Medicine and Health Sciences Commons^™

Depression: The Often Overlooked Sequela Of Head Trauma, Samuel D. Hodge Jr., Jack E. Hubbard

Cleveland State Law Review

Depression is a common sequela of head trauma. Approximately half of all individuals with a cranial injury will experience depression within the first year, regardless of the severity of the injury. The ailment is characterized clinically as a mood disorder, often associated with intense feelings of sadness. However, depression is more complex than mood disorders, as many mental and bodily complaints—such as insomnia, fatigue, anxiety, appetite changes, aches and pains, and lack of interest in previously enjoyable activities—are associated with depression. These intense feelings, particularly when combined with despair and hopelessness, can lead to suicide, a dreaded potential complication of …

Healthcare And Its Impact On Nurses: The United States Vs. The United Kingdom, Alexandria Colovos

Mahurin Honors College Capstone Experience/Thesis Projects

Currently, in the United States, the topic of healthcare reform is in the back of everyone’s mind. What will come of our healthcare system? Will the cost of healthcare decrease? Will patients have better access to care? With this Capstone Experience/Thesis, I wanted to explore the differences between the current healthcare system that we have in the United States, to the nearly seventy-year-old National Health Service (NHS) in the United Kingdom, which provides healthcare to all. The NHS is free at the point of care and is funded by taxation. To understand if such a system would work in the …

Law Library Blog (November 2017): Legal Beagle's Blog Archive, Roger Williams University School Of Law

Law Library Newsletters/Blog

No abstract provided.

Actavis And Error Costs: A Reply To Critics, Aaron S. Edlin, C. Scott Hemphill, Herbert J. Hovenkamp, Carl Shapiro

Aaron Edlin

The Supreme Court’s opinion in Federal Trade Commission v. Actavis, Inc. provided fundamental guidance about how courts should handle antitrust challenges to reverse payment patent settlements. In our previous article, Activating Actavis, we identified and operationalized the essential features of the Court’s analysis. Our analysis has been challenged by four economists, who argue that our approach might condemn procompetitive settlements.As we explain in this reply, such settlements are feasible, however, only under special circumstances. Moreover, even where feasible, the parties would not actually choose such a settlement in equilibrium. These considerations, and others discussed in the reply, serve to confirm …

Mid-Atlantic Ethics Committee Newsletter, Fall 2017

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer Edd

Law Faculty Scholarship

[Excerpt]: "INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects.

A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD) …

Aligning Opioid Prescribing Pathways, Andrea Lai, Outpatient Pharmacy, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488.

After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were …

The Fight Against Breast Cancer: A Policy And Programmatic Approach, Nandi Robinson

Master's Projects and Capstones

Abstract

Breast cancer continues to remain a significant health issue for women. Previously thought to only occur among postmenopausal women, breast cancer has impacted women of different ages; and rates of breast cancer have various impacts among different ethnic groups. For women living in a toxic environment, many of them have become the new wave of breast cancer cases. Screening and detection have succeeded in decreasing mortality rates. However, more research is needed in finding an efficient method of treatment. In the effort to assist in the fight against breast cancer through a policy and programmatic angle, I am fulfilling …

Going Online With Telemedicine: What Barriers Exist And How Might They Be Resolved, Pierron Tackes

Oklahoma Journal of Law and Technology

No abstract provided.

Does Liberalizing State Nurse Practitioner Scope Of Practice Laws Affect The Primary Care Provider Composition And Productivity In Community Health Centers?, Jeongyoung Park, Xinxin Han, Ellen T. Kurtzman

Health Workforce Research Center Publications

The state scope of practice (SOP) laws determine the range of services nurse practitioners (NPs) can provide and the extent to which they can practice independently. This has been a hot topic amid concerns about primary care provider shortages in light of health reform coverage expansion. Many states consider liberalizing NP SOP laws in an effort to expand primary care capacity. As the demand for primary care increases, NPs are expected to have an active role in meeting primary care needs. The purpose of this study was to examine the effects of expanded nurse practitioner (NP) scope of practice (SOP) …

Error Disclosure Training And Organizational Culture, Jason M. Etchegaray, Thomas H. Gallagher, Sigall K. Bell, William M. Sage, Eric J. Thomas

Faculty Scholarship

Objective. Our primary objective was to determine whether, after training was offered to participants, those who indicated they had received error disclosure training previously were more likely to disclose a hypothetical error and have more positive perceptions of their organizational culture pertaining to error disclosure, safety, and teamwork.

