Friday, October 24, 2014

Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty

 2014 Oct 22. pii: 10.1377/hlthaff.2014.0492. [Epub ahead of print]

Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty.

Author information

  • 1Seth A. Seabury (seabury@usc.edu) is an associate professor at the Leonard D. Schaeffer Center for Health Policy and Economics and in the Keck School of Medicine, University of Southern California, in Los Angeles.
  • 2Eric Helland is a professor of economics at Claremont McKenna College, in Claremont, and the RAND Corporation in Santa Monica, both in California.
  • 3Anupam B. Jena is an assistant professor of health care policy and medicine at Harvard Medical School and a physician at Massachusetts General Hospital, both in Boston, Massachusetts.

Abstract

The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to the restrictiveness of the cap ($250,000 versus $500,000). We found that, overall, noneconomic damages caps reduced average payments by $42,980 (15 percent), compared to having no cap at all. A more restrictive $250,000 cap reduced average payments by $59,331 (20 percent), and a less restrictive $500,000 cap had no significant effect, compared to no cap at all. The effect of the caps overall varied according to specialty, with the largest impact being on claims involving pediatricians and the smallest on claims involving surgical subspecialties and ophthalmologists.

From U Washington: Medicolegal pitfalls of cataract surgery

 2014 Oct 21. [Epub ahead of print]

Medicolegal pitfalls of cataract surgery.

Author information

  • Department of Ophthalmology, University of Washington, Washington, USA.

Abstract

PURPOSE OF REVIEW:

To provide a general overview of medicolegal issues that may arise before, during, and after cataract surgery RECENT FINDINGS: The Department of Health and Human Services Office of Inspector General has designated ophthalmology as an auditing target, an unusual step to take for an entire specialty. Ongoing False Claims Act litigation may provide greater clarity on billing Medicare for a premium intraocular lens patient's return to the operating room and charging for an intervening exam when performing cataract surgery on both eyes.

SUMMARY:

Ophthalmologists should continue to follow basic principles that help decrease medicolegal risk. These include a thorough informed consent discussion before surgery and accurate and contemporaneous documentation. When complications arise, surgeons should handle them in accordance with best practices and refer patients appropriately. Problems can arise from inattentive postoperative care, so ophthalmologists should train staff members on handling of patient calls. Implementing safety protocols for intraocular lens implantation and asking for legal advice when considering certain types of financial arrangements are also prudent. Cataract surgeons also should follow guidelines for billing noncovered services carefully.

Pneumothorax in cystic fibrosis

 2014 Oct;6(Suppl 4):S480-7. doi: 10.3978/j.issn.2072-1439.2014.09.27.

Pneumothorax in cystic fibrosis.

Author information

  • 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200438, China ; 3 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 4 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Serbia; 7 Oncology Department, "Biomedicine" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Papageorgiou" General Hospital, Thessaloniki, Greece.

Abstract

Pneumothorax is recognized as a common and life-threatening complication in cystic fibrosis (CF) patients, especially in those who are infected with P. aeruginosa, B. cepacia or Aspergillus, need enteral feeding, are diagnosed as suffering from allergic bronchopulmonary aspergillosis (ABPA), developed massive hemoptysis, and their respiratory function is seriously compromised. Structural impairment and altered airflow dynamics in the lungs of CF patients are considered as the main predisposing factors, but also inhaled medications and non-invasive positive pressure ventilation (NIPPV) could increase the risk of pneumothorax. Clinical presentation could range from dramatic to very mild. Management of spontaneous pneumothorax occurring to patients with CF is essentially similar to that for non-CF patients. Therapeutic options include intercostal tube drainage, video-assisted thoracoscopic surgery (VATS), and medical or surgical pleurodesis. Pneumothorax increases both short- and long-term morbidity and mortality in CF patients and causes significant deterioration of their quality of life.

A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis

 2014 Oct 23;24:14090. doi: 10.1038/npjpcrm.2014.90.

A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis.

