[Medical Malpractice in Neurological Diseases].

The results of medical lawsuits in Japan can affect actual clinical settings, and it might be useful to analyze medical lawsuits in order to understand medical issues. Some diseases such as subarachnoid hemorrhage, cerebral infarction treated with thrombolytic therapy and treatable encephalitis could cause problems, which in turn may lead to lawsuits, when the results of treatment for those situations are fatal. In addition, there are cases in which other neurological diseases are related to litigation. Therefore, I scrutinized such cases and suggested useful tips for establishing good relationships between doctors and patients and preventing troubles that could lead to medical lawsuits.

Common Legal Considerations When Moving to a New Medical Practice.

This article presents a hypothetical case of the legal issues a physician must consider when moving to a new medical practice, such as the enforceability of a noncompete clause, malpractice insurance, communicating this change in practice to existing patients, and custody of medical records.

[Assessment of ability to drive in patients with MCI and dementia]. / Beurteilung der Fahrtauglichkeit bei Patienten mit MCI und demenziellen Syndromen.

People with mild cognitive impairment and dementia are a frequent and continuously increasing patient group in practically all fields of medicine. The associated challenges involve nearly all areas of life in addition to the direct medical treatment. Assessment of the ability to drive in patients with cognitive deficits is becoming increasingly more important. What are the options available to physicians in order to make a valid assessment? Which legal aspects must be taken into consideration? Which rights and obligations arise from the framework conditions? These questions nowadays give rise to great uncertainty for many medical personnel; however, the increasing importance of these problems necessitates a clear procedure, which allows difficult decisions to be made with utmost sovereignty and legal certainty and to be able to give patients and relatives a plausible explanation. Because age is a substantial risk factor for the development of cognitive disorders, the question of the ability to drive is affected not only by neuropsychiatric diseases, such as mild cognitive disorders or dementia but also the frequently occurring somatic comorbidities. Estimation of the ability to drive is therefore a complex approach, which should be standardized in order to appreciate all relevant aspects. It would be desirable to have a practice-oriented algorithm, the formulation of which is the aim of this article. Additionally, we would like to make a contribution to road safety and make medical personnel fully aware of this topic.

On the Necessity of Ethical Guidelines for Novel Neurotechnologies.

Because novel neurotechnologies may alter human identity and society in profound ways, we advocate for the early integration of ethics into neurotechnology. We recommend developing and adopting a set of guidelines, like the Belmont Report on human subject research, as a framework for development and use of brain-related technologies.

Adaptation of neurological practice and policy to a changing US health-care landscape.

Health care in the USA is undergoing a drastic transformation under the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act is driving major health-care policy changes by connecting payment for traditional health-care services to value-based care initiatives and emphasising population health and innovative mechanisms to deliver care. Under the Patient Protection and Affordable Care Act, neurological practice will need to adapt and transform. Therefore, neurological policy should consider employing a new framework for neurological residency training, developing interdisciplinary team approaches to neurological subspecialty care, and strengthening the primary care-neurological specialty care interface to avoid redundancies and other medical waste. Additionally, neurological policy will need to support a more robust review of diagnostic and care pathway use to reduce avoidable expenditures, and test and implement bundled payments for key neurological diagnoses. In view of an anticipated 19% shortage of US neurologists in the next 10 years, development of new neurological policy under the Patient Protection and Affordable Care Act is paramount.

Steroid Use for Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit.

BACKGROUND: Current international guidelines do not recommend the routine administration of methylprednisolone (MP) in patients with acute spinal cord injury (SCI). Its use is known to be associated with complications and death. OBJECTIVES: To identify patterns of practice and reasons for MP prescription for acute SCI in Latin America. METHODS: Portuguese- and Spanish-modified versions of a previously published questionnaire were used to evaluate opinions about the administration of MP for acute SCI in Latin America. This Internet-based survey was conducted with members of AOSpine Latin America. RESULTS: A total of 970 AOSpine Latin America members from 20 countries answered the electronic questionnaire. Of the total sample, 834 surgeons (86%) reported that they routinely treat patients with acute SCI, and 56.1% of them reported routine administration of MP for these patients. Use of MP was associated with country, specialty, length of clinical practice, and number of SCI treated yearly. Among the 468 surgeons who report routine administration of MP, 56.1% believe in the clinical benefit, 29.3% do this because of fear of litigation, 27.1% because this is a protocol in their hospital, 3.5% because they believe that MP has no major adverse effects. CONCLUSIONS: Despite increasing evidence against the routine administration of MP in patients with SCI and international guidelines that do not recommend its use, this potentially dangerous practice remains common on this continent. The Latin American medical associations need to produce guidelines to standardize practices with acute SCI. Moreover, educational campaigns might reduce practices guided mainly by misperception of legal issues instead of clinical benefit.

