Care Legislation Research Articles

Social work, personalisation, and the : A Bourdieusian analysis

Abstract This article considers the role of social work in English social care within the context of the Care Act 2014 and related policy agendas. This is achieved through a theoretical analysis of English social care policy and legislation rooted in the work of Pierre Bourdieu. Having been contextualized in the consolidation of neoliberal hegemony in Britain, particular focus is given to social care reforms stemming from the 2010–2015 Coalition Government, including the implementation of the Care Act 2014 and its associated personalisation principles. Utilizing Pierre Bourdieu’s concepts of ‘habitus’, ‘field’, and ‘capital’, social care policy and reform is viewed as embodying an ongoing ideological shift in the ways in which the state, and its social care professions, are envisaged as functioning and interacting with its citizens. From this, the role of social work in English social care is considered in relation to policy agendas underpinning the Care Act 2014 and more recent policy reviews and proposals. This article concludes by drawing on Bourdieu’s notion of ‘hysteresis’ to conceptualize a profession facing a complex negotiation of its skills and values within destabilizing political, economic, and ideological framings of practice.

Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022.

To analyze the utilization and reimbursement for tracheostomy. Retrospective Cross-Sectional Study. Centers for Medicare & Medicaid Services (CMS) Medicare Provider Utilization and Payment Data (2013 and 2021) and Part B Medicare Fee-For-Service National Summary Data (2000-2022). Utilization, payment, and specialty breakdown were analyzed for planned tracheostomy (Current Procedural Terminology [CPT] codes 31600, 31601, 31610) and emergency tracheostomy (CPT codes 31603, 31605). From 2000 to 2022, there was a 48.9% decrease (40,754-20,812) in number of planned tracheostomies and a 75.3% decrease (3277-811) in number of emergency tracheostomies, leading to an overall decrease of 51%. Similarly, there was a 59.3% inflation-adjusted decrease ($13.4-$5.5 million) in total reimbursement for planned tracheostomies and an 82.1% inflation-adjusted decrease ($1.1 million-$205 thousand) in total reimbursement for emergency tracheostomies. There was a 20.3% inflation-adjusted decrease ($329-$262) in reimbursement per planned tracheostomy and a 27.7% inflation-adjusted decrease ($349-$252) in reimbursement per emergency tracheostomy. In our sample of 280 high-volume tracheostomy providers in 2021 (28.2% otolaryngology, 28.2% general surgery, 14.6% thoracic surgery, 14.3% pulmonary disease, 6.4% critical care), the average provider performed 15.8 tracheostomies and was reimbursed $5362. Despite significant declines in tracheostomy utilization and reimbursement, understanding trends for these lifesaving procedures are critical for otolaryngologists and other providers in delivering high-quality care, and can be used by surgeons, hospital systems, and policymakers to guide future health care legislation.

Characteristics of legislation in the field of health protection

The article examines the essence of administrative and legal regulation in the field of health care through the prism of the systematization of administrative legislation in the specified field. The legal regulation of public administration is defined as a purposeful activity of state authorities regulated by laws and other normative acts, which is aimed at consolidating, organizing and protecting social relations in the specified sphere, which is carried out with the aim of preserving and strengthening health, protecting the rights of patients and medical employees. Attention is focused on determining the role and importance of such types of systematization as incorporation, consolidation, codification, adaptation and their application in the field of health care.
 It was determined that the codification of administrative legislation in the field of health care is the most advanced form of systematization, which is directly related to the change in the form and content of the current legislation by its revision, elimination of conflicts, gaps, obsolescence and multiplicity of legal norms. Special attention is paid to adaptation, as a fundamental component of the European integration course of Ukraine, which consists in the phased adoption and implementation of laws and subordinate normative legal acts of Ukraine, developed considering the European Union legislation, as well as in making appropriate changes to the current legal acts of Ukraine.
 Analysis was conducted and the reasons that complicate the classification of legislation in the field of health care were determined, with the complexity of legal regulation being the main one. The classification of health care legislation according to the principle of hierarchy, subject and scope of legal regulation, as well as by the number of persons is proposed.
 The necessity of supplementing the current Code of Administrative Offences with the section “Offences in the Sphere of Health Care” is substantiated, which will establish responsibility for administrative offences in the sphere of health care, as well as strengthen administrative responsibility for their commission. The specified changes will ensure regulation of relations in the field of medical services, protection of the rights of doctors and patients, and as a result will improve the quality of medical assistance to the population.

Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation.

Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities. Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender. The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change. After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

PERLINDUNGAN KANAK-KANAK DI MALAYSIA: MENILAI KEBERKESANAN JAGAAN PELIHARA DARI PERSPEKTIF UNDANG-UNDANG

Foster care serves as a crucial support system for children in need of care and protection in Malaysia who cannot live with their biological families due to issues such as neglect, abuse, or abandonment. This article examines the concept of foster care, its legal implementation, and challenges. By scrutinizing existing legislation, the paper aims to identify areas for improvement to enhance the effectiveness of foster care as part of the child protection system in Malaysia. The foster care system in Malaysia is primarily governed by the Child Act 2001 and managed by the Social Welfare Department in providing family-based care, especially for abandoned children. This article employs a qualitative study, revealing challenges and limitations within the existing legal framework. The findings indicate that there is no specific law governing foster care in Malaysia. Therefore, the article emphasizes the need to enhance the effectiveness of foster care legislation by increasing resources and support for foster parents, implementing standardized training programs for them, strengthening monitoring and evaluation mechanisms, and encouraging cooperation and information sharing among relevant agencies. This is to ensure positive outcomes and long-term welfare for children in foster care in Malaysia.

Medical students' perspectives on transgender care legislation and its impact on medical residency applications

AbstractMany states have introduced bills restricting healthcare for transgender and gender‐diverse (TGD) individuals. This may prompt medical students to seek residency training in other states, exacerbating TGD healthcare disparities. We assessed medical students' perspectives on legislation prohibiting gender transition procedures (GTP) and how this affects residency applications. We analyzed responses from medical students at a Midwest institution, including demographics, knowledge of GTP legislation, impact on future training and practice, and agreement with proposed legislation. Respondents shared factors influencing their feelings about applying for residency in states that restrict GTP, as well as considerations informing their position about regulations. 36.8% consider GTP legislation important for residency applications. 60.5% think this will impact their future practice. 57.3% are against restricting GTP for minors, and 82.7% for adults. Factors influencing residency applications were LGBTQ+ safety (38.5%), government interference (33.3%), education/training (33.3%), neutral (20.5%), and against GTP (15.4%). Factors informing position on GTP were best practices (71.8%), consent (30.8%), government interference (30.8%), and need more data (7.7%). Most students surveyed were against the restriction of GTP, and legislation prohibiting GTP may drive physicians to other states. Responses also highlighted knowledge gaps about GTP, which may improve with additional training.

Benefits, Risk Factors and Cognitive Insights for Improving the Well-being of Minors in Greek Foster Care.

This research paper presents a holistic analysis of the foster care system in Greece, exploring its historical evolution, legal nuances, practical concerns, and the recent legislative reforms aimed at improving the well-being of minors in foster care. The study examines various types of foster care arrangements—kinship, non-relative, and professional fostering—highlighting their impact on the psychological, social, and cognitive development of children. It underscores the crucial role of foster families and social workers in providing a conducive family environment, while also cataloging the potential drawbacks of the system, including professional intervention challenges, emotional and social strain on the children, and gaps in the fostering infrastructure. By comparing the Greek fostering institution with systems in France, Germany, Denmark, Italy, and Ireland, the paper identifies unique challenges and best practices, contributing to an understanding of international foster care dynamics. The research also delves into the intricacies of adoption versus fostering, detailing the emotional and legal commitments involved. Furthermore, the paper integrates insights from related studies on trauma, mental health, and educational neuroscience, providing a multidisciplinary perspective on the needs of foster children. It illustrates the promising strides made by initiatives like the Child Guarantee program to fight poverty and exclusion, emphasizing the need for targeted policies and legislative action. Toward its conclusion, the research accentuates the call for ongoing interdisciplinary studies, policy refinements, and improved professional training within Greek child welfare systems. It presents a compelling case for robust, trauma-informed care frameworks and legislation designed to secure the best outcomes for vulnerable children in foster care.

