Avoiding litigation in an implant practice

The increase of low-density lipoproteids contents, high-density lipoproteids level lowering, reduction of the lymphocytes blast transformation reaction indexes, IgG level lowering, the rosette formation reduction were noted in patients with an acute pancreatitis. While the programmed relaparotomy application of the lipid-aliphatic metabolism restoration was noted, and the immunological reactivity as well with the dynamics higher than after single operative intervention conduction.     

Impact of malpractice litigation on professional psychology: Survey of practitioners.

Survey data revealed the extent of the rising threat of malpractice litigation against psychologists and its impact on the delivery of psychological services. Relatively few practitioners reported serious concerns about being sued for malpractice, although most had taken steps designed to protect against litigation. There was no evidence to substantiate claims of an outbreak of "litigaphobia" among psychologists. In general, the threat of malpractice litigation appears to act as an impetus for a variety of sound and ethical practice behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The misplace of litigation in medical practice

Cardiac magnetic resonance imaging (MRI) provides a wealth of morphological and physiological information. Automatic extraction of this information is possible by implementing various image processing techniques. However, existing procedures mostly rely on extensive human interaction and are seldom evaluated on a clinical scale. In this study, a nearly automatic process that extracts physiological parameters from cardiac MR images has been both developed and clinically evaluated. Raw images were obtained in the short-axis view and acquired by a gradient-cho (GE) protocol. In images selected to be analyzed, the only manual step required is the indication of a point in the center of the left ventricle (LV). From a set of such images, the process extracts endocardial and epicardial contours and calculates left ventricular volumes, mass and ejection fraction (EF). The process implements novel approaches to image processing techniques such as thresholding and shape extraction and can be adapted to other acquisition protocols. The process has demonstrated a clear potential for accurate extraction of the endocardial contour but a lower one with respect to the epicardial contour as a result of the low contrast between myocardium and some surrounding tissues, generated by the gradient-echo protocol. The ability of the process to asses physiological parameters has been subjected to a systematic clinical evaluation, which compared parameters, derived manually and automatically, in 10 healthy subjects and 10 patients. The evaluation has indicated that although individual volumes and mass were not accurately assessed, the automatic process has shown high potential for assessing the ejection fraction with relatively high accuracy and reliability.     

Cancer screening and early detection: managing malpractice risk

The accumulation of nicotinic acetylcholine receptors (AChRs) at neuromuscular synapses is triggered by agrin, a protein that is synthesized by both nerve and muscle. Nerve-derived agrin, which contains an amino acid insert at a conserved splice site in the carboxy-terminal part of the protein, induces AChR aggregation and causes tyrosine phosphorylation of the AChR beta subunit. In contrast, agrin isoforms synthesized by muscle cells lack such an insert and have no effect on AChR distribution. In order to identify possible functional roles of muscle-derived agrin we have analyzed further the effect of various fragments of recombinant agrin on AChR phosphorylation. A carboxy-terminal fragment of muscle agrin, c95A0B0, reduced AChR gamma and delta subunit phosphorylation when added to C2C12 myotubes in culture. Although c95A0B0 had no effect on AChR beta subunit phosphorylation when added alone, it inhibited AChR beta subunit phosphorylation and AChR aggregation by the nerve-specific agrin isoform c95A4B8. We conclude that muscle-derived agrin can influence, both directly and indirectly, AChR phosphorylation. Such changes may play a role in the formation, maintenance, or function of the neuromuscular junction.     

Ethical and malpractice issues in hospital practice.

Ethical and malpractice issues arising in hospital practice are reviewed. Topics include (a) preparation and authorization to carry out clinical responsibilities, (b) personnel procedures, (c) financial and political forces influencing hospital policies, (d) billing procedures, (e) clinical procedures for responding to patients' needs, (f) confidentiality, (g) discrimination, (h) internship and training issues, (i) sexual abuse of patients, and (j) staff conflicts influencing patient care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing clinical practice: The role of practice guidelines.

Health service researchers believe that significant practice variations occur, in part, because there is no strong consensus on best practices for managing a specific condition. The Agency for Health Care Policy and Research supports the development of science-based clinical guidelines, performance measures, and standards of quality. Since 1992, it has published 6 clinical guidelines and is supporting development of more than 20 others. Each has a consumer version, in English and Spanish, to educate patients and describe care options. Widespread use of these guidelines will improve the quality of health care by assisting providers in making more informed decisions, thereby reducing unnecessary health care practices; will reduce some costs; and will provide feedback on knowledge gaps that merit the attention and support of researchers and policymakers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and professional liability (malpractice) insurance: A retrospective review.

Claims of professional malpractice for a 54-mo period were analyzed and compared with prior experience (1961–1971 and 1974). Results confirm an apparent increase in the total number of claims against psychologists but do not confirm an increase per 1,000 insured. Findings suggest a greater public awareness of the psychologist's professional liability. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study

OBJECTIVE: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice. DESIGN: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete. SETTING: General practice in the Netherlands. SUBJECTS: 61 general practitioners who made 12 880 decisions in their contacts with patients. MAIN OUTCOME MEASURES: Compliance of decisions with clinical guidelines according to the attribute of the guideline. RESULTS: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)). CONCLUSIONS: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.     

