Stress and medical malpractice: Organizational risk assessment and intervention.

Four studies were conducted to examine both the relation between stress and medical malpractice and the impact of stress management programs in reducing malpractice risk. Sixty-seven hospitals and more than 12,000 individuals participated. In Study 1, hospital departments with a current record of malpractice reported higher levels of on-the-job stress than did matched, low-risk departments. In Study 2, workplace stress levels of 61 hospitals correlated significantly with frequency of malpractice claims. In Study 3, a longitudinal investigation was conducted to evaluate the impact of an organization-wide stress management program on the frequency of reported medication errors. Results suggest a significant drop in average monthly medication errors as a result of the program. Study 4 was a 2-year longitudinal investigation that compared the frequency of medical malpractice claims. Hospitals (n?=?22) that implemented an organization-wide stress management program had significantly fewer claims as compared with a matched sample of hospitals (n?=?22) that did not participate. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hillside study of risk and early detection in schizophrenia

BACKGROUND: The Hillside Study of Risk and Early Detection in Schizophrenia is a prospective study of young probands (ages 14-28) and their at-risk siblings (ages 14-24). A major goal is the identification of early predictors of illness that will facilitate intervention. The project design and pilot study are discussed. METHOD: Fifteen adolescents were compared to 14 typical age-of-onset adults, all undergoing their first hospitalisation for schizophrenia. RESULTS: There were no differences between adolescents and adults on any of the measures administered (i.e. attention, eye tracking, neurocognitive or clinical). In addition, for the sample overall, no association was found between neurocognitive functions and clinical state, either at admission or after treatment. CONCLUSIONS: Individuals with adolescent onset of schizophrenia are considered to be representative of schizophrenia in general. Furthermore, neurocognitive deficits and clinical symptoms are concluded to be two independent classes of risk indicators.     

Medical practice guidelines in malpractice litigation: an early retrospective

The role of practice guidelines in malpractice litigation has been discussed in some theoretical detail. Little information is available, however, on how courts use guidelines or on the effort of state legislatures to explicitly link guideline compliance with malpractice defenses. We review all relevant case law and legislative enactments to shed light on the influence of medical malpractice on guidelines. We also use data from a nationwide survey of malpractice attorneys to supplement our legal analysis. Although guidelines are being used for both inculpatory and exculpatory purposes in common-law litigation (a two-way street), legislatures are interested in applying them only for exculpatory purposes (a one-way street).     

Cancer screening: overview and prospects

In Table 4, current "state-of-the-art" screening for various cancers is summarized. It is fair to say that, unfortunately, only a minority of the tumors do have proven screening methods that lead to a lower disease-specific mortality. Given the relative lack of improvement in survival rates over the last few decades, this area should be a priority for research endeavors.     

Cardiovascular risk during ECT: managing the managers

Although atrophie blanche is classified as a vasculitis, its presentation and management differ from the classical vasculitis. We present a patient with idiopathic atrophie blanche and discuss its management.     

Undescended testes: screening and early operation

The prevalence of undescended testes at birth, or cryptorchidism, is about 2-3%--higher among premature babies. Associated complications include infertility and malignancy, and a number of studies have shown that UK screening programs to date--the examinations carried out by the community services, for example--have failed to identify cryptorchidism at an early age in many cases. If complications, particularly infertility, are to be avoided, operations on undescended testes should be done before the age of two; at this age, operation may also be less disturbing for the patient. The cause of maldescent of the testes is uncertain, but there are related conditions, including exposure to oestrogens in the first trimester, and low birth weight: these need to be considered as they influence management.     

Complaints, malpractice, and risk management: Professional issues and personal experiences.

As psychologists strive to affect human welfare in a positive way, their greater exposure and responsibilities have led to worry about potential malpractice lawsuits and state licensing board complaints. Are psychologists at increasing risk for litigation? What steps can they take to alleviate the stress and worry? A survey of licensed psychologists (N?=?284) explored professional awareness, personal experiences, and practice activities related to complaints, malpractice lawsuits, and risk management. Professional psychologists are urged to stay informed regarding events and activities that may result in lawsuits or complaints and to practice in a manner that best provides protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post partum thyroiditis: is early detection of risk patients during pregnancy worthwhile?]

