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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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PubMed1977

Dangerousness, confidentiality, and the duty to warn.

The Tarasoff decision, by imposing on psychiatrists an obligation to warn the intended victim of threats made by a patient, but only under certain vaguely specified circumstances, may stampede psychiatrists into issuing such warnings to avoid possible legal liability no matter how remote the risk of harm may actually be. The authors suggest that the ill effects of such a reaction by psychiatrists--breach of confidentiality and the attendant erosion of trust and harm to the therapeutic alliance--can often be easily avoided by taking less drastic steps, some of which are illustrated by case presentations.

Adult↗
PubMed1990

Patients may not recall disclosure of risk of death: implications for informed consent.

This study examined the issue of rational decision-making involved in the 'patient need' standard of informed consent. A majority of elective cholecystectomy patients (90% of 144) correctly identified their risk of death on a multiple choice questionnaire after preoperative counselling, but before surgery. However, many of those patients who answered correctly (54%) reported that they were not informed about the risk of death when questioned again after discharge. An attempt to discriminate patients who reported being informed from those who did not using measures of preoperative pain, emotional distress and medication was not successful. Faced with an inability to obtain informed consent from some patients, coupled with legal liability for failing to do so, surgeons are advised to obtain consent in writing, to provide comprehensive, multi-media counselling, and to be particularly conscientious with confused patients and those with complications.

Adolescent↗
PubMed1983

Pharmacists' dispensing accuracy in a high-volume outpatient pharmacy service: focus on risk management.

A 12-day peer-review audit was performed in the outpatient pharmacy of a large teaching hospital. The audit process was not masked, that is, the pharmacists were aware of the peer-review evaluation. During the 12-day period, 9394 prescription forms and their corresponding pharmaceutical products were examined manually before being delivered to the patient. A total of 1165 (12.4 percent) dispensing errors were detected, with 141 (1.5 percent) of these considered potentially serious. Seventy-six prescriptions contained two errors and four prescriptions contained three. A linear relationship (r2 = 0.78; p less than 0.001) existed between the number of potentially serious errors and the total number of prescriptions filled. There were no statistically significant differences in the dispensing-error rate for the eight pharmacists audited. There was a trend for the number of pharmacist-hours containing at least one potentially serious dispensing error to increase as the prescription-filling rate accelerated. Outpatient pharmacies with high volumes should set a limit to the number of prescriptions filled by their pharmacists and should experiment with quality assurance systems to reduce dispensing errors and subsequent legal liabilities.

Clinical Competence↗
PubMedDate not supplied

Psychopharmacists' role in neuroleptic therapy. A pharmaceutical care approach.

OBJECTIVE: To describe the roles of the psychopharmacist in the use of neuroleptic therapy. SETTING: A geriatric psychiatry ambulatory care clinic in a 400-bed Department of Veterans Affairs Medical Center, San Diego, California. CONCLUSIONS: In the pharmaceutical care model, the pharmacist is involved in several important roles in the provision of neuroleptic therapy. In the ambulatory care program, psychopharmacists provide important drug-related information to patients and consultation regarding potential neuroleptic-induced adverse effects. In addition, psychopharmacists serve as consultants to other clinicians concerning the risks associated with the use of neuroleptics and participate in neuroleptic-discontinuation clinics. Morbidity associated with neuroleptic-induced tardive dyskinesia has exposed healthcare providers to legal repercussions; therefore, pharmacy intervention may aid in the reduction of legal liability.

Aged↗
PubMed2001

Waiting lists for radiation therapy: a case study.

BACKGROUND: Why waiting lists arise and how to address them remains unclear, and an improved understanding of these waiting list "dynamics" could lead to better management. The purpose of this study is to understand how the current shortage in radiation therapy in Ontario developed; the implications of prolonged waits; who is held accountable for managing such delays; and short, intermediate, and long-term solutions. METHODS: A case study of the radiation therapy shortage in 1998-99 at Princess Margaret Hospital, Toronto, Ontario, Canada. Relevant documents were collected; semi-structured, face-to-face interviews with ten administrators, health care workers, and patients were conducted, audio-taped and transcribed; and relevant meetings were observed. RESULTS: The radiation therapy shortage arose from a complex interplay of factors including: rising cancer incidence rates; broadening indications for radiation therapy; human resources management issues; government funding decisions; and responsiveness to previous planning recommendations. Implications of delays include poorer cancer control rates; patient suffering; and strained doctor-patient relationships. An incompatible relationship exists between moral responsibility, borne by government, and legal liability, borne by physicians. Short-term solutions include re-referral to centers with available resources; long-term solutions include training and recruiting health care workers, improving workload standards, increasing compensation, and making changes to the funding formula. CONCLUSION: Human resource planning plays a critical role in the causes and solutions of waiting lists. Waiting lists have harsh implications for patients. Accountability relationships require realignment.

