Journal of Legal Medicine最新文献

{"title":"Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids","authors":"C. Wyant, Taylor Cornwell-Hinrichs, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914493","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914493","url":null,"abstract":"Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids Cara Wyant, OMS-II Taylor Cornwell-Hinrichs, MPH, MLIS, OMS-II Joseph P. Hardy, MD, Associate Dean of Clinical Education Weldon Havins, MD, JD, LLM, MA, Emeritus Professor Touro University Nevada College of Osteopathic Medicine In accordance with the global opioid epidemic, the CDC issued guidelines for practitioners prescribing opioids for chronic pain. In response to these guidelines and to the opioid epidemic itself, Nevada issued restrictive legislation on practitioners prescribing opioids: SB 459, AB 474, and AB 239. To investigate the relationships between opioid legislature and opioidrelated death rates, data was obtained from the Nevada Board of Pharmacy and the Clark and Washoe County medical examiner offices. The data demonstrate that there was a significant decrease in prescriptions following the legislation; however, there was no correlation between the legislation and overall rate of opioid-related deaths because there was a subsequent and dramatic rise in deaths from illicit opioids. This suggests that more patients switched to the use of heroin and/or fentanyl as a result in limiting legal opioid prescribing power. A Spearman correlation was calculated (-0.04) and a two-way analysis of variance (ANOVA) was used to compare the time periods of the legislation implementation and the county. There were no interactions between the two counties and law; so, both counties experienced the same trends following these laws. To compare opioid-related deaths to opioid prescription rate for each time period, a t-test with law as the only factor was conducted with combined data from both counties (SB 459 p1⁄4 0.744; AB 474 p1⁄4 0.640; AB 239 p1⁄4 0.704). No significance was found. The COVID-19 Stay at Home order has statistically increased opioid-related deaths (p1⁄4 0.010), albeit it is unknown if this increase is due to Nevadans selfmedicating in response to work stoppages and financial stress, inability to see a practitioner in person, or restrictions involving addiction clinics during the pandemic. The goal of Nevada’s three opioid prescription bills was to reduce the rate of Nevadans dying from opioid overdoses, yet more Nevadans are dying from opioids now than before the bills passed. We recommend three provisions that will allow providers to confidently prescribe appropriate 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 49–50 https://doi.org/10.1080/01947648.2021.1914493 pain management for their patients without fear of sanction from another licensing board’s misunderstandings, allow providers to humanely manage their patients’ legitimate pain, and limit unintended consequences where patients are forced to seek out illicit opioids to control their pain and inadvertently die in the process. These are our recommendations: (1) Base law requirements on guidelines provided by professional or governmen","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"27 1","pages":"49 - 50"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88853928","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}

{"title":"Increased Deaths-at-Home in Nevada During the COVID-19 Pandemic","authors":"Proma Mazumder, Crystal Yung, C. Vanier, Joseph P. Hardy","doi":"10.1080/01947648.2021.1914479","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914479","url":null,"abstract":"Indirect effects associated with forced or voluntary changes in behaviors due to COVID-19 are largely unknown Fear of COVID-19 infection may cause patients to avoid medical care for other conditions, and government directives have forced major lifestyle disruptions The purpose of this study was to analyze deaths at home (DaH) relative to gender, age, ethnicity, location, and cause of death to understand the indirect effects of COVID-19 on mortality rates in Nevada DaH increased 25% in Nevada during April 2020 (27 9;95% confidence interval: 26 3, 29 5 deaths per 100,000) compared to mean DaH during April the previous four years (22 3 mean deaths per 100,000) The increase was driven by males, people aged 65-74, and residents of the Las Vegas area There was no trend related to ethnicity Causes of death that increased in 2020 were diabetes mellitus (109%), nutritional deficiencies (860%), non-transport accidents (50%), and as-yet unknown causes (863%)","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"101 1","pages":"24 - 25"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86639655","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}

{"title":"Nevada Healthcare Boards: Violations of Public Record Act and Inaccessibility of Licensee Information","authors":"Ryliezl Abby Reyes, Stephanie Quan, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914489","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914489","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"22 1","pages":"39 - 40"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83950930","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}

{"title":"Emerging Neuralink Brain Machine Interface Technology: An Oversight Proposal to Address the Ethical, Legal, and Social Implications","authors":"Ali Said, L. Sánchez, M. Olek, Weldon Havins","doi":"10.1080/01947648.2021.1914490","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914490","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"81 1","pages":"40 - 41"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91227072","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}

