Resources Information Center

    Alvarez, Irma J.

    The Office Information Systems-International Program at Southwestern College, in California, was designed to provide Hispanic students with training for entry-level office employment. This model program guide stems from a project to improve curricula and delivery and focuses on changes in three intensive bilingual programs in general, medical, and…

  3. [On the applied medicolegal significance of the notion of "medical error"].

    PubMed

    Iurasov, V V; Smakhtin, R E

    2014-01-01

    The current practice of expertise of the adequacy of organization of the provision of medical aid introduces a new aspect of the notion of "medical error" that is widely employed in medical profession, among lawyers, patients, and their relatives as well as in mass media. The universally accepted meaning of this notion has not thus far been proposed. The authors consider the medico-legal concept of "medical error" reconciling the contradictory opinions.

  4. Medical imaging data reconciliation, part 3: reconciliation of historical and current radiology report data.

    PubMed

    Reiner, Bruce I

    2011-11-01

    Correlation of historical imaging and radiology report data with the current imaging data set is a critical step in the radiologic interpretation process and, if incomplete, can adversely affect diagnostic accuracy. In its current form, the extraction and analysis of historical imaging and report data is limited by manual workflow, inefficient data organization, and a lack of imaging and report data integration. The reconciliation of historical and contemporaneous radiology report data provides an opportunity to improve the consistency, completeness, and accuracy of radiology report data, while providing opportunities to automate workflow related to data extraction, interpretation, and peer review. The derived data analytics can in turn be used to facilitate physician consultations, education and training, and proactive intervention in the event of report discrepancies.

  5. Current status of medical and veterinary entomology in France: endangered discipline or promising science?

    PubMed

    Cuisance, Dominique; Antoine Rioux, Jean

    2004-09-01

    Following alarming statements (French Senate, Académie des Sciences) on the present situation concerning entomology and systematics in France, the Conseil Général Vétérinaire designated one of us (D.C.) to carry out a survey on the status of medical and veterinary entomology (MVE) with respect to research orientations and university curricula. Around 100 participants, including scientists, teachers and several directors of research and educational bodies, were interviewed and filled in questionnaires for this survey. On the basis of the results, it was concluded that the deterioration of MVE in France is associated with: (1) the hasty reorganisation of training and research in the life sciences, leading to the disappearance of several disciplines. Hence, the postgraduate DEA degree in entomology was eliminated, and even the name 'entomology' no longer appears in teaching programmes or on research contracts; (2) France's withdrawal from action research programmes in developing countries. Although these programmes were efficient in controlling outbreaks of major endemic diseases, integrated pest and vector management programmes have been replaced by basic health care ('Health for everyone in 2000') and vaccination programmes; (3) the general shift from field to laboratory research, focused mainly on molecular mechanisms. The survey results confirmed generally acknowledged trends concerning many points and highlighted several specific problems, such as the disappearance of systematics experts. Several potential solutions are proposed.

  6. Current state of information technologies for the clinical research enterprise across academic medical centers.

    PubMed

    Murphy, Shawn N; Dubey, Anil; Embi, Peter J; Harris, Paul A; Richter, Brent G; Turisco, Fran; Weber, Griffin M; Tcheng, James E; Keogh, Diane

    2012-06-01

    Information technology (IT) to support clinical research has steadily grown over the past 10 years. Many new applications at the enterprise level are available to assist with the numerous tasks necessary in performing clinical research. However, it is not clear how rapidly this technology is being adopted or whether it is making an impact upon how clinical research is being performed. The Clinical Research Forum's IT Roundtable performed a survey of 17 representative academic medical centers (AMCs) to understand the adoption rate and implementation strategies within this field. The results were compared with similar surveys from 4 and 6 years ago. We found the adoption rate for four prominent areas of IT-supported clinical research had increased remarkably, specifically regulatory compliance, electronic data capture for clinical trials, data repositories for secondary use of clinical data, and infrastructure for supporting collaboration. Adoption of other areas of clinical research IT was more irregular with wider differences between AMCs. These differences appeared to be partially due to a set of openly available applications that have emerged to occupy an important place in the landscape of clinical research enterprise-level support at AMC's. PMID:22686207

  7. Medical information and the right to privacy

    SciTech Connect

    Drell, D.

    1994-06-01

    This report is a compilation of submitted abstracts of papers presented at the DOE-supported workshop on medical information and the right to privacy held at the National Academy of Sciences in Washington, DC, on June 9 and 10, 1994. The aim of this meeting is to provide a forum to discuss the legal, ethical and practical issues related to the computerization and use of medical data, as well as the potential impact the use of these data may have on an individual`s privacy. Topical areas include an overview of the Federal and legal requirements to collect medical data, historical experiences with worker screening programs, currently available medical surveillance technologies (both biomedical and computer technologies) and their limitations. In addition, an-depth assessment of the needs and interests of a wide spectrum of parties as they relate to the use of medical data from both a legal and privacy perspective is provided. The needs of the individual, the public (e.g., blood and tissue banks), private enterprises (e.g., industry and insurance carriers), and the government (e.g., FBI) are discussed. Finally, the practical and legal issues relating to the use of computers to carry, store and transmit this information are also examined. The abstracts are presented in the intended order of presentation as indicated in the agenda for the meeting.

  8. Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada.

    PubMed

    Bosslet, Gabriel T; Baker, Mary; Pope, Thaddeus M

    2016-09-01

    Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States.

  9. Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada.

    PubMed

    Bosslet, Gabriel T; Baker, Mary; Pope, Thaddeus M

    2016-09-01

    Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States. PMID:27298070

  10. Medical marijuana: medical necessity versus political agenda.

    PubMed

    Clark, Peter A; Capuzzi, Kevin; Fick, Cameron

    2011-12-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights. PMID:22129912

  11. Medical marijuana: medical necessity versus political agenda.

    PubMed

    Clark, Peter A; Capuzzi, Kevin; Fick, Cameron

    2011-12-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.

  12. Medical marijuana: Medical necessity versus political agenda

    PubMed Central

    Clark, Peter A.; Capuzzi, Kevin; Fick, Cameron

    2011-01-01

    Summary Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government’s stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights. PMID:22129912

  13. Overview of the current attempts toward the medical treatment of cataract

    SciTech Connect

    Kador, P.F.

    1983-04-01

    A variety of agents are currently available that claim to either prevent, delay, or reverse cataracts associated with aging (senile cataracts), radiation, or diabetes and galactosemia (sugar cataracts). Senile cataract therapy includes formulation containing inorganic salts, nutritional supplements, natural product extracts, sulfhydryl, and sulfonic acid containing compounds and miscellaneous redox and nonsteroidal anti-inflammatory compounds. Agents associated with the treatment of radiation cataracts include antioxidants and free radial scavengers. Aldose reductase inhibitors have been effective in the prevention of sugar cataracts. A summary of these agents and their potential ocular effects are presented.

  14. Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering

    PubMed Central

    2012-01-01

    Serhan and colleagues introduced the term "Resoleomics" in 1996 as the process of inflammation resolution. The major discovery of Serhan's work is that onset to conclusion of an inflammation is a controlled process of the immune system (IS) and not simply the consequence of an extinguished or "exhausted" immune reaction. Resoleomics can be considered as the evolutionary mechanism of restoring homeostatic balances after injury, inflammation and infection. Under normal circumstances, Resoleomics should be able to conclude inflammatory responses. Considering the modern pandemic increase of chronic medical and psychiatric illnesses involving chronic inflammation, it has become apparent that Resoleomics is not fulfilling its potential resolving capacity. We suggest that recent drastic changes in lifestyle, including diet and psycho-emotional stress, are responsible for inflammation and for disturbances in Resoleomics. In addition, current interventions, like chronic use of anti-inflammatory medication, suppress Resoleomics. These new lifestyle factors, including the use of medication, should be considered health hazards, as they are capable of long-term or chronic activation of the central stress axes. The IS is designed to produce solutions for fast, intensive hazards, not to cope with long-term, chronic stimulation. The never-ending stress factors of recent lifestyle changes have pushed the IS and the central stress system into a constant state of activity, leading to chronically unresolved inflammation and increased vulnerability for chronic disease. Our hypothesis is that modern diet, increased psycho-emotional stress and chronic use of anti-inflammatory medication disrupt the natural process of inflammation resolution ie Resoleomics. PMID:22510431

  15. Recent and currently emerging medical treatment options for the treatment of alcoholic hepatitis

    PubMed Central

    Reep, Gabriel L; Soloway, Roger D

    2011-01-01

    Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome. Currently available specific treatment modalities are use of corticosteroids or pentoxifylline. However, the response rate to these drugs is only about 50%-60%. Hence, there is an urgent need for better and more effective treatment options. Tumor necrosis factor plays an important role in the pathogenesis of AH. However, agents blocking the action of tumor necrosis factor have not been found to be effective. Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients. Critical role of tumor necrosis factor in hepatic regeneration explaining this contrast is discussed. Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants, probiotics, and antibiotics in the management of AH. This article reviews the current data and status of these newer agents for the treatment of AH. Of the various options available, Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids. With these encouraging data, future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH. PMID:21954409

  16. [Exchange of medical imaging and data information in radiotherapy: needs, methods and current limits].

