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At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Choosing to do obstetrics in practice: factors affecting the decisions of third-year family practice residents.

To investigate factors influencing a resident's decision to participate in obstetrical care, a survey was undertaken of program directors and third-year residents from the 16 Michigan family practice residency programs. Responses indicated that the majority of third-year residents (55%) intended to practice obstetrics on graduation. Rural practice plans were significantly correlated with a decision to practice obstetrics, but suburban practice plans were negatively correlated. Residents who reported the presence of a good family practice obstetric role model were significantly more likely to practice obstetrics; residents deciding against obstetrical practice expressed concerns about legal liability and malpractice fees. These findings have important implications for family practice training programs if obstetrics is to remain a central part of comprehensive family care.

Career Choice↗
PubMed1986

Elder abuse screening and intervention.

Elder abuse and neglect are forms of family violence, a growing societal concern. Estimates suggest that 500,000 to 1.5 million cases of abuse and neglect occur annually in this country. This article describes the nurse practitioner's legal liability for reporting suspected cases of elder abuse and neglect. In addition, specific screening guidelines for this problem are outlined. Assessment parameters for evaluating suspected cases of elder abuse are described.

Aged↗
PubMed1987

An overview of state medical discipline.

The Office of Inspector General's responsibility for financially penalizing and excluding health care professionals from Medicare and Medicaid participation led to an interest in examining the state medical boards' licensure and discipline processes. This article discusses the results of the subsequent study and focuses only on medical discipline issues. We found that the rate of disciplinary actions taken by boards has been increasing. However, revocations and suspensions, the most serious category of actions, have remained relatively constant. Additionally, consumers and law enforcement agencies are the most active sources of possible violations. Individual health care professionals, hospitals, peer review organizations, and medical societies provide strikingly few reports. To rectify these problems, we encourage states to increase physician license renewal fees to fund expansion and improvement of boards' enforcement activities and to consider ways to limit the legal liability of those making good-faith referrals.

Foreign Medical Graduates↗
PubMed1982

System maintenance, problems, and enhancements.

The procedures required for software and hardware maintenance of a pharmacy computer system, and methods of dealing with operational and administrative problems of such systems, are described. Maintenance of software and hardware purchased from a vendor is usually provided by the vendor under contract. Repair maintenance is required for programs that do not run, produce incorrect results, or run too slowly. Update and revision maintenance is required when user requirements exceed the limits and design of the original program. Typical problems encountered with computer systems include slow computer response time, performance of maintenance personnel, turnover in user personnel, legal liabilities and restrictions, reliability of hardware and software, downtime, security, and changing configuration of equipment. Successful management of predictable and unpredictable problems with computer systems is accomplished through systematic review of the potential problem area and prospective planning.

Computers↗
PubMed1982

Legal consequences of disposable dialyzer reuse.

This Article discusses potential legal liability for adverse effects resulting from reuse of disposable hemodialysis equipment. After explaining the dialysis process and the health risks involved with the reuse of dialyzers, the Article outlines possible theories of recovery for injured dialysis patients. The Article describes the possibility of recovery under a negligence theory against either the treating physician or the institutional provider, and includes a discussion of applicable statutory law. The remainder of the Article discusses possible recovery under the theory of strict liability.

Ambulatory Care Facilities↗
PubMedDate not supplied

Complications of and improvements in pneumatic tourniquets used in surgery.

In North America, it is estimated that at least 10,000 pneumatic tourniquets are used in more than 1 million surgical procedures annually. The increasingly widespread use of pneumatic tourniquets in surgery of the extremities has been accompanied by continuing reports of injuries. Interest in tourniquet-induced complications has recently increased because of concern about potential legal liability. Results are presented from the investigation of 15 cases of complications suspected of being associated with the use of pneumatic tourniquets over an 18-month period. Factors leading to tourniquet-induced complications are identified, difficulties preventing an accurate estimate of the true incidence of such complications are reviewed, and the key elements of a program of inspections aimed at periodically assessing the safety and performance of pneumatic tourniquets are outlined. To reduce the hazards associated with the use of pneumatic tourniquets, a new microprocessor-based tourniquet is being developed. Initial results on a series of 30 patients indicate that the new microprocessor-based tourniquet-in addition to being significantly safer, more accurate, and more reliable-will considerably reduce operating costs by reducing the labor-intensiveness currently associated with tourniquet usage.

Computers↗
PubMed1994

Chronic, recurrent low back pain. A methodology for analyzing fitness for duty and managing risk under the Americans with Disabilities Act.

