bluuebunny/crossref_metadata_2025 huggingface dataset:
Notch Signaling – Constantly on the Move
Authors: Nichols James T. , Miyamoto Alison , Weinmaster Gerry
Published: June 2007

The Notch pathway is a highly conserved and ubiquitous signaling system that functions in determining a diverse array of cell fates and regulates many cellular processes during embryonic development and throughout adulthood. Links to cancer, stroke and Alzheimer's disease underscore the need to define the molecular basis of Notch activation. Notch signaling is induced through direct cell–cell interactions that promote receptor activation following engagement with a membrane‐bound Delta, Serrate, Lag‐2 (DSL) ligand on adjacent cells. Cells take on distinct fates because Notch signaling is consistently activated in only one of the two interacting cells, highlighting the importance of establishing and maintaining signaling polarity. Studies in flies and worms have identified positive and negative transcriptional feedback mechanisms that amplify small differences in Notch and DSL ligand expression to bias which cells send or receive signals. However, endocytosis by signal‐sending and signal‐receiving cells also appears critical for directing and regulating Notch activation. In particular, endocytosis and membrane trafficking of DSL ligands, Notch and modulators can determine the competence of cells to send or receive signals that ensure reproducibility in generating cell types regulated by Notch signaling.
Difficulty and Modern Poetry
Authors: Monte Steven
Published: June 2007

This article examines and expands upon criticism on difficulty, in literature and in other arts, in order to gain theoretical and practical perspective on key questions relating to modern poetry and to poetic difficulty (if not to difficulty in all art). Topics addressed include: the implications of ‘difficulty’ as concept and term, the importance of modernism to our understanding and evaluation of difficulty, what characterizes modern difficulty (difficulty since romanticism), how to account for modern difficulty, how difficulty informs and is informed by postmodern and other perspectives since modernism, the significance and qualities of poetic difficulty, the theoretical challenges of discussing difficulty as something experience by a reader (rather than as an intrinsic property of a text), and difficulty as an aesthetic (a topic that involves discussion of simplicity as an aesthetic and discussion of difficulty as a necessary aesthetic). Beyond its theoretical and historical claims regarding modern poetry, difficulty, and modernism, this article argues for more sustained consideration of the experience of reading in interpretation and for more nuanced aesthetic evaluation in criticism.
Evidence in the Palm of Your Hand: Development of an Outcomes‐Focused Knowledge Translation Intervention
Authors: Doran Diane M. , Mylopoulos John , Kushniruk André , Nagle Lynn , Laurie‐Shaw Brenda , Sidani Souraya , Tourangeau Ann E. , Lefebre Nancy , Reid‐Haughian Cheryl , Carryer Jennifer R. , Cranley Lisa A. , McArthur Greg
Published: June 2007

Aim: The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing‐sensitive outcomes data collection and evidence‐based decision‐making at the point‐of‐patient care.

Background: With the current explosion of health‐related knowledge, it is a challenge for nurses to regularly access information that is most current. The Internet provides timely access to health information, however, nurses do not readily use the Internet to access practice information because of being task‐driven and coping with heavy workloads. Mobile computing technology addresses this reality by providing the opportunity for nurses to access relevant information at the time of nurse–patient contact.

Method: A cross‐sectional, mixed‐method design was used to describe nurses' requirements for point‐of‐care information collection and utilization. The sample consisted of 51 nurses from hospital and home care settings. Data collection involved work sampling and focus group interviews.

Findings: In the hospital sector, 40% of written information was recorded onto “personal papers” at point‐of‐care and later transcribed into the clinical record. Nurses often sought information away from the point‐of‐care; for example, centrally located health records, or policy and procedure manuals. In home care, documentation took place in clients' homes. The most frequent source of information was “nurse colleagues.” Nurses' top priorities for information were vital signs data, information on intravenous (IV) drug compatibility, drug references, and manuals of policies and procedures.

Implications: A prototype software system was designed that enables nurses to use handheld computers to simultaneously document patients' responses to treatment, obtain real‐time feedback about patient outcomes, and access electronic resources to support clinical decision‐making.

Conclusion: The prototype software system has the potential to increase nurses' access to patient outcomes information and evidence for point‐of‐care decision‐making.
Integrated Care for Older People: Methodological Issues in Conducting a Systematic Literature Review
Authors: Reed Jan , Childs Sue , Cook Glenda , Hall Amanda , McCormack Brendan
Published: June 2007

Introduction: Systematic reviews are a useful approach for nurses to take in exploring issues important to their practice, and in this article the process of conducting a systematic literature review on integrated care for older people is described. The review was conducted as one strand of a research project aiming to inform the development of locality‐based integrated care for older people in Northern Ireland, a development driven by observations of user needs.