    PubMed

    Manens, J P

    1997-01-01

    Extension of the image network within radiotherapy departments provides the technical infrastructure which is made necessary by the rapid evolution of techniques in the field of diagnosis and treatment in radiotherapy. The system is aimed at managing the whole set of data (textual data and images) that are needed for planning and control of treatments. The radiotherapy network addresses two objectives: managing both the information necessary for treatment planning (target volumes definition, planning dosimetry) and the control of all parameters involved during the patient's treatment under the treatment unit. The major challenge is to improve the quality of treatment. Multimodal imaging is a major advance as it allows the use of new dosimetry and simulation techniques. The need for standards to exchange medical imaging information is now recognized by all the institutions and a majority of users and manufacturers. It is widely accepted that the lack of standard has been one of the fundamental obstacles in the deployment of operational "Picture Archiving Communication Systems". The International Standard Organisation Open System Interconnection model is the standard reference mode used to describe network protocols. The network is based on the Ethernet and TCP/IP protocol that provides the means to interconnect imaging devices and workstations dedicated to specific image processing or machines used in radiotherapy. The network uses Ethernet cabled on twisted-pair (10 BaseT) or optical fibres in a star-shaped physical layout. Dicom V3.0 supports fundamental network interactions: transfer of images (computerized tomography magnetic resonance imaging query and retrieve of images), printing on network attached cameras, support of HIS/RIS related interfacing and image management. The supplement to the Dicom standard, Dicom RT, specifies five data objects known in Dicom as Information Object Definition for relevant radiotherapy. Dicom RT objects can provide a mean for

  17. [Exchange of medical imaging and data information in radiotherapy: needs, methods and current limits].

    PubMed

    Manens, J P

    1997-01-01

    Extension of the image network within radiotherapy departments provides the technical infrastructure which is made necessary by the rapid evolution of techniques in the field of diagnosis and treatment in radiotherapy. The system is aimed at managing the whole set of data (textual data and images) that are needed for planning and control of treatments. The radiotherapy network addresses two objectives: managing both the information necessary for treatment planning (target volumes definition, planning dosimetry) and the control of all parameters involved during the patient's treatment under the treatment unit. The major challenge is to improve the quality of treatment. Multimodal imaging is a major advance as it allows the use of new dosimetry and simulation techniques. The need for standards to exchange medical imaging information is now recognized by all the institutions and a majority of users and manufacturers. It is widely accepted that the lack of standard has been one of the fundamental obstacles in the deployment of operational "Picture Archiving Communication Systems". The International Standard Organisation Open System Interconnection model is the standard reference mode used to describe network protocols. The network is based on the Ethernet and TCP/IP protocol that provides the means to interconnect imaging devices and workstations dedicated to specific image processing or machines used in radiotherapy. The network uses Ethernet cabled on twisted-pair (10 BaseT) or optical fibres in a star-shaped physical layout. Dicom V3.0 supports fundamental network interactions: transfer of images (computerized tomography magnetic resonance imaging query and retrieve of images), printing on network attached cameras, support of HIS/RIS related interfacing and image management. The supplement to the Dicom standard, Dicom RT, specifies five data objects known in Dicom as Information Object Definition for relevant radiotherapy. Dicom RT objects can provide a mean for

  18. A review of current research in microwave resonance therapy: novel opportunities in medical treatment.

    PubMed

    Jovanović-Ignjatić, Z; Raković, D

    1999-01-01

    Microwave Resonance Therapy (MRT) is a novel medical treatment, which represents a synthesis of the ancient Chinese traditional knowledge in medicine (acupuncture) and recent breakthroughs in biophysics. By affecting the appropriate acupuncture points by the generation of high frequency microwaves (52-78 GHz), remarkable clinical results are being achieved in surgery, orthopedic and traumatology, cardiovascular disorders, urology, gynecology, dermatology, gastroenterology, pulmology, upper respiratory tract, cardiology, neurology, and oncology during the last decade--the MRT being contraindicated only in the cases of acute pain in the abdomen demanding an operation, pregnancy, and menstruation cycle. In this paper the quantum-like macroscopic biophysical basis of the MRT and its technical details are elaborated too, offering a new insight in the mechanisms of the assembling gap junction hemichannels upon the internal microwave (MW) electromagnetic field spatio-temporal maximums at the temporary position of the acupuncture system, and, hence, the very biophysical nature of the temporary psychosomatic health or disease. The quantum-like coherent characteristics of the MRT (sharply-resonant sensory response of the disordered organism, extremely low-intensity and low-energy non-thermal biologically efficient MW radiation, and negligible MW energy losses down acupuncture meridians) might be viewed as a consequence of the existence of biological nonlocal selfconsistent macroscopic quantum potentials, which can give rise to nonlinear coherent EM MW long-range maser-like excitations of biological nonlinear absorption medium with the cells as active centers--with acupuncture meridians related to eigenfrequencies and spatio-temporal eigenwaves distributions of every individual biological quantum system. This suggests that a healthy condition might be considered as an absolute minimum (ground state) of the nonlocal selfconsistent macroscopic quantum potential of the organism

  19. Medical applications of wireless sensor networks - current status and future directions.

    PubMed

    Grgić, Krešimir; Zagar, Drago; Križanović, Višnja

    2012-02-01

    In recent years a significant development of BASN (Body Area Sensor Networks) as a special subclass of WSN (Wireless Sensor Networks) has emerged. These networks have enabled a rapid development of telemedicine systems, which provide remote monitoring of patients and their vital parameters. The article gives a short overview of the BASN networks. Furthermore, a general system architecture of telemedicine systems is proposed. The proposed architecture includes a local sensory area, a communication network area and an institutional network area. It also provides the security and privacy of patient-related data. Furthermore, the article surveys some existing telemedicine systems. Finally, some current problems are explained and the directions for the future development of the telemedicine systems are given. PMID:22634904

  20. Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.

    PubMed

    Dunnenberger, Henry M; Crews, Kristine R; Hoffman, James M; Caudle, Kelly E; Broeckel, Ulrich; Howard, Scott C; Hunkler, Robert J; Klein, Teri E; Evans, William E; Relling, Mary V

    2015-01-01

    Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.

  1. Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

    PubMed Central

    Linder, Regina

    2012-01-01

    Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stake-holders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships. PMID:23653802

  2. THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

    PubMed

    Bărcan, Cristian

    2015-01-01

    Current legislation, namely Law no. 95/2006 on healthcare reform in the medical malpractice domain stipulates that medical staff can be held accountable in the following forms: disciplinary liability, administrative liability, civil liability and criminal liability. Each form of legal liability presents its features, aspects that are found mainly in the procedural rules. However, the differences between the various legal forms of liability are not met only in the procedural rules but also in their effects and consequences. It is necessary to know what the procedure for disciplinary responsibility, administrative liability, civil liability, or criminal liability is. In addition to the differentiation determined by the consequences that may arise from the different forms of legal liability, it is important to know the competent authorities to investigate a case further and the solutions which various public institutions can take regarding the medical staff. Depending on the type of legal liability, authorities have a specialized authority. If the Disciplinary Committee is encountered at the College of Physicians, it may not intervene in cases before the monitoring and competence for malpractice cases Committee. The latter two committees cannot intervene directly in the legal assessment of civil or criminal cases, as no criminal investigation authorities cannot intervene in strictly civilian cases. Therefore, the importance of knowing the competent institutions is imperative.

  3. Legal aspects of satellite teleconferencing

    NASA Technical Reports Server (NTRS)

    Smith, D. D.

    1971-01-01

    The application of satellite communications for teleconferencing purposes is discussed. The legal framework within which such a system or series of systems could be developed is considered. The analysis is based on: (1) satellite teleconferencing regulation, (2) the options available for such a system, (3) regulatory alternatives, and (4) ownership and management aspects. The system is designed to provide a capability for professional education, remote medical diagnosis, business conferences, and computer techniques.

  4. Sepsis: Medical errors in Poland.

    PubMed

    Rorat, Marta; Jurek, Tomasz

    2016-01-01

    Health, safety and medical errors are currently the subject of worldwide discussion. The authors analysed medico-legal opinions trying to determine types of medical errors and their impact on the course of sepsis. The authors carried out a retrospective analysis of 66 medico-legal opinions issued by the Wroclaw Department of Forensic Medicine between 2004 and 2013 (at the request of the prosecutor or court) in cases examined for medical errors. Medical errors were confirmed in 55 of the 66 medico-legal opinions. The age of victims varied from 2 weeks to 68 years; 49 patients died. The analysis revealed medical errors committed by 113 health-care workers: 98 physicians, 8 nurses and 8 emergency medical dispatchers. In 33 cases, an error was made before hospitalisation. Hospital errors occurred in 35 victims. Diagnostic errors were discovered in 50 patients, including 46 cases of sepsis being incorrectly recognised and insufficient diagnoses in 37 cases. Therapeutic errors occurred in 37 victims, organisational errors in 9 and technical errors in 2. In addition to sepsis, 8 patients also had a severe concomitant disease and 8 had a chronic disease. In 45 cases, the authors observed glaring errors, which could incur criminal liability. There is an urgent need to introduce a system for reporting and analysing medical errors in Poland. The development and popularisation of standards for identifying and treating sepsis across basic medical professions is essential to improve patient safety and survival rates. Procedures should be introduced to prevent health-care workers from administering incorrect treatment in cases.

