Consent: Legal and Clinical Implications

The present research is concerned with schizophrenic patients’ perceptions of their own mental health and the relationship of these perceptions to clinical characteristics and cognitive performance. A structured interview was administered to 20 male and 16 female outpatients. When queried about their mental status, 30% of the males and 6% of the females reported that they did not perceive themselves as mentally ill. This sex difference was statistically significant, and there were trends toward greater willingness on the part of women to acknowledge symptoms. Patients who stated that they perceived themselves to be mentally ill had a shorter duration of most recent hospitalization, a smaller number of previous hospitalizations, and greater compliance with treatment. These patients also showed better performance on a measure of attentional abilities. The results are inconsistent with the idea that self-labeling in mental illness has negative consequences. The theoretical, clinical and legal implications of the findings are discussed.

Objectives: This study compares objective measures of cognitive performance with subjective perception of specific performance on neuropsychological tests examining basic cognitive domains, including, for the first time, financial capacity. Additionally, differences in assessment between single- and multiple-domain aMCI, mild AD, and healthy elderly regarding insight are examined. Methods: Participants completed a number of neuropsychological tests and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). After every test, participants were asked to complete the Clinical Insight Rating scale (CIR) and to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. Results: These preliminary findings show significant differences in the self-assessment patterns of the four groups in measures of verbal memory, visuospatial perception and memory, executive functions, tests of attention, and financial capacity. Mild AD expressed the highest overestimations, followed by single- and multiple-domain aMCI as well as controls. Accuracy of self-report is not uniform across groups and functional areas. Conclusions: Unawareness of memory deficits in both MCI subtypes is contradictory to subjective memory complaints as being an important component for clinical diagnosis. Financial capacity is overestimated in MCI and mild AD, a finding that has a plethora of clinical and legal implications.

This article deals with sexual behaviour with children, proposing a tighter clinical definition, based on a phenomenological nosology. This nosology classifies the behavioural symptoms by the object, the act, and the agent. 1. The Object: the child must be prepubertal and the sex of the child denotes either hetero- or homosexual pedophilia. 2. The Act: Consists of either: a) Immature gratification b) Deviant acts c) Genital union Only a) is included under the term pedophilia. 3. The Agent: pedophiles fall into three distinct age groupings, culminating in adolescence, mid to late thirties and mid to late fifties. An account of heterosexual pedophilia, homosexual pedophilia, and the situation of the victim is given, and the clinical, social and legal implications are discussed.

Poor compounding practices by the New England Compounding Center resulted in the 2012-2013 fungal infections outbreak. Contaminated injectable methylprednisolone led to the diagnosis of fungal infections in 751 patients and 64 deaths. In the United States, pharmacy compounding has traditionally been regulated by state boards of pharmacy rather than the FDA. To minimize safety risks related to pharmacy compounding, the Drug Quality and Security Act (DQSA) was signed into law November 27, 2013, to improve regulation of compounding pharmacies. To (a) review the literature regarding clinical, legal, and regulatory implications of pharmacy compounding for patient safety during the 2012-2013 fungal infections outbreak and (b) discuss strategies that managed care organizations (MCOs) can use to promote safe compounding practices. A literature search was conducted via PubMed for original articles on fungal infections related to drug compounding published October 2012 to March 2014. Specific search terms included "drug compounding and fungal infection" and "fungal meningitis outbreak." The FDA website was also utilized for material related to the Food, Drug, and Cosmetic Act and the DQSA. Four articles met inclusion criteria. The 2012-2013 fungal infections outbreak was attributed to 3 lots of preservative-free methylprednisolone acetate, which comprised 17,675 vials distributed to 76 facilities across 23 states. Median incubation period (from time of last injection to initial diagnosis) was 47 days, ranging from 0 to 249 days. According to the FDA, a total of 30 recalls regarding compounded products were issued by pharmacies during March through December 2013. Pharmacy compounding has the potential for significant safety risks. The purpose of the DQSA is to improve regulation of compounding pharmacies. Since registration as an outsourcing facility is voluntary, uncertainty still remains regarding advancement in safe compounding practices. MCOs can employ multiple strategies to ensure patient safety and promote appropriate drug therapy.

