WorldWideScience

Sample records for medical malpractice cases

  1. Medical Malpractice

    DEFF Research Database (Denmark)

    Grembi, Veronica

    2014-01-01

    MM first came to the attention of policy makers primarily in the USA where, from the 1970s, healthcare providers denounced problems in getting insurance for medical liability, pointing out to a crisis in the MM insurance market (Sage WM (2003) Understanding the first malpractice crisis of the 21th...

  2. Medical malpractice and hernia repair: an analysis of case law.

    Science.gov (United States)

    Walters, Amanda L; Dacey, Kristian T; Zemlyak, Alla Y; Lincourt, Amy E; Heniford, B Todd

    2013-04-01

    Litigation analysis and clinician education are essential to reduce the number and cost of malpractice claims. This study evaluates the clinical characteristics and legal outcomes of medical malpractice litigation initiated by patients having undergone a hernia repair operation. Published civil suits were obtained from a legal database for state and federal decisions constituting case law. The published material includes information on defendants, plaintiffs, allegations, outcomes, and a variety of legal issues. A retrospective review of 44 published cases from 25 states was performed. Complications were present in 20 of 44 (45%) suits, four (9%) of which were because of infection. Death occurred in five (11%) cases, and failure to obtain informed consent was alleged in seven (16%) of the suits. Retained foreign bodies were present in 7 of the 44 (16%) suits. Other allegations included incorrect surgical technique, insufficient need for surgery, and emotional distress. Most (64%) patients initiating malpractice litigation were male, and inguinal, hiatal, and ventral hernia repairs account for 39%, 27%, and 14% of cases, respectively. Most suits (40%) were initiated in Southern states. Surgical mesh was indicated in 5 of 44 (11%) suits but four of five were unrelated to the suit. One patient initiated litigation because of the fact that the surgeon did not use mesh during surgery, which was discussed preoperatively during the informed consent. The court ruled in favor of the plaintiff in 12 of 44 (27%) suits, with compensation ranging from roughly $19,000 to $8,000,000. Louisiana and New York had six and seven suits each, which appears disproportionate given their respective populations. Complications and death resulting from alleged clinical negligence play a significant role in both the initiation and the outcome of malpractice litigation. Retained foreign bodies and lack of informed consent account for roughly one-third of malpractice litigation associated with

  3. Medical malpractice in endourology: analysis of closed cases from the State of New York.

    Science.gov (United States)

    Duty, Brian; Okhunov, Zhamshid; Okeke, Zeph; Smith, Arthur

    2012-02-01

    Medical malpractice indemnity payments continue to rise, resulting in increased insurance premiums. We reviewed closed malpractice claims pertaining to endourological procedures with the goal of helping urologists mitigate their risk of lawsuit. All closed malpractice claims from 2005 to 2010 pertaining to endourological procedures filed against urologists insured by the Medical Liability Mutual Insurance Company of New York were examined. Claims were reviewed for plaintiff demographics, medical history, operative details, alleged complication, clinical outcome and lawsuit disposition. A total of 25 closed claims involved endourological operations and of these cases 10 were closed with an indemnity payment. The average payout was $346,722 (range $25,000 to $995,000). Of the plaintiffs 16 were women and mean plaintiff age was 51.4 years. Cystoscopy with ureteral stent placement/exchange resulted in 13 lawsuits, ureteroscopic lithotripsy 8, percutaneous stone extraction 2 and shock wave lithotripsy 2. There were 17 malpractice suits brought for alleged operative complications. Failure to arrange adequate followup was implicated in 4 cases. Error in diagnosis and delay in treatment was alleged in 3 claims. Urologists are not immune to the current medical malpractice crisis. Endourology and urological oncology generate the greatest number of lawsuits against urologists. Most malpractice claims involving endourological procedures result from urolithiasis and alleged technical errors. Therefore, careful attention to surgical technique is essential during stone procedures to reduce the risk of malpractice litigation. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Proof of Causation in Medical Malpractice Cases in the Czech Republic

    Czech Academy of Sciences Publication Activity Database

    Doležal, Adam; Doležal, Tomáš

    2015-01-01

    Roč. 5, č. 3 (2015), s. 195-205 ISSN 1805-8396 R&D Projects: GA ČR GAP408/12/2574 Institutional support: RVO:68378122 Keywords : causation * liability * medical malpractice cases Subject RIV: AG - Legal Sciences

  5. Court decisions on medical malpractice.

    Science.gov (United States)

    Knaak, Jan-Paul; Parzeller, Markus

    2014-11-01

    Recent studies on court cases dealing with medical malpractice are few and far between. This retrospective study, therefore, undertakes an analysis of medical malpractice lawsuits brought before regional courts in two judicial districts of the federal state of Hesse. Over a 5-year period (2006-2010), 232 court decisions on medical malpractice taken by the regional courts (Landgericht) of Kassel and Marburg were evaluated according to medical discipline, diagnosis, therapy, relevant level of care, charge of neglect of duty by the claimant party, outcome of the lawsuit, and further criteria. With certain overlaps, the disciplines most frequently confronted with claims of medical malpractice were accident surgery and orthopedics (30.2%; n = 70), dentistry (16.4%; n = 38), surgery (12.1%; n = 28), and gynecology and obstetrics (7.8%; n = 18), followed by the remaining medical disciplines (38.8%; n = 90). Malpractice allegations were brought against the practice-based sector in 35.8 % (n = 83) of cases, the hospital-based sector in 63.3% (n = 147) of cases, and other sectors in 0.9% (n = 2) of cases. The allegation grounds included false administration of treatment (67.2%; n = 156), false indication of treatment (37.1%; n = 86), false diagnosis (31.5%; n = 73), and/or organizational negligence (13.8%; n = 32). A breach of duty to inform was given as grounds for the claim in 38.8% (n = 90) of cases. A significant majority of 65.6% (n = 152) of cases ended in a court settlement. Of the cases, 18.9% (n = 44) were concluded by claim withdrawal, 11.2% (n = 26) by claim dismissal and 2.6% (n = 6) by criminal sentence. Of the cases, 1.7% (n = 4) were for purposes of securing evidence. Although there was no conclusive evidence of malpractice, two thirds of the cases ended in a court settlement. On the one hand, this outcome reduces the burden on the courts, but on the other, it can in the long term give

  6. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

    Science.gov (United States)

    Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

    2016-10-01

    Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Pathology and medical malpractice. Academic and trainee empirical review of cases by State of Texas physicians.

    Science.gov (United States)

    Allen, Timothy Craig; Stafford, Mehary; Liang, Bryan A

    2014-04-01

    This study examines whether the assumptions that pathologists understand the medical malpractice negligence rule and have a clear single standard of care are reasonable. Two hundred eighty-one Texas academic pathologists and trainees were presented 10 actual pathology malpractice cases from publicly available sources, representing the tort system's signal. Of the respondents, 55.52% were trainees, and 44.48% were pathology faculty. Only in two cases did more than 50% of respondents correctly identify the behavior of pathologists as defined by legal outcomes. In only half of the cases did more than 50% of pathologists concur with the jury verdict. This study provides further evidence that physicians do not understand the legal rule of negligence. Pathologists have a poor understanding of negligence and cannot accurately predict a jury verdict. There is significant divergence from the single standard of care assumption. Alternative methods to provide appropriate compensation and to establish physician accountability should be explored. Additional education about medical negligence is needed.

  8. Limits of negligent responsibility for medical malpractice

    Directory of Open Access Journals (Sweden)

    Marin Mrčela

    2017-01-01

    Full Text Available Criminal offence of medical malpractice is one of core medical criminal offences. Protected object is health of patients. Application of inadequate methods in health treatment can have severe consequences for patient’s health, even death. Croatian jurisprudence is familiar with such cases. However, Croatian literature until now did not deal with this sensitive area of criminal law. Scope and limits of responsibility for negligent form of medical malpractice can cause doubts in court’s practice when deciding about criminal liability. This paper is dedicated to this topic. After presentation of main characteristics of this criminal offence, the authors are making an effort to establish criteria for estimation of negligence in case of medical malpractice. They are testing their thesis on one very complicated case from recent Croatian jurisprudence.

  9. Dissecting malpractice in pancreaticoduodenectomy cases.

    Science.gov (United States)

    Anandalwar, Seema P; Scholer, Anthony J; Ninan, Gigio; Oliver, Joseph B; Christian, Derick; Eloy, Jean Anderson; Chokshi, Ravi J

    2017-05-15

    Medical malpractice is a growing concern for physicians in all fields. Surgical fields have some of the highest malpractice premiums and litigation rates. Pancreaticoduodenectomy (PD) has become a popular procedure; however, it is still associated with significant morbidity and mortality. This study is the first to analyze factors involved in litigation regarding PD cases. The Westlaw database was searched for jury verdicts and settlements using the terms "medical malpractice" and "pancreaticoduodenectomy". Twenty-nine cases from 1991 to 2012 were initially collected. Seven entries not involving PD and three duplicate cases were excluded. Nineteen cases were included for analysis. Of the 19 cases included in the analysis, three (15.8%) reached a settlement, three (15.8%) were ruled in favor of the plaintiff, and 13 (68.4%) were ruled in favor of the physician. The average settlement award was $398,333 (range, $195,000-500,000), and the average plaintiff award was $4,288,869 (range, $1,066,608-10,300,000). The most common factors raised in litigation included PD being allegedly unnecessary (47.4%), followed by postoperative negligence and misdiagnosis (36.8% each). The most common factors present in litigation included the allegation that PD was unnecessarily performed. The cases that are awarded large monetary sums are those that involve continued medical care. Ways to improve patient safety and limit litigation include increasing transparency and communication with a thorough discussion between surgeon and patient of the most common topics of litigation discussed. Published by Elsevier Inc.

  10. Mediation in Medical Malpractice - Realities and Prospects

    Directory of Open Access Journals (Sweden)

    Alexandru Boroi

    2015-05-01

    Full Text Available Medical professional liability is the result of specific breaches of the medical profession, which are contained in Law 95/2006 on health reform. Beyond the motivation of blaming medical personnel activity, there are many other aspects that may give rise to controversy in terms of medical ethics, from the informed consent of the patient and to the need for reaching criminal responsibility and compensation in cases of medical malpractice.

  11. Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations.

    Science.gov (United States)

    Bucci, M B; Aversa, M; Guarda-Nardini, L; Manfredini, D

    2011-01-01

    Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

  12. The role of the autopsy in medical malpractice cases, I: a review of 99 appeals court decisions.

    Science.gov (United States)

    Bove, Kevin E; Iery, Clare

    2002-09-01

    Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. To determine how autopsy information influences the outcome of medical malpractice litigation. We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

  13. Perspectives on medical malpractice self-insurance financial reporting.

    Science.gov (United States)

    Frese, Richard C; Kitchen, Patrick J

    2012-11-01

    Financial reporting of medical malpractice self-insurance is evolving. The Financial Accounting Standards Board Accounting Standards Codification Section 954-450-25 provides guidance for accounting and financial reporting for medical malpractice. Discounting of medical malpractice liabilities has been reassessed in recent years. Malpractice litigation reform efforts continue in several states. Accountable care organizations could increase the frequency of medical malpractice claims because of patients' heightened expectations regarding quality of care.

  14. Hospital exclusion clauses limiting liability for medical malpractice ...

    African Journals Online (AJOL)

    In 2002 the Supreme Court of Appeal ruling in Afrox Healthcare Beperk v. Strydom held that the common law allows hospitals to exclude liability for medical malpractice resulting in death or physical or psychological injury – except in the case of gross negligence. The effect of this judgment has now been superseded by the ...

  15. Tort law and medical malpractice insurance premiums.

    Science.gov (United States)

    Kilgore, Meredith L; Morrisey, Michael A; Nelson, Leonard J

    2006-01-01

    This paper estimated the effects of tort law and insurer investment returns on physician malpractice insurance premiums. Data were collected on tort law from 1991 through 2004, and multivariate regression models, including fixed effects for state and year, were used to estimate the effect of changes in tort law on medical malpractice premiums. The premium consequences of national policy changes were simulated. The analysis found that the introduction of a new damage cap lowered malpractice premiums for internal medicine, general surgery, and obstetrics/gynecology by 17.3%, 20.7%, and 25.5%, respectively. Lowering damage caps by dollar 100,000 reduced premiums by 4%. Statutes of repose also resulted in lower premiums. No other tort law changes had the effect of lowering premiums. Simulation results indicate that a national cap of dollar 250,000 on awards for noneconomic damages in all states would imply premium savings of dollar 16.9 billion. Extending a dollar 250,000 cap to all states that do not currently have them would save dollar 1.4 billion annually, or about 8% of the total. A negative effect on malpractice premiums was found for the Dow Jones industrial average, but not for bond prices; effects of the Nasdaq index were not significant for internal medicine, but were marginally significant for surgery and obstetrics premiums.

  16. The current status of medical malpractice countersuits.

    Science.gov (United States)

    Sokol, D J

    1985-01-01

    The dramatic growth of medical malpractice litigation in recent decades has contributed significantly to an overall increase in health care costs in this country. Although lawmakers, physicians, and other responsible citizens have proposed numerous solutions in an effort to curb the crisis, these proposals have generally been ineffective. In this Article the Author endorses countersuits as the most appropriate response to frivolous medical malpractice actions. The Author also suggests that contingent fee systems, coupled with the economic motivation of private insurers to settle claims quickly, provide incentive for plaintiffs to initiate frivolous claims. This Article analyzes the general legal approaches available for countersuits, emphasizing recent successful actions based on malicious prosecution and abuse of process, and proposes more widespread use of these approaches.

  17. Clinical psychopharmacology and medical malpractice: the four Ds.

    Science.gov (United States)

    Preskorn, Sheldon H

    2014-09-01

    The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case.

  18. A review of medical malpractice issues in Malaysia under tort litigation system.

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-04-07

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability.

  19. Review of Medical Malpractice Issues in Malaysia under Tort Litigation System

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-01-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  20. Actuarial considerations of medical malpractice evaluations in M&As.

    Science.gov (United States)

    Frese, Richard C

    2014-11-01

    To best project an actuarial estimate for medical malpractice exposure for a merger and acquisition, a organization's leaders should consider the following factors, among others: How to support an unbiased actuarial estimation. Experience of the actuary. The full picture of the organization's malpractice coverage. The potential for future loss development. Frequency and severity trends.

  1. Courts, Scheduled Damages, and Medical Malpractice Insurance

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the impact of the introduction of schedules of non-economic damages (i.e. tiered caps systems) on the behavior of insurers operating in the medical liability market for hospitals while controlling the performance of the judicial system, measured as court backlog. Using a difference......-in-differences strategy on Italian data, we find that the introduction of schedules increases the presence of insurers (i.e. medical liability market attractiveness) only in inefficient judicial districts. In the same way, court inefficiency is attractive to insurers for average values of schedules penetration...... of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Finally, no significant impact is registered on paid premiums. Our analysis sheds light on a complex set of elements affecting the decisions of insurers in malpractice markets. The analysis...

  2. [Current issues in legal cases of compensation for healthcare malpractice].

    Science.gov (United States)

    Heiner, Tamás; Barzó, Tímea

    2014-09-21

    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since 1990. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades. In the meantime, a new Hungarian Civil Code (Act V of 2013) has entered into force, which among others, necessitates the revaluation of assessment of damages recoverable for medical malpractices. There are two main areas where fundamental changes have been introduced, which may significantly affect the outcome of medical malpractice lawsuits in the future. In the early stage of medical malpractices it was unclear whether the courts had to consider either the contractual relationship between patients and healthcare providers (contractual liability) or general codal articles on damages arising from non-contractual liability/torts (delictual liability) in their judgement delivered in the cases. Both the theoretical and practical experience of the last ten years shows that healthcare services agreements are concluded between healthcare providers and patients with the aim and intention to provide appropriate professional healthcare services to patients, which meet patients' interests and wishes. The medical service is violated if it fails to meet patients' interests and wishes as well as the objectives of the agreement. Since the new legislation implies a stricter liability for damages in the case of breach of contract and stricter rules for exempting the party in breach from compensation obligations, the opportunities to exempt healthcare providers from these obligations have become limited compared to previous regulations. This modification, which was aimed at further integrating the established judicial practices into legislation, stipulates the application of the rules for liability for damages resulting from medical malpractice in non-contractual situations. This paper analyses

  3. Delays in Medical Malpractice Litigation in Civil Law Jurisdictions

    DEFF Research Database (Denmark)

    Grembi, Veronica; Garoupaa, Nuno

    2013-01-01

    Medical malpractice law and tort reform are contentious issues. In this paper, we focus on Italy as an example of a civil law jurisdiction. Italian medical malpractice law is essentially judge-made law. However, its effectiveness is likely to be curtailed by excessive delays in litigation. Several...... reforms have been enacted since the late 1980s to correct this situation. By making use of the decisions of the Italian Court of Cassation (which have shaped medical malpractice law) from 1970 to 2009, we show that these reforms had no general statistically significant impact on delays. Recent reduction...

  4. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  5. Curb your premium! evaluating state intervention in medical malpractice insurance

    OpenAIRE

    Sofia, AmaralGarcia; Veronica, Grembi

    2011-01-01

    Using data of Italian public healthcare providers over years 2001 through 2008, we evaluate the impact of two policies adopted by Italian Regions (i.e., States) to cope with increasing medical malpractice costs using a Difference-in-Difference specification. We assess the impact of the policies on premiums paid and legal expenditures. The first policy consisted in collecting information and monitoring both compensation requests and any legal action related to a medical malpractice claim again...

  6. Sovereign immunity: Principles and application in medical malpractice.

    Science.gov (United States)

    Suk, Michael

    2012-05-01

    Tort law seeks accountability when parties engage in negligent conduct, and aims to compensate the victims of such conduct. An exception to this general rule governing medical negligence is the doctrine of sovereign immunity. Historically, individuals acting under the authority of the government or other sovereign entity had almost complete protection against tort liability. This article addressed the following: (1) the development of sovereign immunity in law, (2) the lasting impact of the Federal Tort Claims Act on sovereign immunity, and (3) the contemporary application of sovereign immunity to medical malpractice, using case examples from Virginia and Florida. I performed an Internet search to identify sources that addressed the concept of sovereign immunity, followed by a focused search for relevant articles in PubMed and LexisNexis, literature databases for medical and legal professionals, respectively. Historically, sovereign liability conferred absolute immunity from lawsuits in favor of the sovereign (ie, the government). Practical considerations in our democratic system have contributed to an evolution of this doctrine. Understanding sovereign immunity and its contemporary application are of value for any physician interested in the debate concerning medical malpractice in the United States. Under certain circumstances, physicians working as employees of the federal or state government may be protected against individual liability if the government is substituted as the defendant.

  7. Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases.

    Science.gov (United States)

    Kandinov, Aron; Mutchnick, Sean; Nangia, Vaibhuv; Svider, Peter F; Zuliani, Giancarlo F; Shkoukani, Mahdi A; Carron, Michael A

    2017-07-01

    This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. To comprehensively evaluate rhytidectomy malpractice litigation. Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. In this study, although most cases of

  8. Medical malpractice web advertising: a qualitative, cross-sectional analysis of plaintiff medical malpractice firms in Suffolk County, Massachusetts.

    Science.gov (United States)

    Ghobadi, Comeron W; Gevorgyan, Ofelya; Bednarski, Caroline E; Hayman, Emily L; Walter, Jessica R; Xu, Shuai

    2017-01-01

    Medical malpractice plaintiff firms play a central role in the prosecution of malpractice claims. There have been limited studies on the online advertising practices of plaintiff medical malpractice firms. The Martindale-Hubbell directory was used to identify all plaintiff medical malpractice firms in Suffolk County, Massachusetts. Each firm's website was individually mined for relevant data. Thirty-one unique medical malpractice law firms were identified. Seventy-seven percent of law firms advertised awards with the Martindale-Hubbell AV rating, AVVO, and Super Lawyer being the three most common. The second most common method of advertising was accomplished through descriptions of successful verdicts and settlements (61%). A total of 408 verdicts, settlements, and arbitrations collectively representing $1.4 billion dollars were advertised by all law firms. Median awarded values for verdicts was advertised as $4.5 million, while the median awarded values for settlements was $1.25 million. Defendants most commonly practiced obstetrics (18%), followed by primary care (14%). Law firms report treatment and diagnosis delay as the most common successful claim (50%), followed much further by misdiagnosis (8%), and communication error (4%). Our sample correlates with larger claims-based studies surrounding the most commonly sued specialties, however, median reported settlement and verdict values were significantly higher in our cohort. Considerations should be made to provide advertising guidelines for medical malpractice plaintiff firms. Copyright © 2017 by the National Legal Center for the Medically Dependent and Disabled, Inc.

  9. Liability for medical malpractice--recent New Zealand developments.

    Science.gov (United States)

    Sladden, Nicola; Graydon, Sarah

    2009-03-01

    Over the last 30 years in New Zealand, civil liability for personal injury including "medical malpractice" has been most notable for its absence. The system of accident compensation and the corresponding bar on personal injury claims has been an interesting contrast to the development of tort law claims for personal injury in other jurisdictions. The Health and Disability Commissioner was appointed in 1994 to protect and promote the rights of health and disability consumers as set out in the Code of Health and Disability Services Consumers' Rights. An important right in the Code, in terms of an equivalent to the common law duty to take reasonable care, is that patients have the right to services of an appropriate standard. Several case studies from the Commissioner's Office are used to illustrate New Zealand's unique medico-legal system and demonstrate how the traditional common law obligation of reasonable care and skill is applied. From an international perspective, the most interesting aspect of liability for medical malpractice in New Zealand is its relative absence - in a tortious sense anyway. This paper will give some general background on the New Zealand legal landscape and discuss recent case studies of interest.

  10. An insight into medical malpractice and litigation | Aimakhu ...

    African Journals Online (AJOL)

    Medical malpractice otherwise known as a breach of professional obligation and negligence of duty by medical practitioners has been identified as the major cause of emerging medical litigation in Nigeria. Medical personnel must be aware in their practice that patients are becoming more aware of their rights. The public ...

  11. Medical malpractice reform: the role of alternative dispute resolution.

    Science.gov (United States)

    Sohn, David H; Bal, B Sonny

    2012-05-01

    Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to the courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early apology, mediation, and arbitration in the medical arena. (1) Why is ADR needed? (2) Is ADR useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles remain? We performed MEDLINE, PubMed, and Google Scholar searches with key words "medical malpractice", "ADR", and "alternative dispute resolution" to obtain public policy studies, law review articles, case analyses, ADR surveys, and healthcare review articles. Early apology and disclosure programs report 50% to 67% success in avoiding litigation as well as substantial reductions in the amount paid per claim. Mediation boasts 75% to 90% success in avoiding litigation, cost savings of $50,000 per claim, and 90% satisfaction rates among both plaintiffs and defendants. Arbitration is viewed as less satisfying and less efficient than mediation but still more time- and cost-effective than litigation. The current legal environment is favorable to ADR with recent court decisions upholding pretreatment arbitration clauses. The main obstacle to ADR is the mandatory reporting requirement of the National Practitioner Data Bank (NPDB). ADR has the potential to help reform the current tort system, reducing cost and increasing both parties' satisfaction. Easing the reporting requirements for the NPDB would lead to more widespread acceptance of ADR among physicians.

  12. Suicide medical malpractice: an educational overview.

    Science.gov (United States)

    Sher, Leo

    2015-05-01

    A malpractice lawsuit is in the legal category of an action in tort, which is a demand for compensation for the damages that have occurred. For a physician to be found liable to a patient for malpractice, four essential elements must be proved to sustain an assertion of malpractice: duty, negligence, harm, and causation. The incidence of malpractice litigation in the field of psychiatry is increasing. The most common malpractice claim related to psychiatric practice is the failure to provide reasonable protection to patients from killing themselves. A psychiatrist should be able to evaluate suicide risk on the basis of all available information, including patient responses to direct and indirect questions, known risk factors, information on how the patient behaved under similar circumstances in the past, and collateral information. Reasonable care necessitates that a patient who is either thought of being or established to be suicidal must be the subject of some precautions. A failure either to soundly assess a patient's suicide risk or to employ an appropriate safety plan after the suicide potential becomes foreseeable is likely to make a physician liable if the patient is harmed because of a suicide event. It is imperative for a psychiatric office or facility to have a good documentation. Careful documentation of evaluations and treatment interventions with a description of changes related to the patient's clinical condition indicates clinically and legally appropriate psychiatric care.

  13. Medical Malpractice Litigation Following Arthroscopic Surgery.

    Science.gov (United States)

    Shah, Kalpit N; Eltorai, Adam E M; Perera, Sudheesha; Durand, Wesley M; Shantharam, Govind; Owens, Brett D; Daniels, Alan H

    2018-04-10

    Our study aims to analyze a variety of factors involving malpractice lawsuits following arthroscopy, focusing on reasons for lawsuit and establishing predictors for the outcome of the lawsuit. Two legal databases, VerdictSearch and Westlaw, were queried for arthroscopic cases in adult patients. For all included cases, clinical and demographic data were recorded. The effects of plaintiff demographics, joint involved, lawsuit allegation, case ruling, and size of indemnity payments were assessed. Of the 240 included cases, 62 (26%) resulted in plaintiff verdict, 160 (67%) resulted in defense verdict, and 18 (8%) were settled without trial. Plaintiff demographics (age and sex) had no effect on the case ruling. There was no statistical difference between indemnity awards for plaintiff verdicts ($1,013,494) and settled cases ($848,331; P = .13). Patient death was noted in 20 cases (8.3%); a significantly higher proportion of these cases were settled versus went to trial (P = .0022), including 19 patients (95%) who had knee arthroscopy and 16 deaths (80%) resulting from a pulmonary embolus. Plaintiff verdict or settlement were seen significantly more frequently for vascular complications and wrong-sided surgery. Alternatively, defense verdicts followed lawsuits alleging surgeon technical error. Wrong-sided surgery, retained instruments, deep venous thrombosis, and postoperative infections were seen at a significantly higher proportion after knee arthroscopy than after arthroscopy of other joints. Similarly, neurological injury was significantly associated with elbow and hip arthroscopy, while allegations of technical error by the surgeon and block-related complications were associated with shoulder arthroscopy. Plaintiff verdict or settlement were seen for vascular complications and wrong-sided surgery, while defense verdicts followed lawsuits alleging surgeon technical error and block-related complications. We also identified types of allegations that were associated

  14. [Malpractice in laparoscopic cholecystectomy. Results of cases recently considered by the Expert Commission].

    Science.gov (United States)

    Kienzle, H F

    1999-01-01

    The Expert Commission for medical malpractice which is part of the Medical Chamber of Nordrhein received about 60 applications in connection with laparoscopic cholecystectomy; as of August 1998 5 complaints were let off and 11 of them are still being considered. So far 44 complaints have been considered and in 25 of them medical malpractice has been established. The medical malpractice detected laparoscopic cholecystectomy cases were mainly bile duct injuries of which 13 required a biliodigestive anastomosis for reconstruction, four cases required and end-to-end anastomosis and in one case a T-tube drainage was needed. The youngest one of these patients was 21 years old, the oldest one was 61 years old. Four times the bile duct injury was not considered as malpractice, because it could be intraoperatively made out and immediately treated. Trocar injuries were twice a cause for malpractice and once it was not. Each of the following cases was also recognized as a malpractice. One lost gallstone one dislocated Roedersnare, one electric injury, one delayed reintervention and one insufficient information. The following cases were decided as non-malpractice: in two cases a slipped clip, in five cases subhepatical hematoma/abscess, in three cases a secondary bleeding, once a lesion of the splenic capsule and finally a running sore with subsequent incisional hernia. Three courses of treatment with consequence of death also contained mistakes: one electric injury of the bowel, one bile duct lesion and one information rebuke. The bile duct injury is the most considerable risk for laparoscopic cholecystectomy and implies also a high risk for the future health. The experienced surgeon distinguishes himself by the fact that he is right about the situation and converts sooner that later to conventional cholecystectomy if there's any doubt. In open surgery the principle is applied that structures may be only divided when they are clearly identified. The same goes even on a wider

  15. Malpractice claims related to recurrent laryngeal nerve injury: Forensic remarks regarding 15 cases

    Directory of Open Access Journals (Sweden)

    A. Verzeletti

    2016-12-01

    Full Text Available Malpractice claims concerning recurrent laryngeal nerve (RLN injuries are often related to thyroid surgery, but they can also involve surgeons of different specialties. Our survey was made considering expert opinions on claims for medical malpractice evaluated at Brescia Institute of Forensic Medicine in Italy during the period 1992–2012. Fifteen cases concerned RLN injury. Malpractice was identified in 10 cases, according to the following conditions: low pre and intra-operative risk of nerve injury, no documentation showing that the nerve was isolated and preserved despite the existence of potential risk factors. An accurate, well written and complete surgical report is the main tool for the expert examination in malpractice claims.

  16. A 12-year analysis of closed medical malpractice claims of the Taiwan civil court

    Science.gov (United States)

    Hwang, Chi-Yuan; Wu, Chien-Hung; Cheng, Fu-Cheng; Yen, Yung-Lin; Wu, Kuan-Han

    2018-01-01

    Abstract Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan. The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013. Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%). Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is

  17. Medical Malpractice Phenomena: Signals for Changing Medical and Health Care Values

    DEFF Research Database (Denmark)

    Brødsgaard, I.; Moore, R.

    1990-01-01

    Excellent discussion of the economic factors such as medical malpractice and corporate medicine that have begun to interfere with the doctor-patient relationship and why this relationship is so essential in order to prevent medical malpractice. Issues of quality assurance are relevant to the doctor-patient...... relationship and the quality of health care....

  18. Evaluating the medical malpractice system and options for reform.

    Science.gov (United States)

    Kessler, Daniel P

    2011-01-01

    The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

  19. Medical error, malpractice and complications: a moral geography.

    Science.gov (United States)

    Zientek, David M

    2010-06-01

    This essay reviews and defines avoidable medical error, malpractice and complication. The relevant ethical principles pertaining to unanticipated medical outcomes are identified. In light of these principles I critically review the moral culpability of the agents in each circumstance and the resulting obligations to patients, their families, and the health care system in general. While I touch on some legal implications, a full discussion of legal obligations and liability issues is beyond the scope of this paper.

  20. Claims about Medical Malpractices Resulting in Maternal and Perinatal Mortality Referred to Iranian Legal Medicine Organization During 2011–2012

    Science.gov (United States)

    Taghizadeh, Ziba; Pourbakhtiar, Maryam; Ghadipasha, Masoud; Soltani, Kamran; Azimi, Khadijeh

    2017-01-01

    Background: Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality. Materials and Methods: A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed. Results: The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%). Conclusions: Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial. PMID:28904542

  1. An introduction to medical malpractice in the United States.

    Science.gov (United States)

    Bal, B Sonny

    2009-02-01

    Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering.

  2. ["The severe degree of negligence" and its application in the settle of medical malpractice].

    Science.gov (United States)

    Wang, You-Min; Zhang, Qin-Chu

    2006-04-01

    To found the quantifiable index of "The severe degree of negligence" in describing the general severity degree of medical malpractice or medical dispute. "The severe degree of negligence" can be calculated by the way of multiplying the coefficient of medical malpractice's grade by the coefficient of responsibility degree. There are 15 grades of "The severe degree of negligence" through calculation, from the severest degree of 1 to the lightest degree of 20. "The severe degree of negligence" can give an order of severe degree to different grade and different responsibility of medical malpractice. According to this order, the operation of medical malpractice and medical dispute settle will be easier and more rationality.

  3. The Impact of Incident Disclosure Behaviors on Medical Malpractice Claims.

    Science.gov (United States)

    Giraldo, Priscila; Sato, Luke; Castells, Xavier

    2017-06-30

    To provide preliminary estimates of incident disclosure behaviors on medical malpractice claims. We conducted a descriptive analysis of data on medical malpractice claims obtained from the Controlled Risk Insurance Company and Risk Management Foundation of Harvard Medical Institutions (Cambridge, Massachusetts) between 2012 and 2013 (n = 434). The characteristics of disclosure and apology after medical errors were analyzed. Of 434 medical malpractice claims, 4.6% (n = 20) medical errors had been disclosed to the patient at the time of the error, and 5.9% (n = 26) had been followed by disclosure and apology. The highest number of disclosed injuries occurred in 2011 (23.9%; n = 11) and 2012 (34.8%; n = 16). There was no incremental increase during the financial years studied (2012-2013). The mean age of informed patients was 52.96 years, 58.7 % of the patients were female, and 52.2% were inpatients. Of the disclosed errors, 26.1% led to an adverse reaction, and 17.4% were fatal. The cause of disclosed medical error was improper surgical performance in 17.4% (95% confidence interval, 6.4-28.4). Disclosed medical errors were classified as medium severity in 67.4%. No apology statement was issued in 54.5% of medical errors classified as high severity. At the health-care centers studied, when a claim followed a medical error, providers infrequently disclosed medical errors or apologized to the patient or relatives. Most of the medical errors followed by disclosure and apology were classified as being of high and medium severity. No changes were detected in the volume of lawsuits over time.

  4. Electronic Health Record-Related Events in Medical Malpractice Claims.

    Science.gov (United States)

    Graber, Mark L; Siegal, Dana; Riah, Heather; Johnston, Doug; Kenyon, Kathy

    2015-11-06

    There is widespread agreement that the full potential of health information technology (health IT) has not yet been realized and of particular concern are the examples of unintended consequences of health IT that detract from the safety of health care or from the use of health IT itself. The goal of this project was to obtain additional information on these health IT-related problems, using a mixed methods (qualitative and quantitative) analysis of electronic health record-related harm in cases submitted to a large database of malpractice suits and claims. Cases submitted to the CRICO claims database and coded during 2012 and 2013 were analyzed. A total of 248 cases (<1%) involving health IT were identified and coded using a proprietary taxonomy that identifies user- and system-related sociotechnical factors. Ambulatory care accounted for most of the cases (146 cases). Cases were most typically filed as a result of an error involving medications (31%), diagnosis (28%), or a complication of treatment (31%). More than 80% of cases involved moderate or severe harm, although lethal cases were less likely in cases from ambulatory settings. Etiologic factors spanned all of the sociotechnical dimensions, and many recurring patterns of error were identified. Adverse events associated with health IT vulnerabilities can cause extensive harm and are encountered across the continuum of health care settings and sociotechnical factors. The recurring patterns provide valuable lessons that both practicing clinicians and health IT developers could use to reduce the risk of harm in the future. The likelihood of harm seems to relate more to a patient's particular situation than to any one class of error.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share thework provided it is properly cited. The work cannot be changed in any way or used

  5. Mediation as an alternative solution to medical malpractice court claims

    Directory of Open Access Journals (Sweden)

    Neels Claassen

    2016-05-01

    Full Text Available Is there a crisis in the healthcare industry? Most certainly there is. Dr Motsoaledi, Minister of Health, publicly acknowledged the existence of such a crisis at a Medico-Legal Summit held at his initiative in Pretoria on 9 and 10 March 2015 at St Georges Hotel.[1] Currently, as recently confirmed by the MEC for Health, Ms Mahlangu, there are about 2 000 pending court cases against the Gauteng Provincial Health Department, the total quantum being claimed amounting to approximately ZAR 3.5 billion. During 2013/2014 this department spent about ZAR 256 million on legal costs payable to claimants’ attorneys. No budget for these expenses exists, resulting in payment being made from funds designated for the acquisition of medical equipment and other purposes.[1] This undermines the department’s ability to renew old equipment and upgrade to more modern equipment, resulting in even further claims. More claims are therefore to be expected. The Medical Protection Society also confirmed an increase in medical malpractice claims against their members of nearly 550% compared to 10 years ago. The quantum of claims that exceeded ZAR 5 million per claim, also increased by 900%.[2,3] The ripple effect of these increases in medico-legal claims causes insurance premiums for healthcare professionals to become exorbitantly expensive, resulting in some practitioners leaving the medical profession. Practitioners also act more defensively in applying their trade, resulting in additional and sometimes unnecessary tests that increase the costs of medical care and often cause further grounds for the institution of claims.

  6. Analysis of medication-related malpractice claims: causes, preventability, and costs.

    Science.gov (United States)

    Rothschild, Jeffrey M; Federico, Frank A; Gandhi, Tejal K; Kaushal, Rainu; Williams, Deborah H; Bates, David W

    2002-11-25

    Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention. We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs. Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500). Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

  7. A study on the civil liability of radiological technologist in medical malpractice

    International Nuclear Information System (INIS)

    Lim, Chang Seon

    1995-01-01

    Recently the suits for medical malpractice are gradually increasing in this country. The main purpose of this study is to excavate the most suitable theories about civil liabilities on medical malpractice by radiological technologist. To solve the above-mentioned problems in medical malpractice, I have proceeded to make a survey of traditional theories and tried to excavate the most suitable theories for our medical circumstances among those theories. Both domestic and foreign relevant professional literatures and legal cases were investigated in this study. Several important findings of this study are as follows. First, the nature of legal interrelationship between radiological technologist and physician(or the representative of a hospital) is to define the content of employment. But in the eye of medical law, the interrelationship between radiological technologist and physician is written that radiological technologist should be directed by physician. Second, the nature of legal interrelationship between patient and physician(or the representative of a hospital) is to define the content of legal obligation of physician(or the representative of a hospital), and radiological technologist execute his obligation as proxy for physician. Therefore, patient can not clame any legal right to radiological technologist. Third, radiological technologist has the obligation of Due Care in medical practice. Fourth, on the medical malpractice by radiological technologist the civil liability can be treated as either tortious liability or contractual liability, and physician (or the representative of hospital) take the responsibility for the damage compensation. In this case, physician has the right of indemnity to radiological technologist. But it should be dinied or extremely limited

  8. Burnout, job satisfaction, and medical malpractice among physicians.

    Science.gov (United States)

    Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

    2013-01-01

    Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Physicians in Taiwan face both burnout and a high risk in medical malpractice. There is high

  9. Use of Nondisclosure Agreements in Medical Malpractice Settlements by a Large Academic Health Care System.

    Science.gov (United States)

    Sage, William M; Jablonski, Joseph S; Thomas, Eric J

    2015-07-01

    Honesty and transparency are essential aspects of health care, including in physicians' and hospitals' responses to medical error. Biases and habits associated with medical malpractice litigation, however, may work at cross-purposes with compassion in clinical care and with efforts to improve patient safety. To determine the frequency of nondisclosure agreements in medical malpractice settlements and the extent to which the restrictions in these agreements seem incompatible with good patient care. We performed a retrospective review of medical malpractice claim files, including settlement agreements, for claims closed before (fiscal year 2001-2002), during (fiscal year 2006-2007), and after (fiscal years 2009-2012) the implementation of tort reform in Texas. We studied The University of Texas System, which self-insures malpractice claims that involve 6000 physicians at 6 medical campuses in 5 cities. Nondisclosure provisions in medical malpractice settlements. During the 5 study years, The University of Texas System closed 715 malpractice claims and made 150 settlement payments. For the 124 cases that met our selection criteria, the median compensation paid by the university was $100,000 (range, $500-$1.25 million), and the mean compensation was $185,372. A total of 110 settlement agreements (88.7%) included nondisclosure provisions. All the nondisclosure clauses prohibited disclosure of the settlement terms and amount, 61 (55.5%) prohibited disclosure that the settlement had been reached, 51 (46.4%) prohibited disclosure of the facts of the claim, 29 (26.4%) prohibited reporting to regulatory agencies, and 10 (9.1%) prohibited disclosure by the settling physicians and hospitals, not only by the claimant. Three agreements (2.7%) included specific language that prohibited the claimant from disparaging the physicians or hospitals. The 50 settlement agreements signed after tort reform took full effect in Texas (2009-2012) had stricter nondisclosure provisions than the

  10. Users' perception of library use malpractices: case study of ...

    African Journals Online (AJOL)

    This study investigated library users perception of library use malpractices in academic libraries; using University of Calabar as a case study. Simple random sampling technique was use to draw a sample of 500 users from a population of 1804 registered users of the library. Questionnaire was use for data collection.

  11. The effect of medical malpractice liability on rate of referrals received by specialist physicians.

    Science.gov (United States)

    Xu, Xiao; Spurr, Stephen J; Nan, Bin; Fendrick, A Mark

    2013-10-01

    Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.

  12. Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States.

    Science.gov (United States)

    Minami, Christina A; Sheils, Catherine R; Pavey, Emily; Chung, Jeanette W; Stulberg, Jonah J; Odell, David D; Yang, Anthony D; Bentrem, David J; Bilimoria, Karl Y

    2017-03-01

    The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to

  13. A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study.

    Science.gov (United States)

    Hwang, Chi-Yuan; Wu, Chien-Hung; Cheng, Fu-Cheng; Yen, Yung-Lin; Wu, Kuan-Han

    2018-03-01

    Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan.The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013.Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%).Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is also

  14. Nature of Medical Malpractice Claims Against Radiation Oncologists

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, Deborah; Tringale, Kathryn [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Connor, Michael [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); University of California Irvine School of Medicine, Irvine, California (United States); Punglia, Rinaa [Department of Radiation Oncology, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (United States); Hattangadi-Gluth, Jona, E-mail: jhattangadi@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

    2017-05-01

    Purpose: To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Methods and Materials: Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. Results: There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included “improper performance” (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), “errors in diagnosis” (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and “no medical misadventure” (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. “Improper performance” was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment. Conclusions: Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against

  15. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases.

    Science.gov (United States)

    Gurley, Kiersten L; Grossman, Shamai A; Janes, Margaret; Yu-Moe, C Winnie; Song, Ellen; Tibbles, Carrie D; Shapiro, Nathan I; Rosen, Carlo L

    2018-04-17

    Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the U.S (> 350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (non-resident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses and contributing factors. Fisher's exact test or t-test was used for comparisons (alpha set at 0.05). Eight hundred and forty-five EM cases were identified of which 732 (87%) did not name a resident (non-resident cases), while 113 (13%) included a resident (resident cases) (Figure 1). There were higher total incurred losses for non-resident cases (Table 1). The most frequent allegation categories in both cohorts were "Failure or Delay in Diagnosis/Misdiagnosis" and "Medical Treatment" (non-surgical procedures or treatment regimens i.e. central line placement). Allegation categories of Safety and Security, Patient Monitoring, Hospital Policy and Procedure and Breach of Confidentiality were found in the non-resident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty six percent (75) of resident vs 57% (415) of non-resident cases were high severity claims

  16. Changing the Medical Malpractice Dispute Process: What Have We Learned from California's MICRA?

    National Research Council Canada - National Science Library

    2004-01-01

    In 1975, amid growing concern over the price and availability of medical malpractice insurance, California changed the laws that govern how personal injury claims arising from health care treatment...

  17. The importance of distinguishing illegality from guilt in trials for alleged medical malpractice

    Directory of Open Access Journals (Sweden)

    Manuel Fernando Díaz Brousse

    2012-10-01

    Full Text Available A proper analysis of the essential elements that comprise a criminal offense that falls under the purview of medical negligence is fundamental in order to rule, in justice, cases of alleged malpractice. It is necessary to properly distinguish between accusations of illegality and those of guilt. Open legal essays and precedents about such illicit acts provide judges with great latitude in determining when acts are consistent or not with standard care. This power mandates that judges should ground their convictions on objective infringements of the law rather than subjective criteria.

  18. An Analysis of the Number of Medical Malpractice Claims and Their Amounts.

    Directory of Open Access Journals (Sweden)

    Marco Bonetti

    Full Text Available Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction.

  19. 45 CFR 60.7 - Reporting medical malpractice payments.

    Science.gov (United States)

    2010-10-01

    ... note), (v) Date of birth, (vi) Name of each professional school attended and year of graduation, (vii... malpractice has occurred. (Approved by the Office of Management and Budget under control number 0915-0126) ...

