Quality assurance based on civil and penal law

The term "quality assurance" primarily concerns the provisions of professional regulations and law relating to health service physicians. It would be too sweeping to regard liability or criminal law as normative parameters for guaranteeing quality assurance in the narrower sense. Nevertheless, along with expert opinions sought within the context of relevant lawsuits, court rulings under civil law and criminal law in effect constitute an indirect form of "quality control". As a consequence, many court decisions act as a standard for the future. Civil law is concerned with determining whether the patient has received the quality of medical service to which he is entitled; for all intents and purposes, the same applies to the judgement of medical treatment under criminal law, whereby all cases, whether civil or criminal, concern diagnostic and therapeutic practice in specific treatment situations, the organisation of treatment and the provision of information. With regard to these areas, a contribution can therefore be made to quality assurance by observing pertinent civil and criminal judicature.     

Interactions between criminal justice and other areas of law from the viewpoint of the civil rights judge

More than in the past, patients are consulting lawyers to check medical treatment for malpractice. One of 10,000 city-inhabitants institutes proceedings for compensations. In the past, a charge was brought at the same time to achieve examination of patients records and to obtain an expert opinion at government expenses. Due to recent jurisdiction, the patient got the right to examine treatment records without the necessity to specify his reasons. Settlement institutions of the society of physicians of Germany facilitate an examination of a treatment procedure for mistakes without costs. Therefore, there is no more incentive for a charge to achieve compensations. The continuation of civil proceedings may not depend on the result of the investigation proceedings due to the different kind of evidence. The special duties of civil courts working with medical liability and expert opinions seem to show that civil proceedings are suited the best to clarify a dispute between physicians and patients. This also avoids to pillories the physician.     

Serum growth hormone-binding protein is decreased in prepubertal children with idiopathic short stature

Every activity of a medical practitioner may be subjected to court control. This creates not only uncertainty gut also anger amongst most physicians. However, it is clear that no court judgement against a physician will be made without the competent support of independent medical experts. On the basis of the relevant legal literature and judgments, the present article is an attempt to consider medical errors in the administration of contrast media, to describe the required medical informed consent before such measures, and to discuss the ever increasing importance of adequate documentation in the light of malpractice proceedings. importance of adequate documentation in the light of malpractice proceedings. This is followed by a discussion of the very important medical necessity to inform the patient about recommended behaviour after injections of such contrast media, the responsibility question in both civil and criminal terms in case of an incident, and various tips for steps to be taken in the case of a liability action.     

Progressive increase in the quantity of deviation in congenital esotropia

When an expert assessment for health reasons is carried out against a social welfare insurer, the medical expert has to know that he does not decide the outcome of the lawsuit. His task is to solely demonstrate and explain the medical facts. The lawyer decides whether this is followed by the claimed social contributions. It is not sufficient to just make a diagnosis. It has to be demonstrated what kind of consequences, i.e. whether a loss of functions or abilities occur and whether, therefore, impairments for the professional life can be derived. The area of conflict, where the expert witness moves between patient and medicine, legislation and client, becomes clear at the same time and is explained individually.     

Legal rights of the physician as the defendant

Until recently, physicians were confronted with a certain risk of prosecution typical of the medical profession such as personal injury or sometimes manslaughter. Now, physicians are compelled to face accusations apparently outside of this profession such as fraud, embezzlement, or cheating. When physicians get contact with the executive power (i.e. on the occasion of a search), it should be questioned whether one is seen as an accused or as witness. Both positions contain different rights and duties. The witness always has to testify. He can refuse to testify due to personal and professional reasons. Additionally, he may refuse to answer questions that would expose himself or a relative to the risk of charges. According to the German constitution, the witness may request the support of a lawyer. The main duty of the accused is to endure the proceedings against him. There is no option to appeal against the opening of criminal proceedings. The most important rights of the accused are the right to refuse the testimony and the right to be heard at court. The right of hearing includes the right to decide about the time and kind of a possible attendance during the proceedings. This right should be used in any case. Every unconsidered or uncertain statement may be of severe disadvantage. It is regularly indicated to ask a lawyer for legal support which is also the right of the accused. During testimony, the physician faces the problem whether he is allowed to reveal facts that are subject of medical discretion. He has the right to do so if he is unable to refute the accusation otherwise leading to legal sanctions or to a charge. The specific rights and options of an attorney include the scrutiny of the procedures of the executive power and the active participation to find the true facts of the case. It is the attorney but not the accused who has the right to examine the records. Both have the right to influence the criminal proceedings by contribution of evidence.     