Cancer Care Facilities↗
PubMed2006

Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program.

BACKGROUND: Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time. METHODS: This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. RESULTS: A total of 34,972 hospitalized patients (mean age: 67.3, SD +/- 19.3 years; female 53.6%, mean length of stay: 11.9 +/- 13.2 days, mean nursing care time per day: 3.5 +/- 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2%) of the hospitalized patients. From these falls, 2,552 (66.4%) were without injuries, while 1,142 (29.7%) falls resulted in minor injuries, and 148 (3.9%) falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p = 0.086). The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay), as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell. CONCLUSION: Following the implementation of an interdisciplinary falls prevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

Accidental Falls↗
PubMed1999

Parents, physicians, and antibiotic use.

BACKGROUND: Emergence of resistant bacterial pathogens has increased concerns about antibiotic prescribing patterns. Parent expectations and pressure may influence these patterns. OBJECTIVE: To understand how parents influence the prescribing patterns of physicians and what strategies physicians believe are important if we are going to reduce inappropriate use of oral antimicrobial agents. DESIGNS AND METHODS: One thousand pediatricians who are members of the American Academy of Pediatrics were asked to complete a semi-structured questionnaire. The physicians were chosen randomly by the American Academy of Pediatrics. RESULTS: Nine hundred fifteen pediatricians were eligible and 610 surveys were analyzable, for a response rate of 67%. The majority of respondents were male (56%), worked in a group practice (51%), saw an average of 114 patients per week and were in practice for 14 years. Forty percent of the pediatricians indicated that 10 or more times in the past month a parent had requested an antibiotic when the physician did not feel it was indicated. Forty-eight percent reported that parents always, most of the time, or often pressure them to prescribe antibiotics when their children are ill but antibiotics are not indicated. In follow-up questions, approximately one-third of physicians reported they occasionally or more frequently comply with these requests. Seventy-eight percent felt that educating parents would be the single most important program for reducing inappropriate oral antibiotic use and 54% indicated that parental pressure, in contrast to concerns about legal liability (12%) or need to be efficient in practice (19%), contributed most to inappropriate use of oral antibiotics. CONCLUSIONS: Pediatricians acknowledge prescribing antimicrobial agents when they are not indicated. Pediatricians believe educating parents is necessary to promote the judicious use of antimicrobial agents.

Anti-Bacterial Agents↗
PubMed2004

[Cesarean sections: risk perception and indication by attending obstetricians in a public maternity hospital in Rio de Janeiro].

The cesarean section rate in municipal public maternity hospitals in the city of Rio de Janeiro in the year of 2000 was 30.1%. With such a high rate, our hypothesis is that attending obstetricians in these units are indicating cesarean sections for reasons not restricted to clinical factors. The article aims to analyze physicians' representations of the inherent risks in cesarean sections that influence the medical decision for their indication. In this qualitative study, conducted through participant observation during ward duty and interviews with obstetricians, we observed that C-section indications by obstetricians are influenced by various non-obstetric factors, including insecurity about performing obstetric maneuvers, fragmented care, and fear of legal liability. The paper suggests that the widespread use of this intervention in private maternity services has fostered a practice in public obstetric services that compromises the quality of public health care and may jeopardize the health of women and infants.

Adult↗
PubMed2001

Manufacturer's drug interaction and postmarketing adverse event data: what are appropriate uses?

