Pub Date : 2022-01-01DOI: 10.1080/01947648.2022.2162171
Jacob M Appel
The dominant approaches to assessing patients for decisional capacity in the clinical setting, the "four skills" and "sliding scale" models, emerged in the 1970s and 1980s against a backdrop of medical paternalism and reflect their origins in law and forensic psychiatry. They privilege rationality and require the ability to defend one's decisions with knowledge and argument. Unfortunately, these approaches place a heavy burden upon patients who may hold preferences consistent with their underlying values but may not possess the education or reasoning skills necessary to meet the heavy burden imposed by current capacity standards. This article reviews the shortcomings of the dominant models. Then the article proposes a novel value-based approach to capacity assessment that places primary emphasis upon the patient's underlying and longstanding values and the concordance of those values with the patient's current wishes and preferences.
{"title":"A Values-Based Approach to Capacity Assessment.","authors":"Jacob M Appel","doi":"10.1080/01947648.2022.2162171","DOIUrl":"https://doi.org/10.1080/01947648.2022.2162171","url":null,"abstract":"<p><p>The dominant approaches to assessing patients for decisional capacity in the clinical setting, the \"four skills\" and \"sliding scale\" models, emerged in the 1970s and 1980s against a backdrop of medical paternalism and reflect their origins in law and forensic psychiatry. They privilege rationality and require the ability to defend one's decisions with knowledge and argument. Unfortunately, these approaches place a heavy burden upon patients who may hold preferences consistent with their underlying values but may not possess the education or reasoning skills necessary to meet the heavy burden imposed by current capacity standards. This article reviews the shortcomings of the dominant models. Then the article proposes a novel value-based approach to capacity assessment that places primary emphasis upon the patient's underlying and longstanding values and the concordance of those values with the patient's current wishes and preferences.</p>","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10773103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1080/01947648.2023.2179848
Joseph D Piorkowski
{"title":"Editor's Note.","authors":"Joseph D Piorkowski","doi":"10.1080/01947648.2023.2179848","DOIUrl":"https://doi.org/10.1080/01947648.2023.2179848","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1080/01947648.2023.2174768
Ashley Eltorai
Introduction: Medical professionals other than anesthesiologists at times administer sedation for procedures. The aim of this study is to identify the adverse events, and their root causes, resulting in medical malpractice litigation in the United States related to procedural sedation administration by non-anesthesiologists.
Methods: Cases containing the phrase "conscious sedation" were identified using Anylaw, an online national legal database. Cases were excluded if the primary allegation was not malpractice related to conscious sedation or the listing was a duplicate.
Results: Of the 92 cases identified, 25 remained after application of exclusion criteria. The procedure type most commonly involved was dental (56%), followed by gastrointestinal (28%). The remaining procedure types were urology, electrophysiology, otolaryngology, and magnetic resonance imaging (MRI).
Discussion: By reviewing malpractice case narratives and outcomes, this study offers insight and opportunities for practice improvement among non-anesthesiologists providing conscious sedation for procedures.
{"title":"Procedural Sedation by Non-Anesthesiologists: A Review of Malpractice Litigation.","authors":"Ashley Eltorai","doi":"10.1080/01947648.2023.2174768","DOIUrl":"https://doi.org/10.1080/01947648.2023.2174768","url":null,"abstract":"<p><strong>Introduction: </strong>Medical professionals other than anesthesiologists at times administer sedation for procedures. The aim of this study is to identify the adverse events, and their root causes, resulting in medical malpractice litigation in the United States related to procedural sedation administration by non-anesthesiologists.</p><p><strong>Methods: </strong>Cases containing the phrase \"conscious sedation\" were identified using Anylaw, an online national legal database. Cases were excluded if the primary allegation was not malpractice related to conscious sedation or the listing was a duplicate.</p><p><strong>Results: </strong>Of the 92 cases identified, 25 remained after application of exclusion criteria. The procedure type most commonly involved was dental (56%), followed by gastrointestinal (28%). The remaining procedure types were urology, electrophysiology, otolaryngology, and magnetic resonance imaging (MRI).</p><p><strong>Discussion: </strong>By reviewing malpractice case narratives and outcomes, this study offers insight and opportunities for practice improvement among non-anesthesiologists providing conscious sedation for procedures.</p>","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10786437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/01947648.2022.2147368
D. Chan, W. Havins
{"title":"The Retention of Nevada Medical Graduates: A 6-Year Study","authors":"D. Chan, W. Havins","doi":"10.1080/01947648.2022.2147368","DOIUrl":"https://doi.org/10.1080/01947648.2022.2147368","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82394726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/01947648.2022.2147369
S. Murphy, L. Wheeler, E. Valencia
{"title":"The Medical and Legal Dual Degree: A Survey on Motivations, Time Commitment, Outcomes, and Value","authors":"S. Murphy, L. Wheeler, E. Valencia","doi":"10.1080/01947648.2022.2147369","DOIUrl":"https://doi.org/10.1080/01947648.2022.2147369","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76773116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/01947648.2022.2087403
Cheryl L Anderson
{"title":"First Filings and False Judgments: Is the First-to-File Rule Jurisdictional and Can a Medical Opinion be \"False\" Under the False Claims Act?","authors":"Cheryl L Anderson","doi":"10.1080/01947648.2022.2087403","DOIUrl":"https://doi.org/10.1080/01947648.2022.2087403","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10303930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/01947648.2022.2147365