The scope of forensic radiology

The use of x-ray in the solution of forensic problems commenced within days of R?ntgen's discovery; indeed, most of the applications of radiology to the forensic sciences were accomplished or anticipated within the next two years. The scope of forensic radiology ranges widely and includes determination of identity, evaluation of injury and death, applications in both criminal and civil litigation and in administrative proceedings, detection of abuse, investigation of gunshot wounds, medical education and research. Newer modalities and techniques afford opportunity for the expansion of forensic radiology if problems of accessibility and cost can be resolved along with improvement in interdisciplinary cooperation and understanding.     

The radiologist, the patient and Canadian law

A knowledge of basic medico-legal principles is necessary to the practice of medicine. The professional relationships with radiologists undertake with patients, employees, colleagues and hospitals are all founded on mutual consent and governed by a multitude of laws and regulations. The principal forms of legal proceedings which involve radiologists are criminal, civil and disciplinary actions. The discussion in this article is focused on the law relating to consent. The consent of the patient, which may be expressed or implied, is necessary in all phases of the doctor-patient reltionship. The amount of information which must be provided to allow a patient to give informed consent varies from case to case. It is affected by the risk and potential benefit of the procedure, the demand of the patient for information and many other factors. Obtaining informed consent not only helps protect the radiologist from legal action but also allows for a better doctor-patient relationship.     

The governance of psychological practice: Implications of American developments for Canadian psychology.

Describes 5 means of maintaining standards for psychological practice that are currently used in the US: (1) general and criminal law, (2) peer control, (3) federal regulations, (4) state boards of examiners in psychology, and (5) civil malpractice litigation. Their relevance to the Canadian context is discussed, especially with respect to the more restricted role of the Canadian federal government in professional affairs, the lower profile for civil rights, and the lower incidence of civil litigation in Canada. Recommendations made to ensure the exemplary practice of psychology include the increased use of peer control through peer review committees, increased organization of professional practice at the national level, and a closer liaison between professional associations and governing boards at the provincial level. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

建设项目(工程)安全预评价专家系统

专家系统已广泛地应用于各个领域，大大地提高了工作效率和工作质量。文中基于专家系统原理，建立了具有大量专业知识与经验并应用人工智能技术进行推理和判断的安全预评价专家系统，该系统与领域专家的决策过程一致，能科学地获得所需的最优评价方法。     

Ethical Guidelines for Psychologist Participation in Death Penalty Proceedings: A Survey.

Many states are reinstituting the death penalty and are asking psychologists to participate in the sentencing process. In some states we are asked to predict whether the person is likely to be a continuing danger to society. In other states we are asked if there are any reasons why the person should not be put to death. The question remains as to whether we as a profession want to be used as "agents of the State" in criminal, especially death penalty, proceedings. The APA (1978) task force recommended that as protection from abuses, ethical guidelines be instituted for psychologists working in legal settings. The basic thrust of these guidelines is the ensure that mental health expert testimony is truly expert and rest of a scientific, empirical base. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suppression of the degradation of adenine nucleotides during ischemia may not be a sufficient mechanism for infarct size limitation by preconditioning

OBJECTIVES: Exposure to pesticides in fruit growing was estimated by pesticide experts, occupational hygienists, and fruit growing experts to determine whether valid subjective assessments can be made by experts. The study objectives were (i) validation of exposure assessment by experts using different sources of information, (ii) assessment of interrater agreement, (iii) measurement of agreement between experts' assessments and actual quantitative exposure data. METHODS: Three groups with different expertise made four ratings. Three of the ratings were made in three phases in which exposure information was provided. RESULTS: The intraclass correlation was high for each subgroup of experts when tasks in fruit growing were relatively ranked by increasing exposure level. In general, the interrater agreement on factors influencing the internal dose decreased when more information on exposure was provided. Experts correctly considered dermal exposure as the prominent contributor to internal dose. Results were comparable for the three pesticides under study. The ranking of 15 specific sprayings with a fungicide clearly showed differences between raters according to their expertise. The pesticide experts and occupational hygienists were able to rank daily exposure levels during pesticide spraying in a meaningful way. CONCLUSIONS: Experts seem to recognize the most important determinants of external exposure and therefore should be able pay a role in evaluating the effectiveness of control measures taken to reduce external exposure and to determine exposure groups in epidemiologic studies. The expert panel should not be too small, and consensus or average estimates should be used because differences within expert groups can be considerable.     

