A Proposed Approach to Allegations of Sexual Boundary Violation in Health Care

BACKGROUND

Sexual boundary violations in the health care setting cause harm for victims, threaten an organization's culture, and create extraordinary organizational risk. The inherent complexities of health care organizations present unique challenges for the initial triage and response to reports of alleged violations.

METHODS

A group of experts with experience in law, leadership, human resources, medicine, and health care operations identified processes for organizations to triage and implement an early response to allegations of sexual boundary violations. The group reviewed a series of 100 reports of alleged violations described by patients and coworkers from a 200-hospital professional accountability collaborative to identify the elements of an ideal initial triage and management approach.

RESULTS

The group identified three domains to guide early triage and response to reports of boundary violations: (1) severity and acuity of the alleged violation; (2) roles and relationship(s) of the complainant, respondent, and other affected individuals; and (3) contextual information such as prior activity or other mitigating factors. The group identified leadership engagement; coordinated responses; clear articulation of values, policies, and procedures; aligned data reporting; thoughtful reviews; and securing appropriate resources as essential elements of an organization's response.

CONCLUSION

A structured systematic approach to classify and respond to allegations of sexual boundary violation is described. The initial response should be guided by assessment of the severity and timing of the reported behavior, followed by assessment of roles and responsibilities with involvement of all relevant stakeholders. Contextual issues and special circumstances of relevance should be identified and incorporated into the response. Systems to identify, store, and retrieve behavior of concern should be improved and integrated.

Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders

OBJECTIVES

Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD).

METHODS

We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System program. Cases (physicians with probable or possible NCD) and two comparison groups of 60 physicians each (matched for age/sex and site/number of unsolicited patient complaints) were identified from 33,814 physicians practicing at study sites. We compared the frequency of words in patient complaints related to an NCD diagnostic domain between cases and our two comparison groups.

RESULTS

Individual words were all statistically more likely to appear in patient complaints for cases (73% of cases had at least one such word) compared to age/sex matched (8%, p < 0.001 using Pearson's χ² test, χ² = 30.21, df = 1) and site/complaint matched comparisons (18%, p < 0.001 using Pearson's χ² test, χ² = 17.51, df = 1). Cases were significantly more likely to have at least one complaint with any word describing NCD than the two comparison groups combined (conditional logistic model adjusted odds ratio 20.0 [95% confidence interval 4.9-81.7]).

CONCLUSIONS

Analysis of words in unsolicited patient complaints found that descriptions of interactions with physicians with NCD were significantly more likely to include words from one of the diagnostic domains for NCD than were two different comparison groups. Further research is needed to understand whether patients might provide information for healthcare organizations interested in identifying professionals with evidence of cognitive impairment.

Investigation of the localization of dehydroepiandrosterone sulphotransferase in adult rat kidney

Sulphotransferases are a family of enzymes involved in the metabolism and detoxification of many compounds. Dehydroepiandrosterone (DHEA) sulphotransferase (DHEA-ST), which catalyzes the sulphation of steroids such as DHEA, is present in rat liver and adrenals. Sulphated steroids are present in urine, and many other enzymes which catalyze detoxification reactions are found in the kidney. There are not previous reports of DHEA-ST localization in adult kidney. The activity of DHEA-ST was investigated in adult rat kidney by a radio-isotope assay with DHEA as the substrate. Western blotting was used to assess protein expression, and the localization of DHEA-ST was investigated by immunohistochemistry. The DHEA-ST activity in rat kidney was found to be approximately four times less than that in rat liver. In female kidney, the activity was 1.46 +/- 0.06 nmol/min/microg, and in male kidney the activity was 1.29 +/- 0.09 nmol/min/microg. Investigation of protein expression gave a single band at 35 kDa which signified the presence of this enzyme in both male and female adult rat kidneys. Localization studies showed positive staining at high intensity in the collecting ducts of the medulla and in the S3 portion of the proximal convoluted tubule in the cortex. The distribution within the proximal tubules was restricted to the brush border. Reverse-transcriptase polymerase chain reaction showed DHEA-ST RNA expression in adult rat kidney and liver. The presence of this enzyme and its location in the kidney may suggest that in situ sulphation via DHEA-ST may play an important role in the excretion of endogenous and exogenous compounds.

Reading upper and lower case on Viewdata

The times taken to read aloud six passages of nonsense text presented in upper or lower case on an ITT Viewdata receiver were compared. Contrary to the usual finding with printed material, upper case text did not significantly retard reading.

The thermal decomposition of alkali metal chlorochromates, MCrO3Cl

A systematic study of the thermal decomposition of potassium chlorochromate, KCrO3Cl, has been made, and less complete studies with the corresponding lithium, rubidium and caesium compounds. Three major processes occur, characterized by the formation of chromyl chloride, the mixed oxides, MCr308, and of chromium(III) oxide. In each case there is simultaneous production of dichromate and alkali chloride. ��� Chromyl chloride formation increases with rising temperature but decreases as the cationic radius increases. It is the major reaction when KCr3OCl is heated under vacuum at 400°C. Decomposition with the formation of M2Cr2O7 and MCr3O8 in equimolar amounts occurs below the melting point of KCrO3Cl, but, as the temperature of decomposition is raised, a reaction producing these products in the molar ratio 1 : 2 becomes more important. In the presence of air and alkali halide MCr3O8 can oxidize slowly to form dichromate, or at higher temperatures decompose to dichromate, chromium(III) oxide and oxygen. It can also react with alkali halide to form dichromate, chlorochromate and chromium(III) oxide. Decomposition with the formation of chromium(III) oxide is a secondary reaction involving the preliminary formation of MCr3O8 or chromyl chloride. ��� The temperatures and enthalpy increases for the solid state transitions and the fusion of KCrO3Cl, RbCrO3Cl and CsCrO3Cl are reported.

Preparation and properties of alkali metal chromium oxides of the formula MCr3O8

Alkali metal chromium oxides of the formula MCr3O8 can be prepared by thermal decomposition of chlorochromates, trichromates and tetrachromates and by heating chlorochromates or alkali halides with chromium(V1) oxide. The preparation of lithium chlorochromate, LiCrO3Cl, is described and new metastable phases of RbCr2O8 and CsCr3O8 are reported. The temperatures, products and enthalpies of decomposition for LiCr3O8, KCr3O8, RbCr3O8 and two forms of CsCr3O8 have been determined. The decomposition is modified in the presence of alkali halides.

Note on perceived personality of a nude

Separate sub-groups of 18 male and 18 female Ss rated either the face only or the whole torso of underclothed and nude stimulus persons on semantic differential scales. For the female respondents, the nude female SP was rated higher on activity and potency and lower on evaluation by Ss who saw the whole torso.