  5. [Role of classical oral glucose-lowering medications in current treatment].

    PubMed

    Carramiñana Barrera, F C

    2014-07-01

    Classical oral glucose were discovered in the mid twentieth century. Despite the time elapsed since then and the lack of large studies to support the use of some of these drugs, they continue to be employed, are indicated in all clinical practice guidelines and consensus documents and, overall, remain among the most widely prescribed drugs in the national health system. The main arguments for their continued use are their widespread and prolonged prescription, their effectiveness, and cost. Their main disadvantages have always been and continue to be their adverse gastrointestinal effects, weight gain, the risk of hypoglycemia and other adverse effects, which have encouraged the development of new glucose-lowering drugs with an improved pharmacological profile that would cover the various mechanisms of hyperglycemia. Currently, deep knowledge of glucose-lowering drugs is required in the patient-centered management of diabetes. Furthermore, this knowledge should be adapted to each individual patient to acquire the experience necessary to achieve effective metabolic control, delay the development of chronic complications, and improve the quality of life and life expectancy of patients with diabetes.

  6. Anti-dementia medications: current prescriptions in clinical practice and new agents in progress

    PubMed Central

    Stella, Florindo; Radanovic, Márcia; Canineu, Paulo Renato; de Paula, Vanessa J. R.

    2015-01-01

    Almost three decades after the publication of the first clinical studies with tacrine, the pharmacological treatment of Alzheimer’s disease (AD) remains a challenge. Randomized clinical trials have yielded evidence of significant – although modest and transient – benefit from cholinergic replacement therapy for people diagnosed with AD, and disease modification with antidementia compounds is still an urgent, unmet need. The natural history of AD is very long, and its pharmacological treatment must acknowledge different needs according to the stage of the disease process. Cognitive and functional deterioration evolves gradually since the onset of clinical symptoms, which may be preceded by several years or perhaps decades of silent, presymptomatic neurodegeneration. Therefore, the pharmacological treatment of AD must ideally comprise both a symptomatic effect to preserve or improve cognition and a disease-modifying effect to tackle the progression of the pathological process. Primary prevention is the ultimate goal, should these strategies be delivered to patients with preclinical AD. In this article, we briefly address the pharmaceutical compounds that are currently used for the symptomatic treatment of AD and discuss the ongoing strategies designed to modify its natural course. PMID:26301069

  7. [The fiscal position of medical specialists].

    PubMed

    Stevens, S; Moors, M

    2013-01-01

    Independent medical specialists in the Netherlands are treated as entrepreneurs for tax purposes and therefore enjoy tax benefits. A change in the legal relationship between medical specialists and hospitals is foreseen in 2015. Independent medical specialists will then no longer be considered to be entrepreneurs. This could negatively affect their tax position. The Dutch government has adopted a policy aimed at controlling expenses arising from medical specialists' fees. According to this policy, the formation of regional practices or mega-practices of specialists will be discouraged. In contrast, the current fiscal legislation encourages medical specialists to incorporate their practice into regional practices or mega-practices or to become shareholders of their hospitals. It has been proposed that fiscal benefits be linked to certain aspects of entrepreneurship, such as investing in medical equipment or employing medical personnel. PMID:23945433

  8. [The fiscal position of medical specialists].

    PubMed

    Stevens, S; Moors, M

    2013-01-01

    Independent medical specialists in the Netherlands are treated as entrepreneurs for tax purposes and therefore enjoy tax benefits. A change in the legal relationship between medical specialists and hospitals is foreseen in 2015. Independent medical specialists will then no longer be considered to be entrepreneurs. This could negatively affect their tax position. The Dutch government has adopted a policy aimed at controlling expenses arising from medical specialists' fees. According to this policy, the formation of regional practices or mega-practices of specialists will be discouraged. In contrast, the current fiscal legislation encourages medical specialists to incorporate their practice into regional practices or mega-practices or to become shareholders of their hospitals. It has been proposed that fiscal benefits be linked to certain aspects of entrepreneurship, such as investing in medical equipment or employing medical personnel.

  9. Legal issues associated with antimicrobial drug resistance.

    PubMed Central

    Fidler, D. P.

    1998-01-01

    An effective public health strategy against the development of antimicrobial drug resistance needs to be informed by legal as well as scientific analysis. This article describes some legal issues arising from current efforts against antimicrobial resistance and underscores the interdependence between law and public health in these efforts. PMID:9621187

  10. The Employment and Wages of Legalized Immigrants.

    ERIC Educational Resources Information Center

    Borjas, George J.; Tienda, Marta

    1993-01-01

    Analyzes employment and wages of recently legalized immigrants using the Legalization Application Processing System file which is based on individual records of amnesty applicants and draws comparisons with sample of foreign-born population from Current Population Surveys of 1983, 1986, and 1988. Among demographic differences of total foreign-born…

  11. [Legal consequences in cases of child abuse].

    PubMed

    Clauß, D; Richter, C; Klohs, G; Heide, S

    2013-09-01

    Medical child protection includes besides interdisciplinary diagnostics and treatment of physical and psychological symptoms also a discussion that looks at the ensuing legal consequences.This study analyses 21 criminally investigated cases of suspected child abuse from a 2 year study period and compares severity of injury to legal outcome.7 of those 21 criminal proceedings were already dropped by the prosecution and never went to trial. 4 of the 8 cases that led to a trial ended with a conviction. In all of the 4 cases that resulted in an acquittal the judges had been convinced that the child had been abused but found themselves unable to exactly identify the perpetrator. Our study's cases did not show a positive correlation between severity of injury and legal outcome.Diagnosing and treating children and minors within the context of medical child protection should always also include the ques-tion of possible legal consequences. The judicial process in cases of serious child abuse requires high medical expertise. Such expertise particularly includes the ability to determine the time of injury as exactly as possible and to provide precise written documentation of any medical findings. However, our study also shows that medical assessment is only one of many aspects in the legal response to child abuse. PMID:23975849

  12. [Legal consequences in cases of child abuse].

    PubMed

    Clauß, D; Richter, C; Klohs, G; Heide, S

    2013-09-01

    Medical child protection includes besides interdisciplinary diagnostics and treatment of physical and psychological symptoms also a discussion that looks at the ensuing legal consequences.This study analyses 21 criminally investigated cases of suspected child abuse from a 2 year study period and compares severity of injury to legal outcome.7 of those 21 criminal proceedings were already dropped by the prosecution and never went to trial. 4 of the 8 cases that led to a trial ended with a conviction. In all of the 4 cases that resulted in an acquittal the judges had been convinced that the child had been abused but found themselves unable to exactly identify the perpetrator. Our study's cases did not show a positive correlation between severity of injury and legal outcome.Diagnosing and treating children and minors within the context of medical child protection should always also include the ques-tion of possible legal consequences. The judicial process in cases of serious child abuse requires high medical expertise. Such expertise particularly includes the ability to determine the time of injury as exactly as possible and to provide precise written documentation of any medical findings. However, our study also shows that medical assessment is only one of many aspects in the legal response to child abuse.

  13. Current and upcoming erythropoiesis-stimulating agents, iron products, and other novel anemia medications.

    PubMed

    Macdougall, Iain C; Ashenden, Michael

    2009-03-01

    Treatment for anemia has come a long way in the last 20 years since the first recombinant human erythropoietins were licensed for the management of anemia in chronic kidney disease. The first-generation epoetins were succeeded by the development and production of a longer-acting erythropoietin (EPO) analog, darbepoetin alpha, which allowed less frequent dosing, usually once weekly or once every 2 weeks. More recently, another EPO-related molecule has been manufactured called Continuous Erythropoietin Receptor Activator with an even longer half-life, and although for patent reasons this is not available in the United States, it is licensed and is already being used in Europe. Other molecules are in development or are becoming licensed in Europe, including biosimilar epoetin products/follow-on biologics, and elsewhere in the world there are cheaper-production "copy" epoetins. Indeed, it is estimated that up to 80 such products may be sold in countries with less stringent regulatory control of pharmaceutical products. Two different biosimilar epoetins have already been licensed in Europe, one under 2 different brand names and one under 3 different brand names, and others may follow. Hematide is a synthetic peptide-based EPO receptor agonist that, interestingly, has no structural homology with EPO, and yet is still able to activate the EPO receptor and stimulate erythropoiesis. This agent is currently in phase III clinical trials. Research continues for orally active antianemic therapies, and several strategies are being investigated, although none is imminently available. Two new intravenous iron preparations have recently been developed, one in the United States (Ferumoxytol; AMAG Pharmaceuticals, Inc., Cambridge, MA) and one recently licensed in Europe (ferric carboxymaltose [Ferinject; Vifor Pharma, Zurich, Switzerland]). In conclusion, the development of effective therapies for the treatment of anemia has been a highly active field, both scientifically and

  14. Janet Benshoof: Master Legal Activist.

    ERIC Educational Resources Information Center

    Subotnik, Rena F.