  20. The causes of medical malpractice suits against radiologists in the United States.

    Science.gov (United States)

    Whang, Jeremy S; Baker, Stephen R; Patel, Ronak; Luk, Lyndon; Castro, Alejandro

    2013-02-01

    To determine the most frequent causes of malpractice suits as derived from credentialing data of 8401 radiologists. This study was approved by the Institutional Review Board of New Jersey Medical School. A total of 8401 radiologists in 47 states participating in the network of One-Call Medical, a broker for computed tomographic/magnetic resonance studies in workers' compensation cases, were required to provide their malpractice history as part of their credentialing application. Of these, 2624 (31%) radiologists had at least one claim in their career. In each enrollee's credentialing file, if there was a claim against the enrollee there was a narrative regarding each malpractice case from which, in most instances, a primary allegation could be discerned. Among the 4793 cases, an alleged cause could be derived from the narrative in 4043 (84%). Statistical analysis was performed with Stata 12 (2011; Stata, College Station, Tex) software. The most common general cause was error in diagnosis (14.83 claims per 1000 person-years [95% confidence interval {CI}: 14.19, 15.51]). In this category, breast cancer was the most frequently missed diagnosis (3.57 claims per 1000 person-years [95% CI: 3.26, 3.91]), followed by nonspinal fractures (2.49 claims per 1000 person-years [95% CI: 2.28, 2.72]), spinal fractures (1.32 claims per 1000 person-years [95% CI: 1.16, 1.49]), lung cancer (1.26 claims per 1000 person-years [95% CI: 1.11, 1.42]), and vascular disease (1.08 claims per 1000 person-years [95% CI: 0.93, 1.24]). The category next in frequency was procedural complications (1.76 claims per 1000 person-years [95% CI: 1.58, 1.96]), followed by inadequate communication with either patient (0.40 claim per 1000 person-years [95% CI: 0.32, 0.50]) or referrer (0.71 claim per 1000 person-years [95% CI: 0.60, 0.84]). Radiologists had only a peripheral role in 0.92 claim per 1000 person-years (95% CI: 0.77, 1.10). Failure to recommend additional testing was a rare cause (0.41 claim

  1. Medical malpractice reform and employer-sponsored health insurance premiums.

    Science.gov (United States)

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack

    2008-12-01

    Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

  2. Medical Practitioners of Radiology & Imaging in the Dock. ( Malpractice)

    International Nuclear Information System (INIS)

    Muyinda, Z.

    2015-01-01

    The average indemnification has doubled in the last 15 years for all physicians, it has tripled for radiology. Furthermore, 1/3 of all medical malpractice are lost by the radiologist. The most commonly missed diagnoses are breast cancer, lung cancer, and fracture of the spine. Clinical knowledge and practice is no longer a luxury of operating in calm and academic environment. In real life things don’t always go according to plan. Identification of the risk. This may vary depending upon the practice. E.g if the practice involves interpreting studies from a busy trauma center or a mammography center, the practice involves higher risk than a free-standing MRI center. When it is appropriate, a radiologist should not be reluctant to indicate that an additional study or procedure may be of diagnostic or confirmatory value when the initial diagnosis is not clear or in doubt Lack of appropriate and timely communication appears to be one of the greatest problems confronting radiologists today. However, this is the one area in which the radiologist can dramatically improve the odds against being sued, and that is by communicating and documenting the communication. The ACR Guideline for Communication indicates that a precise diagnosis should be given whenever possible and that a differential diagnosis should be given when appropriate Radiologist need be qualified to interpret or perform a procedure and maintain your competence. Do not attempt to interpret studies in an area in which you do not feel comfortable or have not had sufficient training. The ACR Guideline may be a double-edged sword for some. Certainly, the ACR Guideline can be used against you if you deviated from it and did not document why you did so

  3. Criminal law as a response to medical malpractice: pluses and minuses--comparing Italian and U.S. experiences.

    Science.gov (United States)

    Di Landro, Andrea R

    2012-06-01

    The paper is divided into three parts. The first part sets out the comparative differences between the tort of malpractice in common law and the criminal negligence in civil law: while the common law takes for mens rea only the "gross" negligence, and rarely medical negligence, other law systems instead (and particularly Italian law) criminalize also ordinary negligence, frequently in medical malpractice cases. The second part of the paper addresses the pluses of using criminal law as response to medical malpractice: inadequate medical self-policing and "repeat offenders" problems are analysed, in the perspective of the patient, of the doctor, of the insurance company, and of the community. The third part addresses the minuses of the criminal law as response: medical "shame and blame" mentality, criminal stigma and culture of fear are disincentives to incident reporting and to system analysis (the most important means of prevention); "defensive medicine" and "courts-abiding medicine" are managed not yet in the patient's exclusive interest, but in the egoistic/utilitarian aim to avoid denunciations; finally, the uncertainty of the medicine, the accusatory system and the proof "beyond a reasonable doubt" seem hardly compatible with each other.

  4. Trends in medical malpractice claims in patients with cleft or craniofacial abnormalities in the United States.

    Science.gov (United States)

    Rawal, Rounak B; Kilpatrick, Lauren A; Wood, Jeyhan S; Drake, Amelia F

    2016-11-01

    To describe medical malpractice trends in patients with cleft and/or craniofacial abnormalities. A modified Delphi approach was used to gather search terms. Search settings included "all jury verdicts and settlements", with jurisdiction of "all states" and "all federal courts" (by court and circuit). A retrospective review of WestLawNext legal database was conducted. Cases were excluded if they did not have a direct association from the patient's craniofacial anomaly or if they were not related to malpractice. Forty-two cases met inclusion criteria. Cases closed between 1981 and 2014 were included. The mean payment among claims with an indemnity payment was $3.9 million. Of cases brought to trial, 62% were in favor of the plaintiff. Amongst physicians named as co-defendants, pediatricians were most commonly named (24%), followed by plastic surgeons (16%), obstetricians (7.8%), and radiologists (7.8%). "Missed diagnosis" was the most common type of negligent claim (45%), followed by "surgical error" (21%), and "medication error" (17%). "Anoxic brain injury" resulted in the highest median indemnity payment for complication of patient management ($3.5 million), followed by "wrongful birth" ($1.03 million), and "minor physical injury" ($520,000). No specific type of negligent claim (p = 0.764) nor complication of patient management (p = 0.61) was associated with a greater indemnity payment. Mean indemnity payment was $920,000 prior to 2001 and $4.4 million after 2001 (p = 0.058). Mean indemnity payments were fourteen-fold greater in patients as compared to those in the overall population ($3.9 million versus $274,887) and seven-fold greater than those in the average pediatric population ($3.9 million versus $520,923). All healthcare providers should be aware of the associated medical malpractice claims that may be incurred when treating patients at risk for these conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Medical information therapy and medical malpractice litigation in ...

    African Journals Online (AJOL)

    2013-11-01

    Nov 1, 2013 ... Instead, the study proposed the concept of medical information therapy – an .... practitioner's obligations, patient autonomy and self-determination ..... Handbook – Guidelines for Good and Ethical Practice in Medicine,.

  6. An improved accrual: reducing medical malpractice year-end adjustments.

    Science.gov (United States)

    Frese, Richard C

    2012-08-01

    Healthcare organizations can improve their year-end malpractice insurance accruals by taking the following steps: Maintain productive communication. Match accrual and accounting policies. Adjust amount of credit to own historical loss experience. Request more frequent analysis. Obtain a second opinion.

  7. Medication errors as malpractice-a qualitative content analysis of 585 medication errors by nurses in Sweden.

    Science.gov (United States)

    Björkstén, Karin Sparring; Bergqvist, Monica; Andersén-Karlsson, Eva; Benson, Lina; Ulfvarson, Johanna

    2016-08-24

    Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses' work experience in relation to the risk and type for medication errors. All medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses' work experience and associations within and between the errors and contributory factors, Fisher's exact test was used, and Cohen's kappa (k) was performed to estimate the magnitude and direction of the associations. There were a total of 613 medication errors in the 585 cases, the most common being "Wrong dose" (41 %), "Wrong patient" (13 %) and "Omission of drug" (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being "Negligence, forgetfulness or lack of attentiveness" (68 %), "Proper protocol not followed" (25 %), "Lack of knowledge" (13 %) and "Practice beyond scope" (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being "Role overload" (36 %), "Unclear communication or orders" (30 %) and "Lack of adequate access to guidelines or unclear organisational routines" (30 %). The errors "Wrong patient due to mix-up of patients" and "Wrong route" and the contributory factors "Lack of knowledge" and "Negligence, forgetfulness or lack of attentiveness" were more common in less experienced nurses. The experienced nurses were more prone to "Practice beyond scope of practice" and to make errors in spite of "Lack of adequate

  8. Can shared decision-making reduce medical malpractice litigation? A systematic review.

    Science.gov (United States)

    Durand, Marie-Anne; Moulton, Benjamin; Cockle, Elizabeth; Mann, Mala; Elwyn, Glyn

    2015-04-18

    To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation. We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or likely influence of shared decision-making or shared decision-making interventions on medical malpractice litigation or on patients' intentions to litigate. The following databases were searched from inception until January 2014: CINAHL, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, HMIC, Lexis library, MEDLINE, NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge. We also hand searched reference lists of included studies and contacted experts in the field. Downs & Black quality assessment checklist, the Critical Appraisal Skill Programme qualitative tool, and the Critical Appraisal Guidelines for single case study research were used to assess the quality of included studies. 6562 records were screened and 19 articles were retrieved for full-text review. Five studies wee included in the review. Due to the number and heterogeneity of included studies, we conducted a narrative synthesis adapted from the ESRC guidance for narrative synthesis. Four themes emerged. The analysis confirms the absence of empirical data necessary to determine whether or not shared decision-making promoted in the clinical encounter can reduce litigation. Three out of five included studies provide retrospective and simulated data suggesting that ignoring or failing to diagnose patient preferences, particularly when no effort has been made to inform and support understanding of possible harms and benefits, puts clinicians at a higher risk of litigation. Simulated scenarios suggest that documenting the use of decision support interventions in patients' notes could offer some level of medico-legal protection. Our analysis also indicated that a sizeable

  9. American Academy of Pediatrics: Technical report: Alternative dispute resolution in medical malpractice.

    Science.gov (United States)

    Fraser, J J

    2001-03-01

    The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options.

  10. Insurance: Profitability of the Medical Malpractice and General Liability Lines. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    This report on the profitability of the property/casualty insurance industry and in particular of the medical malpractice insurance line was prepared at the request of Representatives Henry A. Waxman and James J. Florio and Senators Paul Simon, Daniel K. Inouye, Albert Gore, Jr., and Jay D. Rockefeller. Four different estimates of medical…

  11. 78 FR 58202 - Federal Tort Claims Act (FTCA) Medical Malpractice Program Regulations: Clarification of FTCA...

    Science.gov (United States)

    2013-09-23

    ...) Medical Malpractice Program Regulations: Clarification of FTCA Coverage for Services Provided to Non... not limit coverage to childhood vaccinations; and (3) To add the following new example as subsection 6... that have substantial direct effects on the states, the relationship between the national government...

  12. The defendant in a medical malpractice suit: an integral part of the defense team

    International Nuclear Information System (INIS)

    Petrek, F.R. Jr.; Slovis, M.R.

    1998-01-01

    This article explains the litigation process of a medical malpractice suit and offers suggestions to help pediatric radiologists cope with the stress of being sued. It provides tangible ways in which the pediatric radiologist can become an important part of the defense team. Our goal is to enable the pediatric radiologist to place the lawsuit in a proper perspective and demonstrate the importance of providing medical insight to aid in forming legal strategy. (orig.)

  13. The role of radiology in diagnostic error: a medical malpractice claims review.

    Science.gov (United States)

    Siegal, Dana; Stratchko, Lindsay M; DeRoo, Courtney

    2017-09-26

    Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.

  14. The practice of mediation to resolve clinical, bioethical, and medical malpractice disputes.

    Science.gov (United States)

    Lee, Danny W H; Lai, Paul B S

    2015-12-01

    Mediation is a voluntary process whereby a neutral and impartial third party-t-he mediator--is present to facilitate communication and negotiation between the disputing parties so that amicable settlements can be agreed. Being confidential and non-adversarial in nature, the mediation process and skills are particularly applicable in clinical practice to facilitate challenging communications following adverse events, to assist bioethical decision making and to resolve disputes. Mediation is also a more effective and efficient means of dispute resolution in medical malpractice claims when compared with civil litigation. Health care mediation teams should be set up at individual facilities to provide education and consultation services to frontline staff and patients. At a community level, the Government, the mediation community, and the health care professionals should join forces to promote mediation as a means to settle medical malpractice claims outside of the courtroom.

  15. Partnering With a Medical Malpractice Insurer to Improve Patient Safety and Decrease Risk.

    Science.gov (United States)

    Keohane, Carol A; Dwyer, Kathy; Boulanger, Jason; Zigmont, Katherine; Babayan, Astrid; Cushing, Elizabeth; Walsh, Brian

    Implementing evolving science into clinical practice remains challenging. Assimilating new scientific evidence into clinical protocols and best practice recommendations, in a timely manner, can be difficult. In this article, we examine the value of partnering with a captive medical malpractice insurance company and its Patient Safety Organization to use data and convening opportunities to build upon the principles of implementation science and foster efficient and widespread adoption of the most current evidence-based interventions. Analyses of medical malpractice and root-cause analysis data set the context for this partnership and acted as a catalyst for creating best practice guidelines for adopting therapeutic hypothermia in the treatment of neonatal encephalopathy. What follows is a powerful example of successfully leveraging the collective wisdom of healthcare providers across specialties and institutional lines to move patient safety forward while managing risk.

  16. Reformers, Batting Averages, and Malpractice: The Case for Caution in Value-Added Use

    Science.gov (United States)

    Gleason, Daniel

    2014-01-01

    The essay considers two analogies that help to reveal the limitations of value-added modeling: the first, a comparison with batting averages, shows that the model's reliability is quite limited even though year-to-year correlation figures may seem impressive; the second, a comparison between medical malpractice and so-called educational…

  17. The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.

    Science.gov (United States)

    Yu, Hao; Greenberg, Michael; Haviland, Amelia

    2017-12-01

    Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars. Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05). A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform. © Health Research and Educational Trust.

  18. Medical malpractice lawsuits and the value of skilled and diverse legal counsel.

    Science.gov (United States)

    Lapuyade, Keith D; Sorkin, Alison C

    2013-12-01

    Medical malpractice claims against dermatologists and dermapathologists arise mostly out of claims for negligence--when a patient claims a provider owed a duty to a patient, breached that duty, and caused damages to the patient. When a health care provider files a claim with his or her insurance company, the insurance company will usually retain and pay an attorney for the health care provider. It is important to understand the role the attorney retained by the insurance company plays to evaluate whether a health care provider should seek the advice of independent or "personal" counsel.

  19. Delays in medical malpractice litigation in civil law jurisdictions: some evidence from the Italian Court of Cassation.

    Science.gov (United States)

    Grembi, Veronica; Garoupa, Nuno

    2013-10-01

    Medical malpractice law and tort reform are contentious issues. In this paper, we focus on Italy as an example of a civil law jurisdiction. Italian medical malpractice law is essentially judge-made law. However, its effectiveness is likely to be curtailed by excessive delays in litigation. Several reforms have been enacted since the late 1980s to correct this situation. By making use of the decisions of the Italian Court of Cassation (which have shaped medical malpractice law) from 1970 to 2009, we show that these reforms had no general statistically significant impact on delays. Recent reduction of delays does not seem to be related to legal reforms but rather explained by other factors.

  20. Does Medical Malpractice Law Improve Health Care Quality?

    Science.gov (United States)

    Frakes, Michael; Jena, Anupam B.

    2016-01-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

  1. Negligence in securing informed consent and medical malpractice.

    Science.gov (United States)

    Perry, C

    1988-01-01

    The doctrine of informed consent requires that the patient must act voluntarily and in the light of adequate information in order to give legally valid consent to medical care. Different models have been developed by various courts to determine whether the informational requirement, what the physician must disclose to the patient about the potential risks of the proposed treatment, has been met under the tort theory of negligence. To prevail, the patient plaintiff must show that a particular jurisdiction's disclosure standard has been breached, that harm has resulted, and that the defendant physician's negligent failure to discuss certain risks was causally responsible for the patient's failure to withhold consent. Perry discusses possible problems of redundancy or inconsistency concerning the relationship between different models for disclosure and causality, and notes that these problems may have serious implications for patient autonomy.

  2. Mandatory presuit mediation: 5-year results of a medical malpractice resolution program.

    Science.gov (United States)

    Jenkins, Randall C; Smillov, Arlene E; Goodwin, Matthew A

    2014-01-01

    The Florida Patient Safety and Presuit Mediation Program (FLPSMP) is a mandatory mediation program designed to provide deserving patients with fast, fair compensation while limiting the healthcare provider expenses incurred during traditional litigation. Mediation occurs before litigation begins; therefore, patients with meritorious claims receive compensation often years earlier than they would with extended litigation. This early mediation fosters confidential and candid communication between doctors and patients, which promotes early fact-finding and candid discussion. The program went into effect across the University of Florida (UF) Health system on January 1, 2008. In an article previously published in this journal, we discussed the positive trend observed 2 years after the implementation of the FLPSMP. This article incorporates 5 years of data, which includes new benchmarks with state and national data, to demonstrate that the program can be used successfully as a medical malpractice solution. © 2014 American Society for Healthcare Risk Management of the American Hospital Association.

  3. Delayed Detection of Esophageal Intubation in Anesthesia Malpractice Claims: Brief Report of a Case Series.

    Science.gov (United States)

    Honardar, Marzieh R; Posner, Karen L; Domino, Karen B

    2017-12-01

    This retrospective case series analyzed 45 malpractice claims for delayed detection of esophageal intubation from the Anesthesia Closed Claims Project. Inclusion criteria were cases from 1995 to 2013, after adoption of identification of CO2 in expired gas to verify correct endotracheal tube position as a monitoring standard by the American Society of Anesthesiologists. Forty-nine percent (95% confidence interval 34%-64%) occurred in the operating room or other anesthesia location where CO2 detection equipment should have been available. The most common factors contributing to delayed detection were not using, ignoring, or misinterpreting CO2 readings. Misdiagnosis, as with bronchospasm, occurred in 33% (95% confidence interval 20%).

  4. Medical Malpractice Reform: A Fix for a Problem Long out of Fashion.

    Science.gov (United States)

    Kirkner, Richard Mark

    2017-10-01

    State tort reforms have all but relegated the malpractice crisis to the history books. But there's good news for those of you into all things retro: The House of Representatives just voted to fix the malpractice crisis by a 222-197 margin.

  5. Disk Battery Ingestion A Malpractice Case that Results in Pneumonia

    Directory of Open Access Journals (Sweden)

    Cihat Şarkış

    2016-12-01

    Full Text Available Alkaline batteries have become the second most swallowed foreign bodies following coins. Most cases have an uncomplicated course, but some may lead to serious complications and even death. Here we report a 28 months old boy who had experienced discomfort, eating refusal, vomiting and slightly wheezing after falling from a sofa bed. He has been in three different county hospitals and two private hospitals due to complaints, has been examined by two pediatricians and a cranial surgeon. A cranial CT imaging, a cranial X-ray radiograph and a chest X-ray radiograph was obtained. Firstly, diagnosed as head and neck trauma, then diagnosed as acute bronchiolitis, and finally pneumonia. Hospitalized twice. Finally, a chest radiograph revealed a button battery in the esophagus. The foreign body was endoscopic removed. The child had a quick clinical impairment after removal of the battery. As a result, alkaline batteries with their increasing risk of engulfment poses very serious problems. The parents and physicians should be informed against increasing frequency of ingestion of alkaline batteries by infants and children. Also, clinicians should be careful about the risk of these batteries that they can cause pneumonia and infiltration which may make it difficult to detect the foreign body.

  6. Survey of malpractice claims in dermatology

    International Nuclear Information System (INIS)

    Altman, J.

    1975-01-01

    A statistical survey of malpractice claims asserted against dermatologists was made. The subject matter of the claims was divided into eight major categories: drug reactions, x-ray burns, poor cosmetic result following surgery, poor cosmetic result following medication, failure to diagnose cancer, improper diagnosis, infection from treatment, and miscellaneous. The study showed that a group of ''serious'' damage cases, which accounted for 34 percent of total claims, generated 94 percent of total dollar losses. The problem areas for malpractice claims appeared to be drug reactions, cosmetic chemosurgery, and failure to diagnose cancer. (U.S.)

  7. Defenses to malpractice: what every emergency physician should know.

    Science.gov (United States)

    Hudson, Michael Jason; Moore, Gregory P

    2011-12-01

    Emergency medicine is a high-risk specialty that carries a constant risk of malpractice litigation. Fear of malpractice litigation can lead to less-than-optimal patient care as well as impairments in physician quality of life. Although malpractice fear can be ubiquitous among emergency physicians, most receive little to no education on malpractice. Medical malpractice requires that 1) The physician had a duty, 2) The physician breached the duty, 3) There was harm to the patient, and 4) The harm was caused by the physician's breach of duty. Even if all four medical malpractice conditions are met, there are still special legal defenses that have been and can be used in court to exonerate the physician. These defenses include assumption of the risk, Good Samaritan, contributory negligence, comparative fault, sudden emergency, respectable minority, two schools of thought, and clinical innovation. These legal defenses are illustrated and explained using defining precedent cases as well as hypothetical examples that are directly applicable to emergency medical practice. Knowledge of these special legal defenses can help emergency physicians minimize their risk of litigation when caring for patients. Published by Elsevier Inc.

  8. Primary care closed claims experience of Massachusetts malpractice insurers.

    Science.gov (United States)

    Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

    Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice

  9. Twenty Years of Evidence on the Outcomes of Malpractice Claims

    Science.gov (United States)

    2008-01-01

    Two decades of social science research on the outcomes of medical malpractice claims show malpractice outcomes bear a surprisingly good correlation with the quality of care provided to the patient as judged by other physicians. Physicians win 80% to 90% of the jury trials with weak evidence of medical negligence, approximately 70% of the borderline cases, and even 50% of the trials in cases with strong evidence of medical negligence. With only one exception, all of the studies of malpractice settlements also find a correlation between the odds of a settlement payment and the quality of care provided to the plaintiff. Between 80% and 90% of the claims rated as defensible are dropped or dismissed without payment. In addition, the amount paid in settlement drops as the strength of the patient’s evidence weakens. PMID:19048355

  10. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

    Science.gov (United States)

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

    2008-02-01

    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

  11. [Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts].

    Science.gov (United States)

    Bruguera, M; Arimany, J; Bruguera, R; Barberia, E; Ferrer, F; Sala, J; Pujol Robinat, A; Medallo Muñiz, J

    2012-04-01

    Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  12. Possible gasoline-induced chronic liver injury due to occupational malpractice in a motor mechanic: a case report.

    Science.gov (United States)

    Gunathilaka, Mahesh Lakmal; Niriella, Madunil Anuk; Luke, Nathasha Vihangi; Piyarathna, Chathura Lakmal; Siriwardena, Rohan Chaminda; De Silva, Arjuna Priyadarshin; de Silva, Hithanadura Janaka

    2017-07-03

    Hydrocarbon-induced occupational liver injury is a well-known clinical entity among petroleum industry workers. There are many types of hydrocarbon exposure, with inhalation being the most common. Hydrocarbon-induced occupational liver injury is a rarely suspected and commonly missed etiological agent for liver injury. We report a case of a non-petroleum industry worker with chronic liver disease secondary to hydrocarbon-induced occupational liver injury caused by chronic low-grade hydrocarbon ingestion due to occupational malpractice. A 23-year-old Sri Lankan man who was a motor mechanic presented to our hospital with decompensated cirrhosis. He had been chronically exposed to gasoline via inadvertent ingestion due to occupational malpractice. He used to remove gasoline from carburetors by sucking and failed to practice mouth washing thereafter. On evaluation, he had histologically proven established cirrhosis. A comprehensive history and workup ruled out other nonoccupational etiologies for cirrhosis. The patient's long-term occupational gasoline exposure and clinical course led us to a diagnosis of hydrocarbon-induced occupational liver injury leading to decompensated cirrhosis. Hydrocarbon-induced occupational liver injury should be considered as a cause when evaluating a patient with liver injury with possible exposure in relevant occupations.

  13. 我國地方法院刑事醫療糾紛判決的實證分析:2000年至2010年 An Empirical Study of Medical Malpractice Judgments from District Criminal Courts in Taiwan: 2000-2010

    Directory of Open Access Journals (Sweden)

    劉邦揚 Pang-Yang Liu

    2011-12-01

    Full Text Available 本文以法學實證研究方法進行撰寫,並全面性地蒐集我國自 2000 年1月1 日起至2010 年6 月30 日止,所有地方法院作成的刑事醫療糾紛判決書,並且擷取判決書中之客觀可辨的資訊進行建檔,利用統計軟體SPSS 17.0版進行描述性統計分析與推論性統計,期待真實呈現地方法院刑事醫療糾紛的訴訟現況。本研究共蒐集到277 個刑事判決,計380 名具醫師身分之被告,並發現此類訴訟有著「低定罪率」與「高自訴比率」等特徵,足供醫療糾紛研究者加以關注。 Recently, the debate on decriminalization of medical malpractice has received mounting attentions in both medical and law communities. An increasing number of studies try to analyze different aspects of the issue for future criminal law revision. However, the existing literature focuses mainly on theoretical discussion. Of the limited legal empirical studies, they are mostly limited in study scope and number of cases analyzed. Due to the limitations in study scope and size, previous findings may not reflect the true picture of medical malpractice lawsuits in Taiwan over time. Therefore, we aimed to conduct a population-based study to analyze characteristics, process, and court decisions of medical malpractice lawsuits in Taiwan. The “Law Bank” database was used to search all the district criminal court’s medical malpractice judgments from 21 district courts in Taiwan during the period of January 1st, 2000 to June 30th, 2010. Exclusion criteria were applied. A total of 277 eligible cases and 380 physician-defendants were included. Contents of each court judgment were analyzed and description statistical methods were applied. Factors affecting judgment was revealed by chi-square test and logistic regression analysis. In general, medical malpractice lawsuits had a low conviction rate, the punishment tended to be trivial, and when patient hurt from medical

  14. Malpractice litigation following spine surgery.

    Science.gov (United States)

    Daniels, Alan H; Ruttiman, Roy; Eltorai, Adam E M; DePasse, J Mason; Brea, Bielinsky A; Palumbo, Mark A

    2017-10-01

    OBJECTIVE Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation. METHODS A search for "spine surgery" spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted. RESULTS A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more

  15. Is South Africa on the verge of a medical malpractice litigation storm ...

    African Journals Online (AJOL)

    A healthy tension between the medical and legal professions should lead to an overall improvement in quality of health care, but consideration will need to be given to issues such as specialist courts, alternative means of resolution, claim quantum determination and capping. Although these issues will technically not ...

  16. [Pitfalls in informed consent: a statistical analysis of malpractice law suits].

    Science.gov (United States)

    Echigo, Junko

    2014-05-01

    In medical malpractice law suits, the notion of informed consent is often relevant in assessing whether negligence can be attributed to the medical practitioner who has caused injury to a patient. Furthermore, it is not rare that courts award damages for a lack of appropriate informed consent alone. In this study, two results were arrived at from a statistical analysis of medical malpractice law suits. One, unexpectedly, was that the severity of a patient's illness made no significant difference to whether damages were awarded. The other was that cases of typical medical treatment that national medical insurance does not cover were involved significantly more often than insured treatment cases. In cases where damages were awarded, the courts required more disclosure and written documents of information by medical practitioners, especially about complications and adverse effects that the patient might suffer.

  17. Malpractice claims in interventional radiology: frequency, characteristics and protective measures.

    Science.gov (United States)

    Magnavita, N; Fileni, A; Mirk, P; Magnavita, G; Ricci, S; Cotroneo, A R

    2013-04-01

    The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process. The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006. In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient's death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity. Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status. Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient's right to autonomy also implies adopting clear and rigorous processes for obtaining the patient's informed consent to the medical procedure.

  18. Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis.

    Science.gov (United States)

    Patterson, Diana C; Grelsamer, Ronald P; Bronson, Michael J; Moucha, Calin S

    2017-10-01

    As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. Analysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. The incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury ("foot drop") was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. Nerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Do fears of malpractice litigation influence teaching behaviors?

    Science.gov (United States)

    Reed, Darcy A; Windish, Donna M; Levine, Rachel B; Kravet, Steven J; Wolfe, Leah; Wright, Scott M

    2008-01-01

    Medical malpractice is prominently positioned in the consciousness of American physicians, and the perceived threat of malpractice litigation may push physicians to practice defensively and alter their teaching behaviors. The purposes of this study were to characterize the attitudes of academic medical faculty toward malpractice litigation and to identify teaching behaviors associated with fear of malpractice litigation. We surveyed 270 full-time clinically active physicians in the Department of Medicine at a large academic medical center. The survey assessed physicians' attitudes toward malpractice issues, fear of malpractice litigation, and self-reported teaching behaviors associated with concerns about litigation. Two hundred and fifteen physicians responded (80%). Faculty scored an average of 25.5 +/- 6.9 (range = 6-42, higher scores indicate greater fear) on a reliable malpractice fear scale. Younger age (Spearman's rho = 0.19, p = .02) and greater time spent in clinical activities (rho = 0.26, p Fear Scale. Faculty reported that because of the perceived prevalence of lawsuits and claims made against physicians, they spend more time writing clinical notes for patients seen by learners (74%), give learners less autonomy in patient care (44%), and limit opportunities for learners to perform clinical procedures (32%) and deliver bad news to patients (33%). Faculty with higher levels of fear on the Malpractice Fear Scale were more likely to report changing their teaching behaviors because of this perceived threat (rho = 0.38, p < .001). Physicians report changes in teaching behaviors because of concerns about malpractice litigation. Although concerns about malpractice may promote increased supervision and positive role modeling, they may also limit important educational opportunities for learners. These results may serve to heighten awareness to the fact that teaching behaviors and decisions may be influenced by the malpractice climate.

  20. [Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger].

    Science.gov (United States)

    Halidou Doudou, M; Manzo, M L; Guero, D

    2014-12-01

    In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. Radiological malpractice

    International Nuclear Information System (INIS)

    Bauer, G.

    1987-01-01

    As medico-legal statistics show, compared with other branches of medicine, cases of liability of the radiologist or his assistants are relatively rare. The duty to exercise due care as set out in Paragraph 6 of the Austrian penal code or Paragraph 276 of the German civil code, respectively, provide a basic rule of law also for radiology. Due to the risk inherent in the investigation method, incidents in angiography cannot be totally excluded. Therefore, it is of utmost importance that all steps be taken with regard to staff, equipment and drugs to be able to deal with any complications and incidents that may arise. The courts of law require the employer to produce strongest exonerating evidence to prove that the duty to exercise due care in the selection and supervision of the assistants has been duly fulfilled. For the practical execution of radiological investigations of the digestive tract, also the RTA is responsible; her liability when performing an irrigoscopy is particularly great, as perforation of the intestine is often lethal. The introduction of the rectal tube into the vagina by mistake, with resultant injury or death of the patient, will regularly lead to conviction under penal law. (orig.) [de

  2. Refractive Surgery: Malpractice Litigation Outcomes.

    Science.gov (United States)

    Custer, Benjamin L; Ballard, Steven R; Carroll, Robert B; Barnes, Scott D; Justin, Grant A

    2017-10-01

    To review data on malpractice claims related to refractive surgery to identify common allegations and injuries and financial outcomes. The WestlawNext database was reviewed for all malpractice lawsuits/settlements related to refractive eye surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. A total of 167 cases met the inclusion criteria, of which 108 cases (64.7%) were found to be favorable and 59 cases (35.3%) unfavorable to the defendant. A total of 141 cases were tried by a jury with 108 cases (76.4%) favorable and 33 cases (23.6%) unfavorable to the defendant. Laser in situ keratomileusis was performed in 127 cases (76%). The most common allegations were negligence in treatment or surgery in 127 cases (76%) and lack of informed consent in 83 cases (49.7%). For all cases, the need for future surgery (P = 0.0001) and surgery resulting in keratoconus (P = 0.05) were more likely to favor the plaintiff. In jury verdict decisions, cases in which failure to diagnose a preoperative condition was alleged favored the defendant (P = 0.03), whereas machine malfunction (P = 0.05) favored the plaintiff. After adjustment for inflation, the overall mean award was $1,287,872. Jury verdicts and settlements led to mean awards of $1,604,801 and $826,883, respectively. Malpractice litigation in refractive surgery tends to favor the defendant. However, large awards and settlements were given in cases that were favorable to the plaintiff. The need for future surgery and surgery leading to keratoconus increased the chance of an unfavorable outcome.

  3. Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.

    Science.gov (United States)

    Baker, Stephen R; Patel, Ronak H; Yang, Lily; Lelkes, Valdis M; Castro, Alejandro

    2013-11-01

    The aim of this study was to present rates of claims, causes of error, percentage of cases resulting in a judgment, and average payments made by radiologists in chest-related malpractice cases in a survey of 8265 radiologists. The malpractice histories of 8265 radiologists were evaluated from the credentialing files of One-Call Medical Inc., a preferred provider organization for computed tomography/magnetic resonance imaging in workers' compensation cases. Of the 8265 radiologists, 2680 (32.4%) had at least 1 malpractice suit. Of those who were sued, the rate of claims was 55.1 per 1000 person years. The rate of thorax-related suits was 6.6 claims per 1000 radiology practice years (95% confidence interval, 6.0-7.2). There were 496 suits encompassing 48 different causes. Errors in diagnosis comprised 78.0% of the causes. Failure to diagnose lung cancer was by far the most frequent diagnostic error, representing 211 cases or 42.5%. Of the 496 cases, an outcome was known in 417. Sixty-one percent of these were settled in favor of the plaintiff, with a mean payment of $277,230 (95% confidence interval, 226,967-338,614). Errors in diagnosis, and among them failure to diagnose lung cancer, were by far the most common reasons for initiating a malpractice suit against radiologists related to the thorax and its contents.

  4. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    International Nuclear Information System (INIS)

    Breen, Micheal A.; Taylor, George A.; Dwyer, Kathy; Yu-Moe, Winnie

    2017-01-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  5. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal A.; Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Dwyer, Kathy; Yu-Moe, Winnie [CRICO Risk Management Foundation, Boston, MA (United States)

    2017-06-15

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality

  6. Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

    Science.gov (United States)

    Breen, Micheál A; Dwyer, Kathy; Yu-Moe, Winnie; Taylor, George A

    2017-06-01

    Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

  7. Responsabilidad por una práctica médica inadecuada: una perspectiva económica Liability for medical malpractice: an economic approach

    Directory of Open Access Journals (Sweden)

    M. Carles

    2003-12-01

    Full Text Available Los cambios en la organización de las instituciones sanitarias y el incremento del número de denuncias por mala praxis de los últimos años han puesto de relieve la necesidad de estudiar el concepto de responsabilidad médica y su repercusión en la provisión de asistencia sanitaria. Hasta el momento, el debate se ha centrado básicamente en los aspectos legales. Sin embargo, falta discutir sus implicaciones económicas. Este trabajo revisa las investigaciones que han realizado un análisis económico del tema. En primer lugar, examinamos las que introducen paulatinamente los conceptos de incertidumbre, aversión al riesgo o riesgo moral. Posteriormente, en el entorno sanitario, prestamos especial atención a los modelos que incluyen nuevos argumentos en la función objetivo de los profesionales o, cuando existe información asimétrica, a los que plantean un problema de negociación. Por último, consideramos el mercado de seguros de responsabilidad sanitaria, y en este apartado vemos cómo la variable reputación, o la posibilidad de ejercer una medicina defensiva, influyen en la provisión de asistencia sanitaria. Nuestro análisis sugiere que, debido a las características del mercado sanitario, deben utilizarse los modelos propuestos por la economía de la información en el análisis económico formal, pero conviene plantear hipótesis alternativas para adaptar dichos modelos a la especificidad de los distintos sistemas sanitarios.In recent years, changes in the organization of healthcare institutions and the increased number of medical malpractice claims have revealed the need to study the concept of medical responsibility and the repercussion of these changes on healthcare provision. To date, discussion has focussed on legal aspects and economic implications have been largely ignored. The present article reviews studies that have performed an economic analysis the subject. Firstly, we examine studies that gradually introduce the

  8. The malpractice crisis in obstetrics and gynecology: is there a solution?

    Science.gov (United States)

    Barber, H. R.

    1991-01-01

    The malpractice ripoff began when the no-fault automobile accident law was passed. Many lawyers were in a panic at this time and turned to medical malpractice litigation to make a living. It became the conduit to quick wealth. The patient was the loser, the lawyer the winner, and the physician often devastated by the patient's ingratitude. For a patient-plaintiff to maintain a successful lawsuit for medical negligence against a physician, four elements must be alleged and proved in a court of law: duty, breach of duty, causation, and damages. Each must be proved by a patient to prevail against a physician. Since this is very difficult to do, the lawyers have subtly brought in a new approach called maloccurrence. This is defined as a bad outcome unrelated to the quality of care provided. The lawyers need not prove the four elements to win a malpractice case; many are won on deceit and in violation of the law by introducing the concept of maloccurrence. Not only are tort reforms needed but out of court alternatives must be mandated by law or our health care delivery system will be destroyed. Government interference and the malpractice ripoff has had a devastating effect on the talent attracted to medical school, and the number of applicants is falling rapidly. The medical malpractice crisis could soon be translated into a health delivery service crisis. Concerned citizens must join together with the medical profession and leaders of the legal profession to halt this monstrous injustice. The litigation milieu has not only paralyzed the health care industry but it has had a devastating effect across the board on the way Americans live and do business. It must be solved now for justice delayed is justice denied. PMID:2049569

  9. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Sheikh Asfandyar

    2012-11-01

    Full Text Available Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6% was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9% was most frequently disagreed. In the event of a medical error, majority (67.7% were ready

  10. Malpractice awareness among surgeons at a teaching hospital in Pakistan.

    Science.gov (United States)

    Sheikh, Asfandyar; Ali, Sajid; Ejaz, Sadaf; Farooqi, Marium; Ahmed, Syed Salman; Jawaid, Imran

    2012-11-06

    The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most

  11. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Science.gov (United States)

    2012-01-01

    Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error

  12. Surgical malpractice in California: res judicata.

    Science.gov (United States)

    Barthel, Erik R; Stabile, Bruce E; Plurad, David; Kim, Dennis; Neville, Angela; Bricker, Scott; Putnam, Brant; Bongard, Fred

    2014-10-01

    Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal. This review was limited to actions involving general surgeons. Such litigation was voluntarily reported by either defense's or plaintiff's counsel at the conclusion of the litigation. Data reviewed included alleged damages incurred by the plaintiff; plaintiff's pretrial settlement demand, plaintiff or defense verdict, use of alternate means of resolution such as arbitration or mediation, and total monetary award to the plaintiff. A total of 69 cases were reported over a 20-month period: 32 (46%) were plaintiffs' verdicts, whereas 37 (54%) were in favor of the surgeon. Only 10 (31%) of the plaintiff verdicts were by jury trial, whereas the rest were settled by pretrial agreement, mediation, or arbitration. Of cases settled by alternate dispute resolution, the median settlement was $820,000 (n = 22) compared with a median jury trial award of $300,000 (n = 10).

  13. Excusable neglect in malpractice suits against radiologists: a proposed jury instruction to recognize the human condition.

    Science.gov (United States)

    Caldwell, Charles; Seamone, Evan R

    2007-01-01

    This article unwraps the nature and source of human errors involved in Radiology, revealing unique elements of the specialty that warrant special consideration in medical malpractice cases. The authors compare these errors to negligent practices in other professions and conclude that a general concept of negligence cannot adequately address the complexities of decision-making in Radiology. After analyzing legal precedent, they develop an innovative jury instruction that recognizes particular situations of error in Radiology that occur in the absence of negligence.

  14. Educational Malpractice in Britain.

    Science.gov (United States)

    Khan, Anwar

    1996-01-01

    The English Court of Appeal found it difficult to establish standards of teachers' duty of care to establish the new tort of educational malpractice. However, the Court recently decided that claims based in negligence and alleging a failure on the part of teachers to identify and respond to the needs of certain learning-disabled students were not…

  15. Perinatal asphyxia and medical professional liability: A case series

    Directory of Open Access Journals (Sweden)

    Andrea Verzeletti

    2016-12-01

    Full Text Available In the context of medical professional liability, obstetrics is one of the most involved medical specialties because the unfavorable outcome of a pregnancy is difficult to accept for parents, who tend to reduce it to inappropriate care that occurred during pregnancy or birth. 32 cases of perinatal asphyxia were evaluated by the Institute of Forensic Medicine in Brescia during the period between 1999 and 2014 (13 in Civil Court and 19 in Penal Court. 9 out of the 32 pregnancies were twins, so the considerations were carried out on a total of 41 fetuses/newborns. Profiles of inadequacy were identified in 66% of cases (85% of the cases evaluated in Civil Court; 53% of the cases evaluated in Penal Court. The existence of a causal relationship between the medical conduct and the onset of asphyxia was recognized in 79% of civil cases and in 38% of penal cases. There is a “greater rigor” in the verification of causal relationship and malpractice profiles in penal cases compared to civil ones: this is in harmony with the most recent Italian Court decisions, characterized by compelling suspect’s protection in the presence of a reasonable doubt in criminal matters and by victim’s protection in civil ones.

  16. [Organisational responsibility versus individual responsibility: safety culture? About the relationship between patient safety and medical malpractice law].

    Science.gov (United States)

    Hart, Dieter

    2009-01-01

    The contribution is concerned with the correlations between risk information, patient safety, responsibility and liability, in particular in terms of liability law. These correlations have an impact on safety culture in healthcare, which can be evaluated positively if--in addition to good quality of medical care--as many sources of error as possible can be identified, analysed, and minimised or eliminated by corresponding measures (safety or risk management). Liability influences the conduct of individuals and enterprises; safety is (probably) also a function of liability; this should also apply to safety culture. The standard of safety culture does not only depend on individual liability for damages, but first of all on strict enterprise liability (system responsibility) and its preventive effects. Patient safety through quality and risk management is therefore also an organisational programme of considerable relevance in terms of liability law.

  17. Forensic evaluation of medical liability cases in general surgery.

    Science.gov (United States)

    Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

    2014-10-01

    Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. Kirit C. Shah, M.D. v. Stan Harris and Nancy Harris. "Construction of Legal Arguments, Statutes of Limitations, and Medical Malpractice." Lesson Plans for Secondary Teachers on How Lawyers Prepare Their Arguments. Courts in the Classroom: Curriculum Concepts and Other Information on Indiana's Courts for the K-12 Educator.

    Science.gov (United States)

    Osborn, Elizabeth

    Stan and Nancy Harris filed a complaint against Kirit C. Shah, M.D., for misdiagnosing Mr. Harris's illness, charging Dr. Shah with negligence and asking for damages. A medical malpractice action in Indiana is governed by a two year statute of limitations. Because the Harrises failed to bring their action against Dr. Shah within this two year…

  19. Medical negligence.

    OpenAIRE

    Rosen, M.

    1992-01-01

    The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malpractice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the standard of care the law required of him in the particular circumstances and that he acted with guilt and therefore can be blamed for the deed. This paper describes medical practitioner negligence and reviews relevant cases.

  20. Effects of health information technology on malpractice insurance premiums.

    Science.gov (United States)

    Kim, Hye Yeong; Lee, Jinhyung

    2015-04-01

    The widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007. To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. It was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%. This study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable.

  1. Medical negligence--prevention and management.

    Science.gov (United States)

    Chao, T C

    1987-04-01

    The rising spate of malpractice cases against doctors appearing in the press and annual reports of medical insurance companies causes concern. Are our doctors more careless or is the public more conscious of litigation? A well publicized malpractice case can ruin the doctor's career and practice. It is well worth a doctor's while to know the pitfalls and learn how to prevent them, and if a mistake happens, how to manage it. Not all mistakes amount to negligence. How will the court view these cases? Some local cases are cited to illustrate the difference between misadventure and negligence. They will serve as guidelines for good medical practice.

  2. Pregnancy-associated Death - Clarifying the Cause of Death and Medico-legal Assessments in Accusations of Malpractice.

