Medical-legal Considerations Research Articles

Investigation on physical restraint use in hospital: health responsibility, ethical and medical legal considerations.

The issue of restraint has long been considered a difficult political and social situation, affecting both healthcare wor-kers and facilities. The practice of restraint is still widespread in many public and private care settings, but there is a lack of systemic studies capable of monitoring the phenomenon. The framing of the question essentially concerns the right to personal freedom, guaranteed by the Italian Constitution. An anonymous questionnaire was developed containing questions on knowledge of the regulations on restraints, how, ways, and when they are implemented, and general information such as age, gender, educational qualification, qualification, O.Us. to which they belong. The collected data were statistically processed (Chi-square test) with the Epi Info 7.1.5 program (CDC-Atlanta- USA). A total of 1002 questionnaires were completed. The stratification of the sample by structure shows that 73.9% were public facilities. The indicative figure is represented by the 23.8% of respondents who say that "the restraint is not noted in the medical record". Restraint could be a real risk for the healthcare worker, encroaching on the issue of health liability. It is therefore important to raise awareness among healthcare professionals and top management of the need to structure, at company level, procedures that comply with the "Recommendations on physical restraint" to overcome the use of restraint through the improvement of care pathways in compliance with organizational and risk management standards.

Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review.

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

Photography in dermatology - a scoping review: Practices, skin of color, patient preferences, and medical-legal considerations.

Clinical photography is essential in dermatology. However, a comprehensive literature review of photography in dermatology is lacking. This scoping review aims to summarize the literature regarding photography practices in dermatology, photography of skin of color, patient preferences, and medical-legal considerations. A search was conducted utilizing Embase, MEDLINE, PubMed, and Evidence Based Medicine databases in accordance with the PRISMA extension for Scoping Reviews. In total, 33studies were summarized. Clinical photography is commonly used in biopsy site marking, assessment, diagnosis, disease monitoring, evaluation of treatment response, medical education, research, seeking advice from colleagues, and teledermatology. Although dermatologic photography remains devoid of skin of color representation, photographic considerations for darker skin are available. Most patients support medical photography, with a preference for clinical photographs to be taken by their own physicians, and for use of clinic/hospital-owned cameras over personal devices. Pertinent medical-legal issues include concerns around privacy, personal device use, and documentation of consent. Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit individuals of various skin tones. Management of consent and privacy must be upheld to sustain the increasing ease of image capture and sharing.

Category II Intrapartum Fetal Heart Rate Patterns Unassociated With Recognized Sentinel Events: Castles in the Air.

The evolution of continuous electronic fetal heart rate (FHR) monitoring has presented the obstetrician with a critical clinical conundrum: basic science observations suggest that such monitoring might be associated with improved long-term neurologic outcomes, yet, after a half century of use and millions of cesarean deliveries based on FHR monitoring, evidence for such improvement remains absent. This dichotomy appears to be related to widespread misconceptions regarding the physiology underlying various FHR patterns and the developmental origins of cerebral palsy. These misconceptions are strengthened by a reliance on anecdotal experience and tradition in lieu of evidence-based medicine, the confusing "category II" FHR designation, medical-legal considerations, and our tendency to view fetal monitoring, as originally conceptualized, as a single, indivisible entity whose concepts must be accepted or rejected en bloc. Ill-defined and largely imaginary conditions such as "depletion of fetal reserve" are particularly harmful and their use in clinical medicine uniquely not evidence based. A solution to this self-inflicted injury to our specialty will require a concerted effort involving teachers, authors, and researchers.

The future of artificial intelligence in medicine: Medical-legal considerations for health leaders.

Artificial Intelligence (AI) is becoming increasingly common in healthcare and has potential to improve the efficiency and quality of healthcare services. As the utility of AI expands, medical-legal questions arise regarding the possible legal implications of incorporating AI into clinical practice. Particularly, the unique black box nature of AI brings distinct challenges. There is limited guidance addressing liability when AI is used in clinical practice, and traditional legal principles present limitations when applied to novel uses of AI. Comprehensive solutions to address the challenges of AI have not been well established in North America. As AI continues to evolve in healthcare, appropriate guidance from professional regulatory bodies may help the medical field realize AI’s utility and encourage its safe use. As the options for AI in medicine evolve, physicians and health leaders would be prudent to consider the evolving medical-legal context regarding use of AI in clinical practices and facilities.

Testosterone replacement therapy in the era of telemedicine.

The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.

State Medical Boards, Licensure, and Discipline in the United States.

Medical practice acts and state medical boards have evolved since their conception in the mid-19th century. Today, state medical boards are usually responsible for a variety of functions, with the main function being the detection and discipline of unprofessional and unethical conduct by physicians and other medical professionals. In this article, a brief history of medical licensing and regulation is first provided, with an overview of the structure and process of state medical boards, and how they vary across states. Next, common causes for medical board complaints are discussed, with a focus on complaints against psychiatrists. Last, the author provides general medical-legal considerations that a psychiatrist should contemplate if he or she is the subject of a medical board complaint.

