O inventário de envolvimento paterno revisado: inclusão de pais com filhos pré-escolares / The inventory of father involvement revised: inclusion of fathers with preschool children / El inventario de envolvimiento paterno revisado: inclusión de padres de preescolares

Apesar da importância do envolvimento paterno, sua avaliação persiste desafiadora. No Brasil, o Inventário de Envolvimento Paterno (IFI-BR) vem se mostrando adequado para uso com pais de crianças de 5 a 10 anos. Entretanto, do ponto de vista do desenvolvimento infantil e de intervenções preventivas, seria importante avaliar o envolvimento paterno quando as crianças são mais novas. Assim, este trabalho teve como objetivos: identificar limitações do IFI-BR, quando usado com pais de crianças entre 2 e 10 anos, e avaliar itens para o IFI-BR-revisado. No Estudo 1, 434 pais com filhos no Ensino Infantil ou Fundamental 1 responderam a um questionário sociodemográfico e ao IFI-BR. Com base em análises de dados omissos, estrutura interna e precisão, modificações foram sugeridas, visando à manutenção da estrutura interna original do instrumento. No Estudo 2, 572 pais com filhos na mesma faixa etária responderam a um questionário sociodemográfico e à versão modificada do IFI-BR. Foram comparadas as frequências de dados omissos e estimativas de precisão para os itens originais e modificados, selecionando aqueles que melhor representavam essa amostra de pais para compor a versão revisada do IFI-BR. Esses resultados indicaram evidências adequadas de validade, com base no conteúdo da versão revisada do IFI-BR, quando utilizada para avaliar a qualidade do envolvimento paterno de pais brasileiros com filhos do Ensino Infantil ao Fundamental 1. Após verificadas evidências de validade adicionais, essa versão revisada do IFI-BR poderá ser utilizada, por exemplo, em estudos longitudinais e na avaliação de intervenções precoces com pais.(AU)

Despite the importance assigned to father involvement, evaluating this construct remains a challenge. In Brazil, the Inventário de Envolvimento Paterno (IFI-BR) has showed satisfactory evidence of validity for fathers of children between 5 and 10 years old. From the perspective of child development and preventive interventions, however, evaluating father involvement with younger children is essential. Hence, this study sought to: identify limitations of the IFI-BR for fathers of children between 2 and 10 years old, and evaluate items for a revised IFI-BR. In Study 1, 434 fathers of children in early childhood and primary school settings answered a sociodemographic questionnaire and the IFI-BR. Based on analyses of missing data, internal structure, and reliability, modifications were suggested to maintain the original internal structure. In Study 2, 572 fathers of children in the same age range answered a sociodemographic questionnaire and the modified IFI-BR. After comparison between values for missing data and reliability of the original and modified items, the items that best represented the broader sample of fathers were selected to compose the revised IFI-BR. Results indicated adequate evidence of content validity for the revised IFI-BR when used to assess the involvement of Brazilian fathers with children in early childhood education and primary school settings. After additional evidence has been verified, this revised IFI-BR can be used, for example, in longitudinal studies and to evaluate early interventions with fathers.(AU)

La participación paterna es importante, pero su evaluación sigue siendo desafiadora. En Brasil, el Inventário de Envolvimento Paterno (IFI-BR) demuestra ser adecuado para aplicar a padres de niños de 5 a 10 años de edad. No obstante, desde la perspectiva del desarrollo infantil y de las intervenciones preventivas, sería importante evaluar la participación de los padres de niños más jóvenes. Este estudio tuvo como objetivos: identificar limitaciones del IFI-BR cuando se aplica a padres de niños entre los 2 y 10 años y evaluar ítems para el IFI-BR-revisado. En Estudio 1, 434 padres con hijos en el jardín de infantes o escuela primaria respondieron un cuestionario sociodemográfico y el IFI-BR. Con base en el análisis de datos faltantes, estructura interna y exactitud, se sugirieron modificaciones para mantener la estructura interna original del instrumento. En Estudio 2, 572 padres respondieron un cuestionario sociodemográfico y la versión modificada del IFI-BR. Se compararon las frecuencias de datos faltantes y estimaciones de exactitud para los ítems originales y modificados, seleccionando aquellos que representaban mejor a esta muestra de padres para la versión revisada del IFI-BR. Estos resultados indicaron evidencia adecuada de validez, basada en el contenido de la versión revisada del IFI-BR, cuando se utilizó para evaluar la calidad de la participación de padres brasileños con niños en el jardín de infantes y en la escuela primaria. Después de verificada la evidencia adicional de validez, la versión revisada del IFI-BR se puede utilizar, por ejemplo, en estudios longitudinales y en la evaluación de intervenciones precoz con los padres.(AU)