Methodology: Systematic literature review methodology is summarized and critiqued. The process of undertaking the review in this study is described with a focus on the first stage of identifying literature, and the challenges that this presents in a review which draws on multiple bodies of work.

Results: Producing a systematic literature review in integrated care is a complex undertaking, comprising a variety of different sectors, organizations, care settings, professionals, and other users, with their own bodies of knowledge; the need for an inclusive approach; the need to search a wide range of databases; nonspecific terminology; and the inappropriateness of study design hierarchies as selection criteria.

Conclusions: While such a literature review might provide a basis for research and practice, the ability of the review team to call upon a wide range of skills, experience, and knowledge across the information management field and the care system is crucial.
Vector activity of Hyalesthes obsoletus living on nettles and transmitting a stolbur phytoplasma to grapevines: a case study
Authors: Bressan A. , Turata R. , Maixner M. , Spiazzi S. , Boudon‐Padieu E. , Girolami V.
Published: June 2007

We report a case study on the vector activity of a Hyalesthes obsoletus (Hemiptera: Cixiidae) population living on nettle plants (Urtica dioica) and transmitting a stolbur phytoplasma (Sp) to grapevines (Vitis vinifera). The research was conducted in a site that included a vineyard bordered with a large fallow area where nettles were the predominant plant species together with sparse old grapevines. Nettles hosted a high population of H. obsoletus. By using transparent sticky traps to sample adults, we observed that the daily flight activity of males and females to grapevines in the fallow was unimodal peaking between 15 and 21 h in the day. Adults were unable of great dispersion into the vineyard and the pattern of insect captures inside the planting reflected the pattern of Sp‐infected grapevines in the late autumn. When insects were forced to feed on grapevine cuttings for transmission assays, survival of H. obsoletus decreased after 24–48 h. The scarce propensity of the vector to move into the vineyard and feed on grapevines was counterbalanced by the rapidity of H. obsoletus to inoculate Sp to grapevines (estimated minimum inoculation access period ranged from 3 to 6 h) and a relative high incidence of Sp in the population of H. obsoletus that ranged between 20% and 30% of sampled insects as shown by a polymerase chain reaction–based procedure. Characterisation of Sp by restriction fragment length polymorphism analysis of nonribosomal phytoplasma DNA showed the occurrence of an Sp strain known to infect H. obsoletus associated to nettles and grapevines in Germany.
Assessing the genetic diversity of tobacco germplasm using intersimple sequence repeat and inter‐retrotransposon amplification polymorphism markers
Authors: Yang B.C. , Xiao B.G. , Chen X.J. , Shi C.H.
Published: June 2007

The genetic diversity of 118 tobacco accessions, including flue‐cured tobacco, sun‐/air‐cured tobacco, burley tobacco, oriental tobacco and wild tobacco, was characterised using intersimple sequence repeat (ISSR) and inter‐retrotransposon amplification polymorphism (IRAP) markers. ISSR and IRAP banding patterns and genetic distance (GD) values showed the low level of genetic diversity within and among cultivated tobacco types. There was higher GD and average heterozygosity among wild tobacco types than those among cultivated tobacco. Genetic diversity of tobacco germplasm was low, with a high level of genetic identity (>0.77) between the different types. However, neighbour‐joining cluster analysis of marker‐based GDs showed that the accessions from the same tobacco type, as classified by manufacturing quality traits, were nearly clustered into the same group. These results will help in the formulation of appropriate strategies for variety improvement in tobacco, and ISSR and IRAP markers of the genetic diversity will contribute to further study and improvement of tobacco.
Prospects of partial root zone irrigation for increasing irrigation water use efficiency of major crops in the Mediterranean region
Authors: Kirda C. , Topcu S. , Cetin M. , Dasgan H.Y. , Kaman H. , Topaloglu F. , Derici M.R. , Ekici B.
Published: June 2007

Field experiments were conducted for 3 years from 2000 to 2002 to assess proportional crop yield differences obtained under conventional deficit irrigation (CDI) and partial root zone irrigation (PRI) practices, compared with full irrigation (FULL) where plant water requirements were fully met. The experimental crops included vegetables (tomato and pepper), field crops (maize and cotton) and citrus. The fruit yield of greenhouse‐grown tomato with FULL irrigation was higher than with PRI (7–22% lower) but was not significantly different. The PRI treatments had 7–10% additional tomato yield over CDI receiving the same amount of water. The yield of pepper, however, decreased in proportion to the level of irrigation deficit with no increase of irrigation water use efficiency (IWUE). No seed yield decrease was evident for cotton with the deficit treatments (PRI and CDI) compared with FULL irrigation. Similarly, the PRI treatment did not give any yield benefit for maize compared with CDI. The ranking of fruit yields of mandarin, FULL > PRI > CDI, was the same as that of other crops; however, the differences were not significant. Although the deficit treatments (PRI and CDI) had as high as 39% increase in IWUE, compared with FULL treatment, some adverse effects on fruit quality were evident such as smaller size of fruits under the deficit treatments.
Long‐term yield and water use efficiency under various tillage systems in Mediterranean rainfed conditions
Authors: Cantero‐Martínez C. , Angás P. , Lampurlanés J.
Published: June 2007

