bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tort Claims Analysis in the Veterans Health Administration for Quality Improvement
Authors: Weeks William B. , Foster Tina , Wallace Amy E. , Stalhandske Erik 
Published: January 2007

Tort claims have been studied for various reasons. Several studies have found that most tort claims are not related to negligent adverse events and most negligent adverse events do not result in tort claims. Several studies have examined the disposition of tort claims to understand the likelihood of payment once a claim has been made. Still others have proposed that tort-claims trend analysis may help administrators target their quality-improvement efforts and identify problems with quality that would not otherwise be captured.In this article, we conduct a tort-claims analysis to explore areas for quality improvement, specifically for patient safety, in the Veterans Health Administration (VHA). Patient safety is an increasingly highlighted aspect of health-care delivery. Failure to assure patient safety can result in bad clinical outcomes, additional costs of care, and a negative organizational image. Filing a tort claim is one way for an individual to express concern about an organization. For our analysis, we draw from resolved tort claims in the Veterans Health Administration from fiscal years 1989 to 2000.
The Artificial Heart: How Close are We, and Do We Want to Get There?
Authors: Simmons Paul D. 
Published: January 2007

On July 2, 2001, a medical milestone was reached when Robert Tools received a total artificial heart implant at Jewish Hospital in Louisville, Kentucky. Tools was implanted with an AbioCor artificial heart, one of several brands of new-generation artificial hearts that has been approved by the U.S. Food and Drug Administration (FDA) for clinical trial. The AbioCor heart was developed by Abiomed of Danvers, Massachusetts.Following the surgery, physicians were guardedly enthusiastic about the device and optimistic about the patient’s future. Tools, 59, has had a history of numerous heart attacks and by-pass surgery, as well as diabetes and kidney problems. He met the requirements of the AbioCor protocol because he was not a candidate for transplant, death was otherwise probable within thirty days, and other interventions were deemed ineffective. Researchers hope that strengthening his heart function will result in increased function of his other vital organs, thus prolonging the patient's life and increasing his energy. But because the device is experimental, nothing can be promised.
Public Health Law: A Renaissance
Authors: Gostin Lawrence O. 
Published: January 2007

This symposium issue of the Journal of Law, Medicine & Ethics is about public health law, not health-care law. There is a difference. Most scholarly writing has examined the rich and textured field of health-care law or law and medicine. This field revolves around several broad themes related to the health-care system: delivery, financing, and research and innovation.In studying health-care delivery, scholars have examined everything from the physician/patient relationship (e.g., consent and privacy) to systems of care (e.g., hospitals and managed care organizations). In studying financing, scholars have examined theories of competition and justice to ensure cost-efficient access to care. And in studying research and innovation, scholars have studied everything from human subject protection to intellectual property.
Rethinking the Meaning of Public Health
Authors: Rothstein Mark A. 
Published: January 2007

Public health is a dynamic field. Outbreaks of new diseases, as well as changing patterns of population growth, economic development, and lifestyle trends all may threaten public health and thus demand a public health response. As the practice of public health evolves, there is an ongoing need to reassess its scientific, ethical, legal, and social underpinnings. Such a reappraisal must consider the disagreement among public health officials, public health scholars, elected officials, and the public about the proper role of public health and the distinctions, for example, between public health and clinical care, and public health and health promotion.In this article I will attempt to characterize the main points of contention as well as offer my own views regarding the proper scope of public health. Greater clarity and consensus on the meaning of public health are likely to lead to more efficient and effective public health interventions as well as increased public and political support for public health activities.
A Globalized Theory of Public Health Law
Authors: Fidler David P. 
Published: January 2007

This symposium issue of theJournal of Law, Medicine & Ethicsindicates that interest in public health law in the United States is enjoying a renaissance. The focus of the articles reflects this renaissance, as they explore the state of public health law in various contexts within the United States. Additionally, all but one of the symposium authors plies his or her trade at a university, institution, or government agency in the United States. My task here is different: I focus on public health law within the context of international relations.Analyzing public health law with an international perspective proves no easy assignment. Examining the role of public health law in the proverbial global village takes the analysis out of the familiar territory of law operating within a single sovereign state. The analysis could take two forms. One could compare different national systems of public health law on specific issues. Such a comparative law approach would be interested in, for example, how the public health laws of the United States and South Africa differ in connection with regulating tobacco consumption.
Public Health Ethics: Mapping the Terrain
Authors: Childress James F. , Faden Ruth R. , Gaare Ruth D. , Gostin Lawrence O. , Kahn Jeffrey , Bonnie Richard J. , Kass Nancy E. , Mastroianni Anna C. , Moreno Jonathan D. , Nieburg Phillip 
Published: January 2007