Chronic, recurrent low back pain, although one of the most commonly encountered medical conditions in the workplace, is one of the most difficult to manage. With the passage of the Americans with Disabilities Act, the proper management of the worker with recurrent low back pain poses an even greater challenge. We propose an interdisciplinary methodology to evaluate the worker at high medical risk of recurrent low back pain and determine the potential ergonomic risks of essential function tasks in material-handling work. The proposal considers the ethical and legal liabilities of risk assessment and fitness for duty evaluation that physicians, ergonomists, attorneys, and ultimately business managers and supervisors experience in balancing the societal interests represented by the Americans with Disabilities Act.

Biomechanical Phenomena↗
PubMedDate not supplied

Cystic fibrosis carrier screening: knowledge and attitudes of prenatal care providers.

We are conducting a trial of population carrier screening for cystic fibrosis (CF), targeting pregnant and nonpregnant patients of prenatal care providers. We first enlisted providers by presenting a description of the trial to the obstetrical staffs of the five Rochester, New York, hospitals having delivery services. Of the 124 prenatal care providers (111 obstetricians and 13 family practitioners) with delivery privileges at the five hospitals, only 81 (65%) attended one of our presentations. Providers who attended lacked knowledge about CF screening and counseling and expressed divergent attitudes about prenatal diagnosis for carrier women having test-negative partners. Of the 79 providers completing an attitude questionnaire, 68 (86%) were willing to offer carrier screening to all their patients if educational materials, testing, and counseling were all provided without charge. After visiting participating physicians' offices to orient their staff, we reached two additional conclusions. First, in considering whether to offer CF carrier screening to their patients, prenatal care providers are less concerned about imperfect test sensitivity, false reassurance of those testing negative, or discrimination against those testing positive than about time required to answer patients' questions if they screen and about legal liability if they do not. Second, some providers are more resistant to offering screening to nonpregnant patients than to pregnant patients, not because they believe that the timing is less appropriate, but because nonpregnant patients do not routinely receive an advance mailing, have phlebotomy, or return for follow-up. Our experience raises concerns about the willingness and capability of prenatal care providers to translate advances in molecular medicine into prenatal screening services.

Attitude of Health Personnel↗
PubMed1993

A study of substance abuse testing in patient care facilities.

Drug testing, once practically ignored as a health care management strategy in curbing legal liability potential, is now the norm rather than exception. Most hospitals today conduct drug tests involving employment considerations and "for cause" (e.g., accidents) involving most employees but excluding physicians. Random drug testing is recommended for health care institutions to consider as a strategy designed to reduce illicit drug abuse in such facilities. This recommendation is based on the nature and sensitivity of the health care institution's mission and purpose relative to patient care and safety.

Confidentiality↗
PubMed1993

What are purchasers looking for in managed care quality?

Spurred by competition and the growth of managed care, providers are seeking new approaches for satisfying the needs of health care purchases. Increasingly, these purchasers are focusing on the value of managed care arrangements, especially the degree to which they manage quality. Underlying the emerging focus on quality are concerns about "undercare," potential legal liability, and the economics of quality. Purchasers are sensitive to the quality of service and the experience of their patients, as well as the clinical quality of the care they receive, and many employers are now engaged in a systematic effort to assess both of these dimensions of quality. The emergence of national data banks, practice standards, and accreditation programs offers additional tools for strengthening provider accountability for quality.

Attitude of Health Personnel↗
PubMed1993

Office of Inspector General U.S. Department of Health and Human Services. An overview.

It has become increasingly important for physicians to be aware of the various legal liabilities regarding licensure they face in the daily practice of medicine. This includes issues related to fraud, waste and abuse. It has become a common refrain that physicians promote significant abusive and possibly fraudulent practices. This article describes the organization, function and work plans of the Office of Inspector General, Department of Health and Human Services. A structural guideline is presented based upon conviction and recovery rates to allow physicians to understand the scope of the problem in greater depth.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

A positive, systematic approach to improve inpatient medical record completion in a family practice residency program.

BACKGROUND AND OBJECTIVES: Timely completion of medical records is a concern for many reasons. For physicians, incomplete records may result in loss of hospital privileges and income and increased legal liability after entering practice. Traditionally, medical record delinquencies have been dealt with punitively. We developed a multifaceted approach to inpatient medical record completion and implemented it at our hospital. METHODS: The intervention involved posting weekly lists of physicians who were in compliance or noncompliance with medical records completion requirements, giving positive rewards (candy bars) for those who were in compliance, and increasing faculty contact with residents over issues of medical records completion. RESULTS: This approach reversed an increasing hospital record delinquency rate that had exceeded 50% and reduced the rate to 10%-30%. Residents' views of the various components of the intervention were positive. CONCLUSION: Medical records completion rates can be increased with positive, rather than punitive, measures.