Conservation tillage (CT) can be beneficial for soil, water and soil organic matter conservation in Mediterranean areas that are prone to soil erosion and where water availability for crops is the main factor for sustainability. CT is the best option to protect the soil from erosion, improve infiltration, reduce soil evaporation and so conserve rainwater to increase crop water use (WU) and also water use efficiency (WUE). While CT can play an important role in reaching the stability and sustainability of these agricultural systems, performance depends upon the choice and adoption of an appropriate soil management (tillage) system. In rainfed areas of the Ebro Valley, winter cereals are the main crop sown. This paper presents the results of 15 years of research in different soil and climatic conditions of the area of CT on water conservation, WU and WUE. Long‐term experiments, comparing different tillage systems, were established in 1987, 1990 and 1992, at three locations in the Ebro Valley, chosen according to their degree of aridity (Selvanera, Agramunt and El Canós). Results reveal that CT was most effective in increasing yield under the driest conditions at Agramunt (10–15%), still effective with a smaller advantage under slightly wetter conditions at El Canós (5–10%) but ineffective at Selvanera, the wettest site. CT only increased WU in some years at Agramunt and never at the other two sites. The benefits of CT to both increased yield at Agramunt and El Canós were determined by improved WUE arising from changes in the pattern of WU before and after anthesis.
Effects of straw mulching on soil temperature, evaporation and yield of winter wheat: field experiments on the North China Plain
Authors: Chen S.Y. , Zhang X.Y. , Pei D. , Sun H.Y. , Chen S.L.
Published: June 2007

Straw mulching is an effective measure to conserve soil moisture. However, the existence of straw on the soil surface also affects soil temperature, which in turn influences crop growth, especially of winter crops. Five‐year field experiments (2000–2005) investigated the effects of straw mulching and straw mass on soil temperature, soil evaporation, crop growth and development, yield and water use efficiency (WUE) of winter wheat (Triticum aestivum L.) at Luancheng Station on the North China Plain. Soil is a moderately well‐drained loamy soil with a deep profile at the station. Two quantities of mulch were used: 3000 kg ha−1 [less mulching (LM)] and 6000 kg ha−1 [more mulching (MM)], representing half and all of the straw from the previous crop (maize). In the control (CK), the full quantity of mulch was ploughed into the top 20 cm of soil. The results showed that the existence of straw on the soil surface reduced the maximum, but increased the minimum diurnal soil temperature. When soil temperature was decreasing (from November to early February the next year), soil temperature (0–10 cm) under straw mulching was on average 0.3°C higher for LM and 0.58°C higher for MM than that without mulching (CK). During the period when soil temperature increased (from February to early April, the recovery and jointing stages of winter wheat), average daily soil temperature of 0–10 cm was 0.42°C lower for LM and 0.65°C lower for MM than that of CK. With the increase in leaf area index, the effect of mulching on soil temperature gradually disappeared. The lower soil temperature under mulch in spring delayed the development of winter wheat up to 7 days, which on average reduced the final grain yield by 5% for LM and 7% for MM compared with CK over the five seasons. Mulch reduced soil evaporation by 21% under LM and 40% under MM compared with CK, based on daily measuring of microlysimeters. However, because yield was reduced, the overall WUE was not improved by mulch.
The Physician's Obligation to Testify and His Right to Compensation
Authors: Hirsh Harold L.
Published: June 2007

It has long been held that a physician who has had no previous professional connection with an incident affecting an individual has no duty to testify on his behalf in court. Where a physician is requested to appear as an expert witness to give opinion testimony, he has no legal obligation to accept and his appearance is purely voluntary and by prearrangement. Under these circumstances, the physician may require that he be paid an “expert” witness fee in an amount determined by the usual and customary fee for such services and by the amount of time he actually spends in the preparation and presentation of his expert testimony.
Accelerating Life-Sustaining Gifts: The Case for Uniform Organ Donor Driver's License
Authors: Raible Jane A.
Published: June 2007

The making of organ donor gifts when one's own body no longer needs the tissue seems a reasonable way in which one may make a gift that projects into the future.

Still, tissue shortages exist everywhere. Even England, where understanding of the intersection of health needs and distributive justice is generally viewed as more advanced than in the United States, suffers from a tissue shortage. We can only assume that the waiting lists for organs will grow unless our response to organ need changes dramatically. since our developing medical technologies will increasingly provide us with methods lor successful transplantation.

