Comparison of European (ESR) and American (ACR) White Papers on Teleradiology: Patient Primacy Is Paramount

The ACR and European Society of Radiology white papers on teleradiology propose best practice guidelines for teleradiology, with each body focusing on its respective local situation, market, and legal regulations. The organizations have common viewpoints, the most important being patient primacy, maintenance of quality, and the “supplementary” position of teleradiology to local services. The major differences between the white papers are related mainly to the market situation, the use of teleradiology, teleradiologist credentialing and certification, the principles of “international” teleradiology, and the need to obtain “informed consent” from patients. The authors describe these similarities and differences by highlighting the background and context of teleradiology in Europe and the United States.     

Characterization and in vitro phase I microsomal metabolism of designer benzodiazepines: An update comprising flunitrazolam,norflurazepam, and 4'‐chlorodiazepam (Ro5–4864)

The number of newly appearing benzodiazepine derivatives on the new psychoactive substances (NPS) drug market has increased over the last couple of years totaling 23 ‘designer benzodiazepines’ monitored at the end of 2017 by the European Monitoring Centre for Drugs and Drug Addiction. In the present study, three benzodiazepines [flunitrazolam, norflurazepam, and 4′‐chlorodiazepam (Ro5–4864)] offered as ‘research chemicals' on the Internet were characterized and their main in vitro phase I metabolites tentatively identified after incubation with pooled human liver microsomes. For all compounds, the structural formula declared by the vendor was confirmed by gas chromatography?mass spectrometry (GC–MS), liquid chromatography?tandem mass spectrometry (LC MS/MS), liquid chromatography?quadrupole time of flight?mass spectrometry (LC?QTOF?MS) analysis and nuclear magnetic resonance (NMR) spectroscopy. The metabolic steps of flunitrazolam were monohydroxylation, dihydroxylation, and reduction of the nitro function. The detected in vitro phase I metabolites of norflurazepam were hydroxynorflurazepam and dihydroxynorflurazepam. 4’‐Chlorodiazepam biotransformation consisted of N‐dealkylation and hydroxylation. It has to be noted that 4′‐chlorodiazepam and its metabolites show almost identical LC–MS/MS fragmentation patterns to diclazepam and its metabolites (delorazepam, lormetazepam, and lorazepam), making a sufficient chromatographic separation inevitable. Sale of norflurazepam, the metabolite of the prescribed benzodiazepines flurazepam and fludiazepam, presents the risk of incorrect interpretation of analytical findings.     

药品管理法律责任的制度创新

目的：评析2019年版《药品管理法》中的法律责任制度的创新,明确药品市场主体的主体责任和药品监管者的监管责任,以期减少药品违法事件的发生,保证公众用药安全。方法：对比2001年版《药品管理法》,结合行政法原理,加之比较法的视角,对2019年版《药品管理法》进行解析。结果与结论：2019年版《药品管理法》强化了法律责任的重要性,设定了更为严格的法律责任,通过体系化的制度设计和完善的法律责任机制,提高了违法者的违法成本,有助于遏制和惩戒违法行为。     

Dangerous Decisions: Influence of Juror Attitudes and Defendant Appearance on Legal Decision-Making

According to the dangerous decisions theory (Porter, S., & ten Brinke, L. (2009). Dangerous decisions: A theoretical framework for understanding how judges assess credibility in the courtroom. Legal and Criminological Psychology, 14(1), 119–134), intuitive evaluations of facial trustworthiness influence the interpretation of evidence presented in courtroom settings. This study examined the role of individual differences in this process. Participants were presented with crime narratives, accompanied by a photograph of the supposed defendant that was previously rated as highly trustworthy or untrustworthy. Following presentation of the evidence in each case, participants rated the defendant's culpability and then completed questionnaires assessing potential biases. Participants endorsing justice–fairness were more likely to exonerate an untrustworthy-looking defendant, but less likely to exonerate a trustworthy-looking one. Individuals who held a strong racial bias, by contrast, were less likely to be influenced by exonerating evidence, specifically for untrustworthy-looking defendants. These results suggest that faces varying in trustworthiness activate particular biases, and a tunnel vision approach to decision-making that may lead to wrongful convictions in a legal setting.     

Knowledge of Eyewitness Identification Issues: Survey of Public Defenders in New South Wales

This article explores the legal and clinical processes underpinning gender differences in Australian Family Court statistics which show that mental illness is the primary reason for limiting mothers’ contact with their children. Analysis of a sample of published judgments from 2009 to 2011 featuring mental illness and outcomes of limited child contact identified that allegations of child sex abuse were a common feature of cases in which mothers’ child contact was limited. Four illustrative cases are presented with a focus on the processes used in the identification of mental illness. The data indicate that there are different patterns of response to cases where a party has a previously diagnosed mental illness and cases where mental illness is invoked as a possible explanation for child sex abuse allegations. These identified patterns of differentiated response provide a possible explanation for the gender disparity in Family Court reasons for limiting child contact on the grounds of mental illness.     

