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PubMed1982

The anal personality: self-disclosure, negativism, self-esteem, and superego severity.

Psychoanalytic implications of anal characterology were operationalized, and an experimental situation devised to test hypotheses of various aspects of interpersonal behavior. Subjects selected for the study had been found to score either high or low on Kline's (Ai3) Anality Scale. Self-disclosure and disclosure reciprocity were shown to be negative functions of anality: productivity and superego measures were also shown to be functions of anality. Self-esteem and socio-economic status did not relate to anality levels, while the hypothesis linking anality with negativism was only partially confirmed. Implications for psychoanalytic and social psychology research are discussed.

Journal Article↗
PubMed2003

A proposal to enhance the disclosure of potential conflict of interest for continuing medical education events.

BACKGROUND: Commercial support for continuing medical education (CME) raises questions about potential conflict of interest. Current disclosure methods provide limited, general information about the nature and degree of support, such that potential conflict of interest cannot be studied by researchers or understood by physicians. SUMMARY: This article proposes a semiquantitative method for disclosure of commercial support for CME. The method includes a statement of the degree of support a program receives from all sources and an estimate of how revenue for the program compares to expenses. The new method would standardize the semiquantitative reporting of commercial support for CME programs. CONCLUSION: The proposed method for disclosing conflict of interest for CME events should facilitate the study and understanding of how commercial support affects these programs.

Conflict of Interest↗
PubMed1996

Implications of the SEC's final continuing disclosure rule.

The Securities and Exchange Commission's (SEC's) final disclosure rule affects healthcare providers who have $10 million or more in bonds outstanding and providers that plan to be active in the bond market in the future. As managed care providers, HMOs come under the jurisdiction of the rule and are required to expand their reporting of financial information and operational data to include secondary market bond purchasers. The SEC's broadened disclosure rule significantly affects the financial reporting practices of healthcare providers involved in capitated contracting--especially the areas of contract reporting, confidentiality of information, and catastrophic case loss reporting.

Capital Financing↗
PubMed1997

Interim rules amending ERISA disclosure requirements for group health plans--DoL. Interim rules with request for comments.

This document contains interim rules governing the content of the summary plan description (SPD) for group health plans, the furnishing of summaries of material reductions in covered services or benefits by group health plans, and the disclosure of SPD and related information through electronic media. The rules contained in this document implement amendments to the disclosure provisions of the Employee Retirement Income Security Act of 1974 (ERISA) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). Interested persons are invited to submit comments on the interim rules for consideration by the Department in developing final rules. The rules contained in this document are being adopted on an interim basis to accommodate statutorily established time frames intended to ensure that sponsors and administrators of group health plans, as well as participants and beneficiaries covered by such plans, have timely guidance concerning compliance with the recently enacted amendments to ERISA.

Employee Retirement Income Security Act↗
PubMed1976

Institutional data disclosure.

Compelling arguments exist both for and against disclosure of hospital and other institutional data relating to effectiveness of care. Olga Boikees, an attorney experienced in administrative law, contends that disclosure should be encouraged--but handled carefully so that the public will be informed, not confused or misled.

Confidentiality↗
PubMed1989

States rule differently on subject of AIDS and disclosure of a blood donor's identity.

Last month, Dr. Decker analyzed recent court decisions that maintain the standard that providing blood and human tissue is a service, not a sale of goods. Under most conditions, he concluded, hospitals can't be held liable for damages to a patient who acquires an infectious virus from blood transfusions or tissue transplants. This month, Dr. Decker considers the effect of AIDS on rulings dealing with the disclosure of a blood donor's identity. In 1988, the Supreme Court of the United States twice declined to review lower court decisions dealing with the disclosure of the names of blood donors in situations where the recipient had contracted AIDS. The issues are complex and require the balancing of conflicting rights. Further, previous decisions have not been consistent from one state to another. Hospital materials managers must understand the issues involved in the court decisions as they carry out their responsibility to the hospital and its patients to provide the safest possible supply of blood. In this dialogue, Dr. Decker reviews the case law and develops the issues.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Cancer patients who experienced diagnostic genetic testing for cancer susceptibility: reactions and behavior after the disclosure of a positive test result.