Common law has prevented individuals in the past from providing for the disposition of their own bodies. Passage of the Uniform Anatomical Gift Act in the 50 states and promulgation of similar measures throughout Canada, however has overcome that tradition. This Act permits persons to donate organs with the gift becoming effective upon death. Support for the Act was strong, and the bill was enacted state by state with unprecedented swiftness. Yet, organs are still not readily available.
The Expert Witness in Medical Liability Cases
Authors: Sanbar S. S. , Pataki Leonard I.
Published: June 2007

This article presents an overview of the role of the medical expert witness in litigation involving issues of medical liability or malpractice in order to introduce the potential physician expert witness to some of the major problems and situations that may arise.

The expert medical witness is needed among other reasons, to define the standard of medical care required in the Physician/patient relationship which is frequently the crucial element in a professional liability case. The plaintiff. in order to prevail in his law suit, must show, among other components, (1) what the required standard of care was in his case, (2) that the defendant failed to meet that standard, and (3)th at this failure was the cause of the injury alleged.

The standard of care required of a physician is commonly defined as adherance to “the skill and learning commonly possessed by a member of the profession in good standing.”
Changing Notes in Medical Records: A Proposal
Authors: Babin Susan
Published: June 2007

The hospital medical record is a multi-purpose document. It is the repository for all relevant (and sometimes not so relevant) medical information concerning the care and treatment of a patient during his or her stay in the hospital or visits to the Out-Patient Department or Emergency Ward. In addition, it serves as a form of communication among all past, present and future providers to help them provide medical care to the patient. With the gradual disappearance of solo practice as a major mode of health care delivery, and with the emergence of group practices, Health Maintenance Organizations, neighborhood health centers and hospital based primary care programs, this communicative function assumes even more importance. As a legal document, its existence is mandated by statute in many states, and it is frequently used as evidence in malpractice suits and other court proceedings. The medical record also serves as a research resource from which statistics and findings can be compiled to aid in a variety of studies and medical audits. Finally, it is an educational document which often is employed as a teaching tool in training students in the health field.
Using the Law to Protect Health: The Frustrating Case of Smoking
Authors: Christoffel Tom , Stein Sandra
Published: June 2007

It is Recommended … That it be recognized by all organizations and associations concerned with smoking and health that the campaign against smoking is political and economic in character and requires decisions based on political and economic factors.

Government and Social Action Conclusions of the Third World Conference on Smoking and Health, 1975

The only way we know today to stop cancer is to stop smoking. …

Dr. David Baltimore, Nobel Laureate and Professor of Biology, Massachusetts Institute of Technology, at the Public Forum on The Future of Cancer Research and Cancer Care, Boston University School of Medicine's Hubert H. Humphrey Cancer Center dedication, Faneuil Hall, Boston. Mass., October 12, 1979.
The Right to Refuse Psychiatric Medication
Authors: Matthews Daryl B.
Published: June 2007

Robert Plotkin of the Mental Health Law Project called the case a “tremendous victory” for the patients’ rights movement. Alan Stone, President of the American Psychiatric Association, bemoaned it as “the most impossible, inappropriate, ill-considered judicial decision in the field of mental health law.” The case is Rogers v. Okin, and in deciding it, U.S. District Court Judge Joseph L. Tauro has gone farther than any previous court in establishing the right of hospitalized psychiatric patients to refuse medication.

The class action suit was filed in 1975 by a group of patients involuntarily committed to the Austin and May Units of the Boston State Hospital. It was brought against the Massachusetts Commissioner of Mental Health, now Dr. Robert Okin, and thirteen psychiatrists and a psychologist who were then on the staff of Boston State Hospital.
The Case of Brother Fox: Immunity Procedures in the Treatment of Terminally Ill Incompetent Patients
Authors: Williams C. Dickerman
Published: June 2007

In the “Brother Fox case,” the Appellate Division of the Supreme Court of New York for the Second Department, in a thoughtful and exhaustive opinion, announced several rulings of significance affecting the treatment of the terminally ill. The decision dealt with both competent and incompetent patients, but is especially relevant to more complex problems associated with the incompetent patient.

The court held that a competent terminally ill patient was entitled to refuse medical treatment and, that a competent person might lawfully direct that treatment be withheld should he later become terminally ill and incompetent. The court then declared that these rights were of constitutional dimension, embodied in the constitutional right of privacy, and not based on a mere common law “bodily right of self determination.”
Report on the National Commission: Good as Gold
Authors: Annas George J.
Published: June 2007

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research ended its work by substantially endorsing the status quo which places primary reliance on local Institutional Review Boards for subject protection. This was predictable because of the Commission's researcher-dominated composition which permitted it to assume that (1) research is good; (2) experimentation is almost never harmful to subjects, and (3) researcher-dominated IRBs can adequately protect the interests of human subjects. The successor Presidential Commission can learn much by re-examining these premises.
Rhetoric and Research Ethics: An Answer to Annas
Authors: Jonsen Albert R. , Yesley Michael
Published: June 2007

