Legal Responsibilities of Physicians When They Diagnose Hepatic Encephalopathy

Vierling, John M.

doi:10.1016/j.cld.2015.04.004

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…While currently there is no current firm legal basis for doing so, the need to address this issue is an ethical one towards preventing car crashes and violations 21–23 . Indeed in a recent survey, only a minority of clinicians were aware of their local driving laws 24 .…”

Section: Discussionmentioning

confidence: 99%

In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving

Lauridsen

Thacker

White

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Further, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis and evaluated changes in simulated driving skills and MHE status after 1 year. Methods We performed a study of outpatients with cirrhosis (n=205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6 months) seen at the Virginia Commonwealth University and McGuire Veterans Administration Medical Center, from November 2008 through April 2014. All participants were given paper-pencil tests to diagnose MHE (98 had MHE, 48%), and 163 patients completed a standardized driving simulation. Data were collected on traffic violations and automobile accidents from the Virginia Department of Motor Vehicles and from participants’ self-assessments when they entered the study, and from 73 participants 1 year later. Participants also completed a questionnaire about alcohol use and cessation patterns. The driving simulator measured crashes, run-time, road center and edge excursions, and illegal turns during navigation; before and after each driving simulation session, patients were asked to rate their overall driving skills. Drivers were classified as safe or unsafe based on crashes and violations reported on official driving records; simulation results were compared with real-life driving records. Multivariable regression analyses of real-life crashes and violations was performed using data on demographics, cirrhosis details, MHE status, and alcohol cessation patterns, at baseline and at 1 year. Results Drivers categorized as unsafe had more crashes and made more illegal turns on the driving simulator than drivers categorized as safe; a higher proportion of subjects with MHE were categorized as unsafe drivers at baseline (16%) than subjects without MHE (7%, P=.02), and at 1 year follow up (18% vs 0%, P=.02). Alcohol cessation within less than 1 year and illegal turns during simulator navigation tasks were associated with real-life automobile crashes and MHE on in regression analysis; road edge excursions in the simulator were associated with real-life traffic violations. Personal assessment of driving skills improved after each simulation episode. Conclusions In a study of 205 patients with cirrhosis, we associated results from driving simulation tests with real-life driving records and MHE. Traffic safety counselling should focus on patients with cirrhosis who recently quit consuming alcohol and perform poorly on driving sim...

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Section: Discussionmentioning

confidence: 99%

In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving

Lauridsen

Thacker

White

et al. 2016

Clinical Gastroenterology and Hepatology

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“…In equation (1), 𝑎 0 , 𝑎 1 , 𝑎 2 , ⋯ , 𝑎 𝑛−1 is the regression parameter to be estimated, Δ is the chance error, and the linearity of the linear regression model is for the regression parameter 𝑎 𝑖 to be estimated. For some regression models in which the independent variables are nonlinear, they can usually be converted to linear ones by variable substitution.…”

Section: Linear Regression Modelmentioning

confidence: 99%

“…Condition (1) indicates that it is a regression problem with deterministic independent variables. Condition (2) indicates that the mean of the random error is zero, and there is no systematic error.…”

Section: Regression Of Teaching Data Indicatorsmentioning

confidence: 99%

“…Jurisprudence is the basic course for law majors in higher education institutions, which is the knowledge system for studying the basic theory and methodology of law, and it needs to provide basic methodological support for departmental jurisprudence and to think arguments for legal practice [1][2][3][4]. Since jurisprudence is the study of the general law science of legal phenomena, it is highly theoretical, abstract, and generalized, which determines that the teaching of jurisprudence is different from other departments of jurisprudence [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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A digital teaching model for jurisprudence courses based on a linear regression model

Luo

2023

Applied Mathematics and Nonlinear Sciences

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To cultivate highly qualified legal talents, this paper designs a digital teaching model for jurisprudence courses based on a linear regression model to enhance the teaching effectiveness of jurisprudence courses. Regression modeling deals with the correlation between teaching variables and establishes a linear regression model in the design process. The sample likelihood function is constructed to output the teaching regression coefficients and the metrics of the model fitting effect, the raw data are dimensionless, and the dimensionless model covariance is calculated according to the nature of teaching expectations. On this basis, the digital teaching model of the jurisprudence course was explored to optimize digital teaching resources, adjust the structure, and establish a student evaluation mechanism. To verify the feasibility of this teaching model, its teaching effect was tested. The results showed that the digital teaching model of jurisprudence based on linear regression led to a teaching level of 2.6594%, and students’ mastery of knowledge reached 2.7952%. And the number of students with failing grades decreased by 480%, and the number of students receiving excellent grades increased by 3.53 times, with a teaching quality rating range of [3.95-4.39] points. It can be seen that the linear regression model promoted the jurisprudence course to break through the traditional teaching model and further improve the teaching quality of the jurisprudence course.

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“…However, none of the motor vehicle codes mentioned HE specifically for automatic reporting in any state and permissive reporting and no reporting statues were found in 35(70%) and 9(18%) states respectively and out of these only some states 25(44%) offered the legal immunity to the physician[83]. However, a recent study reports that 8(16%) states require physicians to report cognitively impaired drivers mandatorily adding Georgia and Maryland to the earlier list with there being legal immunity extended to physician in all the states except Georgia from this list[84]. In the accompanying editorial to the Cohen article, Bajaj et al argue that even as HE is not specifically mentioned in state DMV’s but patients with recent OHE, but not necessarily CHE, will come under the ambit of people with “lapses of consciousness.” And as physicians are not trained to assess fitness to drive and do not act on behalf of the state to do so, but if the provider is concerned, the best course of action is to ask the patient to stop driving with involvement of the caregiver in the discussion and to refer the difficult cases to the proper driving authorities for resolution.…”

Section: What Are the Ethical And Legal Responsibilities For Physicians?mentioning

confidence: 99%

Covert Hepatic Encephalopathy

Shaw

Bajaj²

2017

Journal of Clinical Gastroenterology

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Liver cirrhosis is a public health problem and hepatic encephalopathy (HE) is one of its main complications, which can be either overt meaning thereby evident and readily diagnosed, or covert/minimal (CHE) needing psychometric testing for diagnosis. Patients with CHE hepatic encephalopathy have deficits in multiple domains including visuo-spatial assessment, attention, response inhibition, working memory, along with psychomotor speed to name a few areas. These patients have poor navigational skills, get fatigued easily and demonstrate poor insight into their driving deficits. The combination of all these leads them to have poor driving skills leading to traffic violations and crashes as demonstrated not only on the simulation testing but also in real life driving events. There are multiple psychometric tests for CHE testing but these are not easily available and there is no uniform consensus on the gold standard testing as of yet. It does not automatically connote that all patients who test positive on driving simulation testing are unfit to drive. The physicians are encouraged to take driving history from the patient and the care- givers on every encounter and focus their counseling efforts more on patients with recent history of traffic crashes, with abnormal simulation studies and history of alcohol cessation within last year. As physicians are not trained to determine fitness to drive, their approach towards CHE patients in regards to driving restrictions should be driven by ethical principles while as respecting the local laws.

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Legal Responsibilities of Physicians When They Diagnose Hepatic Encephalopathy

Cited by 4 publications

References 17 publications

In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving

In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving

A digital teaching model for jurisprudence courses based on a linear regression model

Covert Hepatic Encephalopathy

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