Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan

<p>Abstract</p> <p>Background</p> <p>A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability.</p> <p>Methods</p> <p>We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed.</p> <p>Results</p> <p>When the physician's explanation was given before treatment or surgery (<it>p </it>= 0.006), when it was relevant or specific (<it>p </it>= 0.000), and when the patient's consent was obtained (<it>p </it>= 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment.</p> <p>Conclusion</p> <p>These findings may be useful in improving physician-patient communication in the medical setting.</p

Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions

Background Bile duct injury (BDI) is a dreaded complication of cholecystectomy, often caused by misinterpretation of biliary anatomy. To prevent BDI, techniques have been developed for intraoperative assessment of bile duct anatomy. This article reviews the evidence for the different techniques and discusses their strengths and weaknesses in terms of efficacy, ease, and cost-effectiveness. Method PubMed was searched from January 1980 through December 2009 for articles concerning bile duct visualization techniques for prevention of BDI during laparoscopic cholecystectomy. Results Nine techniques were identified. The critical-view-of-safety approach, indirectly establishing biliary anatomy, is accepted by most guidelines and commentaries as the surgical technique of choice to minimize BDI risk. Intraoperative cholangiography is associated with lower BDI risk (OR 0.67, CI 0.61-0.75). However, it incurs extra costs, prolongs the operative procedure, and may be experienced as cumbersome. An established reliable alternative is laparoscopic ultrasound, but its longer learning curve limits widespread implementation. Easier to perform are cholecystocholangiography and dye cholangiography, but these yield poor-quality images. Light cholangiography, requiring retrograde insertion of an optical fiber into the common bile duct, is too unwieldy for routine use. Experimental techniques are passive infrared cholangiography, hyperspectral cholangiography, and near-infrared fluorescence cholangiography. The latter two are performed noninvasively and provide real-time images. Quantitative data in patients are necessary to further evaluate these techniques. Conclusions The critical-view-of-safety approach should be used during laparoscopic cholecystectomy. Intraoperative cholangiography or laparoscopic ultrasound is recommended to be performed routinely. Hyperspectral cholangiography and near-infrared fluorescence cholangiography are promising novel techniques to prevent BDI and thus increase patient safety

Public Funding in Collective Innovations for Public–Private Activities

Whereas in market-driven situations the private parties have an interest in driving innovations towards implementation, in the case of public concerns, it is often the public concern that initiates the innovation process. The issue for the public funding agencies is then to stimulate idea generation and the process towards implementation and impact. However, these innovation processes are complex, as they involve a multiplicity of public and private actors with different and sometimes conflicting concerns. Thus, the benefits and business cases are not immediately clear and this makes it hard to scale beyond the proof of concept. In this paper we examine and derive lessons learned based on a longitudinal case study of a series four EU-funded projects (ITAIDE, INTEGRITY, CASSANDRA and CORE) in the international trade domain that aimed to develop digital trade infrastructure solutions (data pipelines) to address security and trade facilitation challenges. For our case analysis, we adapt and extend Bryson et al.’s framework [1] on cross-sector collaborations. We show how each of these projects covered one part of the public–private innovation trajectory, moving the innovation from the Initial R&amp;D stage, to the Showcasing and dissemination stage to attract critical mass, towards a Turning point stage when the business cases for further upscaling become visible. We identify continuities (i.e. continuity of network &amp; vision, funding and process) as well as a number of alignments as important factors that drive collective innovation processes towards implementation and impact. Further research is needed to establish to what extent these findings are applicable in other contexts.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Information and Communication Technolog

p38γ regulates the localisation of SAP97 in the cytoskeleton by modulating its interaction with GKAP

Activation of the p38 MAP kinase pathways is crucial for the adaptation of mammalian cells to changes in the osmolarity of the environment. Here we identify SAP97/hDlg, the mammalian homologue of the Drosophila tumour suppressor Dlg, as a physiological substrate for the p38γ MAP kinase (SAPK3/p38γ) isoform. SAP97/hDlg is a scaffold protein that forms multiprotein complexes with a variety of proteins and is targeted to the cytoskeleton by its association with the protein guanylate kinase-associated protein (GKAP). The SAPK3/p38γ-catalysed phosphorylation of SAP97/hDlg triggers its dissociation from GKAP and therefore releases it from the cytoskeleton. This is likely to regulate the integrity of intercellular–junctional complexes, and cell shape and volume in response to osmotic stress