At the outset of his “Report on the National Commission,” Professor Annas quotes a satire on federal commissions. He then hastens to add that the quoted passage is an unfair and untrue characterization of the National Commission for the Protection of Human Subjects. This could be said of Annas' entire article. His central theme — that the Commission was biased in favor of research — is supported by poor evidence, and contrary evidence is neglected. For an accurate description of the Commission and its work, readers must turn elsewhere. We would suggest starting with the Commission's own reports, which include detailed explanations of the bases for its recommendations as well as the data that were considered by the Commission in arriving at the recommendations.
Appropriateness Review
Authors: Berriman W. Thomas
Published: June 2007

During the last half of 1980, health systems agencies (HSAs) throughout the country will be conducting appropriateness reviews for the first time. For many HSAs, this will be their initial venture into reviewing existing institutional health services, as distinguished from their reviews of proposed capital expenditures and new institutional health services under the authority of Section 1122 of the Social Security Act or state certificate of need (CON) laws. The scope, content, and effect of appropriateness reviews present numerous areas of uncertainty, some of which this article will examine.

Appropriateness review was enacted originally as part of the National Health Planning and Resources Development Act of 1974 (the “Act”). It was a compromise. The concept originated among health planners who were dissatisfied with their inability to initiate changes in the health care delivery system. This weakness resulted from their essentially reactive posture in reviewing new projects proposed by existing facilities.
Construction Picketing Notices to Health Care Institutions: The National Labor Relations Board Alters its Approach
Authors: King G. Roger
Published: June 2007

In the health care field, the concept of protected employee activity under the National Labor Relations Act (NLRA) must be balanced against the need to avoid the disruption of patient care. Congress acknowledged the need to balance these competing concerns when it included Section 8(g) within the 1974 Health Care Institution Amendments to the NLRA.

Section 8(g) establishes a notification procedure with which a labor organization must comply before commencing a strike or other concerted work-stoppage. In an effort to ameliorate the threat which an unannounced and unanticipated stoppage of work poses to the delivery of health care, Section 8(g) requires that a labor organization provide the health care institution and the Federal Mediation and Conciliation Service with written notice specifying the date and time of any strike, picketing, or other work-stoppage at least ten days in advance of the planned activity.
IPAs and

Per Se

Rules:

Arizona v. Maricopa County Medical Society
Authors: Cohen Harry Philip
Published: June 2007

The recent flurry of antitrust litigation in the health care industry is forcing the courts to reevaluate the legality of existing health care institutions under the Sherman Antitrust Act. One type of institution that poses significant antitrust questions is the independent practice association (IPA), an arrangement which consists of a contractual relationship between subscribers, physicians and an IPA corporate entity. The physicians agree to provide medical services to the IPA's subscribers, who pay a flat rate. In exchange, physicians are reimbursed at rates usually established by a fee schedule.

The Health Maintenance Organization Act of 1973 requires that an IPA, like an HMO, must “assume full financial risk on a prospective basis for the provision of basic health services…” This ensures that the IPA bears the risk that the cost of the services it renders will not exceed the value of the premiums it collects, giving it an incentive to contain costs.
State Nursing Associations and Collective Bargaining: A Conflict of Interest?
Authors: Cwiek Mark
Published: June 2007

The American Nurses’ Association (ANA) and its affiliate state nurses’ associations (SNAs) claim to represent the interests of all registered nurses in this country.’ In reality, an uneasy schism of professional ideology has developed within these organizations. The ANA believes that the state and district nurses’ associations are qualified to act and should act as the exclusive agents of their respective memberships in the important fields of economic security and collective bargaining. In fact, in 1977, 100,000 registered nurses, then somewhat less than 10 percent of all working RNs, were under union contract through an SNA. Yet the leadership in the ANA and SNAs is dominated by nurses who are either supervisors or educators in their daily professional roles. The ANA has identified the director of nursing in any given hospital as the legitimate leader of that nursing staff: “Nursing administration has the responsibility and authority for the quality of nursing practice within the health care organization.” Yet the collective bargaining process itself often pits nursing staff against nursing leadership within a given facility.
The Patient's Right to Refuse Anti-Psychotic Drugs: The Court of Appeals Decision in Rogers v. Okin
Authors: Cole Richard
Published: June 2007

On October 29, 1979, Judge Joseph Tauro of the United States District Court for Massachusetts issued a nationally publicized decision in a case entitled Rogers v. Okin, declaring that voluntary and involuntarily committed patients at Boston State Hospital had a constitutional right to refuse treatment in non-emergency situations. The suit, brought as a class action, was filed on April 25, 1975, by seven patients who were either voluntarily admitted or involuntarily committed to the May and Austin Units at Boston State Hospital. On April 30, 1975, a temporary restraining order was issued by the District Court enjoining the doctors at Boston State Hospital from continuing their practice of forcibly medicating patients in non-emergencies. This temporary order remained in effect through the trial and until the District Court issued its permanent order in October 1979.

