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Rebuilding patient–physician trust in China
Patient-physician trust is the foundation of clinical medicine. Yet in many health-care settings around the world, trust has eroded among structural and social transformations. In transitioning health systems, some patients develop mistrust for physicians' motives as inequalities in health care expand and close ties between pharmaceutical companies and physicians are revealed. At the same time, trust might be undermined by social change, such as an expanding middle class with increasing expectations of medical care. Patient-physician mistrust has become deeply embedded in medical clinics within a wide variety of contexts.
Journal Article
Beyond financial conflicts of interest: Institutional oversight of faculty consulting agreements at schools of medicine and public health
Approximately one-third of U.S. life sciences faculty engage in industry consulting. Despite reports that consulting contracts often impinge on faculty and university interests, institutional approaches to regulating consulting agreements are largely unknown.
To investigate the nature of institutional oversight of faculty consulting contracts at U.S. schools of medicine and public health.
Structured telephone interviews with institutional administrators. Questions included the nature of oversight for faculty consulting agreements, if any, and views about consulting as a private versus institutional matter. Interviews were analyzed using a structured coding scheme.
All accredited schools of medicine and public health in the U.S.
Administrators responsible for faculty affairs were identified via internet searches and telephone and email follow-up. The 118 administrators interviewed represented 73% of U.S. schools of medicine and public health, and 75% of those invited to participate.
Structured, 15-30 minute telephone interviews.
Prevalence and type of institutional oversight; responses to concerning provisions in consulting agreements; perceptions of institutional oversight.
One third of institutions (36%) required faculty to submit at least some agreements for institutional review and 36% reviewed contracts upon request, while 35% refused to review contracts. Among institutions with review, there was wide variation the issues covered. The most common topic was intellectual property rights (64%), while only 23% looked at publication rights and 19% for inappropriately broad confidentiality provisions. Six in ten administrators reported they had no power to prevent faculty from signing consulting agreements. Although most respondents identified institutional risks from consulting relationships, many maintained that consulting agreements are \"private.\"
Oversight of faculty consulting agreements at U.S. schools of medicine and public health is inconsistent across institutions and usually not robust. The interests at stake suggest the need for stronger oversight.
Journal Article
The Policy Argument for Healthcare Workforce Diversity
This perspectives article considers the potential implications an affirmative action ban would have on patient care in the US. A physician’s race and ethnicity are among the strongest predictors of specialty choice and whether or not a physician cares for Medicaid and uninsured populations. Taking this into account, research suggests that an affirmative action ban in university admissions would sharply reduce the supply of primary care physicians to Medicaid and uninsured populations over the coming decade. Our article compares current conditions to the potential effect of an affirmative action ban by projecting how many future medical students will become primary care physicians for Medicaid and uninsured patients by 2025. Based on previous evidence and current medical student training patterns, we project that a ban could deny primary care access for 1.25 million of our nation’s most vulnerable patients, considerably worsening existing healthcare disparities. More broadly, we argue that the effects of eliminating affirmative action would be fundamentally contrary to the Association of American Medical Colleges’ stated goal of medical education—“to improve the health of all.”
Journal Article
The best interests assessor practice handbook
The first textbook to consider the Best Interests Assessor (BIA) role in depth, offering practical guidance and exploring its particular challenges in the context of the Mental Capacity Act and Deprivation of Liberty Safeguards legal framework.
Book
Natural hydrogels R&D process: technical and regulatory aspects for industrial implementation
Since hydrogel therapies have been introduced into clinic treatment procedures, the biomedical industry has to face the technology transfer and the scale-up of the processes. This will be key in the roadmap of the new technology implementation. Transfer technology and scale-up are already known for some applications but other applications, such as 3D printing, are still challenging. Decellularized tissues offer a lot of advantages when compared to other natural gels, for example they display enhanced biological properties, due to their ability to preserve natural molecules. For this reason, even though their use as a source for bioinks represents a challenge for the scale-up process, it is very important to consider the advantages that originate with overcoming this challenge. Therefore, many aspects that influence the scaling of the industrial process should be considered, like the addition of drugs or cells to the hydrogel, also, the gelling process is important to determine the chemical and physical parameters that must be controlled in order to guarantee a successful process. Legal aspects are also crucial when carrying out the scale-up of the process since they determine the industrial implementation success from the regulatory point of view. In this context, the new law Regulation (EU) 2017/745 on biomedical devices will be considered. This review summarizes the different aspects, including the legal ones, that should be considered when scaling up hydrogels of natural origin, in order to balance these different aspects and to optimize the costs in terms of raw materials and engine.
Journal Article
Continuous sedation at the end of life : ethical, clinical, and legal perspectives
\"Continuous sedation until death (sometimes referred to as terminal sedation or palliative sedation) is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness (and thus potentially causing 'subjective death'), the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect\"-- Provided by publisher.
Book
No More Surprises — New Legislation on Out-of-Network Billing
The passage of the federal No Surprises Act — which banned “surprise billing” in many scenarios — was an unexpected step forward. The new legislation will benefit patients and may have little effect on most physicians who don’t engage in surprise billing.
Journal Article