The Road from Medical Injury to Claims Resolution: How No-Fault and Tort Differ

In the area of medical malpractice, no-fault has been offered as a response to the criticisms leveled against tort litigation for medical injuries. Five issues of no-fault are examined within the context of obstetrical malpractice

Cost of managing an episode of relapse in multiple sclerosis in the United States

BACKGROUND: The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. METHODS: Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. RESULTS: Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73$1,847 and mild episode $243. CONCLUSIONS: Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses

Correlation between Cognition and Balance among Middle-Aged and Older Adults Observed through a Tai Chi Intervention program

Background: Age-associated decline in cognition and balance may cause severe ability loss for daily living activities among middle-aged and older adults. The relationship between cognition and balance in this aging population remains to be explored. Objective: The present study Is exploratory in nature and aimed to examine the relationship between balance (both static and dynamic components) and global cognitive function among middle-aged and older adults through Tai Chi (TC) practice as a research avenue. Methods: A short-term (12 weeks) intervention of TC was conducted among middle-aged and older adults in the community setting. Global cognitive function (using the Chinese version of the Montreal Cognitive Assessment score (MoCA) and balance (i.e., one leg standing test score; Timed Up and Go Test score, TUGT) of all participants were assessed before and after the intervention. Age, body mass index (BMI), sex, and physical fitness variables (Chair Stand Test, CST; the 6-Meter Walk Test, 6MWT) were also collected as confounding factors. Results: Significant moderator effects of baseline CST on the association between the dichotomized baseline MoCA score and the baseline left leg balance score (p = 0.0247), the baseline right leg balance score (p = 0.0140) and the baseline TUGT score (p = 0.0346) were found. Change score of left score balance (p = 0.0192) and change score of TUGT (p = 0.0162) were found to be significantly associated with change score of cognitive function. Conclusion: Cognitive function and balance are interrelated in middle-aged and older adults. The association between global cognitive function and balance Is moderated by strength of lower limbs. The change scores of cognitive function and balance introduced by TC training were found to be positively correlated. Future research Is warranted to further confirm the cause-effect relationship of cognitive function and balance and its influencing factors among middle-aged and older adults utilizing intervention studies with larger sample sizes

Externalities from Alcohol Consumption in the 2005 US National Alcohol Survey: Implications for Policy

A subsample (n = 2,550) of the 2005 US National Alcohol Survey of adults was used to estimate prevalence and correlates of six externalities from alcohol abuse––family problems, assaults, accompanying intoxicated driver, vehicular accident, financial problems and vandalized property––all from another’s drinking. On a lifetime basis, 60% reported externalities, with a lower 12-month rate (9%). Women reported more family/marital and financial impacts and men more assaults, accompanying drunk drivers, and accidents. Being unmarried, older, white and ever having monthly heavy drinking or alcohol problems was associated with more alcohol externalities. Publicizing external costs of drinking could elevate political will for effective alcohol controls

Predictors of the psychosocial impact of being a carer of people living with Parkinson’s disease: A systematic review

INTRODUCTION:Caring for a person with Parkinson's disease (PwP) can have a variety of negative consequences that may challenge their ability to continue their caring role. It is still unknown why some individuals adapt better than others in response to such burdens. This review is the first to synthesize and evaluate the evidence on the predictive factors of psychosocial outcomes in PwP carers.METHODS:Studies which identified predictors of psychosocial outcomes for unpaid carers were included. PsychINFO, EMBASE, AMED, BNI and CINAHL databases were searched, supplemented by scanning of references lists of included studies and relevant journals from 2008 onwards. Quality was assessed using the NICE methodology checklist for prognostic studies.RESULTS:Twenty-nine studies were included in the review, providing a low-level of evidence. Carer burden was investigated in 18 studies and mental health and quality of life (QoL) in seven studies each. PwP non-motor symptoms and QoL and carer depression were consistently identified as predictors for at least one psychosocial outcome. Demographics and disease factors were consistently found not to be predictors. Carer involvement and protective factors (e.g. social support, personality) demonstrated promising findings but studies were too few or factors measured inconsistently.CONCLUSION:Confident conclusions could not be drawn regarding the most important predictors that should be targeted in psychosocial interventions due to methodological weaknesses and lack of theoretical testing across the current literature. Future research should build upon psychological theory to gain a better understanding of the mechanisms that explain how carers adapt to caregiving