Confidentiality of medical information: a study of Albertan family physicians.
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The author of this paper examines physicians' regard for the confidentiality of medical information in the light of their perception of their own role. Five case studies of increasing complexity of medical management and ethical issues, derived from practice and accompanied by questions relating to confidentiality and medical management, were submitted to randomly selected family physicians in Alberta. Analysis of the replies to determine attitudes to confidentiality and how the respondents perceived patients' best interests, and statements of how they would act in certain situations, disclosed that a substantial minority of the physicians were still prepared to breach confidentiality and exercise Hippocratic professional judgement in certain situations. The bases of confidentiality of medical information are reviewed, together with changing modes of medical ethics and the increasing trend to rights derived from patients, autonomy, and the ways in which these factors may affect the physician-patient relationship. (+info)
Fertility and parental consent for minors to receive contraceptives.
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OBJECTIVES: I examined the effect of imposing a requirement for parental consent before minors can receive medical contraceptives. METHODS: Birth and abortions among teens, relative to adults, in a suburban Illinois county that imposed a parental consent requirement in 1998 were compared with births and abortions in nearby counties during the period 1997-2000. RESULTS: The relative proportion of births to women under age 19 years in the county rose significantly compared with nearby counties, whereas the relative proportion of abortions to women under age 20 years declined insignificantly, with a relative increase in the proportion of pregnancies (births and abortions) to young women in the county. CONCLUSIONS: Imposing a parental consent requirement for contraceptives, but not abortions, appears to raise the frequency of pregnancies and births among young women. (+info)
Children and adolescents - who can give consent?
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Case histories are based on actual medical negligence claims or medicolegal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Can children and adolescents consent to their own medical treatment? Do general practitioners owe teenagers a duty of confidentiality? This article examines the legal obligations of GPs when obtaining consent to medical treatment from patients who are under 18 years of age. (+info)
Validity of parental reporting of recent episodes of acute otitis media: a Slone Center Office-Based Research (SCOR) Network study.
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BACKGROUND: The validity of parental reporting of children's health outcomes is an important methodological issue in community-based pediatric research. We assessed the validity of parents' reports of their children's acute otitis media (AOM) history over the previous month in a pilot study of xylitol for AOM prevention. METHODS: Parents of children participating in a study conducted in the Slone Center Office-Based Research (SCOR) Network were interviewed monthly for 3 months and asked whether their child had been diagnosed with AOM in the previous month. A blinded physician reviewed medical records. Results from parental interviews and medical records were compared by correlation analysis. RESULTS: Medical records were obtained for 102 of 120 children (85.0%); 272 monthly interviews were completed. Kappa for the agreement between parental reports and medical records was 0.88 [95% confidence intervals (CI): 0.76 to 0.94]. The positive predictive value of a parental report of an AOM episode within the previous month was 85.0%, and the negative predictive value was 99.1%. CONCLUSIONS: The results of this study suggest that parental reporting of children's recent AOM history correlates well with medical records. Parental interview is a reasonable approach to collecting data on recent AOM outcomes, particularly in large-scale community-based studies where obtaining medical records is often impractical. (+info)
Imparting carrier status results detected by universal newborn screening for sickle cell and cystic fibrosis in England: a qualitative study of current practice and policy challenges.
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BACKGROUND: Universal newborn screening for early detection of children affected by sickle cell disorders and cystic fibrosis is currently being implemented across England. Parents of infants identified as carriers of these disorders must also be informed of their baby's result. However there is a lack of evidence for most effective practice internationally when doing so. This study describes current or proposed models for imparting this information in practice and explores associated challenges for policy. METHODS: Thematic analysis of semi-structured interviews with Child Health Coordinators from all English Health Regions. RESULTS: Diverse methods for imparting carrier results, both within and between regions, and within and between conditions, were being implemented or planned. Models ranged from result by letter to in-person communication during a home visit. Non-specialists were considered the best placed professionals to give results and a similar approach for both conditions was emphasised. While national guidance has influenced choice of models, other factors contributed such as existing service structures and lack of funding. Challenges included uncertainty about guidance specifying face to face notification; how best to balance allaying parental anxiety by using familiar non-specialist health professionals with concerns about practitioner competence; and extent of information parents should be given. Inadequate consideration of resource and service workload was seen as the main policy obstacle. Clarification of existing guidance; more specific protocols to ensure consistent countrywide practice; integration of the two programmes; and 'normalising' carrier status were suggested as improvements. CONCLUSION: Differing models for communicating carrier results raise concerns about equity and clinical governance. However, this variation provides opportunity for evaluation. Timely and more detailed guidance on protocols with clarification of existing recommendations is needed. (+info)