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.
Employee Discipline/statistics & numerical data , Licensure, Medical , Physicians/statistics & numerical data , Professional Misconduct , Female , Humans , Male , Middle Aged , Rhode Island
Background: There is no standardized international model for specialist lymphedema services, which covers the types of lymphedema treated and the treatments provided. The aim of this study was to provide a profile of patients attending specialist lymphedema services in different countries to explore similarities and differences. Methods and Results: The LIMPRINT core tool was used in specialist lymphedema services in the United Kingdom, France, Italy, and Turkey. Services in Turkey saw a slightly younger age group, with a higher proportion of female patients reflecting a particular focus on breast cancer-related lymphedema. There were higher levels of obesity and restricted mobility in patients in the United Kingdom compared with other countries. Italy and France saw the highest percentage of patients with primary lymphedema. Diabetes was a common comorbidity in the United Kingdom and Turkey. The United Kingdom saw the largest number of patients with lower limb lymphedema. Conclusions: The results show a wide range of complexity of patients treated in specialist lymphedema services. Some of the differences between countries may reflect different stages in the evolution of specialist lymphedema services, rather than a true difference in prevalence, with those with "younger" services treating a high proportion of patients with cancer and those with more established services treating a wider range of different types of lymphedema, including more elderly people with multiple comorbidities.
Breast Neoplasms/diagnosis , Cellulitis/diagnosis , Edema/diagnosis , Lymphatic System/pathology , Lymphedema/diagnosis , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Breast Neoplasms/physiopathology , Cellulitis/epidemiology , Cellulitis/pathology , Cellulitis/physiopathology , Child , Child, Preschool , Chronic Disease , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Diagnosis, Differential , Edema/epidemiology , Edema/pathology , Edema/physiopathology , Female , France/epidemiology , Humans , Italy/epidemiology , Lower Extremity/pathology , Lower Extremity/physiopathology , Lymphatic System/physiopathology , Lymphedema/epidemiology , Lymphedema/pathology , Lymphedema/physiopathology , Male , Middle Aged , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/physiopathology , Obesity, Morbid/diagnosis , Obesity, Morbid/physiopathology , Practice Guidelines as Topic , Prevalence , Risk Factors , Turkey/epidemiology , United Kingdom/epidemiology
Background and Study Design: This study was undertaken as part of the UK LIMPRINT international study to determine the number of people with chronic edema (CO) and its impact on health services. Overall 7436 with CO were recruited in the main UK study from a range of health settings. Methods and Results: Factors relating to subjective control of arm and leg CO were defined in the UK. A total of 1565 patients were included in the study with exclusions for: no limb swelling or not recorded (1669), having concurrent arm/leg CO (272), control of assessment missing (5) and professional being unsure of control status of CO (325). Arm swelling occurred in 953 (18.5%) with leg CO in 4212 (81.5%). Poor control was found in 1430 (27.2%) and good control in 3735 (72.3%). Control of arm swelling was worse in men and control increased overall in those aged over 45 years. In contrast control of CO worsened in those with leg CO with increasing age and multiple co-morbidities. Obesity and cellulitis, particularly an episode in the last year were associated with poor control. Independent risk factors for arm CO were : obesity, neurological disease and cellulitis in the last year and for leg CO, obesity, poor mobility, heart disease, presence of a wound, cellulitis in the last year and duration of swelling. Conclusion: Control of CO within specialized centers is complex due to sociodemographic and clinical comorbidities.
Edema/diagnosis , Lymphatic System/pathology , Lymphedema/diagnosis , Patient Satisfaction/statistics & numerical data , Aged , Aged, 80 and over , Cellulitis/diagnosis , Cellulitis/physiopathology , Chronic Disease , Diagnosis, Differential , Edema/epidemiology , Edema/pathology , Edema/physiopathology , Female , Heart Diseases/diagnosis , Heart Diseases/physiopathology , Humans , Lower Extremity/pathology , Lower Extremity/physiopathology , Lymphatic System/physiopathology , Lymphedema/epidemiology , Lymphedema/pathology , Lymphedema/physiopathology , Male , Middle Aged , Obesity/diagnosis , Obesity/physiopathology , Prevalence , Quality of Life/psychology , Risk Factors , Surveys and Questionnaires , United Kingdom/epidemiology , Upper Extremity/pathology , Upper Extremity/physiopathology , Wounds and Injuries/diagnosis , Wounds and Injuries/physiopathology
Mycoplasma ovipneumoniae is a globally distributed pathogen that has been associated with pneumonia in both domestic and wild Caprinae. It is closely related to M. hyopneumoniae, a respiratory pathogen of swine that is associated with decreased growth rates of pigs as well as clinical respiratory disease. In order to assess the effects of M. ovipneumoniae on lamb performance, we generated a cohort of lambs free of M. ovipneumoniae by segregation of test negative ewes after lambing, then compared the growth and carcass quality traits of M. ovipneumoniae-free and -colonized lambs from weaning to harvest. Some signs of respiratory disease were observed during the feeding trial in both lamb groups, but the M. ovipneumoniae-exposed group included more affected lambs and higher average disease scores. At harvest, lungs of lambs in both groups showed few grossly visible lesions, although the M. ovipneumoniae-exposed group did exhibit increased microscopic lung lesions (P<0.05). In addition, M. ovipneumoniae exposed lambs produced lower average daily gains (P<0.05), and lower yield grade carcasses (P<0.05) compared to those of non-exposed lambs. The results demonstrated the feasibility of test and segregation for elimination of M. ovipneumoniae from groups of sheep and suggested that this pathogen may impair lamb growth and productivity even in the absence of overt respiratory disease.
Mycoplasma ovipneumoniae/pathogenicity , Pneumonia, Mycoplasma/microbiology , Pneumonia, Mycoplasma/physiopathology , Sheep, Domestic/growth & development , Sheep, Domestic/microbiology , Animals , Female , Lung/microbiology , Lung/physiology , Male , Pilot Projects , Sheep , Sheep Diseases/microbiology , Sheep Diseases/physiopathology , Sheep, Domestic/physiology , Swine/growth & development , Swine/microbiology
The purpose of this article is to describe implications of the Health Information Portability and Accountability Act of 1996 (HIPAA) for nurses engaged in human and health services research. In general, a person's private health information (PHI) may only be disclosed for treatment, payment, and business procedures related to healthcare service delivery. Access and/or use of the same information for research purposes necessitates another layer of review and may require a separate process of authorization. A brief historical overview of regulatory requirements regarding health information privacy and security standards for the electronic transformation of data and protection of electronically kept medical records is discussed and related to the role and responsibilities of researchers and organizations where research is conducted. In addition, a generic document template adaptable for use by an individual or organization is presented that can provide a quick, systematic review of HIPAA compliance when a research proposal is being developed or is received that seeks access to PHI.
Computer Security/standards , Guideline Adherence/standards , Guidelines as Topic , Health Insurance Portability and Accountability Act , Health Services Research/methods , Program Evaluation/methods , Computer Security/legislation & jurisprudence , Confidentiality , Ethics Committees, Research , Health Insurance Portability and Accountability Act/organization & administration , Humans , Information Services , Informed Consent , Internet , United States
