Rationalizing Noneconomic Damages: A Health-Utilities Approach

Studdert et al examine why making compensation of noneconomic damages in personal-injury litigation more rational and predictable is socially valuable. Noneconomic-damages schedules as an alternative to caps are discussed, several potential approaches to construction of schedules are reviewed, and the use of a health-utilities approach as the most promising model is argued. An empirical analysis that combines health-utilities data created in a previous study with original empirical work is used to demonstrate how key steps in construction of a health-utilities-based schedule for noneconomic damages might proceed

A Curricular Reform Viewed Through Bolman and Deal’s Organizational Frames

Professions exist to serve the needs of society, communities and, in the case of the dental profession, patients. Academic dental institutions strive to help meet these needs by educating and developing future practitioners, educators, researchers, and citizen leaders who serve the community and shape the changing environment in which they practice and provide care. The American Dental Association Commission on Change and Innovation affirms, “If dental educators are to meet these purposes, change and innovation in dental education must be responsive to evolving societal needs, practice patterns, scientific developments, and economic conditions”(Haden, et al., 2006). Guiding any institution through such authentic reform requires a number of strategies. Lee Bolman and Terrance Deal suggest four organizational constructs, or frames, through which to view a complex organization: Structural, Human Resource, Political and Symbolic (Bolman and Deal, 1997).“Like maps, frames are both windows on a territory and tools for navigation” (Bolman and Deal, 1997). This reflective case study examines a major curricular reform initiative in a North American school of dentistry through Bolman and Deal’s organizational frames

Intra-oral anatomy training device

Disclosed herein are typodont models and dental mannequins that provide a highly accurate representation of the human or non-human animal oral anatomy. The model embodiments disclosed herein provide life-like materials and various features of the oral cavity not found in typical typodont models. Additionally, the typodont models disclosed herein simulate many challenging conditions that arise in dental procedures when performed on live subjects such as, for example, clouding of instruments including mirrors used to view the interior portion of the oral cavity, oral fluid interfering with the work area, and other real-life interferences and complications. The ability to mimic the oral cavity with as much accuracy as possible is beneficial to the dental field for both practitioners as well as patients

A Curricular reform viewed through Bolman and Deal’s organizational frames

Professions exist to serve the needs of society, communities and, in the case of the dental profession, patients.  Academic dental institutions strive to help meet these needs by educating and developing future practitioners, educators, researchers, and citizen leaders who serve the community and shape the changing environment in which they practice and provide care. The American Dental Association Commission on Change and Innovation affirms, “If dental educators are to meet these purposes, change and innovation in dental education must be responsive to evolving societal needs, practice patterns, scientific developments, and economic conditions”(Haden, et al., 2006). Guiding any institution through such authentic reform requires a number of strategies. Lee Bolman and Terrance Deal suggest four organizational constructs, or frames, through which to view a complex organization:  Structural, Human Resource, Political and Symbolic (Bolman and Deal, 1997).“Like maps, frames are both windows on a territory and tools for navigation” (Bolman and Deal, 1997). This reflective case study examines a major curricular reform initiative in a North American school of dentistry through Bolman and Deal’s organizational frames

The frequency of missed test results and associated treatment delays in a highly computerized health system

<p>Abstract</p> <p>Background:</p> <p>Diagnostic errors associated with the failure to follow up on abnormal diagnostic studies ("missed results") are a potential cause of treatment delay and a threat to patient safety. Few data exist concerning the frequency of missed results and associated treatment delays within the Veterans Health Administration (VA).</p> <p>Objective:</p> <p>The primary objective of the current study was to assess the frequency of missed results and resulting treatment delays encountered by primary care providers in VA clinics.</p> <p>Methods:</p> <p>An anonymous on-line survey of primary care providers was conducted as part of the health systems ongoing quality improvement programs. We collected information from providers concerning their clinical effort (e.g., number of clinic sessions, number of patient visits per session), number of patients with missed abnormal test results, and the number and types of treatment delays providers encountered during the two week period prior to administration of our survey.</p> <p>Results:</p> <p>The survey was completed by 106 out of 198 providers (54 percent response rate). Respondents saw and average of 86 patients per 2 week period. Providers encountered 64 patients with missed results during the two week period leading up to the study and 52 patients with treatment delays. The most common missed results included imaging studies (29 percent), clinical laboratory (22 percent), anatomic pathology (9 percent), and other (40 percent). The most common diagnostic delays were cancer (34 percent), endocrine problems (26 percent), cardiac problems (16 percent), and others (24 percent).</p> <p>Conclusion:</p> <p>Missed results leading to clinically important treatment delays are an important and likely underappreciated source of diagnostic error.</p

The Chest Pain Choice trial: a pilot randomized trial of a decision aid for patients with chest pain in the emergency department

Background: Chest pain is a common presenting complaint in the emergency department (ED). Despite the frequency with which clinicians evaluate patients with chest pain, accurately determining the risk of acute coronary syndrome (ACS) and sharing risk information with patients is challenging. The aims of this study are (1) to develop a decision aid (CHEST PAIN CHOICE) that communicates the short-term risk of ACS and (2) to evaluate the impact of the decision aid on patient participation in decision-making and resource use. Methods/Design: This is a protocol for a parallel, 2-arm randomized trial to compare an intervention group receiving CHEST PAIN CHOICE to a control group receiving usual ED care. Adults presenting to the Saint Mary's Hospital ED in Rochester, MN USA with a primary complaint of chest pain who are being considered for admission for prolonged ED observation in a specialized unit and urgent cardiac stress testing will be eligible for enrollment. We will measure the effect of CHEST PAIN CHOICE on six outcomes: (1) patient knowledge regarding their short-term risk for ACS and the risks of radiation exposure; (2) quality of the decision making process; (3) patient and clinician acceptability and satisfaction with the decision aid; (4) the proportion of patients who decided to undergo observation unit admission and urgent cardiac stress testing; (5) economic costs and healthcare utilization; and (6) the rate of delayed or missed ACS. To capture these outcomes, we will administer patient and clinician surveys after each visit, obtain video recordings of the clinical encounters, and conduct 30-day phone follow-up. Discussion: This pilot randomized trial will develop and evaluate a decision aid for use in ED chest pain patients at low risk for ACS and provide a preliminary estimate of its effect on patient participation in decision-making and resource use

Medical Malpractice : How Legal Liability Affects Medical Decisions

In health care, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouses concerns about possible implications for patients\u2019 health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In the present chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research

A Curricular Reform Viewed Through Bolman and Deal’s Organizational Frames

Professions exist to serve the needs of society, communities and, in the case of the dental profession, patients. Academic dental institutions strive to help meet these needs by educating and developing future practitioners, educators, researchers, and citizen leaders who serve the community and shape the changing environment in which they practice and provide care. The American Dental Association Commission on Change and Innovation affirms, “If dental educators are to meet these purposes, change and innovation in dental education must be responsive to evolving societal needs, practice patterns, scientific developments, and economic conditions”(Haden, et al., 2006). Guiding any institution through such authentic reform requires a number of strategies. Lee Bolman and Terrance Deal suggest four organizational constructs, or frames, through which to view a complex organization: Structural, Human Resource, Political and Symbolic (Bolman and Deal, 1997).“Like maps, frames are both windows on a territory and tools for navigation” (Bolman and Deal, 1997). This reflective case study examines a major curricular reform initiative in a North American school of dentistry through Bolman and Deal’s organizational frames