Data Collection↗
PubMed1995

Ethical problems in prenatal diagnosis: pediatric considerations.

In Europe, the recent advances in prenatal diagnosis and their practical consequences have elicited political rather than ethical discussions. An attempt will be made to outline and to ethically evaluate criteria pertaining to the termination of pregnancy because of malformation or disease of the fetus. Is it possible to determine the beginning of life, of an individual, of a personality? Are the severity of a malformation or disease, the duration of life to be expected, and the probable time of onset of relevant disease symptoms measurable parameters that can be used to arrive at an ethically correct or at least acceptable decision? In spite of efforts towards ethical objectivity, it appears difficult to set criteria completely independent of professional experience and responsibilities, and of legal liabilities sometimes resulting in dialectical patterns of thinking. The mothers' needs and wishes will play a paramount role in obstetric considerations. The paediatric point of view necessarily emphasizes the best interest of the child. Ethical criteria can not provide unequivocal answers. They can help, however, in a 'no-win' situation, to find an acceptable way between two 'evils': the death of an unborn child or the birth of a child with a severe disease.

Ethics, Medical↗
PubMed1995

Progress towards a fire-safe cigarette.

About 1,000 deaths, 3,000 serious injuries, and several billion dollars in costs of property loss, health care and pain and suffering, result each year in the U.S. from fires started by dropped cigarettes. Efforts to prevent these losses have progressed from admonitory slogans to product-flammability standards to addressing the cigarette itself. Two recent federal studies have: a) concluded that it is technically feasible to produce a cigarette with a reduced likelihood of starting fires, and b) published a broadly validated method by which cigarette brands can be tested for this propensity. The long-term effort of scientists, legislators and public health activists to develop and implement a fire-safe cigarette standard also constitutes a legal liability challenge and a threat to the relative and absolute size of the cigarette market shares held by major U.S. tobacco companies.

Burns↗
PubMed1996

[Health promotion in the work environment--old and new challenges for public health].

Associations between work and health can be found at many different levels. Work itself can have health hazardous as well as health promoting effects. Work defines status and life-style as well as social security and occupies a large proportion of time in our lives. Until now the process to integrate issues of worksite prevention and health promotion into Public Health proceeds slowly in contrast to other countries e.g. the USA. Weak connections between occupational medicine and Public Health as well as relative few projects focussing on work site in the Public Health Research Associations reflect this trend. Work site public health research according to the guidelines of the Ottawa Charta (WHO) could enhance the transition of approaches justified now in terms of risk and legal liability towards an orientation on health resources and preventive potentials. This transition is promising in regard to the science of public health. However, bottleneck facilities can be identified: the development of appropriate health reports in companies, the implementation and further development of new steering models for worksite interventions (especially the organizational development) and the implementation and further development of appropriate form of quality assurance which can be evaluated.

Accidents, Occupational↗
PubMed1995

The use of PSSD testing in comparison to vibrotactile testing of vibration exposed workers.

With the acceptance of the Stockholm scale for the neurological effects of Hand-Arm. Vibration Syndrome, there has been increasing interest in selection of the appropriate screening and diagnostic procedures for worker evaluation. With the increased attention to worker surveillance to decrease morbidity, workers compensation and legal liability, a system that provides early detection as well as diagnostic specificity would be desirable. Up to now, most screening tests have suffered from lack of specificity or are time consuming in administration. Most diagnostic tests are too expensive or impractical to use on a screening basis. The Pressure Sensitive Sensory Device (PSSD) system with a modification of the two point discrimination system has been shown to be at least as effective in comparison to vibrotactile testing as well as less time consuming. In addition, the study shows that there is a favorable correlation between PSSD and nerve conduction studies. This system offers and effective method of evaluation of workers for the effects of Hand-Arm Vibration Syndrome as well as other ergonomically induced conditions such as Carpal Tunnel Syndrome. Studies of various population groups will be presented.

Cross-Sectional Studies↗
PubMed1997

The dangerous financial politics of AIDS "cocktail" therapies.

Political pressures by local AIDS activists are forcing some communities to redirect limited financial resources exclusively toward new drug therapies called protease inhibitors. These expensive and often reckless decisions threaten both the financial integrity of AIDS service organizations and the health of the public. The dangerous financial politics surrounding access to the new and complicated drug therapies for AIDS threaten to bankrupt local AIDS health service, create inescapable financial and legal liabilities, and may contribute to a worsening of the AIDS epidemic, causing the elimination of essential systems of prevention and care for the highest risk populations-adolescents and minority women.

Adolescent↗