    Science.gov (United States)

    Dettmeyer, Reinhard; Lang, Juliane; Amberg, Rainer; Zedler, Barbara; Schulz, Ronald; Birngruber, Christoph

    2018-02-01

    Pregnancy-associated deaths are extremely rare in Germany. Most deaths are from natural causes, and a range of causes are possible. The deaths of 22 women who died of pregnancy-associated causes and who were autopsied in the Institute of Forensic Medicine of Justus-Liebig University Gießen between 1992 and 2016 were analyzed. The autopsy results and histological examinations for the majority of women who died of pregnancy-associated causes between 1992 and 2016 showed that they had died of natural causes, although complications of pregnancy were a leading cause of death. The death of a pregnant woman should not automatically raise the suspicion of malpractice, although the question does arise in cases of bleeding complications only detected at very late stages. Experts must prove that a real mistake was made during treatment and provide evidence of the causality between malpractice and patient death. Particularly when well-known complications of pregnancy were present, this is only the case if poor monitoring resulted in the complication being detected too late or if treatment was not in accordance with accepted standards of care. The majority of pregnancy-associated deaths are from natural causes and the death of a pregnant woman does not mean that medical malpractice was involved, although this accusation is often levelled in cases where rupture was not immediately diagnosed or in cases of fatal postpartum hemorrhage.

  3. Possible gasoline-induced chronic liver injury due to occupational malpractice in a motor mechanic: a case report

    OpenAIRE

    Gunathilaka, Mahesh Lakmal; Niriella, Madunil Anuk; Luke, Nathasha Vihangi; Piyarathna, Chathura Lakmal; Siriwardena, Rohan Chaminda; De Silva, Arjuna Priyadarshin; de Silva, Hithanadura Janaka

    2017-01-01

    Background Hydrocarbon-induced occupational liver injury is a well-known clinical entity among petroleum industry workers. There are many types of hydrocarbon exposure, with inhalation being the most common. Hydrocarbon-induced occupational liver injury is a rarely suspected and commonly missed etiological agent for liver injury. We report a case of a non-petroleum industry worker with chronic liver disease secondary to hydrocarbon-induced occupational liver injury caused by chronic low-grade...

  4. Updated Cases for Medical Microbiology

    Directory of Open Access Journals (Sweden)

    Brinda Govindan

    2015-08-01

    Full Text Available Review of: Cases in Medical Microbiology and Infectious Diseases, 4th ed.; Peter H. Gilligan, Daniel S. Shapiro, and Melissa B. Miller; (2014. ASM Press, Washington, DC. 589 pages.

  5. Malpractice by physical therapists: descriptive analysis of reports in the National Practitioner Data Bank public use data file, 1991-2004.

    Science.gov (United States)

    Sandstrom, Robert

    2007-01-01

    As physical therapists increase autonomous practice, medical error becomes more important to public safety and public perceptions of the profession. The purpose of this study was to describe malpractice by physical therapists in the United States based on physical therapist malpractice reports in the National Practitioner Data Bank between January 1, 1991, and December 31, 2004. A frequency analysis of data related to physical therapist malpractice reports was performed. The relationship between size of malpractice payment and public policy related to access to physical therapist services and malpractice experience was explored. A total of 664 malpractice reports were found in the study period (mean, 47.73 events annually). California had 114 malpractice events, while Maine and Wyoming had none. The median payment amount for physical therapist malpractice was $10,000 to $15,000. "Treatment-related" events and events related to "improper technique" were the most common reasons for a malpractice report. Incidence of malpractice by physical therapists is low (estimated at 2.5 events/10,000 working therapists/year), and the average malpractice payment is small (public policy related to direct patient access to physical therapy services.

  6. Malpractice in Radiology: What Should You Worry About?

    Directory of Open Access Journals (Sweden)

    Alessandro Cannavale

    2013-01-01

    Full Text Available Over recent years the professional role of the radiologist has been evolved due to the increasing involvement in the clinical management of the patient. Radiologists have thus been increasingly charged by new duties and liabilities, exposing them to higher risks of legal claims made against them. Malpractice lawsuits in radiology are commonly related to inappropriate medical care or to the poor physician-patient relationship. In the present paper, we provide overview of the basic principles of the medical malpractice law and the main legal issues and causes of legal actions against diagnostic and interventional radiologists. We also address some issues to help radiologists to reduce risks and consequences of malpractice lawsuits. These include (1 following the standard of care to the best of their ability, (2 cautious use of off-label devices, (3 better communication skills among healthcare workers and with the patient, and (4 ensuring being covered by adequate malpractice insurance. Lastly, we described definitions of some medicolegal terms and concepts that are thought to be useful for radiologists to know.

  7. Malpractice in Radiology: What Should You Worry About?

    International Nuclear Information System (INIS)

    Cannavale, A.; Passariello, R.; Santoni, M.; Mancarella, P.; Arbarello, P.

    2013-01-01

    Over recent years the professional role of the radiologist has been evolved due to the increasing involvement in the clinical management of the patient. Radiologists have thus been increasingly charged by new duties and liabilities, exposing them to higher risks of legal claims made against them. Malpractice lawsuits in radiology are commonly related to inappropriate medical care or to the poor physician-patient relationship. In the present paper, we provide overview of the basic principles of the medical malpractice law and the main legal issues and causes of legal actions against diagnostic and interventional radiologists. We also address some issues to help radiologists to reduce risks and consequences of malpractice lawsuits. These include (1) following the standard of care to the best of their ability, (2) cautious use of off-label devices, (3) better communication skills among health care workers and with the patient, and (4) ensuring being covered by adequate malpractice insurance. Lastly, we described definitions of some medicolegal terms and concepts that are thought to be useful for radiologists to know.

  8. Malpractice liability and defensive medicine: a national survey of neurosurgeons.

    Directory of Open Access Journals (Sweden)

    Brian V Nahed

    Full Text Available BACKGROUND: Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. METHODS: A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. RESULTS: A total of 1028 surveys were completed (31% response rate by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%, laboratory tests (67%, referring patients to consultants (66%, or prescribing medications (40%. Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. CONCLUSIONS: Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.

  9. Malpractice liability and defensive medicine: a national survey of neurosurgeons.

    Science.gov (United States)

    Nahed, Brian V; Babu, Maya A; Smith, Timothy R; Heary, Robert F

    2012-01-01

    Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.

  10. Missed Diagnosis of Cardiovascular Disease in Outpatient General Medicine: Insights from Malpractice Claims Data.

    Science.gov (United States)

    Quinn, Gene R; Ranum, Darrell; Song, Ellen; Linets, Margarita; Keohane, Carol; Riah, Heather; Greenberg, Penny

    2017-10-01

    Diagnostic errors are an underrecognized source of patient harm, and cardiovascular disease can be challenging to diagnose in the ambulatory setting. Although malpractice data can inform diagnostic error reduction efforts, no studies have examined outpatient cardiovascular malpractice cases in depth. A study was conducted to examine the characteristics of outpatient cardiovascular malpractice cases brought against general medicine practitioners. Some 3,407 closed malpractice claims were analyzed in outpatient general medicine from CRICO Strategies' Comparative Benchmarking System database-the largest detailed database of paid and unpaid malpractice in the world-and multivariate models were created to determine the factors that predicted case outcomes. Among the 153 patients in cardiovascular malpractice cases for whom patient comorbidities were coded, the majority (63%) had at least one traditional cardiac risk factor, such as diabetes, tobacco use, or previous cardiovascular disease. Cardiovascular malpractice cases were more likely to involve an allegation of error in diagnosis (75% vs. 47%, p <0.0001), have high clinical severity (86% vs. 49%, p <0.0001) and result in death (75% vs. 27%, p <0.0001), as compared to noncardiovascular cases. Initial diagnoses of nonspecific chest pain and mimics of cardiovascular pain (for example, esophageal disease) were common and independently increased the likelihood of a claim resulting in a payment (p <0.01). Cardiovascular malpractice cases against outpatient general medicine physicians mostly occur in patients with conventional risk factors for coronary artery disease and are often diagnosed with common mimics of cardiovascular pain. These findings suggest that these patients may be high-yield targets for preventing diagnostic errors in the ambulatory setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  11. The concept of error and malpractice in radiology.

    Science.gov (United States)

    Pinto, Antonio; Brunese, Luca; Pinto, Fabio; Reali, Riccardo; Daniele, Stefania; Romano, Luigia

    2012-08-01

    Since the early 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology is one of the specialties most liable to claims of medical negligence. The etiology of radiological error is multifactorial. Errors fall into recurrent patterns. Errors arise from poor technique, failures of perception, lack of knowledge, and misjudgments. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation. Errors are an inevitable part of human life, and every health professional has made mistakes. To improve patient safety and reduce the risk from harm, we must accept that some errors are inevitable during the delivery of health care. We must play a cultural change in medicine, wherein errors are actively sought, openly discussed, and aggressively addressed. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Managing examination malpractice in Nigerian University system ...

    African Journals Online (AJOL)

    Examination malpractice is as old as examination itself. However, the rate at which examination malpractices occurs in the Nigerian educational system is highly disturbing. The challenge therefore needs prompt attention. The phenomenon which has both moral and legal dimensions is considered as a hydra-headed ...

  13. Case-based medical informatics

    Directory of Open Access Journals (Sweden)

    Arocha José F

    2004-11-01

    Full Text Available Abstract Background The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. Discussion We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences

  14. Resolving Malpractice Claims after Tort Reform: Experience in a Self-Insured Texas Public Academic Health System.

    Science.gov (United States)

    Sage, William M; Harding, Molly Colvard; Thomas, Eric J

    2016-12-01

    To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation. We retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution. We accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel. Closed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed

  15. Medical Biochemistry – Clinical Cases

    Directory of Open Access Journals (Sweden)

    Gustavo Henrique Cavalcante

    2017-10-01

    Full Text Available The presentation of situations that exemplifies the practical application of the biochemical concepts is one of the main challenges in the development of didactic materials for the teaching of biochemistry. So far, there are a small number of materials, especially in Portuguese language, that present practical situations exemplifying the application of the several biochemical concepts in the area of human health. The Medical Biochemistry-Clinical Cases app/ebook is intended to enable the integrated vision of the basic knowledge in biochemistry and its practical application in day-to-day situations of human health professionals. The biochemical concepts are presented as clinical cases, making possible the exercise of the analytical attitude and decision-making to solve problems based on real situations. The app is available on the internet for free, facilitating both, the access and the use of the material as a supplementary source.

  16. Difficult Decision on Tyroid Surgery of Expert Witness: Complication or Malpractice

    Directory of Open Access Journals (Sweden)

    Ali Rıza Tümer

    2017-10-01

    Full Text Available Introduction: Recurrent laryngeal nerve (RLN paralysis and hypocalcemia following thyroid surgery have been designated as complication or malpractice. In this study, it was aimed to evaluate surgeons’ opinions towards RLN injury and hypocalcemia after bilateral subtotal thyroidectomy (BST and total thyroidectomy (TT in nodular goiter and thyroid carcinoma.  Materials and Methods: We prepared a questionnaire to determine approaches of surgeons in such cases. We grouped the   the respondents according their thyroid surgery experiments and  asked them to determine whether it is malpractice or complication in cases with unilateral or bilateral RLN paralysis and hypocalcemia after “bilateral subtotal thyroidectomy” and in cases with unilateral or bilateral RLN paralysis after “total thyroidectomy”. Results: In all groups describing bilateral RNL injury was more common. Problems which are defined as "complication" in cancer patiens, were more likely defined as "malpractice" in benign cases. However these differences were generally not  statistically significant.  Conclusions: There is no consensus about malpractice and complication discrimination among physicians. Every physician should evaluate every specific case in its own nature and conditions when asked to determine whether the case should be determined as complication or malpractice.

  17. Some malpractices in application of computed radiography

    International Nuclear Information System (INIS)

    Liu Ruihong; Jia Shaotian; Wang Yusheng; Li Baohua; Chen Lin; Wang Zhenguang; Liu Jianxin; Gong Jingyue; Liu Daoyong; Xie Xuesong

    2007-01-01

    Objective: To improve the CR image quality and to promote the digital image standard constitution by analyzing the common problems and malpractices in application of computed radiography. Methods: Phenomenon and reasons of 107 CR junk-films from nine three-'A'-hospitals were analyzed, discussed, recorded, and statistised by 20 radiologists, radiographers and engineers. Results: Among 107 junk films, there are 36 cases (33.64%) of incorrect operations, 29 cases (27.10%) of artifacts in reading and transferring the data of IP, 15 cases (14.02%) of artifacts in IP system, and 13 cases (12.15%) of selection of inappropriate radiographic parameters, and 9 cases (8.41%) of printer-failures, and 5 cases (4.67%) of inappropriate post-processing techniques. By analyzing the reasons of 107 junk films we found that 60.74% were due to less responsibilities and incorrect operations, and 35.51% were due to new problems in CR techniques, and other were due to inappropriate post-processing techniques. Conclusion: Responsibilities, operation regulations, digital image quality standards, studying of new techniques and appropriate use of the post-processing techniques are the key points for improving the CR image quality and the diagnosis level. (authors)

  18. Pharmacy Malpractice: The rate and prevalence of dispensing high-risk prescription-only medications at community pharmacies in Saudi Arabia.

    Science.gov (United States)

    Alshammari, Thamir M; Alhindi, Salman A; Alrashdi, Ahmed M; Benmerzouga, Imaan; Aljofan, Mohamad

    2017-07-01

    To assess the compliance of community pharmacies with the regulations that prohibit the dispensing of prescription-only medications in the absence of a physician prescription in Saudi Arabia. A cross-sectional study was conducted in the period between October 2014 and January 2015. A list of 10 prescription-only medications were selected to be studied. 150 community pharmacies were visited across 6 major regions in Saudi Arabia to assess the prevalence of non-compliance among community pharmacies. Pharmacies were selected in random and researchers (disguised as patients) requested to purchase prescription-only medications in the absence of a prescription. Not all medications were purchased at once. Data were recorded per pharmacy, where pharmacies that approved dispense of the selected drug were scored as non-compliant and the pharmacies that rejected dispense of the selected drug were scored as compliant. Compliance rate was calculated per region per drug. Pharmacies based in governmental hospitals were visited in parallel. A total of 20 were visited. Data and statistical analysis were performed using Statistical Analyses Software (SAS 9.3). A total of 150 pharmacies were visited over a period of 3 months. On average, the percent approved dispense of prescription-only drugs across 6 regions in Saudi Arabia is 63% and the percent rejected dispense is 37% representing a significant non-compliance rate regarding the selected list of medications in this study. The frequency of dispense per medication across 6 major regions in Saudi Arabia is as follows: Isosorbide dinitrate (86%), Enoxaparin (82%), nitroglycerin (74%), Propranolol (73%), Verapamil (70%), Warfarin (65%), Methyldopa (64%), Ciprofloxacin (57%) and Codeine (4%). Non-compliance of community pharmacies with the law of pharmaceutical practice is at an alarming rate in the Kingdom of Saudi Arabia and authoritative figures must intervene to impede and combat such activities .

  19. Predictors of examination malpractice among secondary school ...

    African Journals Online (AJOL)

    African Journal for the Psychological Study of Social Issues ... Validated scales were used to collect data and SPSS was used to carry out a t-test and stepwise ... Keywords: Examination, Malpractice, Text Anxiety, Secondary School Students.

  20. Case outsourcing medical device reprocessing.

    Science.gov (United States)

    Haley, Deborah

    2004-04-01

    IN THE INTEREST OF SAVING MONEY, many hospitals are considering extending the life of some single-use medical devices by using medical device reprocessing programs. FACILITIES OFTEN LACK the resources required to meet the US Food and Drug Administration's tough quality assurance standards. BY OUTSOURCING, hospitals can reap the benefits of medical device reprocessing without assuming additional staffing and compliance burdens. OUTSOURCING enables hospitals to implement a medical device reprocessing program quickly, with no capital investment and minimal effort.

  1. Erro médico em cirurgia do aparelho digestivo: contribuição para o estudo das provas técnicas, periciais e documentais e suas implicações jurídicas Medical malpractice in digestive system surgeries: a contribution to the study of technical, expertise and documentary evidence and its legal implications

    Directory of Open Access Journals (Sweden)

    João Batista Opitz Jr.

    2007-03-01

    . Em 85% das vezes não havia história clínica completa. Em 79% não foi verificada a existência de exame físico. Em 80% dos casos a letra era ilegível. Em 59% não foi verificada a existência da evolução clínica. Em 61% não foram verificadas a identificação ou carimbo do médico. Em 89% não foi interrogado sobre a existência de alergias prévias. Somente em 20% dos casos observou-se descrição cirúrgica legível. Em 47% dos casos as descrições cirúrgicas eram de forma sumária sem as intercorrências alegadas pela defesa. Em 70% não houve visita pré-anestésica. Em 60% a prescrição médica de evolução ocorreu com mais que 24 horas no pós-operatório. Em 19% observou-se administração de medicação pela enfermagem posteriormente à alta médica. Em 64% dos casos não se observou a descrição das condições de alta. Em 7% o médico que figura como pólo passivo não possuía residência médica; em 13% estavam cursando residência ou estágio; em 67% possuíam título de especialização e em 13% dos casos mestrado ou doutorado. CONCLUSÃO: A melhor forma para profilaxia da ação cível indenizatória por erro médico é a boa relação médico-paciente; a manutenção de prontuário médico preenchido, legível, com carimbo e assinatura; o consentimento informado. A condição técnico-curricular do profissional não é fator atenuante para propositura da ação.BACKGROUND: The fear of being prosecuted by their patients in relation to medical malpractice is growing among brazilian medical doctors. This condition may be avoided with preventive orientations. AIM: To analyze legal proceedings in course in the city and state of São Paulo as well as to define what could be the main cause regarding this concern and its consequences. METHODS: Thirty legal proceedings, which were in progress in the regional civil courts in the Capital and countryside of the State of São Paulo - Brazil have been analyzed. Trial court cases were selected from

  2. Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes.

    Science.gov (United States)

    Justin, Grant A; Brietzke, Scott E

    2017-01-01

      This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes.   The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate.   Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes.   A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean = $2,470,552, range = $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P = .0101).   Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.

  3. Operator-related aspects in endodontic malpractice claims in Finland.

    Science.gov (United States)

    Vehkalahti, Miira M; Swanljung, Outi

    2017-04-01

    We analyzed operator-related differences in endodontic malpractice claims in Finland. Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses. Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists. Operator-related factors had no impact on endodontic malpractice claims.

  4. Assurance Cases for Medical Devices

    Science.gov (United States)

    2011-04-28

    the patient, and the hospital setting. Some pumps allow the patient to control part of the injection process (e.g. to inject more painkiller ...overdose, incorrect therapy, etc.   Design and development decisions that bear on safety and effectiveness http://www.fda.gov/MedicalDevices

  5. Educational Malpractice: A Contemporary View with an Eye Towards the Future.

    Science.gov (United States)

    Harris, J. John, III

    This paper examines the developing concept of educational malpractice since the mid-1970s. It discusses the aftermath of Peter Doe v. San Francisco Unified School District, a case in which the court found against the student's claim that his school had failed to provide him with an adequate education. Two approaches are now being taken to define…

  6. Parenting styles, gender, religiosity and examination malpractices ...

    African Journals Online (AJOL)

    This study examined the influence of parenting styles, gender and religiousity on the attitude of students towards examination malpractices. One hundred and ninety –eight participants were used which comprises of 100 males and 98 females of Adekunle Ajasin University, Akungba- Akoko in Ondo state. Parental care scale ...

  7. Examination Management and Examination Malpractice: The Nexus

    Science.gov (United States)

    Ogunji, James A.

    2011-01-01

    Examination malpractice or cheating has become a global phenomenon. In different countries of the world today, developed and developing, academic dishonesty especially cheating in examinations has heightened and taken frightening dimension. In many countries of the world this phenomenon has become a serious matter of concern that has left many…

  8. Factors Influencing Examination Malpractice in Secondary Schools ...

    African Journals Online (AJOL)

    The main purpose of this study was to investigate factors influencing examination malpractice in some selected secondary schools in Cross River State, Nigeria. A sample of one thousand two hundred (1200) students were selected across the three educational zones of Ogoja, Ikom and Calabar using stratified, random ...

  9. Educational Malpractice: Why the Courts Say No.

    Science.gov (United States)

    Hammes, Richard

    1989-01-01

    The courts have refused to award damages to litigants claiming educational malpractice. This article discusses recurring themes in the courts' rationale for their decisions. Discussion focuses on elements of negligence: the duty of care, the breach of duty, injury and proximate cause. (IAH)

  10. Physicians and strikes: can a walkout over the malpractice crisis be ethically justified?

    Science.gov (United States)

    Fiester, Autumn

    2004-01-01

    Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.

  11. Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

    Directory of Open Access Journals (Sweden)

    Scurria Serena

    2011-12-01

    Full Text Available Abstract Background In recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage. Methods In order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk". Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers. Results Most of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law. Conclusion Italy must introduce a compulsory

  12. New journals for publishing medical case reports.

    Science.gov (United States)

    Akers, Katherine G

    2016-04-01

    Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or "predatory" publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers.

  13. Is The Late Mandibular Fracture From Third Molar Extraction a Risk Towards Malpractice? Case Report with the Analysis of Ethical and Legal Aspects

    Directory of Open Access Journals (Sweden)

    Weuler dos Santos Silva

    2017-06-01

    Full Text Available Objectives: The present study reports a case of late mandibular fracture due to third molar extraction and highlights the inherent clinical, ethical and legal aspects related to this surgical complication. Material and Methods: A female patient underwent surgical procedure for the extraction of the mandibular right third molar. Two days after the surgery the patient reported pain and altered occlusion in the right side of the mandible. After clinical and radiographic re-examination, the diagnosis of late mandibular fracture was established. A second surgery, under general anaesthesia, was performed for the fixation of the mandibular bone. Results: The fractured parts were reduced and fixed with locking plate systems and 2 mm screws following load-sharing principles. The masticatory function showed optimal performance within 7 and 21 days after the surgery. Complete bone healing was observed within 1 year of follow-up. Conclusions: For satisfactory surgical outcomes, adequate surgical planning and techniques must be performed. Signed informed consents explaining the risks and benefits of the treatment must be used to avoid ethical and legal disputes in dentistry.

  14. CIVIL LIABILITY OF DOCTORS AND THEIR INSURANCE (MALPRACTICE

    Directory of Open Access Journals (Sweden)

    Gârbo Viorica Irina

    2013-07-01

    Full Text Available Malpractice insurance of medical staff is probably the oldest professional liability insurance underwritten in the insurance market in Romania. The aim of our research is to theoretically examine in a qualitative inquiry the usefulness of insurance completion by the practitioners from the Romanian health system at both state and private, in order to improve a best practice medical insurance. The medical profession is practiced in Romania under the Code of Medical Ethics 30 March 2012 prepared in code that complies with international standards contained in the Geneva Declaration of 1948, as amended by the World Medical Association and the International Code of Medical Ethics. The forms of medical liability are: disciplinary, administrative, civil and criminal and only the civil liability can be taken into insurance because only it meets the conditions of insurability. Once we explain in general and the insurance liability in particular we show articles of the Romanian Civil Code which establishes the obligation the one that caused an injury to a third person for the repair or indemnify and conditions provided by the Civil Code as an act to be considered liability. Then we refer to situations where the patient may be damaged through the fault of the doctor or the doctor unit operates. The object of malpractice insurance is loss of money that the insured would have to pay a patient whom he caused injury as a result of acts or deeds of negligence committed to, during and in relation to professional activity. Risks taken in the insurance are personal injury, illness or death of the patient and / or moral damages. Regarding the excluded risks we have presented an overview of the more common contracts underwritten by Romanian insurance companies. We show the way of underwriting, the insured sums of the standard insurance and the additional one which subscribes moral damages, to companies in Romania agreed by bodies which organize and supervise the

  15. MEDICAL ERRORS IN CLINICAL PRACTICE OF PHYSICIANS IN TERNOPIL REGION (UKRAINE

    Directory of Open Access Journals (Sweden)

    V. V. Franchuk

    2017-02-01

    Full Text Available Background. The professional occupation of a doctor quite often meets different imperfections, which have negative outcome for patients. Objective. The study was aimed to investigate the expert characteristics of improper performance of the professional duties by medical staff on the example of a particular region of Ukraine. Methods. In the study the archival materials (commission on forensic medical examinations held in Ternopil Regional Bureau of Forensic Medical Examination in 2007-2014 years were analysed. The research results are summarized and processed with the use of general statistical methods. Results. It is defined that during this period 112 examinations concerning medical malpractice were implemented (9.05% of all commission examinations. Conclusions. Medical errors were combined, especially during the diagnostics, treatment and in medical records. The majority of cases (82.1% of medical malpractice were caused by the objective reasons.

  16. The flaws in state 'apology' and 'disclosure' laws dilute their intended impact on malpractice suits.

    Science.gov (United States)

    Mastroianni, Anna C; Mello, Michelle M; Sommer, Shannon; Hardy, Mary; Gallagher, Thomas H

    2010-09-01

    Apologies are rare in the medical world, where health care providers fear that admissions of guilt or expressions of regret could be used by plaintiffs in malpractice lawsuits. Nevertheless, some states are moving toward giving health care providers legal protection so that they feel free to apologize to patients for a medical mistake. Advocates believe that these laws are beneficial for patients and providers. However, our analysis of "apology" and "disclosure" laws in thirty-four states and the District of Columbia finds that most of the laws have major shortcomings. These may actually discourage comprehensive disclosures and apologies and weaken the laws' impact on malpractice suits. Many could be resolved by improved statutory design and communication of new legal requirements and protections.

  17. Avoiding malpractice suits through the use of informed consent.

    Science.gov (United States)

    Annas, G J

    1976-03-01

    The doctrine of informed consent is based on a long tradition of promoting self-autonomy and rational decision-making. The amount of information required to be disclosed by the doctor to the patient is that which permits the patient to decide for himself whether or not to undergo the recommended treatment. It includes information about risks of death or serious bodily harm, probability of success, problems of recuperation, and alternative modes of treatment. Disclosing such information contributes to the doctor-patient relationship and therefore makes recourse to malpractice litigation in the face of an unsatisfactory or untoward result less likely. Attempts to abolish the doctrine are potentially counterproductive and could lead to widespread mistrust of the medical profession on the part of a society that increasingly demands more information in all areas. Physicians will best serve both themselves and their patients by fully disclosing all relevant information before asking patients to consent to specific therapies.

  18. USERS' PERCEPTION OF LIBRARY USE MALPRACTICES: CASE ...

    African Journals Online (AJOL)

    Study recommended adherence to user's opinion and an addition of counseling to users-orientation ... student, lecturers, researchers and other community of scholars. ..... School Library Resources Centres for Educational Excellence. Ibadan:.

  19. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology.

    Science.gov (United States)

    Sommer, S A; Geissler, R; Stampfl, U; Wolf, M B; Radeleff, B A; Richter, G M; Kauczor, H-U; Pereira, P L; Sommer, C M

    2016-04-01

    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology--with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. •On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. •Regarding a physician's liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent.

  20. Errors and malpractice lawsuits in radiology: what the radiologist needs to know.

    Science.gov (United States)

    Busardò, Francesco Paolo; Frati, Paola; Santurro, Alessandro; Zaami, Simona; Fineschi, Vittorio

    2015-09-01

    All medical specialties dealing with patients include an intrinsic risk in exposing them to issues resulting from human errors. Radiology is not spared from this risk since it includes "decision-making under conditions of uncertainty." In medical imaging, the line between the word "error" and misdiagnosis or discrepancy is very difficult to demarcate, mainly because the diagnostic process is not a binary relation and it is not always possible to establish if a pathological condition is present or not. The error in radiology is strongly related to the diagnostic process; hence, it can be defined as a "diagnostic error" which represents the most common cause of medical malpractice suits against radiologists. In this paper, the authors described the features of errors occurring in radiology, trying to establish their impact and prevalence. Secondly, some data coming from different countries were compared in order to highlight the most frequent causes leading to malpractice lawsuits in radiology and how the phenomenon of malpractice in this field is represented worldwide.

  1. Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

    Science.gov (United States)

    Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

    2017-08-01

    Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all Pcoaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

  2. Malpractice and radiologists, update 1986: an 11.5-year perspective

    International Nuclear Information System (INIS)

    Berlin, L.

    1986-01-01

    All medical malpractice lawsuits filed in Cook County, IL, from January 1, 1980, through June 30, 1986, were reviewed and compared with similar data for the period of January 1, 1975, through December 30, 1979. A total of 11,203 suits were filed during the 11.5-year period; of these, 1391 (12%) were radiology related. The latter were categorized into six groups. The largest was missed radiologic diagnoses, which accounted for 40% of the total. The remaining groups included complications, 19%; failure to order, 17%; radiation therapy, 11%; slip and fall, 5%; and miscellaneous, 8%. Over the 1975-1986 period, the rise in the number of suits alleging radiologic misses outpaced all other groups. Although the most common type of miss continues to involve fractures, the frequency of missed carcinomas has grown at a disproportionately faster rate. Misses specifically involving CT, nuclear medicine, and sonography also are becoming more prevalent. Radiographic misses continue to occur at an average rate of 30%, with little hope of improvement. Methods to combat the rising number of malpractice suits are discussed. It is concluded that although programs to educate radiologists on risk management should continue, the ultimate solution may be a more enlightened public attitude as to what actually constitutes malpractice, and institution of tort reform measures by federal and state legislatures

  3. [Medical errors from positions of mutual relations of patient-lawyer-doctor].

    Science.gov (United States)

    Radysh, Ia F; Tsema, Ie V; Mehed', V P

    2013-01-01

    The basic theoretical and practical aspects of problem of malpractice in the system of health protection Ukraine are presented in the article. On specific examples the essence of the term "malpractice" is expounded. It was considered types of malpractice, conditions of beginning and kinds of responsibility to assumption of malpractice. The special attention to the legal and mental and ethical questions of problem from positions of protection of rights for a patient and medical worker is spared. The necessity of qualification malpractices on intentional and unintentional, possible and impermissible is grounded.

  4. Epistemic dependence in contemporary science: Practices and malpractices

    DEFF Research Database (Denmark)

    Andersen, Hanne

    2014-01-01

    Despite an increased focus on scientific practice in the philosophy of science in recent years, there has been relatively little focus on malpractices such as intentional fraud or gross negligence. This is the more striking since malpractice in research  both in the form of outright misconduct...... 1999; 1994). Most existing philosophical analyses of malpractice in science have centered on intentional deceit and treated the phenomenon primarily as a topic for ethical analyses. However, in this paper I shall go beyond this focus on deceit and discuss intentional, reckless as well as negligent...

  5. A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field.

    Science.gov (United States)

    Park, Bo Young; Kim, Min Ji; Kang, So Ra; Hong, Seung Eun

    2016-05-01

    Disputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future. We conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved. The claim amounts ranged from under 8 million KRW (6,991 USD) to 750 million KRW (629,995 USD). The most common ratio of the judgment amount to the claim amount was 20%-30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%), violation of the duty of care in 10 cases (17%), violation of both duties in 20 cases (35%), and no violation of duty in six cases (10%). Cosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise.

  6. Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer: A case of medical liability?

    Directory of Open Access Journals (Sweden)

    Pamela Tozzo

    2017-01-01

    Conclusion: There is an urgent need for the specific guidelines to take into account not only the neoplastic follow-up of such patients, but also the possible side effects of necessary surgery, since this could help to ensure the timely diagnosis and management of WE in this setting, and to avoid, when possible, claims for medical malpractice that may cause enormous costs both in economical and professional terms.

  7. Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

    Science.gov (United States)

    Baraff, L J; Cameron, J M; Sekhon, R

    1991-01-01

    To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients

  8. Malpractice paid losses and financial performance of nursing homes.

    Science.gov (United States)

    Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

    2011-01-01

    Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

  9. Medical Liability in the Light of New Hungarian Civil Code

    Science.gov (United States)

    Barzó, Tímea

    2015-01-01

    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since the change of regime. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades.

  10. Shoulder dystocia--malpractice or acceptable risk?

    Science.gov (United States)

    Skolbekken, J A

    2000-09-01

    In 1988 a new patient insurance system was introduced in Norway. It was initially described as an 'objectified' system, similar to one based on the no-fault principle. Early doubts were raised about the system's status, as it contains rules stating that compensation will not be given if the medical intervention is adequate and the involved risk is acceptable. This study was undertaken to examine the practice of these rules. An archival study was performed on the 41 shoulder dystocia cases that had been closed in the decade from 1988-1997. These cases were selected as shoulder dystocia was found to be the obstetrical event most often leading to a decision on acceptable risk. The most common injury in these cases was Erb's palsy, but fatalities and brain injuries were also observed. Compensation was given in nine cases, whereas it was denied due to an acceptable medical risk in the remaining cases. Indications of inconsistency among the reached decisions were found, and judged to be a result of differences of opinion between expert witnesses on the adequacy of the obstetrical practice. Doubts are raised as to whether similar decisions are reached in similar cases. Shoulder dystocia may be an acceptable risk in the sense that it is hard to predict and prevent. Whether the consequences of such a risk should be compensated, remains a political and economical issue. Present thinking leads to decisions that create a divide between the lucky unlucky and the plainly unlucky.

  11. Foundations in the Law: Classic Cases in Medical Ethics

    National Research Council Canada - National Science Library

    Zucker, K. W; Allen, Tracy L; Boyle, Martin J; Burton, Amy R; Smyth, Vito S

    2007-01-01

    .... The converse is also true: decisions within a legal system inform, or impact, ethics -specifically medical ethics The cases discussed in this paper are at the foundation of medical ethics in the United States...

  12. Television Medical Dramas as Case Studies in Biochemistry

    Science.gov (United States)

    Millard, Julie T.

    2009-01-01

    Several case studies from popular television medical dramas are described for use in an undergraduate biochemistry course. These cases, which illustrate fundamental principles of biochemistry, are used as the basis for problems that can be discussed further in small groups. Medical cases provide an interesting context for biochemistry with video…

  13. Medical assistance in case of nuclear accident

    International Nuclear Information System (INIS)

    Dodig, D.; Tezak, S.; Kasal, B.; Huic, D.; Medvedec, M.; Loncaric, S.; Grosev, D.; Rozman, B.; Popovic, S.

    1996-01-01

    Medical service is a prerequisite for work license of nuclear installation. Every nuclear installation incorporate in their safety procedure also medical emergency plan. Usually the medical emergency plan consists of several degrees of action: 1. First aid, 2. First medical treatment, 3. Treatment in regional hospital, 4. Treatment in special institution (centre for radiation medicine). This paper discusses organization and activities of Centre for Radiation Medicine and Protection - Clinical Hospital Centre Zagreb

  14. Basics of elder law and legal liabilities of negligence and malpractice for physicians as they apply to individuals with disabilities.

    Science.gov (United States)

    Ullman, David; Zuller, Michael E

    2005-02-01

    This article provides information regarding the issues that physicians face when dealing with elderly patients with cognitive deficits. It includes a discussion of basic legal terms and concepts that medical personnel should understand, various difficulties encountered by patients and families in crisis situations, and how the legal system deals with these issues. It concludes with a general discussion of the legal liabilities of negligence and malpractice.

  15. Homicide committed by psychiatric patients: Psychiatrists' liability in Italian law cases.

    Science.gov (United States)

    Terranova, Claudio; Rocca, Gabriele

    2016-01-01

    Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients. © The Author(s) 2015.

  16. #DDOD Use Case: Consolidated reporting of medical device recalls

    Data.gov (United States)

    U.S. Department of Health & Human Services — SUMMARY DDOD use case request for consolidated, consistent reporting of medical device recalls. WHAT IS A USE CASE? A “Use Case” is a request that was made by the...

  17. Basic principles of medical aid in cases of radiation accidents

    International Nuclear Information System (INIS)

    Andreev, E.; Mikhajlov, M.A.; Bliznakov, V.

    1979-01-01

    A model scheme has been presented of medical aid organization in emergency cases of irradiation. The tasks of medical service have been pointed out in connection with evacuation stages, bulk of medical aid depending on the natur of radiation damages, first aid and some general principles of radiation sickness treatment. (author)

  18. THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

    Science.gov (United States)

    Bărcan, Cristian

    2015-01-01

    Current legislation, namely Law no. 95/2006 on healthcare reform in the medical malpractice domain stipulates that medical staff can be held accountable in the following forms: disciplinary liability, administrative liability, civil liability and criminal liability. Each form of legal liability presents its features, aspects that are found mainly in the procedural rules. However, the differences between the various legal forms of liability are not met only in the procedural rules but also in their effects and consequences. It is necessary to know what the procedure for disciplinary responsibility, administrative liability, civil liability, or criminal liability is. In addition to the differentiation determined by the consequences that may arise from the different forms of legal liability, it is important to know the competent authorities to investigate a case further and the solutions which various public institutions can take regarding the medical staff. Depending on the type of legal liability, authorities have a specialized authority. If the Disciplinary Committee is encountered at the College of Physicians, it may not intervene in cases before the monitoring and competence for malpractice cases Committee. The latter two committees cannot intervene directly in the legal assessment of civil or criminal cases, as no criminal investigation authorities cannot intervene in strictly civilian cases. Therefore, the importance of knowing the competent institutions is imperative.

  19. USE OF ELECTRONIC CASE HISTORIES IN OPERATION OF MEDICAL UNITS

    Directory of Open Access Journals (Sweden)

    I. B. Boltenkova

    2016-01-01

    Full Text Available Introduction of electronic case histories to medical units including TB units is one of the factors allowing enhancing quality of medical care provision. Use of the electronic case histories provides conditions for information transparency improvement in a medical unit: financial, statistic and medico-technological. Information contained in the electronic case history is important and required both for internal and external use. Use of electronic case histories contributes to reduction of labor costs of workers in medical units, provides fast access of medical personnel to information, formalizes data, provides preservation, invariance and reliability of the information entered into electronic case history during the whole period of storage, regulates the access rights and confidentiality, personifies data and allows unifying health data of all Russian population into one pool.

  20. Epistemic dependence in contemporary science: Practices and malpractices

    DEFF Research Database (Denmark)

    Andersen, Hanne

    2014-01-01

    Despite an increased focus on scientific practice in the philosophy of science in recent years, there has been relatively little focus on malpractices such as intentional fraud or gross negligence. This is the more striking since malpractice in research  both in the form of outright misconduct...... such as fraud and deceit and in the form of the so-called ‘grey zone’ behavior such as sloppiness and incompetence  has been a topic of growing concern both among scientists themselves and among politicians, administrators and in the general population (for an overview of this development, see e.g. Steneck...

  1. Medical education: the case for investment

    African Journals Online (AJOL)

    comparative spends are simply not available. The average spend on undergraduate education per graduate doctor is $122 000. Yet the spend per graduate doctor in China, India, and Africa is considerably less than this average. So one caveat to the answer that we spend less than we should on medical education is that it.

  2. Modern negligence law: Contribution of the medical cases.

    Science.gov (United States)

    Hodgson, John

    The law on medical negligence is part of the law of negligence generally. It has played a significant part in developing two key aspects of the law. There are special rules to determine the standard of care expected of experts when advising and solving problems, and medical cases have largely shaped the law. Although cases on causation may arise in any area, several of the key cases happen to be medical ones. They are particularly likely to assist where there are alternative causes, as it is often difficult to distinguish the effects of disease from those of inappropriate treatment.

  3. Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

    Science.gov (United States)

    Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

    2016-03-01

    As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. © 2016 American Society of Law, Medicine & Ethics.

  4. AMDIS Case Conference: Intrusive Medication Safety Alerts.

    Science.gov (United States)

    Graham, J; Levick, D; Schreiber, R

    2010-01-01

    Clinical decision support that provides enhanced patient safety at the point of care frequently encounters significant pushback from clinicians who find the process intrusive or time-consuming. We present a hypothetical medical center's dilemma about its allergy alerting system and discuss similar problems faced by real hospitals. We then share some lessons learned and best practices for institutions who wish to implement these tools themselves.

  5. AMDIS Case Conference: Intrusive Medication Safety Alerts

    OpenAIRE

    Graham, J.; Levick, D.; Schreiber, R.

    2010-01-01

    Clinical decision support that provides enhanced patient safety at the point of care frequently encounters significant pushback from clinicians who find the process intrusive or time-consuming. We present a hypothetical medical center’s dilemma about its allergy alerting system and discuss similar problems faced by real hospitals. We then share some lessons learned and best practices for institutions who wish to implement these tools themselves.

  6. [Medical negligence in surgery: 112 cases retrospective analysis].

    Science.gov (United States)

    Xiang, Jian; Chang, Lin; Wang, Xu; Zhang, Feng-Qin

    2013-06-01

    To explore the general characteristics of medical negligence in surgery in order to provide the reference for forensic practices. One hundred and twelve cases of medical negligence in surgical department were retrospectively analyzed in Fada Institute of Forensic Medicine and Science from 2008 to 2010. The common types of medical negligence cases in the surgery were improper operation procedure (28.57%), failure of consent (26.79%), and inadequate monitoring (22.32%). The results of complications included disability or functional impairment (61.61%), death (31.25%) and transient impairment with no obvious adverse reactions (7.14%). The most common roles played by the medical negligence cases were minor role (26.79%), equal role (19.64%), and slight role (14.29%). Significant attention should be paid to the operation procedure, consent, and monitoring. It should be cautious to not make assessment on involvement degree of medical negligence.

  7. Examination Malpractice in Nigeria: Rank-ordering the Types ...

    African Journals Online (AJOL)

    Although 'giraffing' and carrying of prepared materials into the examination hall were the most common forms of examination malpractice, bribery (ranked 4.5) was the anchor. Students, peer group and parents were the worst malpractitioners in a decreasing order of culpability. Overvaluing of certificates and teachers' ...

  8. Election malpractice in students union government of Nnamdi ...

    African Journals Online (AJOL)

    Results also showed the preventive measures of election malpractices to include amongst others that votes should not be bought with money or gift items; the electoral body should be well trained and continued to be trained and materials for elections must be adequate and distributed on time. The implications of the study ...

  9. Malpractice Litigation and Nursing Home Quality of Care

    Science.gov (United States)

    Konetzka, R Tamara; Park, Jeongyoung; Ellis, Robert; Abbo, Elmer

    2013-01-01

    Objective. To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. Data Sources/Study Setting. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. Study Design. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. Principal Findings. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Conclusions. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform. PMID:23741985

  10. Pathology Competencies for Medical Education and Educational Cases

    Directory of Open Access Journals (Sweden)

    Barbara E. C. Knollmann-Ritschel MD

    2017-07-01

    Full Text Available Current medical school curricula predominantly facilitate early integration of basic science principles into clinical practice to strengthen diagnostic skills and the ability to make treatment decisions. In addition, they promote life-long learning and understanding of the principles of medical practice. The Pathology Competencies for Medical Education (PCME were developed in response to a call to action by pathology course directors nationwide to teach medical students pathology principles necessary for the practice of medicine. The PCME are divided into three competencies: 1 Disease Mechanisms and Processes, 2 Organ System Pathology, and 3 Diagnostic Medicine and Therapeutic Pathology. Each of these competencies is broad and contains multiple learning goals with more specific learning objectives. The original competencies were designed to be a living document, meaning that they will be revised and updated periodically, and have undergone their first revision with this publication. The development of teaching cases, which have a classic case-based design, for the learning objectives is the next step in providing educational content that is peer-reviewed and readily accessible for pathology course directors, medical educators, and medical students. Application of the PCME and cases promotes a minimum standard of exposure of the undifferentiated medical student to pathophysiologic principles. The publication of the PCME and the educational cases will create a current educational resource and repository published through Academic Pathology .

  11. Class 1 devices case studies in medical devices design

    CERN Document Server

    Ogrodnik, Peter J

    2014-01-01

    The Case Studies in Medical Devices Design series consists of practical, applied case studies relating to medical device design in industry. These titles complement Ogrodnik's Medical Device Design and will assist engineers with applying the theory in practice. The case studies presented directly relate to Class I, Class IIa, Class IIb and Class III medical devices. Designers and companies who wish to extend their knowledge in a specific discipline related to their respective class of operation will find any or all of these titles a great addition to their library. Class 1 Devices is a companion text to Medical Devices Design: Innovation from Concept to Market. The intention of this book, and its sister books in the series, is to support the concepts presented in Medical Devices Design through case studies. In the context of this book the case studies consider Class I (EU) and 510(k) exempt (FDA) . This book covers classifications, the conceptual and embodiment phase, plus design from idea to PDS. These title...