Methods. Across a 3-year span, all clinical faculty from six health institutions (four medical schools, one cancer center, and one health science center) in The University of Texas System were offered the opportunity to anonymously complete an electronic survey focused on measuring error disclosure culture, safety culture, teamwork culture, and intention to …

Mid-Atlantic Ethics Committee Newsletter, Summer 2017

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Analysis Of The Proposed Tpp-Related Patent Linkage System In Taiwan, Ping-Hsun Chen

Journal of Law and Health

The Trans-Pacific Partnership (TPP) Agreement mandates member states to implement a patent linkage system vested in Article 18.53. To successfully join the TPP Agreement, Taiwan has begun the legislation of a patent linkage system by proposing an amendment for the Pharmaceutical Affairs Act. Article 18.53 requires a member either to adopt a notification mechanism under Paragraph 1 or to stay the issuance of marketing approval under Paragraph 2. But, Taiwan’s proposal includes both measures. Taiwan’s patent linkage system allows a pioneer drug company to register patents claiming (a) a material, (b) a combination or formula, or (c) pharmaceutical use. The …

Supporting Mothers With Mental Illness: Postpartum Mental Health Service Linkage As A Matter Of Public Health And Child Welfare Policy, Jesse Krohn, Msed, Jd, Meredith Matone, Drph, Mhs

Journal of Law and Health

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young mothers—a far …

Germ-Line Gene Editing And Congressional Reaction In Context: Learning From Almost 50 Years Of Congressional Reactions To Biomedical Breakthroughs, Russell A. Spivak, J.D., I. Glenn Cohen, J.D., Eli Y. Adashi, M.D., M.S.

Journal of Law and Health

On December 18, 2015, President Obama signed into law a policy rider forestalling the therapeutic modification of the human germ line. The rider, motivated by the science’s potential unethical ends, is only the most recent instance in which the legislature cut short the ongoing national conversation on the acceptability of a developing science. This essay offers historical perspective on what bills were proposed and passed surrounding four other then-developing scientific breakthroughs—Recombinant DNA, in vitro fertilization, Cloning, Stem Cells—to better analyze how Congress is, and should, regulate this exciting and promising science.

Circling The Drain: Regulating Nutrient Pollution From Agricultural Sources, William Gutermuth

Journal of Law and Health

The 2014 Toledo, Ohio tap water ban has, at least temporarily, put a spotlight on United States water supplies. Consequently, many Americans have begun to take a closer look at the quality of the fresh water bodies being used to supply tap water to their homes. Therefore, this Note analyzes the problems currently threatening the lakes, rivers, and other surface waters that are the source of fresh drinking water for huge populations in the United States. Part II examines the problem of nutrient pollution and explains the harmful effects it has on human health. Part III provides an overview of …

Pharmaceutical Federalism, Patricia J. Zettler

Faculty Publications By Year

There is growing interest in states regulating pharmaceuticals in ways that challenge the U.S. Food and Drug Administration’s (FDA) federal oversight. For example, in 2013 Maine enacted a law to permit the importation of unapproved drugs, reflecting concerns that federal requirements are too restrictive, while in 2014 Massachusetts banned an FDA-approved painkiller, reflecting concerns that federal requirements are too lax. This Article provides an account of this recent state interest in regulating drugs and considers its consequences. It argues that these state regulatory efforts, and the nascent litigation about them, demonstrate that the preemptive reach of the FDA’s authority extends …

A Whole Lot Of Shakin' Going On: Movement Disorders Caused By Brain Trauma, Jack E. Hubbard, Samuel D. Hodge, Jr.