    1995-01-01

    An interview with the legal activist, Janet Benshoof, focuses on her current activities (litigation and education about reproductive law), the development of her interest in women's rights and the law, her experience as a female law student at Harvard, her early education, her thoughts about special programs and rural education, and implications…

  15. School Safety & the Legal Community.

    ERIC Educational Resources Information Center

    Nicholson, George; And Others

    The role of the legal community in ensuring school safety is discussed, and effective antischool-crime programs involving attorneys and judges are described. Introductory passages comment on the overall role of courts and lawyers in education, the current national concern over crime and violence in schools, and national and California initiatives…

  16. Endocannabinoid system: An overview of its potential in current medical practice.

    PubMed

    Mouslech, Zadalla; Valla, Vasiliki

    2009-01-01

    The endocannabinoid system (ECS) is a lipid signalling system, comprising of the endogenous cannabis-like ligands (endocannabinoids) anandamide (AEA) and 2-arachidonoylglycerol (2-AG), which derive from arachidonic acid. These bind to a family of G-protein-coupled receptors, called CB1 and CB2. The cannabinoid receptor 1 (CB1R) is distributed in brain areas associated with motor control, emotional responses, motivated behaviour and energy homeostasis. In the periphery, the same receptor is expressed in the adipose tissue, pancreas, liver, GI tract, skeletal muscles, heart and the reproduction system. The CB2R is mainly expressed in the immune system regulating its functions. Endocannabinoids are synthesized and released upon demand in a receptor-dependent way. They act as retrograde signalling messengers in GABAergic and glutamatergic synapses and as modulators of postsynaptic transmission, interacting with other neurotransmitters. Endocannabinoids are transported into cells by a specific uptake system and degraded by the enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL). The ECS is involved in various pathophysiological conditions in central and peripheral tissues. It is implicated in the hormonal regulation of food intake, cardiovascular, gastrointestinal, immune, behavioral, antiproliferative and mammalian reproduction functions. Recent advances have correlated the ECS with drug addiction and alcoholism. The growing number of preclinical and clinical data on ECS modulators is bound to result in novel therapeutic approaches for a number of diseases currently treated inadequately. The ECS dysregulation has been correlated to obesity and metabolic syndrome pathogenesis. Rimonabant is the first CB1 blocker launched to treat cardiometabolic risk factors in obese and overweight patients. Phase III clinical trials showed the drug's ability to regulate intra-abdominal fat tissue levels, lipidemic, glycemic and inflammatory parameters. However

  17. AME survey-003 A1-part1: in current China, do you regret you joined the medical profession

    PubMed Central

    Lǐ, Yáo T.

    2015-01-01

    Background The medical workforce constitutes the foundation of the provision of health services in all countries. The effectiveness of health systems and the quality of health services are directly related to the performance of health workers. Satisfaction level of the job affects the quality of care for patients. An anonymous on-line survey was conducted with the aim to obtain a better understanding of the current morale of Chinese medical professionals. Methods An online cross-sectional questionnaire based survey was conducted during the period of Sep 10-23, 2015, via the platform provided by DXY (www.dxy.cn), which is the largest medical and paramedical related website in China. In addition to demographics of the participants, a particular question was asked to the participants, in current China do you regret you joined the medical profession? This initial report analyzed the relationship between the participants with ‘No’ or ‘Yes’ answers to their demographic characteristics. Results In total 2,356 DXY users completed the survey, including 1,740 males (73.82%) and 617 females (26.18%), with a mean age of 31.96±7.03 yrs. There were more participants from relatively economically developed eastern coast areas. The N/Y (no regret participants vs. regretted participants ratio) ratio for all participants was 1.06 (P=0.181). The N/Y ratio of males and females was 1.04 and 1.11 respectively, and there was no significant difference in this ratio among them. There were 1,549 participants from IIIA hospitals (65.72%, N/Y ratio =1.15, P=0.008), followed by IIIB & IIA hospitals (25.46%, N/Y ratio =0.87, P=0.086), IIB & II C hospitals (3.7%, N/Y ratio =0.83, P=0.394), and lastly 1A & 1B clinics (2.6%, N/Y ratio =1.35, P=0.249). A total of 1,323 participants (56.13%) were trainee doctors with N/Y ratio of 1.19 (P=0.002), followed by lecturer-level attending specialists (27.79%, N/Y ratio =0.81, P=0.009), associate principle doctors (12.43%, N/Y ratio =1.01, P=0

  18. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

    PubMed

    Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

    2014-01-01

    The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

  19. Current medical treatment of diabetes type 2 and long term morbidity: how to balance efficacy and safety?

    PubMed

    Carrera Boada, C A; Martínez-Moreno, J M

    2013-03-01

    Current medical treatment of type 2 diabetes mellitus (T2DM) requires special attention to different comorbidities that often are associated with hyperglycemia, such as overweight or obesity, dyslipidemia, hypertension, microvascular or macrovascular complications, etc. .. The control of these factors risk to health is as important as the glucose control in diabetes type 2, it is essential for the antidiabetes drugs consider these risk factors. The consensus statement published by the ADA/EASD and AACE emphasizes that the potential effects of antidiabetes medications on CV risk factors besides hyperglycemia (ie, overweight/obesity, hypertension, and dyslipidemia) should be considered in pharmacotherapy selection. Since T2DM is a progressive disease with worsening HbA1C values over time, monotherapy, even with different agents, will eventually fail to maintain the glycemic target. Because insulin resistance occurs in a variety of organs and tissues, many patients may achieve fasting glycemic control but develop postprandial hyperglycemia. Other issues include the risk for hypoglycaemia or weight gain with traditional glucose-lowering medications. The AACE/ACE algorithm for glycemic control is structured according to categories of HbA1C and suggests an HbA1C goal of =6.5%, although that may not be appropriate for all patients.42 The algorithm recommends monotherapy, dual therapy, or triple therapy based on initial HbA1C level of 6.5% to 7.5%, 7.6% to 9%, and >9% and reserves initiation of insulin therapy until treatment with oral or other injectable agents has failed. GLP-1 receptor agonists and DPP-4 inhibitors are novel options to improve glycemic control and reduce the incidence of weight gain. Combination therapy with newer and traditional agents improves glycemic control with a low incidence of hypoglycemia.

  20. Medical Management of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage: A Review of Current and Emerging Therapeutic Interventions.

    PubMed

    Adamczyk, Peter; He, Shuhan; Amar, Arun Paul; Mack, William J

    2013-01-01

    Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner.

  1. Gastroparesis: what is the current state-of-the-art for evaluation and medical management? What are the results?

    PubMed

    Lee, Allen

    2013-09-01

    Gastroparesis is a chronic motility disorder that leads to delayed gastric emptying and negatively impacts morbidity, mortality, and quality of life. This paper provides an overview of the pathophysiology leading to symptoms in gastroparesis, discusses tests for diagnosis, and examines the evidence behind different treatment options for gastroparesis. Although delayed gastric emptying is the cardinal finding in gastroparesis, other physiologic abnormalities may contribute to the pathogenesis of symptoms. Gastric emptying scintigraphy is considered the gold standard for the diagnosis of gastroparesis but novel tests are currently available. Although metoclopramide is the only FDA approved medication to treat gastroparesis, alternative therapeutic options are available and should be tailored according to symptoms as well as physiologic abnormalities. PMID:23801519

  2. The impact of marijuana policies on youth: clinical, research, and legal update.

    PubMed

    2015-03-01

    This policy statement is an update of the American Academy of Pediatrics policy statement "Legalization of Marijuana: Potential Impact on Youth," published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents' use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future.

  3. The impact of marijuana policies on youth: clinical, research, and legal update.

    PubMed

    2015-03-01

    This policy statement is an update of the American Academy of Pediatrics policy statement "Legalization of Marijuana: Potential Impact on Youth," published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents' use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future. PMID:25624383

  4. The Legal Implications of Student Use of Social Networking Sites in the UK and US: Current Concerns and Lessons for the Future

    ERIC Educational Resources Information Center

    Davies, Mark R.; Lee, Barbara A.

    2008-01-01

    This paper provides a comparative snapshot of the current state of the law in the US and UK with respect to potential liability of university and college students for use (and misuse) of social networking sites. It reviews the limited case law on this topic, highlights the differences in the two nations' laws of defamation and the various possible…

  5. Medical Practice Plans at U.S. Medical Schools. A Review of Current Characteristics and Trends. Volume I: Interim Final Report.

    ERIC Educational Resources Information Center

    Hilles, William C.; Fagan, Sharon K.

    The study of medical practice plans describes the structural and operational characteristics of over 60 plans in U.S. medical schools. A documented description of the way the respective clinical faculties conduct their patient care activities is included. The study further establishes a typology based on plan structure and classifies the plans…

  6. Managing Legal Affairs.

    ERIC Educational Resources Information Center

    Weeks, Richard H.

    2001-01-01

    Discusses school administrators' legal-affairs management responsibilities regarding legal advice, law versus ethics, and sources of law. Suggests strategies for retaining and managing legal counsel and avoiding situations involving litigation, torts, and conflict resolution. Explains general counsel services; outlines education,…

  7. Legal Scholarship: The Course.

    ERIC Educational Resources Information Center

    Markovits, Richard S.