Governmental agencies overseeing pharmaceutical products use a risk/benefit approach to analyse data and make regulatory decisions. Comprehensive public dissemination of the safety profile of pharmaceutical products is part of an overall strategy for reducing risk associated with the use of any medical product. In the US, reports of postmarketing surveillance of approved drugs are in the public domain. Some, but not all, of the information in drug interaction studies is available to the public through the Freedom of Information Act (FOIA). However, there are concerns over the misuse of these data for commercial or other gain. The need to protect intellectual property and foster innovation in drug development, and concerns of legal liability are often cited as reasons to limit full public access to data from drug development studies. In contrast, intellectual freedom. public safety, and a mandate for transparent decision-making processes by regulatory agencies are issues that support open access to these data. Ultimately. concern for the public safety justifies open access to postmarketing surveillance data, and to a lesser degree, data regarding drug interactions in marketed products, and should outweigh the potential loss of competitive advantage by pharmaceutical companies.

Access to Information↗
PubMed2003

Think they're drunk? Alcohol servers and the identification of intoxication.

Despite alcohol server training programs and legal liability aimed at controlling intoxication, server intervention appears to be rare. Given the difficulty in assessing intoxication, it can be assumed that improvement in assessment skills would increase the likelihood of intervention. Unfortunately, little is known regarding practices servers use to identify intoxication. In order to build a more informed base for policy formation and server training, the focus of this inquiry was to examine practices used by servers to assess intoxication. The analysis was based upon questionnaires mailed to a random probability sample of licensed servers from one state (N = 822). Indicators found to be most important were examined in relation to a variety of occupational characteristics. Implications for training curricula, policy formation, and future research are discussed.

Alcoholic Intoxication↗
PubMed1995

Quality of Life: a critical assessment.

There is increased recognition that Health-Related Quality of Life (HRQOL) or Health Status (HS) is important and, together with other outcome measures, highly relevant to evaluating both the impact of diseases, and the individual and societal benefits/costs of different interventions, management strategies and health policies: yet many problems remain. While the methodology of HS assessment has been extensively studied and greatly improved, implementation has lagged in practice and in clinical research. Resources have been forthcoming for studies which promise increased profit (e.g., marketing advantage) or cost-containment, but funding has been scarce when the focus is on quality of care, patient utility, or health issues such as screening, monitoring or disease prevention. There are well-defined limitations associated with various assessment instruments, with interpretation of scores, and with the lack of relationship between disease activity and overall HRQOL. For these reasons, to date, HS assessment has not been clearly shown to be useful to physicians or to benefit patient outcomes to a degree sufficient to justify the burden of widespread use. Physicians remain cautious of the processes, especially with those aspects that relate to values, autonomy, equity, legal liability and potential for abuse.

Attitude of Health Personnel↗
PubMed2006

Advanced nurse roles in UK primary care.

Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.

Cost-Benefit Analysis↗
PubMed1985

Consultation and referral between physicians in new medical practice environments.

The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

Advertising↗
PubMed1985

Am I the hospital's keeper? Trustee legal responsibility as fiduciary.

In the wake of some recent scandals concerning financial improprieties on the part of hospital trustees, increased attention is being focused on the duties and legal liabilities of governing board members. This article examines how trustees can fulfill their responsibilities and, at the same time, minimize exposure to personal liability for actions of co-trustees and hospital employees.

Governing Board↗
PubMed1999

Foresight begins with FMEA. Delivering accurate risk assessments.

If sufficient factors are taken into account and two- or three-stage analysis is employed, failure mode and effect analysis represents an excellent technique for delivering accurate risk assessments for products and processes, and for relating them to legal liability. This article describes a format that facilitates easy interpretation.

Equipment Safety↗
PubMed2000

[Mixing of medical and scientific responsibilities is undesirable].

Should the medical responsibility to provide good care and the societal responsibility to allocate scarce resources remain separated or be brought together? Bonneux takes the latter position. Guidelines would offer an appropriate tool for this: the consensus groups developing them can at the same time take into account medical knowledge and a just distribution of resources. There are arguments against this view: consensus groups do not have the status and legitimation to take allocative decisions. Such decisions should be made at the political level, the more so since they affect individual entitlements to care under health insurance legislation. If cost effectiveness plays a dominant role in their development, guidelines can no longer be regarded as a true reflection of the professional standard of care. Finally, doctors cannot and should not be exempted from legal liability on the sole ground that they act in accordance with a guideline.

Cost-Benefit Analysis↗
PubMed2000

Patient confidentiality issue looms large for CMs.

Slated to go into effect in October 2002, HIPAA's recently-released confidentiality rules are sure to have long-term consequences on the issues of e-health, legality, and liability. HCM looks at a few of the ways case managers are preparing for the changes.

Case Management↗