The ruling was widely criticized by some psychiatrists as an unwarranted intrusion by the courts into the practice of medicine. However, others within the medical and the legal communities considered the decision a major victory for the civil and human rights of institutionalized patients.
Malpractice Countersuits: Succeeding at Last?
Authors: Taub Sheila
Published: June 2007

From time to time physicians have attempted to retaliate against malpractice suits which they perceive as groundless by filing countersuits against the suing patient, his attorney, or both. In recent years the number of such countersuits filed has risen dramatically, amounting to what one author has called a “legal fad.” A Dallas attorney has reportedly formed an organization, Lawyers for Protecting People From Malicious and Unjustified Lawsuits, Inc., to assist those who countersue attorneys. Until recently, however, such countersuits were nearly always unsuccessful because of the formidable burden of proof placed on the plaintiffs by the applicable legal doctrine. This article will discuss a handful of recent appellate court decisions which suggest that the countersuit may yet prove to be a potent weapon in the physician's arsenal against groundless claims.

In Bull v. McCuskey, a 1980 case, the Supreme Court of Nevada upheld an $85,000 countersuit award. This appears to be the first such decision upheld by a state supreme court and the largest countersuit award to date.
Trends in National Labor Relations Board Decisions for the Health Care Industry
Authors: Zimmerman Don A.
Published: June 2007

The 1974 health care amendments to the National Labor Relations Act (NLRA or the Act) have given rise to several significant developments in the case law. This article focuses on the subjects of appropriate bargaining units, the inclusion — or exclusion — of house staff under the NLRA, and, briefly, the special strike notice requirements under section 8(g) of the Act. These areas have been the subject of substantial controversy and conflict among the federal courts.

In 1947, the Taft-Hartley Act excluded from the term “employer” as defined in the NLRA, “any corporation or association operating a hospital, if no part of the net earnings inures to the benefit of any private shareholder or individual.” In 1974, Congress removed the exclusion for voluntary, nonprofit hospitals and added the new term “health care institution.” In so doing, it found “no acceptable reason why 1,427,012 employees of … non-profit, nonpublic hospitals … should continue to be excluded from the coverage and protections of the Act.
Prescribing Approved Drugs for Nonapproved Uses: Physicians’ Disclosure Obligations to Their Patients
Authors: Kapp Marshall B.
Published: June 2007

A large part of the everyday practice of medicine consists of prescribing drugs for the purpose of curing or alleviating patient ills. In most cases, a drug must be approved for specific uses by the federal government before it becomes available to be prescribed by a physician. However, once a drug has received regulatory approval for a specific medical use, the physician may prescribe it for any purpose, approved or not. The prescribing of drugs for nonapproved uses is a common medical practice. This article discusses the informed consent implications raised by this practice, and argues that the physician should disclose to the patient the legal status of a drug prior to prescribing it for a purpose which has not been governmentally approved.

Relying upon the Constitution's Commerce Clause, Congress has vested jurisdiction over all “drugs” involved in “interstate commerce” in the federal Food and Drug Administration (FDA), a division of the Public Health Service (PHS) of the Department of Health and Human Services (DHHS).
Notions of Teams and Team Talk in Health Care: Implications for Responsibilities
Authors: Erde Edmund L.
Published: June 2007

The use of the phrase “health care team” raises a number of philosophical questions — the fundamental one being whether it is appropriate to apply the word “team” to groups of health care professionals. This column will argue that answering that first question affirmatively will raise other ethical issues. For example, team rhetoric, drawn upon metaphors of athletic teams, is deceptive in the context of health care and can lead to incorrect concepts of the ethical responsibilities of the health care team and its members. Specifically discussed here will be the normative conflict between an individual’s loyalty to the health care team and that person's responsibility to “blow the whistle” on team members who have acted improperly.

One way to answer these questions is to use a general definition of “team” to determine whether there are any “teams” in health care based on that definition. Alternatively, one could look at several uses of the term outside the context of health care, and then see whether the health care situation is sufficiently analogous to these uses to justify the use of the term.
Emergicenters and the Need for a Competitive Regulatory Approach
Authors: Michaels Joel L. , Crouter Mary Jean
Published: June 2007

Third party payment for health services in the United States has created an environment which offers little incentive to health care providers to be efficient. In response, health care policymakers have suggested that increased competition in the health care sector would encourage good managerial practices and improved cost efficiency. In recent years, health care providers that have the ability to provide services in a more cost-efficient manner have emerged; some, including health maintenance organizations and ambulatory surgical centers, have been encouraged by regulatory policy. In addition, a new alternative for the provision of emergency medical services has developed and has generated substantial controversy among physicians, hospitals, government officials, and the public. The entities that comprise this alternative are often collectively referred to as freestanding emergency care centers or “emergicenters.”