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.     

Surgeons'' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer

BACKGROUND: In-vitro and in-vivo studies demonstrated the radiosensitizing effect of interferon beta on malignant tumor tissue as well as simultaneously a radioprotective effect on normal lung tissue. In this phase II study the outcome of combining radiotherapy with interferon beta in patients with advanced non-small cell lung cancer was evaluated. PATIENTS AND METHOD: From February 1994 until November 1996 14 patients with non-small cell lung cancer, stage IIIB were treated with locoregional radiation up to 59.4 Gy, with daily doses of 1.8 Gy and 5 fractions per week. Five million units of interferon beta (Fiblaferon) were given intravenously immediately preceding radiotherapy on the first 3 days of week 1, 3 and 5. RESULTS: Four of 14 patients (28.6%) showed complete response and 7 patients (50%) partial response, resulting in an overall response rate of 78.6%. After a mean follow-up time of 23.3 months the 1-, 2- and 3-year survival rates were 56.3%, 37.5% and 37.5%, respectively. The median survival time was 13 months. Three of 14 patients (21.4%) suffered from 7 Grade-3 acute side effects and 2 patients (14.3%) from 1 Grade-3 late toxicity in each case. One further patient, whose right lung was resected 3 months after completion of radiotherapy, developed as a consequence of this operation 2 Grade-4 complications. CONCLUSION: Considering the toxicity and the preliminary results of combining irradiation and interferon beta in the treatment of locally advanced non-small cell lung cancer it seems, that this procedure is worth to be tested in a phase III study.     

Medical shortages and Confederate medicine: a retrospective evaluation

The Union's decision to treat medicines and medical supplies as contraband of war meant, for the Confederacy, the specter of medical shortages. The Confederate medical department significantly lessened the subsequent suffering through an energetic and resourceful program to supply its physicians' needs. Medicines and medical supplies were purchased abroad and smuggled through the Union blockade, obtained in an illicit trade with the North, captured from the enemy, and manufactured in the Confederacy. The search for home remedies, enthusiastically endorsed by Surgeon General Samuel P. Moore, was one of the most prominent features of the southern program. This paper surveys and analyzes medical shortages and Confederate medicine.     

Medical malpractice involving radiologic colon examinations: a review of 38 recent cases

OBJECTIVE: Our purposes were to determine the causes of malpractice claims against radiologists performing contrast examinations of the colon and to design strategies to reduce litigation and diminish patient morbidity. MATERIALS AND METHODS: Reports of malpractice claims were collected from legal journals and databases between 1985 and 1994. For this period, 38 plaintiffs raised 52 allegations of malpractice that involved radiologists performing barium or Hypaque (meglumine diatrizoate; Winthrop Pharmaceuticals, New York, NY) colon examinations. For the 38 cases, 18 plaintiffs for decedents alleged that failure to diagnose colorectal cancer by barium enema examination caused delay in treatment and the patient's death. Eighteen plaintiffs alleged that improper performance of barium (17 cases) or meglumine diatrizoate (one case) colon examinations caused perforation of the colon, resulting in significant morbidity (15 cases) or death (three cases). Miscellaneous causes for malpractice claims were recorded in two cases. RESULTS: In 18 cases of failure to diagnose colorectal cancer, the initial radiographs were interpreted as follows: normal findings in 14 cases, diverticulosis in one case, and spastic bowel in two cases; in the remaining case, colon cancer was missed because of nonopacification of the cecum. In retrospect, 17 of 18 colorectal cancers were visualized. The delay in the diagnosis of colorectal cancer ranged from 5 to 72 months. Missed colorectal cancers occurred in the cecum (two cases), transverse colon (two cases), rectosigmoid area (nine cases), or unspecified area (five cases). In 18 cases of colon perforation, the site was the cecum (one case), transverse colon (one case), extraperitoneal rectum (seven cases), rectosigmoid area (one case), colostomy stoma (two cases), or unspecified area (six cases). One patient experienced anaphylactic shock that required hospitalization. One underwent unnecessary surgery because barium enema films showing colon cancer were mislabeled with her name. CONCLUSION: On the basis of our analyses of malpractice claims, we suggest strategies to prevent medicolegal litigation. Strategies include communicating with the patient about the type and indications of the barium enema examination, performing digital rectal examinations on all patients to detect distal rectal lesions or strictures, recognizing colon perforation, and obtaining immediate surgical consultation if colon perforation occurs. The number of missed colon cancers may be reduced by reading twice or reviewing at a later time all barium enema examinations.     

Clinical practice guidelines for managing major depression in primary care practice: Implications for psychologists.

Clinical practice guidelines are being developed by professional and governmental bodies to improve the quality of health care. The guidelines developed by the US Public Health Service Agency for Health Care Policy and Research seek to improve the primary care physician's ability to diagnose and treat major depression. Clinical, educational, and research implications for psychologists are considered in light of how the recommended guidelines potentially will influence the nature and quality of care provided for mood disorders by generalist physicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)