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions.
Managed Care and Public Health: Conflict and Collaboration
Authors: Rosenbaum Sara , Kamoie Brian 
Published: January 2007

This article reviews the relationship between managed care and public health. Managed care, with its seemingly infinite structural and organizational variation, dominates the modern American health-care system for the non-elderly U.S. population. Through its emphasis on standarhzed practice norms and performance measurement, coupled with industrial purchasing techniques, prepayment, risk downstreaming, and incentives-based compensation, managed care has the potential to exert considerable influence over the manner in which the health-care system is organized and functions. Given the degree to which the attainment of the basic public health goal of protecting the public against population health threats for which there are known and effective medical interventions depends on the successful interaction between public health policy and the medical care system, the importance of a viable working relationship between public health and managed care is difficult to overstate.The potential for conflict between public health and medical care is nothing new; indeed, delineating the boundaries of public health to shape and influence medical practice has occupied the energies of policymakers and the medical industry for well over a century.
After September 11: Rethinking Public Health Federalism
Authors: Parmet Wendy E. 
Published: January 2007

In the fall of 2001, the need for a vigorous and effective public health system became more apparent than it had been for many decades. With the advent of the first widescale bioterrorist attack on the United States, the government's obligation to respond and take steps to protect the public health became self-evident.Also obvious was the need for of an effective partnership between federal, state, and local officials. Local officials are almost always on the front lines of the struggle against bioterrorism. They are the first to recognize a suspicious case and to provide testing and treatment for the affected population. At the same time, state officials are needed to support and coordinate local efforts, providing an expertise that may be lacking in many communities, especially smaller ones.But few would doubt that the federal government has a key role to play. The Centers for Disease Control and Prevention (CDC) is expected to lead the epidemiological investigation and provide expertise on how to cope with diseases that remain unfamiliar to most physicians.
Administrative Law and the Public's Health
Authors: Kinney Eleanor D. 
Published: January 2007

Today, public health regulation at all levels faces unprecedented challenges both at home and abroad. The September 11, 2001 attacks on New York and Washington, D.C., by the Al Qaeda terrorist network and the anthrax bioterrorism that followed shortly thereafter have put public health regulation at the forefront of homeland security. The anthrax scare, in particular, has greatly tested the American public health system, calling into question whether the United States and its component states and localities are prepared to handle a major outbreak of infectious disease, such as smallpox, in a future bioterrorist action. While the response of public health agencies was commendable, especially in light of the magnitude of the assaults, it is manifestly clear that the American public health system will be hard pressed to meet similar challenges that may lie ahead.The events of fall 2001 follow a period of major challenges for public health. The AIDS pandemic has killed millions of people throughout the globe, especially in Africa and other parts of the developing world.
Evaluating the Impact of Criminal Laws on HIV Risk Behavior
Authors: Lazzarini Zita , Bray Sarah , Burris Scott 
Published: January 2007

Criminal law is one of the regulatory tools being used in the United States to influence risk behavior by people who have HIV/AIDS. Several different types of laws have been or could be used in this way These include:HIV-specific exposure and transmission laws — i.e., laws that explicitly mention and exclusively apply to conduct by people with HIV;public health statutes prohibiting conduct that would expose others to communicable diseases and/or sexually transmitted diseases (STDs); andgeneral criminal laws governing attempted murder and assault.
Bioterrorism Law and Policy: Critical Choices in Public Health
Authors: Hodge James G. 
Published: January 2007

There is perhaps no duty more fundamental to American government than the protection of the public's health, safety, and welfare. On September 11, 2001, this governmental duty was severely tested through a series of terrorist acts. The destruction of the World Trade Towers in New York City and a portion of the Pentagon in Washington, D.C., presented many Americans with a new, visible reality of the potential harms that terrorists can cause. The staggering loss of lives (estimated from 2,600 to 2,900) damaged the national psyche in ways far exceeding the physical scars to American institutions.As horrific as the images of destruction and loss of human lives may be, events that unfolded after September 11 revealed another dreaded, and potentially more catastrophic, threat to Americans sense of security and public health: bioterrorism. Unlike terrorists that use bombs, explosives, or other tools for mass destruction, a bioterrorist's weapon is an infectious agent.
Regulating Tobacco: The Need for a Public Health Judicial Decision-Making Canon
Authors: Daynard Richard A. 
Published: January 2007

