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Biomedical subjects

J J Fraser

Publications and source records attributed to J J Fraser.

11 recordsLinked to original sources
PubMed2001

American Academy of Pediatrics: Technical report: Alternative dispute resolution in medical malpractice.

The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options.

Liability, Legal↗
PubMed1999

Adolescent occupational injuries: Texas, 1990-1996.

BACKGROUND: A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas. METHODS: The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995. RESULTS: There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide. CONCLUSIONS: In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.

Accidents, Occupational↗
PubMed1999

American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling.

Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.

Benchmarking↗
PubMed1997

Medical malpractice arbitration: a primer for Texas physicians.

The medical malpractice crises and ensuing tort reform efforts, including methods of alternative dispute resolution (ADR), are generally reviewed. Arbitration in the context of medical malpractice is examined from the perspective of other states' experiences. Michigan has one of the nation's oldest medical malpractice arbitration programs, but it suffers from underutilization. California's experience derives from the use of arbitration in the managed care setting. While Texas has statutory provisions for medical malpractice arbitration, in light of public policy favoring ADR, the statute could be perceived as antipublic policy, resulting in underuse. The National Practitioner Data Bank also serves to discourage physician participation. Policy options are offered to address these concerns.

Humans↗
PubMed1996

Nonfatal injuries in adolescents: United States, 1988.

PURPOSE: To describe the incidence and impact of nonfatal injuries in a national sample of adolescents. METHODS: Data were obtained from the 1988 Child Health Supplement of the National Health Interview Survey (NHIS). The NHIS is a continuous multistage probability sample of the civilian noninstitutionalized population of the United States. Adolescents 10-17 years old (N = 7,470) of the total number of 17,110 children under 18 years of age in the survey were studied. Incidence rates (I) were calculated for accidents, injuries, and poisonings (AIPs) requiring medical attention in the previous 12 months and recalled by the adult household interviewee. Information on sociodemographic factors and impairment were reported. Sample weights were used to derive population estimates. RESULTS: In 1988, 4,505,000 adolescents 10-17 years old were estimated to have experienced AIPs in the previous 12 months (I = 16.1/100), resulting in 3.2 mean number days of bed rest, 4.1 mean number of days absent from school, and 20% with limited activity due to AIPs. AIPs were most frequent in older adolescents 14-17 years of age (I = 18.2/100), males (I = 20.3/100), whites (19.5/100), and Midwest U.S. residents (I = 18.1/100). The most frequent AIPs were cuts (I = 59.6/1000), sprains (I = 51.3/1,000), and broken bones (I = 43.1/1,000). AIPs most limiting to adolescents' activity were broken bones (62.6%), head injuries (58.3%), and sprains (55.7%). CONCLUSIONS: Although injury is the leading cause of death in adolescence, it also plays an important role in adolescent morbidity. Further national studies with better documentation of nonfatal injuries are needed to eliminate potential recall bias associated with an interview survey.

Accidents↗
PubMed1990

Immunization status of chronically ill children.

The immunization status of 103 chronically ill children attending five specialty clinics, and 52 otherwise healthy children attending an acute care clinic, was determined using a questionnaire self-administered by parents. The immunization rate in specialty clinics was 72%, compared with 85% in the acute care clinic (P = 0.118). Only the neurology clinic rate (55%) differed significantly from the control (P = 0.014). In patients age 48 months or older, there was a significant association between clinics and overall compliance (P = 0.003). Older specialty clinic patients (79%) tended to be more compliant compared to their younger counterparts (60%) (P = 0.057). No significant association was noted between immunization compliance and source of primary care services or intensity of use of services. Greater efforts are needed to identify underimmunized chronically ill children and to provide the means to bring them into compliance.

Child↗
PubMed1983

Hepatic hemangiomatosis of infancy.

A 2-month-old female infant with congestive heart failure secondary to hepatic hemangiomatosis was treated with prednisone for five weeks without clinical improvement. She then underwent acute cardiac decompensation and required assisted ventilation. The hepatic artery was ligated to decrease the blood supply to the hemangiomata. Although the engorged liver softened dramatically, she continued to require mechanical ventilation for cardiac failure. Ten days postoperatively, she underwent digitalization with significant improvement in cardiac function, and she was then weaned from the respirator. Although, at 2 1/2 years of age, her liver has remained somewhat enlarged, her cardiovascular function has been normal. Our experience indicates that hepatic hemangiomatosis can be successfully treated via hepatic artery ligation and that cardiotonic measures might sometimes be required for recovery from coexisting congestive heart failure.

Angiomatosis↗
PubMed1983

Neonatal sepsis and meningitis due to alpha-hemolytic Streptococcus.

We have reported a case of septicemia and meningitis due to alpha-hemolytic Streptococcus in a 5-day-old infant. The microbiologic and clinical characteristics of neonatal infection with this organism lead us to conclude that this bacterium can be pathogenic in the newborn and should not be dismissed as a contaminant.

Adult↗
PubMed1983

Prevalence of cervical Chlamydia trachomatis and Neisseria gonorrhoeae in female adolescents.

The prevalence of cervical infection with Chlamydia trachomatis and Neisseria gonorrhoeae was examined in 125 girls receiving primary gynecologic care in a general adolescent clinic. C trachomatis was isolated in 8% of the patients using a microtiter tissue-culture method, and N gonorrhoeae was found in 12%. A significant association was found between the use of oral contraceptives and positive chlamydial cultures. Patients with Chlamydia-positive cultures were frequently asymptomatic and exhibited no positive findings on physical examination. Three of ten women with cervical chlamydial infection developed pelvic inflammatory disease. These results support the use of cervical screening for both of these pathogens in sexually active adolescents.

Adolescent↗
PubMedDate not supplied

Gastrointestinal decontamination in the emergency department.

Pediatric poisoning is a problem commonly encountered in the emergency department. After stabilization of airway, breathing, and circulation, one of the goals of treatment is decontamination in order to limit poison absorption and the resulting systemic toxicity. Decontamination modalities include gastric emptying (ipecac and gastric lavage), inhibiting absorption (activated charcoal), and catharsis (sorbital, magnesium citrate, and whole bowel irrigation). Each modality is discussed. Choice of modality by the practitioner must be individualized to each patient's situation.

Adolescent↗