Dental Service Organization affiliation: Understanding key aspects of State Dental Practice Act compliance.

Dental Service Organizations (DSOs) are an increasingly visible and available practice option for new dental graduates. While guidance has been published to help dental students make informed decisions when considering a DSO affiliation, they have not focused on the complexities of assessing compliance with controlling state laws. Accordingly, this Perspectives article provides a concise summary of the common components of state regulatory provisions across the United States to support an understanding of the corporate practice of dentistry and compliance considerations. The guiding principles to consider include ownership or proprietorship of and control over a dental practice; control over dental offices, equipment, and materials; employment of dental personnel; and control over clinical judgment. This article should be helpful to students who are considering a DSO affiliation and educators who prepare them to enter dental practice.

HHC-induced psychosis: a case series of psychotic illness triggered by a widely available semisynthetic cannabinoid.

Use of both cannabis and synthetic cannabinoids has been regularly linked to the development of psychotic illness. Thus, semisynthetic cannabinoids such as hexahydrocannabinol (HHC), which have a similar neurobiological profile to delta-9-THC, may also be expected to lead to psychotic illness. However, no such relationship has yet been reported in scientific literature. HHC is readily available online and in many vape shops in Ireland. Here, we present two cases of psychotic illness which appear to have been precipitated by use of legally purchased HHC and discuss its psychotogenic role and factors linked to its current widespread availability.

[Useful knowledge regarding tattoos]. / Nützliches Wissen zu Tätowierungen.

The number of people with tattoos has continued to increase in recent years. In the USA about 23% and in Europe 9-12% of the population have tattoos. In the German media (2019) and by the infoportal Statista (2017), it is assumed that 21-25% of citizens have tattoos and that the trend is increasing (Statista 2018: 36%). Men and women wear tattoos equally. The age group 20-29 years dominates with almost 50% having tattoos. The following article describes the new regulations especially the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation, legal basis, and governmental controls on the subject of "tattoos". The composition of tattooing agents and testing options relevant for the user before and for the performance of tattooing are presented. Dermatologically associated diseases and testing procedures are listed. Since 70% of the population denies knowledge of this information even when they have tattoos themselves, this update is written as an overview for treating physicians and users.

Waiting for guardianship in a public hospital geriatric inpatient unit: a mixed methods observational case series.

BACKGROUND: Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients. AIMS: This study aims to examine processes around Guardianship applications in a public hospital Geriatric inpatient setting including times to, reasons for and outcomes of referral; and to explore the content of the medical records in relation to criteria for application. METHOD: This was a mixed methods observational case series using descriptive data supplemented by qualitative case-note analysis of inpatients referred for guardianship (with/without FM) from 2018 to 2020 in a New South Wales Geriatric Medicine inpatient unit. Medical records were examined for evidence of operationalised criteria for guardianship, aligned with disability, capacity and need/risk common to most Australian jurisdictions. RESULTS: Of 45 patients with guardianship applications, 98% were granted guardians and 33 of 37 (89%) FM applications. Multiple risks underpinned applications, most commonly frequent falls (49%) and medication mismanagement (49%). Although only 29% were in receipt of services preadmission, 98% were discharged to residential care. Average hospital LOS was 70 days (interquartile range, 35), contributed to by delays between admission and decision to apply for guardianship/FM (median, 28 inpatient days) and uncertainties around or lack of documented capacity assessments. CONCLUSION: This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.

Estimating costs of bedside assessment by a judge in each case of mechanical restraint in Germany after new legislation.

Background: In 2018, the German Federal Constitutional Court decided that mechanical restraint is the most intrusive coercive measure and its use requires a judge's decision after bedside assessment if lasting longer than 30 min. Subsequently, legal changes were realized. The objective of our study was to determine the number of saved coercive episodes and saved hours in seclusion or restraint in 2019 compared to the average of the previous years, 2015-2017, as well as costs per saved episode, hour, and case saved from any coercive measure. Methods: We used data from the Baden-Wuerttemberg case registry for coercive measures, covering all 32 psychiatric hospitals of the Federal State and 435,767 admissions in the study period. Time expenditure was calculated as 3.5 h with an average of 51.95 € per working hour on the side of the justice system and 1.5 h (45.94 €/h) on the side of the hospital per case. Results: The number of coercive episodes decreased by 10.0% from 28,181 (average 2015-2017) to 25,371 (2019). The number of hours in seclusion or restraint decreased by 17.9% from 321,956 (2015-2017) to 264,423 (2019). This resulted in the cost of 872.33 € per saved episode and 42.61 € per saved hour in seclusion or restraint. Conclusion: Given the correctness of our estimations, saving 1 h in coercion by less than 1 h of an expert's work might be justified from an ethical and economic perspective.

