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Causes and outcomes of cauda equina syndrome in medico-legal practice: a single neurosurgical experience of 40 consecutive cases.

BACKGROUND: This is a unique report of 40 patients litigating in relation to the management of a cauda equina syndrome (CES), with prospective data collection. METHODS: Patients were seen and examined; medical records and radiological imaging were reviewed. The following data were collected prospectively: age; sex; the level of cauda equina (CE) compression; the pathology causing the compression; the clinical picture at first presentation; the causes of any iatrogenic injury; possible breaches of duty of care and the responsible discipline; recovery of bladder control; return to work. FINDIN

[Unilateral laryngeal immobility after surgery of the thyroid gland].

BACKGROUND: The authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication. OBJECTIVE: This retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined. PATIENTS

Hippocratic ideal, Faustian bargain and Damocles' sword: erosion of patient autonomy in obstetrics.

Respect for patient autonomy remains a foundational principle guiding the ethical practice of medicine-a mission first articulated by Hippocrates. Damocles, another figure from ancient Greece, provides a useful parable for describing performance under distress: Damocles loses his desire for opulence and power when he notices a sword dangling precariously above his head. Contemporary obstetricians deciding whether to forestall or impose major abdominal surgery on parturients entrusted to their care struggle valiantly in the chasm dividing Hippocratic idealism from the economic realism driven by

Vascular injuries after total joint arthroplasty.

Vascular injuries, although highly feared, can occur after total joint arthroplasty, often resulting in legal suits. This study evaluates the circumstances related to vascular injuries after joint arthroplasty. Using prospectively collected data on 13,517 patients undergoing total joint arthroplasty at our institution, 16 (0.1%) vascular injuries were identified. Eleven injuries occurred after total knee arthroplasty (TKA) and 5 after total hip arthroplasty (THA). Indirect injury was the most common mechanism in TKA. In contrast, direct injury was most prevalent in THA. One patient died of com

Caring and communicating. Observations on 19 Baby Doe patients.

Under authority of Section 504 of the Rehabilitation Act of 1973, and stimulated by the well-publicized birth of a child with Down syndrome and esophageal atresia in 1982, the US Department of Health and Human Services (HHS) has actively responded to reports of alleged discriminatory failure to care for handicapped infants. Investigators and consultants from the (HHS) Office for Civil Rights have visited hospitals and interviewed various persons. Observations made and unofficial conclusions drawn by one participant in 19 such investigations relate not only to the care provided to these childre

About a case of missed diagnosis of a post-traumatic aneurysm in the ulnar artery. Medical-legal aspects in respect to the professional liability.

Compartment syndrome of the left hand from a late diagnosed post-traumatic ulnar artery pseudoaneurysm. We report the case of 27 years old boy with a tipping and cutting wound on his left wrist, generating an ulnar artery pseudoaneurysm, that was late diagnosed, and therefore complicated by a compartment syndrome in the wrist. Immediately after the trauma the subject went to the emergency room where the severity of the injury was undestimated; in fact, it was sutured and medicated, without further investigation. When he went to the same hospital for the second time, symptoms (pulsatile mass, r

Glucocorticoid-induced osteoporosis: unawareness or negligence in India?

BACKGROUND: The burden of osteoporosis is on the rise and glucocorticoids are one of the leading causes of drug-induced osteoporosis. According to available guidelines, patients on long-term glucocorticoid therapy should receive adequate prophylaxis to prevent osteoporosis. OBJECTIVES: To compare prescription patterns in relation to Royal College of Physicians (RCP) Guidelines 2002. To identify prescribing trends for prophylaxis and management of steroid-induced osteoporosis. METHODS: We conducted a retrospective audit for patients in a tertiary care center to determine whether clinicians ar

[The anaesthetist's liability and bullfights].

Whether you are an aficionado or completely uninitiated, everyone has an opinion on bull-fighting. The bull-fighter is in constant risk of injury. A medical team made up of surgeons, anesthetists, emergency physicians and nurses remains present throughout the show. For the anaesthetist and surgeon, a wounded bullfighter is an emergency because the vital and functional prognosis are engaged. The team must act in conformity with normal practice and the Code of Medical Ethics because any lack of coordination between the practitioners is punishable by law in the same way as technical fault. Severa

Medicolegal aspects of altered sensation following implant placement in the mandible.

