Hospital committee proceedings and reports: their legal status.

This Article examines the legal status of hospital committee proceedings and reports, focusing on how they may be used in a medicolegal context. Specific topics dealt with include the hospital medical staff in legal perspective, the concept of institutional responsibility, liability considerations arising from committee work, and the discovery and admissiblity of committee records in litigation cases. The author concludes that the danger of committee members facing liability for their activities is slight and that the fear that these reports and proceedings may be subject to discovery or be admissible into evidence in subsequent litigation is remote because candid and conscientious evaluations of clinical practices within every institution are essential and, therefore, public policy must encourage such evaluations by maintaining the confidentiality of committee activities.     

A structure for organizational learning

The Journal of Technology Transfer - Japanese manufacturers have demonstrated for the past 20 years that continuous learning within their organizations has been, and continues to be, fundamental to...     

Medium‐Chain Acyl‐CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity

Medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency is a rare but important component of the differential diagnosis for adults with a history of premortem mental status changes and the postmortem finding of hepatic steatosis. This case report describes a 30‐year‐old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as MCAD deficiency and take action accordingly.     

Emergence of fentanyl-related deaths in Travis County,Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit “Xanax” (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.     

Conceptualizing Usage in Voting Behavior for Political Marketing: An Application of Consumer Behavior

Political marketing has borrowed and adapted many terms from mainstream marketing, such as image management (segmentation, targeting, and positioning) and consumer (voter). In marketing, the terms “user” and “usage” have been established, yet their application to political marketing is less clear. This paper analyzes the feasibility and usefulness of usage in the political context. Drawing from the literature on usage, a model is developed and applied to four voting environments: Britain, Australia, Russia, and Belarus. One critical factor that emerges is the concept of choice, whereby the voter may chose to indicate their preference for one party yet be forced to use a different party as chosen by collective choice. Another issue is the potential for habitual voting behavior to limit decision making. It is concluded that usage needs to be contextualized specifically for political marketing.