Psicologia escolar na educação superior: demandas apresentadas por coordenadores de cursos / School psychology in higher education: demands presented by course coordinators / Psicología escolar en educación superior: demandas presentadas por coordinadores de cursos

A Psicologia Escolar e Educacional vem conquistando novos espaços para a atuação e campo de pesquisa, dentre eles, destacamos a educação superior. Assim, este estudo teve por objetivo conhecer as demandas apresentadas por coordenadores de cursos de graduação, analisá-las à luz da Psicologia Escolar na vertente crítica e apontar possibilidades de atuação do psicólogo escolar junto a estes. A pesquisa, de caráter qualitativo, foi realizada a partir da análise de conteúdo das respostas obtidas dos questionários enviados por e-mail aos coordenadores dos 77 cursos de graduação oferecidos por uma instituição pública de ensino superior de Minas Gerais. Contamos com 28 questionários respondidos. As demandas apresentadas referem-se a questões acadêmicas e emocionais dos estudantes; sobrecarga de trabalho docente; relações interpessoais e formação continuada; burocracias enfrentadas pelos coordenadores; além da falta de preparação prévia e apoio para o exercício da função e concepções sobre o trabalho do psicólogo escolar. Concluímos que o coordenador, ao ouvir e compreender demandas advindas de discentes, docentes e técnicos, responde a elas por meio de uma parceria auspiciosa com o psicólogo escolar, juntamente com outros segmentos e instâncias da instituição.(AU)

The School and Educational Psychology has been conquering new spaces for professional performance and research field, among them, we highlight Higher Education. Therefore, this study aimed to get the demands presented by coordinators of undergraduate courses and analyze them in the light of School Psychology in the critical perspective and to point out possibilities for the performance of the school psychologist with them. The qualitative research was carried out based on the content analysis of the answers obtained from the questionnaires sent by e-mail to the coordinators of the 77 undergraduate courses offered by a public Higher Education institution in Minas Gerais. We have 28 answered questionnaires. The demands presented refer to students' academic and emotional issues; the overload of teaching work; interpersonal relationships and continuing education; the bureaucracies faced by coordinators; and the lack of prior preparation and support for the practice of the function and conceptions about the work of the school psychologist. We conclude that the coordinator, when listening to and understanding demands from students, teachers, and technicians, seeks to respond to them with an auspicious partnership with the school psychologist, together with other segments and instances of the institution.(AU)

La Psicología Escolar y Educacional sigue conquistando nuevos espacios para la actuación y campo de investigación, entre ellos destaca la educación superior. Por lo tanto, este estudio tuvo como objetivo conocer las demandas presentadas por los coordinadores de cursos de graduación, analizarlas desde la perspectiva crítica de la Psicología Escolar y señalar posibilidades de actuación del psicólogo escolar. La investigación cualitativa realizó el análisis de contenido de las respuestas obtenidas de los cuestionarios enviados por correo electrónico a los coordinadores de los 77 cursos ofrecidos por una institución pública de educación superior en Minas Gerais (Brasil). Se respondieron 28 cuestionarios. Las demandas presentadas se refieren a cuestiones académicas y emocionales de los estudiantes; a la sobrecarga del trabajo docente; a las relaciones interpersonales y educación continua; a las burocracias que enfrentan los coordinadores; además de la falta de preparación previa y apoyo para el ejercicio de la función y concepciones sobre el trabajo del psicólogo escolar. Se concluye que el coordinador escucha y considera las demandas de los estudiantes, profesores y técnicos, y trata de responderlas por medio de una asociación favorable con el psicólogo escolar, junto con otros segmentos e instancias de la institución.(AU)

Vagalumes e biografemas: poéticas e políticas públicas no desligamento institucional por maioridade / Fireflies and biographems: poetics and public policies regarding institutional removal due to adulthood / Luciérnagas y biografemas: poéticas y políticas públicas en desconexión institucional debido a la edad adulta

