The Australian Royal Commission into Institutional Responses to Child Sexual Abuse.

The Royal Commission into Institutional Responses to Child Sexual Abuse is the largest royal commission in Australia's history and one of the largest public inquiries into institutional child abuse internationally. With an investment from the Australian government of half a billion dollars, it examined how institutions with a responsibility for children, both historically and in the present, have responded to allegations of child sexual abuse. Announced in the wake of previous Australian and international inquiries, public scandals and lobbying by survivor groups, its establishment reflected increasing recognition of the often lifelong and intergenerational damage caused by childhood sexual abuse and a strong political commitment to improving child safety and wellbeing in Australia. This article outlines the background, key features and innovations of this landmark public inquiry, focusing in particular on its extensive research program. It considers its international significance and also serves as an introduction to this special edition on the Australian Royal Commission, exploring its implications for better understanding institutional child sexual abuse and its impacts, and for making institutions safer places for children in the future.

Basics of employment law: understanding and dealing with adverse employment actions and discrimination in the workplace.

In the present setting of fiscal and other constraints placed upon the business world during economically challenging times, there exists both intentional and unintentional opportunities for unfair and illegal treatment of employees. Hospitals and other health care facilities or organizations are not immune. In fact, given the demographics of our field and the general "graying" of our colleagues, a disproportionately higher number of perfusionists reside within the age-protected guidelines established by both federal and state law. Not coincidentally, the pressures on hospitals to stay solvent in the presence of decreasing reimbursement and declining revenues may well create a prescription for unfair treatment of employees. This article will explain the basic concepts of the protections afforded employees by law with regard to freedom from harassment and discrimination in the workplace. Matters related to the hostile workplace environment; age, sex, and race discrimination; and adverse employment actions will be explained and illustrated by applicable case law. In this regard, it is intended that this article will enhance the opportunity for perfusionists to be cognizant of both the express and implied behaviors (both verbal and nonverbal) that may be detrimental to an employment situation, as well as to be cognizant of some of the remedies at law available regarding adverse employment circumstances.

Seguridad, confidencialidad y práctica asistencial / Safety, confidentiality and nursing practice

La presencia de las tecnologías de la información en la práctica asistencial es cada vez mayor, generando dependencias de tipo tecnológico. Minimizar y asumir el riesgo de los problemas generados por las tecnologías es una cultura que debemos aprender e incorporar a nuestra actividad asistencial. La legislación en materia de salud y de protección de datos crea el marco de trabajo, que junto con el tecnológico (protocolos, estándares, normas, etc) delimitan las actuaciones de los Sistemas y Tecnologías de la Información. Asegurar la credibilidad y la confianza sobre dichos sistemas es una tarea que debemos asumir todos (AU)

The authors seek to show us, through this article, how to minimize and assume the risk of the problems generated by technology, and which we should learn and incorporate into our nursing activity (AU)

Practices and hospitals, their physicians, and their noncompetes: breaking up should be hard to do.

The availability of specialty healthcare has become an issue of increasing importance. Practices and hospitals must be encouraged to assume the risk and responsibilities of expanding their fields of care. For their part, courts must give heavier weight to that aspect of the public interest in determining how their decision impacts access to specialty healthcare. In short, courts deciding the enforceability of noncompetition agreements must be willing to do something more than count doctors.

Reserved procedures in Dutch hospitals: knowledge, experiences and views of physicians and nurses.

The Individual Health Care Professions Act came into force in The Netherlands in 1997, introducing a mixed system for the regulation of the practice of medicine. One of its components, the reserved procedures regulations, was studied in hospitals to gain insight into the knowledge, experiences and views of physicians and nurses with regard to these regulations. Questionnaires were sent to representative samples of 250 gynaecologists, 350 internists, and 3200 nurses, response rates were 65, 60 and 71%, respectively. Almost all respondents were aware that physicians are authorised to perform reserved procedures on their own initiative (93-99%), and 48-63% knew that nurses are not authorised to do this. A substantial percentage of the nurses performed reserved procedures on their own initiative (17-53%). A majority of gynaecologists and internists presumed that the hospital had ensured the proficiency of the nurses to perform reserved procedures (58% resp. 65%), while 82% of the nurses determined their own proficiency for each procedure. Most respondents felt that the reserved procedures regulations offer adequate protection for patients (58-72%). Although recommendations are made for improvement, the functioning of the reserved procedures regulations in hospitals is considered to be moderately positive.

Regulation of junior doctors' work hours: an analysis of British and American doctors' experiences and attitudes.

Regulations of junior doctors' work hours were first enacted in the United States (US) and United Kingdom (UK) over a decade ago, with the goals of improving patient care and doctors' well-being while maintaining a high quality of medical training. This study examines experiences and attitudes regarding the implementation of these regulations among physicians and surgeons at two teaching hospitals, one in South-East England, and the other in New England, US. This paper presents the findings of a survey questionnaire and a series of in-depth interviews administered to a sample of junior doctors and the consultants responsible for their supervision. The study finds that the different policy mechanisms employed in the two countries have had different degrees of success in reducing the work hours of junior doctors. The results also indicate, however, that even in settings in which hours have been reduced significantly, the regulations have only had limited effects on the quality of medical care, junior doctors' well-being, and the quality of medical education. A number of barriers to the success of the regulations in achieving their objectives are identified, and the relative merits of political action and professional self-regulation are discussed. This research suggests that recently enacted policies requiring further reductions in junior doctors' hours in both the US and UK may face similar barriers when implemented. Understanding the lessons that emerge from implementation of the original regulations is essential if future reforms are to succeed and a high-quality system of health care is to be sustained.

A focus on the institutionalized aged and special care patient for today's practice.

Dentists must understand the growing institutionalized-aged and special-needs population, the places wherein they reside, and the unique challenges of access that confront both the patient and dentist. This article discusses governmental regulation and legislation of long-term-care facilities and outlines professional duties and requirements of dentists who care for residents of such facilities. It will also cover the treatment needs of this population and the venues available to the hospital-trained dentist.

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.