The aim of this prospective study was to evaluate the consequences of the disclosure of a positive genetic test result to patients affected with cancer. Personal repercussions and patients' behavior with the transmission of their results to relatives were considered. We conducted semistructured interviews with 23 cancer patients identified as carriers of a cancer-predisposing mutation for hereditary breast ovarian or nonpolyposis colorectal cancers, 1 month after the disclosure of the test result. Eight patients spontaneously expressed distressed reactions ("you no longer feel cured"), and 14 patients reported at least one negative feeling (dissatisfied, discouraged, unhappy, or worried), despite expecting to be a carrier. Sixteen patients expressed concerns about the risk of developing another cancer, and 18 were concerned for their children's future, in that they may carry the mutation and develop a cancer. Although 8 patients found that disadvantages of knowing their genetic status outweighed the advantages, all but 1 did not regret having undergone genetic testing. All of the patients transmitted their results to at least one close relative. Although 6 of them expressed difficulties in being the only person who could transmit the information and 9 said it was a heavy responsibility, all except 1 did not want someone else to have to inform their families. Our results illustrate the potential negative impact of diagnostic genetic testing in patients with cancer. This includes distressed reactions and difficulties in transmitting their results to relatives. Future large-scale studies are warranted to confirm our findings.

Adaptation, Psychological↗
PubMed2000

Public disclosure of serostatus -- the impact on HIV-positive people.

AIDS is steeped in moral judgments about who becomes infected with HIV. Consequently, an AIDS diagnosis inevitably brings with it feelings of shame, guilt, loss, depression, fear of disclosure and some form of self-imposed isolation. Because of the stigma of an HIV-positive diagnosis, people are often reluctant to come forward and be tested, which makes it difficult for them to make informed decisions about their own future and that of their family. Nevertheless, since early in the epidemic, people living with HIV/AIDS have spoken out to present their personal perspectives on living with HIV and to challenge perceptions about who can and cannot become infected. However, there has been little research to explore their role in the global response to AIDS and the impact of public HIV disclosure on the HIV-positive persons themselves.

AIDS Serodiagnosis↗
PubMed2002

[Mandatory disclosure and infectious disease. From "pestilential" disease to "emerging" diseases].

Due to the recent overhaul of the procedure on mandatory disclosure of infectious diseases (law relating to the reinforcement of sanitation quality control established in July 1998, and the May 1999 and May 2001 decrees on the application of this law), wishing to take advantage of this opportunity, the authors propose a chronological review retracing the history of these legal declarations. For over a century, they have represented the main instrument used for intervention and surveillance allowing for the fight against infectious diseases. The health options kept have varied over the years, as well as the precautions taken to respect secrecy (nominative or anonymous disclosure, modalities of transmission...). Procedures adopted to reconcile the principle of confidentiality along with the necessity to protect public health in the case where it would require an immediate and urgent intervention are examined throughout the chronology (determining the source of contamination, prevention of contagion).

Communicable Diseases, Emerging↗
PubMedDate not supplied

Full-disclosure monitoring: a concept that will change the way arrhythmias are detected and interpreted in the hospitalized patient.

Conventional methods of detecting and documenting arrhythmia in the hospitalized patient are inadequate. A system of full-disclosure monitoring has been expanded from its roots in Holter monitoring to real-time telemetry. This archiving system stores 24 hours of electrocardiogram (ECG) tracing per patient in computer memory and prints 60 minutes (one minute per line, 60 lines per page) of ECG hourly. This technique eliminates the fear of missing ventricular tachycardia, heart block, or automatic implantable cardioverter defibrillator discharges and ensures that onsets and terminations of runs are captured. Documentation is facilitated by the use of a laser printer that makes standard-sized tracings. The retrospective capability of full disclosure monitoring aids in correlating symptoms to ECG changes and serves as a tool for quality control, bed utilization, and research.

Arrhythmias, Cardiac↗
PubMed1998

Sexual ethics. Disclosure of HIV-positive status to partners.

OBJECTIVE: To determine factors associated with disclosure of human immunodeficiency virus (HIV)-positive status to sexual partners. METHODS: We interviewed 203 consecutive patients presenting for primary care for HIV at 2 urban hospitals. One hundred twenty-nine reported having sexual partners during the previous 6 months. The primary outcome of interest was whether patients had told all the sexual partners they had been with over the past 6 months that they were HIV positive. We analyzed the relationships between sociodemographic, alcohol and drug use, social support, sexual practice, and clinical variables; and whether patients had told their partners that they were HIV positive was analyzed by using multiple logistic regression. RESULTS: Study patients were black (46%), Latino (23%), white (27%), and the majority were men (69%). Regarding risk of transmission, 41% were injection drug users, 20% were homosexual or bisexual men, and 39% were heterosexually infected. Sixty percent had disclosed their HIV status to all sexual partners. Of the 40% who had not disclosed, half had not disclosed to their one and only partner. Among patients who did not disclose, 57% used condoms less than all the time. In multiple logistic regression analysis, the odds that an individual with 1 sexual partner disclosed was 3.2 times the odds that a person with multiple sexual partners disclosed. The odds that an individual with high spousal support disclosed was 2.8 times the odds of individuals without high support, and the odds that whites or Latinos disclosed was 3.1 times the odds that blacks disclosed. CONCLUSIONS: Many HIV-infected individuals do not disclose their status to sexual partners. Nondisclosers are not more likely to regularly use condoms than disclosers. Sexual partners of HIV-infected persons continue to be at risk for HIV transmission.