Este artigo versa sobre o processo de desligamento institucional por maioridade de jovens que residem em serviços de acolhimento. Aposta-se em uma política do sensível para visibilizar os encontros e desencontros que acontecem entre as e os jovens e as políticas públicas brasileiras. Para tanto, realizaram-se encontros com jovens que já haviam passado pelo processo de desligamento e com jovens que logo completariam 18 anos e teriam de sair das instituições de acolhimento. Para tornar visíveis essas existências, investiu-se na escrita de biografemas, inspirados na obra de Roland Barthes. Os conceitos de necropolítica e vidas precárias foram fundamentais para compreender as omissões do Estado no momento do desligamento. Verificou-se que o Estado pode maximizar a precariedade de algumas vidas, especialmente daquelas marcadas por características de raça, gênero e classe culturalmente marginalizados. Contudo, é também o encontro com as políticas públicas que garante melhores condições de vida para alguns, facilitando o acesso à universidade e ao mercado de trabalho. A pesquisa aponta que, diante do abandono, as e os jovens se fazem vagalumes, produzindo luminosidades em meio à escuridão e reivindicando o direito à vida.(AU)

This article discusses the process of institutional removal of young people that reside in foster care institutions for reaching adulthood. It relies on a politics of the sensitive to make visible the encounters and mismatches that take place between young people and Brazilian public policies. To do so, meetings were held with young people who had already experienced the removal process and with young people who would soon turn 18 and would have to leave the host institutions. To make these existences visible, this study invested in the writing of biographems, inspired by the works of Roland Barthes. The concepts of necropolitics and precarious lives were fundamental to understand the omissions of the State at the time of removal. It was also found that the State can maximize the precariousness of some lives, especially those marked by culturally marginalized race, gender, and class characteristics. However, it is also the encounter with public policies that ensures better living conditions for some, facilitating access to the university and the labor market. This research points out that, in the face of abandonment, young people become fireflies, producing luminosity amid the darkness and claiming the right to life.(AU)

Este artículo aborda el proceso de desconexión institucional justificado por la edad adulta de los jóvenes que residen en los servicios de acogida. Utilizamos una política sensible para hacer visibles las reuniones y los desajustes que tienen lugar entre los jóvenes y las políticas públicas brasileñas. Con este fin, se celebraron reuniones con los jóvenes que ya habían pasado por el proceso de desconexión institucional y también con los jóvenes que pronto cumplirían los 18 años y tendrían que abandonar las instituciones de acogida. Para hacer visibles estas existencias, se redactaron biografemas, inspirados en el trabajo de Roland Barthes. Los conceptos de necropolítica y vida precaria fueron fundamentales para comprender las omisiones del Estado en el momento de la desconexión. Se encontró que el Estado puede maximizar la precariedad de algunas vidas, principalmente de aquellas marcadas por características de raza, género y clase culturalmente marginadas. Sin embargo, el encuentro con las políticas también puede garantizar mejores condiciones de vida para algunos, facilitándoles el acceso a la universidad y al mercado laboral. Esta investigación señala que, ante el abandono, los jóvenes se convierten en luciérnagas, produciendo luminosidad en medio de la oscuridad y reclamando el derecho a la vida.(AU)

20 anos da comissão consultiva em avaliação psicológica: desafios da ADI 3481 / 20 years of the advisory committee on psychological assessment: challenges of ADI 3481 / 20 años de la comisión consultiva en evaluación psicológica: desafíos de la ADI 3481

A Comissão Consultiva em Avaliação Psicológica (CCAP) do Conselho Federal de Psicologia (CFP), em seu 20º aniversário, vem discutir os possíveis efeitos, ainda efetivamente desconhecidos, da Ação Direta de Inconstitucionalidade (ADI) 3481, instruída no Supremo Tribunal Federal (STF), a qual desestruturou o modo como os testes psicológicos eram comercializados no Brasil. A livre comercialização de testes psicológicos coloca em risco a segurança de avaliações psicológicas e cabe à categoria profissional pensar estratégias de enfrentamento desses riscos. Neste artigo, são discutidos possíveis efeitos da ADI 3481 para a categoria profissional da psicologia, bem como para a sociedade em geral, e são também elencadas possíveis estratégias de enfrentamento desses riscos, sem desconsiderar aspectos éticos relacionados a eles. Dessa forma, busca-se neste manuscrito, além da problematização dos efeitos derivados da ADI 3481, pensar soluções ou alternativas que venham a redirecionar a trajetória da área da avaliação psicológica no Brasil. Com isso, abre-se um espaço de discussão e encaminhamentos que a categoria profissional precisará tomar nos próximos anos.(AU)