Cigarette smoke is by far the leading preventable cause of death and disease in the United States. It has been estimated to kill between 419,000 and 589,000 smokers and up to 65,000 non-smokers each year. This premier status is hardly a new development, having been true for most of the last century, and known to be true at least since the first Surgeon General’s Report in 1964.Why then are tobacco products exempt from any significant federal oversight or control? Why do cigarette advertisements, pitched to young smokers and non-smokers, continue to be plastered on every available surface inside and outside many convenience stores and to adorn the pages of popular magazines? Why, decades since the makers of far less dangerous products began to be held accountable in tort law, was the first payment by a cigarette company on a products liability judgment not made until 2001?
Conflicts of Interest in Clinical Research: Addressing the Issue of Physician Remuneration
Authors: Caulfield Timothy , Griener Glenn 
Published: January 2007

In the past few years, there have been a number of high profile incidents that have emphasized the issues associated with financial conflicts of interest. As a result, commentators and policy-makers throughout the world have been directing their attention to how financial conflicts should be addressed. Despite such activity, however, there are few policies that provide specific guidance addressing one of the most common forms of financial conflict-the provision of generous remuneration packages to clinical investigators.In this column, we explore the conflict of interest issues that flow from the pharmaceutical industry paying community physicians to be investigators in clinical drug trials. In particular, we are interested in the challenges associated with the management of this complex issue by local research ethics boards. We suggest the need for more research on this topic and specific guidelines to empower these boards to address this growing concern. We recognize that this is one of many current conflict issues faced by policy-makers today.
The Podium
Authors: Folkman Judah 
Published: January 2007

Thank you very much, Ladies and Gentleman. I am very honored by the invitation to give a keynote address at this very informative, national meeting, before such a distinguished audience.If you made a list of the hundreds of different activities that go on during the day in a major medical center and tried to rank order them in terms of degree of difficulty, or judgment required, or risk of error, or damage that can result from an error of omission or an error of commission, at the top of the list one might consider the teaching of a surgical resident at the operating table by a senior experienced surgeon, hours on end, often emotionally draining.
RAC Oversight of Gene Transfer Research: A Model Worth Extending?
Authors: King Nancy M. P. 
Published: January 2007

Clinical gene transfer research (GTR) has both a unique history and a complex and layered system of research oversight, featuring a unique review body, the Recombinant DNA Advisory Committee (RAC). This paper briefly describes the process of decision-making about clinical GTR, considers whether the questions, problems, and issues raised in clinical GTR are unique, and concludes by examining whether the RAC's oversight is a useful model that should be reproduced for other similar areas of clinical research.Clinical GTR is governed by the same oversight system as most clinical trials, with a significant addition: the RAC. Like other research with human subjects, GTR, if it is affiliated with a federally funded institution, must be approved by an institutional review board (IRB) whose activities are governed by the common rule, that is, the federal regulations for protection of human subjects in research. Like other research intended to produce a drug, device, or biologic to be marketed in the United States, GTR is also overseen by the Food and Drug Administration (FDA).
Financial Conflicts of Interest in Human Subjects Research: The Problem of Institutional Conflicts
Authors: Barnes Mark , Florencio Patrik S. 
Published: January 2007

In both academic literature and the media, financial conflicts of interest in human subjects research have come center-stage. The cover of a recent edition ofTimemagazine features a research subject in a cage with the caption human guinea pigs, signifying perhaps that human research subjects are no more protected from research abuses than are laboratory animals. That magazine issue highlights three well-publicized cases of human subjects research violations that occurred at the University of Oklahoma, the University of Pennsylvania, and Johns Hopkins University.At St. John Medical Center in Tulsa, Oklahoma, a study that was co-sponsored by the University of Oklahoma Health Sciences Center investigated an experimental vaccine for malignant melanoma. In that case, the chair of the university's institutional review board (IRB) — the committee within each medical institution charged with ethics review of human research projects undertaken at that institution — and the dean of the University's College of Medicine allegedly concealed from both the IRB and the United States Food and Drug Administration (FDA) a report by an outside consulting firm that had found severe deficiencies with the melanoma vaccine study being conducted at the medical center.
Universality and its Limits: When Research Ethics Can Reflect Local Circumstances
Authors: Orentlicher David 
Published: January 2007

