Impact of the Florida Birth-Related Neurological Injury Compensation Association (NICA) on Obstetrician and Attorney Practices

As health reform continues to unfold nationally, one ofthe more dramatic strategies for reform ofthe current medical liability system is to move towards a no-fault compensation system. Although, no state has established a comprehensive no-fault medical malpractice system, the Florida Birth-Related Neurological Injury Compensation Association (NICA) is a unique and rare working model ofa functioning no-fault insurance program. A cross-sectional design was utilized to survey obstetricians and health law attorneys practicing in Florida in 2011 to ascertain their knowledge and opinions of NICA and its impact on practice patterns and defensive medicine. The findings indicate that respondents believe NICA has had no effect on insurance rates among both obstetricians (39.8%) and attorneys(35.3%) nor did obstetricians (52.8%) or attorneys (35.8%) believe it has affected defensive medicine practices. Additionally, the findings further reinforced stereotypic expectations that obstetricians prefer an administrative process (35%) or arbitration (37.5%), while attorneys have a strong preference towards a standard courtroom venue (57.2%). With over two decades of experience with successful implementation of a no-fault obstetrical mal- practice model, Florida has a strong foundation for further bold experimentation. In addition, because of its large population size, the potential for a pilot study expanding the scope ofclinical practice coverage is promising. Further study and experi- mental models should be considered as possible next steps to explore in Florida

Healthcare preferences among lesbians: a focus group analysis

OBJECTIVE: The healthcare needs of lesbians are not well understood. We sought to characterize lesbians\u27 experiences with, and preferences for, women\u27s healthcare. METHODS: We conducted three age-stratified focus groups (18-29, 30-50, and \u3e50 years) with a total of 22 participants using a semistructured interview guide to elicit lesbians\u27 experiences and preferences. We analyzed transcripts of these audiotaped sessions using the constant comparative method of grounded theory. Community-dwelling women who self-identified as lesbian and responded to advertisements were selected on first-come basis. RESULTS: Participants voiced experiences and preferences for healthcare that emerged into three themes: desired models of care, desired processes of care, and desired patient-provider relationship. Each theme was further developed into multiple subthemes. Within the subthemes we identified issues that were specific to lesbians and those that were general women\u27s health issues. Participants preferred, but did not always receive, care that is comprehensive in scope, person centered, nondiscriminatory, and inclusive of them as lesbians. CONCLUSIONS: Healthcare providers, institutions, and society should adopt an inviting, person-centered approach toward lesbians seeking healthcare, assure them access to healthcare information, and establish healthcare delivery systems that take all aspects of health into account

Supporting clinician educators to achieve “work-work balance”

Clinician Educators (CE) have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve “work-work balance.” Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE’s “Four Ps”; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance

Obscured by administrative data? Racial disparities in occupational injury

Objectives: Underreporting of occupational injuries is well documented, but underreporting patterns may vary by worker characteristics, obscuring disparities. We tested for racial and ethnic differences in injury reporting patterns by comparing injuries reported via research survey and administrative injury database in the same group of healthcare workers in the US. Methods: We used data from a cohort of 1568 hospital patient-care workers who were asked via survey whether they had been injured at work during the year prior (self-reported injury; N=244). Using the hospital’s injury database, we determined whether the same workers had reported injuries to the hospital’s occupational health service during that year (administratively reported injury; N=126). We compared data sources to test for racial and ethnic differences in injury reporting practices. Results: In logistic regression models adjusted for demographic and occupational characteristics, black workers’ odds of injury as measured by self-report data were 1.91 [95% confidence interval (95% CI) 1.04–3.49] compared with white workers. The same black workers’ odds of injury as measured by administrative data were 1.22 (95% CI 0.54–2.77) compared with white workers. Conclusions: The undercount of occupational injuries in administrative versus self-report data may be greater among black compared to white workers, leading to underestimates of racial disparities in workplace injury

Qualitative Analysis of Student Physical Therapist Reflective Writing: Does an Interprofessional Discharge Planning Simulation Increase their Understanding of the Role they play In Discharge Planning?

