Medical and legal professionals’ attitudes towards confidentiality and disclosure of clinical information in forensic settings: a survey using case vignettes

2012 ◽  
Vol 53 (3) ◽  
pp. 132-148 ◽  
Author(s):  
Marie-Charlotte Bruggen ◽  
Ariel Eytan ◽  
Bruno Gravier ◽  
Bernice S Elger
Keyword(s):  
Clinical Information ◽  
Legal Professionals ◽  
Case Vignettes

scholarly journals Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews?

2016 ◽  
Vol 55 (03) ◽  
pp. 292-298 ◽  
Author(s):  
Dympna O’Sullivan ◽  
Craig Kuziemsky ◽  
Wojtek Michalowski ◽  
Ken Farion ◽  
Bartosz Kukawka ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Clinical Setting ◽  
Contextual Factors ◽  
Clinical Information ◽  
Pediatric Emergency ◽  
Emergency Physicians ◽  
Web Based ◽  
Case Vignettes ◽  
Study Participants ◽  
Based Medicine

SummaryBackground: A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors.Objectives: To assess to what extent physi -cians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance.Methods: A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emer gency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three.Results: Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians’ assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected speci ficity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting.Conclusions: There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physi -cian’s preferences and contextual factors, including differences in the micro environment of each clinical setting.

scholarly journals Predictive Validity of Operationalized Criteria for the Assessment of Criminal Responsibility of Sexual Offenders With Paraphilic Disorders—A Randomized Control Trial With Mental Health and Legal Professionals

2020 ◽  
Vol 11 ◽  
Author(s):  
Sascha Dobbrunz ◽  
Anne Daubmann ◽  
Jürgen Leo Müller ◽  
Peer Briken
Keyword(s):  
Mental Health ◽  
Predictive Validity ◽  
Sexual Offenders ◽  
Criminal Responsibility ◽  
Validity And Reliability ◽  
Paraphilic Disorder ◽  
Legal Professionals ◽  
Diminished Capacity ◽  
Case Vignettes ◽  
Paraphilic Disorders

The prevention of sexual violence is a major goal of sexual health. In cases of accused sexual offenders, the assessment of diminished criminal responsibility of the accused is one of the most important procedures undertaken by experts in the German legal system. This assessment follows a two-stage method assessing first the severity of a paraphilic disorder and then second criteria for or against diminished capacity. The present study examines the predictive validity of two different sets of criteria for the assessment of criminal responsibility in the context of paraphilic disorders combined with sexual offending. Two exemplary case vignettes of two suspected sexual offenders were developed to assess the criteria. For each participant, one of the two exemplary case vignettes was randomly presented. The presentation of the two different sets of criteria was also randomized, so that each participant was assigned only one of the two criteria sets to rate one of the presented cases. N = 349 participants from different professional backgrounds (mental health and legal professionals) completed their assessments and were included in the data analysis. The data were evaluated using logistic regression. Results show that the more recently published criteria set (Briken and Müller, 2014) predicts both the severity of the disorder as well as the diminished capacity twice as good as the older criteria set of Boetticher et al. (2005) currently used regularly for forensic court reports. In preliminary conclusion, the new criteria of Briken and Müller (2014) form an empirically based assessment of criminal responsibility. However, the proposed criteria cannot replace an extensive exploration of the accused person and a careful file analysis. Validity and reliability of the results are also limited due to the methodical choice of a vignette study.

South Asian Stories: Firsthand Client Perspectives on Barriers to Accessing Speech-Language Pathology Services

2012 ◽  
Vol 19 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Nidhi Mahendra
Keyword(s):  
South Asian ◽  
Empirical Support ◽  
Communication Disorders ◽  
Speech Language Pathology ◽  
Client Experiences ◽  
Individual Interviews ◽  
Timely Access ◽  
Phenomenological Perspective ◽  
Case Vignettes ◽  
Language Pathology

This article details the experience of two South Asian individuals with family members who had communication disorders. I provide information on intrinsic and extrinsic barriers reported by these clients in responses to a survey and during individual ethnographic interviews. These data are part of a larger study and provide empirical support of cultural and linguistic barriers that may impede timely access to and utilization of speech-language pathology (SLP) services. The purpose of this article is to shed light on barriers and facilitators that influence South Asian clients' access to SLP services. I provide and briefly analyze two case vignettes to provide readers a phenomenological perspective on client experiences. Data about barriers limiting access to SLP services were obtained via client surveys and individual interviews. These two clients' data were extracted from a larger study (Mahendra, Scullion, Hamerschlag, Cooper, & La, 2011) in which 52 racially/ethnically diverse clients participated. Survey items and interview questions were designed to elicit information about client experiences when accessing SLP services. Results reveal specific intrinsic and extrinsic barriers that affected two South Asian clients' access to SLP services and have important implications for all providers.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

An Automated Clinical Information System

1964 ◽  
Vol 3 (02) ◽  
pp. 45-50 ◽  
Author(s):  
D. Yoder ◽  
R. Swearingen ◽  
E. Schenthal ◽  
W. Sweeney ◽  
J. Nettleton
Keyword(s):  
Natural Language ◽  
Clinical Information System ◽  
Drug Evaluation ◽  
Scientific Information ◽  
Clinical Information ◽  
Clinical Situation ◽  
Field Variable ◽  
Record System ◽  
New Members ◽  
Clinical Terminology

An automated clinical record system must have the following characteristics: as far as the physician is concerned it must operate in natural language on standard sized paper; it must be able to accept information from the physician at a time when he is oriented to clinical terminology and a clinical mode of thinking; it must have an output which is clinically useful for the care and management of a patient; each item of information must be addressable so that it may act as an index for scientific information retrieval; it must be capable of accepting quantative and natural language information.Clinical information constitutes a mathematical set, only a few members of which are applicable to any particular clinical situation, and to which new members are constantly being added. The members of this set are seldom mutually exclusive. An acceptable system which is capable of processing this type of information has been designed utilizing the concepts of self-encoding forms and variable-field, variable-length records. Applications of these principles will expedite hospital automation, the establishment of drug evaluation information systems, and of regional and nationwide medical record systems.