  12. Recurrent Local Tetanus: A Case Report | Talabi | Nigerian Medical ...

    African Journals Online (AJOL)

    This case report is on the recurrence of tetanus localized over the (R) upper limb within a seventeen-month period. Recurrent localized tetanus has not been reported in our local medical literature just as there is paucity of reported localized tetanus. The patient in this case sustained a piercing broomstick injury to the medial ...

  13. Medical intervention in case of nuclear or radiation event

    International Nuclear Information System (INIS)

    Blanc, J.; Bourguignon, M.; Carli, P.; Carosella, E.; Challeton de Vathaire, C.; Court, L.; Ducousso, R.; Facon, A.; Fleutot, J.B.; Goldstein, P.; Gourmelon, P.; Herbelet, G.; Kolodie, H.; Lallemand, J.; Martin, J.C.; Menthonnex, P.; Masse, R.; Origny, S.; Pasnon, J.; Peton Klein, D.; Rougy, C.; Schoulz, D.; Romet, G.; Telion, C.; Vrousos, C.

    2002-01-01

    This guide aims to be a practical tool for intervenors in case of nuclear or radiation accident. It proposes many sheets to favor the reactivity and the implementing of adapted measures. It concerns the course of action to take in case of irradiation accident or contamination and the reception in medical structure or a hospital. (A.L.B.)

  14. From cases to projects in problem-based medical education

    Directory of Open Access Journals (Sweden)

    Diana Stentoft

    2014-06-01

    Full Text Available Problem-based learning (PBL based on patient cases has become a well-established worldwide educational approach in medical education. Recent studies indicate that case-based PBL when used throughout an entire curriculum may develop into a counter-productive routine for students as well as teachers. Consequently, there is a need to develop PBL approaches further allowing students to work with more ill-defined problems and alternative learning structures. In this paper, we argue that this can be realised by introducing project-PBL into the medical curriculum, as in the medical education at Aalborg University, Denmark. We outline organisations of case- and project- PBL in the medical curriculum and present an explorative study of 116 first and second year students’ experiences working in the two settings of PBL. Results reveal that students generally rate their PBL experiences positively however, project-PBL is rated more positively than case-PBL on all parameters studied. These results invite further consideration of the differences in working with cases and projects. Two central differences are discussed; the nature of the problem as the trigger of learning and students' possibilities for directing their own learning processes. The study demonstrates that introducing project-PBL may contribute significantly in problem-based medical education. However, the need for extensive research into advantages and limitations of the combined use of case- and project-PBL is also emphasised.

  15. Discounting medical malpractice claim reserves for self-insured hospitals.

    Science.gov (United States)

    Frese, Richard; Kitchen, Patrick

    2011-01-01

    The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

  16. A Case of Pain, Factitious Disorder and Boundary Violations

    Directory of Open Access Journals (Sweden)

    Isabelle Cote

    2001-01-01

    Full Text Available Although health professionals are usually familiar with factitious disorders, evaluating such cases may be complicated, particularly in the legal arena. This article describes a patient who presented with pain complaints to numerous doctors. Eventually, a malpractice suit was brought against one of the patient's physicians who had diagnosed her condition as multiple personality disorder (dissociative identity disorder. Factitious disorder and the doctor's prescription of pain medications were issues raised during the trial. In view of the issue of harm, physicians' responsibilities and limitations during ongoing medical care are addressed in this case report.

  17. Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

    Science.gov (United States)

    Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

    2017-08-07

    Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

  18. [Research and development of medical case database: a novel medical case information system integrating with biospecimen management].

    Science.gov (United States)

    Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang

    2010-04-01

    To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

  19. Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

    Science.gov (United States)

    Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

    2017-11-01

    Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. Evidence in clinical reasoning: a computational linguistics analysis of 789,712 medical case summaries 1983-2012.

    Science.gov (United States)

    Seidel, Bastian M; Campbell, Steven; Bell, Erica

    2015-03-21

    Better understanding of clinical reasoning could reduce diagnostic error linked to 8% of adverse medical events and 30% of malpractice cases. To a greater extent than the evidence-based movement, the clinical reasoning literature asserts the importance of practitioner intuition—unconscious elements of diagnostic reasoning. The study aimed to analyse the content of case report summaries in ways that explored the importance of an evidence concept, not only in relation to research literature but also intuition. The study sample comprised all 789,712 abstracts in English for case reports contained in the database PUBMED for the period 1 January 1983 to 31 December 2012. It was hypothesised that, if evidence and intuition concepts were viewed by these clinical authors as essential to understanding their case reports, they would be more likely to be found in the abstracts. Computational linguistics software was used in 1) concept mapping of 21,631,481 instances of 201 concepts, and 2) specific concept analyses examining 200 paired co-occurrences for 'evidence' and research 'literature' concepts. 'Evidence' is a fundamentally patient-centred, intuitive concept linked to less common concepts about underlying processes, suspected disease mechanisms and diagnostic hunches. In contrast, the use of research literature in clinical reasoning is linked to more common reasoning concepts about specific knowledge and descriptions or presenting features of cases. 'Literature' is by far the most dominant concept, increasing in relevance since 2003, with an overall relevance of 13% versus 5% for 'evidence' which has remained static. The fact that the least present types of reasoning concepts relate to diagnostic hunches to do with underlying processes, such as what is suspected, raises questions about whether intuitive practitioner evidence-making, found in a constellation of dynamic, process concepts, has become less important. The study adds support to the existing corpus of

  1. Assessment of risk in radiology using malpractice RVU

    International Nuclear Information System (INIS)

    Cristofaro, Massimo; Bellandi, Giuseppe; Squarcione, Salvatore; Petecchia, Antonella; Mammarella, Assunta; Bibbolino, Corrado

    2007-01-01

    Introduction: Analysis on the causes and remedies needed to reduce the incidence of malpractice has been under continual studies, although limited data is available regarding quantitative evaluation of the risk. Objectives: To determine radiological risk in a preventive and quantitative manner and verify if the malpractice relative value units (MP-RVU) are a good indicator of associated risk factors. Materials and methods: Radiological examinations executed by our Radiology Department in 2000-2004 have been codified according to nomenclature HCPCS (Healthcare Common Procedure Coding System) used by United States of America Centers for Medicare and Medicaid Services (CMS). For every examination was calculated the annual weight of malpractice. The data has been groupped in macroaggregates by methodology. The ratio MP-RVU/no. examinations has been considered as an index of insurance risk (MP index) Results: A total of 133,005 examinations were performed, which produced 25,252 MP-RVU points, the total mp index was 0.193. Traditional radiology represents 38% of the examinations, accounting for 8% of MP-RVU with a MP index = 0.039. Ultrasound represents 35% of the examinations, accounting for 23% of MP-RVU with a MP index = 0.125. CT represents 13% of the examinations, accounting for 28% of MP-RVU with a MP index = 0.434. MR represents 11% of the examinations, accounting for 39% of MP-RVU with a MP index = 0.667. Conclusions: Malpractice relative value units (MP-RVU) are indicative of the risk considered globally and when subgrouped. MP index correlates this risk with number of exams carried out divided by methodology. This model providing quantitative data for projects concerning risk management and in allowing the correlation between data obtained in different departments

  2. Assessment of risk in radiology using malpractice RVU

    Energy Technology Data Exchange (ETDEWEB)

    Cristofaro, Massimo [U.O. di Diagnostica per Immagini, Istituto Nazionale per le Malattie Infettive IRCCS, L. Spallanzani Via Portuense, 292, 00149 Rome (Italy)]. E-mail: mcristofar@srm.org; Bellandi, Giuseppe [Servizio di Radiologia ASL 3 Ospedale di Pescia, Via Battisti 2, 51017 Pescia (PT) (Italy)]. E-mail: g.bellandi@mail.vdn.usl3.toscana.it; Squarcione, Salvatore [Direzione Sanitaria Istituto Istituto Nazionale per le Malattie Infettive IRCCS, L. Spallanzani, Via Portuense 292, 00149 Rome (Italy)]. E-mail: squarcione@inmi.it; Petecchia, Antonella [Direzione Sanitaria Istituto Istituto Nazionale per le Malattie Infettive IRCCS, L. Spallanzani, Via Portuense 292, 00149 Rome (Italy)]. E-mail: petecchia@inmi.it; Mammarella, Assunta [Direzione Sanitaria Istituto Istituto Nazionale per le Malattie Infettive IRCCS, L. Spallanzani, Via Portuense 292, 00149 Rome (Italy)]. E-mail: mammarella@inmi.it; Bibbolino, Corrado [U.O. di Diagnostica per Immagini, Istituto Nazionale per le Malattie Infettive IRCCS, L. Spallanzani Via Portuense, 292, 00149 Rome (Italy)]. E-mail: bibbolino@inmi.it

    2007-02-15

    Introduction: Analysis on the causes and remedies needed to reduce the incidence of malpractice has been under continual studies, although limited data is available regarding quantitative evaluation of the risk. Objectives: To determine radiological risk in a preventive and quantitative manner and verify if the malpractice relative value units (MP-RVU) are a good indicator of associated risk factors. Materials and methods: Radiological examinations executed by our Radiology Department in 2000-2004 have been codified according to nomenclature HCPCS (Healthcare Common Procedure Coding System) used by United States of America Centers for Medicare and Medicaid Services (CMS). For every examination was calculated the annual weight of malpractice. The data has been groupped in macroaggregates by methodology. The ratio MP-RVU/no. examinations has been considered as an index of insurance risk (MP index) Results: A total of 133,005 examinations were performed, which produced 25,252 MP-RVU points, the total mp index was 0.193. Traditional radiology represents 38% of the examinations, accounting for 8% of MP-RVU with a MP index = 0.039. Ultrasound represents 35% of the examinations, accounting for 23% of MP-RVU with a MP index = 0.125. CT represents 13% of the examinations, accounting for 28% of MP-RVU with a MP index = 0.434. MR represents 11% of the examinations, accounting for 39% of MP-RVU with a MP index = 0.667. Conclusions: Malpractice relative value units (MP-RVU) are indicative of the risk considered globally and when subgrouped. MP index correlates this risk with number of exams carried out divided by methodology. This model providing quantitative data for projects concerning risk management and in allowing the correlation between data obtained in different departments.

  3. The anatomy of a malpractice suit

    International Nuclear Information System (INIS)

    Reuter, S.R.; Bundy, A.L.; Gunn, W.G.; Johnson, G.C.

    1987-01-01

    The Medical-Legal Committee of the RSNA presents an overview of medical negligence in the radiologic context and discusses the procedural aspects of the legal process that a radiologist who has been sued might expect to face during discovery and a trial. Special aspects of radiologic negligence, such as misdiagnosis and complications of special procedures, are discussed. The defendant radiologist's role during discovery and the role of the radiologist as a witness completes the program

  4. Breadth versus volume: Neurology outpatient clinic cases in medical education.

    Science.gov (United States)

    Albert, Dara V; Blood, Angela D; Park, Yoon Soo; Brorson, James R; Lukas, Rimas V

    2016-06-01

    This study examined how volume in certain patient case types and breadth across patient case types in the outpatient clinic setting are related to Neurology Clerkship student performance. Case logs from the outpatient clinic experience of 486 students from The University of Chicago Pritzker School of Medicine, USA, participating in the 4week Neurology Clerkship from July 2008 to June 2013 were reviewed. A total of 12,381 patient encounters were logged and then classified into 13 diagnostic categories. How volume of cases within categories and the breadth of cases across categories relate to the National Board of Medical Examiners Clinical Subject Examination for Neurology and a Neurology Clerkship Objective Structured Clinical Examination was analyzed. Volume of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.290, pNeurology (r=.231, p=.017), however was not significantly correlated with any component of the Objective Structured Clinical Examination. Volume of cases correlated with higher performance on measures of specialty knowledge and clinical skill. Fewer relationships emerged correlating breadth of cases and performance on the same measures. This study provides guidance to educators who must decide how much emphasis to place on volume versus breadth of cases in outpatient clinic learning experiences. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. The Perception of Patient Safety in Medical Students

    Directory of Open Access Journals (Sweden)

    Unal Demirtas

    2014-08-01

    CONCLUSION:It is seen that effects that increase the awareness such as more intense clinical studies, having knowledge about the subject, getting harmed from malpractice increase the perception of malpractice. Particularly the practices and studies of patient safety done in university hospitals have some benefits on the approach and point of views of medical school students, taking these benefits into account, we consider that taking active role in these studies for students and including patient safety classes into the medical school programs would be useful in increasing the awareness and in being more cautious against malpractice [TAF Prev Med Bull 2014; 13(4.000: 315-320

  6. Disclosing harmful medical errors to patients: tackling three tough cases.

    Science.gov (United States)

    Gallagher, Thomas H; Bell, Sigall K; Smith, Kelly M; Mello, Michelle M; McDonald, Timothy B

    2009-09-01

    A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that failed due to the pancreas graft being discarded, an error that was not disclosed partly because the family did not ask clarifying questions. Relying on patient or family questions to determine the content of disclosure is problematic. We propose a standard of materiality that can help clinicians to decide what information to disclose. The second case involves a fatal diagnostic error that the patient's widower was unaware had happened. The error was not disclosed out of concern that disclosure would cause the widower more harm than good. This case highlights how institutions can overlook patients' and families' needs following errors and emphasizes that benevolent deception has little role in disclosure. Institutions should consider whether involving neutral third parties could make disclosures more patient centered. The third case presents an intraoperative cardiac arrest due to a large air embolism where uncertainty around the clinical event was high and complicated the disclosure. Uncertainty is common to many medical errors but should not deter open conversations with patients and families about what is and is not known about the event. Continued discussion within the medical profession about applying disclosure principles to real-world cases can help to better meet patients' and families' needs following medical errors.

  7. A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field

    Directory of Open Access Journals (Sweden)

    Bo Young Park

    2016-05-01

    Full Text Available BackgroundDisputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future.MethodsWe conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved.ResultsThe claim amounts ranged from under 8 million KRW (6,991 USD to 750 million KRW (629,995 USD. The most common ratio of the judgment amount to the claim amount was 20%–30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%, violation of the duty of care in 10 cases (17%, violation of both duties in 20 cases (35%, and no violation of duty in six cases (10%.ConclusionsCosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise.

  8. Team effectiveness in academic medical libraries: a multiple case study.

    Science.gov (United States)

    Martin, Elaine Russo

    2006-07-01

    The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams.

  9. The Terri Schiavo case: legal, ethical, and medical perspectives.

    Science.gov (United States)

    Perry, Joshua E; Churchill, Larry R; Kirshner, Howard S

    2005-11-15

    Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.

  10. Rhetorical Structure and Linguistic Features of Case Presentations in Case Reports in Taiwanese and International Medical Journals

    Science.gov (United States)

    Hung, Hsuan; Chen, Pi-Ching; Tsai, Jing-Jane

    2012-01-01

    The case presentation is the core section of a medical case report. Issues in the teaching of case report writing have recently been the subject of great interest in medical education, especially in the era of globalization. Given that Taiwanese medical students, residents and junior physicians are requested to write case reports in English and…

  11. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Science.gov (United States)

    2010-04-01

    ... for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the mortgagor to maintain adequate liability, fire, and extended coverage insurance on the property. The... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Covenant for malpractice, fire, and...

  12. Factor Responsible for Examination Malpractices as Expressed by Undergraduates of Osun State University, Nigeria

    Science.gov (United States)

    Yusuf; Adeoti, Florence; Olufunke, Yinusa Rasheedat; Ruth, Bamgbose Oluwayemisi

    2015-01-01

    The study investigated perception of undergraduates on factors responsible for examination malpractices. The study is a descriptive study; a sample of two hundred (200) undergraduates formed the participants for the study. A questionnaire titled: "Factor responsible for examination malpractices was used for data collection. Data collected…

  13. External Quality Assurance in Higher Education: How Can It Address Corruption and Other Malpractices?

    Science.gov (United States)

    Martin, Michaela

    2016-01-01

    Corruption and malpractices in higher education are today a major concern in nearly all higher education systems worldwide. It is a multifaceted phenomenon and has become particularly visible in the academic domain. This paper represents an exploration of the possible role that quality assurance can play in addressing corruption and malpractices.…

  14. Correlates of Examination Malpractice among Secondary School Students in Oyo State, Nigeria

    Science.gov (United States)

    Animasahun, R. A.; Ogunniran, J. O.

    2014-01-01

    The purpose of this study is to investigate the correlates of examination malpractice among secondary school students in Oyo State, Nigeria. The instrument used for the study was tagged Predisposing Factors towards Examination Malpractice Questionnaire (PFTEMQ). The instrument was administered to 300 students randomly selected from 20 multi staged…

  15. Poor Agreement Among Expert Witnesses in Bile Duct Injury Malpractice Litigation An Expert Panel Survey

    NARCIS (Netherlands)

    de Reuver, Philip R.; Dijkgraaf, Marcel G. W.; Gevers, Sjef K. M.; Gouma, Dirk J.

    2008-01-01

    Objective: To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. Background Data: Malpractice litigation is an increasing concern in modem surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to

  16. Poor agreement among expert witnesses in bile duct injury malpractice litigation: an expert panel survey.

    NARCIS (Netherlands)

    Reuver, P.R. de; Dijkgraaf, M.G.; Gevers, S.K.; Gouma, D.J.; Bleichrodt, R.P.; Cuesta, M.A.; Erp, W.F. van; Gerritsen, J.; Hesselink, E.J.; Laarhoven, C.J.H.M. van; Lange, J. de; Obertop, H.; Stassen, L.P.; Terpstra, O.T.; Tilanus, H.W.; Vroonhoven, T.J.; Wit, L. de

    2008-01-01

    OBJECTIVE: To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. BACKGROUND DATA: Malpractice litigation is an increasing concern in modern surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to

  17. Systematic analysis of ear-nose-throat malpractice complaints may be beneficial for patient safety

    DEFF Research Database (Denmark)

    Nikoghosyan-Bossen, Gohar; Hauberg, Agnes; Homøe, Preben

    2012-01-01

    The analysis of malpractice complaints can provide valuable information on patient safety. This study offers a detailed examination of the backgrounds concerning reasons and outcomes of ear, nose and throat (ENT) malpractice complaints handled by the National Board of Patients' Complaints (NBPC),...

  18. Root Canal Stripping: Malpractice or Common Procedural Accident-An Ethical Dilemma in Endodontics.

    Science.gov (United States)

    Ciobanu, Ionela Elisabeta; Rusu, Darian; Stratul, Stefan-Ioan; Didilescu, Andreea Cristina; Cristache, Corina Marilena

    2016-01-01

    Root canal stripping is defined as an oblong, vertical perforation that appears especially in the middle section of curved root canals during endodontic treatments with nickel-titanium (Ni-Ti) instruments. Its occurrence may drastically affect the outcome of the treatment, transforming a common otherwise efficient endodontic procedure into a complication such as tooth extraction. In order to discuss the ethical and legal consequences, two cases of dental strip perforations are herewith presented. Due to the existence of risk factors for dental strip perforation, experience of the clinician and the use of magnification and modern imagistic methods (CBCT) may avoid or reduce the frequency of this type of accidents. Under correct working circumstances, dental stripping should not be regarded as a malpractice but as a procedural accident. However, the patient must always be informed, before and during the endodontic procedure, about the event and the possible complications that may occur.

  19. Application of medical cases in general genetics teaching in universities.

    Science.gov (United States)

    He, Zhumei; Bie, Linsai; Li, Wei

    2018-01-20

    General genetics is a core course in life sciences, medicine, agriculture and other related fields. As one of the most fast-developing disciplines of life sciences in the 21th century, the influence of the genetics knowledge on daily life is expanding, especially on human health and reproduction. In order to make it easier for students to understand the profound principles of genetics and to better apply the theories to daily life, we have introduced appropriate medical cases in general genetics teaching and further extended them combined with theoretical basis of genetics. This approach will be beneficial to enhance students' abilities of genetic analysis and promote their enthusiasm to learn and master practical skills. In this paper, we enumerate medical cases related to the modern genetics teaching system to provide a reference for genetics teaching in general and normal universities.

  20. Doctors' new tool to fight lawsuits: saying 'I'm sorry.' Malpractice insurers find owning up to errors soothes patient anger. 'The risks are extraordinary'.

    Science.gov (United States)

    Zimmerman, Rachel

    2004-06-01

    A lot of attention and energy has been spent over the past several years on reducing the amount of settlements and awards in malpractice cases. Of course these are important issues, but the best situation for physicians is not to be sued at all. Therefore, the medical community needs to start focusing on ways to prevent lawsuits from being filed in the first place. Recent studies and publications indicate that physicians may have more control over the lawsuit lottery than they realize. An article that appeared on the front page of the May 18, 2004 edition of the Wall Street Journal is reprinted below with permission. This article supports the proposition that the best tool to minimize the possibility of being sued may be as simple as expressing condolence and empathy when there is a bad outcome. The lawsuit reform bill that recently passed the Oklahoma legislature, H.B. 2661, contains an "I'm Sorry Law" that permits physicians to express condolence without those statements being used against them in court. For more information regarding the power of an apology, physicians may want to obtain the book by Michael S. Woods, M.D. (a speaker at the OSMA Physician Survival Summit) titled: "Healing Words: The Power of Apology in Medicine." The book can be obtained from: Doctors in Touch, 708.697.6447 or info@doctorsintouch.com.

  1. Foreign Accent Syndrome Secondary to Medication Withdrawal: A Case Report

    Directory of Open Access Journals (Sweden)

    Michael J. Schuh

    2017-08-01

    Full Text Available Objective: The purpose of this case report is to demonstrate a possible alternative etiology related to dopamine may exist for foreign accent syndrome (FAS. Methods: A 79-year-old, 205 pound, Caucasian woman originally presented to the department of Neurology for treatment and subsequently to the pharmacist pharmacotherapy service for evaluation of bilateral upper extremity tremor of high amplitude but was found to also exhibit FAS. Discussion: This case report contributes to the limited literature regarding foreign accent syndrome and adds to the few case reports of psychogenic origin, as opposed to the majority, which are of neurogenic origin. This also represents the first case that seems related to withdrawal of medication rather than psychotic exacerbation and ranks a six on the Naranjo algorithm. Conclusion: FAS is a rare disorder and little is understood about it. This case presentation also suggests that chronic use of high-dose dopamine and/or anticholinergic agents may alter pathways in the brain, which in this case, may have potentially contributed to the development of FAS. There remain many unanswered questions regarding FAS, but hopefully more clarity may be found as more cases are discovered and published. Conflict of Interest I declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Case Study

  2. Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

    Science.gov (United States)

    Comer, Rachel; Lizer, Mitsi

    2017-10-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

  3. Reminder: call 74444 also in case of a medical emergency

    CERN Multimedia

    2005-01-01

    What happened? A CERN colleague, suffering from heart trouble, went to the ‘infirmary' on the Prévessin site for medical aid. He was unaware that the ‘infirmary' was in fact no such thing, but the office of the French medical officer, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin site (building 65). The firemen and the CERN infirmary took care of him and requested a helicopter transport to the Geneva cantonal hospital, where he received medical treatment.   What do we learn from this event?   You can call the CERN internal number 74444 also in case of serious and acute illness, not only in the event of an accident, pollution, fire, etc.   Professional aid (ambulance firemen and medical assistance, if needed) will be provided.   The CERN Fire station is located in building 65, on ‘Route Einstein', the first road on your right when you enter CERN entrance B on the Meyrin site. It is open permanently, 24 hours per day, 7 days per we...

  4. Team effectiveness in academic medical libraries: a multiple case study*

    Science.gov (United States)

    Russo Martin, Elaine

    2006-01-01

    Objectives: The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. Methods: The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Findings: Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Conclusions: Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams. PMID:16888659

  5. Medical illness, medication use and suicide in seniors: a population-based case-control study.

    Science.gov (United States)

    Voaklander, D C; Rowe, B H; Dryden, D M; Pahal, J; Saar, P; Kelly, K D

    2008-02-01

    Suicide among seniors is a significant health problem in north America, particularly for men in whom the rates rise steadily after 50 years of age. The goal of this study was to examine elder suicides identified from a large population-based database using case-control methods to determine disease and medication factors related to suicide. A population-based 1 : 5 case-control study was conducted comparing seniors aged 66 years and older who had died by suicide with age and sex-matched controls. Case data were obtained through British Columbia (BC) Vital Statistics, whereas controls were randomly selected from the BC Health Insurance Registry. Cases and controls were linked to the provincial PharmaCare database to determine medication use and the provincial Physician Claims and Inpatient Hospitalization databases to determine co-morbidity. Between 1993 and 2002 a total of 602 seniors died by suicide in BC giving an annual rate of 13.2 per 100,000. Firearms were the most common mechanism (28%), followed by hanging/suffocation (25%), self-poisoning (21%), and jumping from height (7%). In the adjusted logistic model, variables related to suicide included: lower socioeconomic status, depression/psychosis, neurosis, stroke, cancer, liver disease, parasuicide, benzodiazepine use, narcotic pain killer use and diuretic use. There was an elevated risk for those prescribed inappropriate benzodiazepines and for those using strong narcotic pain killers. This study is consistent with previous studies that have identified a relationship between medical or psychiatric co-morbidity and suicide in seniors. In addition, new and potentially useful information confirms that certain types and dosages of benzodiazepines are harmful to seniors and their use should be avoided.

  6. 29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

    Science.gov (United States)

    2010-07-01

    ... surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation—(1) How do I classify medical removal cases on the OSHA 300 Log? You must enter each medical removal case on the OSHA 300 Log as either a case involving days away from work or a case involving restricted...

  7. Suicide and psychiatrist's liability in Italian law cases.

    Science.gov (United States)

    Terranova, Claudio; Sartore, Daniela

    2013-03-01

    The aim of the study is to analyze the factors that are most frequently associated with a verdict of guilty delivered to the psychiatrist in cases of a patient's suicide in Italian law. Twenty-six sentences (1975-2009) were analyzed according to the claim of malpractice, patient characteristics, circumstances of the suicide, and reasons for the court's judgment. The court held the psychiatrist guilty in 12 cases, considering that the act of suicide was predictable and could have been avoided. Predictability was mainly related to errors in surveillance (7 cases), therapy (1 case), or both (2 cases). An error in diagnosis was considered to be related to the patient's death in two cases. Analysis of medical behavior considered to be erroneous and associated with a verdict of guilty provides an opportunity to discuss the topics relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of patient suicide. © 2012 American Academy of Forensic Sciences.

  8. Medical bribery and the ethics of trust: the Romanian case.

    Science.gov (United States)

    Manea, Teodora

    2015-02-01

    Medical bribery seems to be a global problem from Eastern Europe and the Balkans to China, a diffuse phenomenon, starting with morally acceptable gratitude and ending with institutional bribery. I focus my attention on Romania and analyze similar cases in Eastern European and postcommunist countries. Medical bribery can be regarded as a particular form of human transaction, a kind of primitive contract that occurs when people do not trust institutions or other forms of social contract that are meant to guarantee their rights and protect their interests. Concluding with strategies to fight medical bribery, I will underline better public policies for financing health and social care, and an ethic of trust that may help to restore trustworthiness of institutions and to rebuild interpersonal trust. This should be complemented by an educational program dedicated to understanding the negative consequences and mechanisms of corruption and the importance of ethical behavior. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Medical measures in case of nuclear power plant accidents

    International Nuclear Information System (INIS)

    1986-01-01

    The Laender governments of the Federal Republic of Germany are of the opinion that within the framework of precautionary disaster control, plans have to be set up dealing with nuclear disasters that seem improbable but cannot be completely excluded. Accordingly, recommendations presented by the Federal Government and the Laender governments have been combined into a framework disaster control scheme where the competencies for activities and measures lie with the several Laender governments, as given by the Basic Law. A further recommendation deals with the medical care and service in case of a nuclear disaster, and the practical guide presented here is intended to give the information and instructions needed in order to comply with the legal framework. A working group has been set up in order to work out the rules and facts for optimum medical care. The activities are planned to be based on an emergency station responsible for medical examination, treatment, and transfer of victims. The practical guide has been discussed by the 'Committee for disaster control in the vicinity of nuclear installations' of the SSK, has been approved of by the supreme Land authorities of the Laender concerned, and has been passed by the SSK at its 63rd meeting. With 5 figs., 6 tabs [de

  10. Medical liability and patient law in Germany. Main features with particular focus on treatments in the field of interventional radiology

    International Nuclear Information System (INIS)

    Sommer, S.A.; Geissler, R.; Stampfl, U.; Radeleff, B.A.; Kauczor, H.U.; Sommer, Christof M.; Richter, G.M.; Pereira, P.L.

    2016-01-01

    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology - with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liability of malpractice law.

  11. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students

    Science.gov (United States)

    Chamberlain, Neal R.; Stuart, Melissa K.; Singh, Vineet K.; Sargentini, Neil J.

    2012-01-01

    Background Small-group case presentation exercises (CPs) were created to increase course relevance for medical students taking Medical Microbiology (MM) and Infectious Diseases (ID) Methods Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Results Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I) and students who participated in the CPs (Group II). In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P<0.018; P<0.001; Mann-Whitney Rank Sum Test). Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P<0.001; P<0.001). Conclusion Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians. PMID:22435014

  12. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students.

    Science.gov (United States)

    Chamberlain, Neal R; Stuart, Melissa K; Singh, Vineet K; Sargentini, Neil J

    2012-01-01

    Small-group case presentation exercises (CPs) were created to increase course relevance for medical students taking Medical Microbiology (MM) and Infectious Diseases (ID) METHODS: Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I) and students who participated in the CPs (Group II). In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P<0.018; P<0.001; Mann-Whitney Rank Sum Test). Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P<0.001; P<0.001). Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians.

  13. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students

    Directory of Open Access Journals (Sweden)

    Neal R. Chamberlain

    2012-03-01

    Full Text Available Background : Small-group case presentation exercises (CPs were created to increase course relevance for medical students taking Medical Microbiology (MM and Infectious Diseases (ID Methods : Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Results : Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I and students who participated in the CPs (Group II. In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P < 0.018; P < 0.001; Mann-Whitney Rank Sum Test. Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P < 0.001; P < 0.001. Conclusion : Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians.

  14. Academic Dishonesty in Medical Schools

    African Journals Online (AJOL)

    drive academic dishonesty among aspiring doctors. Objective: To establish the ... Cross sectional survey using self-administered questionnaire. ... There is no data to show how medical students compare to other .... by mandated bodies to contain the malpractice, hence bigger ... on Plagiarism and Cheating, in Perspectives.

  15. Analysis of the experience in participation of army medical service in medical arrangement in case of radiation accident

    International Nuclear Information System (INIS)

    Zhilyaev, E.G.; Goncharov, S.F.; Vorontsov, I.V.; Legeza, V.I.; Berzin, I.A.

    1995-01-01

    The paper presented calculations of manpower and money funds for rendering aid to the injured persons in case of radiation accident. The authors offered a scheme of using medical anti-radial aids on various stages of radiation accident; immediately after the accident in case of non-predicted and controlled radiation exposure. Army Medical Service is capable of solving promptly the tasks of medical aid with the help of highly mobile specialized medical units, the use of which is stipulated in the system of the Russian Service of disaster medicine. 10 refs.; 1 tab

  16. Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School.

    Science.gov (United States)

    To, Matthew J; MacLeod, Anna; Hwang, Stephen W

    2016-01-01

    PHENOMENON: Homelessness is a major public health concern. Given that homeless individuals have high rates of mortality and morbidity, are more likely to be users of the healthcare system, and often report unmet health needs, it is important to examine how homelessness is addressed in medical education. We wanted to examine content and framing of issues related to homelessness in the case-based learning (CBL) curriculum and provide insights about whether medical students are being adequately trained to meet the health needs of homeless individuals through CBL. CBL content at a Canadian medical school that featured content related to homelessness was analyzed. Data were extracted from cases for the following variables: curriculum unit (e.g., professionalism/ethics curriculum or biomedical/clinical curriculum), patient characteristics (e.g., age, sex), and medical and social conditions. A thematic analysis was performed on cases related to homelessness. Discrepancies in analysis were resolved by consensus. Homelessness was mentioned in five (2.6%) of 191 CBL cases in the medical curriculum. Homelessness was significantly more likely to be featured in professionalism/ethics cases than in biomedical/clinical cases (p = .03). Homeless patients were portrayed as socially disadvantaged individuals, and medical learners were prompted to discuss ethical issues related to homeless patients in cases. However, homeless individuals were largely voiceless in cases. Homelessness was associated with serious physical and mental health concerns, but students were rarely prompted to address these concerns. Insights: The health and social needs of homeless individuals are often overlooked in CBL cases in the medical curriculum. Moreover, stereotypes of homelessness may be reinforced through medical training. There are opportunities for growth in addressing the needs of homeless individuals through medical education.

  17. Triggered by Medication Used in Dental Procedures: A Case Report

    Directory of Open Access Journals (Sweden)

    Aristo Vojdani

    2012-01-01

    Full Text Available Enhanced intestinal permeability and food sensitivity are two of the many proven causes of gastrointestinal disorders. This present report describes a woman with no previous gastrointestinal (GI complaints, who underwent dental root canal, bone graft, and implant procedures. Postsurgery she experienced an allergic reaction to the combined medications. In the weeks that followed, she presented with multiple food intolerances. Four weeks after the final dental procedure, she was assessed serologically for mucosal immune function, salivary, and blood-gluten reactivity, intestinal permeability, and other food sensitivities. Compared to her test reports from two months prior to her first dental procedure, the patient’s results showed high total secretory IgA (SIgA and elevated salivary antibodies to alpha-gliadin, indicating abnormal mucosal immunity and loss of tolerance to gluten. Her serologic assessments revealed immunoglobulin G (IgG and IgA antibodies to a range of wheat/gluten proteins and peptides, gut bacterial endotoxins and tight junction proteins. These test results indicate gut dysbiosis, enhanced intestinal permeability, systemic gluten-reactivity, and immune response to other dietary macromolecules. The present case suggests that patients who experience severe allergic or pseudoallergic reactions to medication should be assessed and monitored for gut dysfunction. If left untreated this could lead to autoimmune reactions to self tissues.

  18. Closed medical negligence claims can drive patient safety and reduce litigation.

    Science.gov (United States)

    Pegalis, Steven E; Bal, B Sonny

    2012-05-01

    Medical liability reform is viewed by many physician groups as a means of reducing medical malpractice litigation and lowering healthcare costs. However, alternative approaches such as closed medical negligence claims data may also achieve these goals. We asked whether information gleaned from closed claims related to medical negligence could promote patient safety and reduce costs related to medical liability. Specifically, we investigated whether physician groups have examined such data to identify error patterns and to then institute specific patient treatment protocols. We searched for medical societies that have systematically examined closed medical negligence claims in their specialty to develop specific standards of physician conduct. We then searched the medical literature for published evidence of the efficacy, if any, related to the patient safety measures thus developed. Anesthesia and obstetric physician societies have successfully targeted costs and related concerns arising from medical malpractice lawsuits by using data from closed claims to develop patient safety and treatment guidelines. In both specialties, after institution of safety measures derived from closed medical negligence claims, the incidence and costs related to medical malpractice decreased and physician satisfaction improved. Tort reform, in the form of legislatively prescribed limits on damages arising from lawsuits, is not the only means of addressing the incidence and costs related to medical malpractice litigation. As the experience of anesthesia and obstetric physicians has demonstrated, safety guidelines derived from analyzing past medical malpractice litigation can achieve the same goals while also promoting patient safety.

  19. A UTÓPICA APLICAÇÃO DA TEORIA DA PERDA DE UMA CHANCE NO ÂMBITO DO DIREITO MÉDICO:UMA ANÁLISE DA JURISPRUDÊNCIA DO TJRS, TJPR E TJPE/THE UTOPIAN APPLICATION OF THE LOSS OF CHANCE DOCTRINE IN MEDICAL LAW:AN ANALISYS OF THE CASES JUDGED BY TJRS TJPR AND TJPE

    Directory of Open Access Journals (Sweden)

    Igor de Lucena Mascarenhas

    2016-12-01

    Full Text Available This essay analyzes the application of the Loss of Chance Doctrine in cases of medical civil liability. The growth of lawsuits due to medical malpractice allowed the application of multiple theories to solve the civil liability of the physician. Through a bibliographical analysis, it was observed that the Loss of Chance Doctrine cannot be applied in the medical law, because it uses data observed in studies that may not be the same of the real case. Thus, the objectification of the human body, a subjective element, demonstrates that the nuclear element of the theory is incompatible with the medical law. It was observed that 80% of judicial decisions of TJPR, TJRS and TJPE between 01.01.2014 and 09.22.2015, did not include the percentage of the chance, a violation to the contradictory and full defense. Finally, it is proposed that the percentage of recovering and healing can be used to establish the indemnity, but cannot be the only element of the judicial consideration.

  20. [Scientometric and publication malpractices. The appearance of globalization in biomedical publishing].

    Science.gov (United States)

    Fazekas, T; Varró, V

    2001-09-16

    Attention is drawn to publication and scientometric malpractices utilized by biomedical authors who do not adhere to the accepted ethical norms. The difference between duplicate/redundant and bilingual publications is defined. In the course of discussion of the manipulations that may be observed in the field of scientometry, it is pointed out that abstract of congress lectures/posters can not be taken into consideration for scientometric purposes even if such abstracts are published in journals with impact factors. A further behavioral form is likewise regarded as unacceptable from the aspect of publication ethics: when a physician who has participated in a multicentre, randomized clinical trial receives recognition (in an appendix or in an acknowledgement of an article) as having contributed data, but assesses this appreciation as co-authorship and thereby attempts to augment the value of his or her publication activity. The effects of globalization on biomedical publication activity are considered, and evidence is provided that the rapidly spreading electronic publication for a give rise to new types of ethical dilemmas. It is recommended that, in the current age of Anglo-American globalization, greater emphasis should be placed on the development of medical publication in the mother tongue (Hungarian).

  1. Ethical implications of medical crowdfunding: the case of Charlie Gard.

    Science.gov (United States)

    Dressler, Gabrielle; Kelly, Sarah A

    2018-05-04

    Patients are increasingly turning to medical crowdfunding as a way to cover their healthcare costs. In the case of Charlie Gard, an infant born with encephalomyopathic mitochondrial DNA depletion syndrome, crowdfunding was used to finance experimental nucleoside therapy. Although this treatment was not provided in the end, we will argue that the success of the Gard family's crowdfunding campaign reveals a number of potential ethical concerns. First, this case shows that crowdfunding can change the way in which communal healthcare resources are allocated. Second, within the UK's National Health Service, healthcare is ostensibly not a market resource; thus, permitting crowdfunding introduces market norms that could commodify healthcare. Third, pressures inherent to receiving funds from external parties may threaten the ability of patients-cum-recipients to voluntarily consent to treatment. We conclude that while crowdfunding itself is not unethical, its use can have unforeseen consequences that may influence conceptions of healthcare and how it is delivered. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. [Medical education and medical anthropology in Europe: the cases of Italy and Spain].

    Science.gov (United States)

    Comelles, Josep M; Riccò, Isabella; Bañuelos, Aida Terrón; Perdiguero-Gil, Enrique

    2017-01-01

    The aim of this article is to compare the development of health education in Italy and Spain from the point of view of the role played by medical anthropology in both countries. The context is provided by the changes in the concept of health education advocated by the UN technical agencies, especially the World Health Organization and Unesco, during the second half of the twentieth century. Despite their many similarities, Italy and Spain underwent different political evolutions over the last century. Therefore, it is interesting to compare both cases and the influence the social sciences had in health education initiatives. In order to assess the role of medical anthropology, the 1958 launch and the development of the Centro Sperimentale per l'Educazione Sanitaria (Perugia, Italy), which was at the forefront of health education in Europe until the 1990s, was reconstructed through oral sources. After a brief description of the scant initiatives regarding health education existing in the Spain of the dictatorship, the influence of the Perusine anthropologists on Spanish health education during the democratic transition is evaluated.

  3. Quality assurance of medical education: a case study from Switzerland

    Science.gov (United States)

    Schirlo, Christian; Heusser, Rolf

    2010-01-01

    In the light of ongoing changes and challenges in the European health systems which also have significant implications for undergraduate medical education, the present paper describes the accreditation of medical education programmes in Switzerland focussing on undergraduate medical education. A summary of the methodology used is provided and first experiences as well as future perspectives are discussed in the light of the aim to achieve continuous quality assurance and improvement in medical education. PMID:21818193

  4. [The forensic medical aspects of the inappropriate medical care in the modern-day Ukraine].

    Science.gov (United States)

    Franchuk, V V

    2018-01-01

    Despite the fact that the ever growing relevance of the problem of the inappropriate medical care was long ago brought to the worldwide attention, it has not been practically addressed in the Ukraine since the country gained independence in 1991. The objective of the present study was to consider the specific features of expert examination of the cases of inappropriate medical care as exemplified by the materials of the legal actions and lawsuits instituted against healthcare specialists violating their occupational duties. The results of forensic medical examination by the local Bureaux of forensic medical expertise concerning the 350 so-called malpractice suits instituted in the Ternopol, Zhitomir, and Chernovtsy regions during the period from 207 to 2016 were available for the analysis. The facts of inadequate and inappropriate medical care were documented in 245 (72.0%) cases. The frequency of diagnostic and therapeutic errors amounted to 29.7% and 26.9% respectively while the improper formulation of the medical documentation was recorded in 21.3% of the cases. The cases of poor organization of the diagnostic and treatment process accounted for 14.6% of the total whereas the improper behaviour of the medical personnel was reported in 7.5% of all the known cases of provision of the healthcare services. It is concluded that in the majority of the cases, the citizens of the modern-day Ukraine receive the inappropriate (insufficient and untimely) medical care. Over 80% of the cases of the inappropriate medical care currently provided in the country can be accounted for by the objective reasons, with each fifths case being due to the violation of professional responsibilities by the healthcare providers.

  5. Embedding care management in the medical home: a case study.

    Science.gov (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  6. Case studies in cholera: lessons in medical history and science.

    Science.gov (United States)

    Kavic, S. M.; Frehm, E. J.; Segal, A. S.

    1999-01-01

    Cholera, a prototypical secretory diarrheal disease, is an ancient scourge that has both wrought great suffering and taught many valuable lessons, from basic sanitation to molecular signal transduction. Victims experience the voluminous loss of bicarbonate-rich isotonic saline at a rate that may lead to hypovolemic shock, metabolic acidosis, and death within afew hours. Intravenous solution therapy as we know it was first developed in an attempt to provide life-saving volume replacement for cholera patients. Breakthroughs in epithelial membrane transport physiology, such as the discovery of sugar and salt cotransport, have paved the way for oral replacement therapy in areas of the world where intravenous replacement is not readily available. In addition, the discovery of the cholera toxin has yielded vital information about toxigenic infectious diseases, providing a framework in which to study fundamental elements of intracellular signal transduction pathways, such as G-proteins. Cholera may even shed light on the evolution and pathophysiology of cystic fibrosis, the most commonly inherited disease among Caucasians. The goal of this paper is to review, using case studies, some of the lessons learned from cholera throughout the ages, acknowledging those pioneers whose seminal work led to our understanding of many basic concepts in medical epidemiology, microbiology, physiology, and therapeutics. PMID:11138935

  7. Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature.

    Science.gov (United States)

    Wong, Kam Cheong

    2011-03-29

    Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries.In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learning settings.An Ishikawa diagram annotated with references to relevant medical cases and literature can be continually updated and can assist memory and retrieval of relevant medical cases and literature. It could also be used to cultivate a lifelong learning habit in medical professionals.

  8. Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature

    Directory of Open Access Journals (Sweden)

    Wong Kam Cheong

    2011-03-01

    Full Text Available Abstract Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries. In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learning settings. An Ishikawa diagram annotated with references to relevant medical cases and literature can be continually updated and can assist memory and retrieval of relevant medical cases and literature. It could also be used to cultivate a lifelong learning habit in medical professionals.

  9. The approach of Bayesian model indicates media awareness of medical errors

    Science.gov (United States)

    Ravichandran, K.; Arulchelvan, S.

