ABSTRACT: Medication errors can be detrimental to patient safety and contribute to additional costs in healthcare. The United States has seen a steady increase in internationally-educated nurses (IENs) entering the nursing workforce. The current study builds upon the existing research examining the relationship between IENs and medication errors by controlling for confounding factors and testing whether IENs were more likely to make multiple medication errors compared to USENs. This study was a quasi-case control study. The 2006 and 2010 medication error incident data from hospital risk management departments were used. The final sample was 1,773, representing 788 registered nurse in the case group and 985 registered nurses in the control group. Multivariable analyses were conducted to examine single medication error, multiple errors, and consequence of medication errors, in comparing the IENs to USENs. IENs tended to have multiple errors more often than USENs in 2006 (31.7% for IENs and 20.5% for USENs, p = 0.03), but these differences became marginally significant after combining both years of data and completing the multivariable models adjusting for covariates (Odds ratio = 1.38, p = 0.06). No significant differences in making a single error and medication error consequences were observed between IENs and USENs. Although no significant differences between IENs and USENs in having medication error incidents were observed, IENs might be more likely to have multiple medication error incidents in a year compared to USENs. Policies that encourage targeted orientation addressing implicit belief systems about the nursing role and explains patient safety expectations as well as procedures for medication administration may be beneficial for IENs. Supportive leadership that is culturally competent, ensures ongoing continuing education in pharmacology, and provides culturally appropriate incentives for self-reporting medication errors are important.

ABSTRACT: The purpose of this theoretical policy analysis report was to determine if antitrust laws should be based upon concrete wrongful conduct and should not force the health care industry to adopt defensive, cumbersome business practices that actually impede their ability to compete. The role of antitrust is to ensure that competition is preserved and protected so that it can be harnessed. It is in the government interest to supports efforts that bring more competition to the health insurance marketplace that lowers costs, expand choice, improve quality; with the role of antitrust to ensure that competition is preserved and protected to help improving the U.S. health care system, together with regulation to expand coverage and control cost of health care for general population.  Therefore, antitrust cases and sanctions need to be tightly tied to defensible theories of wrongful conduct in order to properly reflect what society thinks is wrong and clarify what is punishable conduct.

ABSTRACT: African-Americans represent 12% of the total United States population, but account for more recent human immunodeficiency virus (HIV) diagnoses (44%), people estimated to be living with HIV disease (40%), and HIV-related deaths (44%) than any other racial/ethnic group in the United States. This paper examines the prevalence of HIV testing and its correlates among African Americans during the pre-exposure HIV prophylaxis era. Secondary analysis of the 2016 National Health Interview Survey (NHIS) data was carried out using descriptive and logistic regression analyses to determine the prevalence of recent HIV testing and factors associated with HIV testing. Of the 33,028 individuals included in the Sample Adult Core, 3,777 (11.43%) were African Americans, the sample for this study. Among them, an estimated 2,050 respondents (54.3%) reported to have ever tested for HIV. Respondents aged 25 to 34 years of age were more likely to have ever tested for HIV compared to individuals aged 25 years or younger (OR: 2.47, P<0.001). Respondents who had a paid employment were more likely to have ever tested for HIV compared to those who were unemployed (OR: 1.74, P<0.05). There was no difference in HIV testing among the marital status categories. Since HIV testing is critical to improve prevention efforts, more research is needed to understand the characteristics of individuals who get tested for HIV to inform the design of innovative interventions to motivate younger adults and individuals from different marital status categories to seek HIV testing.

ABSTRACT: The aim of the study is to assess the knowledge, attitudes and practices of medical ethics among male and female healthcare professionals in a public sector hospital in Karachi, Pakistan. A structured questionnaire about knowledge of medical ethics and its role in the everyday decision making in the hospital was developed, tested and distributed among residents, consultant physicians at the Abbasi Shaheed Hospital, a tertiary care teaching hospital, during June and August 2016. The paper analyzed 70 responses from doctors at various level of training comprising residents and consultants. Each question had sub parts and hence was scored accordingly. The participants encountered ethical decision making situations in a diverse regularity, varying from ‘daily’ to ‘annually’. Interestingly, 9% of the doctors were not aware of the primary contents of the Hippocratic Oath, and 89% of these were junior doctors. Details of Nuremberg Code and Helsinki Code were known only to 4% of the total sample. Female physicians had a stronger opinion as compared to male physicians regarding practice of ethics. This included topics such as complying with the consent for procedures, treating violent/non-compliant patients, listening to the patient’s wishes, autonomy and above all the attribute of maintaining confidentiality. A significant difference in the level of knowledge between diverse cadres of physicians was noted. Physicians who had cleared their qualifying and/or licensing exams exams in first attempt scored higher than those who did not. The female participants have 1.65 times the odds of having a higher knowledge about medical ethics, than male participants, keeping all other variables constant. The study highlights the need to strengthen the professional knowledge regarding medical ethics issues, among the health care workforce in public sector hospitals of the developing world. In our data, female physicians working in the government sector hospitals in Karachi, demonstrate a higher knowledge about medical ethics, than male participants, keeping all other variables constant.