    1998-01-01

    Outlines content of a law-school course in legal scholarship, describes course mechanics, and reports on its success. A section explains why law students should be given additional instruction in jurisprudence, legal history, and social science. Discusses legal education's content and quality, effects of student-run law reviews, and…

  8. Should medical laboratorians admit mistakes?

    PubMed

    Vermoch, K L

    2000-01-01

    Medical errors are a significant cause of adverse patient outcomes. However, the culture of health care expects laboratorians and other caregivers to perform perfectly at all times. When mistakes occur, the emphasis often is placed on punishing the "guilty" rather than on analyzing and improving the processes that allowed the mistake to happen. Owing to a fear of punishment, laboratory staff may be afraid to report errors and mishaps. Therefore, opportunities to learn from mistakes may not be recognized. In this article, a laboratory case study is used to describe the characteristics of medical errors and the ethical dilemmas presented to care-givers when mistakes occur. The legal and cultural barriers that often prevent the handling of medical mistakes in an ethical manner also are discussed. Finally, current initiatives proposed to improve the manner of dealing with medical mistakes are described.

  9. Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective.

    PubMed

    Ahmadiani, Saeed; Nikfar, Shekoufeh

    2016-01-01

    The right to health as a basic human right- and access to medicine as a part of it- have been a matter of attention for several decades. Also the responsibilities of different parties- particularly pharmaceutical companies- in realization of this right has been emphasized by World Health Organization. This is while many companies find no incentive for research and development of medicines related to rare diseases. Also some legal structures such as "patent agreements" clearly cause huge difficulties for access to medicine in many countries. High prices of brand medicine and no legal production of generics can increase the catastrophic costs- as well as morbidity-mortality of medication in lower income countries. Here we evidently review the current challenges in access to medicine and critically assess its legal roots. How societies/governors can make the pharmaceutical companies responsible is also discussed to have a look on possible future and actions that policy makers- in local or global level- can take.

  10. Implications of marijuana legalization for adolescent substance use.

    PubMed

    Hopfer, Christian

    2014-01-01

    Marijuana that is legally available for adults has multiple implications for adolescent substance use. One potential effect that legalization may have is an increase in adolescent use to due increased availability, greater social acceptance, and possibly lower prices. Legalization may also facilitate the introduction of new formulations of marijuana (edible, vaporized) and with potentially higher potencies. It is unknown what adolescent consumption patterns will be if marijuana is widely available and marketed in different forms, or what effects different patterns of adolescent use will have on cognition, the development of marijuana use disorders, school performance, and the development of psychotic illnesses. Also unclear is whether adolescent users will be experiencing higher levels of tetrahydrocannabinol (THC) compared with previous generations of users due to higher potencies. Although previous studies of the effects of adolescent marijuana use provide some guidance for current policy and public health recommendations, many new studies will be needed that answer questions in the context of use within a legal adult environment. Claims that marijuana has medicinal benefits create additional challenges for adolescent prevention efforts, as they contrast with messages of its harmfulness. Prevention and treatment approaches will need to address perceptions of the safety of marijuana, claims of its medicinal use, and consider family-wide effects as older siblings and parents may increasingly openly consume and advocate for marijuana use. Guidance for primary care physicians will be needed regarded screening and counseling. Widespread legalization and acceptance of marijuana implies that as law enforcement approaches for marijuana control decline, public health, medical, and scientific efforts to understand and reduce negative consequences of adolescent marijuana use need to be substantially increased to levels commensurate with those efforts for tobacco and alcohol.

  11. Implications of Marijuana Legalization for Adolescent Substance Use

    PubMed Central

    Hopfer, Christian

    2014-01-01

    Marijuana that is legally available for adults has multiple implications for adolescent substance use. One potential effect that legalization may have is an increase in adolescent use to due increased availability, greater social acceptance, and possibly lower prices. Legalization may also facilitate the introduction of new formulations of marijuana (edible, vaporized) and with potentially higher potencies. It is unknown what adolescent consumption patterns will be if marijuana is widely available and marketed in different forms, or what effects different patterns of adolescent use will have on cognition, the development of marijuana use disorders, school performance, and the development of psychotic illnesses. Also unclear is whether adolescent users will be experiencing higher levels of THC compared with previous generations of users due to higher potencies. While previous studies of the effects of adolescent marijuana use provide some guidance for current policy and public health recommendations, many new studies will be needed that answer questions in the context of use within a legal adult environment. Claims that marijuana has medicinal benefits create additional challenges for adolescent prevention efforts as they contrast with messages of its harmfulness. Prevention and treatment approaches will need to address perceptions of the safety of marijuana, claims of its medicinal use, and consider family-wide effects as older siblings and parents may increasingly openly consume and advocate for marijuana use. Guidance for primary care physicians will be needed regarded screening and counseling. Widespread legalization and acceptance of marijuana implies that as law enforcement approaches for marijuana control decline, public health, medical, and scientific efforts to understand and reduce negative consequences of adolescent marijuana use need to be substantially increased to levels commensurate with those efforts for tobacco and alcohol. PMID:25127003

  12. Intern doctors’ views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh

    PubMed Central

    Hoque, Rozina; Mostafa, Asma; Haque, Mainul

    2015-01-01

    Background Bacterial resistance due to antibiotic misuse is reported every day. Such threat calls for a consensus to develop new strategies to prevent the development of antibiotic resistance of bacteria. Medical doctors must play a pivotal role to control and prevent the misuse of antibiotics. There were complaints that prescribers are lacking behind in updates and advancement in the field. To address such knowledge gap, a study was conducted to know the views of interns on the current antibiotic resistance situation in a teaching hospital in Bangladesh. Methods This study was a cross-sectional, randomized, and questionnaire-based survey. Interns of the medicine, gynecology, and surgery departments of Chattagram Maa O Shishu Hospital Medical College were the study population. Results Out of 50 respondents, 98% would like more education on antibiotic selection. All respondents believed that prescribing inappropriate or unnecessary antibiotics was professionally unethical. Ninety percent of the participants were confident in making an accurate diagnosis of infection. Eighty-four percent of them were confident about dosage schedule. In all, 98% participants thought that antibiotic resistance is a national problem and 64% of the respondents thought that same problem also existed in their hospital. Study participants were of the view that 41%–60% of antibiotic usages are irrational in Bangladesh. Fifty-eight percent of the study population thought that antimicrobial resistance (AR) would be a greater problem in the future. Conclusion The interns believe that there is a knowledge gap on AR. More emphasis should be given to AR and its implications in the undergraduate curriculum. Latest national and international guidelines for antimicrobial therapy and resistance should be made available to the interns. PMID:26316762

  13. Provision of clinical forensic medical services in Australia: a qualitative survey 2011/12.

    PubMed

    Stark, Margaret M; Payne-James, J Jason

    2014-01-01

    The provision of clinical forensic medicine services is dependent on jurisdiction and relevant legal instruments. A needs analysis was performed to understand the current service provision within NSW and compare and contrast the service with other jurisdictions in Australia. The aim of this study was therefore to identify the roles, functions and clinical forensic medical services currently provided in the different Australian jurisdictions.

  14. Update on the right to refuse antipsychotic medication.

    PubMed

    Williams, Karl G

    1991-01-01

    The legal history and current developments in the right to refuse antipsychotic medication are reviewed. In Washington v. Harper the US Supreme Court analyzed the right to refuse antipsychotic medication under the due process clause of the Fourteenth Amendment to the US Constitution. A narrow issue was clarified but substantial uncertainty remains. As a result, law and policy problems at both state and institutional levels have become evident and may need to be addressed by drug policy decision makers. PMID:11659419

  15. Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning (APPEAL) study

    PubMed Central

    Briggs, Emma V; Battelli, Daniele; Gordon, David; Kopf, Andreas; Ribeiro, Sofia; Puig, Margarita M; Kress, Hans G

    2015-01-01

    Objectives Unrelieved pain is a substantial public health concern necessitating improvements in medical education. The Advancing the Provision of Pain Education and Learning (APPEAL) study aimed to determine current levels and methods of undergraduate pain medicine education in Europe. Design and methods Using a cross-sectional design, publicly available curriculum information was sought from all medical schools in 15 representative European countries in 2012–2013. Descriptive analyses were performed on: the provision of pain teaching in dedicated pain modules, other modules or within the broader curriculum; whether pain teaching was compulsory or elective; the number of hours/credits spent teaching pain; pain topics; and teaching and assessment methods. Results Curriculum elements were publicly available from 242 of 249 identified schools (97%). In 55% (133/242) of schools, pain was taught only within compulsory non-pain-specific modules. The next most common approaches were for pain teaching to be provided wholly or in part via a dedicated pain module (74/242; 31%) or via a vertical or integrated approach to teaching through the broader curriculum, rather than within any specific module (17/242; 7%). The curricula of 17/242 schools (7%) showed no evidence of any pain teaching. Dedicated pain modules were most common in France (27/31 schools; 87%). Excluding France, only 22% (47/211 schools) provided a dedicated pain module and in only 9% (18/211) was this compulsory. Overall, the median number of hours spent teaching pain was 12.0 (range 4–56.0 h; IQR: 12.0) for compulsory dedicated pain modules and 9.0 (range 1.0–60.0 h; IQR: 10.5) for other compulsory (non-pain specific) modules. Pain medicine was principally taught in classrooms and assessed by conventional examinations. There was substantial international variation throughout. Conclusions Documented pain teaching in many European medical schools falls far short of what might be expected given the

  16. Controlling Legal Risk for Effective Hospital Management

    PubMed Central

    Park, Hyun Jun; Cho, Duk Young; Park, Yong Sug; Kim, Sun Wook; Park, Jae-Hong

    2016-01-01

    Purpose To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. Materials and Methods This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Results Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Conclusions Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital. PMID:27169130

  17. [Ethical, legal, and social issues of genome research--new phase of genome research desperately requires social understanding and safeguards on the use of medical records and other personal information].