The Advisory Commission for Psychological Assessment of the Federal Council of Psychology discusses, on its 20th anniversary, the possible and still effectively unknown effects of the Direct Action of Unconstitutionality (DAU) 3481, following the Supreme Federal Court, which interrupted how psychological tests were marketed in Brazil. The free trade of psychological tests puts the safety of psychological assessments at risk, and this professional category must think of strategies to face these risks. This study discusses the possible effects of DAU 3481 for professional psychology and for society in general, listing possible strategies for coping with these risks without disregarding its ethical aspects. Thus, this study seeks to problematize the effects derived from DAU 3481 and think of solutions or alternatives that may redirect the trajectory of the field of psychological assessment in Brazil, thus opening a space for discussion and referrals professional psychology will require in the coming years.(AU)

La Comisión Consultiva en Evaluación Psicológica (CCEP) del Consejo Federal de Psicología (CFP), en su 20.º aniversario, propone discutir los posibles efectos aún efectivamente desconocidos de la Acción Directa de Inconstitucionalidad (ADI) 3481, determinada por el Supremo Tribunal Federal (STF), por la cual trastornó la forma de comercializar las pruebas psicológicas en Brasil. La comercialización sin restricciones de las pruebas psicológicas pone en riesgo la seguridad de las evaluaciones psicológicas, y le corresponde a la categoría profesional pensar estrategias para enfrentar estos riesgos. En este artículo se discuten los posibles efectos de la ADI 3481 para la categoría profesional de la Psicología, así como para la sociedad en general, pero también se enumeran posibles estrategias para el enfrentamiento de estos riesgos, sin descuidar los aspectos éticos relacionados con ellos. Así, este manuscrito busca, además de problematizar los efectos derivados de la ADI 3481, pensar en soluciones o alternativas que puedan reconducir la trayectoria del campo de la evaluación psicológica en Brasil. Esto abre un espacio de discusión y derivaciones que la categoría profesional deberá tomar en los próximos años.(AU)

Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions.

AIM: This study aims to explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority. BACKGROUND: Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses. METHODS: This is a retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007 to 2016. The data were analysed using a quantitative design with descriptive statistics. RESULTS: We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under 1 month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety. CONCLUSION: This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organisations ensure patient safety when unprofessional conduct is suspected. IMPLICATIONS FOR NURSING MANAGEMENT: Retaining nursing professionals is vital due to global shortages, and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

Is Academic Attainment or Situational Judgment Test Performance in Medical School Associated With the Likelihood of Disciplinary Action? A National Retrospective Cohort Study.

PURPOSE: Disciplinary action imposed on physicians indicates their fitness to practice medicine is impaired and patient safety is potentially at risk. This national retrospective cohort study sought to examine whether there was an association between academic attainment or performance on a situational judgment test (SJT) in medical school and the risk of receiving disciplinary action within the first 5 years of professional practice in the United Kingdom. METHOD: The authors included data from the UK Medical Education Database for 34,865 physicians from 33 U.K. medical schools that started the UK Foundation Programme (similar to internship) between 2014 and 2018. They analyzed data from 2 undergraduate medical assessments used in the United Kingdom: the Educational Performance Measure (EPM), which is based on academic attainment, and SJT, which is an assessment of professional attributes. The authors calculated hazard ratios (HRs) for EPM and SJT scores. RESULTS: The overall rate of disciplinary action was low (65/34,865, 0.19%) and the mean time to discipline was 810 days (standard deviation [SD] = 440). None of the physicians with fitness to practice concerns identified as students went on to receive disciplinary action after they qualified as physicians. The multivariate survival analysis demonstrated that a score increase of 1 SD (approximately 7.6 percentage points) on the EPM reduced the hazard of disciplinary action by approximately 50% (HR = 0.51; 95% confidence interval [CI]: 0.38, 0.69; P < .001). There was not a statistically significant association between the SJT score and the hazard of disciplinary action (HR = 0.84; 95% CI: 0.62, 1.13; P = .24). CONCLUSIONS: An increase in EPM score was significantly associated with a reduced hazard of disciplinary action, whereas performance on the SJT was not. Early identification of increased risk of disciplinary action may provide an opportunity for remediation and avoidance of patient harm.

Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools.

PURPOSE: The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes. This study examined the relationship between USMLE attempts and the likelihood of receiving disciplinary actions from state medical boards. METHOD: The sample population was 219,018 graduates from U.S. and Canadian MD-granting medical schools who passed all USMLE Step examinations by 2011 and obtained a medical license in the United States, using data from the NBME and the Federation of State Medical Boards. Logistic regressions estimated how attempts on Steps 1, 2 Clinical Knowledge (CK), and 3 examinations influenced the likelihood of receiving disciplinary actions by 2018, while accounting for physician characteristics. RESULTS: A total of 3,399 physicians (2%) received at least 1 disciplinary action. Additional attempts needed to pass Steps 1, 2 CK, and 3 were associated with an increased likelihood of receiving disciplinary actions (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01, 1.13; OR: 1.09, 95% CI: 1.03, 1.16; OR: 1.11, 95% CI: 1.04, 1.17, respectively), after accounting for other factors. CONCLUSIONS: Physicians who took multiple attempts to pass Steps 1, 2 CK, and 3 were associated with higher estimated likelihood of receiving disciplinary actions. This study offers support for licensure and practice standards to account for physicians' USMLE attempts. The relatively small effect sizes, however, caution policy makers from placing sole emphasis on this relationship.

[Dutch medical disciplinary law cases concerning psychiatry, 2015-2019]. / Uitspraken van regionale tuchtcolleges in zaken betreffende de psychiatrie, 2015-2019.

BACKGROUND: The aim of medical disciplinary law (as part of the Dutch law 'Wet BIG') is to safeguard the quality of professional practice in the health services. Quantitative data about Dutch medical disciplinary law is sparse: little is known about the nature, quantity and the verdicts of disciplinary law complaints against psychiatrists and residents. AIM: Gaining insight in Dutch medical disciplinary law, in particular with regard to number and nature of disciplinary law complaints against psychiatrists(-psychotherapist) and psychiatry residents. METHOD: Descriptive retrospective study. We examined all medical disciplinary law cases against psychiatrists(-psychotherapist) and psychiatry residents in the period 2015-2019. RESULTS: In the study period the regional medical disciplinary courts handled 353 cases against psychiatrists(-psychotherapist) and residents psychiatry, on average 70.6 per year. 321 of these cases were against psychiatrists and 32 against residents. Complaint density was 1.74 for psychiatrists and 0.37 for residents. Subject of most cases was 'wrong diagnosis', followed by 'wrong therapeutic plan' and 'incorrect communication'. The number of cases resulting in a disciplinary measure was on average 31%: warning (49%), reprimand (30%), (conditional) suspension (15%). In 17 cases the professional was (partially) denied to practice. CONCLUSIONS Within Dutch psychiatry little attention is paid to disciplinary law, despite the fact that psychiatrists are relatively often confronted with disciplinary law complaints. The current explorative analysis underlines the need for further research, especially on the difference between male/female psychiatrists and an international comparison with respect to complaints about (sexual) misconduct.

Is Covid-19 sowing the seeds for future litigation?

We consider various types of litigation that may follow the Covid-19 pandemic, including: claims against National Health Service (NHS) Trusts by patients who have contracted the coronavirus (or by their bereaved families), claims by NHS staff against their employer for a failure to provide any or adequate personal protective equipment or testing, commercial claims arising from the procurement of medical supplies, the potential liabilities to those who suffer adverse reactions to any vaccine and the guidance issued by the regulators in relation to subsequent disciplinary action.

The Current State of Opioid Prescribing and Drug Enforcement Agency (DEA) Action Against Physicians: An Analysis of DEA Database 2004-2017.