Coverage of Congenital Anomalies: Ensuring Lasting Smiles Act in Legislation.

The Ensuring Lasting Smiles Act (ELSA) is a federal bill that would require all health federally regulated insurance products to cover the full treatment of a congenital anomaly or congenital disability until complete restoration of normal function or appearance. ELSA has been a key federal priority for the Legislative Advocacy Committee of the American Society of Plastic Surgeons since the 115th Congress in 2018. Although it has gained momentum, particularly in the 117th Congress, the bill remains stalled. Congressional Budget Office review, conducted in March of 2022, appears to have overestimated this bill's cost for the private sector, secondary to an alleged lack of data on the prevalence of the conditions, extent of treatments and their costs, and the current extent of private sector coverage. The present review highlights the progress of the ELSA bill and serves to illustrate the hurdles involved in passing significant health care bills. This review emphasizes the need for health care professionals to provide their congressional representatives with accurate information on realistic cost of currently covered treatments of congenital defects, the necessary treatments not currently covered by insurance, and additional out-of-pocket costs covered by patients. A concerted effort by plastic surgeons should provide tools for ELSA legislative champions to reintroduce and pass the bill during the 118th Congress. This process highlights the essential role of organized medicine in advocating for the successful passage of health care legislation.

Preventative Social Care and Community Development in Wales: “New” Legislation, “Old” Tensions?

Prevention is becoming ever more central in UK care policy for older people, though precisely what this entails, and how it works most effectively in social care and support, remains ambiguous. Set against the “newness” of recent social care legislation in Wales, this article explores the perspectives of professionals on prevention and community development, particularly for older people. This draws on qualitative data collected from 11 Welsh local authorities, four NHS Wales health boards, and eight regional third-sector organisations, incorporating 64 interviews with directors, executives, and senior managers. Recent research has highlighted concerns over the slipperiness of prevention as a concept, resulting in multiple interpretations and activities operating under its banner. Consistent with this, our data suggested a kaleidoscopic picture of variously named community-based initiatives working to support the intricate web of connections that sustain older people, as well as provide practical or material help. Similarly, professionals highlighted varied agendas of community resilience, individual independence, and reducing the need for state-funded health and social care, as well as a range of viewpoints on the roles of the state, private sector, and the third sector. Analysis revealed fragments of familiar themes in community development; positive hopes for community initiatives, tensions between the mixed agendas of state-instigated activities, and the practical challenges arising from systems imbued with neo-liberal ideas. Realising the promise of prevention will require deft steering through these challenges.

A 50-Year Review of Congressional Membership by Health Care Professionals: Is Surgical Representation Adequate?

Although 100% of congressional legislators vote on health care policy, only a minority have a background in health care. A review of the participation of health care professionals (HCPs) in Congress, highlighting participation by surgeons, is critical to the future policy-making endeavors in health care. This article seeks to better understand the characteristics of HCPs who engage in advocacy and describe the trends in their representation in Congress, with commentary on participation by surgeons and its impact on current health advocacy efforts.A search of Congress.gov and the Biographical Directory of the United States Congress was performed to identify professional health care history for each congressperson, followed by review of official campaign websites for health advocacy work. Statistical analysis was performed using IBM SPSS Statistics Software for changes in representation of HCPs, physicians, and surgeons in Congress over time. Although there has been increasing representation of HCPs in Congress in the past 25 years, surgeons have the lowest increase in congressional membership. For health care reform to optimally address high costs, variable insurance coverage and reimbursement rates, and equal access to care, more physicians must make health care advocacy efforts an integral part of their careers. Incorporation of education in areas of health care advocacy and/or reform into undergraduate and graduate medical education curricula may help address deficiencies in knowledge of current health care-related events to further encourage involvement in health care legislation.

Tackling health inequalities through integrated care in English police custodies: an inclusion perspective and model of care

PurposeThe purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.Design/methodology/approachThis research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.FindingsPolicies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.Research limitations/implicationsThe research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.Practical implicationsIt offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.Social implicationsReducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.Originality/valueThe paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.

