Hepatitis B virus infected physicians and disclosure of transmission risks to patients: A critical analysis

BACKGROUND: The potential for transmission of blood-borne pathogens such as hepatitis B virus from infected healthcare workers to patients is an important and difficult issue facing healthcare policymakers internationally. Law and policy on the subject is still in its infancy, and subject to a great degree of uncertainty and controversy. Policymakers have made few recommendations regarding the specifics of practice restriction for health care workers who are hepatitis B seropositive. Generally, they have deferred this work to vaguely defined "expert panels" which will have the power to dictate the conditions under which infected health care workers may continue to practice. DISCUSSION: In this paper we use recent Canadian policy statements as a critical departure point to propose more specific recommendations regarding disclosure of transmission risks in a way that minimizes practice restriction of hepatitis B seropositive health care workers without compromising patient safety. The range of arguments proposed in the literature are critically examined from the perspective of ethical analysis. SUMMARY: A process for considering the ethical implications of the disclosure of the sero-status of health care workers is advanced that considers the varied perspectives of different stakeholders

Protecting Clinical Trial Participants and Protecting Data Integrity: Are We Meeting the Challenges?

Susan Ellenberg discusses alternative approaches towards evaluating data as it accumulates in clinical trials, and to protecting the integrity and preventing undue risks to participants, as the trial continues

Controversies concerning the diagnosis and treatment of bipolar disorder in children

This commentary grows out of an interdisciplinary workshop focused on controversies surrounding the diagnosis and treatment of bipolar disorder (BP) in children. Although debate about the occurrence and frequency of BP in children is more than 50 years old, it increased in the mid 1990s when researchers adapted the DSM account of bipolar symptoms to diagnose children. We offer a brief history of the debate from the mid 90s through the present, ending with current efforts to distinguish between a small number of children whose behaviors closely fit DSM criteria for BP, and a significantly larger number of children who have been receiving a BP diagnosis but whose behaviors do not closely fit those criteria. We agree with one emerging approach, which gives part or all of that larger number of children a new diagnosis called Severe Mood Dysregulation or Temper Dysregulation Disorder with Dysphoria

BRIEF REPORT: Needlestick Injury and Inadequate Post-Exposure Practice in Medical Students

BACKGROUND: Medical students are at a particularly high risk for needlestick injury and its consequences because of their relative inexperience and lack of disability insurance. OBJECTIVE: To determine the risk of needlestick injury and the use of post-exposure prophylaxis among medical students. DESIGN: Internet-based survey. PARTICIPANTS: The 2003 graduating medical school class at the University of Toronto. MEASUREMENTS: Number of needlestick injuries, circumstances surrounding those incidents, and post-exposure actions. RESULTS: The response rate was 88% (157/178). Over one third (55/157) of respondents suffered at least 1 needlestick injury. In more than half the high-risk injuries, the students continued working and did not seek medical advice. Six students who suffered a needlestick injury began prophylactic human immunodeficiency virus medications. Of those students who suffered an injury, 15% had purchased disability insurance prior to the incident. CONCLUSIONS: Poor use of post-exposure procedures and a lack of disability insurance leave medical students at high risk for career and life-altering consequences from a needlestick injury