BACKGROUND: Prescribing opioids has become a challenge. The US Drug Enforcement Agency (DEA) and Centers for Disease Control and Prevention (CDC) have become more involved, culminating in the March 2016 release of the CDC's "Guidelines for Prescribing Opioids for Chronic Pain." OBJECTIVES: Given the new guidelines, we wanted to see if there have been any changes in the numbers, demographics, physician risk factors, charges, and sanctions involving the DEA against physicians who prescribe opioids, when compared to a previous DEA database review from 1998 to 2006. STUDY DESIGN: This study involved an analysis of the DEA database from 2004 to 2017. SETTING: The review was conducted at the Henry Ford Health System Division of Pain Medicine. METHOD: After institutional review board approval at Henry Ford Health System, an analysis of the DEA database of criminal prosecutions of physician registrants from 2004-2017 was performed. The database was reviewed for demographic information such as age, gender, type of degree (doctor of medicine [MD] or doctor of osteopathic medicine [DO]), years of practice, state, charges, and outcome of prosecution (probation, sentencing, and length of sentencing). An internet-based search was performed on each registrant to obtain demographic data on specialty, years of practice, type of medical school (US vs foreign), board certification, and type of employment (private vs employed). RESULTS: Between 2004 and 2017, Pain Medicine (PM) had the highest percentage of in-specialty action at 0.11% (n = 5). There was an average of 18 prosecutions per year vs 14 in the previous review. Demographic risk factors for prosecution demonstrated the significance of the type of degree (MD vs. DO), gender, type of employment (private vs. employed), and board certification status for rates of prosecution. Having a DO degree and being male were associated with significantly higher risk as well as being in private practice and not having board certification (P < .001). In terms of type of criminal charges as a percent of cases, possession with intent to distribute (n = 90) was most prevalent, representing 52.3% of charges, with new charges being prescribing without medical purpose outside the usual course of practice (n = 71) representing 41.3% of charges. Comparison of US graduates (MD/DO) vs. foreign graduates showed higher rates of DEA action for foreign graduates but this was of borderline significance (P = .072). LIMITATIONS: State-by-state comparisons could not be made. Specialty type was sometimes self-reported, and information on all opioid prosecutions could not be obtained. The previous study by Goldenbaum et al included data beyond DEA prosecution, so direct comparisons may be limited. CONCLUSION: The overall risk of DEA action as a percentage of total physicians is small but not insignificant. The overall rates of DEA prosecution have increased. New risk factors include type of degree (DO vs. MD) and being in private practice with a subtle trend toward foreign graduates at higher risk. With the trend toward less prescribing by previously high-risk specialties such as Family Medicine, there has been an increase in the relative risk of DEA action for specialties treating patients with pain such as PM, Physical Medicine and Rehabilitation, neurology, and neurosurgery bearing the brunt of prosecutions. New, more subtle charges have been added involving interpretation of the medical purpose of opioids and standard of care for their use. KEY WORDS: Certification, CDC, criminal, DEA, opioid, prescribing, prosecution, sanctions.

Review of Rhode Island Physician Loss-of-Licensure Cases, 2009-2019.

Disciplinary actions against physicians are uncommon, and loss of license is less common. This unmatched, case-control, and descriptive study reviews disciplinary actions involving physician loss-of-license cases from January 1, 2009, to December 31, 2019. There were 82 physician loss-of-license cases involving 66 physicians, which were categorized by age, sex, and specialty and were compared to 4,347 non-disciplined controls. In this study, males (OR 4.69, p<0.001) were associated with an increased risk of loss of license; age was a separate risk factor (OR 1.24, p<0.05). Preventive strategies are discussed to reduce future physician loss of license.

Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health.

Whistleblowing has been examined from various angles over the past 40 years, but not yet as a matter of epistemology. Whistleblowing can be understood as resulting from the improper transmission of critical knowledge in an organization (eg, knowledge about poor care or wrongdoing). Using the sociology of ignorance, we wish to rethink whistleblowing and the failures it brings to light. This article examines how nurses get caught in the strategic circulation of knowledge and ignorance, which can culminate in acts of whistleblowing. The sociology of ignorance helps understand how whistleblowing is borne out of the complex and strategic circulation of knowledge and ignorance that spells multiple and intersecting epistemic positions for nurses. In particular, various organizational blind spots position nurses as untrustworthy and illegitimate speakers in the "business" of the organization. Organizational failings therefore remain concealed while nurses become hypervisible, both as faulty care providers and as problematic information brokers.

A descriptive study of the effect of a disciplinary proceeding decision on medical practitioners' practice behaviour in the context of providing a hydrocortisone and lignocaine injection.