The concept of personal responsibility in Bulgarian health and social legislation

Abstract Background In the context of scarce health care resources, national policies and legislation increasingly advocate patients’ personal responsibility for their ill health. This report aims at studying the concept of personal responsibility as a basis for resources prioritisation in Bulgarian health and social legislation. Methods Official normative documents were subjected to content and comparative analysis. Results Indirect personal responsibility can be found in the Bulgarian Health Act, Art.94 stating the duty of the patient to take care of his own health. Further, in the liver transplant algorithm of the Recipient Selection Ordinance, it is possible to distinguish a hidden criterion of patient's responsibility. One possible interpretation of Article 12 of the Code of Professional Ethics of Physicians in Bulgaria is the right of a physician to refuse medical care on the grounds of lack of trust due to patient's non-compliance with prescriptions. The latter correlates with the idea of prospective responsibility. Direct personal retrospective responsibility is imputed in the Health Insurance Act, Art. 111, where persons who themselves have damaged their health or in a state of alcoholic intoxication or drug abuse have damaged the health of others, must reimburse the costs of the NHIF. We also find clearly defined personal responsibility in the Social Security Code, Art. 46, according to which monetary compensation for temporary incapacity is not paid to insured persons who intentionally damage their health. There is no official data on the applicability of these legal norms. Conclusions Although in a less categorical form and not in relation to access to specific planned treatments, the idea of the personal responsibility is embodied in the Bulgarian legislation. It is necessary to accumulate further data on the applicability of these norms, as well as to study the views of patients, users of social services, professionals and general public. Key messages • Personal responsibility is gradually entering Bulgarian legislation as an official criterion for the allocation of social and health resources. • It is necessary to accumulate further data on the applicability of the prescribed legal norms, as well as to study the views of patients, users of social services, professionals and general public.

8.G. Workshop: Developments in patient experience surveys: how do we maintain relevance and maximise impact?

Abstract Background Patient and service-user experiences of healthcare are a vital component of the monitoring and assessment of the quality and performance of health and social care services and systems, as well as an important predictor of patient outcomes. The National Care Experience Programme (NCEP) is a partnership between the Irish health and social care regulator (Health Information and Quality Authority, HIQA), the national public healthcare provider (Health Service Executive, HSE), and policy makers (Department of Health). The NCEP conducts national care experience surveys with the aim of learning from people's experiences in order to improve the quality of health and social care services in Ireland. The programme includes surveys of acute hospital inpatient, maternity, maternity bereavement, nursing home and end-of-life care. Additional surveys of cancer care and mental health services are currently in development. Objectives Regular review and adaptation of existing surveys, expansion into new areas of care, and development of new methods of data collection, analysis and dissemination of survey findings and stakeholder engagement are required in order to remain agile and responsive to evolving health and social care landscapes and the changing needs of stakeholders, as well as harnessing technological advances and ensuring sustainability. The aim of this workshop is to bring together experts in patient experience from across the health system to stimulate discussion, knowledge sharing and cross-fertilisation of ideas. Presentations will focus on international developments and trends in patient experience, as well as considerations for surveying bereaved parents and families on their experiences of maternity bereavement and end-of-life care. The use of new technologies, including computational text analytics and predictive modelling to facilitate qualitative data analysis and maximise the use of survey findings will be outlined, followed by case studies of how care experience data are used to inform health and social care legislation, policy and practice in Ireland. Experiences from other jurisdictions and potential implications will be discussed with the audience. The workshop will contribute to a better understanding of the value and impact of collecting patient experience feedback and explore how new technologies can be used to generate insights and maximise the use of survey data. Format of the workshop The workshop will include a brief introduction on patient experience and the Irish National Care Experience Programme, followed by five presentations with time for audience contributions and questions after each speaker. The workshop will conclude with a discussion with the audience and presenters. Key messages • Patient experiences are a key component of the monitoring and assessment of the quality and performance of health and social care services and systems. • Regular review and adaptation of surveys and development of new methods are required to remain responsive to evolving health and social care landscapes and ensure sustainability.