    2016-06-01

    This research study brings out the factors behind the increase in medical malpractices in the Indian subcontinent in the present day environment and impacts of television media awareness towards it. Increased media reporting of medical malpractices and errors lead to hospitals taking corrective action and improve the quality of medical services that they provide. The model of Cultivation Theory can be used to measure the influence of media in creating awareness of medical errors. The patient's perceptions of various errors rendered by the medical industry from different parts of India were taken up for this study. Bayesian method was used for data analysis and it gives absolute values to indicate satisfaction of the recommended values. To find out the impact of maintaining medical records of a family online by the family doctor in reducing medical malpractices which creates the importance of service quality in medical industry through the ICT.

  10. Emerging Communication Technology and Examination Malpractices in Nigerian Educational Sector

    Directory of Open Access Journals (Sweden)

    Olufemi Sunday Adeoye

    2010-12-01

    Full Text Available The breakthrough in communication technology, especially that of GSM phones, in Nigeria is one of the best things that has happened to the nation in terms of its technological advancement. In Nigeria, GSM means Telecom Explosion. The GSM revolution began in August 2001 and changed the face of Information and Communications Technology in Nigeria. It is much easier to reach anybody that you have his / her number, whether they are in the village or in their closet unless in a place where there is no network of the service provider. As revolutionary as GSM may seem to be, its negative effect on our educational sector is of great concern. The ongoing war against examination malpractice is yet to take its toll on perpetrators as they have devised a new method to continue their game through the cell phone technology. Described as e-cheating, the cell phone technology is providing students a smart way to beat the best effort of stakeholders to stamp out the menace. This paper examines GSM technology, the various ways in which cell phones are employed to cheat and suggestions on how to stop e-cheating through cell phones.

  11. The use of Latin terminology in medical case reports: quantitative, structural, and thematic analysis.

    Science.gov (United States)

    Lysanets, Yuliia V; Bieliaieva, Olena M

    2018-02-23

    This paper focuses on the prevalence of Latin terms and terminological collocations in the issues of Journal of Medical Case Reports (February 2007-August 2017) and discusses the role of Latin terminology in the contemporary process of writing medical case reports. The objective of the research is to study the frequency of using Latin terminology in English-language medical case reports, thus providing relevant guidelines for medical professionals who deal with this genre and drawing their attention to the peculiarities of using Latin in case reports. The selected medical case reports are considered, using methods of quantitative examination and structural, narrative, and contextual analyses. We developed structural and thematic typologies of Latin terms and expressions, and we conducted a quantitative analysis that enabled us to observe the tendencies in using these lexical units in medical case reports. The research revealed that the use of Latin fully complies with the communicative strategies of medical case reports as a genre. Owing to the fact that Latin medical lexis is internationally adopted and understood worldwide, it promotes the conciseness of medical case reports, as well as contributes to their narrative style and educational intentions. The adequate use of Latin terms in medical case reports is an essential prerequisite of effective sharing of one's clinical findings with fellow researchers from all over the world. Therefore, it is highly important to draw students' attention to Latin terms and expressions that are used in medical case reports most frequently. Hence, the analysis of structural, thematic, and contextual features of Latin terms in case reports should be an integral part of curricula at medical universities.

  12. Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall.

    Science.gov (United States)

    Nalliah, R P

    2017-01-13

    Background Little is known about trends in the number of malpractice payments made against dentists and other health professionals. Knowledge of these trends will inform the work of our professional organisations.Methods The National Practitioner Data Bank (NPDB) in the United States was utilised. Data about malpractice payments against dentists, hygienists, nurses, optometrists, pharmacists, physicians (DO and MD), physicians' assistants, podiatrists, psychologists, therapists and counsellors during 2004-14 were studied. Variables include type of healthcare provider, year malpractice payment was made and range of payment amount.Results In 2004 there were 17,532 malpractice payments against the studied health professions. In 2014 there were 11,650. In 2004, the number of malpractice payments against dentists represented 10.3% of all payments and in 2014 it represented 13.4%. Number of malpractice payments against dentists in 2012-2014 increased from 1,388 to 1,555.Conclusions There is an upward pressure on the number of dental malpractice payments over the last 3 years. Concurrently, there is a downward pressure on the number of combined non-dentist healthcare professional malpractice payments.

  13. Medical liability and patient law in Germany. Main features with particular focus on treatments in the field of interventional radiology; Arzthaftung und Patientenrechtegesetz in Deutschland. Die Grundzuege unter besonderer Beruecksichtigung von Behandlungen auf dem Gebiet der Interventionellen Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, S.A.; Geissler, R. [Kapp and Geissler Lawyers, Stuttgart (Germany); Stampfl, U.; Radeleff, B.A.; Kauczor, H.U.; Sommer, Christof M. [Univ. Hospital Heidelberg (Germany). Clinic for Diagnostic and Interventional Radiology; Wolf, M.B. [German Cancer Research Center (DKFZ), Heidelberg (Germany). Radiology (E010); Richter, G.M. [Klinikum Stuttgart (Germany). Clinic for Diagnostic and Interventional Radiology; Pereira, P.L. [SLK Kliniken, Heilbronn (Germany). Radiology, Minimally-invasive Therapies and Nuclearmedicine

    2016-04-15

    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology - with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liability of malpractice law.

  14. Attitude of medical students towards psychiatry: the case of Jimma ...

    African Journals Online (AJOL)

    Background: The inability to attract medical graduates to specialize in psychiatry has always been a serious challenge to psychiatry training programs. Therefore, the aim of this study was to assess the attitude of medical students towards psychiatry. Methods: A comparative cross-sectional survey was conducted among 122 ...

  15. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  16. Threats to bioethical principles in medical practice in Brazil: new medical ethics code period.

    Science.gov (United States)

    Gracindo, G C L; da Silva Gallo, J H; Nunes, R

    2018-03-15

    We aimed to outline the profile of medical professionals in Brazil who have violated the deontological norms set forth in the ethics code of the profession, and whose cases were judged by the higher tribunal for medical ethics between 2010 and 2016. This survey was conducted using a database formed from professional ethics cases extracted from the plenary of the medical ethics tribunal of the Federal Council of Medicine. These were disciplinary ethics cases that were judged at appeal level between 2010 and 2016. Most of these professionals were male (88.5%) and their mean age was 59.9 years (SD=11.62) on the date of judgment of their appeals, ranging from 28 to 95 years. Most of them were based in the southeastern region of Brazil (50.89%). Articles 1 and 18 of the medical ethics code were the rules most frequently violated. The sentence given most often was the cancellation of their professional license (37.6%) and the acts most often sentenced involved malpractice, imprudence, and negligence (18.49%). It is acknowledged that concern for the principles of bioethics was present in the appeal decisions made by the plenary of the medical ethics tribunal of the Federal Council of Medicine.

  17. Threats to bioethical principles in medical practice in Brazil: new medical ethics code period

    Directory of Open Access Journals (Sweden)

    G.C.L. Gracindo

    2018-03-01

    Full Text Available We aimed to outline the profile of medical professionals in Brazil who have violated the deontological norms set forth in the ethics code of the profession, and whose cases were judged by the higher tribunal for medical ethics between 2010 and 2016. This survey was conducted using a database formed from professional ethics cases extracted from the plenary of the medical ethics tribunal of the Federal Council of Medicine. These were disciplinary ethics cases that were judged at appeal level between 2010 and 2016. Most of these professionals were male (88.5% and their mean age was 59.9 years (SD=11.62 on the date of judgment of their appeals, ranging from 28 to 95 years. Most of them were based in the southeastern region of Brazil (50.89%. Articles 1 and 18 of the medical ethics code were the rules most frequently violated. The sentence given most often was the cancellation of their professional license (37.6% and the acts most often sentenced involved malpractice, imprudence, and negligence (18.49%. It is acknowledged that concern for the principles of bioethics was present in the appeal decisions made by the plenary of the medical ethics tribunal of the Federal Council of Medicine.

  18. Medical treatment of radiation damages and medical emergency planning in case of nuclear power plant incidents and accidents

    International Nuclear Information System (INIS)

    Ohlenschlaeger, L.

    1981-03-01

    Medical measures in case of radiation damages are discussed on the basis of five potential categories of radiation incidents and accidents, respectively, viz. contaminations, incorporations, external local and general radiation over-exposures, contaminated wounds, and combinations of radiation damages and conventional injuries. Considerations are made for diagnostic and therapeutic initial measures especially in case of minor and moderate radiation accidents. The medical emergency planning is reviewed by means of definations used in the practical handling of incidents or accidents. The parameters are: extent of the incident or accident, number of persons involved, severity of radiation damage. Based on guiding symptoms the criteria for the classification into minor, moderate or severe radiation accidents are discussed. Reference is made to the Medical Radiation Protection Centers existing in the Federal Republic of Germany and the possibility of getting advices in case of radiation incidents and accidents. (orig.) [de

  19. Psychiatry in American Medical Education: The Case of Harvard's Medical School, 1900-1945.

    Science.gov (United States)

    Abraham, Tara H

    2018-01-01

    As American psychiatrists moved from the asylum to the private clinic during the early twentieth century, psychiatry acquired a growing presence within medical school curricula. This shift in disciplinary status took place at a time when medical education itself was experiencing a period of reform. By examining medical school registers at Harvard University, records from the Dean's office of Harvard's medical school, and oral histories, this paper examines the rise in prominence of psychiatry in medical education. Three builders of Harvard psychiatry - Elmer E. Southard, C. Macfie Campbell, and Harry C. Solomon - simultaneously sought to mark territory for psychiatry and its relevance. In doing so, they capitalized on three related elements: the fluidity that existed between psychiatry and neurology, the new venues whereby medical students gained training in psychiatry, and the broader role of patrons, professional associations, and certification boards, which sought to expand psychiatry's influence in the social and cultural life of twentieth-century America.

  20. Biopiracy and the ethics of medical heritage: the case of India's traditional knowledge digital library'.

    Science.gov (United States)

    Kidd, Ian James

    2012-09-01

    Medical humanities have a central role to play in combating biopiracy. Medical humanities scholars can articulate and communicate the complex structures of meaning and significance which human beings have invested in their ways of conceiving health and sickness. Such awareness of the moral significance of medical heritage is necessary to ongoing legal, political, and ethical debates regarding the status and protection of medical heritage. I use the Indian Traditional Knowledge Digital Library as a case study of the role of medical humanities in challenging biopiracy by deepening our sense of the moral value of medical heritage.

  1. Do medical students really understand plagiarism? - Case study.

    Science.gov (United States)

    Badea, Oana

    2017-01-01

    In the last decade, more and more medicine students are involved in research, either in the form of a research project within specialized courses or as a scientific article to be presented at student international conferences or published in prestigious medical journals. The present study included 250 2nd year medical students, currently studying within the University of Medicine and Pharmacy of Craiova, Romania. There were collected 239 responses, with a response rate of 95.6%. In our study, the results showed that foreign students within the University of Medicine and Pharmacy of Craiova did have some issues understanding plagiarism with fewer foreign students (34%) than Romanian students (66%) recognizing that simply changing words does not avoid plagiarism. In our opinion, there should be put more emphasis upon plagiarism implications and its aspects, as well, with a permanent order to try to prevent future attempts of plagiarizing among medical students as future researchers within the medical science field.

  2. Emergency medicine in case of disasters. Guideline for medical care in case of disasters. 4. rev. ed.

    International Nuclear Information System (INIS)

    2006-01-01

    Medical care in case of disasters means being pressed for time, facing difficult structures and a shortage of resources while trying to attend to many injured at a time. The knowledge required must be immediately available, and this is where this book comes in handy. The guide addresses primarily doctors and medical staff. It answers medical questions, lists contacts, provides information on disaster management, and goes into legal and ethical aspects as well. (orig.)

  3. Medical negligence | Otto | SA Journal of Radiology

    African Journals Online (AJOL)

    The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malpractice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the standard of care the law required of him in the particular ...

  4. Medical Litigation Across Specialties

    LENUS (Irish Health Repository)

    Murphy, JFA

    2013-07-01

    Medical negligence is a major cause of fear and anxiety for doctors. The threat of malpractice consists of 3 factors, the risk of a claim, the probability of a claim leading to a payment, and the size of the payment. The Clinical Indemnity Scheme (CIS) insures against indemnity payments but it cannot protect the doctor against the indirect consequences of litigation including stress, the long hours mounting a defence against the allegation, and the damage to one’s reputation. The adversarial tort system focuses on punishment, blame and compensation. The emotional anguish and potential damage to the doctor’s reputation can be considerable. Doctors subjected to malpractice suits regardless of the outcome may experience depression, anger, frustration and excessive use of alcohol

  5. Creating New Medical Ontologies for Image Annotation A Case Study

    CERN Document Server

    Stanescu, Liana; Brezovan, Marius; Mihai, Cristian Gabriel

    2012-01-01

    Creating New Medical Ontologies for Image Annotation focuses on the problem of the medical images automatic annotation process, which is solved in an original manner by the authors. All the steps of this process are described in detail with algorithms, experiments and results. The original algorithms proposed by authors are compared with other efficient similar algorithms. In addition, the authors treat the problem of creating ontologies in an automatic way, starting from Medical Subject Headings (MESH). They have presented some efficient and relevant annotation models and also the basics of the annotation model used by the proposed system: Cross Media Relevance Models. Based on a text query the system will retrieve the images that contain objects described by the keywords.

  6. Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings.

    Science.gov (United States)

    Yu, Lin-Sheng; Ye, Guang-Hua; Fan, Yan-Yan; Li, Xing-Biao; Feng, Xiang-Ping; Han, Jun-Ge; Lin, Ke-Zhi; Deng, Miao-Wu; Li, Feng

    2015-09-01

    Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases. © 2015 American Academy of Forensic Sciences.

  7. Relevance of medical reports in criminal investigations of cases of suspected child abuse.

    Science.gov (United States)

    Janßen, Katharina; Greif, Dominik; Rothschild, Markus A; Banaschak, Sibylle

    2017-07-01

    If a case of physical child abuse is suspected in Germany, the general feeling is often that "it does not matter whether you make a report or not" because, generally, no conviction is made anyway. This study investigates the juridical analysis of complaint cases of physical child abuse [criminal complaint parag. 225 StGB (German penal code) with filial victim]. It focuses on the doctor's role and the impact of their practice in relation to a later conviction. It is based on the analysis of 302 files of the enquiry from 2004-2009 from the department of public prosecution in Cologne, Germany. Besides general epidemiological data on the reporting person, the affected child and the presumed offender, the documents were reassessed for the relevance of medical reports for successful convictions. Only 7% (n = 21) of 302 complaints led to a conviction. In 38.1% (n = 8) of those cases, a medical report was mentioned as a piece of evidence, and just in two cases a (legal) medical report was quoted and mentioned as relevant for the conviction. 50% of the complaint cases with legal medical expertise led to a trial. In contrast, only 30.2% with a common medical report and 7.3% without a report led to a trial. The results show how a medical report existed in only a few cases. In those cases, the rate of performed trials was higher than for those without a medical report, but the report played a minor part when reasoning a verdict.

  8. Increased number of ear-nose-throat malpractice complaints in Denmark

    DEFF Research Database (Denmark)

    Nikoghosyan-Bossen, Gohar; Hauberg, Agnes; Homøe, Preben

    2012-01-01

    Danish ear, nose and throat (ENT) physicians have little knowledge of the type of decisions made at the Danish National Board of Patients' Complaints (NBPC). The aim of this study was to analyze and describe the epidemiology of ENT malpractice complaints by showing their distribution and volume i...

  9. A panacea to the asymptotic effect of examination malpractice in a ...

    African Journals Online (AJOL)

    We prove that in a dense population of candidates seeking admission in an environment saddled with examination malpractice, educational institutions can maintain the enrolment structure at a certain level n * if a specific quota is fixed by the Ministry of Education or its regulating agency for new entrants into the system.

  10. Educational Malpractice: Breach of Statutory Duty and Affirmative Acts of Negligence by a School District.

    Science.gov (United States)

    Beckham, Joseph

    1979-01-01

    A cause of action for educational malpractice may well receive initial judicial recognition through successfully harmonizing allegations of breach of a statutory duty of care and acts of negligence of a type and magnitude that would distinguish a student-plaintiff's injuries from others for whose benefit the statutory duty was created. (Author)

  11. Primary breast sarcoma: case report | Hassan | East African Medical ...

    African Journals Online (AJOL)

    East African Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 81, No 7 (2004) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  12. Case report: Kounis syndrome | Ntuli | South African Medical Journal

    African Journals Online (AJOL)

    There are many triggering factors, including reactions to multiple medications, exposure to radiological contrast media, poison ivy, bee stings, shellfish and coronary stents. In addition to coronary arterial involvement, Kounis syndrome comprises other arterial systems with similar physiologies, such as mesenteric and ...

  13. An aberrant uterus: Case report | Ondieki | East African Medical ...

    African Journals Online (AJOL)

    A case of an aberrant uterus is presented and literature reviewed. The patient presented with abnormal uterine bleeding, left iliac fossa pain and was managed by excising the aberrant uterus. This case was an enigma as it didn't present in the classical way one with anomalies of the uterus would present. Despite ...

  14. Stylistic features of case reports as a genre of medical discourse.

    Science.gov (United States)

    Lysanets, Yuliia; Morokhovets, Halyna; Bieliaieva, Olena

    2017-03-13

    The present paper discusses the lexical and grammatical peculiarities of English language medical case reports, taking into account their communicative purposes and intentions. The objective of the research is to clarify the principal mechanisms of producing an effective English language medical case report and thus to provide recommendations and guidelines for medical professionals who will deal with this genre. The analysis of medical case reports will largely focus on the most significant linguistic peculiarities, such as the use of active and passive voice, the choice of particular verb tenses, and pronouns. The selected medical case reports will be considered using methods of lexico-grammatical analysis, quantitative examination, and contextual, structural, narrative, and stylistic analyses. The research revealed a range of important stylistic features of medical case reports which markedly distinguish them from other genres of medical scientific writing: educational and instructive intentions, conciseness and brevity, direct and personal tone, and material presented in a narrative style. The present research has shown that the communicative strategies of the analyzed discourse, mentioned immediately above, are effectively implemented by means of specific lexical units and grammatical structures: the dominance of active voice sentences, past simple tense, personal pronouns, and modal verbs. The research has also detected the occasional use of the present perfect, present simple, and future simple tenses and passive voice which also serve particular communicative purposes of medical case reports. Medical case reports possess a range of unique characteristics which differ from those of research articles and other scientific genres within the framework of written medical discourse. It is to be emphasized that it is highly important for medical professionals to master the major stylistic principles and communicative intentions of medical case report as a genre in

  15. The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

    Science.gov (United States)

    Wong, Kendrew; MacKenzie, Todd A.

    2015-01-01

    Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

  16. Engagement or Marriage: The Case for an Expanded Military Medical Role in America

    National Research Council Canada - National Science Library

    Carroll, Terry

    2001-01-01

    ... disasters and build medical self-sufficiency. The case for engagement in Africa is also presented in the context of shared national interests - security, prosperity and democracy, and the evolution of these institutions as health enablers...

  17. Medication errors in anaesthetic practice: A report of two cases and ...

    African Journals Online (AJOL)

    Background: Mistakes in the identification and administration of drugs may be fatal. This is especially so in the practice of anaesthesia. This is a report of 2 cases of near fatality due to mistakes in drug administration from look-alike medications. Objective: To highlight the significance of medication errors in our practice and ...

  18. Anencephaly: A case report | Uduma | Journal of Medical ...

    African Journals Online (AJOL)

    Background: Anencephaly is a lethal congenital defect due to the failure of closure of the cranial end of the embryologic neural tube. Case: Pre-natal abdominopelvic ultrasonography of a 38 year old G3P2 woman revealed a 14 week intrauterine anencephalic live gestation accompanied by polyhydramnois. She refused ...

  19. Retrocaval uterer: Two case reports | Kyei | Ghana Medical Journal

    African Journals Online (AJOL)

    ... of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly.

  20. Eales' Disease: Case report | Atipo-Tsiba | East African Medical ...

    African Journals Online (AJOL)

    Eales' disease is a retinal vasculopathy of unknown origin. Ischaemic step associated retinal perivasculitis. Neovascularisation step after the previous one, characterised by vitreous haemorrhage in relation with retinal neo vessels. This observation presents the first reported case of this pathology in Brazzaville. A man of 32 ...

  1. Wolfram syndrome: Case report | Atipo-Tsiba | East African Medical ...

    African Journals Online (AJOL)

    The third type or Wolfram-like syndrome is autosomal dominant, differs from the first two by the late onset of optic atrophy and diabetes mellitus type 1 (after adolescence) and hearing impairment is not always present. We report the first documented case of Wolfram syndrome at the University Hospital of Brazzaville in a nine ...

  2. Neurofibromatosis type I: Case report | Gaido | East African Medical ...

    African Journals Online (AJOL)

    We present a case of neurofibromatosis type 1 (NF-1) discussing how cutaneous manifestations of disorders or syndromes can be difficult to identify, especially when they are present since birth, present also in a percentage of normal population, and especially when these are isolated findings, not accompanied by other ...

  3. Cypermethrin Poisoning and Anti-cholinergic Medication- A Case Report

    Directory of Open Access Journals (Sweden)

    Dr Sudip Parajuli

    2006-07-01

    Full Text Available A 30 years old male was brought to emergency department of Manipal Teaching Hospital, Pokhara, Nepal with alleged history of consumption of pyrethroid compound ‘cypermethrin’. It was found to be newer insecticide poisoning reported in Nepal. We reported this case to show effectiveness of anti-cholinergic like hyosciane and chlorpheniramine maleate in the treatment of cypermethrin poisoning.

  4. Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature

    OpenAIRE

    Wong, Kam Cheong

    2011-01-01

    Abstract Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries. In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learni...

  5. [Burnout in Tunisian medical residents: About 149 cases].

    Science.gov (United States)

    Ben Zid, A; Homri, W; Ben Romdhane, I; Bram, N; Labbane, R

    2017-09-01

    Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. This syndrome concerns all professions but especially healthcare staff. Numerous studies have attempted to document the impact of work activities on the doctor's mental health. According to the literature, junior doctors are more vulnerable to develop this syndrome. Are to determine the prevalence of severe burnout among residents of different specialties: anesthesiology, general surgery, emergency medicine, psychiatry, basic sciences. The secondary end points are to analyze risk factors, causes and consequences associated with burnout. A cross-sectional study conducted among medical residents working in hospitals located in the governorates of Tunis. Three instruments were used: an anonymous self-administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, and Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment. A total of 149 participants (response rate=76.8%) participated in the survey. Among participants, 17.14% (n=26) had a severe burnout. The emergency medicine residents had the highest rate of emotional exhaustion and depersonalization and severe depression. Overall, resident respondents, 31% (n=46), had moderate to severe depression. Among stress factors, those significantly correlated to burnout were: lack of hobbies (Pburnout were: Antecedents of specialty change (P=0.017) and desire for a specialty change (Pburnout was not found. Medical residents in all specialties are at risk of burnout. Nevertheless, this study revealed that some specialties are more exhausting, which is consistent with the results reported in the literature. Moreover, it is shown that several stress factors

  6. Identification and medical utilization of incident cases of alcohol dependence: A population-based case-control study.

    Science.gov (United States)

    Pan, Chun-Hung; Li, Min-Shan; Yang, Tien-Wey; Huang, Ming-Chyi; Su, Sheng-Shiang; Hung, Yen-Ni; Chen, Chiao-Chicy; Kuo, Chian-Jue

    2018-05-05

    Patients with alcohol dependence (AD) often seek help from medical professionals due to alcohol-related diseases, but the overall distribution of medical specialties identifying new AD cases is unclear. We investigated how such cases were identified and how medical resources were utilized before the identification of AD in a nationwide cohort. We enrolled a population-based cohort (N = 1,000,000) using the National Health Insurance Research Database of Taiwan; 8181 cases with incident AD were retrieved between January 1, 2000, and December 31, 2010. For this nested case-control study, four controls were matched for age and sex with each case based on risk-set sampling. We measured various dimensions of medical utilization before AD was diagnosed, including department visited, physical comorbidity, and medication used. Conditional logistic regression was used for estimating the variables associated with AD. Patients living in less urbanized areas who were unemployed were more likely to develop AD. The highest proportions (34.2%) of AD cases were identified in the internal medicine department, followed by the emergency (22.3%) and psychiatry (18.7%) departments. AD patients had a higher risk of comorbid chronic hepatic disease (adjusted RR = 2.72, p identification of AD than controls. AD patients also had greater numbers of hospital admissions than controls, including non-psychiatric and psychiatric hospitalizations. Outpatient visit numbers were similar for AD patients and controls. The findings indicate that clinicians providing care in diverse medical settings should be prepared to screen for unhealthy alcohol use and to mitigate its detrimental effects. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Foundations in the Law: Classic Cases in Medical Ethics

    Science.gov (United States)

    2007-01-01

    bedridden . Except for a few fingers of one hand and some slight head and facial movements, she is immobile. She is physically helpless and wholly unable to...including the poor, the elderly , and disabled persons -- from abuse, neglect, and mistakes. The Court of Appeals dismissed the state’s concern that...have prevented abuses in cases involving vulnerable persons, including severely disabled neonates and elderly persons suffering from dementia

  8. Medical emergency planning in case of severe nuclear power plant accidents

    International Nuclear Information System (INIS)

    Ohlenschlaeger, L.

    1980-01-01

    This paper is an attempt to discuss a three-step-plan on medical emergency planning in case of severe accidents at nuclear power plants on the basis of own experiences in the regional area as well as on the basis of recommendations of the Federal Minister of the Interior. The medical considerations take account of the severity and extension of an accident whereby the current definitions used in nuclear engineering for accident situations are taken as basis. A comparison between obligatory and actual state is made on the possibilities of medical emergency planning, taking all capacities of staff, facilities, and equipment available in the Federal Republic of Germany into account. To assure a useful and quick utilization of the existing infra-structure as well as nation-wide uniform training of physicians and medical assistants in the field of medical emergency in case of a nuclear catastrophe, a federal law for health protection is regarded urgently necessary. (orig.) [de

  9. Enabling coordination within medical settings: case of a maternity ward

    Directory of Open Access Journals (Sweden)

    Fouzi LEZZAR

    2013-06-01

    Full Text Available Purpose: This study evaluates the planning process issues in healthcare institutions that can be considered as a high risk environment. Most recent healthcare research has focused on methods mainly based on communication, rather than collaboration supports. Material Methods: We followed then a collaborative-based planning approach which constitutes an evolution of planning environment toward new shared workspaces supporting collaboration. Our work led us first, to analyse the related tasks in an Algerian maternity ward in order to highlight the vital collaborative medical tasks that need to be modelled. Results: the paper summaries basic design concepts of our collaborative planning system that is designed to make group interaction support flexible for care coordination and continuity. Conclusion: after development and test of our collaborative planning system, we noticed that our collaborative and planning system can increase awareness and hence decrease coordination breakdowns, reduce costs of information collecting and sharing. All these factors constitute a crucial aspect of an efficient management of a hospital.

  10. Geotourism, Medical Geology and local development: Cape Verde case study

    Science.gov (United States)

    Rocha, F.; Ferreira da Silva, E.

    2014-11-01

    Geotourism and Geoparks in particular are real opportunities to rural developments promoting the rate decline of unemployment and emigration through engaging the local communities in geopark activities and tourism marketing in the form of adventure tourism, ecotourism, rural tourism and health geotourism. Geotourism is closely linked with Medical Geology. The intake of minerals and chemical elements for food, water, soil (through geophagy) or dust can be accomplished by ingestion, inhalation or dermal absorption. Pelotherapy or “Mudtherapy” is the use of mud/clay for therapeutic applications, internal or external. Cape Verde archipelago is located in Atlantic ocean, 400 km westwards of Senegal coast. Geotourism is being developed, mainly focused on the development of a geopark in Fogo island huge caldera, but also trying to take advantage of their potentialities for Geomedecine. A cooperative program established between Cape Verde University (UCV) and Aveiro University (UA, Portugal) is under way, aiming, on a first stage, to identify Geotouristic potentialities and, on a second stage, to develop products. Geotourism is being developed, mainly focused on the development of a geopark in Fogo isl. huge caldera, but also trying to take advantage of their potentialities for Geomedecine.

  11. A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain.

    Science.gov (United States)

    Abrecht, Christopher R; Brovman, Ethan Y; Greenberg, Penny; Song, Ellen; Rathmell, James P; Urman, Richard D

    2017-11-01

    Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO). The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Another objective was to identify claims most likely to result in payments and use this information to propose a strategy for reducing medicolegal risk. The CRICO Strategies Comparative Benchmarking System is a database of claims drawing from >350,000 malpractice claims from Harvard-affiliated institutions and >400 other academic and community institutions across the United States. This database was queried for closed claims from January 1, 2009, to December 31, 2013, and identified 37 cases concerning noninterventional, outpatient chronic pain management. Each file consisted of a narrative summary, including expert witness testimony, as well as coded fields for patient demographics, medical comorbidities, the alleged damaging event, the alleged injurious outcome, the total financial amount incurred, and more. We performed an analysis using these claim files. The mean patient age was 43.5 years, with men representing 59.5% of cases. Payments were made in 27% of cases, with a median payment of $72,500 and a range of $7500-$687,500. The majority of cases related to degenerative joint disease of the spine and failed back surgery syndrome; no patients in this series received treatment of malignant pain. Approximately half (49%) of cases involved a patient death. The use of long

  12. Combined surgical and medical treatment of giant prolactinoma: case report

    Directory of Open Access Journals (Sweden)

    Rădoi Mugurel

    2016-06-01

    Full Text Available The operative management of giant pituitary prolactinoma represents a significant challenge for neurosurgeons, due to the degree of local tumor infiltration into adjacent structures such as cavernous sinus. The degree of parasellar tumor extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the modified Hardys classification system. This report describes the case of a male patient with a giant pituitary prolactinoma in which a partial tumor resection via a subfrontal approach was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Prolactin levels were very high, consistent with invasive giant prolactinoma. Our patient was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of the residual tumor. This case serves to illustrate that in the presence of significant suprasellar and parasellar extension, multi-modal treatment strategies with surgery and dopamine agonist, is the gold standard in the management of locally aggressive pituitary prolactinomas.

  13. Medical Ethics Code: an Analysis from Ethical-Disciplinary Cases Against Medical Professionals within the Specialty of Psychiatry

    Directory of Open Access Journals (Sweden)

    Giselle Crosara Gracindo

    2018-02-01

    Full Text Available Objective: To identify the nature of infractions committed by doctors working within the field of psychiatry, between 2010 and 2016, from the scope of appeals within ethical-disciplinary cases judged at the Plenary Tribunal of the Federal Medical Council, based on the medical ethics code, and to list some elements that make it possible to outline the professional profile of those involved. Method: This was a document-based investigation in the form of a retrospective and descriptive study. Data were gathered using the Federal Medical Council (CFM database and from consultation of judgments issued by the Plenary Body of the Medical Ethics Tribunal (TSEM, of the CFM. The investigation used a sample consisting of 206 appeals and 19 referrals, totaling 224 appeals by doctors who underwent trials. We took into account cases judged between April 13, 2010 and August 3, 2016. Three databases were used in the investigation: cases (224; doctors facing charges (191 and cases/penalties (146. Based on the records of the 191 doctors charged, the ethical-disciplinary cases of seven doctors working in psychiatry were analyzed specifically for the present study, whether or not they had a specialist title. Characterization of infractions committed encompassed references to the articles of the medical ethics code most frequently infringed in the field of psychiatry, along with a survey of the motives for these infractions and some characteristics relating to these professionals’ profile. Results: Among the findings from this investigation, infractions of the articles of the medical ethics code can be highlighted, such as article 30 “[...] Use of the profession to corrupt customs and to commit or favor crime [...]” and article 40 “[...] Taking advantage of situations arising from the doctor-patient relationship to obtain physical, emotional, financial or any other advantage [...]”. The professional profile of those involved in these cases was also shown

  14. How informative are case studies of spider bites in the medical literature?

    Science.gov (United States)

    Stuber, Marielle; Nentwig, Wolfgang

    2016-05-01

    We analyzed the reliability and information content of 134 medical case studies on spider bites, published in 91 journal articles. Overall, we found that only 22% of these studies fulfilled the criteria for a verified spider bite. This means that the majority of such case studies cannot be attributed to a given spider species and usually not even to a spider. Their scientific value is negligible, moreover, such publications are even dangerous because they suggest incorrect conclusions. Secondly, we found that such case studies usually do not follow an obvious structure and many details on the development of symptoms, therapy and healing process are widely lacking. So even for verified spider bites, the comparability of case studies is limited. We discuss the obvious failure of a reviewing process for case studies and give recommendations how to increase the currently low information content of medical case studies on spider bites. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Impact of the National Practitioner Data Bank on resolution of malpractice claims.

    Science.gov (United States)

    Waters, Teresa M; Studdert, David M; Brennan, Troyen A; Thomas, Eric J; Almagor, Orit; Mancewicz, Martha; Budetti, Peter P

    2003-01-01

    Policymakers and commentators are concerned that the National Practitioner Data Bank (NPDB) has influenced malpractice litigation dynamics. This study examines whether the introduction of the NPDB changed the outcomes, process, and equity of malpractice litigation. Using pre- and post-NPDB analyses, we examine rates of unpaid claims, trials, resolution time, physician defense costs, and payments on claims with a low/high probability of negligence. We find that physicians and their insurers have been less likely to settle claims since introduction of the NPDB, especially for payments less than dollars 50,000. Because this disruption appears to have decreased the proportion of questionable claims receiving compensation, the NPDB actually may have increased overall tort system specificity.

  16. Researcher liability for negligence in human subject research: informed consent and researcher malpractice actions.

    Science.gov (United States)

    Jansson, Roger L

    2003-02-01

    Two sets of federal regulations, the "Common Rule" and Food and Drug Administration (FDA) regulations, govern human subject research that is either federally-funded or involves FDA regulated products. These regulations require, inter alia, that: (1) researchers obtain informed consent from human subjects, and (2) that an Institutional Review Board (IRB) independently review and approve the research protocol. Although the federal regulations do not provide an express cause of action against researchers, research subjects should be able to bring informed consent and malpractice actions against researchers by establishing a duty of care and standard of care. Researchers owe human subjects a duty of care analogous to the special relationship between physicians and patients. The federal regulations should provide the minimum standard of care for informed consent in human subject research, and complying with them should be a partial defense. In contrast, expert testimony should establish the standard of care for researcher malpractice, and IRB approval should be a partial defense.

  17. Creating, curating, and sharing online faculty development resources: the medical education in cases series experience.

    Science.gov (United States)

    Chan, Teresa M; Thoma, Brent; Lin, Michelle

    2015-06-01

    It is difficult to engage clinicians in continuing medical education that does not focus on clinical expertise. Evolving online technologies (e.g., massive open online courses [MOOCs]) are disrupting and transforming medical education, but few online nonclinical professional development resources exist. In August 2013, the Academic Life in Emergency Medicine Web site launched the Medical Education in Cases (MEdIC) series to engage clinicians in an online professional development exercise. Each month, a complex, realistic scenario featuring a nonclinical medical education dilemma is published with accompanying discussion questions. A weeklong discussion is moderated on Twitter and the Web site. This discussion is curated to create a community commentary, which is published alongside presolicited expert responses. Case resources are available for download. The first six MEdIC cases (published August 2013-January 2014) emphasized different CanMEDS and/or Accreditation Council on Graduate Medical Education competencies. Median reader engagement metrics (interquartile range 25%-75%) in the first week following publication were 861 (634-1,114) pageviews, 767 (518-953) unique visitors from 326 (218-405) cities in 45 (32-50) countries, 30 (24-39) comments, 52 (40-56) tweets, 17 (13-30) Facebook Likes, and 5 (5-7) Google Plus +1s. The MEdIC series is proof of concept that online activities can engage clinicians in nonclinical professional development. The early experience suggests the connectivist nature of MEdIC allows for crowdsourcing solutions to ill-defined problems via the wisdom of readers. This methodology may also be effective for other nonclinical and medical education topics.

  18. Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia.

    Science.gov (United States)

    Ormond, Meghann

    2015-01-01

    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and

  19. The (Mal)Practice of Dowry in Contemporary India. A Challenge to Marriage and Family Ministry

    OpenAIRE

    Jainus Xavier, Nixen Raj; Jainus Xavier, Nixen Raj; Knieps-Port le Roi, Thomas

    2012-01-01

    The author explores the (mal)practice of dowry in contemporary India and the challenge it presents to marriage and family ministry. He explains how originally harmless and well-intended dowry customs changed under the influence of historical circumstances that turned them into a business-like family strategy aimed at rising families’ social status, wealth and power. This evolution had dramatic consequences for Indian marriage and family life and especially for women. Dowry-related violence an...

  20. Disclosing medical mistakes: a communication management plan for physicians.

    Science.gov (United States)

    Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

    2013-01-01

    There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

  1. Case-based e-learning to improve the attitude of medical students towards occupational health, a randomised controlled trial

    NARCIS (Netherlands)

    Smits, P. B. A.; de Graaf, L.; Radon, K.; de Boer, A. G.; Bos, N. R.; van Dijk, F. J. H.; Verbeek, J. H. A. M.

    2012-01-01

    Objectives Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical

  2. Medical student storytelling on an institutional blog: a case study analysis.

    Science.gov (United States)

    Becker, Katherine A; Freberg, Karen

    2014-05-01

    Despite the proclivity and proliferation of blogs on the Internet, the use of blogs at medical institutions is not well documented. In examining the structured stories that medical students share with the digital community, we may better understand how students use institutional blogs to discuss their medical school experiences while maintaining their role as a medical student ambassador for the program. We conducted a case study to analyze the stories within 309 medical student blogs from one medical institution in the United States. In an attempt to communicate their experiences to different benefactors, student bloggers engaged in structured and personal storytelling. Structured stories offered medical school advice to prospective students, while personal stories embodied features of a personal diary where students recounted significant milestones, talked about personal relationships and engaged in emotional reflection and disclosure. Institutional blogs may provide social marketing for medical institutions, as students strategically framed their experiences to reflect a positive attitude about the medical institution and focused on providing advice to prospective students. Although these structured stories limit complete disclosure, students may still achieve benefits by engaging in emotional disclosure and personal reflection.

  3. Education research: case logs in the assessment of medical students in the neurology outpatient clinic.

    Science.gov (United States)

    Albert, Dara V; Brorson, James R; Amidei, Christina; Lukas, Rimas V

    2014-04-22

    Using outpatient neurology clinic case logs completed by medical students on neurology clerkships, we examined the impact of outpatient clinical encounter volume per student on outcomes of knowledge assessed by the National Board of Medical Examiners (NBME) Clinical Neurology Subject Examination and clinical skills assessed by the Objective Structured Clinical Examination (OSCE). Data from 394 medical students from July 2008 to June 2012, representing 9,791 patient encounters, were analyzed retrospectively. Pearson correlations were calculated examining the relationship between numbers of cases logged per student and performance on the NBME examination. Similarly, correlations between cases logged and performance on the OSCE, as well as on components of the OSCE (history, physical examination, clinical formulation), were evaluated. There was a correlation between the total number of cases logged per student and NBME examination scores (r = 0.142; p = 0.005) and OSCE scores (r = 0.136; p = 0.007). Total number of cases correlated with the clinical formulation component of the OSCE (r = 0.172; p = 0.001) but not the performance on history or physical examination components. The volume of cases logged by individual students in the outpatient clinic correlates with performance on measures of knowledge and clinical skill. In measurement of clinical skill, seeing a greater volume of patients in the outpatient clinic is related to improved clinical formulation on the OSCE. These findings may affect methods employed in assessment of medical students, residents, and fellows.

  4. A case study on how the Apple Watch can benefit medical heart research

    OpenAIRE

    Dellgren, Emelie

    2017-01-01

    The medical health industry is entering a new era and technology will play a great role in this area. Equipment in hospitals is in many cases strictly dependent on technology that works. However, technology in the medical health industry will maybe become a bigger part of our private lifestyle. This lifestyle includes digital health apps, wearables and devices that track your daily physical routines with “Internet of things”. These ways of keeping track of your health can be used for private ...

  5. THE BASIS OF MEDICAL LIABILITY A) CONTRACT AND TORT are ...

    African Journals Online (AJOL)

    showed such disregard for the life and safety of others as to amount to a crime against the State and conduct deserving punishment. LITIGATION IN MEDICAL PRACTICE. The most common examples of the interjection of the law into medicine occur when patients sue their physicians or health professionals for malpractice.

  6. Increasing medical students' engagement in public health: case studies illustrating the potential role of online learning.

    Science.gov (United States)

    Sheringham, J; Lyon, A; Jones, A; Strobl, J; Barratt, H

    2016-09-01

    The value of e-learning in medical education is widely recognized but there is little evidence of its value in teaching medical students about public health. Such evidence is needed because medical students' engagement with public health has been low. We present three recent case studies from UK medical schools to illustrate diverse ways in which online approaches can increase medical students' engagement with learning public health. A comparative case study approach was used applying quantitative and qualitative data to examine engagement in terms of uptake/use amongst eligible students, acceptability and perceived effectiveness using an analytic framework based on Seven Principles of Effective Teaching. Across the three case studies, most (67-85%) eligible students accessed online materials, and rated them more favourably than live lectures. Students particularly valued opportunities to use e-learning flexibly in terms of time and place. Online technologies offered new ways to consolidate learning of key public health concepts. Although students found contributing to online discussions challenging, it provided opportunities for students to explore concepts in depth and enabled students that were uncomfortable speaking in face-to-face discussions to participate. E-learning can be applied in diverse ways that increase medical student engagement with public health teaching. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Improving case study research in medical education: a systematised review.

    Science.gov (United States)

    Cheek, Colleen; Hays, Richard; Smith, Janie; Allen, Penny

    2018-05-01

    Case study research (CSR) is a research approach that guides holistic investigation of a real phenomenon. This approach may be useful in medical education to provide critical analyses of teaching and learning, and to reveal the underlying elements of leadership and innovation. There are variations in the definition, design and choice of methods, which may diminish the value of CSR as a form of inquiry. This paper reports an analysis of CSR papers in the medical education literature. The review aims to describe how CSR has been used and how more consistency might be achieved to promote understanding and value. A systematised review was undertaken to quantify the number of CSR articles published in scholarly medical education journals over the last 10 years. A typology of CSR proposed by Thomas and Myers to integrate the various ways in which CSR is constructed was applied. Of the 362 full-text articles assessed, 290 were excluded as they did not meet the eligibility criteria; 76 of these were titled 'case study'. Of the 72 included articles, 50 used single-case and 22 multi-case design; 46 connected with theory and 26 were atheoretical. In some articles it was unclear what the subject was or how the subject was being analysed. In this study, more articles titled 'case study' failed than succeeded in meeting the eligibility criteria. Well-structured, clearly written CSR in medical education has the potential to increase understanding of more complex situations, but this review shows there is considerable variation in how it is conducted, which potentially limits its utility and translation into education practice. Case study research might be of more value in medical education if researchers were to follow more consistently principles of design, and harness rich observation with connection of ideas and knowledge to engage the reader in what is most interesting. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  8. Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports

    International Nuclear Information System (INIS)

    Wiesinger, Isabel; Scharf, Gregor; Platz, Natascha; Dendl, Lena M.; Stroszczynski, Christian; Schreyer, Andreas G.; Pawlik, Michael T.

    2015-01-01

    To evaluate the clinical value and impact of radiological imaging in published medial case reports. We analysed 671 consecutively published case reports of a peer-reviewed medical journal for case reports. The general use of radiological imaging as well as the specific imaging modality used in each case (ultrasound, x-ray, fluoroscopy, CT, MRI) was documented, and most importantly the 'final problem solver', i.e. the diagnostic modality giving the final clue to the patient's diagnosis, was identified. In 511 of 671 (76.1 %) analysed case reports at least one radiological modality was used in the diagnostic cascade. In 28.6 % of all cases the final diagnosis was achieved by radiological imaging. All other cases were solved by the patient's history and physical examination (15.2 %), histology (12.4 %), and blood analysis (9.6 %). When radiology was the 'final problem solver', it was mainly CT (51.6 %) and MRI (30.6 %). In 52.2 % of the case reports the radiological image was included in the article. In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis. (orig.)

