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Biomedical subjects

L E Ferris

Publications and source records attributed to L E Ferris.

At least 19 recordsLinked to original sources
PubMed2004

Better governance in academic health sciences centres: moving beyond the Olivieri/Apotex Affair in Toronto.

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair (OAA) regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are.

Academic Medical Centers↗
PubMed2001

Problems for clinical judgement: 4. Surviving in the report card era.

Health care report cards involve comparisons of health care systems, hospitals or clinicians on performance measures. They are going to be an important feature of medical care in Canada in the new millennium as patients demand more information about their medical care. Although many clinicians are aware of this growing trend, they may not be prepared for all of its implications. In this article, we provide some historical background on health care report cards and describe a number of strategies to help clinicians survive and thrive in the report card era. We offer a number of tips ranging from knowing your outcomes first to proactively getting involved in developing report cards.

Canada↗
PubMed2001

Problems for clinical judgement: 3. Thinking clearly in an emergency.

The resuscitation of a patient in extremis is frequently characterized by chaos and disorganization, and is one of the most stressful situations in medicine. We reviewed selected studies from the fields of anesthesia, emergency medicine and critical care that address the process of responding to a critically ill patient. Individual clinicians can improve their performance by increased exposure to emergencies during training and by the incorporation of teamwork, communication and crisis resource management principles into existing critical care courses. Team performance may be enhanced by assessing personality factors when selecting personnel for high-stress areas, explicit assignment of roles, ensuring a common "culture" in the team and routine debriefings. Over-reliance on technology and instinct at the expense of systematic responses should be avoided. Better training and teamwork may allow for clearer thinking in emergencies, so that knowledge can be translated into effective action and better patient outcomes.

Clinical Competence↗
PubMed2001

Problems for clinical judgement: 2. Obtaining a reliable past medical history.

Ordinary human reasoning may lead patients to provide an unreliable history of past experiences because of errors in comprehension, recall, evaluation and expression. Comprehension of a question may change depending on the definition of periods of time and prior questions. Recall fails through the loss of relevant information, the fabrication of misinformation and distracting cues. Evaluations may be mistaken because of the "halo effect" and a reluctance to change personal beliefs. Expression is influenced by social culture and the environment. These errors can also occur when patients report a history of present illness, but they tend to be more prominent with experiences that are more remote. An awareness of these specific human fallibilities might help clinicians avoid some errors when eliciting a patient's past medical history.

Diagnostic Errors↗
PubMed2001

Problems for clinical judgement: 1. Eliciting an insightful history of present illness.

This article presents the results of a review of studies of psychology that describe how ordinary human reasoning may lead patients to provide an unreliable history of present illness. Patients make errors because of mistakes in comprehension, recall, evaluation and expression. Comprehension of a question changes depending on ambiguities in the language used and conversational norms. Recall fails through the forgetting of relevant information and through automatic shortcuts to memory. Evaluation can be mistaken because of shifting social comparisons and faulty personal beliefs. Expression is influenced by moods and ignoble failures. We suggest that an awareness of how people report current symptoms and events is an important clinical skill that can be enhanced by knowledge of selected studies in psychology. These insights might help clinicians avoid mistakes when eliciting a patient's history of present illness.

Humans↗
PubMed2001

Medical care use among women before and after sexual assault: a population study.

We set out to compare medical care utilisation patterns between women who were sexually assaulted and women who were not sexually assaulted in the year before and the year after the assault. Cases studied were 690 females aged 15 and over who had undergone a forensic evidence examination for sexual assault between April 1996 and March 1997 and the same number of female age-matched controls. This was a population-based, matched case-control study using administrative databases of medical encounters (only physician services). Outcomes included physician visits by physician specialty; clinic and hospital diagnoses and hospital discharges. Of the cases, 38.4% were aged 1519; 21.4% aged 2024; and 40.2% aged 25 or older. Before and after the sexual assault, cases were more frequent users of medical services than controls. Cases were seen more often, received more medical services and were more likely to be hospitalised than controls in both time periods. Cases were also more likely to be diagnosed with a vast range of physical and psychological problems during the period of study. The persistence of mental and physical health problems before and after a forensic examination for sexual assault presents a challenge. Of paramount concern are issues concerning informed consent to undergo the examination. Collection and documentation of evidence may be important for victims with severe mental illness who may have more difficulty testifying in court. Our study suggests the need for future research examining the reasons why women do not undergo the examination both in terms of whether it is offered and declined or not offered to them.

Journal Article↗
PubMed2001

Should Canadian physicians have a mandatory duty to report woman abuse?

As in other countries, woman abuse is a leading public health issue in Canada. In recognition of its seriousness and the need to interrupt the cycle of violence, several jurisdictions outside of Canada have enacted mandatory reporting laws for woman abuse that require health care workers to report cases. This article reviews the major debates surrounding mandatory reporting of woman abuse with an emphasis on where knowledge is incomplete but would be of benefit when weighing the pros and cons of such laws. We conclude with comments and recommendations with respect to Canada and its health legislation.

Battered Women↗
PubMed2000

What the courts need to know about mental health diagnoses of abused women.