How the supervisory board was replaced by a monitoring board in the Healthcare unit

As a result of the simultaneous implementation of medical reform and corporate governance reform in Ukraine in the state and communal sectors of the economy, supervisory and supervisory boards appeared in medical enterprises. However, in 2022, supervisory boards were replaced by supervisory boards in the Fundamentals of Health Care Legislation. In order to consolidate this strange novel, the Ministry of Health of Ukraine prepared and presented for public discussion a draft resolution of the Cabinet of Ministers of Ukraine «On the supervisory board of a health care institution».
 In the article, based on the analysis of the current and prospective legislation of Ukraine, scientific and practical publications and court practice, the conclusion about the different legal nature, purpose of activity, procedure of formation and competence of the supervisory board and the supervisory board is substantiated, and the illegality of replacing supervisory boards with supervisory boards is proven. The author substantiates the conclusion that the promotion of the idea of a special status of supervisory boards in health care institutions is carried out by the Ministry of Health of Ukraine with the aim of creating a collegial body to control the activities of the executive body of health care institutions of the director (directorate, board) that provide specialized medical assistance However, the means by which such a goal is achieved do not meet the requirements of the law.

Integrated Care Models: HIV and Substance Use.

Behaviors and practices associated with substance use contribute to lack of HIV virologic suppression and onward transmission. In the USA, many recent HIV outbreaks have been connected with substance use. Evidence-based strategies for integrating care of those at risk for and living with HIV and who use substances continue to evolve. This review, based on scientific and medical literature through March 2023, provides an overview and evaluation of initiatives for integrated care aimed to serve patients at risk for and with HIV and a substance use disorder. Integrated care services can improve health outcomes for patients at risk for and with HIV and a substance use disorder; for instance, treatment for an opioid use disorder can help improve HIV viral suppression. Brick-and-mortar facilities can provide successful care integration with appropriate clinic leadership to support multidisciplinary care teams, up-to-date provider training, and sufficient pharmacy stock for substance use treatment. Delivering healthcare services to communities (e.g., mobile healthcare clinics and pharmacies, telehealth) may prove to be an effective way to provide integrated services for those with or at risk of HIV and substance use disorders. Incorporating technology (e.g., mobile phone applications) may facilitate integrated care. Other venues, including harm reduction programs and carceral settings, should be targets for integrated services. Venues providing healthcare should invest in integrated care and support legislation that increases access to services related to HIV and substance use.

The assuring of rights of of medical workers within the framework of modernization of primary health care legislation

The more active implementation of innovative medical technologies, digital transformation in medical sphere, sanction restrictions resulted in complication of already existed problems in medical law and raised new questions. The necessity in improving medical legislation is obvious. The number of lawsuits concerning medical organizations and medical workers is invariably increasing. Hence request of adoption of normative legal regulations and decisions supporting effective functioning of industry and protection of rights and interests of medical organizations and medical workers. The purpose of the research is to study and to analyze current issues of ensuring rights of medical workers as one of the main aspects of modernization of modern medical law. The main normative legal acts of modern medical law were studied. The analysis, comparison, generalization and systematization of published statistical data, judicial practice, national and foreign sources of scientific publications, devoted to topical issues of modernization of legislation regulating health care and rights of health workers were implemented. The content analysis was applied to acts regulating legal responsibility and protection of rights of medical workers. The protection of rights of physicians in system of medical care of population at the present stage was investigated. A number of problems related to legal regulation of activities of health workers was established. The proposals for its improvement was summarized. The legal regulation of medical care support by multitude of normative acts makes actual issues of systematization of normative documentation. the assignment of independent sector of medical law where legal status of medical worker is to become its main institute.

Striking the Balance: A Human Rights Approach to Consent for People with Dementia in Residential Aged Care

Older people are often stigmatised as ageless and sexless individuals. This perception, and the increasing need for care as people age, means that many older people are subjected to prejudices when entering residential aged care facilities, and denied opportunities for sexual expression. This paper considers the often-forgotten human dignity of people with dementia in aged care facilities, and the need to provide opportunities for sexual expression. The paper considers the broad capacity spectrum for individuals with cognitive impairments and the difficulties of assessing decision-making abilities. Drawing on international human rights instruments, the paper identifies rights to intimacy and sexual expression, and argues that those rights should be recognised in reforms to aged care legislation and policy. The paper considers some of the existing barriers to intimacy and sexual expression, including staff attitudes, and, taking New South Wales as an example, existing criminal legislation which provides a narrow view of consent. Recommendations are made with respect to emphasising the intrinsic benefits of intimacy and sexual expression for all people, regardless of age or cognitive impairment.