  9. Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports

    Energy Technology Data Exchange (ETDEWEB)

    Wiesinger, Isabel; Scharf, Gregor; Platz, Natascha; Dendl, Lena M.; Stroszczynski, Christian; Schreyer, Andreas G. [University Hospital Regensburg, Institute of Radiology, Regensburg (Germany); Pawlik, Michael T. [Intensive Care and Emergency Medicine, Institute of Anaesthesiology, Regensburg (Germany)

    2015-05-01

    To evaluate the clinical value and impact of radiological imaging in published medial case reports. We analysed 671 consecutively published case reports of a peer-reviewed medical journal for case reports. The general use of radiological imaging as well as the specific imaging modality used in each case (ultrasound, x-ray, fluoroscopy, CT, MRI) was documented, and most importantly the 'final problem solver', i.e. the diagnostic modality giving the final clue to the patient's diagnosis, was identified. In 511 of 671 (76.1 %) analysed case reports at least one radiological modality was used in the diagnostic cascade. In 28.6 % of all cases the final diagnosis was achieved by radiological imaging. All other cases were solved by the patient's history and physical examination (15.2 %), histology (12.4 %), and blood analysis (9.6 %). When radiology was the 'final problem solver', it was mainly CT (51.6 %) and MRI (30.6 %). In 52.2 % of the case reports the radiological image was included in the article. In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis. (orig.)

  10. Medicolegal Investigation of Medical Negligence in India: A Report of Forensic Autopsy Case

    Directory of Open Access Journals (Sweden)

    Raktim Pratim Tamuli

    2016-01-01

    Full Text Available In general negligence means failure to take proper care over something and according to law negligence means breach of a duty of care which results in damage. Medical negligence is not very uncommon; every now and then cases of medical negligence are reported in the electronic media. Medical Negligence is doing something that one is not supposed to do, or failing to do something that one is supposed to do. Role of Forensic Pathologist in cases of Medical Negligence is always unquestionable. Forensic Pathologists need to explore and maintain a high degree of transparency between the doctors, patients and the law enforcing agencies. In the present case, a person was attacked by a wild animal and he fell down on a rough surface. Immediately he was rushed to a local hospital. The treating doctor stitched the external injury and allowed him to go home; he neither advised any investigation nor kept him under observation to rule out any internal injury. After 12 hours the victim succumbed to death. At autopsy a fractured skull with underlying subdural haemorrhage was noticed. Was not the treating doctor negligent in this case? Were the protocols followed? What should be the role of a Forensic Pathologist in such kind of cases?

  11. Development of case-based medication alerting and recommender system: a new approach to prevention for medication error.

    Science.gov (United States)

    Miyo, Kengo; Nittami, Yuki S; Kitagawa, Yoichiro; Ohe, Kazuhiko

    2007-01-01

    The purpose of this study was to develop a new alerting and recommender system for preventing medication errors. In recent years, alerting systems have been widely implemented, but because these systems apply a same static threshold for all patients in all cases, they produce excessive alerts and subject physicians to "alert fatigue". We believe that the most commonly-written prescription for a patient's status is the safest one. From this standpoint, we developed a real-time case-based medication alerting and recommender system linked to a database of past prescriptions. When a physician issues his or her prescription, our system dynamically compares it with past ones for similar patients in the database. An analysis of the 10 most frequently-used drugs in the University of Tokyo Hospital revealed that our system reduced the number of false alerts compared to the traditional static alert method. Our system contributes to the creation of alerts that are appropriate for patients' clinical conditions and based on physicians' empirical discretion.

  12. The milestones in patient safety -The Harvard Medical Practice Study I , Study II and Study III

    Directory of Open Access Journals (Sweden)

    Giuseppe La Torre

    2005-12-01

    Full Text Available

    Over the past decade there has been a steady increase in the number of malpractice claims brought against healthcare providers [1,2] and in the monetary damages awarded to plaintiffs [1,3]. This increase has precipitated numerous state programs designed to moderate the number of claims and encourage providers to develop quality of care initiatives [4,5].

    It is important to develop more reliable estimates of the incidence of adverse events and negligence in hospitalized patients.An adverse event is defined as an injury caused by medical management (rather than the underlying disease that prolongs the hospitalization and results in disability at the time of discharge, or both. Negligence is defined as care that has fallen below the standard expected of physicians in their community.

    The Harvard Medical Practice Study (HMPS was first published in 1991 and was based on 1984 case records of more than 30,000 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals.The study attempts to measure the extent of medical malpractice in hospitals in the state of New York, and compare the resulting patterns with the negligence claims actually filed [6-8]. The HMPS reviews randomly selected records with disability injuries caused by medical treatment.To establish that an adverse event or negligence has occurred, it uses as a criterion an average confidence score of four or more (on a six point scale. Data identified are age, sex, and primary discharge diagnosis. The significance of the differences in rates of adverse events and negligence according to sex and age were tested.

  13. Evaluation of Cases Applying to Child and Adolescent Psychiatry Outpatient Clinic to Receive Medical Board Report

    Directory of Open Access Journals (Sweden)

    Sibelnur Avcil

    2017-11-01

    Full Text Available Objective: The aim of this study was to evaluate socio-demographic characteristics, application reasons and diagnoses of cases applying to child and adolescent psychiatry outpatient clinic in order to receive a medical board report. Materials and Methods: File data of 405 cases in the child and adolescent group (0-18 years, who applied to Child and Adolescent Psychiatry Outpatient clinics of Adnan Menderes University Faculty of Medicine between 1 November 2014 and 31 October 2015 in order to receive a medical board report, were retrospectively examined. Results: Average age of the cases was determined as 6.32±4.62 years, and 42.7% (173 were female and 57.3% (232 were male. When reasons of applications to medical board for the disabled were examined, it was found that the most frequent reason of application is to make them receive special education or to continue their special education at the rate of 66%; when diagnosis distribution of the cases was examined, the most frequent diagnoses included mild mental retardation (28.3%, borderline intellectual functioning (23.5%, attention-deficit/hyperactivity disorder (13.6%, and learning disorder (12.6%. Conclusion: In our study, it was determined that the most frequent diagnosis in children applying to receive a medical board report was mild mental retardation and the most frequent reason of application was to receive special education report. The studies to be conducted with relation to cases applying to medical board for the disabled will help in formation of healthy demographic data about pathologies in our field and in approaching clinically to such cases.

  14. Medical students¿ assessment of pediatric patients - teaching and evaluation using video cases

    DEFF Research Database (Denmark)

    Malon, Michelle; Cortes, Dina; Greisen, Gorm

    2014-01-01

    and examination for pediatric medicine.MethodsMedical students on a pediatric clerkship at the University of Copenhagen assessed eight short pediatric video cases during autumn 2011 and spring 2012. Two independent observers evaluated a subset of records in a pilot study. A blind evaluation was made...

  15. On the constraints of encapsulated knowledge : Clinical case representations by medical experts and subexperts

    NARCIS (Netherlands)

    Rikers, Remy MJP; Schmidt, Henk G; Boshuizen, Henny PA

    2002-01-01

    This article is concerned with the role of so-called encapsulated knowledge and biomedical knowledge in the process of diagnosing clinical cases within and outside the medical specialist's domain of expertise. Based on the theory of knowledge encapsulation, we predicted that subexperts (i.e.,

  16. It System Integration: Global Medical Acquisition of Health Tech Case Study

    Science.gov (United States)

    Russo, Mark; White, Bruce

    2013-01-01

    Mergers and Acquisitions are just part of life in business. For example, in the health care technology field in 2012, Veritas Capital Partners acquired Thomson Reuters' Healthcare. Other major active acquisition companies included: Medical Transcription Billing, T-System Technologies and Sharecare. In this case study, a larger health technology…

  17. Supporting Medical Students to Do International Field Research: A Case Study

    Science.gov (United States)

    Pearson, Stephen; Parr, Jennifer; Ullah, Zafar; Omar, Maye

    2014-01-01

    Field research can benefit medical students' learning through experiential engagement with research and personal exposure to foreign health systems. However, the off-campus nature of the activity raises challenges for teachers. This article presents a case study that illustrates the benefits and challenges of organising a field research project…

  18. Medical tourism: game-changing innovation or passing fad?

    Science.gov (United States)

    Underwood, Howard R; Makadon, Harvey J

    2010-09-01

    Outbound medical tourism presents several concerns for U.S. providers: Potential lost revenue could reach almost $600 billion by 2017. Continuity of care can become an issue if complete medical records are not available to the patient's home physician and communications are not maintained between the domestic physician and the physician who rendered medical care abroad. Potential malpractice liability could place the U.S.-based provider at risk.

  19. THE ALGORITHM OF THE CASE FORMATION DURING THE DEVELOPMENT OF CLINICAL DISCIPLINES IN MEDICAL SCHOOL

    Directory of Open Access Journals (Sweden)

    Andrey A. Garanin

    2016-01-01

    Full Text Available The aim of the study is to develop the algorithm of formation of the case on discipline «Clinical Medicine». Methods. The methods involve the effectiveness analysis of the self-diagnosed levels of professional and personal abilities of students in the process of self-study. Results. The article deals with the organization of independent work of students of case-method, which is one of the most important and complex active learning methods. When implementing the method of case analysis in the educational process the main job of the teacher focused on the development of individual cases. While developing the case study of medical character the teacher needs to pay special attention to questions of pathogenesis and pathological anatomy for students’ formation of the fundamental clinical thinking allowing to estimate the patient’s condition as a complete organism, taking into account all its features, to understand the relationships of cause and effect arising at development of a concrete disease, to master new and to improve the available techniques of statement of the differential diagnosis. Scientific novelty and practical significance. The structure of a medical case study to be followed in the development of the case on discipline «Clinical Medicine» is proposed. Unification algorithm formation cases is necessary for the full implementation of the introduction in the educational process in the higher medical school as one of the most effective active ways of learning – method of case analysis, in accordance with the requirements that apply to higher professional education modern reforms and, in particular, the introduction of new Federal State Educational Standards. 

  20. Stigma associated with medication treatment for young adults with opioid use disorder: a case series.

    Science.gov (United States)

    Hadland, Scott E; Park, Tae Woo; Bagley, Sarah M

    2018-05-07

    Opioid-related overdose deaths have risen sharply among young adults. Despite this increase, access to evidence-based medication for opioid agonist treatment (OAT) for youth remains low. Among older adults, barriers to OAT include the paucity of buprenorphine-waivered prescribers and low rates of prescribing among waivered physicians. We have increasingly found in our clinical practice significant stigma related to using OAT to treat addiction for young adults. In this series, we describe three cases of young adults who faced significant stigma related to their treatment. The first case is a young male with a history of significant trauma and a severe opioid use disorder. He started buprenorphine and has found a job, stayed abstinent, and began a healthy relationship. At each step in his recovery, he has faced resistance to taking medication from other treatment providers, directors of sober houses, and his parents. The second case is a young woman who presented to a substance use treatment program after a relapse. She was unable to restart buprenorphine despite our calling to ask that it be restarted. Ultimately, she left against medical advice and was stabilized as an outpatient on buprenorphine. The final case is a young woman who stopped buprenorphine after being told she was "not sober" while attending 12-step group but restarted after conversations with her clinical team. In each case, the patient has continued their medication treatment and are stable. Opioid-related deaths continue to rise among all age groups, including young adults. Stigma related to medication treatment can be a substantial barrier for many young adult patients but there are concrete steps that providers and communities can take to address this stigma.

  1. What's the difference? Comparison of American and Japanese medical practice.

    Science.gov (United States)

    Kitano, Masami

    2007-09-01

    Medical systems in the USA such as EBM., DRG., Informed Consent and Second Opinion have already been introduced into the Japanese medical system. However, some of these systems have met resistance from a part of the population due to the differences of social structures, morals and customs between the two countries. Briefly, I described the medical education and licensure, the private practice and "open hospital system" of the USA. The following 4 topics which drew great interest in Japan will be discussed. 1) CEREBRAL DEATH AND BIOETHICS: Cerebral death has been restrictively accepted as human death since the 1980's only in terms of terminal cares in clinical medicine. The rather simplified current neurological criteria for death are approved in the USA. In order for an organ transplant to take place, a potential donor must be diagnosed as brain dead. However, Japanese society has not accepted the concept of cerebral death completely because of an accident in the 1960's where an organ was improperly removed when the donor who was not in the state of brain death. Recently, more people in Japan are showing interest in Dignity and Euthanasia from the point of view of "Right to die". 2) MALPRACTICE AND LITIGATION: "To err is human" was introduced by the Institute of Medicine for Risk Management. Accidental deaths of patients under medical care ranks No.8 in total number of deaths in the USA. There are 100,000 malpractice cases in the "Lawsuit Society" of America, which is 100 times that of Japan. Furthermore, the legal fees and insurance premiums are extremely high in the US as opposed to very low in Japan. 3) HEALTH CARE INSURANCE: To reduce medical costs, the insurance companies introduced "Competitive Managed Care" which resulted in the formation of "Health Maintenance Organizations" (HMO). Furthermore, when you compare the two countries in respect to those who have health insurance, 44 million in the USA carry no health insurance, whereas in Japan, the government

  2. Childhood maltreatment and the medical morbidity in bipolar disorder: a case-control study.

    Science.gov (United States)

    Hosang, Georgina M; Fisher, Helen L; Uher, Rudolf; Cohen-Woods, Sarah; Maughan, Barbara; McGuffin, Peter; Farmer, Anne E

    2017-09-07

    Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls. The study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders. A history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70-23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34-10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls. To summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.

  3. The opinion of Turkish cardiologists on current malpractice system and an alternative patient compensation system proposal: PCS study group.

    Science.gov (United States)

    Olcay, Ayhan; Emren, Sadık Volkan; Babür Güler, Gamze; Güler, Ekrem; Ertunç, Vedat; Berilgen, Rida; Aslan, Abdullah; Şimşek, Ersin Çağrı; Gölcük, Şükriye Ebru; Yalın, Kıvanç

    2017-10-01

    Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.

  4. iCBLS: An interactive case-based learning system for medical education.

    Science.gov (United States)

    Ali, Maqbool; Han, Soyeon Caren; Bilal, Hafiz Syed Muhammad; Lee, Sungyoung; Kang, Matthew Jee Yun; Kang, Byeong Ho; Razzaq, Muhammad Asif; Amin, Muhammad Bilal

    2018-01-01

    Medical students should be able to actively apply clinical reasoning skills to further their interpretative, diagnostic, and treatment skills in a non-obtrusive and scalable way. Case-Based Learning (CBL) approach has been receiving attention in medical education as it is a student-centered teaching methodology that exposes students to real-world scenarios that need to be solved using their reasoning skills and existing theoretical knowledge. In this paper, we propose an interactive CBL System, called iCBLS, which supports the development of collaborative clinical reasoning skills for medical students in an online environment. The iCBLS consists of three modules: (i) system administration (SA), (ii) clinical case creation (CCC) with an innovative semi-automatic approach, and (iii) case formulation (CF) through intervention of medical students' and teachers' knowledge. Two evaluations under the umbrella of the context/input/process/product (CIPP) model have been performed with a Glycemia study. The first focused on the system satisfaction, evaluated by 54 students. The latter aimed to evaluate the system effectiveness, simulated by 155 students. The results show a high success rate of 70% for students' interaction, 76.4% for group learning, 72.8% for solo learning, and 74.6% for improved clinical skills. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. The Application of Use Case Modeling in Designing Medical Imaging Information Systems

    International Nuclear Information System (INIS)

    Safdari, Reza; Farzi, Jebraeil; Ghazisaeidi, Marjan; Mirzaee, Mahboobeh; Goodini, Azadeh

    2013-01-01

    Introduction. The essay at hand is aimed at examining the application of use case modeling in analyzing and designing information systems to support Medical Imaging services. Methods. The application of use case modeling in analyzing and designing health information systems was examined using electronic databases (Pubmed, Google scholar) resources and the characteristics of the modeling system and its effect on the development and design of the health information systems were analyzed. Results. Analyzing the subject indicated that Provident modeling of health information systems should provide for quick access to many health data resources in a way that patients' data can be used in order to expand distant services and comprehensive Medical Imaging advices. Also these experiences show that progress in the infrastructure development stages through gradual and repeated evolution process of user requirements is stronger and this can lead to a decline in the cycle of requirements engineering process in the design of Medical Imaging information systems. Conclusion. Use case modeling approach can be effective in directing the problems of health and Medical Imaging information systems towards understanding, focusing on the start and analysis, better planning, repetition, and control

  6. Implementing video cases in clinical paediatric teaching increases medical students' self-assessed confidence

    DEFF Research Database (Denmark)

    Malon, Michelle; Cortes, Dina; Andersen, Jesper

    2014-01-01

    INTRODUCTION: Use of video cases in clinical education is rarely used systematically. MATERIAL AND METHODS: Medical students (n = 127) reported by questionnaire whether they had or had not seen a bedside case of each of 22 specific clinical conditions during their five-week clinical course...... the intervention, this share was 75% (218/289) (p = 0.06). Furthermore, internal as well as external examiners found video cases valuable, but the use of videos did not change the average examination grade. CONCLUSION: A video case supplement to teaching in clinical paediatrics was considered to be of value...... for teaching. We were successful in establishing an educational resource that students considered useful. Internal and external examiners found that a short video case was a valuable supplementary tool during the oral examination. FUNDING: The University of Copenhagen funded the study. TRIAL REGISTRATION...

  7. The political economy of a public health case management program's transition into medical homes.

    Science.gov (United States)

    Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele

    2015-11-01

    Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. Published by Elsevier Ltd.

  8. Disaster medicine. A guide for medical care in case of disasters. 4. rev. ed.

    International Nuclear Information System (INIS)

    1997-01-01

    This is the fourth edition of a vademecum for medical experts in the Federal Republic of Germany, published by the Civil Defence Commission, an advisory body of the Federal Ministry of the Interior. The booklet is to help to provide and organize medical care in case of disasters, panic, mass injuries, radiation damage, poisoning and epidemics. There is a separate chapter on radiation accidents and radiation disasters as well as an appendix with a glossary of radiological terms and a list of radiation protection centers. (orig/MG) [de

  9. Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

    Science.gov (United States)

    Zhao, Fang; Hämäläinen, Juha; Chen, Yu-Ting

    2017-01-01

    With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

  10. The "Glocalization" of Medical School Accreditation: Case Studies From Taiwan, South Korea, and Japan.

    Science.gov (United States)

    Ho, Ming-Jung; Abbas, Joan; Ahn, Ducksun; Lai, Chi-Wan; Nara, Nobuo; Shaw, Kevin

    2017-12-01

    In an age of globalized medical education, medical school accreditation has been hailed as an approach to external quality assurance. However, accreditation standards can vary widely across national contexts. To achieve recognition by the World Federation for Medical Education (WFME), national accrediting bodies must develop standards suitable for both local contexts and international recognition. This study framed this issue in terms of "glocalization" and aimed to shine light on this complicated multistakeholder process by exploring accreditation in Taiwan, South Korea, and Japan. This study employed a comparative case-study design, examining the national standards that three accreditation bodies in East Asia developed using international reference standards. In 2015-2016, the authors conducted document analysis of the English versions of the standards to identify the differences between the national and international reference standards as well as how and why external standards were adapted. Each country's accreditation body sought to balance local needs with global demands. Each used external standards as a template (e.g., Liaison Committee on Medical Education, General Medical Council, or WFME standards) and either revised (Taiwan, South Korea) or annotated (Japan) the standards to fit the local context. Four categories of differences emerged to account for how and why national standards departed from external references: structural, regulatory, developmental, and aspirational. These countries' glocalization of medical accreditation standards serve as examples for others seeking to bring their accreditation practices in line with global standards while ensuring that local values and societal needs are given adequate consideration.

  11. The alarming reality of medication error: a patient case and review of Pennsylvania and National data

    Directory of Open Access Journals (Sweden)

    Brianna A. da Silva

    2016-09-01

    Full Text Available Case description: A 71-year-old female accidentally received thiothixene (Navane, an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Discussion: Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy. Conclusion: Medication reconciliation including an ‘indication review’ for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider–patient relationship.

  12. Medical Big Data Warehouse: Architecture and System Design, a Case Study: Improving Healthcare Resources Distribution.

    Science.gov (United States)

    Sebaa, Abderrazak; Chikh, Fatima; Nouicer, Amina; Tari, AbdelKamel

    2018-02-19

    The huge increases in medical devices and clinical applications which generate enormous data have raised a big issue in managing, processing, and mining this massive amount of data. Indeed, traditional data warehousing frameworks can not be effective when managing the volume, variety, and velocity of current medical applications. As a result, several data warehouses face many issues over medical data and many challenges need to be addressed. New solutions have emerged and Hadoop is one of the best examples, it can be used to process these streams of medical data. However, without an efficient system design and architecture, these performances will not be significant and valuable for medical managers. In this paper, we provide a short review of the literature about research issues of traditional data warehouses and we present some important Hadoop-based data warehouses. In addition, a Hadoop-based architecture and a conceptual data model for designing medical Big Data warehouse are given. In our case study, we provide implementation detail of big data warehouse based on the proposed architecture and data model in the Apache Hadoop platform to ensure an optimal allocation of health resources.

  13. Integration testing through reusing representative unit test cases for high-confidence medical software.

    Science.gov (United States)

    Shin, Youngsul; Choi, Yunja; Lee, Woo Jin

    2013-06-01

    As medical software is getting larger-sized, complex, and connected with other devices, finding faults in integrated software modules gets more difficult and time consuming. Existing integration testing typically takes a black-box approach, which treats the target software as a black box and selects test cases without considering internal behavior of each software module. Though it could be cost-effective, this black-box approach cannot thoroughly test interaction behavior among integrated modules and might leave critical faults undetected, which should not happen in safety-critical systems such as medical software. This work anticipates that information on internal behavior is necessary even for integration testing to define thorough test cases for critical software and proposes a new integration testing method by reusing test cases used for unit testing. The goal is to provide a cost-effective method to detect subtle interaction faults at the integration testing phase by reusing the knowledge obtained from unit testing phase. The suggested approach notes that the test cases for the unit testing include knowledge on internal behavior of each unit and extracts test cases for the integration testing from the test cases for the unit testing for a given test criteria. The extracted representative test cases are connected with functions under test using the state domain and a single test sequence to cover the test cases is produced. By means of reusing unit test cases, the tester has effective test cases to examine diverse execution paths and find interaction faults without analyzing complex modules. The produced test sequence can have test coverage as high as the unit testing coverage and its length is close to the length of optimal test sequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Case study: a midclerkship crisis-lessons learned from advising a medical student with career indecision.

    Science.gov (United States)

    Levine, Rachel B; Cayea, Danelle; Shochet, Robert B; Wright, Scott M

    2010-04-01

    Advising medical students is a challenging task. Faculty who serve as advisors for students require specific skills and knowledge to do their jobs effectively. Career choice is one of the many complex issues about which medical students often seek assistance from a faculty advisor. The authors present a case of a third-year medical student with career indecision, with a focus on the various factors that may be influencing her thinking about career choice. Key advising principles are provided as a framework for the discussion of the case and include reflection, self-disclosure, active listening, support and advocacy, confidentiality, and problem solving. These principles were developed as part of the Advising Case Conference series of the Johns Hopkins University School of Medicine Colleges Advisory Program. Emergent themes from the case included a student's evolving professional identity, a student's distress and burnout, lifestyle considerations, and advisor bias and self-awareness. The authors propose reflective questions to enhance meaningful discussions between the advisor and student and assist in problem solving. Many of these questions, together with the key advising principles, are generalizable to a variety of advising scenarios between advisors and learners at all levels of training.

  15. Essays on the medical malpractice reform in Belgium: A law and economics analysis

    OpenAIRE

    Vandersteegen, Tom

    2016-01-01

    In 2010 werd het Belgische vergoedingssysteem voor medische ongevallen hervormd, om het hoofd te bieden aan de tekortkomingen van het gemeen aansprakelijkheidsrecht. De toepassing van de traditionele foutaansprakelijkheid in rechtbanken resulteert namelijk in dure, tijdrovende en vaak onzekere en onvoorspelbare procedures, veroorzaakt defensieve geneeskunde bij artsen en heeft ertoe geleid dat een aantal verzekeraars de omvang van hun dekking beperkten of zelfs de markt verlieten. Daarom w...

  16. Quantifying the Economics of Medical Malpractice: a view from a civil law perspective

    NARCIS (Netherlands)

    S.I. de Carvalho Amaral Garcia (Sofia Isabel)

    2011-01-01

    textabstractLife is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring

  17. Distributed medical image analysis and diagnosis through crowd-sourced games: a malaria case study.

    Science.gov (United States)

    Mavandadi, Sam; Dimitrov, Stoyan; Feng, Steve; Yu, Frank; Sikora, Uzair; Yaglidere, Oguzhan; Padmanabhan, Swati; Nielsen, Karin; Ozcan, Aydogan

    2012-01-01

    In this work we investigate whether the innate visual recognition and learning capabilities of untrained humans can be used in conducting reliable microscopic analysis of biomedical samples toward diagnosis. For this purpose, we designed entertaining digital games that are interfaced with artificial learning and processing back-ends to demonstrate that in the case of binary medical diagnostics decisions (e.g., infected vs. uninfected), with the use of crowd-sourced games it is possible to approach the accuracy of medical experts in making such diagnoses. Specifically, using non-expert gamers we report diagnosis of malaria infected red blood cells with an accuracy that is within 1.25% of the diagnostics decisions made by a trained medical professional.

  18. Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective

    Directory of Open Access Journals (Sweden)

    M S Pandit

    2009-01-01

    Full Text Available A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief to his medical problem. The relationship takes the shape of a contract retaining the essential elements of tort. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. The doctor has a duty to obtain prior informed consent from the patient before carrying out diagnostic tests and therapeutic management. The services of the doctors are covered under the provisions of the Consumer Protection Act, 1986 and a patient can seek redressal of grievances from the Consumer Courts. Case laws are an important source of law in adjudicating various issues of negligence arising out of medical treatment.

  19. Intellectual Property as a Drive for Sustainable Medical Tourism – The Ana Aslan case

    Directory of Open Access Journals (Sweden)

    Bolos Mihaela Daciana

    2014-11-01

    Full Text Available The present paper studies the way intellectual property rights may encourage sustainable medical tourism, meaning the advantages that a patent, traditional knowledge, a trademark, or other IP right may offer to a hospital in order to attract foreign patients. The analysis is done trough the Institute of Gerontology and Geriatrics “Ana Aslan” case study, seen not from a medical point of view but from the perspective of the intellectual property importance for the development of medical tourism. The Institute of Gerontology and Geriatrics “Ana Aslan” was founded in 1952 and become an international renowned center in the study and the diminishing of old age effects. Many celebrities (artist and state presidents came to receive treatment here, even though Romania had, at that time, a communist regime.

  20. A Case of Medication-Resistant Acanthamoeba Keratitis Treated by Corneal Crosslinking in Turkey

    Directory of Open Access Journals (Sweden)

    Goktug Demirci

    2013-01-01

    Full Text Available Purpose. To report a case of medication-resistant acanthamoeba keratitis (AK treated successfully by corneal crosslinking (CXL. Methods. A 26-year-old male with medication-resistant AK underwent a standard CXL procedure with local anesthesia, followed by central corneal epithelial debridement, application of riboflavin 0.1%, and UV-A irradiation. Results. The patient experienced a dramatic symptomatic improvement within 24 hours. At two months, keratitis was healed with a semitransparent paracentral scar that did not affect visual acuity. Conclusions. Our experience, considered in the context of recent studies, suggests that CXL may be an option for selected patients with medication-resistant AK and corneal melting. CXL allows patients to avoid emergency keratoplasty and experience rapid symptomatic relief.

  1. Distributed medical image analysis and diagnosis through crowd-sourced games: a malaria case study.

    Directory of Open Access Journals (Sweden)

    Sam Mavandadi

    Full Text Available In this work we investigate whether the innate visual recognition and learning capabilities of untrained humans can be used in conducting reliable microscopic analysis of biomedical samples toward diagnosis. For this purpose, we designed entertaining digital games that are interfaced with artificial learning and processing back-ends to demonstrate that in the case of binary medical diagnostics decisions (e.g., infected vs. uninfected, with the use of crowd-sourced games it is possible to approach the accuracy of medical experts in making such diagnoses. Specifically, using non-expert gamers we report diagnosis of malaria infected red blood cells with an accuracy that is within 1.25% of the diagnostics decisions made by a trained medical professional.

  2. Medical Tourism in Romania. The Case Study of Cardiovascular Rehabilitation in Covasna

    Directory of Open Access Journals (Sweden)

    Roxana Oana Darabont

    2014-11-01

    Full Text Available Romania has one of the highest mortality rates in Europe for ischemic heart disease and, especially, for cerebrovascular disease. Taking into account the actual prevalence of cardiovascular diseases, an augmentation of the demand for specialized medical services is expected. As this paper argues, this situation can have an important impact on medical tourism. We analyze original data on the case study of a hospital, specialized in cardiovascular treatment, in the Romanian county of Covasna, which is offering specific balneal procedures, such as CO2 .hydrotherapy, alongside regular rehabilitation programs. The aim of our study is to evaluate the demographic characteristics, and the pathology of the hospitalized patients, as well as the specific rehabilitation procedures. Our findings suggest that the interest of patients, with cardiovascular diseases, for medical tourism can be influenced by accessibility, by some particularities of the location, but also by the holistic nature of the rehabilitation procedures.

  3. Rare medical conditions and suggestive past-life memories: a case report and literature review.

    Science.gov (United States)

    Lucchetti, Giancarlo; dos Santos Camargo, Luizete; Lucchetti, Alessandra L G; Schwartz, Gary E; Nasri, Fabio

    2013-01-01

    We aim to report the case of a 38-year-old male with suggestive past-life memories during a regression session and to show how these memories were related to unusual medical conditions: (1) isolated obstruction of the right coronary artery in a young patient, (2) omental infarction, and (3) right aortic arch with isolation of the left subclavian artery. These conditions were related to the following suggestive past-life memories: (1) a priest who committed suicide with a crucifix nailed to his chest and (2) a medieval weapon (skull flail) hitting his cervical and left back region. There was an intriguing relation between the patient's suggestive past-life memories and rare medical conditions. In this article, the authors highlight possible explanations, rarity of findings, and similarities/differences from previous cases and potential pitfalls in this area. © 2013 Elsevier Inc. All rights reserved.

  4. Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

    Directory of Open Access Journals (Sweden)

    Fathelrahman Ahmed I

    2009-09-01

    Full Text Available Abstract Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed.

  5. The Value of Outsourcing Selected Cases in a Medical Examiner Population: A 10-Year Experience.

    Science.gov (United States)

    McCleskey, Brandi C; Reilly, Stephanie D; Atherton, Dan

    2017-01-01

    Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate. The final cause and manner of death were determined by the referring state FP after review of all findings. A majority of the 421 cases were ruled accidental deaths (233), most due to drug toxicity. Of the 178 natural deaths, 118 were attributed to cardiovascular disease. Outsourcing select forensic cases can be educational and an effective tool to manage workflow without compromising quality. © 2016 American Academy of Forensic Sciences.

  6. A Novel Approach to Medical Student Peer-assisted Learning Through Case-based Simulations.

    Science.gov (United States)

    Jauregui, Joshua; Bright, Steven; Strote, Jared; Shandro, Jamie

    2018-01-01

    Peer-assisted learning (PAL) is the development of new knowledge and skills through active learning support from peers. Benefits of PAL include introduction of teaching skills for students, creation of a safe learning environment, and efficient use of faculty time. We present a novel approach to PAL in an emergency medicine (EM) clerkship curriculum using an inexpensive, tablet-based app for students to cooperatively present and perform low-fidelity, case-based simulations that promotes accountability for student learning, fosters teaching skills, and economizes faculty presence. We developed five clinical cases in the style of EM oral boards. Fourth-year medical students were each assigned a unique case one week in advance. Students also received an instructional document and a video example detailing how to lead a case. During the 90-minute session, students were placed in small groups of 3-5 students and rotated between facilitating their assigned cases and participating as a team for the cases presented by their fellow students. Cases were supplemented with a half-mannequin that can be intubated, airway supplies, and a tablet-based app (SimMon, $22.99) to remotely display and update vital signs. One faculty member rotated among groups to provide additional assistance and clarification. Three EM faculty members iteratively developed a survey, based on the literature and pilot tested it with fourth-year medical students, to evaluate the course. 135 medical students completed the course and course evaluation survey. Learner satisfaction was high with an overall score of 4.6 on a 5-point Likert scale. In written comments, students reported that small groups with minimal faculty involvement provided a safe learning environment and a unique opportunity to lead a group of peers. They felt that PAL was more effective than traditional simulations for learning. Faculty reported that students remained engaged and required minimal oversight. Unlike other simulations, our

  7. The Challenge Treatment of Medication Related Osteonecrosis of the Jaw: A Case Report

    OpenAIRE

    M Rodríguez Sánchez; Bassi AP; Carvalho PS

    2015-01-01

    Bisphosphonates toxicological effect on alveolar bone could be associated to medication related osteonecrosis of the jaw. (MRONJ) Oral surgical procedures as; tooth extractions, implants placements or trauma are suggested risk factors. The aim of this paper is to describe a case of MRONJ and recurrence after the first right mandibular molar extraction. A 54 years old man was referred to the Department of Surgery and Integrated Clinic of Aracatuba Dental School, Univ. Estadual Paulista - UNESP...

  8. A new method for the automatic retrieval of medical cases based on the RadLex ontology.

    Science.gov (United States)

    Spanier, A B; Cohen, D; Joskowicz, L

    2017-03-01

    The goal of medical case-based image retrieval (M-CBIR) is to assist radiologists in the clinical decision-making process by finding medical cases in large archives that most resemble a given case. Cases are described by radiology reports comprised of radiological images and textual information on the anatomy and pathology findings. The textual information, when available in standardized terminology, e.g., the RadLex ontology, and used in conjunction with the radiological images, provides a substantial advantage for M-CBIR systems. We present a new method for incorporating textual radiological findings from medical case reports in M-CBIR. The input is a database of medical cases, a query case, and the number of desired relevant cases. The output is an ordered list of the most relevant cases in the database. The method is based on a new case formulation, the Augmented RadLex Graph and an Anatomy-Pathology List. It uses a new case relatedness metric [Formula: see text] that prioritizes more specific medical terms in the RadLex tree over less specific ones and that incorporates the length of the query case. An experimental study on 8 CT queries from the 2015 VISCERAL 3D Case Retrieval Challenge database consisting of 1497 volumetric CT scans shows that our method has accuracy rates of 82 and 70% on the first 10 and 30 most relevant cases, respectively, thereby outperforming six other methods. The increasing amount of medical imaging data acquired in clinical practice constitutes a vast database of untapped diagnostically relevant information. This paper presents a new hybrid approach to retrieving the most relevant medical cases based on textual and image information.

  9. The importance of Evolutionary Medicine in developing countries: A case for Pakistan's medical schools.

    Science.gov (United States)

    Enam, Syed Faaiz; Hashmi, Shumaila

    2018-01-01

    Evolutionary Medicine (EM) is a fundamental science exploring why our bodies are plagued with disease and hindered by limitations. EM views the body as an assortment of benefits, mistakes, and compromises molded over millennia. It highlights the role of evolution in numerous diseases encountered in community and family medicine clinics of developing countries. It enables us to ask informed questions and develop novel responses to global health problems. An understanding of the field is thus crucial for budding doctors, but its study is currently limited to a handful of medical schools in high-income countries. For the developing world, Pakistan's medical schools may be excellent starting posts as the country is beset with communicable and non-communicable diseases that are shaped by evolution. Remarkably, Pakistani medical students are open to studying and incorporating EM into their training. Understanding the principles of EM could empower them to tackle growing health problems in the country. Additionally, some difficulties that western medical schools face in integrating EM into their curriculum may not be a hindrance in Pakistan. We propose solutions for the remaining challenges, including obstinate religious sentiments. Herein, we make the case that incorporating EM is particularly important in developing countries such as Pakistan and that it is achievable in its medical student body.

  10. Craniofacial Surgery and Adverse Outcomes: An Inquiry Into Medical Negligence.

    Science.gov (United States)

    Svider, Peter F; Eloy, Jean Anderson; Folbe, Adam J; Carron, Michael A; Zuliani, Giancarlo F; Shkoukani, Mahdi A

    2015-07-01

    This study aimed to evaluate factors contributing to medical negligence relevant to craniofacial surgery. Retrospective analysis of verdict and settlement reports on the Westlaw legal database for outcome, awards, physician defendants, and other specific factors raised in malpractice litigation. Of 42 verdicts and settlement reports included, 52.4% were resolved with either an out-of-court settlement or plaintiff verdict, with aggregate payments totaling $50.1M (in 2013 dollars). Median settlements and jury-awarded damages were $988,000 and $555,000, respectively. Payments in pediatric cases ($1.2M) were significantly higher. Plastic surgeons, oral surgeons, and otolaryngologists were the most commonly named defendants. The most common alleged factors included intraoperative negligence (69.0%), permanent deficits (54.8%), requiring additional surgery (52.4%), missed/delayed diagnosis of a complication (42.9%), disfigurement/scarring (28.6%), postoperative negligence (28.6%), and inadequate informed consent (20.6% of surgical cases). Failure to diagnose a fracture (19.0%) and cleft-reparative procedures (14.3%) were the most frequently litigated entities. Medical negligence related to craniofacial surgery involves plaintiffs in a wide age range as well as physician defendants in numerous specialties, and proceedings resolved with settlement and plaintiff verdict involve substantial payments. Cases with death, allegedly permanent injuries, and pediatric plaintiffs had significantly higher payments. © The Author(s) 2015.

  11. Medical risk factors associated with cholangiocarcinoma in Taiwan: a population-based case-control study.

    Directory of Open Access Journals (Sweden)

    Jeffrey S Chang

    Full Text Available BACKGROUND: Cholangiocarcinoma, including intra- and extrahepatic cholangiocarcinoma, is a rare but highly lethal cancer. Despite effort in finding the risk factors of cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown. This study utilized a population-based case-control design using data from the National Health Insurance Research Database (NHIRD of Taiwan to assess the medical conditions associated with cholangiocarcinoma. METHODS: 5,157 incident cases of cholangiocarcinoma diagnosed during 2004 to 2008 and 20,628 controls matched to the cases on sex, age, and time of diagnosis (reference date for the controls were identified from the NHIRD. Medical risk factors were ascertained from the NHIRD for each individual. Conditional logistic regression was performed to evaluate the association between cholangiocarcinoma and each medical risk factor. RESULTS: The results showed that factors associated with an increased risk of cholangiocarcinoma included cholangitis, cholelithiasis, cholecystitis, cirrhosis of liver, alcoholic liver disease, chronic non-alcoholic liver disease, hepatitis B, hepatitis C, diabetes, chronic pancreatitis, inflammatory bowel disease, and peptic ulcer. In addition, sex and age differences were observed. CONCLUSIONS: This study confirms the association between cholangiocarcinoma and several less established risk factors, including diabetes, inflammatory bowel disease, hepatitis B, hepatitis C, and peptic ulcer (proxy for the presence of Helicobacter Pylori. Future studies should focus on finding additional environmental and genetic causes of cholangiocarcinoma.

  12. Research on Practice Carrier and Method Formed by Medical Humanistic Spirit for Medical Students: Tianjin Medical University as a Case in Point

    Science.gov (United States)

    Hou, Jie; Geng, Xin; Su, Zhenxing; Wang, Yutao

    2014-01-01

    Medical humanistic quality is an indispensable quality that eligible doctors should possess, and medical humanism is strongly advocated and carried forward by contemporary medicine. These are commonly understood worldwide, and formed by reflection on medicine and medical education. Cultivation of medical humanism requires in-depth discussions of…

  13. Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004-2012).

    Science.gov (United States)

    De Decker, Steven; Wawrzenski, Lauren A; Volk, Holger A

    2014-08-15

    To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment. Retrospective case series. Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS. Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire. Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management. Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

  14. Evaluation of an interactive, case-based review session in teaching medical microbiology

    Science.gov (United States)

    Blewett, Earl L; Kisamore, Jennifer L

    2009-01-01

    Background Oklahoma State University-Center for Health Sciences (OSU-CHS) has replaced its microbiology wet laboratory with a variety of tutorials including a case-based interactive session called Microbial Jeopardy!. The question remains whether the time spent by students and faculty in the interactive case-based tutorial is worthwhile? This study was designed to address this question by analyzing both student performance data and assessing students' perceptions regarding the tutorial. Methods Both quantitative and qualitative data were used in the current study. Part One of the study involved assessing student performance using archival records of seven case-based exam questions used in the 2004, 2005, 2006, and 2007 OSU-CHS Medical Microbiology course. Two sample t-tests for proportions were used to test for significant differences related to tutorial usage. Part Two used both quantitative and qualitative means to assess student's perceptions of the Microbial Jeopardy! session. First, a retrospective survey was administered to students who were enrolled in Medical Microbiology in 2006 or 2007. Second, responses to open-ended items from the 2008 course evaluations were reviewed for comments regarding the Microbial Jeopardy! session. Results Both student performance and student perception data support continued use of the tutorials. Quantitative and qualitative data converge to suggest that students like and learn from the interactive, case-based session. Conclusion The case-based tutorial appears to improve student performance on case-based exam questions. Additionally, students perceived the tutorial as helpful in preparing for exam questions and reviewing the course material. The time commitment for use of the case-based tutorial appears to be justified. PMID:19712473

  15. Evaluation of an interactive, case-based review session in teaching medical microbiology.

    Science.gov (United States)

    Blewett, Earl L; Kisamore, Jennifer L

    2009-08-27

    Oklahoma State University-Center for Health Sciences (OSU-CHS) has replaced its microbiology wet laboratory with a variety of tutorials including a case-based interactive session called Microbial Jeopardy!. The question remains whether the time spent by students and faculty in the interactive case-based tutorial is worthwhile? This study was designed to address this question by analyzing both student performance data and assessing students' perceptions regarding the tutorial. Both quantitative and qualitative data were used in the current study. Part One of the study involved assessing student performance using archival records of seven case-based exam questions used in the 2004, 2005, 2006, and 2007 OSU-CHS Medical Microbiology course. Two sample t-tests for proportions were used to test for significant differences related to tutorial usage. Part Two used both quantitative and qualitative means to assess student's perceptions of the Microbial Jeopardy! session. First, a retrospective survey was administered to students who were enrolled in Medical Microbiology in 2006 or 2007. Second, responses to open-ended items from the 2008 course evaluations were reviewed for comments regarding the Microbial Jeopardy! session. Both student performance and student perception data support continued use of the tutorials. Quantitative and qualitative data converge to suggest that students like and learn from the interactive, case-based session. The case-based tutorial appears to improve student performance on case-based exam questions. Additionally, students perceived the tutorial as helpful in preparing for exam questions and reviewing the course material. The time commitment for use of the case-based tutorial appears to be justified.

  16. Evaluation of an interactive, case-based review session in teaching medical microbiology

    Directory of Open Access Journals (Sweden)

    Kisamore Jennifer L

    2009-08-01

    Full Text Available Abstract Background Oklahoma State University-Center for Health Sciences (OSU-CHS has replaced its microbiology wet laboratory with a variety of tutorials including a case-based interactive session called Microbial Jeopardy!. The question remains whether the time spent by students and faculty in the interactive case-based tutorial is worthwhile? This study was designed to address this question by analyzing both student performance data and assessing students' perceptions regarding the tutorial. Methods Both quantitative and qualitative data were used in the current study. Part One of the study involved assessing student performance using archival records of seven case-based exam questions used in the 2004, 2005, 2006, and 2007 OSU-CHS Medical Microbiology course. Two sample t-tests for proportions were used to test for significant differences related to tutorial usage. Part Two used both quantitative and qualitative means to assess student's perceptions of the Microbial Jeopardy! session. First, a retrospective survey was administered to students who were enrolled in Medical Microbiology in 2006 or 2007. Second, responses to open-ended items from the 2008 course evaluations were reviewed for comments regarding the Microbial Jeopardy! session. Results Both student performance and student perception data support continued use of the tutorials. Quantitative and qualitative data converge to suggest that students like and learn from the interactive, case-based session. Conclusion The case-based tutorial appears to improve student performance on case-based exam questions. Additionally, students perceived the tutorial as helpful in preparing for exam questions and reviewing the course material. The time commitment for use of the case-based tutorial appears to be justified.