Purpose: The Core Competencies for Entry-Level Practice in Acute Care Physical Therapy provides an expectation of entry-level practice in acute care for physical therapists including discharge planning (DP). Physical therapists (PT), despite having appropriate clinical reasoning and unique skills for determining the functional abilities of patients, are less often a part of the DP process. The purpose of this study was to determine, by use of qualitative analysis of reflective writing, if an interprofessional discharge planning simulation will increase students’ understanding of the role of physical therapy in DP. Methods: Students from physical therapy (n=57), undergraduate nursing (n=36), graduate nurse practitioners (n=2), and social work (n=37) participated in a simulation enhanced interprofessional education (Sim-IPE) DP meeting utilizing simulated participants. DPT students were required to complete a reflection paper on this activity. Reflection papers were reviewed and analyzed to identify trends and main themes regarding the role of physical therapist in the discharge planning process. In addition, and sub-themes were then identified through secondary analysis. Results: Three main themes and seven sub-themes were established based on the direct responses to the reflective questions. The first main theme was that it is imperative to identify the main discharge issue particularly as it relates to patient safety and fall risk and to resolve this issue through the DP process. The second main theme was understanding the roles and responsibilities of an interprofessional DP team. The third theme was the identification of the gaps in knowledge with a lack of understanding of the DP process and insurance regulations. Conclusions: DPT students’ gained better understanding of the PT’s role on the healthcare team as it relates to DP; however, there was a belief that other professions were unaware of the PT’s role. The use of a Sim-IPE DP meeting may improve knowledge regarding the discharge process and the role of the PT

Involvement of Platelet-Activating Factor in Ultraviolet B-Induced Hyperalgesia

Ultraviolet B (UVB) radiation causes cutaneous inflammation. One important clinical consequence of UVB-induced inflammation is increased pain or hyperalgesia, which is likely mediated by enhanced sensitivity of cutaneous sensory neurons. Previous studies have demonstrated that UVB radiation generates the lipid mediator, platelet-activating factor (PAF), as well as oxidized phospholipids that act as PAF-mimetics. These substances exert effects through the PAF receptor (PAF-R). This study was designed to assess whether PAF-R is involved in UVB-induced hyperalgesia. Intradermal injection of carbamoyl PAF (CPAF; 1-hexadecyl-2-N-methylcarbamoyl glycerophosphocholine) resulted in an enhanced response to mechanical stimuli in wild-type mice but not in PAF-R knockout (KO) mice. There was no significant change in paw withdrawal to noxious thermal stimuli in either genotype after intradermal injection of CPAF. Exposure of the hind paw to 1,500Jm-2 UVB radiation caused an increased sensitivity to both mechanical and thermal stimulation in wild-type mice but not in PAF-R KO mice. The thermal hyperalgesia caused by UVB irradiation was inhibited in mice that lacked PAF-R in bone marrow-derived cells. These data demonstrate that the PAF-R is important for UVB-induced hyperalgesia. Further investigation of the role of PAF-R signaling in UVB-induced hyperalgesia could provide better understanding of the pathological processes initiated by UVB-induced skin damage

Firearm Safety, Gun Violence and Chicago Families: Voices of Child Health in Chicago Report

Chicago has seen continuing firearm violence, with over 2,000 shooting victims so far in 2021. The epidemic of firearm violence impacts children across the state, as it remains the number one cause of death in children and youth across Illinois. In some of our previous reports, Chicago parents identified gun violence as their top social concern for kids in the city, and in recent years, they reported it was the main social problem getting worse the fastest for Chicago youth. In this month's Voices of Child Health in Chicago Report, we focus on the importance of firearm safety and parents' concerns about gun violence in the city. We asked 1,505 Chicago parents from all 77 community areas in the city about their experiences with firearm safety as well as other gun violence prevention and concern-related questions.

Terminal 18q deletions are stabilized by neotelomeres

Background: All human chromosomes are capped by tandem repeat (TTAGGG)n sequences that protect them against end-to-end fusion and are essential to chromosomal replication and integrity. Therefore, after a chromosomal breakage, the deleted chromosomes must be stabilized by retaining the telomere or acquiring a new cap, by telomere healing or telomere capture. There are few reports with molecular approaches on the mechanisms involved in stabilization of 18q terminal deletions.Results: in this study we analyzed nine patients with 18q terminal deletion identified by G-banding and genomic array. FISH using PNA probe revealed telomeric signals in all deleted chromosomes tested. We fine-mapped breakpoints with customized arrays and sequenced six terminal deletion junctions. in all six deleted chromosomes sequenced, telomeric sequences were found directly attached to the breakpoints. Little or no microhomology was found at the breakpoints and none of the breaks sequenced were located in low copy repeat (LCR) regions, though repetitive elements were found around the breakpoints in five patients. One patient presented a more complex rearrangement with two deleted segments and an addition of 17 base pairs (bp).Conclusions: We found that all six deleted chromosomes sequenced were probably stabilized by the healing mechanism leading to a neotelomere formation.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Morphol & Genet, BR-04023900 São Paulo, BrazilEmory Univ, Sch Med, Dept Human Genet, Atlanta, GA 30322 USAUniversidade Federal de São Paulo, Dept Biophys, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, Lab Citogenom, BR-05403000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biophys, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, Lab Citogenom, BR-05403000 São Paulo, BrazilFAPESP: 2012/51150-0FAPESP: 2012/15572-7Web of Scienc