{"title":"Assessing the Relationship between Infection Citations and COVID-19 Infections in Nursing Homes","authors":"Meghan Mahalawat, Nur Fatimah Mirza, C. Vanier, W. Havins","doi":"10.1080/01947648.2021.1914478","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914478","url":null,"abstract":"In the US, 40% of fatalities from COVID-19 have occurred in nursing homes Identifying warning signs of nursing homes with a higher chance of having COVID-19 cases and deaths can help target interventions to lower the overall spread and mortality associated with the disease The purpose of this study was to determine whether staff shortages, staff infections, or previous citations would affect the likelihood of cases of COVID-19 and associated deaths in nursing homes Data was obtained from the Center for Medicare and Medicaid Services' Nursing Home Compare Dataset and the COVID-19 Nursing Home Dataset for six western states for 03/01/2019 through 02/29/2020 States were heterogeneous and were analyzed independently of each other The relationship between staff-confirmed COVID-19 cases and resident cases was tested using a Fisher's exact test A logistic regression was used to model how prior citations and staff shortages affected the likelihood of cases and deaths, relative to the number of occupied beds per facility","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"1 1","pages":"22 - 23"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73308935","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}

{"title":"Decreasing Inmate Populations to Mitigate Effects of COVID-19 in State Prisons","authors":"Seung Joon Hwang, M. Kim, W. Havins","doi":"10.1080/01947648.2021.1914477","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914477","url":null,"abstract":"With the spread of COVID-19 comes reports of rising outbreaks in prisons throughout the United States. On a national level, the Federal Bureau of Prisons (BOP) has modified operation guidel...","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"660 1","pages":"20 - 21"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76844691","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}

{"title":"Proposal for Using Digital Tools in Mitigating a Pandemic: Lessons Learned from COVID-19","authors":"Stephanie N Bernardo, Kylie Zeng, W. Havins","doi":"10.1080/01947648.2021.1914469","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914469","url":null,"abstract":"BACKGROUND: Since the COVID-19 outbreak began in Wuhan China, countries across the world have been forced to take unprecedented measures to combat it. While some countries are still grappling with the COVID-19 pandemic, others have fared better and have established relative normalcy quickly. The rapid transmission rate of the virus has shown a greater need for efficient and technologically modern containment measures. The use of digital tools to facilitate strict containment measures in countries that have faired well against the COVID-19 pandemic has sparked both interest and controversy. OBJECTIVE: In this study, we compare the precautions taken against the spread of COVID-19, particularly the use of digital tools in contact tracing, and propose policies that could be utilized in the U.S. for future COVID-19 waves or pandemics. METHODS: COVID-19 death rates data were obtained from the European Center for Disease Prevention and Control (ECDC) accessed through the Our World in Data database, and were evaluated based on population size per 100,000 from December 31, 2019 to September 6, 2020. All policies and measures enacted were obtained from their respective governmental websites. RESULTS: We found a strong association between lower death rates per capita and countries that implemented early mask use and strict border control measures that included mandatory quarantine using digital tools. There is a significant difference in the number of deaths per 100,000 when comparing Taiwan, South Korea, and Singapore versus the U.S., Spain, and Italy. CONCLUSIONS: Based on our research, it is evident that early intervention with the use of digital tools has a strong correlation for containing COVID-19. Infection rates and subsequent deaths in Italy, Spain, and more specifically the U.S. could have been much lower with early mask use and, more importantly, timely border control measures utilizing modern digital tools. Thus, we propose that the U.S. execute the following national policies should a public health emergency be declared: (1) Immediately establish a National Command responsible for enacting strict mandatory guidelines enforced by federal and state governments, including national mask use. (2) Mandate civilian cooperation with health officials in contact tracing and quarantine orders. Incoming travelers to the U.S. and those quarantined will be required to download a contact tracing app. We acknowledge the countries we studied differ in their cultures, political systems, and reporting criteria for COVID-19 deaths. Further research may need to be conducted to address these limitations; however, we believe that the proposed policies could protect the American public.","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"82 1","pages":"3 - 4"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90890397","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}