Author information

  • 1Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK.
  • 2Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • 3Department of Physiotherapy (Respiratory Medicine), Royal Infirmary of Edinburgh, Edinburgh, UK.
  • 4Department of Pharmacy (Respiratory Medicine), Royal Infirmary of Edinburgh, Edinburgh, UK.
  • 51] Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK [2] Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Abstract

Background:We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.
Aim:To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.
Methods:In this prospective study conducted over 5 years, we assessed patients' eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.
Results:A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.
Conclusion:Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

Ovarian reserve screening: a scientific and ethical analysis

 2014 Oct 21. pii: deu265. [Epub ahead of print]

Ovarian reserve screening: a scientific and ethical analysis.

Author information

  • 1Repromed, 180 Fullarton Road, Dulwich, South Australia, Australia Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK ktremellen@repromed.com.au.
  • 2Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.

Abstract

Ovarian reserve (OR) screening of the general population is generally not advocated as it has not been conclusively established to reflect immediate potential for natural conception, while it may also potentially create anxiety for women. However, in this paper, we argue in support of screening of the general population for diminished OR. First, OR tests such as measurements of anti-Müllerian hormone and antral follicle count are predictive of the chances of IVF conception, and therefore predict a woman's total fertility potential (i.e. chances of natural and IVF-related conceptions). Since the requirement for assisted conception increases with age, this is an important point. Secondly, women identified as having low OR are at increased risk of early loss of fertility potential in the longer term, limiting their reproductive life span and the size of their family if they delay conception. Thirdly, women often disregard generic advice to avoid delaying conception beyond 30 years of age, yet studies suggest that personalized risk assessment tools such as OR testing can actually increase an individual's motivation for positive change. A poor OR screening test result is more likely to convince a woman to bring forward her plans for natural conception, or alternatively explore oocyte vitrification, at a stage when these approaches still have reasonable prospects of success. Finally, we believe that women have a right, based on the ethical concept of autonomy, to be made aware of OR screening, so that they themselves can determine if OR testing is useful in assisting them with reproductive life planning.

The ethics and safety of medical student global health electives

 2014 Apr 10;5:63-72.

The ethics and safety of medical student global health electives.

Author information

  • 1Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada.
  • 2Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada.
  • 3Department of Medicine, Psychiatry, University of Toronto, Canada.
  • 4Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada.

Abstract

OBJECTIVE:

To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them.

METHODS:

Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced.

RESULTS:

We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety.

CONCLUSIONS:

Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.

Thursday, October 23, 2014

From Dartmouth: Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube

PLoS One. 2014 Oct 15;9(10):e110171. doi: 10.1371/journal.pone.0110171. eCollection 2014.

Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube.

Author information

  • 1The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America.
  • 2The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, United States of America.
  • 3The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America.
  • 4The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America; The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, United States of America.

Abstract

Increasingly, people with diverse health conditions turn to social media to share their illness experiences or seek advice from others with similar health concerns. This unstructured medium may represent a platform on which individuals with severe mental illness naturally provide and receive peer support. Peer support includes a system of mutual giving and receiving where individuals with severe mental illness can offer hope, companionship, and encouragement to others facing similar challenges. In this study we explore the phenomenon of individuals with severe mental illness uploading videos to YouTube, and posting and responding to comments as a form of naturally occurring peer support. We also consider the potential risks and benefits of self-disclosure and interacting with others on YouTube. To address these questions, we used qualitative inquiry informed by emerging techniques in online ethnography. We analyzed n = 3,044 comments posted to 19 videos uploaded by individuals who self-identified as having schizophrenia, schizoaffective disorder, or bipolar disorder. We found peer support across four themes: minimizing a sense of isolation and providing hope; finding support through peer exchange and reciprocity; sharing strategies for coping with day-to-day challenges of severe mental illness; and learning from shared experiences of medication use and seeking mental health care. These broad themes are consistent with accepted notions of peer support in severe mental illness as a voluntary process aimed at inclusion and mutual advancement through shared experience and developing a sense of community. Our data suggest that the lack of anonymity and associated risks of being identified as an individual with severe mental illness on YouTube seem to be overlooked by those who posted comments or uploaded videos. Whether or not this platform can provide benefits for a wider community of individuals with severe mental illness remains uncertain.