Disclosure↗
PubMed1994

Statutory requirements for disclosure of breast cancer treatment alternatives.

Therapeutic options for breast cancer, particularly for early-stage disease, and increased patient participation in medical decision-making have oriented state legislatures toward ensuring that women with breast cancer have adequate information about treatment alternatives. Currently, 18 states have enacted statutes regarding physician disclosure of treatment alternatives to breast cancer patients. This paper reviews these statutes in the context of the requirements imposed on the physician as health care provider and the content of medical information presented to the patient as a consequence of the laws. State statutes were identified through the National Cancer Institute's State Cancer Legislative Database, and the statutory requirements were analyzed. For statutes requiring development of a written summary of treatment alternatives, the most recent summary was obtained through the responsible state agency, and informational content was analyzed for relevance to treatment decisions in early-stage disease. As a group, these laws address informed consent for treatment, physician behavior within the patient-physician relationship, and the medical information upon which treatment decisions are based. Individual statutes vary in the scope of the issues addressed, particularly in the responsibility placed on physicians, and treatment option summaries developed in response to this legislation vary widely in content and scope. Despite broad implications of these statutes in oncology practice, little is known about their effects on breast cancer care. Additional research is needed to define the impact of these statutes on breast cancer care, as such legislation is considered by other states for this and other diseases.

Breast Neoplasms↗
PubMed2002

Emotional processes following disclosure of an extramarital affair.

In-depth interviews with individuals who had experienced marital infidelity revealed a three-stage process following disclosure of an affair. The process starts with an "emotional roller coaster" and moves through a "moratorium" before efforts at trust building are recognized. Implications for the literature on forgiveness and the process of change in couples therapy are discussed as well as implications for future research and for practice.

Adaptation, Psychological↗
PubMed1998

Information disclosure: the moral experience of nurses in China.

While the movement to ensure patient's rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients' best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse's narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients' autonomy or safeguarding patients' right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care.

Beneficence↗
PubMed1997

Donor insemination: attitudes of parents towards disclosure.

OBJECTIVE: To determine attitudes of parents of children conceived by donor insemination to telling the children of their origin. DESIGN: Questionnaire survey, in 1992-1993, of parents who had had a child by donor insemination at four New South Wales clinics from 1979 to 1990. SETTING: Three hospital-based clinics (two public, one private) and a private clinic service. PARTICIPANTS: 276 families who altogether had had 420 children by donor insemination. MAIN OUTCOME MEASURES: Number of children told that they had been conceived by donor insemination; parents' intentions, before conceiving and after the birth, of informing the child; and whether other people were informed of the child's origin. RESULTS: Of 393 families who could be contacted, 353 agreed to participate and 276 (70%) replied to the questionnaire. Only 22 of the 420 children (5.2%) had been informed of their origin. Before conceiving, 18% of parents (49/273) planned to tell the child. Seventy-one per cent of families (182/257) had told others of the origin of the child, but 94% (241/257) had not told the child. Of the 29% of families (75/257) who had not told others of the child's origins, none had told the child. As the children grow older, more parents decide not to tell them of their origin. CONCLUSIONS: Most parents of children conceived by donor insemination do not plan to tell their child, but most of these parents have told others, creating the potential for accidental disclosure. Because of the small number of children who are told of their origin, there may not be a need for government-regulated donor registers, provided donor insemination units maintain a high standard of record-keeping.

Adult↗
PubMed1989

Informed consent: patient rights and the doctor's duty of disclosure in South Africa.

In this paper, read at a conference on 'Law, Medicine and Human Rights', at Sun City in August 1987, the South African case law and legal opinion on the patient's right to be informed of, and the doctor's corresponding duty to disclose, the risks and dangers inherent in the medical intervention involved are systematized, expounded and discussed. The conclusion arrived at is that, although a variety of issues concerning the scope and test of disclosure have not yet been settled, the principle of patient autonomy and its corollary, informed consent, have received clear recognition in South African medical law.

Disclosure↗
PubMed1993

Disclosure of a diagnosis to children and adolescents when parents object. A clinical ethics analysis.

Parents of children and adolescents occasionally request nondisclosure of a diagnosis to the patient. This ethical dilemma was analyzed using a case in which parents of a child with cystic fibrosis demanded that the physician not reveal the diagnosis to their daughter. The case study helps to identify the specific clinical factors that may be considered when confronting similar dilemmas in other cases. Any justification for lying to the patient or hiding information must derive from clinical circumstances that override the basic moral duty to tell the truth. The physician, the disease, the patient, and the family are all pertinent to the ethical decision of disclosure. These factors may change over time with the natural history of the disease and the maturation of the patient.

Attitude of Health Personnel↗