Much of the controversy surrounding emergicenters is caused by the lack of a definition which can be applied to the various emergicenter structures and operations.
Physicians and Nurses: Roles and Responsibilities in Caring for the Critically Ill Patient
Authors: Corless Inge B.
Published: June 2007

Most health professionals today would agree about the necessity of interdisciplinary health care for clients. The optimal division of labor, however, has been a source of concern if not outright disagreement.

Literature on “professional status” and on the interrelationships of health professionals abounds, possibly leading one to the impression that everything worth saying has already been said. However, developments in health care and in professional education are of a dynamic rather than of a static nature. For this reason alone a reconsideration of the roles and relationships of health care team members is justified from time to time.

Determining whether the health care system meets the needs of service recipients is only one important reason for studying role interactions.
Mississippi University for Women v. Hogan: The Supreme Court Rules on Female-Only Nursing School
Authors: Greenlaw Jane
Published: June 2007

On July 1, 1982, the United States Supreme Court issued its opinion in Mississippi University for Women v. Hogan, ruling that the “female only” admission policy of a state-supported nursing school violated the equal protection clause of the fourteenth amendment. The case has political and legal implications not only for nursing education, but for the nursing profession as well.

Joe Hogan, a registered nurse, worked as a nursing supervisor in a medical center in Columbus, Mississippi. In 1979, he applied for admission to the baccalaureate program at Mississippi University for Women (MUW) School of Nursing, located in Columbus. Although he met all of the school’s substantive admission criteria, Hogan was denied admission solely because MUW has, since its inception, admitted only females. The school’s policies would, however, permit him to audit nursing courses and to attend continuing ed,ucation courses.
Liability for Nursing Negligence in the Operating Room
Authors: Greenlaw Jane
Published: June 2007

In a lawsuit involving nursing negligence in the course of an operative procedure, generally the question arises as to whether liability for the nurse's negligence will rest on the nurse's employer or on the operating physician.

Imposition of vicarious liability for a plaintiff's injury is based upon a master-servant relationship between the negligent actor and a third party, such as a hospital or surgeon. Under the doctrine of respondeat superior, liability is imposed upon an employer for the negligent acts of employees, which arise in the course and scope of employment. The operating physician, however, may also be declared liable through the application of two legal mechanisms: the doctrines of captain of the ship and borrowed servant.

Under the captain of the ship doctrine, responsibility is imposed upon the physician because he is the one who is looked to by the patient as responsible for the patient's welfare and safety generally.
Does Hospital Corporate Liability Extend to Medical Staff Supervision?
Authors: Hollowell Edward E.
Published: June 2007

Corporate liability has proven to be fertile ground for claimants against hospitals. Charitable hospitals’ loss of immunity has produced a sudden and often traumatic change in hospital liability. The impact of corporate liability has been slower, but has produced the same result—extended hospital liability.

In the October 1980 issue of Medicolegal News, Lee J. Dunn, Jr., discussed the then-current tendency of courts to find hospitals culpable in tort litigation under the theory of corporate liability. That article concentrated on two decisions: Johnson v. Misericordia Community Hospital, and Bost u. Riley. Six months later, an article by Miles J. Zaremski discussed the continuing trend to hold hospitals accountable for the selection and maintenance of physicians on their medical staffs, and examined the Johnson decision, Fridena v. Evans, and Capan v. Divine Providence Hospital.
Withholding Treatment from Defective Newborns
Authors: Taub Sheila
Published: June 2007

The birth of Siamese twins to a Danville, Illinois physician and his wife on May 5,1981, renewed the recurrent debate on the morality, ethics, and legality of euthanasia for severely defective newborns. The twins, Jeff and Scott Mueller, were joined below the waist and shared the lower part of their digestive tract and three legs. Later studies revealed internal anomalies as well. At birth they were in critical condition, suffering from respiratory distress, and were not expected to survive more than a few days.

A note written by a nurse, and countersigned by Dr. Petra Warren, reading “do not feed in accordance with parents’ wishes” was entered on their hospital chart. Several nurses disobeyed the order and fed the infants. As the twins continued to live, against expectations, word of their birth spread. An anonymous caller informed the Illinois Department of Children and Family Services that they were being starved to death.
Standards of Medical Care: How Does an Innovative Medical Procedure Become Accepted?
Authors: Necheles Thomas
Published: June 2007

The question of how and when a novel medical procedure becomes accepted as standard practice has important legal implications. It may in certain situations be determinative of whether third-party reimbursement is available for such procedures. It may also affect the standard used in determining a physician’s liability for negligence. This article discusses several innovative medical procedures and the process of their acceptance by the medical community. It will be seen that none of these examples effectively delineates the process by which an innovative procedure becomes the accepted standard of care. Finally, the article suggests a system based upon consensus among recognized medical experts, and recommends that this system supplant the traditional cost-benefit analysis which is currently used to determine the accepted standard of care.