Wednesday, October 22, 2014

“One of the hangups for a lot of doctors is this inherent assumption with social media that it only exists to engage with patients. Nothing could be further from the truth”

Twitter touted as tool to sway minds


Dr. Vartabedian, associate professor of pediatrics at Baylor College of Medicine, has spoken about social media at meetings of the American College of Physicians and other physician organizations. In a forthcoming ebook, The Public Physician—Practical Wisdom for Life in a Connected, Always-On World, he offers detailed advice to help doctors thrive in the age of Twitter and tablet computers. He notes that social-media engagement’s greatest value may come in sparking communication with fellow health care professionals.
“One of the hangups for a lot of doctors is this inherent assumption with social media that it only exists to engage with patients. Nothing could be further from the truth,” Dr. Vartabedian says. “In fact, when you look at the public stream and then tens of thousands of doctors on there now—a lot of the conversation is professional to professional.”

Dallas nurse's dog, Bentley, doesn't have Ebola



Dallas nurse's dog, Bentley, doesn't have Ebola

Current Lung Cancer Screening Guidelines May Exclude High Risk Populations

 2014 Oct 1;146(4_MeetingAbstracts):593A. doi: 10.1378/chest.1994637.

Current Lung Cancer Screening Guidelines May Exclude High Risk Populations.

Abstract

SESSION TITLE:

Lung Cancer Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Lung cancer is the leading cause of mortality from cancer worldwide. Current lung screening guidelines recommend annual screening with low-dose computed tomography in 55 - 80 year old individuals with a 30 pack-year smoking history, who are currently smoking or have quit within the past 15 years. We applied the current guidelines to lung cancer cases diagnosed at an urban medical center over a 5-year time frame to determine the fraction of lung cancer cases that would be missed.
METHODS: Retrospective analysis of electronic medical record data from a tertiary teaching hospital in Georgia was used to evaluate all patients diagnosed with lung cancer between 2007 and 2012. Lung cancer cases staged IA, IB, IIA, IIB, IIIA, IIIB, IV were included.RESULTS: Of 843 lung cancer cases diagnosed in 2007 - 2012, the subjects were primarily African American and male. Racial and gender distributions are as follows: African Americans, n = 726 (86.1%) vs. 89 (10.5%) cases in non-Hispanic Whites vs. others 28 (3.3%); 338 (40.1%) females and 505 (59.9%) males. There were 5 (0.5%) lung cancer diagnoses in individuals aged 20 - 29 yrs; 16 (1.8%) diagnoses in ages 30 - 39 yrs; 93 (11%) cases in ages 40 - 49 yrs; 304 (36%) cases in ages 50-59; 272 (32.2%) cases in ages 60-69 yrs; 117 (13.8%) cases in ages 70-79 yrs; and 36 (4.2%) cases in subjects > 80 years of age. 150 (17.7%) cases would not have been captured by the current guidelines for lung cancer screening.
CONCLUSIONS: In this high-risk population, application of the current lung cancer screening guidelines would not have detected 17.7% of the cancers, as the majority (62%) occurred in 40-49 year-olds. As the mortality for lung cancer is high for African Americans, a one-size-fits-all screening policy may not be appropriate. Further research to determine screening guidelines for targeted groups, as indicated by our data, is warranted.
CLINICAL IMPLICATIONS: Early detection of lung cancer improves outcomes and the use of its screening methods can reduce mortality. Based on our data, current guidelines might have to be applicable on an individual basis so that we can incorporate factors such as race.

From Cook Co. Chief Medical Examiner Steve Cina and colleagues: Suggested guidelines for the management of high-profile fatality cases

 2008 Oct;132(10):1630-4. doi: 10.1043/1543-2165(2008)132[1630:SGFTMO]2.0.CO;2.

Suggested guidelines for the management of high-profile fatality cases.

Author information

  • 1Broward County Medical Examiners Office, Fort Lauderdale, Florida 33315, USA.