Architecture Models to Facilitate Communication of Clinical Information

1999 ◽  
Vol 38 (04/05) ◽  
pp. 326-331
Author(s):  
S. Kay
Keyword(s):  
Health Care ◽  
Clinical Information ◽  
Reference Architecture ◽  
Context Model ◽  
Electronic Health

AbstractThis is an account of the development and use of a context model for facilitating the communication of clinical information. Its function is to articulate the principle of context within a reference architecture for the Electronic Health Care Record (EHCR). The work required a re-examination of established models of communication, the purpose being to use them to support an architecture that could be reasonably expected to accommodate future, and by definition unforeseeable, developments in EHCR communication. The Context Model is built upon seven recognized constituents of communication. These constituents, although having their origin in the engineering of signal communication, have been found to be useful for explication both in the verbal and textual communication of narratives between people. The electronic health care record architecture supported by the model is the European prestandard ENV13606-1.

MS2/Cardio: Towards a Multi-Service Medical Software for Cardiology

1992 ◽  
Vol 31 (01) ◽  
pp. 18-28 ◽  
Author(s):  
C. Combi ◽  
G. Pozzi ◽  
R. Rossi ◽  
F. Pinciroli
Keyword(s):  
Statistical Processing ◽  
Clinical Information ◽  
Daily Practice ◽  
Management Unit ◽  
Record Management ◽  
Medical Software ◽  
Software Packages ◽  
Ambulatory Patients ◽  
Patient Database ◽  
Individual Program

Abstract:Many clinics are interested to use software packages in daily practice, but lack of integration of such packages seriously limits their scope. In practice this often entails switching between programs and interrupting the run of an individual program. A multi-task approach would not solve this problem as it would not eliminate the need to input the same data many times, as often occurs when using separate packages. The construction of a Multi-Service Medical Software package (MSx2) is described, which was also developed as an example of practical integration of some clinically relevant functions. The package runs on a personal computer in an MS-DOS environment and integrates a time-oriented medical record management unit (TOMRU) for data of ambulatory patients, and a drug information management unit (DIMU) concerning posology, content, effects, and possible interactions. Of the possible database configurations allowed by MSx2, the cardiology patient database (MSx2/C) and hypertensive patient database (MSx2/H) were developed and described here. Clinical information to be included in the configurations was obtained after discussion and consensus of clinical practitioners. MSx2/C was distributed to several hundred clinical centers during computerized courses to train future users. MSx2 can easily transfer patient data to statistical processing packages.

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

1996 ◽  
Vol 35 (01) ◽  
pp. 41-51 ◽  
Author(s):  
F. Molino ◽  
D. Furia ◽  
F. Bar ◽  
S. Battista ◽  
N. Cappello ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Information ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Clinical Documentation ◽  
Data Set ◽  
Knowledge Based ◽  
Number Of Patients ◽  
Support Tools ◽  
Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Assigning Value to Clinical Information – A Major Limiting Factor in the Implementation of Decision-Support Systems

1996 ◽  
Vol 35 (01) ◽  
pp. 1-4 ◽  
Author(s):  
F. T. de Dombal
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Support Systems ◽  
Clinical Information ◽  
Limiting Factor ◽  
Major Difficulty ◽  
Computer Aided ◽  
Computer Aided Decision

AbstractThis paper deals with a major difficulty and potential limiting factor in present-day decision support - that of assigning precise value to an item (or group of items) of clinical information. Historical determinist descriptive thinking has been challenged by current concepts of uncertainty and probability, but neither view is adequate. Four equations are proposed outlining factors which affect the value of clinical information, which explain some previously puzzling observations concerning decision support. It is suggested that without accommodation of these concepts, computer-aided decision support cannot progress further, but if they can be accommodated in future programs, the implications may be profound.

A Computer-based Clinical Information System

1987 ◽  
Vol 26 (04) ◽  
pp. 189-194
Author(s):  
S. S. El-Gamal
Keyword(s):  
Information System ◽  
Hospital Information System ◽  
Clinical Information System ◽  
Research Work ◽  
Clinical Information ◽  
Hospital Staff ◽  
Vital Role ◽  
Daily Routine ◽  
Specialized Hospital ◽  
Computer Based

SummaryModern information technology offers new opportunities for the storage and manipulation of hospital information. A computer-based hospital information system, dedicated to urology and nephrology, was designed and developed in our center. It involves in principle the employment of a program that allows the analysis of non-restricted, non-codified texts for the retrieval and processing of clinical data and its operation by non-computer-specialized hospital staff.This Hospital Information System now plays a vital role in the efficient provision of a good quality service and is used in daily routine and research work in this hospital. This paper describes this specialized Hospital Information System.

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