As we delve into Issue 1 of 2023, I’d like to highlight several papers in this issue. Gao et al and Stefanowicz et al both published manuscripts examining the impact of toxicant exposures (gold and silver nanoparticles in Gao et al, and acetaminophen by Stefanowicz et al) in isolated cell monocultures vs co-cultures with organ-relevant cells. In the case of Gao et al, the researchers noted that the cytotoxicity of gold and silver nanoparticles to rat dorsal root ganglion cells was greatly mitigated when the neurons were co-cultured with glial (Schwann) cells. In addition, neuronal markers such as synapsin I were better-preserved in the co-cultured neurons compared to isolated neurons alone. Stefanowicz et al similarly examined the cytotoxicity of acetaminophen in primary hepatocytes alone, compared to hepatocytes co-cultured with hepatic non-parenchymal cells; these investigators similarly demonstrated reduced cytotoxicity in response to acetaminophen exposure in the hepatocyte co-cultures, compared to hepatocytes alone. While neither of these systems capture the complexity of microphysiological systems such as “organs on chips” (reviewed recently), they do demonstrate that by simulating an intact organ with multiple cell types in coculture, compared to single cell populations alone, laboratory scientists can use “off the shelf” reagents such as commercially-available (or freshly isolated) cell lines to examine organ toxicity under more realistic organ-specific physiological conditions. Looking back to 2022, we were happy to participate in a faceto-face American College of Toxicology (ACT) annual meeting, following 2 years of virtual annual meetings. As has been our practice in the past, the abstracts of posters that had not been previously published are included in this issue of International Journal of Toxicology. We had another year of over 400 manuscript submissions to the Journal. So many manuscripts necessitate a lot of peer review, so I want to thank my Editorial Board members for their tireless efforts, as well as the dozens of ad hoc reviewers who contributed their time and expertise to assist with review of submitted manuscripts. The Editorial Board members are listed in each issue of the printed version of the Journal and on the ACTwebsite. I also compile a list of ad hoc reviewers each year, with my thanks, which appears for 2022 ad hoc reviewers on page 103 of this issue of International Journal of Toxicology. Finally, it’s my great pleasure to recognize the recipients of the award for the Best Paper published in International Journal of Toxicology in 2021. For those unfamiliar with this award, all papers published in the previous calendar year in International Journal of Toxicology are eligible to be nominated for the annual Best Paper award. So, for the 2022 award, nominators selected from among all International Journal of Toxicology publications in 2021. The 2022 award went to Dr. Brian Welsh and collaborators for their publicati
{"title":"Editor's Note.","authors":"","doi":"10.1080/01947648.2022.2147365","DOIUrl":"10.1080/01947648.2022.2147365","url":null,"abstract":"As we delve into Issue 1 of 2023, I’d like to highlight several papers in this issue. Gao et al and Stefanowicz et al both published manuscripts examining the impact of toxicant exposures (gold and silver nanoparticles in Gao et al, and acetaminophen by Stefanowicz et al) in isolated cell monocultures vs co-cultures with organ-relevant cells. In the case of Gao et al, the researchers noted that the cytotoxicity of gold and silver nanoparticles to rat dorsal root ganglion cells was greatly mitigated when the neurons were co-cultured with glial (Schwann) cells. In addition, neuronal markers such as synapsin I were better-preserved in the co-cultured neurons compared to isolated neurons alone. Stefanowicz et al similarly examined the cytotoxicity of acetaminophen in primary hepatocytes alone, compared to hepatocytes co-cultured with hepatic non-parenchymal cells; these investigators similarly demonstrated reduced cytotoxicity in response to acetaminophen exposure in the hepatocyte co-cultures, compared to hepatocytes alone. While neither of these systems capture the complexity of microphysiological systems such as “organs on chips” (reviewed recently), they do demonstrate that by simulating an intact organ with multiple cell types in coculture, compared to single cell populations alone, laboratory scientists can use “off the shelf” reagents such as commercially-available (or freshly isolated) cell lines to examine organ toxicity under more realistic organ-specific physiological conditions. Looking back to 2022, we were happy to participate in a faceto-face American College of Toxicology (ACT) annual meeting, following 2 years of virtual annual meetings. As has been our practice in the past, the abstracts of posters that had not been previously published are included in this issue of International Journal of Toxicology. We had another year of over 400 manuscript submissions to the Journal. So many manuscripts necessitate a lot of peer review, so I want to thank my Editorial Board members for their tireless efforts, as well as the dozens of ad hoc reviewers who contributed their time and expertise to assist with review of submitted manuscripts. The Editorial Board members are listed in each issue of the printed version of the Journal and on the ACTwebsite. I also compile a list of ad hoc reviewers each year, with my thanks, which appears for 2022 ad hoc reviewers on page 103 of this issue of International Journal of Toxicology. Finally, it’s my great pleasure to recognize the recipients of the award for the Best Paper published in International Journal of Toxicology in 2021. For those unfamiliar with this award, all papers published in the previous calendar year in International Journal of Toxicology are eligible to be nominated for the annual Best Paper award. So, for the 2022 award, nominators selected from among all International Journal of Toxicology publications in 2021. The 2022 award went to Dr. Brian Welsh and collaborators for their publicati","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10528951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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