No formal mechanism currently exists for the introduction of innovative medical technologies, in contrast to the complicated procedures developed for the orderly introduction of new drugs into the marketplace.
The Emerging Stowaway: Patients' Rights in the 1980s
Authors: Annas George J.
Published: June 2007

At one point in Edgar Allan Poe’s Narrative of Arthur Gordon Pym of Nantucket, Pym, who has stowed away in the hold of a whaling vessel, believes he has been abandoned and that the hold will be his tomb. He expressed sensations of “extreme horror and dismay,” and “the most gloomy imagining, in which the dreadful deaths of thirst, famine, suffocation, and premature interment, crowded in as the prominent disasters to be encountered.”

It is probably uncommon for hospitalized patients to feel as gloomy as Pym. Nevertheless, installed in a strange institution, separated from friends and family, forced to wear a degrading costume, confined to bed, and attended to by a variety of strangers who may or may not keep the patient informed of what they are doing, the average patient is intimidated and disoriented. Such an environment encourages dependence and discourages the assertion of individual rights.

As the physician-director of Boston’s Beth Israel Hospital has warned: “today’s hospital stands increasingly to become a jungle, whose pathways to the uninitiated are poorly marked and fraught with danger. . . .”
Damage Remedies and Institutional Reform: The Right to Refuse Treatment
Authors: Furrow Barry R.
Published: June 2007

The articulation by a court of a new constitutional norm serves a valuable function: the right, as elaborated by judicial opinion, provides a standard for critically evaluating current social practices. The “right to refuse treatment,” that “newly created constitutional right of personal autonomy,” draws attention to the problems of institutionalized mental patients and their desires to make their own decisions to accept or reject drug therapies, particularly where severe side effects are involved. The enunciation of the right to refuse treatment, with its hard-edged overtones, forces us to look at the tension created by the conflict between institutional attempts to treat these patients, the sometimes antithetical desire of those within the institution to control them without regard for treatment impact, and the patient's desire to retain whatever control is left to him in such settings.

The right to refuse treatment-like its common law analogue in tort, informed consent doctrine-draws its roots from concepts of personal autonomy that pervade both tort doctrine and constitutional law.
A Procrustean Approach to Informed Consent: The Texas Medical Disclosure Panel
Authors: Richards Edward P. , Rathbun Katharine C.
Published: June 2007

One of the central dilemmas in contemporary medical practice is determining how much information a patient needs to make an informed choice of medical care alternatives. On June 1, 1982, Texas began an experiment that requires specific information to be given to patients about to undergo selected medical procedures. The objective of this uniform disclosure is to reduce the threat of medical malpractice lawsuits based on a failure of informed consent. While this is of benefit to physicians, it is unclear whether patients’ needs for information, like the unfortunate guests of Procrustus, will be cut and stretched to fit an inflexible standard. This article reviews the antecedents of this approach to informed consent, the legal and philosophical problems involved in uniform disclosure standards, and the practical problems that uniform disclosure standards pose for health care providers.
Allied Health Professionals and Hospital Privileges: An Introduction to the Issues
Authors: Grad John D.
Published: June 2007

The concept of allied health professionals practicing in hospitals arouses the opposition of many in the medical establishment. What is the nature of this conflict, and how can it be resolved? This article gives an overview of the reasons that allied health professionals are demanding hospital privileges, as well as the reasons that such privileges are opposed by physicians. In the author's opinion, the medical establishment should learn to accept practice in hospitals by non-physician providers, and can expect considerable legal opposition if it does not.

The first problem is to define what is meant by “allied health professional.” Generally, the term is applied to any health care provider who is not in the “MOD” group, which traditionally has included medicine (MD), osteopathy, and dentistry, although pursuant to certain federal regulations podiatry also falls within the MOD group. Thus, in a general sense, “allied health professionals” means everyone else who directly provides health care services.
Ethical Dilemmas and the Practice of Infection Control
Authors: Chavigny Katherine Hill , Helm Ann
Published: June 2007

To be a nurse involves the assumption of ethical responsibility in all areas of practice. Infection control practice is a nursing specialty which exemplifies two ethical issues: the nurse's duty or moral obligation for patient advocacy and the right of patients to safe care. Individual moral responsibility is an important issue for the nurse epidemiologist because epidemiologic fact-finding provides information that may present ethical problems as well as suggest solutions. This paper discusses ethical dilemmas arising in infection control practice, as illustrated by three actual situations.

In the course of practice, questions may arise concerning the ethical responsibilities of a nurse epidemiologist to provide facts that may be used in cases of dispute. This discussion shall be limited to institutionally acquired or nosocomial infections.