Abused women may appear before the courts because of family or criminal matters. It is not uncommon for an abused woman to be diagnosed as having a mental health condition, including a mental disorder. In this paper, we consider the implications of the use of mental health diagnoses in the court system. We discuss the diagnostic criteria in the DSM-IV and ICD-10 classification systems and examine what other information is needed by the courts to interpret the behaviour and thought processes of abused women. This other information includes: whether the abuse is continuing and the likely impact of its continuance, diagnosis and prognosis, as well as the woman's survival strategies, her coping mechanisms, her support systems, and the severity of the physical and/or psychological abuse. This information needs to be stated within the context of what we currently know about abuse, including up-to-date knowledge about its epidemiology (e.g., prevalence, physical and psychological manifestations, and complex psychological responses). Information about other intervening factors is essential for the courts; and in order to present meaningful testimony on these factors, it is critical for clinicians to have a thorough understanding of the complex dynamics of spousal abuse.

Battered Women↗
PubMed1999

Clinical factors affecting physicians' management decisions in cases of female partner abuse.

BACKGROUND AND OBJECTIVES: This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. METHODS: We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. RESULTS: The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. CONCLUSIONS: Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

Adult↗
PubMed1998

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform.

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario.

Advisory Committees↗
PubMed1998

The sensitivity of forensic tests for rape.

The objective of this study is to provide an overview of the types of forensic evidence gathered during clinical examinations in cases of sexual assault, and to review the literature regarding the sensitivity of individual procedures. The methodology involved a computerized literature search of the MEDLINE, PsycINFO, Cinahl and HealthStar databases from 1992 to 1996, and a secondary search involving consultation with local facilities and manual searching of reference lists. Based on our review, the chance of finding positive evidence is largely time-dependent, particularly regarding sperm and seminal products, which are weighted most heavily in rape investigations. The best chance of recovering seminal evidence is most frequently stated as being less than 50%, with far lower chances after 24 hours. Specific tests such as pubic hair combing would not be expected to yield evidence in more than 4% of cases. That test, while of low sensitivity, is at least not as invasive as some of the others. More invasive tests, such as sampling from the rectal cavity, yield positive sperm findings in fewer than 2% of cases. The importance of ensuring that those working in the field of sexual assault understand that no positive finding on forensic tests does not mean that no attack occurred is highlighted. Medico-legal implications are discussed and suggestions for future research initiatives are highlighted.

Female↗
PubMed1997

Guidelines for managing domestic abuse when male and female partners are patients of the same physician. The Delphi Panel and the Consulting Group.

OBJECTIVE: To provide clinical guidelines for primary care physicians who are dealing with domestic abuse and who have both the abused woman and her partner as patients. PARTICIPANTS: A 15-member expert panel with members having experience in family practice, gynecology, emergency medicine, medical ethics, nursing, psychology, law, and social work; an 11-member consulting group with members representing medicine, consumers, police, psychology, social work, and nursing; and participants from focus groups including 48 previously abused women and 10 previously abusive men. Members of the expert panel and the consulting group were recruited by the research team. Focus group members were recruited through the agencies from which they were receiving services. EVIDENCE: Available research information, and opinions of the expert panel, the consulting group, and the focus group participants. CONSENSUS PROCESS: Scoring of 144 clinical scenarios was performed by the expert panel using a modified Delphi technique involving 4 iterations. Scenarios were rated in terms of best practice for primary care physicians dealing with suspected and confirmed cases of physical abuse. Consulting group members and focus group participants then commented on the panel's results. Final guidelines were approved by the panel and the consulting group, with comments reserved in the guidelines for information from focus group participants. CONCLUSIONS: It is not a conflict of interest for the physician to deal with abuse of the female partner when both partners are patients. Both patients have a right to autonomy, confidentiality, honesty, and quality care. Patients should be dealt with independently, thereby facilitating assessment of the magnitude and severity of the victim's injuries. Physicians should not discuss the possibility of domestic abuse with the male partner without the prior consent of the abused female partner. Joint counseling is generally inadvisable and should be attempted only when the violence has ended, provided both partners give independent consent and the physician has adequate training and skills to deal with the situation without escalating the violence. If the physician feels unable to deal effectively with either patient because of the dual relationship, referral to another qualified physician is preferred.

Confidentiality↗
PubMed1997

Documenting wife abuse: a guide for physicians.

An estimated 12% to 30% of women are assaulted by their male partners at least once during the relationship. Therefore, in their everyday practice, physicians are likely to encounter women who have suffered domestic abuse. The authors define wife abuse, outline epidemiologic aspects and discuss common signs and symptoms. In cases of suspected or confirmed abuse, it is very important for physicians to document the details of the injuries, the patient visit, any treatment and follow-up as well as to screen for associated conditions and ensure that any samples taken are not tampered with. When asked to disclose information by police or courts, physicians need to know when they are obliged to submit copies of their patients' medical records, when patient consent is required, what information should be divulged and how to defend this information in court. The authors present information about the necessary, relevant and appropriate evidence to be collected and documented for both medical and legal purposes. They also discuss the criminal justice system and the role of physicians in legal proceedings concerning wife abuse.

Adult↗