Identification of the psychopathic batterer: The clinical, legal, and policy implications

Parents’ refusal of medical treatment based on religious and/or cultural beliefs: The law, ethical principles, and clinical implications

This paper focusses on the legal, ethical, and clinical implications for Canadian psychologists of the child protection legislation that makes it mandatory to report children who are in need of protection. Provincial and territorial statutes and Canadian case law dealing with the reporting duty are examined. The Canadian Code of Ethics for Psychologists (C.P.A., 1991) and its proposed decision-making process for resolving ethical dilemmas are applied to a review of the ethical and clinical issues associated with the mandatory reporting laws. Guidelines are proposed regarding how psychologists can best negotiate the dilemma of how to participate in society's mandate to protect children given often conflicting legal, ethical, and professional obligations.Child maltreatment has been recognized as a problem requiring state intervention since the first child protection legislation was enacted in 1893 (S.O., Child Protection Act). Since 1980, nearly every province and territory has amended its child protection legislation in order to more easily protect children whose and developmental needs are at risk. Duty to report statutes have been designed to identify children in need of protection as quickly as possible to enable the child welfare systems to respond with protection for the child and help for the family. However, legislating the reporting of suspected and known maltreatment as mandatory has caused specific ethical difficulties for practitioners who are regularly confronted with suspicions or testimonials of child abuse, but whose professional regulatory organizations, practice guidelines, and ethical codes reinforce the importance of psychologist-client confidentiality.This paper will examine the implications of duty to report legislation for Canadian psychologists. Provincial and territorial statutes and Canadian case law dealing with the reporting duty will be reviewed(f.1). Ethical and clinical issues associated with this duty will also be examined following the Canadian Psychological Association Canadian Code of Ethics for Psychologists (1991)(f.2) and its procedures for resolving ethical dilemmas. Finally, guidelines will be proposed regarding how psychologists can best negotiate the dilemma of how to participate in the societal mandate to protect children given often conflicting professional, ethical, and legal requirements.OBJECTIVES OF THE REPORTING LAWSLaws against child abuse and neglect reflect a recognition that has a compelling interest in stopping child maltreatment. Justification for mandatory reporting and state intervention in child abuse cases is based on two important concepts: (1) parents' interests and rights are not always congruent with those of their children (Racusin & Felsman, 1986; Wald, 1986), and (2) the state has a compelling interest in protecting vulnerable children (Finlayson & Koocher, 1991).The Canadian Charter of Rights and Freedoms (1982) outlines that everyone has the right to life, and of the and the right not to be deprived thereof except in accordance with the principles of fundamental justice (s. 7). The right to security of the person has often been interpreted to protect the family from unreasonable state interference (e.g., R. v. X (1983); Re Mugford (1970); both cited in Bala & Cruickshank, 1986). However, the Charter guarantees the right to liberty and of the person... only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society (Canadian Charter, 1982, s. 1). Duty to report legislation may therefore be seen as imposing a legally recognized limitation on the constitutional rights of parents in order to protect the welfare of children (Bala & Cruickshank, 1986) through establishing systems of state intervention in circumstances where the caretakers are unable or unwilling to provide a minimum standard of care (Wilson & Tomlinson, 1986). …

BACKGROUND AND OBJECTIVES: Trigeminal sensitivity changes may lead to neuropathic pain after surgical handling. These complaints generate questions. First: are they real? Because a causal relationship between implant and nerve is not always present. Second: should the implant be removed? This study aimed at reviewing the literature on the subject. CONTENTS: The literature is prodigal on information about loss of implants related to osteointegration, but there are few studies on losses related to nerve loss or to neuropathic pain. The risk for implants longevity is multifactorial. Contributors are: patients' health, surgical technique, receptor region and functional activation, among other factors. Pain is a complication with significant clinical, psychological, social and legal implications, requiring special attention to patients, very often prolonged or permanent. Currently, specialized literature is already voluminous about the prevalence of sensory abnormalities and nervous injury after dental procedures. Together, these pieces of information suggest an approach including detailed exams, interconsultations and the adoption of preventive, curative or palliative measures to treat pain. Implant removal depends on this analysis and it is not always a simple decision. CONCLUSION: Information about dental implants removal due to pain or nervous injury is scarce and not always homogeneous, however it already calls the attention to the fact that such decision is not always simple. It depends on the adoption of diagnostic measures, some of them specialized, including image exams. Early diagnosis and treatment of nervous injury and neuropathic pain are beneficial to patients and have major ethic and legal implications.