Ethical issues in long-term care settings: Care workers' lived experiences.

Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. Our aim was to describe the care workers' lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. This was a sensitive study, which was connected to the participants' individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society.

Intellectual property rights in the context of biology, medicine and pharmacy: a look into the future

The article covers the study of some aspects of protecting the intellectual property rights in the areas of biology, medicine and pharmacy including biotechnological inventions. The rapid progress of science and technology, the generation and accumulation of knowledge, the possibilities to process large amounts of various data further stimulate the development of all social areas and unprecedentedly contribute to the emergence of innovations, in particular in the area of biotechnology. Intellectual property rights have a direct impact on the progress of medical and biological research, but increasingly require coordination with the ethical and moral principles of the society regarding the patentability of inventions in biology, medicine and pharmacy.The article analyzes the modern trends in the protection of intellectual property rights to biotechnology inventions at an international level, and forecasts the likely subsequent development in legal protection of intellectual property rights in the areas of biology, medicine and pharmacy in view of the ever increasing ethical and law controversies of medical and biological research in some areas, the emergence of big data, use of artificial intelligence, etc.The national legislation refers to the term «biotechnology» in the Law of Ukraine «On Environmental Protection», while not giving any legal definition of “biotechnology” in any laws. The Ukrainian intellectual property and health care legislation require reformation to get properly updated to respond to the ongoing challenges. There is a whole layer of gaps regarding the legal regulation of using biotechnology in Ukraine, and this extends to all areas where biotechnology is actually integrated. The use of biotechnology in biology, medicine and pharmacy requires a systemic and multi-aspect study in order to develop the appropriate legal norms.To ensure the stability of the pharmaceutical market, which is focused on the national manufacturer, it is necessary to create the proper conditions for the development of a high-tech research environment in Ukraine. It is necessary to improve nationallegislation in the field of biobanking and the legal regime of human biological material for the purpose of using it in research.

Place of Death From Cancer in US States With vs Without Palliative Care Laws

In the US, improving end-of-life care has become increasingly urgent. Some states have enacted legislation intended to facilitate palliative care delivery for seriously ill patients, but it is unknown whether these laws have any measurable consequences for patient outcomes. To determine whether US state palliative care legislation is associated with place of death from cancer. This cohort study with a difference-in-differences analysis used information about state legislation combined with death certificate data for 50 US states (from January 1, 2005, to December 31, 2017) for all decedents who had any type of cancer listed as the underlying cause of death. Data analysis for this study occurred between September 1, 2021, and August 31, 2022. Presence of a nonprescriptive (relating to palliative and end-of-life care without prescribing particular clinician actions) or prescriptive (requiring clinicians to offer patients information about care options) palliative care law in the state-year where death occurred. Multilevel relative risk regression with state modeled as a random effect was used to estimate the likelihood of dying at home or hospice for decedents dying in state-years with a palliative care law compared with decedents dying in state-years without such laws. This study included 7 547 907 individuals with cancer as the underlying cause of death. Their mean (SD) age was 71 (14) years, and 3 609 146 were women (47.8%). In terms of race and ethnicity, the majority of decedents were White (85.6%) and non-Hispanic (94.1%). During the study period, 553 state-years (85.1%) had no palliative care law, 60 state-years (9.2%) had a nonprescriptive palliative care law, and 37 state-years (5.7%) had a prescriptive palliative care law. A total of 3 780 918 individuals (50.1%) died at home or in hospice. Most decedents (70.8%) died in state-years without a palliative care law, while 15.7% died in state-years with a nonprescriptive law and 13.5% died in state-years with a prescriptive law. Compared with state-years without a palliative care law, the likelihood of dying at home or in hospice was 12% higher for decedents in state-years with a nonprescriptive palliative care law (relative risk, 1.12 [95% CI 1.08-1.16]) and 18% higher for decedents in state-years with a prescriptive palliative care law (relative risk, 1.18 [95% CI, 1.11-1.26]). In this cohort study of decedents from cancer, state palliative care laws were associated with an increased likelihood of dying at home or in hospice. Passage of state palliative care legislation may be an effective policy intervention to increase the number of seriously ill patients who experience their death in such locations.