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Defensive Medicine

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8301. Medical Malpractice Reform and Employer-Sponsored Health Insurance Premiums Full Text available with Trip Pro

Medical Malpractice Reform and Employer-Sponsored Health Insurance Premiums Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance.Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance

2008 Health Services Research

8302. Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. (Abstract)

Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions

2006 Social Science & Medicine

8303. Limiting Exposure to Medical Malpractice Claims and Defamatory Cyber Postings via Patient Contracts. Full Text available with Trip Pro

Limiting Exposure to Medical Malpractice Claims and Defamatory Cyber Postings via Patient Contracts. The documents patients sign on admission to a medical practice can constitute a legal contract. Medical practices around the country are attempting to use these documents as a prospective defense against medical malpractice claims. Protective contractual provisions are often attacked on grounds that they are legally void as a result of unconscionability. Widespread use of arbitration clauses (...) have been met with mixed success. Arbitration clauses that limit damages available in medical negligence cases have been stricken in some states as having provisions that impose excessive entry costs on a patient starting the arbitration process. Other provisions relating to prequalification requirements for expert witnesses are now being used with increasing frequency. Clauses have even been placed in patient contracts that address cyber postings of adverse claims against physicians. Prospective

2008 Clinical Orthopaedics and Related Research

8304. Polymorphisms in innate immunity genes predispose to bacteremia and death in the medical intensive care unit* (Abstract)

of bacteremia or risk of death in patients admitted to a medical intensive care unit.DNA was available from 774 medical intensive care unit patients. We selected 31 single nucleotide polymorphisms in 14 genes involved in host innate immune defense. Serum levels of MASP2 and chemotactic capacity, phagocytosis, and killing capacity of monocytes at admission were quantified. Univariate Kaplan-Meier estimates with log-rank analysis and multivariate logistic regression were performed. Bootstrap resampling (...) Polymorphisms in innate immunity genes predispose to bacteremia and death in the medical intensive care unit* Critically ill patients are at risk of sepsis, organ failure, and death. Studying the impact of genetic determinants may improve our understanding of the pathophysiology and allow identification of patients who would benefit from specific treatments. Our aim was to study the influence of single nucleotide polymorphisms in selected genes involved in innate immunity on the development

2008 Critical Care Medicine

8305. Teaching medical decision modeling: a qualitative description of student errors and curriculum responses. (Abstract)

Teaching medical decision modeling: a qualitative description of student errors and curriculum responses. Novice medical decision modelers are prone to errors. The purpose of this article is to describe the common errors committed by decision modeling students and the changes made to a structured decision modeling project course in response.The decision modeling curriculum includes month-long segments in decision analysis, cost-effectiveness analyses, and a project course. In the project course (...) . Errors were common in sensitivity analyses and model construction, among other areas. Defensible differences in structural programming decisions were rare. More recently, result ranges have narrowed as stepwise homework ensures progress and areas prone to error are emphasized. Student communication is timelier, facilitated by homework-related questions. Individual, rather than group, work avoids potential problems with weaker students being carried by the more advanced. Student satisfaction has

2006 Medical Decision Making

8306. A multifacited approach to improve patient safety, prevent medical errors and resolve the professional liability crisis. (Abstract)

be taught proper communication skills and the importance of teamwork. Providers with frequent patient, nursing or medical staff complaints must be critically reviewed. The present system of risk management needs to move from a reactive position to a role of being proactive for both patient and physician. Claims management should offer the patient early compensation when appropriate and pursue a vigorous defense when medical care is adequate. Experts should be identified who will render fair, unbiased (...) A multifacited approach to improve patient safety, prevent medical errors and resolve the professional liability crisis. The current professional liability crisis is the third in the last 30 years. Similarities of the 3 crises are the rising cost of professional liability insurance and a diminishing number of sources available to purchase coverage. Proposed tort reform with caps on noneconomic damages and attorney contingency fees is a back end approach and will do little to solve this crisis

2006 American Journal of Obstetrics and Gynecology

8307. Juries and Medical Malpractice Claims: Empirical Facts versus Myths. Full Text available with Trip Pro

on negligence are roughly similar to assessments made by medical experts and judges. Damage awards tend to correlate positively with the severity of injury. There are defensible reasons for large damage awards. Moreover, the largest awards are typically settled for much less than the verdicts. (...) Juries and Medical Malpractice Claims: Empirical Facts versus Myths. Juries in medical malpractice trials are viewed as incompetent, antidoctor, irresponsible in awarding damages to patients, and casting a threatening shadow over the settlement process. Several decades of systematic empirical research yields little support for these claims. This article summarizes those findings. Doctors win about three cases of four that go to trial. Juries are skeptical about inflated claims. Jury verdicts