    PubMed

    Masui, Tohru; Takada, Yoko

    2003-03-01

    This article provides an overview of the use of human materials and information (human subject) in the new phase of pharmacological research and development in the current context, especially as it relates to the progress of the human genome project. In a sense, humanity has been drastically reduced to an array of DNA sequences that can be universally used in comparing living things. Pharmacological studies now acquire a unique status in bridging chemical substances to human body function. To perform the full activity of the nature of pharmacology, it requires both genotype and personal information, i.e. medical records and life style information, as research resources. In the UK, the Medical Research Council, the Wellcome Trust, and the Department of Health had started to plan UK Biobank for promoting and supporting the new stage of medical and pharmacological research and development. UK Biobank will collect DNA samples, medical records, and life style information of 500,000 people between the age range of 45 to 69 years old. It will follow the changes in health status of the participants for more than 10 years. The Biobank will provide researchers chances to correlate the genotypic traits to phenotypic ones, i.e. common diseases. In relation to the secondary use of medical records in health research, National Health Service (NHS) initiated a new strategy on the governance of patient information. These movements clearly demonstrated the indispensable nature of infrastructures for promoting and supporting pharmacological and medical research. We discuss on the necessary policies in constructing the Japanese infrastructure.

  18. A legal framework for biobanking: the German experience.

    PubMed

    Simon, Jürgen; Paslack, Rainer; Robienski, Jürgen; Cooper, David N; Goebel, Jürgen W; Krawczak, Michael

    2007-05-01

    Although biobanks are vital for modern medical research, serious concerns have been raised about the legal basis and framework of such endeavours. This led the German 'Telematics Platform for Medical Research Networks' ('Telematikplattform für Medizinische Forschungsnetze', TMF) to initiate a project in 2004 that was designed to place German biobanks on a sound legal footing. This project involved the planning, writing and evaluation of an expert report that addresses in great detail the legal issues concerning property rights, medical professional regulations, general liability insurance, resource continuity and research secrecy. Here, we provide a brief summary of the major results of this project.

  19. Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

    PubMed

    Barrocas, Albert; Cohen, Michael L

    2016-06-01

    Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team.

  20. Encapsulation and modified-release of thymol from oral microparticles as adjuvant or substitute to current medications.

    PubMed

    Rassu, G; Nieddu, M; Bosi, P; Trevisi, P; Colombo, M; Priori, D; Manconi, P; Giunchedi, P; Gavini, E; Boatto, G

    2014-10-15

    The aim of this study was to encapsulate, thymol, in natural polymers in order to obtain (i) taste masking effect and, then, enhancing its palatability and (ii) two formulations for systemic and local delivery of herbal drug as adjuvants or substitutes to current medications to prevent and treat several human and animal diseases. Microspheres based on methylcellulose or hydroxypropyl methylcellulose phthalate (HPMCP) were prepared by spray drying technique. Microparticles were in vitro characterized in terms of yield of production, drug content and encapsulation efficiency, particle size, morphology and drug release. Both formulations were in vivo orally administered and pharmacokinetic analysis was carried out. The polymers used affect the release and, then, the pharmacokinetic profile of thymol. Encapsulation into methylcellulose microspheres leads to short half/life but bioavailability remarkably increases compared to the free thymol. In contrast, enteric formulation based on HPMCP shows very limited systemic absorption. These formulations could be proposed as alternative or adjuvants for controlling pathogen infections in human or animal. In particular, methylcellulose microspheres can be used for thymol systemic administration at low doses and HPMCP particles for local treatment of intestinal infections. PMID:25442269

  1. Medical innovation laws: an unnecessary innovation.

    PubMed

    Richards, Bernadette

    2016-06-01

    Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

  2. [Deceased organ donors, legal regulations governing diagnosis of brain death, overview of donors and liver transplants in the Czech Republic].

    PubMed

    Pokorná, E

    2013-08-01

    The key restriction of transplantation medicine globally, as well as in the Czech Republic, concerns the lack of organs. The number of deceased donors, and thus the availability of organ transplants, has been stagnating in our country. The paper describes current legal regulations governing the dia-gnosis of brain death and primary legal and medical criteria for the contraindication of the deceased for organ explantation, gives an overview of the number of liver transplants, age structure, and diagnosis resulting in brain death of the deceased liver donors in the Czech Republic.

  3. [Deceased organ donors, legal regulations governing diagnosis of brain death, overview of donors and liver transplants in the Czech Republic].

    PubMed

    Pokorná, E

    2013-08-01

    The key restriction of transplantation medicine globally, as well as in the Czech Republic, concerns the lack of organs. The number of deceased donors, and thus the availability of organ transplants, has been stagnating in our country. The paper describes current legal regulations governing the dia-gnosis of brain death and primary legal and medical criteria for the contraindication of the deceased for organ explantation, gives an overview of the number of liver transplants, age structure, and diagnosis resulting in brain death of the deceased liver donors in the Czech Republic. PMID:24007222

  4. Epilepsy: legal discrimination from negative to positive.

    PubMed

    Mani, K S

    1997-01-01

    Indian law equates epilepsy with temporary insanity and also prohibits a legally valid marriage for a person with epilepsy with inherent risk of divorce. This absurd law, unique to India and possibly Brazil, must be excised in toto. Repeated petitions, by the Indian Epilepsy Association, to the Federal Government, have resulted in only vague assurances and alternate methods are under consideration. There are no legal impediments to education or work. Strict regulations against driving have yielded place to lax rules wherein a person can drive a vehicle, even after a recent fit, provided he gets a certificate from any registered medical practitioner. The nascent medical insurance specifically excludes epilepsy from its ambit. The cost of anti-epileptic drugs includes a 40% tax akin to Value Added Tax in the West. We must consider the impact of these legal impediments on the social fabric of the individual in his/her milieu and vis-a-vis priorities in national development. PMID:9212628

  5. Epilepsy: legal discrimination from negative to positive.

    PubMed

    Mani, K S

    1997-01-01

    Indian law equates epilepsy with temporary insanity and also prohibits a legally valid marriage for a person with epilepsy with inherent risk of divorce. This absurd law, unique to India and possibly Brazil, must be excised in toto. Repeated petitions, by the Indian Epilepsy Association, to the Federal Government, have resulted in only vague assurances and alternate methods are under consideration. There are no legal impediments to education or work. Strict regulations against driving have yielded place to lax rules wherein a person can drive a vehicle, even after a recent fit, provided he gets a certificate from any registered medical practitioner. The nascent medical insurance specifically excludes epilepsy from its ambit. The cost of anti-epileptic drugs includes a 40% tax akin to Value Added Tax in the West. We must consider the impact of these legal impediments on the social fabric of the individual in his/her milieu and vis-a-vis priorities in national development.

  6. Current state of professional and core competency in pediatric residency program at Shiraz University of Medical Sciences: A local survey

    PubMed Central

    EBRAHIMI, SEDIGHEH; REZAEE, RITA

    2015-01-01

    strengthening the quality of educational programs. According to this study the current status of the pediatrics department of Shiraz University of Medical Sciences was desirable leading to a satisfactory level in general. However, additional educational development will be needed in order to achieve a widespread change and improvement. PMID:26457316

  7. A primer on medical education in the United States through the lens of a current resident physician.

    PubMed

    Mowery, Yvonne M

    2015-10-01

    Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor's degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship.

  8. A primer on medical education in the United States through the lens of a current resident physician

    PubMed Central

    2015-01-01

    Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor’s degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26605316

  9. A primer on medical education in the United States through the lens of a current resident physician

    PubMed Central

    2015-01-01

    Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor’s degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26623123

  10. A primer on medical education in the United States through the lens of a current resident physician.

    PubMed

    Mowery, Yvonne M

    2015-10-01

    Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor's degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26623123

  11. A primer on medical education in the United States through the lens of a current resident physician.

    PubMed

    Mowery, Yvonne M

    2015-10-01

    Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor's degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26605316

  12. 42 CFR 35.12 - Solicitation of legal business prohibited.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal...

  13. 42 CFR 35.12 - Solicitation of legal business prohibited.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal...

  14. 42 CFR 35.12 - Solicitation of legal business prohibited.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal...

  15. Hereditary breast and gynecological tumors: Italian legal issues.

    PubMed

    DI Vella, Giancarlo

    2016-10-01

    The availability of diagnostic and therapeutic procedures that lower the risk for developing hereditary family-related tumors is weighed against Italian ethical and legal provisions. The healthcare environment in which a professional works should require that he possess specific technical, relational and medical competencies based upon legal orientation in addition to scientific evidence. Particular emphasis is attributed to the doctor-patient relationship, with explicit reference to the following: 1) all of the information at hand that is required to achieve a "therapeutic alliance" that combines the best interests of the patient with treatment options; 2) the completeness and intelligibility of health records, as they are likely to explain the background logic and the following of scientific clinical procedure; 3) the observance of guidelines and protocols, and their relevance to the legal responsibility of the individual and health care companies; 4) the need of a multidisciplinary approach in the treatment of these patients and the obligation of the team to have malpractice insurance. Advances on "provisions concerning liability of health personnel", which is currently awaiting approval, allows the professional to protect the patient's health without the fear of being unnecessarily censured, and unjustified from a penal or civil point of view which can deteriorate the relationship of trust and cooperation established.