INTRODUCTION: We conducted a descriptive study to evaluate any changes in practice behaviour regarding the provision of hydrocortisone and lignocaine (H&L) injections among doctors and how an H&L injection is priced following a disciplinary proceeding decision. A doctor had been fined SGD 100,000 for failing to obtain informed consent before an H&L injection. METHODS: We performed a survey shortly after the disciplinary decision to ascertain: (a) the category of the respondent; (b) whether the respondent provided H&L injections and how much he charged before the decision; and (c) after the decision. All members of the Singapore Medical Association and College of Family Physicians Singapore are doctors and were invited to participate. RESULTS: 1,927 doctors responded to the survey. Prior to the decision, 804 doctors did not perform H&L injections; this increased by 20.4% to 968 after the decision. The number of doctors who gave H&L injections decreased by 164 (14.6%), from the previous 1,123. Pre-decision, doctors who determined their own price for H&L injections charged a median pricing ≤ SGD 100. Post-decision, the median charge rose to > SGD 100 to SGD 200. At higher price bands, the number of doctors who charged > SGD 1,000 increased eight-fold, from eight to 65. CONCLUSION: The study demonstrated how a disciplinary decision can affect practice behaviour, and specifically how doctors may choose to not offer a service, an example of defensive medicine through avoidance behaviour. It also showed how prices for a service can rise following such a decision, which demonstrates the concept of negative general deterrence in sentencing.

Experiences and outcomes of nurses referred to a peer health assistance program: Recommendations for nursing management.

AIM: To provide recommendations for nursing management based on the experiences of current and former nurses who were served by a peer health assistance program (PHAP). BACKGROUND: Providing help for nurses with impaired practice is critical to their health and well-being, assuring patient safety and public trust, as well as returning competent nurses to the healthcare workforce. METHODS: Nurses (n = 268) who were current clients or former clients of a PHAP were surveyed about their experiences. RESULTS: Nearly half of nurses were referred by the board of nursing with 69% reporting the referral was due to substance use, alcohol being the most common. Most (62%) did not believe that their substance use affected their practice yet relayed that recognition of their emotional or physical condition could have led to earlier identification. Key barriers to seeking assistance were fear and embarrassment, along with concerns about losing their nursing license. CONCLUSIONS: Nurses in management are in key roles to identify and intervene with nurses who are at risk for impaired practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses in management and nurse colleagues would benefit from workplace education on the warning signs of impaired nursing practice and how to address it.

Association of Participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification Program and Physician Disciplinary Actions.

OBJECTIVE: The study analyzed the relationship between participation in the American Board of Physical Medicine and Rehabilitation maintenance of certification program and the incidence of disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not maintain their board certification have a higher likelihood of state medical board disciplinary actions. DESIGN: This retrospective cohort study analyzed American Board of Physical Medicine and Rehabilitation maintenance of certification data from all board-certified physiatrists who were enrolled in the American Board of Physical Medicine and Rehabilitation maintenance of certification program from 1993 to 2007. RESULTS: Matching examination and license data were available for 4794 physicians, who received a total of 212 disciplinary action reports through the Federation of State Medical Boards. The results showed that physicians who have a lapse in completing the American Board of Physical Medicine and Rehabilitation maintenance of certification program have a 2.5-fold higher incidence of receiving a disciplinary action report through the Federation of State Medical Boards (95% confidence interval = 1.76-3.63) and had higher severity violations (χ = 7.14, P < 0.05) than physicians whose certificate never lapsed. CONCLUSIONS: For physicians in physical medicine and rehabilitation, loss of board certification through failure to fulfill the maintenance of certification program requirements is associated with an increased risk of disciplinary action from a state medical licensing board.

Understanding Client Vulnerability in the Disciplining of Legal Professionals in New South Wales.

Despite the increasing use of "vulnerability" in policy and legal documents, and the emerging scholarly literature about vulnerability and the law, there is little research focused on vulnerability from clients' perspectives. To address this gap, we analysed the New South Wales Civil and Administrative Tribunal (NCAT) and appellate court cases involving vulnerable clients and disciplined lawyers in NSW from 1 January 2011 to 30 January 2019. Our analysis of the cases draws from the "vulnerability theory" literature. We identified the following characteristics of clients for analysis: older age, gender, health impairment, and immigrant status. Twenty-eight tribunal cases and two appellate court cases involved vulnerable clients. Overall, the cases revealed that the relationship between public protection and vulnerability is not expressly discussed by NCAT. To optimise the legislative intent to safeguard the public, the NSW legislation should explicitly include vulnerability as a relevant feature of the disciplinary regime.