Development of a Psychological Scale for Measuring Disruptive Clinician Behavior.

OBJECTIVES: Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations. Therefore, this study developed a psychometric scale based on the psychological paradigm to assess disruptive clinician behavior. METHODS: The scale was developed through a sequence of steps. First, we used an open-ended questionnaire targeting 712 nurses, content analysis, and content validity assessment by 5 experts to determine valid items for disruptive clinical behavior. Next, an Internet questionnaire survey targeting 1000 health care staff, exploratory factor analysis, and subfactor analysis was conducted to identify necessary and sufficient factors. Then, we calculated difficulty level and discriminative power. We also conducted a field questionnaire survey targeting 84 staff in a hospital. Finally, we calculated ω coefficients and then used confirmatory factor analysis to verify the fit of the hypothesized model. RESULTS: Our open-ended survey involving 478 nurses identified 47 codes in 9 categories. The questionnaire survey involving hospital 1000 medical staff identified 6 factors, with 1 factor subdivided into 4 subfactors and 1 into 2 subfactors. The goodness of fit of the hypothesized 10-factor models with factor pairs and groups was confirmed. CONCLUSIONS: We developed a psychometric scale measuring subjective assessments of harm covering various disruptive clinician behaviors. The scale complements interviews and case reports by generating valid, reliable scores for various disruptive clinician behaviors in health care institutions.

Enantioselective reaction of N-cyano imines: decarboxylative Mannich-type reaction with malonic acid half thioesters.

The enantioselective reaction of imines bearing a cyano group as an activating group with malonic acid half thioesters gave chiral cyanamide derivatives with high enantioselectivity. The density functional theory (DFT) calculation clarified the stereochemical outcome and importance of the N-cyano group for imines.

[End-of-Life Medical Care for Cranial Nerve Diseases from Ethical and Legal Perspective].

After showing the basic knowledge of law, I examined the relation ship between law and ethics. Subsequently, I explained a related law about the end-of-life stage and neurological intractable diseases based on specific cases. I analyzed the structure of the guidelines for end-of-life and dementia guidelines, which have great significance in Japan. In addition, the issue of notification (informed consent) and removal of the ventilator were examined.

The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine.

Background: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.

[Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints].

In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice. (5) To deliberate the difference between ethical and legal judgment, an interdisciplinary approach should be carried out. (6) To achieve consensus among the people, the importance of an Advanced-Directive should prevail widely.

[The significant of practical guideline in social context].

After drawing clinical practice guideline, we are going to face the significant of practice guideline in social context, both negative aspect and positive aspect. Negative aspect is the worry about misuse concerning medical malpractice lawsuits in courtroom. By analyzing the resent 3 Supreme Court decisions, I explain that practice guideline is the only one of recourses to determine medical negligence. Positive aspect is that practical guidelines would be the one of tools, which improves informed consent between medical practitioners and patients under the some conditions. Proper using practice guideline could reduce the conflict on informed consent.