The enforceability of expert opinion in theory and practice

This article provides a short review of the legal rules in Austria dealing with the minimum standards of expert opinions, absolutely necessary for the understanding and assessment of the opinion. As shown by an example of a case of handwriting investigation experts often ignore even the minimum standards. On the other hand judges do not consequently require these standards. This gap between theory and practice can only be filled by a thorough and perfect examination and by providing specific information to potential clients, given by professional associations.     

Assessment of digital EEG, quantitative EEG, and EEG brain mapping: report of the American Academy of Neurology and the American Clinical Neurophysiology Society

A. Digital EEG is an established substitute for recording, reviewing, and storing a paper EEG record. It is a clear technical advance over previous paper methods. It is highly recommended. (Class III evidence, Type C recommendation). B. EEG brain mapping and other advanced QEEG techniques should be used only by physicians highly skilled in clinical EEG, and only as an adjunct to and in conjunction with traditional EEG interpretation. These tests may be clinically useful only for patients who have been well selected on the basis of their clinical presentation. C. Certain quantitative EEG techniques are considered established as an addition to digital EEG in: C.1. Epilepsy: For screening for possible epileptic spikes or seizures in long-term EEG monitoring or ambulatory recording to facilitate subsequent expert visual EEG interpretation. (Class I and II evidence, Type A recommendation as a practice guideline). C.2. OR and ICU monitoring: For continuous EEG monitoring by frequency-trending to detect early, acute intracranial complications in the OR or ICU, and for screening for possible epileptic seizures in high-risk ICU patients. (Class II evidence, Type B recommendation as a practice option). D. Certain quantitative EEG techniques are considered possibly useful practice options as an addition to digital EEG in: D.1. Epilepsy: For topographic voltage and dipole analysis in presurgical evaluations. (Class II evidence, Type B recommendation). D.2. Cerebrovascular Disease: Based on Class II and III evidence, QEEG in expert hands may possibly be useful in evaluating certain patients with symptoms of cerebrovascular disease whose neuroimaging and routine EEG studies are not conclusive. (Type B recommendation). D.3. Dementia: Routine EEG has long been an established test used in evaluations of dementia and encephalopathy when the diagnosis remains unresolved after initial clinical evaluation. In occasional clinical evaluations, QEEG frequency analysis may be a useful adjunct to interpretation of the routine EEG when used in expert hands. (Class II and III evidence as a possibly useful test, Type B recommendation). E. On the basis of current clinical literature, opinions of most experts, and proposed rationales for their use, QEEG remains investigational for clinical use in postconcussion syndrome, mild or moderate head injury, learning disability, attention disorders, schizophrenia, depression, alcoholism, and drug abuse. (Class II and III evidence, Type D recommendation). F. On the basis of clinical and scientific evidence, opinions of most experts, and the technical and methodologic shortcomings, QEEG is not recommended for use in civil or criminal judicial proceedings. (Strong Class III evidence, Type E recommendation). G. Because of the very substantial risk of erroneous interpretations, it is unacceptable for any EEG brain mapping or other QEEG techniques to be used clinically by those who are not physicians highly skilled in clinical EEG interpretation. (Strong Class III evidence, Type E recommendation).     

Judge and attorney experiences, practices, and concerns regarding expert testimony in federal civil trials.

The results of 3 surveys (1 each of federal judges in 1991 and 1998 and another of attorneys in 1999) indicate that practices and beliefs concerning expert testimony have changed in the wake of the 1993 Supreme Court decision on admissibility in Daubert v. Merrell Dow Pharmaceuticals, Inc. Reporting both on their general experience with expert testimony and on their most recent civil trial involving such testimony, judges and attorneys indicated that judges were more likely in 1998 than in 1991 to scrutinize expert testimony before trial and then limit or exclude proffered testimony. The results describe common problems with expert testimony, the characteristics of trials in which expert testimony is introduced, and the types of experts who testify. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Medical expert systems]

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advice to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, self-education, directing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. Though, expert systems also have certain bad features: primarily, they are not physicians i.e. they can not examine a patient. Furthermore, expert system that is good for one certain area is often not good for another one. There are some cases, when these systems can confuse a physician and make him to make a wrong decision. This occurs very often in two specific cases: when the clinical situation is urgent; and when accuracy of clinical information is not definite.     