[Legalized deprivation of rights: on the legal construction of dismissal and expulsion under National Socialism]. / Legalisierte Entrechtung: zur juristischen Konstruktion von Entlassung und Vertreibung im Nationalsozialismus.

In order to provide a deeper understanding of the mechanisms and background leading to the persecution and expulsion, particularly of physicians labelled as "Jewish" in Nazi Germany, this article outlines their gradual disenfranchisement, through laws and decrees in the years 1933-1939. As the publicly visible terror immediately after the Nazi takeover was rejected in large parts of society, the regime resorted early on to supposedly legal forms of exclusion. With the Law for the Restoration of the Professional Civil Service of 7 April 1933, "non-Aryan" (§â€¯3) and politically unreliable (§â€¯4) persons could be removed from office, if necessary, even without any further comment (§â€¯6). However, regulations for long-standing civil servants as well as the "front-line fighter privilege" reduced the desired effect, e.g. in university medicine in a way that was not intended by those in power. The Reich Citizenship Law of 1935, as part of the so-called Nuremberg Laws introduced the criterion of "German blood". This resulted in a second large wave of dismissals. Outside the universities, a plethora of further defamatory legal norms, from the regulation on the approval of physicians for activities with the health insurances and the Law on Honorary Appointments (both in 1933), the so-called Flag Decree (1937) and withdrawal of the approbation (1938), aimed at the gradual "elimination" of Jewish physicians, which for many of them ended in extermination in the Holocaust. This practice implemented over years was based on a jurisdiction devised especially for that purpose and in hindsight it has been perfectly defined as "legal injustice".

Midwives in Health Sciences as a Sociocultural Phenomenon: Legislation, Training and Health (XV-XVIII Centuries).

Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography of the 15th-18th centuries still has important bibliographic and interpretive gaps in the care provided by women. The main objective was to analyse the care provided by midwives in the legislative and socio-sanitary context of New Castile, in the inquisitorial Spain of the 15th-18th centuries. Materials and Methods: A historical review was conducted, following the Dialectical Structural Model of Care. Historical manuals, articles and databases were analysed. Results: The Catholic Monarchs established health profession regulations in 1477, including midwives. However, all legislations were annulled by Felipe II in 1576. These were not resumed until 1750. Midwives assumed a huge range of functions in their care commitment (teaching, care and religion) and were valued in opposing ways. However, many of them were persecuted and condemned by the Inquisition. They used to accompany therapeutic action with prayers and charms. Midwives were usually women in a social vulnerability situation, who did not comply with social stereotypes. Conclusions: Midwives, forerunners of current nursing and health sciences, overcame sociocultural difficulties, although they were condemned for it. Midwives achieved an accredited title, which was taken from them for two centuries. They acted as health agents in a society that demanded them while participating in a "witch hunt".

Prevention from Sharp Injuries in the Hospital Sector: An Italian National Observatory on the Implementation of the Council Directive 2010/32/EU before and during the COVID-19 Pandemic.

Sharp injuries, determining the risk of bloodborne infections and psychological distress in healthcare workers, may be prevented by a set of strategies, legally enforced in Europe through the Directive 2010/32/EU. To assess its level of implementation in Italy, a national survey was conducted in 2017 and again in 2021, evaluating the progress and possible drawbacks of the COVID-19 pandemic. Altogether, 285 safety managers and 330 nurses from a representative sample of 97 and 117 public hospitals were interviewed using a standardized questionnaire. Knowledge of the Directive requirements decreased significantly, with <60% of participants answering correctly in 2021, and nurses' attendance in specific courses dropped to 25% in 2021 compared to 54% in 2017. Over 75% of hospitals introduced multiple safety-engineered devices (SED), though total replacement occurred in <50% of cases; routine SED availability increased for blood collection (89%) and venous access devices (83%). Incorrect behaviors in handling sharps decreased significantly over time. Nurses' HBV vaccination coverage was high (89% in both surveys); in the last year, 97% were vaccinated against COVID, and 47% against influenza. Average annual injuries per hospital did not increase significantly (32 in 2021 vs. 26 in 2017). In 2017, nurses' perceived safety barriers were working in emergency situations (49%) and lack of resources (40%); in 2021, understaffing (73%), physical fatigue (62%), and handling difficulties while wearing full protective equipment (59%). Safety measures were implemented in Italian hospitals, and although the average injuries per hospital did not show a decrease, these measures could have helped protect healthcare workers during the pandemic, mitigating its potential impact on the increase in situations at risk of injury.