2008 Clinical Orthopaedics and Related Research

8308. Medical Malpractice: The Experience in Italy. Full Text available with Trip Pro

defensive medicine, thereby overutilizing resources with the goal of documenting diligence, prudence, and skill as defenses against potential litigation, rather than aimed at any patient benefit. To reduce the practice of defensive medicine and healthcare costs, a possible solution could be the introduction of an extrajudicial litigation resolution, as in other civil law countries, and a reform of the Italian judicial system on matters of medical malpractice litigation. (...) Medical Malpractice: The Experience in Italy. At the present time, legal actions against physicians in Italy number about 15,000 per year, and hospitals spend over 10 billion euros (approximately US$15.5 billion) to compensate patients injured from therapeutic and diagnostic errors. In a survey summary issued by the Italian Court for the Rights of the Patient, between 1996 and 2000 orthopaedic surgery was the highest-ranked specialty for the number of complaints alleging medical malpractice

2008 Clinical Orthopaedics and Related Research

8309. Medical malpractice and the chest physician. (Abstract)

injured through negligence are compensated, but most are not. Claims are brought against some negligent physicians but also some who are not negligent, and being negligent does not guarantee that a claim will be brought. The deterrent effect of medical malpractice is unproven, and the malpractice system may prompt defensive medicine and increase health-care costs. And by stressing individual accountability, it conflicts with a systems-oriented approach to reducing medical errors. (...) Medical malpractice and the chest physician. The US malpractice system is based on tort law, which holds physicians responsible for not harming patients intentionally or through negligence. Malpractice claims are brought against physicians from most medical disciplines in proportion to their numbers in practice and to the frequency with which they perform procedures. Claims against chest physicians most commonly allege injuries caused by the following: (1) errors in diagnosis, (2) improper

2008 Chest

8310. Informed consent and ethical issues in military medical research. (Abstract)

Informed consent and ethical issues in military medical research. Informed consent in military research shares many of the same fundamental principles and regulations that govern civilian biomedical research. In fact, much of modern research ethics is grounded in events that occurred in the context of war or government-sponsored research. Despite these similarities and common origins, research in the military has additional requirements designed to preserve service members' informed consent (...) rights. The special nature of the superior-subordinate relationship in the military necessitates careful protections to avoid perceptions of coercion or undue influence on a military subject. Additionally, current legal and regulatory requirements for advanced informed consent significantly restrict the flexibility of the military to conduct research using waiver of consent. This has implications on the ability of the nation to develop effective medical treatments for the global war on terrorism

2005 Academic Emergency Medicine

8311. Prehospital emergency medical services in Malaysia. (Abstract)

, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time (...) , there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.

2007 Journal of Emergency Medicine

8312. The use of defenses and physician health care costs: are physician health care costs lower in persons with more adaptive defense profiles? (Abstract)

defense use by the Defense-Q. We obtained physician health care costs for 3 months before and after the interview, as well as medical diagnoses and measures of psychological functioning.A more adaptive defense profile significantly predicted lower future physician health care costs. These results were found when controlling for other psychosocial variables, before and after controlling for previous physician health care costs, and when testing only within a physically healthy subsample. Results (...) The use of defenses and physician health care costs: are physician health care costs lower in persons with more adaptive defense profiles? The objective of the present study was to determine if persons who use more adaptive defenses have lower physician health care costs compared to those who use less adaptive defenses.We randomly selected 667 persons from the 1995 population-based Nova Scotia Health Survey who completed a videotaped structured interview. Each interview was rated for typical

2003 Psychotherapy and Psychosomatics

8313. Threats from patients and their effects on medical decision making: a cross-sectional, randomised trial. (Abstract)

Threats from patients and their effects on medical decision making: a cross-sectional, randomised trial. Negative experiences are not uncommon among doctors in Norway. Our aim was to find out about the various types of negative reactions (eg, complaints, negative exposure to the media, financial claims, and notification to the police) received by physicians from patients or relatives in response to treatment, to identify their cause, and to study their effects on subsequent clinical (...) %]) and family physicians (157 [58%]) than by other participants. Negative experiences did not affect choice of strategy for case simulations. For the first case, chest pain, 217 (44%) physicians presented with a threat chose a defensive strategy compared with 145 (30%) of those who were not (difference 14%; 95% CI 8-20). For the second case, a headache case, the corresponding numbers were 278 (57%) and 118 (25%) (32%; 26-38). Physician age, sex, specialty, or experience of negative reactions of patients did

2001 Lancet Controlled trial quality: uncertain

8314. [Dynamics of lipid peroxidation and antioxidant defense in response to dalteparin therapy in acute coronary syndrome]. (Abstract)

[Dynamics of lipid peroxidation and antioxidant defense in response to dalteparin therapy in acute coronary syndrome]. The aim of the study was examination of lipid peroxidation (LPO) and antioxidant system (AOS) in patients with acute coronary syndrome (ACS); evaluation of the effect of dalteparin therapy on LPO and ACS. Fifty one patients (mean age 57.5 +/- 1.5 years) were randomized into two groups: group 1 (n = 31) received low-molecular heparin dalteparin, group 2 (n = 17) was given non (...) -fractionated heparin. The course of the anticoagulant therapy lasted 8 days. LPO and antioxidant defense in plasm and blood red cells were investigated on day 1 and 9. ACS patients appeared to have elevated LPO products production both in plasm and blood red cells, low plasm antioxidant activity (AOA). Dalteparin therapy lowered content of malonic dialdehyde (MD) in red cells and plasm, AOA enhanced. Heparin activity was lower: MDA in plasm decreased in a lesser degree while MDA in red cells continued