{"title":"COVID-19 and Firearms: Public Health Considerations","authors":"Emily Silver","doi":"10.1080/01947648.2021.1914491","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914491","url":null,"abstract":"COVID-19 and Firearms: Public Health Considerations Emily M. Silver, MA; esilver3@uchicago.edu Department of Psychology Integrative Neuroscience Program, The University of Chicago, IL The global SARS-CoV-2 (otherwise known as COVID-19) pandemic has wreaked havoc across the world, infected over 100 million people and resulted in the deaths of approximately 2 million people to date (1). The need for people to remain physically separated from one another to reduce the spread of disease has resulted in many public health, corporate, and government policy changes. One particularly troubling phenomenon has been the increase in the rates of deaths by firearm violence in the US in 2020 (2). The evolving literature has documented increases across a number of inter-related issues including mental health conditions (3), suicide rates (4), violence (5), and firearm purchases (6). It is of paramount importance to recognize these trends and discuss the implications regarding short-term and long-term effects as well as how they may affect the delivery of health services. Pandemic-related Increases: Firearms Firearms have been purchased at historic rates during the pandemic (Mannix et al). Firearm sales in March 2020 increased by 85% from the previous year (7), resulting in an estimated 2.1 million excess firearm sales (6). The recent surge in firearm purchases is likely linked at least in part to the pandemic, which has induced heightened states of uncertainty and anxiety. The pandemic is associated with increased worry about violence, both for oneself and others, as well as increased firearm acquisition and changes in practices related to storage of firearms, including unlocked storage (8,9). Intent to purchase a firearm in the next twelve months is associated with more severe anxiety specific to COVID-19 (10). Therefore, not only are sales of firearms increasing, but people may be buying them in reaction to fears resulting from the pandemic. Pandemic-related Increases: Mental Health Conditions Measures intended to limit the spread of the virus, such as city-wide lockdowns and social distancing policies, have also induced pervasive psychological distress (11). Social isolation and loneliness, known risk factors for depression 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 42–46 https://doi.org/10.1080/01947648.2021.1914491 and feelings of hopelessness, likely contribute to the prevalence of anxiety and depression (12). An analysis of depressive symptomology in the US found a 3fold increase during the COVID-19 pandemic as compared to before (13). The pandemic has also been associated with disruptions in sleep (11,14), substance abuse (11,15), and posttraumatic stress (16,17). Frontline health workers are at particular risk for an increase in anxiety and depression (18). Pandemic-related Increases: Suicide Increases in prevalence of psychopathology and mental health crises during the pandemic has brought on concerns abou","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"27 1","pages":"42 - 46"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80241689","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}

{"title":"Should Healthcare Workers Treat COVID-19 Patients Despite the Inadequate Personal Protective Equipment?","authors":"J. Parra, Heerod Malekghassemi, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914485","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914485","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"58 1","pages":"34 - 35"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80333979","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}

{"title":"Euthanasia Should Be Legalized in Nevada","authors":"Ellie Ok, Kristine Rosas, W. Havins","doi":"10.1080/01947648.2021.1914484","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914484","url":null,"abstract":"Euthanasia Should Be Legalized in Nevada Ellie Ok, MS, OMSII; eok@student.touro.edu Kristine Rosas, OMSII; krosas@student.touro.edu Weldon Havins, MD, JD, LLM, FCLM, Emeritus Professor Touro University Nevada College of Osteopathic Medicine Current palliative care option for terminally ill patients disregards the autonomy of patients in some cases. These patients may request euthanasia with the intent to make an autonomous decision and gain back some control that they have lost to the disease. As physicians, we should strive to understand the rationale behind the patient’s request of euthanasia to alleviate suffering and provide the most suitable care that preserves the patients’ dignity and autonomy. The purpose of our research is to propose the legalization of euthanasia in Nevada for terminal patients. To examine the legality and morality of euthanasia, we applied the four biomedical ethics principles (autonomy, justice, beneficence, and maleficence) to the use of this practice. The number of cases of euthanasia and Physician-Assisted Suicides (PAS) in Netherlands and Canada were analyzed. Reports of PAS cases in Canada were obtained from Regional Euthanasia Review Committees and Interim Reports. Individual statutes and numerous studies were reviewed to compare the qualifications and requirements of euthanasia and PAS in different countries. This study found that in countries where both euthanasia and PAS are legal, euthanasia occurs at a higher rate than PAS. In Netherlands, the incidence of euthanasia from 2002 and 2010 to 2018 was 1672, 2910, 5277, 5856, 6303, and 5898 whereas PAS was 184, 182, 208, 216, 250, and 212. In Canada, the occurrence of euthanasia from 2016 to 2018 was 503, 1960, and 2613 compared to four, one, and one PAS cases. Although euthanasia is illegal in the United States, patients showed higher support for euthanasia over PAS, finding euthanasia to be more acceptable (67%) than assisted suicide (33%). We carefully compared and studied the qualifications of euthanasia in other countries to propose our guidelines for Nevada. We acknowledge that there should be strict limitations and documentation of cases to limit its abuse. Further studies are needed to examine the validity of child euthanasia or other vulnerable populations. More 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 32–33 https://doi.org/10.1080/01947648.2021.1914484 training and education of medical professionals in palliative care is indicated. This research highlights and challenges the need for change in our current palliative care options to include euthanasia. References upon request 33","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"161 1","pages":"32 - 33"},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81730119","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}