National Legislation (national + legislation)

Distribution by Scientific Domains

Selected Abstracts

Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office Data

Brett Coldiron MD, FACP
Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source]

Two steps forward, one step back: advance care planning, Australian regulatory frameworks and the Australian Medical Association

M Parker
Abstract The Australian Medical Association has recently adopted a policy position concerning advance care planning, which is generally supportive of extending patient self-determination beyond the loss of decision-making capacity. It calls for uniform national legislation for legally enforceable advance health directives (AHD), and statutory protection for practitioners who comply with valid AHD, or who do not comply on several grounds. Analysis of the grounds for non-compliance indicate that they undermine patient autonomy, and aspects of the policy are inconsistent with current common law and statutory regimes that allow an adult to complete a legally binding AHD. The policy therefore threatens the patient self-determination, which it endorses, and places doctors who participate in advance care planning at legal risk. [source]

The Insecure Social Protection of Migrant Workers From the Maghreb

Abdellah Boudahrain
Is it possible to speak of just and equitable social protection for the active populations of poor countries which suffer from development problems and are dominated by an international order in which only the law of the strongest prevails, especially when those populations emigrate to seek work in order to live or merely to survive? Universal standards that are supposed to ensure some measure of international coordination of national legislation and practice in social security between developed countries and the so-called developing countries suffer from this somewhat original form of inequality. The adaptation of such standards at the bilateral, regional and multilateral levels only reflects the discrimination and selfish interests of States and of the rich and powerful, and indeed of broad sectors of their civil society who reject others simply because of their different culture and traditions. The debate is more involved than at first it may seem. By accepting others as being like oneself one can imagine a better world in which, when people move freely - including migrant workers and their families - they enjoy effective protection through social security. A study of the situation of Maghreb migrants employed and residing in western Europe and the Gulf States has much to teach us in this respect, especially in determining whether any form of solidarity is plausible or achievable in some not too distant future. [source]

Monitoring terrestrial mammals in the UK: past, present and future, using lessons from the bird world

MAMMAL REVIEW, Issue 1-2 2004
ABSTRACT 1.,A monitoring network for UK terrestrial mammals, the Tracking Mammals Partnership, is currently being set up to provide a coordinated programme to collect surveillance and monitoring data. 2.,Monitoring UK mammals is important for a number of reasons including: setting conservation priorities; measuring the effects of conservation management; managing populations of problem species and the sustainable use of game species; assessing the effects of agriculture and other human activities; providing evidence for the need for policy change; and because of obligations under intergovernmental treaties and national legislation. 3.,The bird world, largely but not solely through the work carried out by the British Trust for Ornithology, has provided a useful model for mammal surveillance and some important lessons in setting up and running a UK wide multispecies monitoring programme. 4.,Lessons include the importance: of annual monitoring; of long-term data sets of population indices rather than absolute population sizes; and of the use of volunteers in data collection. 5.,Two scoping studies have been carried out to assess the feasibility and costs of setting up a mammal surveillance and monitoring network and the survey methods that could be used for different species. 6.,The Tracking Mammals Partnership, comprising 23 organizations, has the remit of implementing the recommendations of the scoping studies. There are a number of programmes operating within the Partnership including the National Dormouse Monitoring Programme, the National Bat Monitoring Programme and the Breeding Bird Survey Mammal Monitoring. There are also a number of pilot schemes being tested. 7.,Reports on the population trend data collected should enable more informed policy and management decisions concerning UK mammal species. [source]

Predicting Family Reunification, Adoption, and Subsidized Guardianship Among Adolescents in Foster Care

Sonya J. Leathers
Although national legislation has attempted to decrease the length of time that children spend in foster care, these policies have been less effective with adolescents than with children, raising questions about how best to promote permanency for adolescents. This study examined factors that predict adolescent adoption, subsidized guardianship, and reunification. The caseworkers and foster parents of 203 randomly selected 12- to 13-year-olds placed in traditional or specialized foster care were interviewed. Permanency outcomes were prospectively tracked for 8 years. By the end of the study, over 40% of the adolescents were placed in permanent homes. As hypothesized, a strong relationship with a biological mother predicted successful reunification, and a high degree of integration into a foster home predicted adoption. Additionally, when compared with adoption, subsidized guardianship with foster parents occurred more frequently for youth with strong relationships with their biological mothers and weaker relationships with their foster families. Unexpectedly, behavior problems were not related to any permanency outcomes. Results suggest that promotion of strong relationships with adults is the key in efforts to find permanent families for foster children. Furthermore, efforts to attain permanency should not cease during adolescence. [source]