2004 Klinicheskaia meditsina Controlled trial quality: uncertain

8315. A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine. (Abstract)

of these residencies were evaluated; four residents left their programs and one took medical leave, resulting in 46 graduating residents evaluated. MC did not affect the residency choice of interns. Although perceived likelihood of serious disease increased in case scenarios over time, defensive medicine decreased in 27% of cases and increased in 20%. On a scale with 1 representing extremely influential and 5 representing not at all influential, the mean (+/-SD) influence of MC on interns' and graduates' case (...) A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine. To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents.Using a validated instrument consisting of case scenarios and Likert-type scale questions, the authors performed a prospective, longitudinal (June 2001 to June 2005) study of EM residents at five 4-year California residency programs.All 51 EM interns

2007 Academic Emergency Medicine

8316. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. Full Text available with Trip Pro

Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. (a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged.Postal questionnaire survey. Each questionnaire was followed by a reminder.500 systematically (...) adopted, the most common (over half of doctors stating likely or very likely) seemed to be increased diagnostic testing, increased referrals, increased follow up, and more detailed patient explanations and note taking. Respondents practised defensive medicine as a possible consequence of concerns about the risks of being sued or having a complaint lodged. This association was particularly strong for negative defensive practices. Defensive medical practice did not correlate with any misunderstanding

1995 BMJ : British Medical Journal

8317. Parlaying digital imaging and communications in medicine and open architecture to our advantage: The new Department of Defense picture archiving and communications system Full Text available with Trip Pro

Parlaying digital imaging and communications in medicine and open architecture to our advantage: The new Department of Defense picture archiving and communications system The Department of Defense (DoD) undertook a major systems specification, acquisition, and implementation project of multivendor picture archiving and communications system (PACS) and teleradiology systems during 1997 with deployment of the first systems in 1998. These systems differ from their DoD predecessor system in being (...) multivendor in origin, specifying adherence to the developing Digital Imaging and Communications in Medicine (DICOM) 3.0 standard and all of its service classes, emphasizing open architecture, using personal computer (PC) and web-based image viewing access, having radiologic telepresence over large geographic areas as a primary focus of implementation, and requiring bidirectional interfacing with the DoD hospital information system (HIS). The benefits and advantages to the military health-care system

1999 Journal of Digital Imaging

8318. Trends in negative defensive medicine within general practice. Full Text available with Trip Pro

Trends in negative defensive medicine within general practice. Negative defensive medical practice has adverse consequences both for individual patients and for public health. This paper reports the results from a survey conducted in 1999 in which certain features indicative of negative defensive practice were compared with an identical survey conducted five years previously. Responding general practitioners stated that they are now significantly more likely to undertake diagnostic testing

2000 The British Journal of General Practice

8319. Reducing error, improving safety : Defensive culture of British medicine needs to change Full Text available with Trip Pro

Reducing error, improving safety : Defensive culture of British medicine needs to change 10948039 2000 09 28 2018 11 13 0959-8138 321 7259 2000 Aug 19-26 BMJ (Clinical research ed.) BMJ Reducing error, improving safety. Defensive culture of British medicine needs to change. 505 Barley V V Neale G G Burns-Cox C C Savage P P Machin S S El-Sobky A A Savage A A eng Letter England BMJ 8900488 0959-8138 AIM IM Defensive Medicine Humans Medical Errors Safety State Medicine United Kingdom United States

2000 BMJ : British Medical Journal

8320. Defensive nature of Sargassum polycystum (Brown alga) against acetaminophen-induced toxic hepatitis in rats: Role of drug metabolizing microsomal enzyme system, tumor necrosis factor-α and fate of liver cell structural integrity Full Text available with Trip Pro

Defensive nature of Sargassum polycystum (Brown alga) against acetaminophen-induced toxic hepatitis in rats: Role of drug metabolizing microsomal enzyme system, tumor necrosis factor-α and fate of liver cell structural integrity To assess the defensive nature of Sargassum polycystum (S. polycystum) (Brown alga) against acetaminophen (AAP)-induced changes in drug metabolizing microsomal enzyme system, tumor necrosis factor (TNF-alpha) and fine structural features of the liver during toxic (...) , lipid infiltration and ballooning of mitochondria in the acetaminophen-intoxicated rats, whereas the rats treated with S. polycystum showed considerable protection against acetaminophen-induced alterations in structural integrity.These observations suggest that the animals treated with S. polycystum extract may have the ability to protect the drug metabolizing enzyme system and mitochondrial functional status from free radical attack, thereby showing its defense mechanism in protecting hepatic cells

2006 World journal of gastroenterology : WJG

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