Assessing the effectiveness of New York's 911 Good Samaritan Law-Evidence from a natural experiment.

BACKGROUND: Drug overdose is the leading cause of accidental death in the United States. Nationally, opioids are the primary drugs associated with accidental overdoses. In response to increasing overdose deaths, 40 states and the District of Columbia have enacted Good Samaritan Laws (GSLs). Generally, these policies attempt to encourage witnesses or those experiencing an overdose to call 911 by providing limited immunity from arrest, charge and/or prosecution of possession of narcotics. The aim of the current study is to evaluate the effectiveness of New York State's 911 GSL. METHODS: We exploit a difference in state law between New York State, where the policy was adopted in 2011, and New Jersey, where the policy was not adopted until 2013, to provide a reasonable comparison condition. We examine variation in accidental opioid overdose emergency department visits and inpatient admissions from 2010 to 2012 across 270 hospitals in New York and New Jersey at the quarterly level controlling for hospital fixed effects and time trends using State Emergency Department Databases (SEDD) and State Inpatient Databases (SID). RESULTS: Accidental opioid overdose emergency department visits and inpatient hospital admissions were increasing in both New York and New Jersey. After the enactment of New York's 911 GSL, emergency department visits and inpatient hospital admissions for accidental heroin overdoses increased differently in New York and New Jersey, with an incident rate ratio (IRR) of 1.34 (95% CI = 1.00, 1.86). The results were inconclusive for accidental non-heroin opioid overdoses (IRR = 0.98, 95% CI = 0.86, 1.13). CONCLUSIONS: Accidental heroin overdose emergency department visits and inpatient hospital admissions increased in New York State after the enactment of the 911 GSL, consistent with the intended effect of the GSL. Preliminary evidence suggests that either persons who use heroin and/or those around them were impacted by the policy change.

Resolving ethical dilemmas in suicide prevention: the case of telephone helpline rescue policies.

The ethical basis of suicide prevention is illustrated by contrasting helpline emergency rescue policies of the Samaritans and the AAS and the U.S. National Suicide Prevention Lifeline network. We contrast moralist, relativist, and libertarian ethical premises and question whether suicide can be rational. Samaritans respect a caller's right to decide to die by suicide; U.S. helplines oblige emergency intervention during an attempt even against the caller's will. We analyze the effect of emergency rescue when there is high suicide risk but an attempt has not been initiated. We examine links between values and actions, needs for empirical evidence to guide practice, and propose vigorous dialogue about values in the gray zone of moral practice.

Toll-free number for reporting adverse events on labeling for human drug products. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule that confirms the interim final rule entitled "Toll-Free Number for Reporting Adverse Events on Labeling for Human Drug Products" (73 FR 402, January 3, 2008) (interim final rule) and responds to comments submitted in response to the request for comments in the proposed rule of the same title (69 FR 21778, April 22, 2004) (proposed rule). This final rule affirms the interim final rule's requirement for the addition of a statement to the labeling for certain human drug products for which an application is approved under section 505 of the Federal Food, Drug, and Cosmetic Act (the act). The statement includes a toll-free number and advises that the number is to be used only for reporting side effects and is not intended for medical advice (the side effects statement). This final rule also affirms the interim final rule's addition of new part 209 to the regulations requiring distribution of the side effects statement. This final rule implements provisions of the Best Pharmaceuticals for Children Act (the BPCA) and the Food and Drug Administration Amendments Act of 2007 (FDAAA).

Toll-free number for reporting adverse events on labeling for human drug products. Interim final rule.

The Food and Drug Administration (FDA) is issuing an interim final rule to codify the provisions of the proposed rule entitled "Toll-Free Number for Reporting Adverse Events on Labeling for Human Drug Products" (69 FR 21778, April 22, 2004) (the toll-free number proposed rule or proposed rule) that, under the Food and Drug Administration Amendments Act of 2007 (FDAAA), became effective by operation of law on January 1, 2008. This interim final rule requires the addition of a statement on the labeling of certain human drug products for which an application is approved under the Federal Food, Drug, and Cosmetic Act (the act). The added statement includes a toll-free number and advises that the number is to be used only for reporting side effects and is not intended for medical advice (the side effects statement). As mandated by FDAAA, this interim final rule does not apply to over-the-counter drug products approved as new drugs under the act if the product packaging includes a manufacturer's or distributor's toll-free number for reporting complaints.

[Health warnings on cigarette packets. An overview]. / Warnhinweise auf Zigarettenschachteln. Eine Ubersicht.

The implementation of health warnings leads to continuous dissemination of the latest scientific findings on the health consequences of smoking. In combination with other recognized effective tobacco control measures, a lower consumption and an increased quit-rate are thus to be stimulated. The effectiveness of health warnings depends on their content as well as on their design and size. Thus, large warnings are by far better than smaller warnings. The same applies for warnings that are placed on the front of cigarette packets. Warnings that incorporate pictures are considerably more effective than warnings based solely on text. The combination of pictures and text format is most effective. International experience shows that the dissemination of Quitline phone numbers in combination with health warnings on every packet clearly improves the effectiveness and broad reach of smoking cessation advice via Quitlines. The implementation of pictorial health warnings combined with the imprint of the phone number of the Quitline of the Federal Center for Heath Education is highly recommended in Germany.

La responsabilidad legal de los centros de información y asesoramiento toxicológico / Legal responsability of the poison control centers

En el desempeño de sus funciones, los Centros de información y Asesoramiento Toxicológico realizan diversos actos que en ocasiones, pueden llevarlos a enfrentar procesos judiciales. El articulo analiza los diversos factores que particularizan la responsabilidad legal de los CIAT, en especial la frecuente disociación entre las situaciones concretas planteadas por el solicitante y la información de las fluentes disponibles. Se definen, a partir de la experiencia de los autores, las solicitudes más propensas a desembocar en procesos judiciales. Se enfatiza la necesidad de la aplicación de buenas practicas de información como medio para elevar la calidad de la misma, así como el empleo de fuentes de información computarizados y expertos en las diversas áreas de la toxicología. Por ultimo se señala, la escasa divulgación que sobre esta temática existe en América Latina en particular, y en la literatura especializada en general (AU)

Telephone triage. A challenge for practicing midwives.

Telephone triage is the process by which a health care provider communicates with a client via the telephone and, thereby, assesses the presenting concerns, develops a working diagnosis, and determines a suitable plan of management. Determination of the seriousness of the situation will dictate whether a client can be cared for at a distance or whether a more comprehensive in-person evaluation is in order. The process of telephone triage is fraught with potential problems, including difficulty in establishing a reliable database, environmental distractions, cost concerns, liability issues, and, frequently, inadequate documentation. This article will describe an approach to these concerns by discussing the use of appropriate communication techniques, the development of a working diagnosis, the establishment of a plan of intervention, and the appropriate documentation of care. Such steps will go far toward diminishing the growing legal threats that arise to midwives who utilize this technology to render care to their patients.

Liability issues affecting toll-free nurse lines.

The expansion of nurse advice lines by health plans has exposed them to a new area of liability. The author explores several recent cases in which health plans have been found accountable for actions of their nurse advice lines, and offers a series of suggestions for reducing health plan liability.