Legal issues of return to play after a concussion.

It is increasingly important for neurologists to recognize the legal implications of assessing and treating an athlete who sustained a concussion, then returning the athlete back to play. Poor initial identification of the concussion or failure to recognize persistent symptoms may lead to premature return to play and unnecessary long-term neurologic consequences. Becoming familiar with recent guidelines and practice parameters on concussion management is of paramount importance. Clear documentation of neurologic signs and symptoms of the patient and discussion of short- and long-term risks of concussion is also crucial. It is also important to learn about state legislation regarding concussion education and return to play.

Concussion advocacy and legislation: a neurological surgeon's view from the epicenter.

Traumatic brain injury is the leading cause of death and disability in the world for adolescents according to the World Health Organization. Sports-related concussion is a small but perhaps one of the most preventable causes of that morbidity. Legislation to protect student athletes is one of the ways in which we can advocate for safety in sports. This paper reviews the legislative history of the first concussion law passed to protect youth athletes: Washington State's Zackery Lystedt Law. This history is viewed from the point of view of one of the participants in the efforts to pass laws in all 50 states. The key provisions of the Zackery Lystedt Law include (1) education for parents, athletes, and coaches; (2) immediate removal from play during a game or practice, after a suspected concussion with no return to play until (3); (3) written clearance by a concussion expert for return to play; and (4) uniformity of rules for all schools who use public land. Last, the nature of this legislative process, which included attorneys, legislators, and physicians, demonstrated that effective collaboration of local, state, and national leaders can address a critical public health challenge such as concussion affecting student athletes.

Legal and ethical implications in the evaluation and management of sports-related concussion.

OBJECTIVE: To examine the ethical and legal issues physicians face when evaluating and managing athletes with sports-related concussions, and to offer guidance to physicians as they navigate these situations. RESULTS: This position paper reviews and compares the components of sports-related concussion laws, including education, removal from play, and clearance for return to play. It highlights the challenges privacy laws present relevant to providing care to concussed athletes and suggests ways to help physicians overcome these obstacles. The report also explores the ethical considerations physicians should bear in mind as they evaluate and manage concussed athletes, addressing them through a framework that includes considerations of professionalism, informed decision-making, patient autonomy, beneficence, nonmaleficence, conflicts of interest, and distributive justice. CONCLUSIONS: Physicians caring for concussed athletes have an ethical obligation to ensure that their primary responsibility is to safeguard the current and future physical and mental health of their patients. Physicians have a duty to provide athletes and their parents with information about concussion risk factors, symptoms, and the risks for postconcussion neurologic impairments. Physicians should facilitate informed and shared decision-making among athletes, parents, and medical teams while protecting athletes from potential harm. Additionally, including concussion evaluation and management training in neurology residency programs, as well as developing a national concussion registry, will benefit patients by the development of policies and clinical guidelines that optimize prevention and treatment of concussive head injury.

Medical devices; neurological devices; classification of the neuropsychiatric interpretive electroencephalograph assessment aid. Final order.

The Food and Drug Administration (FDA) is classifying the neuropsychiatric interpretive electroencephalograph (EEG) assessment aid into class II (special controls). The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

[Internet presence of neurologists, psychiatrists and medical psychotherapists in private practice]. / Internetauftritte niedergelassener Neurologen, Psychiater und ärztlicher Psychotherapeuten.

OBJECTIVE: The world wide web provides new options to physicians in terms practice marketing, information brokerage, and process optimization. This study explores prevalence and content of homepages of neurologists, psychiatrists and medical psychotherapists in private practice. METHODS: Through the legal bodies of physicians in private practice in six northern German states neurologists, psychiatrists and medical psychotherapists were identified. According to a standardized and operationalized criteria catalogue, homepages were rated. RESULTS: 1804 physicians were identified, 352 (19.5 %) had operated a homepage. Higher frequencies of homepages found for male physicians (vs. female physicians), practice centres (vs. single practices) and urban practices (vs. rural practices). In average, practices reached 18.8 (±â€Š5.3) of 42 points; contact data and accessibility information were generally available; information as to qualification and specialization was provided more infrequently. Legal specifications were not considered in more than every second homepage, interactive elements like online appointment of follow-up prescription were only rarely offered. CONCLUSIONS: Only every fifth neurological or psychiatric practice operates an own homepage, higher competition (urban area) and higher professionalization (practice centres) seem to act as promotors. The legal framework has to be focused, and patient needs should be taken into account.