IL-12, which play a fundamental antitumor role, would be also involved in the physiological regulation of neuroendocrine and immune interactions. At present, however, there are no data about the endocrine effects of IL-12. This preliminary study was performed to investigate the acute endocrine effects of IL-12 in metastatic renal cell cancer patients. Each IL-12 injection consisted of 0.5 micrograms/kg/bw subcutaneously in the morning. The study has evaluated the effects of 6 different injection cycles. Serum samples were collected before, and 4, 8 and 12 hours from IL-12 injection. In each sample, we have measured by the RIA method serum levels of GH, PRL, TSH, FSH, LH, T3, T4, cortisol, testoterone, estradiol and the pineal hormone melatonin. No significant change occurred in TSH, FSH, LH, T3, T4, testoterone and melatonin mean serum levels in response to IL-12 administration. In contrast, cortisol, PRL and estradiol significantly increased after Il-12 injection. GH also increased in response to IL-12, without however, significant differences with respect to the baseline values. This preliminary study shows that the acute subcutaneous injection of IL-12 may influence the endocrine secretions in humans. In particular, IL-12 would stimulate the secretions of cortisol, PRL and estradiol. Therefore, this study would further confirm that IL-12 may act as biological response modifier in humans, not only on the immune system, but also on the neuroendocrine functions.     

Colorectal cancer detection and screening

Colon cancer is a leading cause of death in the United States and is estimated to cause 56,500 deaths during 1998. Most cancers evolve from adenomatous polyps. Screening asymptomatic average-risk individuals is recommended to reduce colorectal cancer mortality by detection and removal of adenomatous polyps.     

Preventing and managing board complaints: The downside risk of custody evaluation.

Data compiled by the American Psychological Association (APA) revealed that 7%–10% of ethics complaints filed were against custody evaluators. Comparative data from various state and provincial psychology boards remain too sketchy to permit an accurate appraisal of this problem at the local level. Nevertheless, vulnerability to ethics complaints remains an occupational hazard for the private practitioner who engages in custody assessment. This article offers practitioners who conduct custody evaluations suggestions for reducing their risk of incurring an ethics complaint and discusses variables to consider when responding to a review board inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer prevention and screening in women

In recent years, there have been several advances in blood irradiation practice. These include a better definition of the most appropriate dose level that should be used when irradiating blood components. Commercial innovation has provided the tools for a quality assurance program to assess the dose that is delivered throughout the canister in a free-standing irradiator, and, through the use of radiation-sensitive indicator labels, to confirm that the irradiation process has taken place. With the apparent increased use of linear-accelerators to irradiate blood components, appropriate quality assurance measures need to be developed. The maximum storage period for irradiated red cells should be shorter than for nonirradiated red cells if the treatment is performed early during the storage period because irradiation reduces the in vivo 24-hour red cell recovery parameter. The storage period for irradiated platelets does not need to be modified. Some questions are being raised regarding whether fresh-frozen plasma should be irradiated to inactivate a small number of immunocompetent progenitor cells that may be present. Table 4 summarizes the practices that should be followed in connection with the technical issues that have been addressed in this article. These guidelines follow the recommendations issued in July 1993 by the FDA in the United States. This article and Tables 1 and 2 contain additional guidelines.     

Solo versus group practice in the medical profession: the influence of malpractice risk

While Partnerships are a significant form of business organization in many sectors of the economy, relatively little is known about the incentives which lead to their formation. This paper explores the formation of partnerships among office based physicians when facing some risk of malpractice litigation. Theoretical results indicate that malpractice exposure can increase the incentives to shirk within a partnership, and so exert a significant influence on the decision to form a partnership. Empirical results find that malpractice risk has the expected negative effect on some partnership formation.     

Dental malpractice: practical tips on avoiding a dental malpractice claim

With a few simple strategies, dentists can avoid the expensive trauma of malpractice litigation. Sometimes it's just a matter of maintaining good records.     

Observations on the early detection of prostate cancer from the American Cancer Society National Prostate Cancer Detection Project

BACKGROUND: The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was established in 1987. The experience of the ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer. METHODS: A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial study outcomes were the detection yield of multimodality testing and the comparative sensitivity and specificity of the different tests employed. Longer term outcomes included patient quality of life and survival. RESULTS: The cancer detection rate declined significantly across the years of intervention. DRE had lower sensitivity than TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that of DRE. Fewer than 9% of the cancers detected in this study were clinically advanced at the time of diagnosis. Ninety-four percent of patients in whom cancer was detected are alive after an average follow-up of 54 months. In one case, death occurred after surgery. Two deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment. CONCLUSIONS: Results of the ACS-NPCDP indicate that a combined-modality approach to prostate cancer detection yields high levels of early detection with infrequent adverse outcomes. Continued follow-up is required to evaluate long term morbidity and mortality.