  16. The legal status of 'no code orders'.

    PubMed

    Memel, S L; Lemkin, J W

    1978-05-01

    No code orders, lacking explicit definition and direct legal authority, pose many liability hazards for hospital medical staffs dealing with terminally ill patients. The decision to withhold life-support procedures must consider the high risk involved. Various situations that might entail no code orders are presented along with suggestions concerning the use of these orders. PMID:10306909

  17. Draft secure medical database standard.

    PubMed

    Pangalos, George

    2002-01-01

    Medical database security is a particularly important issue for all Healthcare establishments. Medical information systems are intended to support a wide range of pertinent health issues today, for example: assure the quality of care, support effective management of the health services institutions, monitor and contain the cost of care, implement technology into care without violating social values, ensure the equity and availability of care, preserve humanity despite the proliferation of technology etc.. In this context, medical database security aims primarily to support: high availability, accuracy and consistency of the stored data, the medical professional secrecy and confidentiality, and the protection of the privacy of the patient. These properties, though of technical nature, basically require that the system is actually helpful for medical care and not harmful to patients. These later properties require in turn not only that fundamental ethical principles are not violated by employing database systems, but instead, are effectively enforced by technical means. This document reviews the existing and emerging work on the security of medical database systems. It presents in detail the related problems and requirements related to medical database security. It addresses the problems of medical database security policies, secure design methodologies and implementation techniques. It also describes the current legal framework and regulatory requirements for medical database security. The issue of medical database security guidelines is also examined in detailed. The current national and international efforts in the area are studied. It also gives an overview of the research work in the area. The document also presents in detail the most complete to our knowledge set of security guidelines for the development and operation of medical database systems.

  18. The Use of Psychotropic Medication for People with Severe Disabilities and Challenging Behavior: Current Status and Future Directions.

    ERIC Educational Resources Information Center

    Kennedy, Craig H.; Meyer, Kim A.

    1998-01-01

    This article reviews basic literature on behavioral pharmacology and integrates these findings with existing applied research regarding psychotropic medication. Suggestions are provided for improving research practices, increasing the diversity of people in decision-making regarding medication use, and developing consumer-friendly strategies for…

  19. Current state of medical device nomenclature and taxonomy systems in the UK: spotlight on GMDN and SNOMED CT

    PubMed Central

    White, Judith; Carolan-Rees, Grace

    2013-01-01

    A standardised terminology for describing medical devices can enable safe and unambiguous exchange of information. Proposed changes to EU-wide medical devices regulations mandate the use of such a system. This article reviews two important classification systems for medical devices in the UK. The Global Medical Device Nomenclature (GMDN) provides a classification system specifically for medical devices and diagnostics, and facilitates data exchange between manufacturers and regulators. SNOMED CT is the terminology of choice in the NHS for communicating, sharing and storing information about patients’ healthcare episodes. Harmonisation of GMDN and SNOMED CT will encourage use of single terminology throughout the lifetime of a device; from regulatory approval through clinical use and post-marketing surveillance. Manufacturers will be required to register medical devices with a European device database (Eudamed) and to fit certain devices with a Unique Device Identifier; both are efforts to improve transparency and traceability of medical devices. Successful implementation of these elements depends on having a consistent nomenclature for medical devices. PMID:23885299

  20. Understanding the current anatomical competence landscape: Comparing perceptions of program directors, residents, and fourth-year medical students.

    PubMed

    Fillmore, Erin P; Brokaw, James J; Kochhar, Komal; Nalin, Peter M

    2016-07-01

    A mixed methods survey of fourth-year medical students, resident physicians, and residency program directors at the Indiana University School of Medicine gathered perceptions of anatomical competence-defined as the anatomical education necessary for effective clinical practice. The survey items explored numerous aspects of anatomical competence, including the most effective modes of instruction, perceptions of readiness for clinical practice, and specific suggestions for improving anatomical education during medical school and residency. The response rate was 46% for fourth-year medical students, 47% for residents (as graduates from 137 medical schools), and 71% for program directors. A majority of students and residents reported that their course in Gross Anatomy prepared them well for clinical practice; that cadaveric dissection was important in the early development of their anatomical competence; and that placing a greater emphasis on clinical relevance in medical school would have improved their anatomical competence even further. However, in terms of anatomical preparedness upon entering residency, the program directors rated their residents less prepared than the residents rated themselves. All three groups agreed that there is need for additional opportunities for anatomical educational during medical school and residency. Suggestions for improving anatomical education included the following: providing more opportunities for cadaveric dissection during medical school and residency; more consistent teaching of anatomy for clinical practice; more workshops that review anatomy; and better integration of anatomy with the teaching of other subjects during medical school. Anat Sci Educ 9: 307-318. © 2015 American Association of Anatomists.

  1. The legal status of Uncertainty

    NASA Astrophysics Data System (ADS)

    Altamura, M.; Ferraris, L.; Miozzo, D.; Musso, L.; Siccardi, F.

    2011-03-01

    An exponential improvement of numerical weather prediction (NWP) models was observed during the last decade (Lynch, 2008). Civil Protection (CP) systems exploited Meteo services in order to redeploy their actions towards the prediction and prevention of events rather than towards an exclusively response-oriented mechanism1. Nevertheless, experience tells us that NWP models, even if assisted by real time observations, are far from being deterministic. Complications frequently emerge in medium to long range forecasting, which are subject to sudden modifications. On the other hand, short term forecasts, if seen through the lens of criminal trials2, are to the same extent, scarcely reliable (Molini et al., 2009). One particular episode related with wrong forecasts, in the Italian panorama, has deeply frightened CP operators as the NWP model in force missed a meteorological adversity which, in fact, caused death and dealt severe damage in the province of Vibo Valentia (2006). This event turned into a very discussed trial, lasting over three years, and intended against whom assumed the legal position of guardianship within the CP. A first set of data is now available showing that in concomitance with the trial of Vibo Valentia the number of alerts issued raised almost three folds. We sustain the hypothesis that the beginning of the process of overcriminalization (Husak, 2008) of CPs is currently increasing the number of false alerts with the consequent effect of weakening alert perception and response by the citizenship (Brezntiz, 1984). The common misunderstanding of such an issue, i.e. the inherent uncertainty in weather predictions, mainly by prosecutors and judges, and generally by whom deals with law and justice, is creating the basis for a defensive behaviour3 within CPs. This paper intends, thus, to analyse the social and legal relevance of uncertainty in the process of issuing meteo-hydrological alerts by CPs. Footnotes: 1 The Italian Civil Protection is working

  2. A special report of current state of the medical physicist workforce - results of the 2012 ASTRO Comprehensive Workforce Study.

    PubMed

    Chen, Erli; Arnone, Anna; Sillanpaa, Jussi K; Yu, Yan; Mills, Michael D

    2015-01-01

    The medical physics profession is undergoing significant changes. Starting in 2014, candidates registering for certification exams by the American Board of Radiology must have completed a CAMPEP-accredited residency. This requirement, along with tightened state regulations, uncertainty in future reimbursement, and a stronger emphasis on board certification, have raised questions concerning the state of the medical physics workforce and its ability to adapt to changing requirements. In 2012, ASTRO conducted a workforce study of the comprehensive field of radiation oncology. This article reviews the findings of the medical physics section of the study, including age and gender distribution, educational background, workload, and primary work setting. We also report on job satisfaction, the perceived supply and demand of medical physicists, and the medical physicists' main concerns pertaining to patient safety and quality assurance. PMID:26103483

  3. A special report of current state of the medical physicist workforce - results of the 2012 ASTRO Comprehensive Workforce Study.

    PubMed

    Chen, Erli; Arnone, Anna; Sillanpaa, Jussi K; Yu, Yan; Mills, Michael D

    2015-05-08

    The medical physics profession is undergoing significant changes. Starting in 2014, candidates registering for certification exams by the American Board of Radiology must have completed a CAMPEP-accredited residency. This requirement, along with tightened state regulations, uncertainty in future reimbursement, and a stronger emphasis on board certification, have raised questions concerning the state of the medical physics workforce and its ability to adapt to changing requirements. In 2012, ASTRO conducted a workforce study of the comprehensive field of radiation oncology. This article reviews the findings of the medical physics section of the study, including age and gender distribution, educational background, workload, and primary work setting. We also report on job satisfaction, the perceived supply and demand of medical physicists, and the medical physicists' main concerns pertaining to patient safety and quality assurance.

  4. Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea

    PubMed Central

    Oh, Hyang Soon; Uhm, Dong Choon

    2015-01-01

    Objectives: Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea. Methods: A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test. Results: The mean age of the participants was 34.8±15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001). Conclusions: IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed. PMID:26639747

  5. Medical-Legal Partnership for Health Act

    THOMAS, 112th Congress

    Sen. Harkin, Tom [D-IA

    2011-09-22

    09/22/2011 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S5907-5908) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  6. Legal briefing: informed consent in the clinical context.