Studies in several developing countries for treatmen to prevent HIV-transmission from mother to child generated considerable controversy in 1997. Critics of the studies argued that basic principles of research ethics were violated. According to the critics, researchers subjected women in developing countries to studies that would have been unethical in the United States (and other developed countries) and that the researchers were therefore engaged in unethical exploitation ofcitizens of the developing countries in which the studies were conducted.While the critics agreed that unethical exploitation had occurred, they differed on the exact nature of the exploitation. Some observers condemned the researchers for employing a double standard — because the researchers were applying a standard of care that would have been unacceptable in their own country. In the view of these critics, researchers should have been comparing the experimental treatment to established therapy rather than to placebo, as would have been required in the United States or other developed countries.
Professionalism in Forensic Bioethics
Authors: Spielman Bethany J. 
Published: January 2007

As the public profile of bioethics rises, and as litigation about issues ranging from assisted reproduction to gene therapy multiplies, the presence of bioethics experts in a litigation context has become more common. Dozens of appellate opinions refer to bioethics testimony in the lower courts. Today's technical advisory services for attorneys advertise bioethics experts along with experts in scientific fields. A single bioethicist has served as an expert in more than fifty cases. In all likelihood, opportunities for bioethicists to fill the role of testifying expert will grow as medicine and biotechnology become more complex. Bioethics experts have also been involved in several other kinds of litigation-related activities, including investigation, consultation with attorneys, preparing reports that express expert opinions, and explaining and defending these opinions by deposition.Despite the growth of these activities by bioethicists, they have never been free of controversy, have recently been received with little enthusiasm by the judiciary, and could become highly problematic in the future.
Currents in Contemporary Ethics: Reforming Medical Ethics Education
Authors: Martinez Serge A. 
Published: January 2007

Biomedical advances of the past 20 years have stimulated a renewed interest in medical ethics. Transplantation of multiple human organs, implantation of artificial devices, advances in genetics, and stem cell research are a few of the medical procedures and discoveries that have awakened in both professionals and the public an awareness that medical discoveries often raise important ethical and societal issues. Today, members of the medical profession face issues that did not seem so pressing to their predecessors, and physician conduct in response to many of these issues involves decision-making based on ethical principles. Issues of informed consent, gifts from pharmaceutical companies, and patient rights to privacy were not of great concern to most physicians a generation ago. However, these and other topics that involve a physician's ethical conduct have become increasingly pertinent to the practice of medicine.A renewed emphasis on ethics has been voiced by leaders in the field of medicine.
Taking Rights Seriously in Health
Authors: Burris Scott , Lazzarini Zita , Gostin Lawrence O. 
Published: January 2007

Few now question that population health is significantly shaped by social ecology. Power, wealth, and social status clearly matter: Their enactment in daily life makes them fundamental social determinants of health. Important as it is that we accept the broad importance of social factors in health, it is not enough. Our current grasp of the importance of social factors in health has to be strengthened by research that more precisely delineates the workings of social health through social processes, and the investment in research must in turn be vindicated by interventions that make a difference. The work presented in this issue of the Journal of Law, Medicine & Ethics is intended to advance the agenda for research and action.An ecological theory puts health everywhere. Population health is shaped in the hierarchies of the workplace, the neighborhood, and the home.
Does Indebtedness Influence Health? A Preliminary Inquiry
Authors: Jacoby Melissa B. 
Published: January 2007

In recent years, consumer debt and the bankruptcy filing rate have received substantial public and media attention in the United States. That attention pales in comparison with widespread concerns and media reporting about health. Yet, both sets of discussions may be relevant to individuals and families facing a combination of health problems and financial problems. In a recent study, nearly half of the sample of individual bankruptcy filers reported they also were dealing with illness, injury, or substantial medical debt.Whether somethmg other than coincidence explains this correlation is worthy of consideration for those who study health. For some debtors, debt problems may be health-care finance issues; income interruption or financial obligations stemming from health ailments may contribute to financial downfall?The opposite relationship, however, not only is possible, but potentially more pervasive.