Children, psychiatrists and the courts: understanding the ambivalence of the legal profession. Part 1--General principles

Psychiatrists and other mental health professionals are frequently involved as expert witnesses in court proceedings related to children and adolescents. Their testimony may be based on a therapeutic relationship, but frequently arises because of an assessment conducted specifically for the court process. This two part paper discusses some of the issues that arise when child psychiatrists are involved as expert witnesses in litigation, with specific focus on their role in child custody, sexual abuse and young offender cases. It also offers some practical advice for those who may be called as witnesses. There is controversy in the legal profession about the role of mental health professionals in the court process. While there is recognition of their expertise, there is also a concern about not wanting to have experts usurp the role of the courts. Legal professionals also question the "objectivity" of experts, and the reliability of their opinions. Frequently the opinions of psychiatrists about children and adolescents involved in litigation have inherently speculative and value based dimensions, and not "scientific". Participation in the court process by mental health experts is nevertheless a vitally important role, providing information, analysis and recommendations about what are often very difficult societal decisions. Part two of this paper starts on page 531.     

The family, the courts, and mental health professionals.

Discusses the different facets of the role of mental health professionals (MHPs) in the legal system. The MHP's role in the family court is compared with that in the criminal court. In the family court, MHPs generally deal in crisis intervention, evaluation, and referral for treatment. Involuntary civil commitment and child abuse are also major issues. MHPs are called on to intervene in divorce and child custody proceedings. Some state legislatures have mandated the employment of MHPs in mental health clinics attached to the courts. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and suicide: A multisample investigation.

Evidence suggests that behavioral aspects of psychopathy are associated with suicidal behavior, whereas the affective and interpersonal aspects are not. The authors tested the robustness of this bifurcated association across 1,711 persons and 12 samples of adult and juvenile criminal offenders, forensic psychiatric patients, and civil psychiatric patients. The authors observed a small but significant partial correlation (.13) between the behavioral/impulsive lifestyle features of psychopathy and suicidality, but no effect for affective/interpersonal features. Several method and sample features (mental disorder; psychopathy and suicidality measurement format) significantly strengthened or weakened this association. The authors conclude that it is not possible to speak of "the" association between psychopathy and suicide, but that this relationship appears to be partially dependent on methodological (i.e., self-report vs. clinician-administered psychopathy measures) and sample composition (i.e., age; mental illness) factors. Recommendations for practice are provided, including that clinicians should not consider psychopathy a buffer against suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching psychology to jurists: Initiatives and reactions prior to World War I.

This article deals with the kind of psychology suggested for jurists that was thought to be necessary training for their work. An analysis of the content of two textbooks by Otto Lipmann and Karl Marbe reveals that such teaching activity involves two different levels of historical analysis. On the one hand, it relates to experimental research done by psychologists on law-related issues; on the other, it concerns the professional experience psychologists accumulated by acting as expert witnesses in court. The paper investigates how psychologists presented psychology to jurists, which methods and theories they suggested as being essential for juristic training and professional performance, and whether jurists appreciated these materials and efforts. These inquiries are embedded in the debate on the history of criminal psychology, taking into account the European, particularly the German, context. The author shows how specific historical developments led to an increased exchange between experimental psychology and criminal law during the first decades of the 20th century. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detecting Semantic Anomalies in Truck Weigh-in-Motion Traffic Data Using Data Mining

Monitoring data from event-based monitoring systems are becoming more and more prevalent in civil engineering. An example is truck weigh-in-motion (WIM) data. These data are used in the transportation domain for various analyses, such as analyzing the effects of commercial truck traffic on pavement materials and designs. It is important that such analyses use good quality data or at least account appropriately for any deficiencies in the quality of data they are using. Low quality data may exist due to problems in the sensing hardware, in its calibration, or in the software processing the raw sensor data. The vast quantities of data collected make it infeasible for a human to examine all the data. The writers propose a data mining approach for automatically detecting semantic anomalies i.e., unexpected behavior in monitoring data. The writers’ method provides automated assistance to domain experts in setting up constraints for data behavior. The effectiveness of this method is shown by reporting its successful application to data from an actual WIM system, the experimental data the Minnesota department of transportation collected by its Minnesota road research project (Mn/ROAD) facilities. The constraints the expert set up by applying this method were useful for automatic anomaly detection over the Mn/ROAD data, i.e., they detected anomalies the expert cared about, e.g., unlikely vehicles and erroneously classified vehicles, and the misclassification rate was reasonable for a human to handle (usually less than 3%). Moreover, the expert gained insights about system behavior, such as realizing that a system-wide change had occurred. The constraints detected, for example, periods in which the WIM system reported that roughly 20% of the vehicles classified as three-axle single-unit trucks had only one axle.