Cleveland State Law Review

There has been a lot of publicity directed to the consequence of brain trauma, such as headaches forgetfulness, irritability, and depression. That is only part of the sequelae. A little-known but challenging result of brain trauma is the development of or aggravation of a movement disorder such as a tremor, dystonia, a tic, or Parkinson’s Disease.

A movement disorder is an all-encompassing term that refers to a constellation of neurological issues that cause involuntary or voluntary movements or abnormal positioning of a body part. Various regions of the brain interact with each other to control movements of the body. If …

Do Desperate Times Really Call For Desperate Measures? The Ethical Dilemma Behind The Regulation And Use Of Experimental Drugs, Lauren Kuehn

Notre Dame Journal of International & Comparative Law

This Note will argue that, unlike what many patients believe, the U.S. Food and Drug Administration (FDA) plays an invaluable and imperative role in seeking the efficacy and safety of new treatment options and drugs. The balance of interests between those who are terminally ill, who wish to see increased access to unapproved medicines; the general public, who has an interest in preserving the drug approval process; and the FDA, who has been mandated by law to safeguard the safety of the general public, creates a tension that will continue to go unresolved. Thus, the patients who continue to advocate …

Legal Mapping Analysis Of State Telehealth Reimbursement Policies, Kate E. Trout, Sankeerth Rampa, Fernando A. Wilson, Jim P. Stimpson

Publications and Research

Background: There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database. Introduction: We describe the creation of a legal mapping database of state-level policies related to telehealth reimbursement of healthcare services. Trends and characteristics of these policies are presented.

Materials and Methods: Information provided by the Center for Connected Health Policy was used to identify state-wide laws and regulations regarding telehealth reimbursement. Other information was retrieved using: (1) LexisNexis database, (2) Westlaw database, and (3) retrieval …

Rape Crisis Center Professionals' Perception Of Sexual Violence Policy: A Qualitative Analysis, Stephanie Manieri

Scholarly and Creative Works Conference (2015 - 2021)

The purpose of this study is to collect information about the perceptions of rape crisis center professionals regarding the current policies surrounding sexual violence crimes that victimize people over the age of 18. This research aims to gather information about effective and ineffective policies from professionals who are first- responders to sexual assaults.

How Healthcare And Culture Impacts Cost And Experience Of Sex Reassignment Surgery In Various Sites Of Europe, Carson Shaw

Student Symposium

My presentation reviews how more widely accessible forms of health insurance impact a trans person’s ability to transition in the Netherlands, Germany, the Czech Republic, and Poland. This includes the steps and processes they must go through, the pressures of transitioning, and the overall costs of sex reassignment surgery, both socially and financially. It also takes into account the cultural stressors of transitioning as well as how different types of insurances are more or less beneficial to people in each of these countries. In order to achieve this research, I performed interviews and lectures on trans experience in each country …

Obamacare: Under The Knife, Kylan Rutherford

Marriott Student Review

President Trump and Congress have tried and failed to pass through a replacement plan for Obamacare. This article details why this effort failed, and several issues extant in Obamacare that may move the law toward insolvency. These issues are the mandate, guaranteed issue, and the 'risk corridor' funding set up to back struggling insurance companies.