Diagnostic Failure of Ciprofloxacin-Induced Spontaneous Bilateral Achilles Tendon Rupture: Case-Report and Medical-Legal Considerations

Rare side-effects of fluoroquinolone therapy are tendinitis and tendon rupture. Many reports have demonstrated that the concomitant use of corticosteroids, in patients aged 60 years or older, increase the risk substantially. We present a case of spontaneous bilateral Achilles tendon rupture induced by ciprofloxacin and methylprednisolone. A 61-year-old woman was diagnosed with Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) and was started on oral ciprofloxacin 500 mg twice daily for 3 weeks and on oral methylprednisolone 16 mg twice daily for 2 weeks. The diagnosis was made after doctors, rather than stop drug therapy and advise complete rest, had mistakenly prescribed for the woman to undergo physiotherapy and local NSAIDs, thus favoring the onset of tendon ruptures and resulting in surgical and legal implications. Inspired by this case, we also submit a brief review on professional liability in Orthopaedics.

Mycobacteriosis in ornamental fish. Case reports in Sicily and medical-legal considerations

Mycobacteriosis in ornamental fish. Case reports in Sicily and medical-legal considerations

Medical–Legal Considerations in the Medical Spa Environment

A better understanding of the medical-legal considerations of the medical spa environment plays a role in promoting a successful medical spa. The medical spa setting is ideal for the performance of procedures that are incision-less, provide minimal discomfort, create little to no skin wound, and are performed in less than one hour. The procedures that fit this model include those that promote antiaging, those that lead to rhytid treatment, and hair removal.

Computer-Assisted Detection in Clinical Practice: Medical Legal Considerations

Preoperative imaging for early-stage cutaneous melanoma is not recommended by current guidelines. Our goal was to investigate our institutional usage and utility.Patients with clinically node-negative cutaneous melanoma undergoing surgery with sentinel lymph node biopsy were identified retrospectively. Any melanoma-related imaging after diagnosis and before surgery was considered a staging study.Five hundred fifteen studies were performed in 409 of 546 (75%) patients. Chest x-rays was performed in 70% and advanced imaging in 14% (computed tomography imaging, magnetic resonance imaging, ultrasound, and positron-emission computed tomography imaging). No metastatic lesions were identified. A Breslow thickness greater than 4 mm (odds ratio = 6.46 vs <1 mm; 95% confidence interval, 2.07 to 20.15) and male sex (odds ratio = 2.62 vs female; 95% confidence interval, 1.26 to 5.46) were associated with an increased likelihood of advanced imaging.Preoperative imaging was performed in the majority of patients with node-negative melanoma, with 14% undergoing advanced studies. No metastatic lesions were identified, confirming the limited utility in this setting.

Guidelines for the treatment of venous ulcers

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

Medical Legal Considerations of the Traveling Team Physician.

Medical Legal Considerations of the Traveling Team Physician.

Medical-Legal Considerations Regarding the Provision of Medication-Related Information to Consumers by a Pharmaceutical Manufacturer

This article provides a brief overview of recent direct-to-consumer advertising rulings that may impact the provision of information to consumer-related inquiries. Suggested guidelines are provided that may help minimize the risk when providing information to consumers.

Medical legal considerations in temporomandibular disorders

Dentists commonly see patients with temporomandibular disorders who are involved in litigation, and dentists are occasionally accused of temporomandibular disorder–related negligence. Rapidly changing scientific knowledge must be reflected in dental practice and in the courtroom, where dentists act as experts. In this article, concepts pertaining to assessments of patients with temporomandibular disorders for impairment and disability and concepts pertaining to legal causation are discussed, especially in relation to motor vehicle accidents. Recommendations for avoiding malpractice suits are presented. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:395-9)

The Politics of Breast Imaging

There are numerous political issues concerned with the roles of breast imaging in the detection, diagnosis, and management of breast cancer. These include issues regarding screening mammography, quality control, and results including cost-effectiveness of medical-legal considerations, but also their relation to overall health care of other societal needs.

Medical-legal considerations related to symptom duration and patient outcome after bacterial meningitis

Bacterial meningitis and viral encephalitis are infectious disease emergencies that can cause significant patient morbidity and mortality. Clinicians use epidemiologic, historical, and physical examination findings to identify patients at risk for these infections, and central nervous system (CNS) imaging and lumbar puncture (LP) may be needed to further evaluate for these diagnoses. The diagnosis of bacterial meningitis can be challenging, as patients often lack some of the characteristic findings of this disease with presentations that overlap with more common disorders seen in the emergency department. This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.

Laser Applications in Oral and Maxillofacial Surgery

Qualitative Laser Physics. Photobiological Effects of Laser Energy on Skin and Mucous Membranes. Practical Clinical Laser Safety in Anesthesia and Oral and Maxillofacial Surgery. Wavelength Conversion Effect. Contact and Free Beam Laser Surgery. Fundamentals of the Carbon Dioxide Laser. Selected Surface Lesions Amenable to the Laser. Laser Management of Discreet Lesions. Laser Management of Malignant Lesions of the Head and Neck. Laser Management of Vascular and Pigmented Lesions. Lasers in Preprosthetic and Peridontal Surgery. Use of the Holmium Laser in Arthroscopy of the Temporomandibular Joint. Lasers for Use in Facial Esthetic Surgery. Laser Assisted Uvulopalatostomy. Complications and Side Effects of Laser Surgery. Future Laser Technology in Oral and Maxillofacial Surgery. Medical Legal Considerations in Laser Surgery. Overview of Available Laser Products. Glossary of Laser Terms.

LAPAROSCOPIC HERNIORRHAPHY

There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent unilateral or bilateral hernias, and patients who, because of economic pressures, must return to work within 10 days of surgery. Within these limitations we feel that the laparoscopic approach definitely has a place in repair of inguinal hernias. In the future new techniques, decreased equipment costs, and the ability to use local anesthesia may increase the applicability of laparoscopic herniorrhaphy.