PURPOSE: Altered mandibular sensation following implant surgery may result in liability claims. Therefore the authors conducted a retrospective analysis of all liability claims related to persistent altered sensation following placement of mandibular implants reported to the Medical Consultants International (MCI) Company from 1992 to 1999. MATERIALS AND METHODS: Reports related to persistent altered mandibular sensation in 16 patients (12 women and 4 men) who underwent implant surgery in Israel were examined. The MCI files were retrospectively evaluated according to a structured form. The pa

A story of scrutiny and fear: Australian midwives' experiences of an external review of obstetric services, being involved with litigation and the impact on clinical practice.

OBJECTIVES: to describe Australian midwives' experiences of an external review of obstetric services, involvement in legal proceedings and the impact on midwives' clinical practice and personal wellbeing. BACKGROUND: the external review process (commonly referred to as the 'Douglas Inquiry') was initiated by a state government and was in response to hospital staff and consumer complaints that focused on anomalies in client care and a significantly high rate of adverse outcomes and clinical errors. It took place within the context of a number of legal proceedings against medical practitioners.

Labor pains: unraveling the complexity of OB decision making.

While a discussion of technology and childbirth seems paradoxical, the use of statistical modeling can extend the capacity of the human mind to quantify risk, to communicate clearly, and to recognize when action is necessary in an obstetrical setting. These models provide clinicians envelopes that define safe and reasonable clinical paths. They obviate the myriad of environmental, experiential, and individual factors that inevitably affect the process of identifying and responding to unsafe situations. As the number of variables increases, the ability of the human mind to analyze multiple, int

Historical controversy in health technology assessment: the case of electronic fetal monitoring.

Electronic fetal monitoring (EFM) was introduced in the late 1950s as an alternative to traditional auscultation by stethoscope or fetoscope in the management of labor and delivery. The new technology was seen as a valuable tool in the prevention of cerebral palsy and other adverse fetal outcomes and diffused rapidly into clinical practice. In the late 1970s, some scepticism began to be voiced about the evidence for the effectiveness of EFM. The authors published a systematic review of the evidence in 1979 that concluded that there was insufficient evidence for the effectiveness of the routine

Physician understanding of the National Practitioner Data Bank.

National Practitioner Data Bank (NPDB) reports are part of the process for acquiring staff privileges, professional credentials, and licenses throughout a physician's entire career. We surveyed our hospital's 66 residents to assess their understanding of NPDB. Only 9 residents had heard about NPDB. A follow-up survey of the 10 medical schools in Pennsylvania and Maryland showed just 4 schools covered NPDB in their curricula. Finally, we did a third survey--of 1,410 Pennsylvania Medical Society members. Eighty-one percent did not know that denial of initial license application was not a reporta

Assessing equitable care for Indigenous and Afrodescendant women in Latin America.

OBJECTIVE: To identify and understand the barriers to equitable care within health care settings that women of ethnic minorities encounter in Latin America and to examine possible strategies for mitigating the issues. METHODS: This was a comprehensive review of the literature from 2000-2015 available from the online databases PubMed, Google Scholar, EBSCOhost, and SciELO in Spanish, English, and Portuguese, using a keyword search that included the Region and country names. RESULTS: Health provider discrimination against Indigenous and Afrodescendant women is a primary barrier to quality heal

Litigations for HIV Related Complications

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Совпадение в полном тексте источника
… Medico-legal Issues The patient (plaintiff) initiated litigation against the GP (defendant) for medical malpractice. … Medico-legal Issues The patient in 2000 initiated lawsuit against his original FP for medical malpractice. …

First fruits: genetic screening.

[C]ritics of modern obstetric practices have taken note of the ways in which increased diagnostic surveillance can change the character and mood of pregnancy, and they have urged special caution about increased prenatal genetic testing. This paper explores these issues and suggests the need for national standards articulating criteria for introducing and funding new genetic tests as a part of normal prenatal care.

Traumatic dental injuries during anaesthesia. Part II: medico-legal evaluation and liability.

INTRODUCTION: Claims for tooth damage following intubation are increasing. An anaesthetic chart (AC) has been proposed to describe patient's pre-existent dental diseases and any possible lesions caused during intubation and extubation. MATERIALS AND METHODS: We conducted a retrospective study of 235 cases of dental lesions reported in litigation files from January 2000 to June 2009. Based on preoperative oral inspection the anaesthetist decided whether or not to use a protective aid. Two different tooth protectors were applied: (i) a standard mouthguard and (ii) silicone impression putty. RE