Projected Financial Losses Experienced By Community Health Centers Under A Scenario Of Major Cuts In Key Sources Of Federal Funding: 2018-2022, Avi Dor, Eric Luo, Ali Moghtaderi, Anne Rossier Markus

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Congress is currently considering options to significantly reduce federal funding for the Medicaid expansion and the Marketplace subsidies implemented under the Affordable Care Act (ACA). Separately, the Health Centers Fund, which currently accounts for 70% of all federal health center grant funding, is set to expire in September 2017. These potential changes in federal funding could have a dramatic impact on health centers and the communities they serve. The purpose of this brief is to simulate the potential combined impact of these major changes in federal funding that will directly affect community health centers. Secondarily, this brief also assesses the …

How Could Repealing Key Provisions Of The Affordable Care Act Affect Community Health Centers And Their Patients?, Sara J. Rosenbaum, Jessica Sharac, Thao-Chi Tran, Anne Rossier Markus, David Reynolds, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Analyses of repeal of the Affordable Care Act (ACA) have tended to focus on coverage. This study, which gauges the potential effects of repealing certain ACA provisions, looks at the question of primary health care access itself, with a focus on medically underserved communities. A survey developed and fielded in early 2017 asked community health centers to estimate the impact of ending the Health Centers Fund established under the ACA as well as ending expanded Medicaid coverage and subsidies designed to make private insurance affordable for lower income patients. Forty-one percent of health centers responded; 69 percent were located in …

Marijuana Regulation And Federalism, John M. Greabe

Law Faculty Scholarship

[Excerpt] "Federal law makes the cultivation and use of marijuana illegal for all purposes. Yet, over the past two decades, 28 states plus the District of Columbia have legalized marijuana for medicinal purposes, and eight states plus the District of Columbia have legalized it for recreational purposes. Marijuana regulation thus provides a useful and timely example for exploring the ways in which the distribution of power between the federal government and the states can facilitate policy change."

Surgical Consent And The Importance Of A Substitute Decision-Maker: A Case Study, Julia Gilbert, Brigid M. Gillespie

Journal of Perioperative Nursing

At law, all individuals are presumed to have the legal capacity to provide consent or refusal of treatment unless there are clinical indications of cognitive impairment. Once concerns are raised regarding the ability of an individual to provide valid consent for a surgical procedure, the use of a substitute decision-maker may be necessary. In this paper, we present an analysis of a clinical case study to illustrate the principles of valid consent. As part of the analysis, we discuss the issues relating to obtaining valid consent for an operative surgical procedure from an elderly client with obvious cognitive impairment. We …

The Double-Edged Sword Of Health Care Integration: Consolidation And Cost Control, Erin C. Fuse Brown, Jaime S. King

Erin C. Fuse Brown

The average family of four in the United States spends $25,826 per year on health care. American health care costs so much because we both overuse and overpay for health care goods and services. The Affordable Care Act's cost control policies focus on curbing overutilization by encouraging health care providers to integrate to promote efficiency and eliminate waste, but the the cost control policies largely ignore prices. This article examines this overlooked half of health care cost control policy: rising prices and the policy levers held by the states to address them. We challenge the conventional wisdom that reducing overutilization …

Opinion: The Mental Health Parity And Addiction Equity Act: What Parity Means For New Hampshire, Lucy C. Hodder

Law Faculty Scholarship

[Excerpt] "New Hampshire lawyers can help clients and colleagues with mental health or substance use disorders by advising individuals how to overcome barriers to insurance coverage for treatment, and encouraging them to pursue state and federally mandated internal, external and expedited appeal opportunities when denied coverage."

The Economic And Employment Consequences Of Repealing Federal Health Reform: A 50 State Analysis, Leighton Ku, Erika Steinmetz, Erin Brantley, Brian K. Bruen

Health Policy and Management Issue Briefs

Donald Trump and Congressional leaders have stated their intent to repeal the Patient Protection and Affordable Care Act (ACA or Obamacare). This report examines the consequences of repealing two key elements: (1) federal premium tax credits that help low and middle income Americans afford insurance policies bought through the Health Insurance Marketplaces (exchanges) and (2) federal payments to states for expansions of Medicaid eligibility for low-income adults. Congress passed similar legislation (H.R. 3762) in late 2015, which President Obama vetoed.

This report analyzes how the repeal of these policies could affect state-level employment, economies and fiscal conditions. If tax credits …