More Hippocrates, Less Hypocrisy: Early Offers as a Means of Implementing the Institute of Medicine\u27s Recommendations on Malpractice Law

To remove the fear of personal liability from individual health care workers and eliminate the incentive to hide errors rather than report them, the IOM acknowledges that tort reform of some sort is also needed. Since the IOM calls for shifting attention away from the faults of individual care providers to the defects of the system itself, the current tort system\u27s blame culture is itself blamed by the IOM for providing an impediment to improving the safety of patients by deterring physicians from reporting their own errors in the first place. However, the IOM\u27s To Err is Human does not offer an extensive account of just what tort reform scheme should be pursued. In what follows, the Early Offers plan, created by the first-named author, is urged as particularly well-suited to address the problem of medical errors dealt with in To Err is Human. \u27Early Offers\u27 is not only designed to promote the reporting of medical errors by reducing the level of fear and pain associated with current medical malpractice law, but at the same time to allow victims of medical error to receive compensation earlier and easier. In so doing, Early Offers promotes a better medical and legal culture by rendering the health care and medical malpractice systems more Hippocratic - and less hypocritical

Africa’s Development Debts

Public debt levels in sub-Saharan Africa rose sharply in the wake of the global financial crisis, and a number of countries are now classified by the World Bank and International Monetary Fund as at high risk of debt distress. By contrast with the debt crisis of the 1980s and 1990s, however, concerns were not region wide as recently as early 2020, and the policy environment for growth remains robust for the majority of countries in the region. The external environment nonetheless poses a set of region-wide risks that include the economic effects of the COVID-19 pandemic and are exacerbated by the increase in market-based debt and the retreat of the Paris Club among official creditors. Changes in perceived creditworthiness can now drive distress, and new challenges of creditor coordination will complicate the debt restructuring process. We motivate a research agenda that focuses on development assets at risk as rising debt service obligations crowd out development as well as operational and maintenance budgets. Preserving and enhancing these assets, which include advances in human capital and infrastructure and an improved investment environment, should be a central objective of domestic policy actions, preventative debt restructurings and institutional approaches to debt distress

Clinical features of low back pain in people with hip osteoarthritis: A cross sectional study.

BACKGROUND: Low back pain (LBP) is commonly reported in people with hip osteoarthritis (OA) and is a poor prognostic indicator of outcome in OA. This study aimed to identify the clinical features associated with LBP in people with hip OA attending orthopaedic and rheumatology clinics. METHODS: A cross-sectional study was undertaken. Twenty-four people with radiographically confirmed OA were recruited and completed self-report questionnaires for hip and LBP severity (Visual Analogue Scale), hip-related disability (Western Ontario and McMaster Universities Osteoarthritis Index) and back-related disability (Roland Morris Disability Questionnaire). Physical examination comprised spinal palpation, pelvic girdle pain provocation tests and hip and spinal range of motion tests. Between-group (presence/absence of LBP) differences in self-report and physical examination items were compared using Mann-Whitney U and Chi-squared tests. RESULTS: A total of 16/24 (66.7%) patients reported LBP. Those with LBP were younger, reported more pain locations and had higher self-report pain and disability. On physical examination, people with LBP and OA hip had reduced hip flexion, greater pain provocation with hip abduction, hip lateral rotation, spinal palpation and a greater number of painful pelvic girdle tests and spinal level palpation. CONCLUSIONS: Assessment of patients with hip OA should incorporate examination of the lumbar spine and pelvic regions. It appears from our study that LBP is a common co-morbidity in those with OA of the hip and may indicate greater severity of hip disease, although the small sample size limits interpretation of results. Further research should investigate the exact relationships between presence of LBP and hip OA

Resistance training for rehabilitation after burn injury: A systematic literature review and meta-analysis

Background/aim: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury. Methods: Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and rated using the GRADE framework. Results: Eleven studies matched our inclusion criteria. Primary analysis did not demonstrate significant improvements for increasing muscle strength (SMD 0.74, 95% CI _0.02 to 1.50, p=0.06). Sensitivity analysis to correct an apparent anomaly in published data suggested a positive effect (SMD 0.37, 95% CI 0.08–0.65, p=0.01). Psychological quality of life demonstrated benefit from training (MD=25.3, 95% CI 3.94–49.7). All studies were rated as having high risk of bias. The quality of the evidence was rated as low or very low. Conclusion: Further research with robust methodology is recommended to assess the potential benefit suggested in this review

Structural VARs And The Monetary Transmission Mechanism In Low-Income African Countries

Structural Vector Autoregression (SVAR) methods suggest the monetary transmission mechanism may be weak and unreliable in many low-income African countries. But are structural VARs identified via short-run restrictions capable of detecting a transmission mechanism when one exists, under research conditions typical of low-income countries (LICs)? Using a small DSGE as our data-generating process, we assess the impact on VAR-based inference of short data samples, measurement error, high-frequency supply shocks, and other features of the LIC environment. The impact of these features on finite-sample bias appears to be relatively modest when identification is valid—a strong caveat, especially in LICs. Nonetheless many of these features undermine the precision of estimated impulse responses to monetary policy shocks, and cumulatively they suggest that statistically and economically insignificant results can be expected even when the underlying transmission mechanism is strong. These data features not only undermine the efficacy of the SVAR methodology for research and policy-making, but are also severe enough to motivate a continued search for monetary policy rules that are robust to these limitations