Physicians, it's in your court now.
Ontology highlight
ABSTRACT:
SUBMITTER: Lewis S
PROVIDER: S-EPMC1180660 | biostudies-literature | 2005 Aug
REPOSITORIES: biostudies-literature
Publications
Physicians, it's in your court now.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20050620 3
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Project description: Not available
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Project description:Has the US Supreme Court become more conservative than the public? We introduce results of three surveys conducted over the course of a decade that ask respondents about their opinions on the policy issues before the court. Using these data, we show that the gap between the court and the public has grown since 2020, with the court moving from being quite close to the average American to a position that is more conservative than the majority of Americans. Second, in contrast to findings showing consistency in the public’s approval of or deference to the court, we find that the public’s expectations of the court vary significantly over time and in tandem with changes in the court’s composition and recent rulings. Even so, many members of the public currently underestimate the court’s conservative leaning. Third, we find that respondents’ perceptions of the court’s ideology relative to their own are associated with support for institutional changes but with important differences between Democrats and Republicans. The fact that so many people currently underestimate how conservative the court is implies that support for proposed changes to the court may be weaker than it would be if people knew with greater accuracy the court’s conservative nature.
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Project description:BackgroundTask shifting is an approach where specific tasks are transferred, when convenient, from health workers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increasingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflections of physicians and their leaders related to giving up tasks or how such policies can best be implemented is limited. This study aimed to explore physicians' and their leaders' perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments.MethodsThe study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and leaders from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study.ResultsFrom the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting - moving towards a person-centred culture.ConclusionsThe study indicates that developing a person-centred culture and fostering a team approach in emergency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departments.
| S-EPMC11330047 | biostudies-literature
Project description:Clinical practice that utilizes chronic opioid therapy has been recognized as one major cause of the opioid crisis. Among patients living with HIV, the risks associated with chronic opioid therapy may be complicated by factors such as co-occurring mental health diagnoses, substance use, and economic marginalization. Improving opioid prescribing practices in HIV clinics requires attention to these and other characteristics common to HIV care. In the context of a randomized controlled trial testing an intervention to improve opioid prescribing practices in HIV outpatient clinics, we interviewed physicians about their perspectives on chronic opioid therapy. Overwhelmingly, physicians voiced ambivalence about their own knowledge and comfort with prescription opioids. They raised concerns about the impact of opioid prescribing on patient-provider relationships and the increasing workload associated with prescribing and monitoring patients. In this report, we explore these concerns and propose several strategies for improving clinical care in which chronic opioid therapy is addressed.
| S-EPMC6610859 | biostudies-literature
Project description:BackgroundIllicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl's dramatic increase in the recreational drug supply over the past decade.MethodsWe conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes.ResultsPWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers.ConclusionPWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.
| S-EPMC9275036 | biostudies-literature
Project description:BackgroundIn the modern world with new family structures, international migration and increased life expectancy, there is a growing need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets. There are few studies about the physician's role when a court appoints proxies for vulnerable elderly. Many doctors do not know how to assess mental capacity, and most lawyers and judges know little about medicine.MethodsApplications for a custodian sent to the Stockholm Chief Guardian' Office in Sweden were used. Physician's statements to the court for elderly with memory impairment were selected and 260 statements were scrutinized with regard to formal quality, the narrative content and the physician who wrote it.ResultsThe quality of the statements varied from one sentence to excellent. Most statements were written by senior family practitioners or geriatricians. Seventeen % of the statements were handwritten and had more formal shortcomings than machine/computer written statements.The majority of patients needed massive help with daily life and economy. Median age was 84 years of age. MMSE score was given in 20% of the cases and varied from 6-27.A diagnosis of dementia was established in 57%. At the time of application, at least 48% were in a hospital or nursing home and at least 27% were in their private home. Only 5% were living with a spouse or a child. In 53% of the cases, the doctor knew the patient, but in 40% of the cases, the identity of the patient was not confirmed. The physician found that 54% were unable to understand the idea of getting a custodian, but out of those very vulnerable elderly, 20% had signed consent and 57% were considered able to be heard in court.ConclusionsThere is a large variation in the quality of physicians' statements to the court concerning the mental capacity of elderly patients with cognitive impairment. Many statements have serious short-comings, and the system is not safe. There is a strong need for guide-lines, and additional training for all professionals involved.
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Project description:BackgroundLittle research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians' perceptions of responsibility for smoking cessation.MethodsData were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach.ResultsThe analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care.ConclusionsThe organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.
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Project description:PurposeAlmost 40 years after its development, in this article, we reexamine the relevance and validity of the ubiquitously used Revised Speech Perception in Noise (R-SPiN) sentence corpus. The R-SPiN corpus includes "high-context" and "low-context" sentences and has been widely used in the field of hearing research to examine the benefit derived from semantic context across English-speaking listeners, but research investigating age differences has yielded somewhat inconsistent findings. We assess the appropriateness of the corpus for use today in different English-language cultures (i.e., British and American) as well as for older and younger adults.MethodTwo hundred forty participants, including older (60-80 years) and younger (19-31 years) adult groups in the the United Kingdom and United States, completed a cloze task consisting of R-SPiN sentences with the final word removed. Cloze, as a measure of predictability, and entropy, as a measure of response uncertainty, were compared between culture and age groups.ResultsMost critically, of the 200 "high-context" stimuli, only around half were assessed as highly predictable for older adults (United Kingdom: 109; United States: 107); and fewer still, for younger adults (United Kingdom: 75; United States: 81). We also found dominant responses to these "high-context" stimuli varied between cultures, with U.S. responses being more likely to match the original R-SPiN target.ConclusionsOur findings highlight the issue of incomplete transferability of corpus items across English-language cultures as well as diminished equivalency for older and younger adults. By identifying relevant items for each population, this work could facilitate the interpretation of inconsistent findings in the literature, particularly relating to age effects.
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Project description:Predicting case outcomes is useful for legal professionals to understand case law, file a lawsuit, raise a defense, or lodge appeals, for instance. However, it is very hard to predict legal decisions since this requires extracting valuable information from myriads of cases and other documents. Moreover, legal system complexity along with a huge volume of litigation make this problem even harder. This paper introduces an approach to predicting Brazilian court decisions, including whether they will be unanimous. Our methodology uses various machine learning algorithms, including classifiers and state-of-the-art Deep Learning models. We developed a working prototype whose F1-score performance is ~80.2% by using 4,043 cases from a Brazilian court. To our knowledge, this is the first study to present methods for predicting Brazilian court decision outcomes.
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