  17. Unified modeling language and design of a case-based retrieval system in medical imaging.

    Science.gov (United States)

    LeBozec, C; Jaulent, M C; Zapletal, E; Degoulet, P

    1998-01-01

    One goal of artificial intelligence research into case-based reasoning (CBR) systems is to develop approaches for designing useful and practical interactive case-based environments. Explaining each step of the design of the case-base and of the retrieval process is critical for the application of case-based systems to the real world. We describe herein our approach to the design of IDEM--Images and Diagnosis from Examples in Medicine--a medical image case-based retrieval system for pathologists. Our approach is based on the expressiveness of an object-oriented modeling language standard: the Unified Modeling Language (UML). We created a set of diagrams in UML notation illustrating the steps of the CBR methodology we used. The key aspect of this approach was selecting the relevant objects of the system according to user requirements and making visualization of cases and of the components of the case retrieval process. Further evaluation of the expressiveness of the design document is required but UML seems to be a promising formalism, improving the communication between the developers and users.

  18. Provision of prehospital emergency medical services in Punjab, Pakistan: Case study of a public sector provider.

    Science.gov (United States)

    Sriram, Veena M; Naseer, Rizwan; Hyder, Adnan A

    2017-12-01

    The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore. We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization. Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting. Copyright © 2017. Published by Elsevier Inc.

  19. Does reflection have an effect upon case-solving abilities of undergraduate medical students?

    Directory of Open Access Journals (Sweden)

    Koole Sebastiaan

    2012-08-01

    Full Text Available Abstract Background Reflection on professional experience is increasingly accepted as a critical attribute for health care practice; however, evidence that it has a positive impact on performance remains scarce. This study investigated whether, after allowing for the effects of knowledge and consultation skills, reflection had an independent effect on students’ ability to solve problem cases. Methods Data was collected from 362 undergraduate medical students at Ghent University solving video cases and reflected on the experience of doing so. For knowledge and consultation skills results on a progress test and a course teaching consultation skills were used respectively. Stepwise multiple linear regression analysis was used to test the relationship between the quality of case-solving (dependent variable and reflection skills, knowledge, and consultation skills (dependent variables. Results Only students with data on all variables available (n = 270 were included for analysis. The model was significant (Anova F(3,269 = 11.00, p  Conclusion Medical students’ reflection had a small but significant effect on case-solving, which supports reflection as an attribute for performance. These findings suggest that it would be worthwhile testing the effect of reflection skills training on clinical competence.

  20. Medical humanitarianism, human rights and political advocacy: the case of the Israeli Open Clinic.

    Science.gov (United States)

    Gottlieb, Nora; Filc, Dani; Davidovitch, Nadav

    2012-03-01

    In the context of neo-liberal retrenchments humanitarian NGOs have become alternative healthcare providers that partially fill the vacuum left by the welfare state's withdrawal from the provision of services to migrants and other marginalized populations. In many cases they thus help to build legitimacy for the state's retreat from social responsibilities. Human rights organizations play an important role in advocating for migrants' rights, but in many cases they represent a legalistic and individualized conceptualization of the right to health that limits their claims for social justice. This paper analyzes the interactions and tensions between the discourses of medical humanitarianism, human rights and political advocacy using the example of an "Open Clinic" run by an Israeli human rights organization as a case-study: In 2007 dramatically increasing patient numbers provoked an intense internal debate concerning the proposal to temporarily close the "Open Clinic" in order to press the government to take action. Based on protocols from internal meetings and parliamentary hearings and in-depth interviews, we have analyzed divergent contextualizations of the Clinic's closure. These reflect conflicting notions regarding the Clinic's variegated spectrum of roles--humanitarian, political, legitimizing, symbolic, empowering and organizational--and underlying conceptualizations of migrants' "deservingness". Our case-study thus helps to illuminate NGOs' role in the realm of migrant healthcare and points out options for a possible fruitful relationship between the divergent paradigms of medical humanitarianism, human rights and political advocacy. Copyright © 2011. Published by Elsevier Ltd.

  1. Cost-sensitive case-based reasoning using a genetic algorithm: application to medical diagnosis.

    Science.gov (United States)

    Park, Yoon-Joo; Chun, Se-Hak; Kim, Byung-Chun

    2011-02-01

    The paper studies the new learning technique called cost-sensitive case-based reasoning (CSCBR) incorporating unequal misclassification cost into CBR model. Conventional CBR is now considered as a suitable technique for diagnosis, prognosis and prescription in medicine. However it lacks the ability to reflect asymmetric misclassification and often assumes that the cost of a positive diagnosis (an illness) as a negative one (no illness) is the same with that of the opposite situation. Thus, the objective of this research is to overcome the limitation of conventional CBR and encourage applying CBR to many real world medical cases associated with costs of asymmetric misclassification errors. The main idea involves adjusting the optimal cut-off classification point for classifying the absence or presence of diseases and the cut-off distance point for selecting optimal neighbors within search spaces based on similarity distribution. These steps are dynamically adapted to new target cases using a genetic algorithm. We apply this proposed method to five real medical datasets and compare the results with two other cost-sensitive learning methods-C5.0 and CART. Our finding shows that the total misclassification cost of CSCBR is lower than other cost-sensitive methods in many cases. Even though the genetic algorithm has limitations in terms of unstable results and over-fitting training data, CSCBR results with GA are better overall than those of other methods. Also the paired t-test results indicate that the total misclassification cost of CSCBR is significantly less than C5.0 and CART for several datasets. We have proposed a new CBR method called cost-sensitive case-based reasoning (CSCBR) that can incorporate unequal misclassification costs into CBR and optimize the number of neighbors dynamically using a genetic algorithm. It is meaningful not only for introducing the concept of cost-sensitive learning to CBR, but also for encouraging the use of CBR in the medical area

  2. Medical Treatment for Burn Patients with Eating Disorders: A Case Report

    Directory of Open Access Journals (Sweden)

    Minekatsu Akimoto

    2011-01-01

    Full Text Available There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5% of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa cause emaciation and malnutrition, and consent for hospitalization from the patient and/or family is often difficult. During the medical treatment of burns for these patients, consideration not only of physical symptoms caused by malnutrition but also the psychiatric issues is required. Therefore, multifaceted and complex care must be given to burn patients with eating disorders.

  3. Medical records documentation of constipation preceding Parkinson disease: A case-control study.

    Science.gov (United States)

    Savica, R; Carlin, J M; Grossardt, B R; Bower, J H; Ahlskog, J E; Maraganore, D M; Bharucha, A E; Rocca, W A

    2009-11-24

    Parkinson disease (PD) may affect the autonomic nervous system and may cause constipation; however, few studies have explored constipation preceding the motor onset of PD. We investigated constipation preceding PD using a case-control study design in a population-based sample. Using the medical records-linkage system of the Rochester Epidemiology Project, we identified 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control. We reviewed the complete medical records of cases and controls in the medical records-linkage system to ascertain the occurrence of constipation preceding the onset of PD (or index year). Constipation preceding PD or the index year was more common in cases than in controls (odds ratio [OR] 2.48; 95% confidence interval [CI] 1.49 to 4.11; p = 0.0005). This association remained significant after adjusting for smoking and coffee consumption (ever vs never), and after excluding constipation possibly induced by drugs. In addition, the association remained significant in analyses restricted to constipation documented 20 or more years before the onset of motor symptoms of PD. Although the association was stronger in women than in men and in patients with PD with rest tremor compared with patients with PD without rest tremor, these differences were not significant. Our findings suggest that constipation occurring as early as 20 or more years before the onset of motor symptoms is associated with an increased risk of Parkinson disease.

  4. Case based learning: a method for better understanding of biochemistry in medical students.

    Science.gov (United States)

    Nair, Sandhya Pillai; Shah, Trushna; Seth, Shruti; Pandit, Niraj; Shah, G V

    2013-08-01

    Health professionals need to develop analytic and diagnostic thinking skills and not just a mere accumulation of large amount of facts. Hence, Case Based Learning (CBL) has been used in the medical curriculum for this reason, so that the students are exposed to the real medical problems, which helps them in develop analysing abilities. This also helps them in interpreting and solving the problems and in the course of doing this, they develop interest. In addition to didactic lectures, CBL was used as a learning method. This study was conducted in the Department of Biochemistry, S.B.K.S.M.I and R.C, Sumandeep Vidyapeeth ,Piparia, Gujarat, India. A group of 100 students were selected and they were divided into two groups as the control group and the study group. A total of 50 students were introduced to case based learning, which formed the study group and 50 students who attended didactic lectures formed the control group. A very significant improvement (pmedical curriculum for a better understanding of Biochemistry among the medical students.

  5. Public Use of Mobile Medical Applications: A Case Study on Cloud-Based Medical Service of Taiwan.

    Science.gov (United States)

    Lu, Chen-Luan; Yan, Yu-Hua

    2016-01-01

    The use of smart mobile devices has been getting increasingly popular. The focus of this study is an attempt to explore the development of mobile medical App by medical centers and regional hospitals of Taiwan and the function of the App for comparison. The results show indicated that many hospitals developed Apps for the public for mobile medical service, of which 26 medical centers (100%) and 72 regional hospitals (84.7%) availed appointment making service via Apps. The result indicated variance at significant level (p < 0.01). There are 23 medical centers (88.5%) and 74 regional hospitals (87.1%) availed Apps for checking service progress. The result indicated insignificant variance level (p > 0.01). We can see that mobile medical service is gradually emerging as a vital issue. Yet, this is a new domain in medical service. With the mushrooming of medical applications in smart mobile devices, the medical service system is expected to be installed in these devices to enhance interactive mode of operation and inquiry services, such as medication and inquiries into physical examination results. By then, people can learn the status of their health with this system.

  6. Beyond the standard of care: a new model to judge medical negligence.

    Science.gov (United States)

    Brenner, Lawrence H; Brenner, Alison Tytell; Awerbuch, Eric J; Horwitz, Daniel

    2012-05-01

    The term "standard of care" has been used in law and medicine to determine whether medical care is negligent. However, the precise meaning of this concept is often unclear for both medical and legal professionals. Our purposes are to (1) examine the limitations of using standard of care as a measure of negligence, (2) propose the use of the legal concepts of justification and excuse in developing a new model of examining medical conduct, and (3) outline the framework of this model. We applied the principles of tort liability set forth in the clinical and legal literature to describe the difficulty in applying standard of care in medical negligence cases. Using the concepts of justification and excuse, we propose a judicial model that may promote fair and just jury verdicts in medical negligence cases. Contrary to conventional understanding, medical negligence is not simply nonconformity to norms. Two additional concepts of legal liability, ie, justification and excuse, must also be considered to properly judge medical conduct. Medical conduct is justified when the benefits outweigh the risks; the law sanctions the conduct and encourages future conduct under similar circumstances. Excuse, on the other hand, relieves a doctor of legal liability under specific circumstances even though his/her conduct was not justified. Standard of care is an inaccurate measure of medical negligence because it is premised on the faulty notion of conformity to norms. An alternative judicial model to determine medical negligence would (1) eliminate standard of care in medical malpractice law, (2) reframe the court instruction to jurors, and (3) establish an ongoing consensus committee on orthopaedic principles of negligence.

  7. ["Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time].

    Science.gov (United States)

    Lindner, Christina; Lindner, Gregor; Exadaktylos, Aristomenis K

    2013-12-11

    Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law.

  8. Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills.

    Science.gov (United States)

    Hurtado-de-Mendoza, Alejandra; Cabling, Mark L; Sheppard, Vanessa B

    2015-12-01

    Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency. © 2015 John Wiley & Sons Ltd.

  9. Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

    Science.gov (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

    2003-12-01

    Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

  10. Legal Medicine in Medical Schools: A Survey of the State of the Art.

    Science.gov (United States)

    Grumet, Barbara Ruhe

    1979-01-01

    Results of a survey of American medical schools indicate that there is considerable interest in legal medicine and that while 40 percent of the schools require students to complete some course work in legal medicine, the curricula vary considerably among the schools. Topics most frequently covered are informed consent and malpractice. (Author/JMD)

  11. Emergency medicine in case of disasters. Guideline for medical care in case of disasters. 4. rev. ed.; Katastrophenmedizin. Leitfaden fuer die aerztliche Versorgung im Katastrophenfall

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

    Medical care in case of disasters means being pressed for time, facing difficult structures and a shortage of resources while trying to attend to many injured at a time. The knowledge required must be immediately available, and this is where this book comes in handy. The guide addresses primarily doctors and medical staff. It answers medical questions, lists contacts, provides information on disaster management, and goes into legal and ethical aspects as well. (orig.)

  12. Education at the Dittrick Museum of Medical History, Case Western Reserve University, Cleveland, Ohio, USA.

    Science.gov (United States)

    Edmonson, James M

    2009-01-01

    The Dittrick Museum of Medical History pursues an educational mission as being part of a major research university. While the Dittrick dates to 1899 as a historical committee of the Cleveland Medical Library Association, it first affiliated with Case Western Reserve University in 1966, and became a department of the College of Arts and Sciences of CWRU in 1998. The Dittrick maintains a museum exhibition gallery that is open to the public free of charge, and museum staff provide guided tours on appointment. Much of the teaching and instruction at the Dittrick is conducted by university professors; their classes meet in the museum and use museum resources in the form of artifacts, images, archives, and rare books. Class projects using Dittrick collections may take the form of research papers, exhibitions, and online presentations. Dittrick staff assist in these classes and are available to help researchers use museum resources.

  13. Medical student case presentation performance and perception when using mobile learning technology in the emergency department.

    Science.gov (United States)

    Tews, Matthew; Brennan, Kimberly; Begaz, Tomer; Treat, Robert

    2011-01-01

    Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students' case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters. Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos. Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p=0.032). There was no difference when the presentations were summed for the entire rotation (p=0.671). The reliable (alpha=0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations. Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. Clinical educators should consider whether, in an instance where live bedside or direct interactive teaching is unavailable, using just-in-time educational videos on a handheld device might be useful as a supplemental instructional strategy.

  14. Evaluation of an interactive case simulation system in dermatology and venereology for medical students

    Directory of Open Access Journals (Sweden)

    Hindbeck Hans

    2006-08-01

    Full Text Available Abstract Background Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. Methods Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85 or conventional teaching plus NUDOV (n = 31 and comparing the results of the two groups in a final written examination. Results The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. Conclusion We created a computerised case simulation program allowing students to manage patients in a non

  15. Visualizing the Bayesian 2-test case: The effect of tree diagrams on medical decision making.

    Science.gov (United States)

    Binder, Karin; Krauss, Stefan; Bruckmaier, Georg; Marienhagen, Jörg

    2018-01-01

    In medicine, diagnoses based on medical test results are probabilistic by nature. Unfortunately, cognitive illusions regarding the statistical meaning of test results are well documented among patients, medical students, and even physicians. There are two effective strategies that can foster insight into what is known as Bayesian reasoning situations: (1) translating the statistical information on the prevalence of a disease and the sensitivity and the false-alarm rate of a specific test for that disease from probabilities into natural frequencies, and (2) illustrating the statistical information with tree diagrams, for instance, or with other pictorial representation. So far, such strategies have only been empirically tested in combination for "1-test cases", where one binary hypothesis ("disease" vs. "no disease") has to be diagnosed based on one binary test result ("positive" vs. "negative"). However, in reality, often more than one medical test is conducted to derive a diagnosis. In two studies, we examined a total of 388 medical students from the University of Regensburg (Germany) with medical "2-test scenarios". Each student had to work on two problems: diagnosing breast cancer with mammography and sonography test results, and diagnosing HIV infection with the ELISA and Western Blot tests. In Study 1 (N = 190 participants), we systematically varied the presentation of statistical information ("only textual information" vs. "only tree diagram" vs. "text and tree diagram in combination"), whereas in Study 2 (N = 198 participants), we varied the kinds of tree diagrams ("complete tree" vs. "highlighted tree" vs. "pruned tree"). All versions were implemented in probability format (including probability trees) and in natural frequency format (including frequency trees). We found that natural frequency trees, especially when the question-related branches were highlighted, improved performance, but that none of the corresponding probabilistic visualizations did.

  16. Increased resin collection after parasite challenge: a case of self-medication in honey bees?

    Directory of Open Access Journals (Sweden)

    Michael D Simone-Finstrom

    Full Text Available The constant pressure posed by parasites has caused species throughout the animal kingdom to evolve suites of mechanisms to resist infection. Individual barriers and physiological defenses are considered the main barriers against parasites in invertebrate species. However, behavioral traits and other non-immunological defenses can also effectively reduce parasite transmission and infection intensity. In social insects, behaviors that reduce colony-level parasite loads are termed "social immunity." One example of a behavioral defense is resin collection. Honey bees forage for plant-produced resins and incorporate them into their nest architecture. This use of resins can reduce chronic elevation of an individual bee's immune response. Since high activation of individual immunity can impose colony-level fitness costs, collection of resins may benefit both the individual and colony fitness. However the use of resins as a more direct defense against pathogens is unclear. Here we present evidence that honey bee colonies may self-medicate with plant resins in response to a fungal infection. Self-medication is generally defined as an individual responding to infection by ingesting or harvesting non-nutritive compounds or plant materials. Our results show that colonies increase resin foraging rates after a challenge with a fungal parasite (Ascophaera apis: chalkbrood or CB. Additionally, colonies experimentally enriched with resin had decreased infection intensities of this fungal parasite. If considered self-medication, this is a particularly unique example because it operates at the colony level. Most instances of self-medication involve pharmacophagy, whereby individuals change their diet in response to direct infection with a parasite. In this case with honey bees, resins are not ingested but used within the hive by adult bees exposed to fungal spores. Thus the colony, as the unit of selection, may be responding to infection through self-medication

  17. Medical biomodelling in surgical applications: results of a multicentric European validation of 466 cases.

    Science.gov (United States)

    Wulf, J; Vitt, K D; Erben, C M; Bill, J S; Busch, L C

    2003-01-01

    The study started in September 1999 and ended in April 2002. It is based on a questionnaire [www.phidias.org] assessing case-related questions due to the application of stereolithographic models. Each questionnaire contains over 50 items. These variables take into account diagnosis, indications and benefits of stereolithographic models with view on different steps of the surgical procedures: preoperative planning, intraoperative application and overall outcome after surgical intervervention. These questionnaires were completed by the surgeons who performed operation. Over the time course of our multicentric study (30 months), we evaluated 466 cases. The study population consists of n=231 male and n= 235 female patients. 54 surgeons from 9 European countries were involved. There are main groups of diagnosis that related to the use of a model. Most models were used in maxillofacial surgery. The operative planning may help to determine the resection line of tumor and optimize reconstructive procedures. Correction of large calvarian defects can be simulated and implants can be produced preoperatively. Overall in 58 % of all cases a time- saving effect was reported. The study strongly suggests, that medical modeling has utility in surgical specialities, especially in the craniofacial and maxillofacial area, however increasingly in the orthopedic field. Due to our results, medical modeling optimizes the preoperative surgical planning. Surgeons are enabeled to perform realistic and interactive simulations. The fabrication of implants, its design and fit on the model, allow to reduce operation time and in consequence risk and cost of operation. In addition, the understanging of volumetric data is improved, especially if medical models are combined with standart imaging modalities. Finally, surgeons are able to improve communication between their patientents and colleagues.

  18. Game-based versus traditional case-based learning: comparing effectiveness in stroke continuing medical education.

    Science.gov (United States)

    Telner, Deanna; Bujas-Bobanovic, Maja; Chan, David; Chester, Bob; Marlow, Bernard; Meuser, James; Rothman, Arthur; Harvey, Bart

    2010-09-01

    To evaluate family physicians' enjoyment of and knowledge gained from game-based learning, compared with traditional case-based learning, in a continuing medical education (CME) event on stroke prevention and management. An equivalence trial to determine if game-based learning was as effective as case-based learning in terms of attained knowledge levels. Game questions and small group cases were developed. Participants were randomized to either a game-based or a case-based group and took part in the event. Ontario provincial family medicine conference. Thirty-two family physicians and 3 senior family medicine residents attending the conference. Participation in either a game-based or a case-based CME learning group. Scores on 40-item immediate and 3-month posttests of knowledge and a satisfaction survey. Results from knowledge testing immediately after the event and 3 months later showed no significant difference in scoring between groups. Participants in the game-based group reported higher levels of satisfaction with the learning experience. Games provide a novel way of organizing CME events. They might provide more group interaction and discussion, as well as improve recruitment to CME events. They might also provide a forum for interdisciplinary CME. Using games in future CME events appears to be a promising approach to facilitate participant learning.

  19. [Considerations concerning medical knowledge inherited in Mexico from 19th century: the diabetes mellitus case].

    Science.gov (United States)

    García de Alba-García, Javier Eduardo; Salcedo-Rocha, Ana Leticia; Milke-Najar, María Eugenia; Alonso-Reynoso, Carlos; García de Alba-Verduzco, Javier Eugenio

    2017-01-01

    In Mexico, as in the entire Western world, during the 19th century and the beginnings of the 20th century, medical knowledge developed in a remarkable way and the case of diabetes mellitus was not the exception. This situation, which arose on the basis of the antique paradigm, and which in turn was overthrown by the positivism as the emergent paradigm (with its clinical and anatomical, as well as physiopathological and etiopathological viewpoints), was reflected during the 19th the century through its actors and the communications that opened the access of Mexican medicine to the modernity.

  20. [A Case of Rectal Syphilis Incidentally Found at Regular Medical Check-up].

    Science.gov (United States)

    You, Ji Hong; Cho, Ki Won; Cha, Yoon Jin; Park, Hyo Jin

    2016-10-25

    Syphilis is a rare disease in the rectum. It is difficult to diagnose because the characteristics of the rectal syphilis rectal lesion are highly varied. The endoscopic findings of rectal syphilis are proctitis, ulcers, and masses. If rectal syphilis is suspected to be the cause for rectal lesions, it is important for physicians to consider the sexual history and sexual orientation of the patient. We report a case of incidental rectal syphilis in a 41-year-old man diagnosed during a regular medical check-up.

  1. Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

    Science.gov (United States)

    Sasnett, Bonita; Harris, Susie T; White, Shelly

    Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

  2. The impact of being involved in a medical adverse event on GP's (General Physicians) professional behavior in an ambulatory healthcare fund

    NARCIS (Netherlands)

    Manor, Orly

    2017-01-01

    Assurance behavior: performing unnecessary tests so as to deter patients from filing complaints or medical malpractice suits Avoidance behavior: choosing to behave in a way that prevents recurrence of an unpleasant stimulus This thesis examines the impact of involvement in a medical adverse event on

  3. Evaluation of forensic medical history taking from the child in cases of child physical and sexual abuse and neglect.

    Science.gov (United States)

    Drummond, Rachel; Gall, John A M

    2017-02-01

    Suspected child physical abuse, sexual abuse and neglect are not uncommon presentations. As part of the assessment of these cases, a forensic medical history may be taken. This forensic history is used not only to determine the steps necessary to address the child's wellbeing but also to direct the forensic examination. Currently, there is no clear consensus on whether or not a forensic medical history should consistently be considered an integral element within the paediatric forensic evaluation. This study examines the value derived by the medical practitioner taking a forensic medical history rather than relying on hearsay evidence when a child presents for an assessment. A retrospective review of paediatric cases seen by the Victorian Forensic Paediatric Medical Service (VFPMS) between 2014 and 2015 was undertaken. 274 forensic case reports were reviewed and the data was entered into an Excel spread sheet and analysed using chi squared tests within STATA ® . With increasing age of the child, a forensic medical history is significantly more likely to be taken. Additional information is made available to the medical practitioner what would otherwise have been provided if the medical practitioner relied only on the interview conducted by the police. Discrepancies observed between the official third parties (police or child protection) report of what a child has said and what the child says to the medical practitioner decrease with age, as do discrepancies observed between the child's version of events and a third party's (eg. parents, caregivers, friends) version of events. The study showed that by taking a forensic medical history from the child additional information can be obtained. Further, that there is a value in the examining medical practitioner taking a forensic medical history from children in cases of child physical and sexual abuse and neglect. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  4. [The approaches to factors which cause medication error--from the analyses of many near-miss cases related to intravenous medication which nurses experienced].

    Science.gov (United States)

    Kawamura, H

    2001-03-01

    Given the complexity of the intravenous medication process, systematic thinking is essential to reduce medication errors. Two thousand eight hundred cases of 'Hiyari-Hatto' were analyzed. Eight important factors which cause intravenous medication error were clarified as a result. In the following I summarize the systematic approach for each factor. 1. Failed communication of information: illegible handwritten orders, and inaccurate verbal orders and copying cause medication error. Rules must be established to prevent miscommunication. 2. Error-prone design of the hardware: Look-alike packaging and labeling of drugs and the poor design of infusion pumps cause errors. The human-hardware interface should be improved by error-resistant design by manufacturers. 3. Patient names similar to simultaneously operating surgical procedures and interventions: This factor causes patient misidentification. Automated identification devices should be introduced into health care settings. 4. Interruption in the middle of tasks: The efficient assignment of medical work and business work should be made. 5. Inaccurate mixing procedure and insufficient mixing space: Mixing procedures must be standardized and the layout of the working space must be examined. 6. Time pressure: Mismatch between workload and manpower should be improved by reconsidering the work to be done. 7. Lack of information about high alert medications: The pharmacist should play a greater role in the medication process overall. 8. Poor knowledge and skill of recent graduates: Training methods and tools to prevent medication errors must be developed.

  5. Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report

    Directory of Open Access Journals (Sweden)

    Karlsen Tom H

    2004-10-01

    Full Text Available Abstract Background Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS. This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

  6. Treatment of 31 Cases of Infant Respiratory Tract Infection by Health-care Tuina plus Medicated Bath

    Institute of Scientific and Technical Information of China (English)

    LI Jie; WU Xue-fei

    2003-01-01

    Thirty-one cases of infant respiratory tract infection were treated by no-pain health-care Tuina plus medicated bath. Since the therapeutic effects were satisfactory, so parents and infants are willing to accept.

  7. An Experimental Study of Medical Error Explanations: Do Apology, Empathy, Corrective Action, and Compensation Alter Intentions and Attitudes?

    Science.gov (United States)

    Nazione, Samantha; Pace, Kristin

    2015-01-01

    Medical malpractice lawsuits are a growing problem in the United States, and there is much controversy regarding how to best address this problem. The medical error disclosure framework suggests that apologizing, expressing empathy, engaging in corrective action, and offering compensation after a medical error may improve the provider-patient relationship and ultimately help reduce the number of medical malpractice lawsuits patients bring to medical providers. This study provides an experimental examination of the medical error disclosure framework and its effect on amount of money requested in a lawsuit, negative intentions, attitudes, and anger toward the provider after a medical error. Results suggest empathy may play a large role in providing positive outcomes after a medical error.

  8. Communication between general practitioners and the emergency medical dispatch centre in urgent cases

    DEFF Research Database (Denmark)

    Mieritz, Hanne Beck; Rønnow, Camilla; Jørgensen, Gitte

    2018-01-01

    , and we found that these calls were more likely to contain problematic communication (odds ratio = 5.1). In 18% (n = 236) of the cases, there was not sufficient information to assess if the physician-manned mobile emergency care unit (MECU) should have been dispatched along with the ambulance......INTRODUCTION: When general practitioners (GPs) order an ambulance, their calls are handled by staff at the emergency medical dispatch centre (EMDC) who then select an appropriate response. There are currently no data evaluating this mode of communication between the GPs and the staff at the EMDC....... 
RESULTS: We found problematic communication in less than 2% (n = 25) of the evaluated calls. In 68% of the 25 problematic cases transactional analysis showed that the staff at the EMDC initiated the problematic communication. In 4% (n = 51) of the calls, the GP delegated the call to a secretary or nurse...

  9. Disaster medicine. A guide for medical care in case of disasters. 3. rev. ed.

    International Nuclear Information System (INIS)

    Weidringer, J.W.

    2003-01-01

    This guide was first published in 1982. The 2003 edition takes account of new research, of practical experience in natural disasters, and of the organisational plans of the German civil service units. All factors are considered which are important for successful medical care in case of natural disasters, large-scale accidents, and war. Among the new issues that are considered in this volume is the new European situation with regard to national safety, the new German legislation on civil safety, the hazards of an increasingly technological society, and the options and requirements for protection of the population in case of emergencies. After the Chernobyl accident, the focus in the field of nuclear radiation has shifted to radiation protection problems. There are new chapters on stress management during and after emergency shifts which take account of the experience gained in major disasters. (orig.)

  10. Gender bias in clinical case reports: A cross-sectional study of the "big five" medical journals.

    Directory of Open Access Journals (Sweden)

    Pascale Allotey

    Full Text Available Gender bias in medical journals can affect the science and the benefit to patients. It has never been investigated in clinical case reports. The oversight is important because of the role clinical case reports play in hypothesis generation and medical education. We investigated contemporary gender bias in case reports for the highest ranked journals in general and internal medicine.PubMed case reports data from 2011 to 2016 were extracted for the Annals of Internal Medicine, British Medical Journal, the Journal of the American Medical Association, The Lancet, and New England Journal of Medicine. The gender of the patients were identified and a text analysis of the Medical Subject Headings conducted.A total of 2,742 case reports were downloaded and 2,582 (95.6% reports contributed to the final analysis. A pooled analysis showed a statistically significant gender bias against female case reports (0.45; 95%CI: 0.43-0.47. The Annals of Internal Medicine was the only journal with a point estimate (non significant in the direction of a bias against male patients. The text analysis identified no substantive difference in the focus of the case reports and no obvious explanation for the bias.Gender bias, previously identified in clinical research and in clinical authorship, extends into the patients presented in clinical case reports. Whether it is driven by authors or editors is not clear, but it likely contributes to and supports an overall male bias of clinical medicine.

  11. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

    Directory of Open Access Journals (Sweden)

    H Zare Ahmadabadi

    2007-07-01

    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  12. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

    Science.gov (United States)

    Dredla, Brynn; Freeman, William D

    2016-04-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient's medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis.

  13. Automated external defibrillators in the hospital: A case of medical reversal.

    Science.gov (United States)

    Stewart, John A

    2018-05-01

    Automated external defibrillators (AEDs) emerged in the 1980s as an important innovation in pre-hospital emergency cardiac care (ECC). In the years since, the American Heart Association (AHA) and the International Liaison Committee for Resuscitation (ILCOR) have promoted AED technology for use in hospitals as well, resulting in the widespread purchase and use of AED-capable defibrillators. In-hospital use of AEDs now appears to have decreased survival from cardiac arrests. This article will look at the use of AEDs in hospitals as a case of "medical reversal." Medical reversal occurs when an accepted, widely used treatment is found to be ineffective or even harmful. This article will discuss the issue of AEDs in the hospital using a conceptual framework provided by recent work on medical reversal. It will go on to consider the implications of the reversal for in-hospital resuscitation programs and emergency medicine more generally. Copyright © 2017 The Author. Published by Elsevier Inc. All rights reserved.

  14. A case of nasal septal abscess caused by medication related osteonecrosis in breast cancer patient.

    Science.gov (United States)

    Maeda, Mayuka; Matsunobu, Takeshi; Kurioka, Takaomi; Kurita, Akihiro; Shiotani, Akihiro

    2016-02-01

    Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Teaching community diagnosis to medical students: evaluation of a case study approach.

    Science.gov (United States)

    Bair, C W

    1980-01-01

    A unique case study approach to training medical students in community diagnosis techniques was initiated at the Medical College of Ohio at Toledo. This paper describes the five elements of this teaching method: preliminary specification of target community and data base; group problem-solving requirement; specification of desired output; defined performance objectives; and regularly scheduled time for analysis. Experience with the case study method over two years was evaluated to identify specific strengths and weaknesses. The identified strengths include use of limited educational time to introduce community health problems, development of experience in a collegial team work setting, and specific awareness of the types of data useful to the analysis of community health service problems. Negative evaluations suggested that the method was not conducive to the development of skills in three areas: ability to establish the relative importance of health problems in communities; ability to identify an appropriate health system response to a community health problem from feasible alternatives; and ability to anticipate the community impact of health program modifications or improvements. Potential explanations for these deficiencies include: need for increased didactic support in the classroom for particular skill areas; need to establish a direct field experience in community diagnosis; inappropriateness of the data base used for evaluation of particular skills; and the probability that quantitative analysis, as used in this evaluation, may not be sufficient in and of itself to measure the outcome of a community diagnosis experience.

  16. Topical Medical Cannabis: A New Treatment for Wound Pain-Three Cases of Pyoderma Gangrenosum.

    Science.gov (United States)

    Maida, Vincent; Corban, Jason

    2017-11-01

    Pain associated with integumentary wounds is highly prevalent, yet it remains an area of significant unmet need within health care. Currently, systemically administered opioids are the mainstay of treatment. However, recent publications are casting opioids in a negative light given their high side effect profile, inhibition of wound healing, and association with accidental overdose, incidents that are frequently fatal. Thus, novel analgesic strategies for wound-related pain need to be investigated. The ideal methods of pain relief for wound patients are modalities that are topical, lack systemic side effects, noninvasive, self-administered, and display rapid onset of analgesia. Extracts derived from the cannabis plant have been applied to wounds for thousands of years. The discovery of the human endocannabinoid system and its dominant presence throughout the integumentary system provides a valid and logical scientific platform to consider the use of topical cannabinoids for wounds. We are reporting a prospective case series of three patients with pyoderma gangrenosum that were treated with topical medical cannabis compounded in nongenetically modified organic sunflower oil. Clinically significant analgesia that was associated with reduced opioid utilization was noted in all three cases. Topical medical cannabis has the potential to improve pain management in patients suffering from wounds of all classes. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  17. Does reflection have an effect upon case-solving abilities of undergraduate medical students?

    Science.gov (United States)

    Koole, Sebastiaan; Dornan, Tim; Aper, Leen; Scherpbier, Albert; Valcke, Martin; Cohen-Schotanus, Janke; Derese, Anselme

    2012-08-13

    Reflection on professional experience is increasingly accepted as a critical attribute for health care practice; however, evidence that it has a positive impact on performance remains scarce. This study investigated whether, after allowing for the effects of knowledge and consultation skills, reflection had an independent effect on students' ability to solve problem cases. Data was collected from 362 undergraduate medical students at Ghent University solving video cases and reflected on the experience of doing so. For knowledge and consultation skills results on a progress test and a course teaching consultation skills were used respectively. Stepwise multiple linear regression analysis was used to test the relationship between the quality of case-solving (dependent variable) and reflection skills, knowledge, and consultation skills (dependent variables). Only students with data on all variables available (n = 270) were included for analysis. The model was significant (Anova F(3,269) = 11.00, p effect on case-solving, which supports reflection as an attribute for performance. These findings suggest that it would be worthwhile testing the effect of reflection skills training on clinical competence.

  18. Severe Hypertriglyceridemia Induced by Sirolimus Treated With Medical Management Without Plasmapheresis: A Case Report.

    Science.gov (United States)

    Kido, Kazuhiko; Evans, Rickey A; Gopinath, Anil; Flynn, Jeremy D

    2018-02-01

    Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis. The most recent triglyceride was down to 520 mg/dL 2 months after discontinuation of sirolimus. We estimate the probability of this reaction to sirolimus as probable based on a score of 5 points on the Naranjo scale. This is the first case report to our knowledge that highlights the sole use of oral lipid-lowering drug agents to treat severe hypertriglyceridemia secondary to sirolimus without the use of plasmapheresis. Sirolimus-induced severe hypertriglyceridemia can be managed with oral lipid-lowering agents without plasmapheresis. Clinician needs to be aware of the importance of baseline and regular triglyceride monitoring in patients on sirolimus.

  19. Case-based Learning in Microbiology: Observations from a North West Indian Medical College.

    Science.gov (United States)

    Singhal, Anita

    2017-12-01

    Microbiology is usually taught by conventional lectures, and its retention and application is observed to be poor among medical graduates/practitioners. Introduction of case-based learning (CBL) in microbiology for second-year professional MBBS students. Students were divided into two groups of fifty each. Four clinical cases were used for CBL. One group had two CBL sessions whereas the other had didactic lectures (DLs) and then the groups were crossed over. Case scenario handouts were given to students a week before the session, and smaller groups were formed for discussions and presentations in CBL sessions. Posttest, in multiple choice questions format, was conducted in two phases: First, immediately after the completion of the four CBL and DL sessions, and second, 6 weeks after the first posttest. Student and faculty feedback was taken about CBL sessions. Hundred MBBS students of the fourth semester voluntarily participated in the CBL study. The CBL scores were significantly higher than DL session scores ( P = 0.015). This difference was more marked in scoring done after 6 weeks of session completion ( P < 0.001). Student reported satisfaction in being taught by CBL method in 5-point Likert scale feedback form. Faculty feedback was positive for CBL. CBL helped in retention of knowledge and its application better than DL in our observation. More sessions on commonly encountered case scenarios will be useful for students in recalling basic science knowledge in their later years as practitioners.

  20. CHILD ABUSE IN A MEDICAL SETTING: CASE ILLUSTRATIONS OF TWO VARIANTS OF MUNCHAUSEN SINDROME BY PROXY.

    Directory of Open Access Journals (Sweden)

    Antonietta Lanzarone

    2017-04-01

    Full Text Available Munchausen syndrome is a complex type of abuse, which is often underdiagnosed or misdiagnosed in clinical practice, and has harmful consequences for children. Its relationship with child abuse, of which it is a variety, must be recognized in clinical and forensic practice. The authors report herein two observed cases of different types of Münchausen syndrome by proxy (MSbP. The first, is the most severe form of MSbP, with induced, true illness and related pathological symptoms into victim. The second case is a moderate form, much more complex to detect, in which a perpetrator parent simulates and aggravates the child‘s illness. Adequate training of health professionals and investigators is essential in revealing cases of MSbP. Diagnosis must be based on the study of the different forms of "abuse" and the knowledge of clinical protocols used to validate any suspected behaviour which could be potentially harmful to the child. Moreover, a lack of training may lead to misleading interpretations of medical history interpretation and fallacious conclusions. Our study aims to review the features that are to be considered in a suspected case of MSbP, in accordance with a recently updated consensus statement by the Committee on Child Abuse and Neglect from the American Academy of Pediatrics.

  1. Crossing boundaries: a comprehensive survey of medical licensing laws and guidelines regulating the interstate practice of pathology.

    Science.gov (United States)

    Hiemenz, Matthew C; Leung, Stanley T; Park, Jason Y

    2014-03-01

    In the United States, recent judicial interpretation of interstate licensure laws has found pathologists guilty of malpractice and, more importantly, the criminal practice of medicine without a license. These judgments against pathologists highlight the need for a timely and comprehensive survey of licensure requirements and laws regulating the interstate practice of pathology. For all 50 states, each state medical practice act and state medical board website was reviewed. In addition, each medical board was directly contacted by electronic mail, telephone, or US registered mail for information regarding specific legislation or guidelines related to the interstate practice of pathology. On the basis of this information, states were grouped according to similarities in legislation and medical board regulations. This comprehensive survey has determined that states define the practice of pathology on the basis of the geographic location of the patient at the time of surgery or phlebotomy. The majority of states (n=32) and the District of Columbia allow for a physician with an out-of-state license to perform limited consultation to a physician with the specific state license. Several states (n=5) prohibit physicians from consultation without a license for the specific state. Overall, these results reveal the heterogeneity of licensure requirements between states. Pathologists who either practice in multiple states, send cases to out-of-state consultants, or serve as consultants themselves should familiarize themselves with the medical licensure laws of the states from which they receive or send cases.

  2. A case study on better iconographic design in electronic medical records' user interface.

    Science.gov (United States)

    Tasa, Umut Burcu; Ozcan, Oguzhan; Yantac, Asim Evren; Unluer, Ayca

    2008-06-01

    It is a known fact that there is a conflict between what users expect and what user interface designers create in the field of medical informatics along with other fields of interface design. The objective of the study is to suggest, from the 'design art' perspective, a method for improving the usability of an electronic medical record (EMR) interface. The suggestion is based on the hypothesis that the user interface of an EMR should be iconographic. The proposed three-step method consists of a questionnaire survey on how hospital users perceive concepts/terms that are going to be used in the EMR user interface. Then icons associated with the terms are designed by a designer, following a guideline which is prepared according to the results of the first questionnaire. Finally the icons are asked back to the target group for proof. A case study was conducted with 64 medical staff and 30 professional designers for the first questionnaire, and with 30 medical staff for the second. In the second questionnaire 7.53 icons out of 10 were matched correctly with a standard deviation of 0.98. Also, all icons except three were matched correctly in at least 83.3% of the forms. The proposed new method differs from the majority of previous studies which are based on user requirements by leaning on user experiments instead. The study demonstrated that the user interface of EMRs should be designed according to a guideline that results from a survey on users' experiences on metaphoric perception of the terms.

  3. Integrating the results of user research into medical device development: insights from a case study.

    Science.gov (United States)

    Martin, Jennifer L; Barnett, Julie

    2012-07-19

    It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision making processes may assist manufacturers to take a more integrated and

  4. Integrating the results of user research into medical device development: insights from a case study

    Directory of Open Access Journals (Sweden)

    Martin Jennifer L

    2012-07-01

    Full Text Available Abstract Background It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. Methods A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. Results A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. Conclusion There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision

  5. Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

    Directory of Open Access Journals (Sweden)

    Martin Bac

    2015-05-01

    Full Text Available Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach. Aim: To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies. Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations. Method: Consecutive student groups had to engage with a hospital’s compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42, a written group report (n = 42 and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139. Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice. Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.

  6. Risk factors for prostate cancer in Universiti Kebangsaan Malaysia Medical Centre: a case-control study.

    Science.gov (United States)

    Subahir, Mohd Nizam; Shah, Shamsul Azhar; Zainuddin, Zulkifli Md

    2009-01-01

    In Malaysia, prostate cancer is ranked 6th among male cancer and expected to increase in the future. Several factors have shown to be related to prostate cancer such as sociodemographic, lifestyle, diet, occupational exposure, medical and health status. This is the first time a similar study was conducted in Malaysia to recognize the risk factors for prostate cancer patients who came for treatment at University Kebangsaan Malaysia Medical Centre (UKMMC). Prostate cancer cases diagnosed between 2003 and 2008 which met with the inclusion criteria were included in the study. One hundred and twelfth (112) pairs of cases and controls matched by age and ethnicity were analysed. McNemar Odds Ratios (OR(M)) were calculated using McNemar Calculator software for univariate analysis while conditional logistic regression was used for multivariate analysis, both using SPSS version 12.0. Most of the prostate cancer patients (68.8%) that came for treatment in UKMMC were above 70 years old. The majority were Chinese (50.0%) followed by Malay (46.4%) and Indian (3.6%). Multivariate analysis showed cases were more likely to have a first-degree relative with a history of cancer (OR= 3.77, 95% CI= 1.19-11.85), to have been exposed to pesticides (OR= 5.57, 95% CI= 1.75-17.78) and consumed more meat (OR= 12.23, 95% CI= 3.89-39.01). Significantly reduced risks of prostate cancer were noted among those consuming more vegetables (OR= 0.12, 95% CI= 0.02-0.84), more tomatoes (OR= 0.35, 95% CI= 0.13-0.93) and those who had frequent sexual intercourse (OR= 0.44, 95% CI= 0.19-0.96). Some lifestyle and occupation factors are strong predictors of the occurrence of prostate cancer among patients in UKMMC. More importantly, with the identification of the potentially modifiable risk factors, proper public health intervention can be improved.

  7. Medical intervention in case of nuclear or radiation event; Intervention medicale en cas d'evenement nucleaire ou radiologique

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, J.; Bourguignon, M.; Carli, P.; Carosella, E.; Challeton de Vathaire, C.; Court, L.; Ducousso, R.; Facon, A.; Fleutot, J.B.; Goldstein, P.; Gourmelon, P.; Herbelet, G.; Kolodie, H.; Lallemand, J.; Martin, J.C.; Menthonnex, P.; Masse, R.; Origny, S.; Pasnon, J.; Peton Klein, D.; Rougy, C.; Schoulz, D.; Romet, G.; Telion, C.; Vrousos, C

    2002-07-01

    This guide aims to be a practical tool for intervenors in case of nuclear or radiation accident. It proposes many sheets to favor the reactivity and the implementing of adapted measures. It concerns the course of action to take in case of irradiation accident or contamination and the reception in medical structure or a hospital. (A.L.B.)