Civilian Petitioners and Extreme Risk Protection Orders in the State of Washington.

OBJECTIVE: Extreme risk protection orders (ERPOs) are civil orders designed to temporarily restrict access to firearms when people are at substantial risk of harm to themselves or others. A minority of ERPOs in the United States have been filed by civilians, with most filed by law enforcement. The authors examined barriers and facilitators to the ERPO filing process from the perspective of the civilian petitioner. METHODS: Semistructured interviews of civilian petitioners who filed ERPOs in Washington State from December 2016 to September 2020 were conducted. The interviews examined both barriers and facilitators to filing an ERPO. A descriptive and qualitative approach with inductive-deductive thematic analysis was used to identify and code themes. RESULTS: Fifteen civilian petitioners were interviewed. Barriers to ERPO filing included perceived lack of help connecting with social services to address the potential for harmful behavior, confusion regarding the filing and court process, and petitioner distress. Facilitators included having previous legal experience, having assistance from advocates who helped shepherd petitioners through the process, and simplification of the ERPO process. CONCLUSIONS: ERPO is a useful tool for suicide and violence prevention, but several barriers may be inhibiting ERPO use among civilian petitioners. Better educational resources and advocacy programs, as well as simplified filing steps, could improve the process and make ERPOs more accessible for civilians.

Propofol abuse among healthcare workers: an analysis of criminal cases using the database of the Supreme Court of South Korea's judgments.

BACKGROUND: Due to its abuse potential, propofol has been classified as a controlled substance since February 2011 in South Korea. Healthcare workers are exposed to propofol abuse considering their easy access to this substance in hospitals. Therefore, we aimed to investigate propofol abuse among healthcare workers through the database of the Supreme Court in South Korea. METHODS: We retrospectively analyzed adjudicated criminal cases related to propofol abuse among healthcare workers from January 1, 2013, to December 31, 2020, using the database of the Supreme Court of South Korea's judgments. We collected the clinical characteristics and punishment-related information of healthcare workers who abused propofol. RESULTS: Of the 194 cases collected using the search term 'propofol,' 20 were included in the final analysis. The most common healthcare workers who abused propofol were nursing aides (n = 15). Among them, 40% (n = 8) of the defendants had previously been punished for substance abuse, and 35% (n = 7) had a history of psychological disease. Of the defendants, 65% (n = 13) self-administered propofol more than twice, and the median number of self-administrations was three. Except for two, the defendants were sentenced to imprisonment, including suspended sentences, and the median values of their duration of prison and probation were 9 months and 24 months. CONCLUSIONS: Despite propofol being strongly regulated as a controlled substance in South Korea, its abuse among healthcare workers remains. Healthcare workers should be vigilant against its abuse among themselevs.

Repercussions of the labor reform on nursing work in the context of the covid-19 pandemic / Repercusiones de la reforma laboral sobre el trabajo en enfermería en el contexto de la pandemia de COVID-19 / Repercussões da reforma trabalhistas sobre o trabalho em enfermagem no contexto da pandemia de Covid-19

ABSTRACT Objective: To reflect on the repercussions of the Labor Reform on nursing work during the COVID-19 pandemic. Methods: This is a reflective study based on the legal aspects of the Labor Reform in dialog with scientific productions pertaining to nursing work. Results: With the rise of the COVID-19 pandemic, the flexibilization of labor is being intensified, legally backed up by the Labor Reform. For nursing workers, the repercussions are felt in the work relationship, during the workday, in the salary, in union action, and in job protection. Final considerations: It is evident that, after the legislative changes, there's no certainty that the flexibilization of labor and social security laws will bring favorable results in terms of economic growth, reduction of inequalities, and lower unemployment rates for the nursing workers. Therefore, the political organization of the professional categories is the way to overcome this scenario.