    PubMed

    Pope, Thaddeus Mason; Hexum, Melinda

    2014-01-01

    This issue's "Legal Briefing" column covers recent legal developments involving informed consent.1 We covered this topic in previous articles in The Journal of Clinical Ethics.2 But an updated discussion is warranted. First, informed consent remains a central and critically important issue in clinical ethics. Second, there have been numerous significant legal changes over the past year. We categorize recent legal developments into the following 13 categories: (1) Medical Malpractice Liability, (2) Medical Malpractice Liability in Wisconsin, (3) Medical Malpractice Liability in Novel Situations, (4) Enforcement by Criminal Prosecutors, (5) Enforcement by State Medical Boards, (6) Enforcement through Anti-Discrimination Laws, (7) Statutorily Mandated Disclosures Related to End-of-Life Counseling, (8) Statutorily Mandated Disclosures Related to Aid in Dying, (9) Statutorily Mandated Disclosures Related to Abortion, (10) Statutorily Mandated Disclosures Related to Telemedicine, (11) Statutorily Mandated Disclosures Related to Other Interventions, (12) Statutorily Mandated Gag and Censorship Laws, (13) Informed Consent in the Research Context. PMID:24972066

  7. [Second medical opinions].

    PubMed

    Vashitz, Geva; Davidovitch, Nadav; Pliskin, Joseph S

    2011-02-01

    Second opinion is a decision-support tool for ratification or modification of a suggested treatment, by another physician. Second opinion may have a critical influence on the diagnosis, treatment and prognosis. The patient can benefit from treatment optimization and avoid unnecessary risks. The physician can benefit from less exposure to legal claims, and healthcare organizations can benefit from increased treatment, quality assurance and costs saving from unnecessary surgery and treatments. Nevertheless, injudicious use of this tool can provoke unnecessary medical costs. In recent years, many patients prefer to seek a second opinion on their disease and available treatments. Private and public insurance companies are trying to control surgery costs by urging and even demanding a second opinion before surgery. Although second opinions are common in medical practice, relatively little is known on this subject. Most of the studies reviewed in this article evaluated the clinical benefit of second opinions, the reasons patients seek a second opinion and the characteristics of these patients, as well as technological interventions to promote second opinions, and ethical or legal issues related to second opinions. Yet, there are opportunities for further studies about physicians attitudes and barriers towards second opinions, their effect on patient-physician communication and cost-effectiveness analyses of second opinions. Due to the relevance of second opinions for public heath, this review aims to summarize the current research on second opinions.

  8. Cannabis, pesticides and conflicting laws: the dilemma for legalized States and implications for public health.

    PubMed

    Stone, Dave

    2014-08-01

    State laws on the legalization of medical and recreational cannabis are rapidly evolving. Similar to other crops, cannabis is susceptible to multiple pests during cultivation. Growers have an economic incentive to produce large yields and high quality plants, and may resort to pesticides to achieve these outcomes. Currently, there are no pesticides registered for cannabis in the United States, given its illegal status by the federal government. This discrepancy creates a regulatory vacuum and dilemma for States with legal medical and recreational cannabis that seek to balance lawful compliance with pesticides and worker or public health. Pesticide use presents occupational safety issues that can be mitigated through established worker protection measures. The absence of approved products for cannabis may result in consumer exposures to otherwise more hazardous pesticides or higher residue levels. While many legal and scientific hurdles exist to register conventional pesticides for use on cannabis, legalized States have explored other opportunities to leverage the present regulatory infrastructure. Stakeholder engagement and outreach to the cannabis industry from credible sources could mitigate pesticide misuse and harm.

  9. Cannabis, pesticides and conflicting laws: the dilemma for legalized States and implications for public health.

    PubMed

    Stone, Dave

    2014-08-01

    State laws on the legalization of medical and recreational cannabis are rapidly evolving. Similar to other crops, cannabis is susceptible to multiple pests during cultivation. Growers have an economic incentive to produce large yields and high quality plants, and may resort to pesticides to achieve these outcomes. Currently, there are no pesticides registered for cannabis in the United States, given its illegal status by the federal government. This discrepancy creates a regulatory vacuum and dilemma for States with legal medical and recreational cannabis that seek to balance lawful compliance with pesticides and worker or public health. Pesticide use presents occupational safety issues that can be mitigated through established worker protection measures. The absence of approved products for cannabis may result in consumer exposures to otherwise more hazardous pesticides or higher residue levels. While many legal and scientific hurdles exist to register conventional pesticides for use on cannabis, legalized States have explored other opportunities to leverage the present regulatory infrastructure. Stakeholder engagement and outreach to the cannabis industry from credible sources could mitigate pesticide misuse and harm. PMID:24859075

  10. Tuskegee redux: Evolution of legal mandates for human experimentation

    PubMed Central

    Levine, Robert S.; Williams, Jamila C.; Kilbourne, Barbara A.; Juarez, Paul D.

    2013-01-01

    Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the US by the PHS Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly question legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks -- not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease and other problems -- with PHS workers as silent partners. PMID:23124504

  11. Current Legal I-O Issues.

    ERIC Educational Resources Information Center

    Ofsanko, Frank

    This report focuses on a myriad of national, state, and local laws, regulations and court decisions which govern the everyday work of industrial and organizational psychologists. Legislation already in effect and legislation still pending are discussed. Citing relevant legislation and court decisions throughout the text, the paper addresses such…

  12. Legal interfaces in telemedicine technology.

    PubMed

    Lott, C M

    1996-05-01

    Telemedicine, an emerging technology which seeks to use advanced telecommunications equipment to enhance medical care, is progressing rapidly in the Department of Defense health care delivery system. This paper recommends that a cautious, preventive law approach be simultaneously initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed. Seven interfaces, in the areas of informed consent, physician liability, non-physician liability, costs, practice parameters, physician-patient relationships, and ergonomics, are discussed in the context of telemedicine. The author recommends that telemedicine pioneers include the legal community's early input in the application of telemedicine technology to help avoid needless litigation.

  13. School Safety Legal Anthology.

    ERIC Educational Resources Information Center

    Stephens, Ronald D., Ed.; And Others

    This legal anthology presents contemporary thoughts covering a broad range of topics in education and school safety from a national perspective. It covers four major areas: (1) an overview of schools in U.S. society from historical and legal perspectives; (2) an exploration of some aspects of school crime; (3) restitution, parental liability,…

  14. Fuller on Legal Education.

    ERIC Educational Resources Information Center

    Summers, Robert S.

    1984-01-01

    The perspectives of Lon L. Fuller on legal education in the 1940s and 1950s is outlined, including the responsibilities and tasks of the lawyer, curricular deficiencies, pedagogical deficiencies, the need for and objectives of a course in jurisprudence, research needs, and obstacles to good legal education. (MSE)

  15. Should Drugs Be Legalized?

    ERIC Educational Resources Information Center

    Chambliss, William; Scorza, Thomas

    1989-01-01

    Presents two opposing viewpoints concerning the legalization of drugs. States that control efforts are not cost effective and suggests that legalization with efforts at education is a better course of action (W. Chambliss). The opposing argument contends that the cost in human suffering negates any savings in dollars gained through legalization…

  16. Development of Legal Expertise

    ERIC Educational Resources Information Center

    Glöckner, Andreas; Towfigh, Emanuel; Traxler, Christian

    2013-01-01

    In a comprehensive empirical investigation (N = 71,405) we analyzed the development of legal expertise in a critical 1-year period of academic legal training in which advanced law students start practicing to solve complex cases. We were particularly interested in the functional form of the learning curve and inter-individual differences in…

  17. Legal responsibility and accountability.

    PubMed

    Cox, Chris

    2010-06-01

    Shifting boundaries in healthcare roles have led to anxiety among some nurses about their legal responsibilities and accountabilities. This is partly because of a lack of education about legal principles that underpin healthcare delivery. This article explains the law in terms of standards of care, duty of care, vicarious liability and indemnity insurance.

  18. Accreditation's Legal Landscape

    ERIC Educational Resources Information Center

    Graca, Thomas J.

    2009-01-01

    Like most issues in higher education, the accreditation paradigm in the United States is defined in large measure by the legal and political climate in which the academy finds itself. In the case of accreditation in particular, the legal substrate is of particular importance given the central role of accreditation in a college's ability to receive…

  19. Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions

    PubMed Central

    Akeroyd, Julia M; Chan, Winston J; Kamal, Ayeesha K; Palaniappan, Latha; Virani, Salim S

    2015-01-01

    AIM: To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients. METHODS: We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate. RESULTS: These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence. CONCLUSION: The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence. PMID:26730300

  20. Defending diversity: affirmative action and medical education.

    PubMed Central

    DeVille, K

    1999-01-01

    Affirmative action programs of all types are under attack legally and politically. Although medical schools have not been specifically targeted, their affirmative action programs, like others in higher education, are potentially in danger. This article examines the current legal status of affirmative action in medical education and concludes that a refurbished defense of such programs is essential if they are to survive impending judicial and political scrutiny. An analysis of existing case law and available evidence suggests that a carefully reinvigorated diversity argument is the tactic most likely to pass constitutional muster, as well as the justification most likely to blunt growing public and political opposition to admissions policies that take race and ethnicity into consideration. PMID:10432920