When a patient's condition changes, you as a physical therapist (PT) must quickly consider when, how, and what to communicate to the physician. As you do, remember that these questions have not only clinical implications, but also legal implications.

When a patient's condition changes, you as a physical therapist (PT) must quickly consider when, how, and what to communicate to the physician. As you do, remember that these questions have not only clinical implications, but also legal implications.

The sphygmomanometer is an essential piece of diagnostic equipment, used in many routine consultations in primary care. Its accuracy depends on correct maintenance and calibration. This study was designed to: (1) assess the maintenance and calibration of sphygmomanometers in use in primary care; (2) assess the clinical, ethical, legal and public health implications of our findings. A researcher assessed the accuracy of mercury and aneroid sphygmomanometers in use in 231 English general practices. He also made enquiries about arrangements for the maintenance and calibration of sphygmomanometers. We conducted a small telephone survey in general practices across the country to determine maintenance and calibration arrangements across the country. We carried out a modelling exercise to explore the clinical, ethical and public health implications of our findings. Of 1462 sphygmomanometers, 9.2% gave readings were more than 5 mm Hg inaccurate. No practice had arrangements for maintenance and calibration of sphygmomanometers. Nationally, one of 54 practices had an arrangement for maintenance and calibration. True hypertension is very uncommon in women under 35, a blood pressure which is measured as high is much more likely to be caused by calibration error than by hypertension. It is rare for sphygmomanometers used in primary care to be maintained and calibrated. Because of this women under 35 are at risk of misclassification and inappropriate treatment. This has ethical and public health implications. Clinicians using equipment which has not been maintained and calibrated may be medically negligent.

Methodological issues and practical strategies in research on child maltreatment victims’ abilities and experiences as witnesses

Brain death is defined as the irreversible loss of function of cerebrum, cerebellum, and brain stem. It is a clinical diagnosis based on clinical observations of coma, absent reflexes, and apnea. The diagnosis of brain death has important legal and clinical implications, as brain death means that life support is futile, and the diagnosis is the principal prerequisite for the donation of organs for transplantation.

Hereditary Ovarian Cancer: Molecular Genetics and Clinical Implications

Aims Genomic technologies, such as array comparative genomic hybridisation (aCGH) and whole genome/whole exome (WG/ WES) sequencing, have transformed our ability to provide a genetic diagnosis for a range of common presentations of childhood, including congenital anomalies, developmental delay and autistic spectrum disorders. Associated with the use of genomewide technologies are the management of ‘off-target’ information – incidental genetic findings with known clinical sequela, and uncertain information – variants where the clinical implications are currently unknown (variants of uncertain significance). Decisions around how and when to share this information with families has significant ethical, legal, social and practical implications. For paediatric and neonatal patients, these issues are especially complex when considering the potential future implications of these results and the consequences for (future) autonomy. How frequently are these type of genetic variants identified in the neonatal population? Method Retrospective audit of all aCGH requests received by the regional cytogenetic laboratory for neonatal patients in a 12 month period. Results 339 requests for aCGH in neonatal patients were received. 16 requests were rejected as ‘inappropriate requests’. 323 samples were processed. 23 samples failed to reach quality control standards and were not reported. 300 clinical reports were issued. 255 (85%) patients had no clinically significant variants identified. In 45 patients (15%), a clinically significant variant was identified: 22 (7.3%) of which had a clear association with the phenotype described (pathogenic), 19 (6.3%) of which were classified as variants of uncertain significance, and 4 (1.3%) of which were not associated with the presenting phenotype (incidental findings). Conclusion Variants of uncertain significance and incidental findings are frequently identified when array CGH is undertaken for neonatal patients. Variants of uncertain significance account for 42% of reported variants in this patient group. The consequences for pre-test counselling are important: parents and families should be prepared that genetic technologies can contribute to, as well as resolve, uncertainty. More work is needed to ascertain the consequences of uncertain and incidental information, both for the clinical management and lived experience of patients and families, particularly as the frequency with which incidental and uncertain genetic information are encountered will increase as sequencing technologies transition from bench-to-bedside.