Abstract

CONTEXT:

The investigation of high-profile fatalities poses special challenges to medical examiners and coroners. Most high-profile cases can be readily recognized early in the course of the investigation. Commonly encountered examples include police-related fatalities or deaths in custody, deaths of celebrities, and mass fatalities or clustered deaths (eg, serial killers). Medical examiner and coroner offices should have policies and procedures in place for adequately handling such cases. A rational approach to these high-profile cases includes activating medical examiner or coroner investigative teams, preplanning before the autopsy, using special autopsy techniques and toxicology procedures, skillful questioning of key witnesses, preparing detailed and comprehensive reports, and planning effective communication with the media.

OBJECTIVE:

The investigation of the sudden and unexpected death of Anna Nicole Smith, an entertainment personality, is presented as an example of how to address the challenging issues inherent in high-profile fatalities and how to adequately prepare for the forensic investigation of high-profile cases.

DESIGN:

This article presents a methodical approach to the investigation of high-profile deaths.

RESULTS:

A comprehensive, preplanned forensic investigation and autopsy (including use of adjunctive studies) following the death of Anna Nicole Smith resulted in the accurate determination of the cause and manner of her death while adequately convincing the public of the objectivity and reliability of the Medical Examiners Office with respect to its conclusions.

CONCLUSION:

The forensic investigation of death in high-profile cases can be much more tedious and demanding than the investigation of routine cases. It requires more stringent safekeeping of the body and its evidence, more extensive and sophisticated dissection techniques on occasion, and exhaustive toxicologic analysis to exclude low-probability allegations. Procedures for honest, unbiased, and judicious communication with outside agencies and the media must be followed. Failure to follow such procedures might have serious consequences for the medical examiner, the family of the deceased, and the community at large. Adherence to these suggested guidelines may resolve most of the intricate problems involved in the investigation of these types of cases.

Tuesday, October 21, 2014

Michael Misialek: See, Test, and Treat Is Coming to Tufts Medical Center

See, Test, and Treat Is Coming to Tufts Medical Center


For the fifth straight year, Tufts Medical Center will host See, Test, & Treat®, a free cervical and breast cancer screening program, funded through grants from the College of American Pathologists (CAP) Foundation. The event features same-day test results, diagnoses, and follow-up care for uninsured and underserved women ages 21 and older. Dr. Michael J. Misialek, an associate chair of pathology at Newton-Wellesley Hospital and the medical director of the Vernon Cancer Center, attended See, Test, & Treat® at Rhode Island Hospital and filled us in on what it’s like from a doctor’s point of view.

Mapping the war: gender, health, and the medical profession in France and Germany, 1914-1918

 2014 Oct 13:1-19. [Epub ahead of print]

Mapping the war: gender, health, and the medical profession in France and Germany, 1914-1918.

Author information

  • a Institute for History, Philosophy and Ethics of Medicine , Johannes-Gutenberg University , Mainz , Germany.

Abstract

This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial 'map' which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war's impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?

Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?

 2014 Sep;4(5):672-5. doi: 10.4103/2141-9248.141495.

Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?

Author information

  • 1Department of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria ; Department of Public Health, Scholars of the South African Research Ethics Training Initiative, School of Health Sciences and Public Health University of Pretoria, Pretoria, South Africa.
  • 2Department of Public Health, Scholars of the South African Research Ethics Training Initiative, School of Health Sciences and Public Health University of Pretoria, Pretoria, South Africa ; Department of Obstetrics and Gynecology, Federal Medical Centre Abakaliki, Ebonyi State, Nigeria.
  • 3Department of Public Health, University of Ibadan Scholar of West African Bioethics Training, Ibadan, Oyo State, Nigeria.
  • 4Department of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.