RESUMEN Objetivo: Reflexionar sobre las repercusiones de la Reforma Laboral en la enfermería durante la pandemia de COVID-19. Métodos: Estudio del tipo reflexivo basado en los aspectos legales de la Reforma Laboral en diálogo con producciones científicas acerca del trabajo en enfermería. Resultados: Con la ascensión de la pandemia de COVID-19, observado el provocamiento de flexibilidad laboral, amparado jurídicamente por la Reforma Laboral. Para los/las trabajadores/as de enfermería, las repercusiones se producen en el vínculo de trabajo, en la jornada laboral, en el salario, en la actuación sindical y en la protección al empleo. Consideraciones finales: Evidenciado que, para los/las trabajadores/as de enfermería, tras los cambios legislativos, no hay seguridad de que la flexibilidad de las leyes laborales y previsiones traigan resultados favorables para el crecimiento económico, reducción de desigualdades y menores tasas de desempleo. Así, la organización política de las categorías es la vía para el enfrentamiento de ese escenario.

RESUMO Objetivo: Refletir sobre as repercussões da Reforma Trabalhista no trabalho em enfermagem durante a pandemia de COVID-19. Métodos: Trata-se de um estudo do tipo reflexivo com base nos aspectos legais da Reforma Trabalhista em diálogo com produções científicas acerca do trabalho em enfermagem. Resultados: Com a ascensão da pandemia de COVID-19, observa-se o acirramento da flexibilização do trabalho, amparado juridicamente pela Reforma Trabalhista. Para os/as trabalhadores/as da enfermagem, as repercussões dão-se no vínculo de trabalho, na jornada de trabalho, no salário, na atuação sindical e na proteção ao emprego. Considerações finais: Evidencia se que, para os/as trabalhadores/as da enfermagem, após as mudanças legislativas, não há segurança de que a flexibilização das leis trabalhistas e previdenciárias tragam resultados favoráveis para o crescimento econômico, redução das desigualdades e menores taxas de desemprego. Com isso, a organização política das categorias é a via para o enfrentamento desse cenário.

Midwives and protection of pregnant workers in Western Switzerland: Practices, difficulties and contributions.

BACKGROUND: Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. AIMS: Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. METHODS: 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. FINDINGS: Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be-and deserves to be-formally and legally recognised and integrated into Switzerland's maternity protection legislation.

Policy Approaches Toward Combatting Venereal Diseases in the Soviet Occupation Zone in Germany (1945-1949), the German Democratic Republic (1949-1989), and the Polish People's Republic (1945-1989).

The spread of venereal diseases after the Second World War constituted a grave public health danger in Europe. Especially in all four occupation zones in Germany and the Polish People's Republic high morbidity rates were observed. In order to limit the spread of diseases, respective administrations adopted specific regulations. The aim of this research is the analysis and comparison of legal regulations for controlling and combating venereal diseases in these countries. We have analyzed legislative and administrative acts concerning combatting venereal diseases issued by the official organs of the Soviet Occupation Zone, the German Democratic Republic, and the Polish People's Republic from 1945 to 1989. Subsequently, the analyzed sources were evaluated in light of the existing literature on the topic. Our analysis shows that policy approaches in both countries were based the Soviet Union's model for fighting venereal diseases. Visible are similarities of the approaches. They include organization of anti-venereal services, compulsory hospitalization, and actions against social groups perceived as sources of venereal diseases. Beside the purpose of breaking the spread of the epidemics, the approaches had also a political aim of sanctioning behavior that diverged from prescribed socialist moral norms.

[Physician's role in the medical and legal protection of elderly patients]. / "Rôle du médecin traitant dans la protection médicale et juridique des patients âgés".

"Physician's role in the medical and legal protection of elderly patients.The world and french population is currently aging and losing autonomy both medically and legally. Preventing the vulnerability and loss of autonomy of the elderly is a public health objective. These complex situations could be anticipated through an exchange of elderly patients with their general practitioner. The evolution of medical protection measures (such as advance directives and the appointment of a trustworthy person) and the evolution of legal protection measures (such as a mandate for future protection, family empowerment, placement under guardianship or curatorship, ...) make it necessary to reassess the role of the GP in the medical and legal protection of his elderly patients. This development is the result of a thesis work based on the interrogation of GPs in a thesis."