Adverse drug and device reactions in the oral cavity: Surveillance and reporting

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, 48 percent of Americans (roughly 144 million people) used at least one prescribed medication in the preceding month; 11 percent used five or more. The authors describe the U.S. Food and Drug Administration's (FDA's) MedWatch program, the safety surveillance system for drugs and devices in the United States, and the dentist's role with regard to voluntary reporting of adverse effects (AEs). They also identify the most frequent AEs in the oral cavity as reported in the FDA Adverse Event Reporting System (FAERS).MethodsThe authors reviewed the literature regarding MedWatch, and they mined data in the FAERS public database for the 100 most commonly prescribed medications and their associated AEs.ResultsPharyngitis was the most common AE. Cough, dysgeusia and dysphagia also were common.ConclusionThe MedWatch program and its related databases contain useful information about AEs of pharmaceuticals and devices manifested in the oral cavity. Increased participation in the reporting of suspected adverse reactions will improve the national surveillance system and ultimately will protect patients' safety.Practical ImplicationsAs pharmaceutical consumption increases exponentially for a growing segment of the population, and as innovation in dental technology and devices flourishes, dentists have a distinct role in safeguarding patients' well-being. Promptly reporting AEs in the oral cavity improves quality of care and protects patients' well-being.     

Inferior Alveolar Neurosensory Deficiency Associated With Placement of Dental Implants

Background: This study reports and analyzes a large series of patients with neurosensory deficiency related to the placement of dental implants (DIs) and resulting in liability claims (LCs). Methods: From 1998 to 2009, there were 92 LCs related to persistent altered sensation post DI placements in Israel. Patients’ demographics, year and source of LCs, interval between the procedure that resulted in a neurosensory deficiency and the LC, qualifications of the surgeon, preoperative imaging modality, DI length, available alveolar bone for DI placement, placement site, timing of DI placement (immediately after tooth extraction or after socket healing), and treatment after the diagnosis of neurosensory deficiency were recorded and analyzed. Results: There were 21 cases during the first 5 years of the study (mean 4.2/year) and 63 cases (mean 12.6/year) over the following 5 years. Thirty LCs were issued during the second postoperative year and 15 LCs after >5 years. Most LCs (76%) involved procedures that were planned and performed according to radiographs and 24% after computed tomography. Sixty‐five percent of the LCs were performed by general dental practitioners and 35% by specialists. More than one DI was performed during the surgical procedure that resulted in a neurosensory deficiency in 73 LCs (79.3%), and the DI was >10 mm in 55 (59.8%) cases. Conclusions: LCs for DIs that result in a neurosensory deficiency pose a legal risk to the practitioner long after the injury has occurred.     

HIV and dentistry in Australia: clinical and legal issues impacting on dental care

The number of people in Australia living with HIV is growing. This reflects a consistent rate of new HIV infections combined with an increased life expectancy of people with HIV. Dentists are ideally positioned to identify, manage and treat HIV-associated oral manifestations and have a responsibility to themselves and to their patients to be up-to-date with the evolving area of HIV and related issues. Those issues include medico-legal implications associated with HIV diagnosis and treatment. This article provides a review of the current clinical and medico-legal aspects of HIV in Australia. The oral manifestations of HIV can be divided into five categories: microbiological infections (fungal, bacterial and viral); oral neoplasms; neurological conditions; other oral conditions that may be associated with HIV infection; and oral conditions associated with HIV treatment. Current treatment options in the scope of general dental practice are outlined. Medico-legal issues related to the management of patients with HIV are explored, including rights of the patient regarding disclosure of HIV status; an algorithm for the management of a patient with signs or symptoms indicating possible HIV infection, including referral pathways; and an algorithm for dealing with patient management and referral issues.     

中药老字号专有技术的法律特征及保护对策

目的：尝试建立法律保护体系对中药老字号企业专有技术的有效覆盖。方法：检索相关数据和研究相关文献,在厘清中药老字号专有技术的法律特征的基础上,分析中药老字号企业专有技术保护存在的问题。结果与结论：分析发现目前我国中药老字号专有技术保护存在以下问题：专利对老字号保护效用欠缺;技术秘密保护手段受挤压;商标保护形式未得到中药老字号的重视;行政保护作用受限。而解决中药老字号专有技术的保护问题,有必要从完善专利、技术秘密和行政保护制度和商标保护等几个维度实现。