Abstract

Bioethics principles and practice can be influenced by different cultural background. This is because the four globally accepted bioethics principles are often based on basic ethical codes such as autonomy, beneficence, nonmaleficence and justice. Beneficence/nonmaleficence requires us to maximize possible benefits, while minimizing possible harms and consequently secure the well-being of others by refraining from harming them. Autonomy gives individuals the right to self-actualization and decision-making, while justice is concerned with the fair selection and distribution of the burdens and benefits of research among participants. Applications of these principles in cultural settings vary more often from one cultural perspective to the other because of the different understanding and practices of "what is good." The proponents of global ethics may argue that these principles should be universally generalizable and acceptable, but this is not possible because of the existing cultural diversities. In the African set-up, despite the existence of major common cultural practices, there are other norms and practices, which differ from one society to the other within the communities. Therefore, the word "global" bioethics may not be applicable generally in practice except if it can account for the structural dynamics and cultural differences within the complex societies in which we live in. However, the extent to which cultural diversity should be permitted to influence bioethical judgments in Africa, which at present is burdened with many diseases, should be of concern to researchers, ethicist and medical experts taking into considerations the constantly transforming global society. This topic examines the cultural influence on principles and practice of bioethics in Africa.

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991

 2014 Oct 16:e1-e8. [Epub ahead of print]

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991.

Author information

  • 1At the time of the study, Deepak Sobti was a chief resident and Yuan He was a medical and public health student at the University of Arizona, Tucson. Marcos Cueto is with the Casa de Oswaldo Cruz, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.

Abstract

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political, and Policy Streams

 2014 Oct;88(5):292-301.

The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political and Policy Streams.

Abstract

PURPOSE:

Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking.

METHODS:

Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute.

RESULTS:

After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care.

CONCLUSION:

The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.

From Transilvania U and UC-Irvine: Informed Consent: How Much Awareness Is There?

 2014 Oct 16;9(10):e110139. doi: 10.1371/journal.pone.0110139. eCollection 2014.

Informed Consent: How Much Awareness Is There?

Author information

  • 1Department of Medical Ethics, Transilvania University, Brasov, Romania; Department of Clinical Research, Neomed Medical Center, Brasov, Romania.
  • 2Department of Psychiatry and Human Behavior, University of California Irvine School of Medicine, Irvine, California, United States of America; University of California Irvine Neuropsychiatric Center, Orange, California, United States of America.
  • 3Faculty of Psychology and Sciences of Education, Transilvania University, Brasov, Romania.
  • 4Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University, Brasov, Romania.
  • 5Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University, Brasov, Romania.

Abstract

Improving the informed consent process in clinical research is of constant concern to regulatory authorities in the field and presents a challenge for both the specialists and patients involved. Informed consent is a process that should adequately match the complexity of clinical research. In analyzing the behaviour of 68 patients during the informed consent process related to the clinical research performed at Neomed Clinical Center in Brasov, we found that many patients do not ask any questions (35.3%). From those who do, part of the questions (20,6%) referred to general aspects (addressed the form but not the gist) of the clinical trial, some (72,8%) referred to specific aspects of the clinical trial they will attend and others (6,6%) unrelated to the clinical trial. These results suggest a lack of interest, awareness, and understanding of the information presented in the informed consent form. The possible underlying causes of this attitude and its bureaucratic, ethic, and legal implications are discussed.

Monday, October 20, 2014

The specificity triad: notions of disease and therapeutic specificity in biomedical reasoning

Philos Ethics Humanit Med. 2014 Oct 18;9(1):14. [Epub ahead of print]

The specificity triad: notions of disease and therapeutic specificity in biomedical reasoning.

Abstract

Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model - the specificity triad - that draws on late philosopher and physician Ludwik Fleck's concept of "style of thought" to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine--psychiatry and regenerative medicine--this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology -- historically relatively disjointed from biomedical enterprise -- and the burgeoning field of regenerative medicine.

Wednesday, October 15, 2014

Tuesday, October 14, 2014

Clinical and Ethical Implications of Placebo Effects

 2014;225:217-235.

Clinical and Ethical Implications of Placebo Effects: Enhancing Patients' Benefits from Pain Treatment.

Author information

  • 1Outpatient Clinic of Behavior Therapy, Department of Psychology, University of Hamburg, Hamburg, Germany, rklinger@uni-hamburg.de.

Abstract

Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.