"Rôle du médecin traitant dans la protection médicale et juridique des patients âgés .La population française, et même mondiale, est actuellement vieillissante et en perte d'autonomie tant sur le plan médical que juridique. La prévention de la vulnérabilité et de la perte d'autonomie des personnes âgées est un objectif de santé publique. Ces situations complexes pourraient être anticipées grâce à un échange des patients âgés avec leur médecin généraliste. L'évolution des mesures de protection médicale (telles que les directives anticipées et la désignation d'une personne de confiance) et l'évolution des mesures de protection juridique (telles que mandat de protection future, habilitation familiale, placement sous tutelle ou curatelle…) obligent à réévaluer le rôle du médecin généraliste dans la protection médicale et juridique de ses patients âgés. Cette mise au point est l'aboutissement d'un travail de thèse fondé sur une enquête auprès de médecins généralistes."

[Regulatory path of the medical device]. / Parcours réglementaire du dispositif médical.

Regulatory path of the medical device. The safety of medical devices (MD) is recognized by the CE marking allowing their free circulation on the European market. The new European regulation will reinforce the application and the survey of MD. For implantable MD, clinical data will be required, and the traceability will be facilitated by the implementation of a unique identifier. The safety of MD is under the European governance responsibility, while the circulation, the reimbursement and the survey of MD is under the responsibility of each country. In France, the evaluation of the clinical benefit and conditions of use of MD reimbursed is under the responsibility of a specific commission of the HAS, while their surveillance is under the responsibility of the ANSM.

"Parcours réglementaire du dispositif médical. Le marquage CE médical garantit la sécurité des dispositifs médicaux et permet sa libre circulation sur le marché européen. Les exigences de ce marquage CE vont se renforcer grâce à la mise en application du nouveau règlement européen tant à l'obtention que dans son suivi. Les investigations cliniques pour les dispositifs médicaux implantables deviennent une règle. La mise en place de l'identifiant unique du dispositif médical va faciliter sa traçabilité. Si la sécurité du dispositif médical relève d'une gouvernance européenne, la prise en charge et la surveillance relève de la compétence de chaque pays. En France l'évaluation du bénéfice clinique et des conditions d'utilisation des dispositifs médicaux relève de la HAS alors que leur surveillance est sous la responsabilité de l'ANSM."

The 21st Century Cures Act and Challenges to Adolescent Confidentiality.

Confidentiality is an important part of adolescent health care, providing a safe arena for young people to address sensitive health concerns and develop independent relationships with their providers. State and federal laws support a range of adolescent confidentiality protections. However, the full implementation of the 21st Century Cures Act, with the release of all medical records to patients and caregivers, may endanger this expectation of privacy. This policy brief reviews implications of the open notes requirement of the Cures Act, suggests strategies to improve care for adolescent patients, and recommends advocacy to improve the 2020 Final Rule implementation.

Analysis of endotracheal intubation-related judicial precedents in South Korea.

BACKGROUND: Medical malpractice during endotracheal intubation can result in catastrophic complications. However, there are no reports on these severe complications in South Korea. We aimed to investigate the severe complications associated with endotracheal intubation occurring in South Korea, via medicolegal analysis. METHODS: We retrospectively analyzed the closed judicial precedents regarding complications related to endotracheal intubation lodged between January 1994 and June 2020, using the database of the Supreme Court of Korea. We collected clinical and judicial characteristics from the judgments and analyzed the medical malpractices related to endotracheal intubation. RESULTS: Of 220 potential cases, 63 were included in the final analysis. The most common event location was the operating room (n = 20, 31.7%). All but 3 cases were associated with significant permanent or more severe injury, including 31 deaths. The most common problems were failed or delayed intubation (n = 56, 88.9%). Supraglottic airway device was used in 5.2% (n = 3) cases of delayed or failed intubation. Fifty-one (81%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of Korean Won 133,897,845 (38,000,000, 308,538,274). The most common malpractice recognized by the court was that of not attempting an alternative airway technique (n = 32, 50.8%), followed by violation of the duty of explanation (n = 10, 15.9%). CONCLUSIONS: Our results could increase physicians' awareness of the major complications related to endotracheal intubation and help ensure patient safety.