  8. Medical intervention in case of nuclear or radiation event; Intervention medicale en cas d'evenement nucleaire ou radiologique

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, J; Bourguignon, M; Carli, P; Carosella, E; Challeton de Vathaire, C; Court, L; Ducousso, R; Facon, A; Fleutot, J B; Goldstein, P; Gourmelon, P; Herbelet, G; Kolodie, H; Lallemand, J; Martin, J C; Menthonnex, P; Masse, R; Origny, S; Pasnon, J; Peton Klein, D; Rougy, C; Schoulz, D; Romet, G; Telion, C; Vrousos, C

    2002-07-01

    This guide aims to be a practical tool for intervenors in case of nuclear or radiation accident. It proposes many sheets to favor the reactivity and the implementing of adapted measures. It concerns the course of action to take in case of irradiation accident or contamination and the reception in medical structure or a hospital. (A.L.B.)

  9. The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) - A systematic review of 796 cases.

    Science.gov (United States)

    Yates, Gregory; Bass, Christopher

    2017-10-01

    Little is known about the perpetrators of medical child abuse (MCA) which is often described as "Munchausen's syndrome by proxy" or "factitious disorder imposed on another". The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature. A systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes. Nearly all abusers were female (97.6%) and the victim's mother (95.6%). Most were married (75.8%). Mean caretaker age at the child's presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%). From the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias. Copyright © 2017. Published by Elsevier Ltd.

  10. The first 8 years: International Medical Case Reports Journal – summary of publications from 2008 to July 2016

    Directory of Open Access Journals (Sweden)

    Prineas RJ

    2017-03-01

    Full Text Available RJ Prineas,1 SG Fraser,2 CE Stevens31Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 2Sunderland Eye Infirmary, Sunderland, UK; 3Department of Epidemiology, New York Blood Center, New York, NY, USAThe case report has a secure place in medical reporting and medical history stretching back to hand-written manuscripts, early medical texts, and earliest medical scientific publications. As scientific methods took hold, fewer case histories were accepted for publication, being replaced by case series and then analyses from epidemiologic studies, clinical trials (controlled and otherwise, and reports of laboratory clinical practice. Clinicopathology conferences around reporting and presentation of separate cases continue to be convened for regular meetings in hospitals and medical schools for teaching purposes. Case reports appear regularly in sections of medical journals or, more recently, as separate journals devoted entirely to them. Further, open-access case report journals have increased in number markedly in the past decade in parallel with International Medical Case Reports Journal (IMCRJ submissions.1Since the beginning of the publication, the number of journal articles published in IMCRJ has increased steadily from 3 in the inauguration year (2008 to 69 in the latest full year of publication (Table 1, indicating the growing interest in disseminating such reports.The Journal, established by Dove Press, started publishing in 2008. During the first 8 years (until July 2016, published reports came from 50 separate countries (including articles from Africa, Asia, Europe UK, and USA. Sixty one percent of submitted reports (235/387 have been published, and 152 reports were rejected.The number of “reviewers” for each report ranged from 2 to 6, with an average of 3. The 3 leading countries submitting articles were the United States, Japan, and Turkey. Most papers have come from a single author

  11. Case based reasoning applied to medical diagnosis using multi-class classifier: A preliminary study

    Directory of Open Access Journals (Sweden)

    D. Viveros-Melo

    2017-02-01

    Full Text Available Case-based reasoning (CBR is a process used for computer processing that tries to mimic the behavior of a human expert in making decisions regarding a subject and learn from the experience of past cases. CBR has demonstrated to be appropriate for working with unstructured domains data or difficult knowledge acquisition situations, such as medical diagnosis, where it is possible to identify diseases such as: cancer diagnosis, epilepsy prediction and appendicitis diagnosis. Some of the trends that may be developed for CBR in the health science are oriented to reduce the number of features in highly dimensional data. An important contribution may be the estimation of probabilities of belonging to each class for new cases. In this paper, in order to adequately represent the database and to avoid the inconveniences caused by the high dimensionality, noise and redundancy, a number of algorithms are used in the preprocessing stage for performing both variable selection and dimension reduction procedures. Also, a comparison of the performance of some representative multi-class classifiers is carried out to identify the most effective one to include within a CBR scheme. Particularly, four classification techniques and two reduction techniques are employed to make a comparative study of multiclass classifiers on CBR

  12. Health inequalities, physician citizens and professional medical associations: an Australian case study

    Directory of Open Access Journals (Sweden)

    Naccarella Lucio

    2007-08-01

    Full Text Available Abstract Background As socioeconomic health inequalities persist and widen, the health effects of adversity are a constant presence in the daily work of physicians. Gruen and colleagues suggest that, in responding to important population health issues such as this, defining those areas of professional obligation in contrast to professional aspiration should be on the basis of evidence and feasibility. Drawing this line between obligation and aspiration is a part of the work of professional medical colleges and associations, and in doing so they must respond to members as well as a range of other interest groups. Our aim was to explore the usefulness of Gruen's model of physician responsibility in defining how professional medical colleges and associations should lead the profession in responding to socioeconomic health inequalities. Methods We report a case study of how the Royal Australian College of General Practitioners is responding to the issue of health inequalities through its work. We undertook a consultation (80 interviews with stakeholders internal and external to the College and two focus groups with general practitioners and program and policy review of core programs of College interest and responsibility: general practitioner training and setting of practice standards, as well as its work in public advocacy. Results Some strategies within each of these College program areas were seen as legitimate professional obligations in responding to socioeconomic health inequality. However, other strategies, while potentially professional obligations within Gruen's model, were nevertheless contested. The key difference between these lay in different moral orientations. Actions where agreement existed were based on an ethos of care and compassion. Actions that were contested were based on an ethos of justice and human rights. Conclusion Colleges and professional medical associations have a role in explicitly leading a debate about values

  13. The protracted demise of medical technology. The case of intermittent positive pressure breathing.

    Science.gov (United States)

    Duffy, S Q; Farley, D E

    1992-08-01

    In this study, the effects of hospital, staff, and patient characteristics on the rates of use and abandonment of an outmoded medical technology, intermittent positive pressure breathing (IPPB) are analyzed. The study focuses specifically on the use of IPPB to treat inpatients with chronic obstructive pulmonary disease in a national sample of more than 500 community hospitals from 1980 to 1987. Cross-sectionally, hospitals with shorter case-mix-adjusted lengths of stay, private nonprofit or investor-owned hospitals, and hospitals located outside of the north central United States were more likely to abandon IPPB by 1980. Teaching status, location, ownership, volume, and source of payment all appeared to affect rates of IPPB use in 1980. The longitudinal analysis examines both the probability a hospital abandoned IPPB and declines in rates of IPPB use over the study period, conditioned on the availability of IPPB in 1980. The results show that changes in the characteristics of hospitals, patients, and physicians all help to explain variations in the abandonment of IPPB. These findings contrast with previous studies of technological change, which find hospital size to be the most important variable. Size is important in explaining the rate of use in 1980, but it has no effect on the rate of decline in use or abandonment after 1980. In general, the analysis demonstrates that a combination of factors, economic incentives as well as information, contribute to the abandonment of outmoded medical technologies. Given the surprisingly long time periods required for this process to occur, the analysis underscores the need to strengthen financial incentives that encourage appropriate medical decisions and to disseminate information about the efficacy of specific procedures more widely and effectively.

  14. Evaluating Coding Accuracy in General Surgery Residents' Accreditation Council for Graduate Medical Education Procedural Case Logs.

    Science.gov (United States)

    Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason

    The Accreditation Council for Graduate Medical Education (ACGME) case log captures resident operative experience based on Current Procedural Terminology (CPT) codes and is used to track operative experience during residency. With increasing emphasis on resident operative experiences, coding is more important than ever. It has been shown in other surgical specialties at similar institutions that the residents' ACGME case log may not accurately reflect their operative experience. What barriers may influence this remains unclear. As the only objective measure of resident operative experience, an accurate case log is paramount in representing one's operative experience. This study aims to determine the accuracy of procedural coding by general surgical residents at a single institution. Data were collected from 2 consecutive graduating classes of surgical residents' ACGME case logs from 2008 to 2014. A total of 5799 entries from 7 residents were collected. The CPT codes entered by residents were compared to departmental billing records submitted by the attending surgeon for each procedure. Assigned CPT codes by institutional American Academy of Professional Coders certified abstract coders were considered the "gold standard." A total of 4356 (75.12%) of 5799 entries were identified in billing records. Excel 2010 and SAS 9.3 were used for analysis. In the event of multiple codes for the same patient, any match between resident codes and billing record codes was considered a "correct" entry. A 4-question survey was distributed to all current general surgical residents at our institution for feedback on coding habits, limitations to accurate coding, and opinions on ACGME case log representation of their operative experience. All 7 residents had a low percentage of correctly entered CPT codes. The overall accuracy proportion for all residents was 52.82% (range: 43.32%-60.07%). Only 1 resident showed significant improvement in accuracy during his/her training (p = 0

  15. Medical Students and Patient-Centred Clinical Practice: The Case for More Critical Work in Medical Schools

    Science.gov (United States)

    Donetto, Sara

    2012-01-01

    In the last two decades, undergraduate medical education in the United Kingdom has undergone several important changes. Many of these have revolved around a paradigmatic shift from "paternalistic" to "patient-centred" approaches to healthcare. Adopting a Foucauldian understanding of power and borrowing from Freire's critical…

  16. Remarkable Works and Cases in the History of Medical Mycology in Japan.

    Science.gov (United States)

    Nishimoto, Katsutaro

    2017-01-01

    Several pathogenic fungi and cases related to Japanese medical mycologists were reviewed. Trichosporon inkin (as Sarcinomyces inkin) was reported as a pathogen of scrotal lesion by Oho in 1921, and Trichosporon asahii was isolated from generalized keratotic lesions in 1922 by Akagi in Japan. They were once included in Trichophyton beigelii, but then based on revision using DNA molecular technology, were returned to their original names.Microsporum ferrugineum was reported by Ota as a causative dermatophyte of tinea capitis in Japan and surrounding areas. It was once classified under the genus Trichophyton, but after the discovery of characteristic rough-walled macroconidia belonging to genus Microsporum, the fungus was again assigned to the original name.

  17. Explanatory memorandum on European Community Document -mutual medical assistance in the case of a nuclear accident

    International Nuclear Information System (INIS)

    1987-01-01

    The report lists the Commissions proposals for further action on its suggestion of mutual health assistance in the event of a nuclear accident. These include surveys and studies, further research on the medical treatment of radiation casualties and the methodology of epidemiological investigations, the promotion of contacts between experts and the attempt to assemble a handbook listing facilities and procedures for mutual assistance. The memorandum explains some of the points further under the headings, ministerial responsibility, legal and procedural issues and policy implications. The United Kingdom position is then stated. The UK government welcomes the proposals provided there is no duplication of work already covered by the IAEA Convention on Assistance in the case of a Nuclear Accident or Radiological Emergency. (U.K.)

  18. Analysis of overexposure cases for female radiation workers in medical and research institutions in India

    International Nuclear Information System (INIS)

    Mahajan, J.M.; Massand, O.P.; Venkataraman, G.

    1996-01-01

    Radiation Protection Services Division, Bhabha Atomic Research Centre conducts country wide personnel monitoring service for 40,000 radiation workers, of which about 22,000 radiation workers are from industrial, medical and research institutions. The number of female radiation workers constitute about 5% of the total radiation workers monitored. Basis for control of occupational exposures of women are same as that for men except for pregnant women (foetus). Equivalent dose above 10 mSv in a service period is investigated as to the causes of exposure whether the exposure was really received by the worker (genuine) or only the monitoring badge received the exposure due to other reasons (non-genuine) and necessary remedial actions are taken. Analysis of overexposure cases in female radiation workers as a group has been done for the period of four years (1990-1993) and the conclusions are presented. (author). 2 refs., 4 tabs

  19. A case study: the evolution of a "facilitator model" liaison program in an academic medical library.

    Science.gov (United States)

    Crossno, Jon E; DeShay, Claudia H; Huslig, Mary Ann; Mayo, Helen G; Patridge, Emily F

    2012-07-01

    What type of liaison program would best utilize both librarians and other library staff to effectively promote library services and resources to campus departments? The case is an academic medical center library serving a large, diverse campus. The library implemented a "facilitator model" program to provide personalized service to targeted clients that allowed for maximum staff participation with limited subject familiarity. To determine success, details of liaison-contact interactions and results of liaison and department surveys were reviewed. Liaisons successfully recorded 595 interactions during the program's first 10 months of existence. A significant majority of departmental contact persons (82.5%) indicated they were aware of the liaison program, and 75% indicated they preferred email communication. The "facilitator model" provides a well-defined structure for assigning liaisons to departments or groups; however, training is essential to ensure that liaisons are able to communicate effectively with their clients.

  20. Mobile learning in resource-constrained environments: a case study of medical education.

    Science.gov (United States)

    Pimmer, Christoph; Linxen, Sebastian; Gröhbiel, Urs; Jha, Anil Kumar; Burg, Günter

    2013-05-01

    The achievement of the millennium development goals may be facilitated by the use of information and communication technology in medical and health education. This study intended to explore the use and impact of educational technology in medical education in resource-constrained environments. A multiple case study was conducted in two Nepalese teaching hospitals. The data were analysed using activity theory as an analytical basis. There was little evidence for formal e-learning, but the findings indicate that students and residents adopted mobile technologies, such as mobile phones and small laptops, as cultural tools for surprisingly rich 'informal' learning in a very short time. These tools allowed learners to enhance (a) situated learning, by immediately connecting virtual information sources to their situated experiences; (b) cross-contextual learning by documenting situated experiences in the form of images and videos and re-using the material for later reflection and discussion and (c) engagement with educational content in social network communities. By placing the students and residents at the centre of the new learning activities, this development has begun to affect the overall educational system. Leveraging these tools is closely linked to the development of broad media literacy, including awareness of ethical and privacy issues.

  1. REGULATION OF AUSTRALIAN MEDICAL PROFESSIONALS AND NATIONAL SECURITY: LESSONS FROM THREE CASE STUDIES.

    Science.gov (United States)

    Faunce, Thomas; McKenna, Michael; Rayner, Johanna; Hawes, Jazmin

    2016-03-01

    In recent times, Australia's national security concerns have had controversial impacts on regulation of Australian medical practitioners in areas related to immigration detention. This column explores three recent case studies relevant to this issue. The first involves the enactment of the Australian Border Force Act 2015 (Cth), which has a significant impact on the regulation of medical professionals who work with people in immigration detention. The second involves the decision of the High Court of Australia in Plaintiff M68/2015 v Minister for Immigration and Border Protection [2016] HCA 1 that an amendment to Australian federal legislation justified sending children back to immigration detention centres in Papua New Guinea and Nauru. This legislation was previously heavily criticised by the Australian Human Rights Commissioner. The third concerns the deregistration of Tareq Kamleh, an Australian doctor of German-Palestinian heritage who came to public attention on ANZAC Day 2015 with his appearance online in a propaganda video for the Islamic State terrorist organisation al-Dawla al-Islamyia fil Iraq wa'al Sham, also known as Islamic State of Iraq and Syria (ISIS) or Daesh. Australia's professional regulatory system should presumptively respect professional virtues, such as loyalty to the relief of individual patient suffering, when dealing with doctors (whether in Australia or ISIS-occupied Syria) working under regimes whose principles appear inconsistent with those of ethics and human rights.

  2. A case study from the perspective of medical ethics: refusal of treatment in an ambulance.

    Science.gov (United States)

    Erbay, Hasan; Alan, Sultan; Kadıoğlu, Selim

    2010-11-01

    This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. 'If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,' he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?

  3. Medical incidents in developing countries: A few case studies from Nigeria.

    Science.gov (United States)

    Chukwuneke, F N

    2015-12-01

    The moral worth of a clinician's, action in patients' management depends exclusively on the moral acceptability of the rule of obligation to duty on which the clinician acts. Since every rational being thinks of him or herself as an end, all people must act in such a way that they treat humanity, whether in their own person or in the person of another, always as an end and never simply as a means. A duty of care is, therefore, paramount in the relationship between clinician and patient. While litigation in healthcare system is rapidly increasing globally, which affords individual explanation and compensation for perceived wrong diagnosis and treatment; it is still rudimentary in Nigeria. This default position has made most health care providers indifferent in the presence of gross clinical negligence and medical errors. Though most Nigerians may be aware of their rights to institute legal action in situations such as, negligence with serious harm or death, but, the socioeconomic factors, cultural, and religious notions among other reasons within the society often makes litigation impossible for an individual. Attributing every medical adverse event in the course of treatment as "God's Will" and the saying "It's God's Time" for every death among most African people has also become a great impediment to curbing clinical negligence in our environment. This paper presents a few case studies from author's experience and complaints from patients during clinical practice.

  4. Identification of primary thyroid lymphoma with medical imaging: A case report and review of the literature.

    Science.gov (United States)

    Wang, Jia-Huan; Chen, Liang; Ren, Ke

    2014-12-01

    Primary thyroid lymphoma (PTL) is a rare thyroid malignancy. Clinical diagnosis of PTL may not be easily established based on imaging studies, as the imaging features of PTL are similar to those of lymphocytic thyroiditis and primary thyroid cancer. The present study describes the case of a patient who was confirmed to have PTL by intra-operative pathological diagnosis. On color Doppler ultrasound, the PTL was shown as a significantly enlarged thyroid with reduced gland echoes. Color Doppler flow imaging showed increased blood flow. By computed tomography, the thyroid was revealed to be enlarged with reduced tissue density, particularly in the left lobe and the isthmus. In addition, calcified spots and swollen lymph nodes were evident. The clinical history of the patient was obtained and the imaging results were retrospectively analyzed. The imaging features of PTL were investigated through reviewing the literature. PTL exhibits specific features on medical imaging that aid in distinguishing it from other thyroid diseases. PTL exhibits specific features on medical imaging that aid in distinguishing PTL from other thyroid diseases, which may aid the support for clinical diagnosis and improve the clinical accuracy.

  5. Diagnostic x-ray in use in federal medical centre, case study Makurdi metropolis

    International Nuclear Information System (INIS)

    Onoja, R.A.; Fiase, J.O.

    2009-01-01

    Every year more than two thousand patients go for routine medical check-up at the Federal Medical Centre using diagnostic x-rays. This paper is based on a study to determine the entrance surface doses per radiograph of 108 patients that had diagnostic examinations at the Federal Medical Centre Makurdi. The examinations considered in this study are chest x-ray examinations, abdomen, skull and other extremities, for both adults and children. The results show that the mean entrance surface doses of PA chest x-ray for female range between 237-275μGy, for male is between 1183-297μGy, and for children range between 47-237μGy. The AP chest x-ray for female range between 1943-3440μGy, for male is between 1583-3484μGy and for children it ranges between 177-451μGy. The PA examination of the skull for adult female ranged between 117-787μGy, for male it ranged between 117-532μGy and children from 472-948μGy. Also for the AP examination for skull the adult female mean entrance surface doses range from 129-798μGy, for the male it range from 145-178μGy and for children 138-650μGy. The AP abdomen for adult female produces a mean entrance surface doses range between 620-682μGy, for the male is between 105-930μGy, and children it range between 144-398μGy. In the case of extremities AP examination are between the range of 173-468μGy for adult female, 300-595μGy for adult male and between 254-887μGy for the children. In the case of extremities PA examination mean entrance surface doses are between the range of 145-517μGy for adult female, 363-517μGy for adult male and between 130-566μGy for the children. The data shows that the entrance surface doses due to the x-ray examination for adult and children are within the ICRP guidance levels. These guidance levels of dose for diagnostic radiography for a typical adult patient are 10 mGy for AP abdomen, 0.4 mGy PA chest, 7 mGy for AP chest and 5 mGy for PA skull

  6. Arabicization in high education: The case of medical colleges in the Sudan

    Science.gov (United States)

    El-Fadni Suliman, Issameldin

    This thesis explores language policies, language conflict and language-user attitudes toward arabicization which refers to the use of Arabic as a medium of instruction in teaching medicine in universities in the Sudan. It follows up these objectives: (1) To highlight the roots of arabicization and implemented language planning activities through document analysis. (2) To report on the advantages and disadvantages of both Arabic and English as media of instruction in teaching medicine in the Sudan. (3) To survey the attitudes of students and their instructors in the colleges of Khartoum, Omdurman and Gezira universities towards arabicization using two similar developed questionnaires and an interview for faculty members. The questionnaires were distributed to the students and faculty members in the three colleges to probe six factors: (I) The extent of use of languages of instruction (2) Readiness of the students to receive medical studies in English (3) The difficulties they face (4) English as a medium of instruction in medical colleges (5) Arabic as a medium of instruction in medical colleges (6) Students' preference of a language of instruction. The study utilized tables, charts and chi square tests to illustrate the attitudes of students and their faculty members. The study has revealed that the attitude of most of the students and their faculty members were in favor of arabicization in principle. In fact, students showed support for the pedagogical benefits of Arabic like they can prepare and study in Arabic in less time than English. They can take more notes in Arabic than in English. The study has highlighted that Arabic as a native language of the students offers them a mighty and indispensable support for the ability to convey ideas, capacity for imaginative or creative thinking than the limited capacity given by the foreign language. Notwithstanding, English is reported to be very important for students' current medical studies and future career. The

  7. Solidarity by demand? Exit and voice in international medical travel - The case of Indonesia

    NARCIS (Netherlands)

    Ormond, M.E.

    2015-01-01

    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts

  8. Effectiveness of Medical-Care Equipment Management: Case Study in a Public Hospital in Belo Horizonte / Minas Gerais

    OpenAIRE

    Estevão Maria Campolina de Oliveira; Eloísa Helena Rodrigues Guimaraes; Ester Eliane Jeunon

    2017-01-01

    This study aimed to identify and analyze the factors that contribute to the effectiveness of the management of medical-care equipment at the Hospital of Federal University of Minas Gerais (HC-UFMG) in Belo Horizonte, Minas Gerais. To achieve this goal, a case study was performed along with a field research at HC-UFMG, through interviews using a semi-structured questionnaire to professionals who handle and operate medical-care equipment; professionals who provide maintenance on equipment, and ...

  9. [Burden of proof in medical cases--presumption of fact and prima facie evidence. 1. Burden of proof].

    Science.gov (United States)

    Sliwka, Marcin

    2004-01-01

    The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. This paper also describes the subject of evidence were presented and explained. The court influence on evidence procedure was also analysed. The effect of the institution of informed consent on burden of proof in polish civil law is also described. This paper includes numerous High Court sentences on evidential and medical issues.

  10. Preclinical diagnosis and emergency medical care in case of radiation accidents

    International Nuclear Information System (INIS)

    Ohlenschlaeger, L.

    1990-01-01

    Reference is made to preclinical diagnosis and emergency medical care at the site of a potential radiation accident. Possibilities and limits, respectively, of the medical measures are shown. Cooperation between the experts of the technical and medical rescue services is described. Exposition to radiation for the emergency medical staff resulting from the medical care of contaminated persons, is negligible if the personal precautions are observed. (orig.) [de

  11. Clinical errors and medical negligence.

    Science.gov (United States)

    Oyebode, Femi

    2013-01-01

    This paper discusses the definition, nature and origins of clinical errors including their prevention. The relationship between clinical errors and medical negligence is examined as are the characteristics of litigants and events that are the source of litigation. The pattern of malpractice claims in different specialties and settings is examined. Among hospitalized patients worldwide, 3-16% suffer injury as a result of medical intervention, the most common being the adverse effects of drugs. The frequency of adverse drug effects appears superficially to be higher in intensive care units and emergency departments but once rates have been corrected for volume of patients, comorbidity of conditions and number of drugs prescribed, the difference is not significant. It is concluded that probably no more than 1 in 7 adverse events in medicine result in a malpractice claim and the factors that predict that a patient will resort to litigation include a prior poor relationship with the clinician and the feeling that the patient is not being kept informed. Methods for preventing clinical errors are still in their infancy. The most promising include new technologies such as electronic prescribing systems, diagnostic and clinical decision-making aids and error-resistant systems. Copyright © 2013 S. Karger AG, Basel.

  12. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports.

    Science.gov (United States)

    Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H; Plazzi, Giuseppe

    2014-08-15

    To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.

  13. Antipsychotic Medications and Risk of Acute Coronary Syndrome in Schizophrenia: A Nested Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hsing-Cheng Liu

    Full Text Available This study assessed the risk of developing acute coronary syndrome requiring hospitalization in association with the use of certain antipsychotic medications in schizophrenia patients.A nationwide cohort of 31,177 inpatients with schizophrenia between the ages of 18 and 65 years whose records were enrolled in the National Health Insurance Research Database in Taiwan from 2000 to 2008 and were studied after encrypting the identifications. Cases (n = 147 were patients with subsequent acute coronary syndrome requiring hospitalization after their first psychiatric admission. Based on a nested case-control design, each case was matched with 20 controls for age, sex and the year of first psychiatric admission using risk-set sampling. The effects of antipsychotic agents on the development of acute coronary syndrome were assessed using multiple conditional logistic regression and sensitivity analyses to confirm any association.We found that current use of aripiprazole (adjusted risk ratio [RR] = 3.68, 95% CI: 1.27-10.64, p<0.05 and chlorpromazine (adjusted RR = 2.96, 95% CI: 1.40-6.24, p<0.001 were associated with a dose-dependent increase in the risk of developing acute coronary syndrome. Although haloperidol was associated with an increased risk (adjusted RR = 2.03, 95% CI: 1.20-3.44, p<0.01, there was no clear dose-dependent relationship. These three antipsychotic agents were also associated with an increased risk in the first 30 days of use, and the risk decreased as the duration of therapy increased. Sensitivity analyses using propensity score-adjusted modeling showed that the results were similar to those of multiple regression analysis.Patients with schizophrenia who received aripiprazole, chlorpromazine, or haloperidol could have a potentially elevated risk of developing acute coronary syndrome, particularly at the start of therapy.

  14. A radiological case collection with interactive character as a new element in the education of medical students

    International Nuclear Information System (INIS)

    Heye, T.; Kurz, P.; Eiers, M.; Kauffmann, G.W.; Schipp, A.

    2008-01-01

    Purpose: evaluation of an interactive, multimedia case-based learning platform for the radiological education of medical students. Materials and methods: an interactive electronic learning platform for the education of medical students was built in html format independent of the operating system in the context of the Heidelberg Curriculum Medicinale (HeiCuMed). A case collection of 30 common and authentic clinical cases is used as the central theme and clinical background. The user has to work on each case by making decisions regarding a selection of diagnostic modalities and by analyzing the chosen studies. After a reasonable selection and sequence of diagnostic radiological modalities and their interpretation, a diagnosis has to be made. An extensive collection of normal findings for any modality is available for the user as a reference in correlation with the pathology at anytime within each case. The case collection consists of 2053 files with 1109 Internet pages (html) and 869 image files (jpeg) with approximately 10 000 crosslinks (links). The case collection was evaluated by a questionnaire (scale 1 - 5) at the end of the radiological student course. The development of the results of the radiological course exam was analyzed to investigate any effect on the learning performance after the case collection was introduced. Results: 97.6% of the course participants would use the case collection beyond the radiological student course to learn radiology in their medical studies. The handling of the case collection was rated excellent in 36.9%, good in 54.6%, satisfactory in 8% and unsatisfactory in 0.4%. 41% felt that the case collection was overall excellent, 49.2% good, 7.8% satisfactory, 1.6% unsatisfactory and 0.4% poor. A positive trend in the development of the results in the radiological course exam with less variance after the introduction of the case collection was found but failed statistical significance. (orig.)

  15. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges.

    Science.gov (United States)

    Fais, Paolo; Viero, Alessia; Viel, Guido; Giordano, Renzo; Raniero, Dario; Kusstatscher, Stefano; Giraudo, Chiara; Cecchetto, Giovanni; Montisci, Massimo

    2018-04-07

    Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.

  16. Ethical dilemmas in medical humanitarian practice: cases for reflection from Médecins Sans Frontières.

    Science.gov (United States)

    Sheather, Julian; Shah, Tejshri

    2011-03-01

    Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. Ethical dilemmas can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations.

  17. Medical knowledge and the improvement of vernacular languages in the Habsburg Monarchy: a case study from Transylvania (1770-1830).

    Science.gov (United States)

    Sechel, Teodora Daniela

    2012-09-01

    In all European countries, the eighteenth century was characterised by efforts to improve the vernaculars. The Transylvanian case study shows how both codified medical language and ordinary language were constructed and enriched by a large number of medical books and brochures. The publication of medical literature in Central European vernacular languages in order to popularise new medical knowledge was a comprehensive programme, designed on the one hand by intellectual, political and religious elites who urged the improvement of the fatherland and the promotion of the common good by perfecting the arts and sciences. On the other hand, the imperial administration's initiatives affected local forms of medical knowledge and the construction of vernacular languages. In the eighteenth century, the construction of vernacular languages in the Habsburg Monarchy took on a significant political character. However, in the process of building of the scientific and medical vocabulary, the main preoccupation was precision, clarity and accessibility of the neologisms being invented to encompass the medical phenomena being described. In spite of political conflicts among the 'nations' living in Transylvania, physicians borrowed words from German, Hungarian and Romanian. Thus they elevated several words used in everyday language to the upper social stratum of language use, leading to the invention of new terms to describe particular medical practices or phenomena. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Apologies and Medical Error

    Science.gov (United States)

    2008-01-01

    One way in which physicians can respond to a medical error is to apologize. Apologies—statements that acknowledge an error and its consequences, take responsibility, and communicate regret for having caused harm—can decrease blame, decrease anger, increase trust, and improve relationships. Importantly, apologies also have the potential to decrease the risk of a medical malpractice lawsuit and can help settle claims by patients. Patients indicate they want and expect explanations and apologies after medical errors and physicians indicate they want to apologize. However, in practice, physicians tend to provide minimal information to patients after medical errors and infrequently offer complete apologies. Although fears about potential litigation are the most commonly cited barrier to apologizing after medical error, the link between litigation risk and the practice of disclosure and apology is tenuous. Other barriers might include the culture of medicine and the inherent psychological difficulties in facing one’s mistakes and apologizing for them. Despite these barriers, incorporating apology into conversations between physicians and patients can address the needs of both parties and can play a role in the effective resolution of disputes related to medical error. PMID:18972177

  19. Medical Tourism Destination SWOT Analysis: A Case Study of Malaysia, Thailand, Singapore and India

    Directory of Open Access Journals (Sweden)

    Wong Kee Mun

    2014-01-01

    Full Text Available The growth of global medical tourism in the recent years had spurred the interest of many governments to join in the bandwagon, particularly from Asia. Using the SWOT analytical model, this paper provides pertinent comparative analysis of the medical tourism destinations here being Malaysia, Thailand, Singapore and India. Each destination possesses its own value propositions to convince the demands of medical tourists. Malaysia and Thailand have a good mixture of elements (medical, tourism and wellness to be an excellent medical tourism destination while Singapore and India need further development in some of these elements. Meeting or exceeding the medical tourists’ expectations and requirements are the priority of medical tourism destination marketers in ensuring a successful medical tourism industry development.

  20. Medical Tourism Destination SWOT Analysis: A Case Study of Malaysia, Thailand, Singapore and India

    OpenAIRE

    Wong Kee Mun; Velasamy Peramarajan; Tengku Arshad Tengku Nuraina

    2014-01-01

    The growth of global medical tourism in the recent years had spurred the interest of many governments to join in the bandwagon, particularly from Asia. Using the SWOT analytical model, this paper provides pertinent comparative analysis of the medical tourism destinations here being Malaysia, Thailand, Singapore and India. Each destination possesses its own value propositions to convince the demands of medical tourists. Malaysia and Thailand have a good mixture of elements (medical, tourism an...

  1. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports.

    Science.gov (United States)

    Brown, Amy C; Hairfield, Michelle; Richards, Douglas G; McMillin, David L; Mein, Eric A; Nelson, Carl D

    2004-09-01

    This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the Psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the Psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post-test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.

  2. Using death certificates and medical examiner records for adolescent occupational fatality surveillance and research: a case study.

    Science.gov (United States)

    Rauscher, Kimberly J; Runyan, Carol W; Radisch, Deborah

    2012-01-01

    Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that

  3. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  4. Integral Health Care As A Guiding Axis Of Medical Training: Case Studies

    Directory of Open Access Journals (Sweden)

    Alcides Viana de Lima Neto

    2017-04-01

    Full Text Available Objective: The aim is to report the experiences during the practical experiences in the territory assigned to a basic health unit provided by the module of Integral Health Care I. Methods: Case studies resulting from a process of critical reflections about practical experiences by medical students in a basic health unit from August to December 2015. Results: Through the module of Integral Health Care I, students were allowed to recognize the assigned area of a family health team, as well as to develop the territorialization process and to classify the demographic, epidemiological, socioeconomic and environmental profile in that place; in addition to perform other activities as a singular therapeutic project and intervention project. Conclusion: The activities developed motivated the students to be able to apply the concepts of family and community medicine in primary health care, in addition to bringing them closer to the reality of this work process. Descriptors: Integral Health Care; Family Health Strategy; Physician-Patient Relationship; Basic Health Unit.

  5. Enhancing active learning in microbiology through case based learning: experiences from an Indian medical school.

    Science.gov (United States)

    Ciraj, A M; Vinod, P; Ramnarayan, K

    2010-01-01

    Case-based learning (CBL) is an interactive student-centered exploration of real life situations. This paper describes the use of CBL as an educational strategy for promoting active learning in microbiology. CBL was introduced in the microbiology curriculum for the second year medical students after an orientation program for faculty and students. After intervention, the average student scores in CBL topics were compared with scores obtained in lecture topics. An attempt was also made to find the effect of CBL on the academic performance. Student and faculty perception on CBL were also recorded. In a cross sectional survey conducted to assess the effectiveness of CBL, students responded that, apart from helping them acquire substantive knowledge in microbiology, CBL sessions enhanced their analytic, collaborative, and communication skills. The block examination scores in CBL topics were significantly higher than those obtained for lecture topics. Faculty rated the process to be highly effective in stimulating student interest and long term retention of microbiology knowledge. The student scores were significantly higher in the group that used CBL, compared to the group that had not used CBL as a learning strategy. Our experience indicated that CBL sessions enhanced active learning in microbiology. More frequent use of CBL sessions would not only help the student gain requisite knowledge in microbiology but also enhance their analytic and communication skills.

  6. Medical approach to the treatment of feline injection site sarcoma with masitinib: a case report

    Directory of Open Access Journals (Sweden)

    Ledoux JM

    2014-09-01

    Full Text Available Jean-Marie Ledoux,1 Pascal Brun,2 Tom Chapuis,2 Paul Dumas,3 Jean Guillotin41Veterinary Surgery, Lys-Lez-Lannoy, 2AB Science, Paris, 3Laboratoire de Pathologie Vétérinaire du Nord, Annœullin, 4Laboratoire Départemental Public, Villeneuve d'Ascq, FranceAbstract: Feline injection site sarcoma is a common tumor among cats, for which existing medical treatments do not prove to be entirely satisfactory. In this tumor, the platelet-derived growth factor receptor, a tyrosine kinase receptor, is frequently hyperactivated. In the past, clinical case reports with imatinib, a tyrosine kinase inhibitor (TKI, have demonstrated tumoral stabilization. Here we describe the use of another TKI, masitinib, which specifically inhibits c-Kit, platelet-derived growth factor receptor, and Lyn, and is currently licensed for veterinary use in canine mast cell tumors. The therapeutic results were initially satisfactory, with regression of the tumor followed by tumoral recurrence which was stabilized and moderately reduced. Further studies are suggested, in order to evaluate the relevance of TKIs in the treatment and prevention of recurrences of feline injection site sarcoma. Tumoral stabilization by means of an inexpensive and reasonably well tolerated treatment would prove to be of true therapeutic relevance, in particular for inoperable feline injection site sarcomas. Another indication for such TKIs could be in preoperative treatment as a means of facilitating surgical excision by reduction of adhesions.Keywords: fibrosarcoma, imatinib, platelet-derived growth factor receptor, tyrosine kinase receptor

  7. ROLE OF MEDICAL REHABILITATION TREATMENT IN POST-POLIO SYNDROME – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    DOGARU Gabriela

    2015-05-01

    Full Text Available The term post-polio syndrome (PPS was introduced in 1985 by Halstead. It is characterized by sudden or progressive muscle weakness, new muscular atrophy, muscle pain, fatigue, functional impotence, cold intolerance, after a period of at least 15 years from acute polio virus infection, a period of neurological and functional stability, in the absence of other medical explanation [1]. The reported prevalence of PPS is between 15% and 80% of all patients with previous polio virus infections [2, 3]. Poliomyelitis continues to be a public health problem, because the consequences of the disease last throughout life. In Europe, there are about 700,000 persons who survived the infection and are still alive. Non-randomized studies with kinesitherapy programs with a duration between 6 weeks and 7 months, involving isokinetic and isometric endurance muscle training, have demonstrated an increase of muscle strength in the case of patients with mild or moderate muscle weakness, and a reduction of muscle fatigue [7, 8, 9]. The differential diagnosis of PPS can be difficult because of the need to exclude both neurological and non-neurological conditions that aggravate the pre-existing motor deficit. Rehabilitation programs using therapeutic means: kinesitherapy, thermotherapy, hydrothermotherapy, occupational therapy represent the only way to limit functional deficit and to improve pain, playing an important role in the long-term management and care of patients.

  8. Mapping "region" in Canadian medical history: the case of British Columbia.

    Science.gov (United States)

    Davies, M J

    2000-11-01

    The notion of "region" can be a valuable analytical tool in the writing of Canadian medical history. This article explores themes in the history of British Columbia that link medicine and regional development. Employing a historiographical sweep from the colonial period to the 1970s, the author considers doctors and imperialism, medical practice and the economy, and the relationship between metropolis and periphery in shaping medical institutions and medical culture in the western province. The intent of the piece is to stimulate thought about the potential of introducing the sense of place into regional medical history in Canada.

  9. Enhancing the power of genetic association studies through the use of silver standard cases derived from electronic medical records.

    Directory of Open Access Journals (Sweden)

    Andrew McDavid

    Full Text Available The feasibility of using imperfectly phenotyped "silver standard" samples identified from electronic medical record diagnoses is considered in genetic association studies when these samples might be combined with an existing set of samples phenotyped with a gold standard technique. An analytic expression is derived for the power of a chi-square test of independence using either research-quality case/control samples alone, or augmented with silver standard data. The subset of the parameter space where inclusion of silver standard samples increases statistical power is identified. A case study of dementia subjects identified from electronic medical records from the Electronic Medical Records and Genomics (eMERGE network, combined with subjects from two studies specifically targeting dementia, verifies these results.

  10. Association of Research Self-Efficacy with Medical Student Career Interests, Specialization, and Scholarship: A Case Study

    Science.gov (United States)

    Bierer, S. Beth; Prayson, Richard A.; Dannefer, Elaine F.

    2015-01-01

    This study used variables proposed in social cognitive career theory (SCCT) to focus the evaluation of a research curriculum at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CCLCM). Eight cohorts of CCLCM medical students completed a web-based version of the six-scale Clinical Research Appraisal…

  11. Gastroschisis in Europe - A Case-malformed-Control Study of Medication and Maternal Illness during Pregnancy as Risk Factors

    DEFF Research Database (Denmark)

    Given, Joanne E; Loane, Maria; Garne, Ester

    2017-01-01

    BACKGROUND: Gastroschisis, a congenital anomaly of the abdomen, is associated with young maternal age and has increased in prevalence in many countries. Maternal illness and medication exposure are among environmental risk factors implicated in its aetiology. METHODS: A population-based case-malf...

  12. A case report of over-the-counter codeine dependence as consequence of self-medication for premature ejaculation

    Directory of Open Access Journals (Sweden)

    Sethulakshmi Sreevalsam Anil

    2017-01-01

    Full Text Available Over-the-counter (OTC opioid abuse, including codeine, has been a growing problem around the world. Although the majority of the abusers use it for recreational purposes, many become dependent on it after having used it a medication for pain or cough. We present a case of codeine dependence where the initial prescribed use had been as a cough medication, but the subsequent abuse of it occurred the following self-medication for premature ejaculation. There is growing need for awareness among doctors and pharmacists of OTC abuse of opioids and for preventive interventions such as restricting supply, audit of pharmacies, training pharmacists, and counter staff and dispensing knowledge about proper use of opioid-containing medications to patients.

  13. Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study.

    Science.gov (United States)

    Tomlinson, Emily Jane; Phillips, Nicole M; Mohebbi, Mohammadreza; Hutchinson, Alison M

    2017-03-01

    To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and

  14. The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

    Science.gov (United States)

    Farre, Albert; Heath, Gemma; Shaw, Karen; Jordan, Teresa; Cummins, Carole

    2017-04-01

    Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

  15. Treatment errors resulting from use of lasers and IPL by medical laypersons: results of a nationwide survey.

    Science.gov (United States)

    Hammes, Stefan; Karsai, Syrus; Metelmann, Hans-Robert; Pohl, Laura; Kaiser, Kathrine; Park, Bo-Hyun; Raulin, Christian

    2013-02-01

    The demand for hair and tattoo removal with laser and IPL technology (intense pulsed light technology) is continually increasing. Nowadays these treatments are often carried out by medical laypersons without medical supervision in franchise companies, wellness facilities, cosmetic institutes and hair or tattoo studios. This is the first survey is to document and discuss this issue and its effects on public health. Fifty patients affected by treatment errors caused by medical laypersons with laser and IPL applications were evaluated in this retrospective study. We used a standardized questionnaire with accompanying photographic documentation. Among the reports there were some missing or no longer traceable parameters, which is why 7 cases could not be evaluated. The following complications occurred, with possible multiple answers: 81.4% pigmentation changes, 25.6% scars, 14% textural changes and 4.6% incorrect information. The sources of error (multiple answers possible) were the following: 62.8% excessively high energy, 39.5% wrong device for the indication, 20.9% treatment of patients with darker skin or marked tanning, 7% no cooling, and 4.6% incorrect information. The causes of malpractice suggest insufficient training, inadequate diagnostic abilities, and promising unrealistic results. Direct supervision by a medical specialist, comprehensive experience in laser therapy, and compliance with quality guidelines are prerequisites for safe laser and IPL treatments. Legal measures to make such changes mandatory are urgently needed. © The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  16. “Malasanità” and/or malpractice: a bioethical view

    Directory of Open Access Journals (Sweden)

    Renato Malta

    2013-05-01

    Full Text Available BACKGROUND Inspired by a series of newspaper articles, the authors consider the different semantic meaning of the Italian word “malasanità” and the English word “malpractice”. They feel that many cases of “malasanità” are rarely due to technical problems, which are rarely proven in a trial, but mainly to the ethical problems. They claim that ethics lead human behaviour particularly in healthcare, as can be seen in the loving care of the patients. Patients take free medical service as granted and appreciate the personal behaviour and the empathy of the doctors. Today the practice of informed consent is the failure of the relationship between physician and patient. Medicine should be humanized not through technical improvements, but through ethics. AIM OF THE PAPER By the analysis of single cases the healthcare operator’s behaviour and actions are studied, as well as the authentic humanity of the professionals called to help other people. CONCLUSIONS When dealing with a single case, the media use the word “malasanità” globally, as if the whole healthcare system was responsible. The authors, criticizing both the terminology and the interpretation, prefer to proceed to the analysis of the single case, without ignoring however the many lacks and faults that occurred during the hospitalization.

  17. Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

    Science.gov (United States)

    Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati

    2018-05-18

    Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death

  18. Medical intervention in case of a nuclear or radiological event - national guide, release V3.6

    International Nuclear Information System (INIS)

    Ammerich, M.; Giraud, J.M.; Helfer, N.; Menetrier, F.; Schoulz, D.; Blanc, J.; Vilain, D.; Boll, H.; Bourguignon, M.; Chappe, P.; Mehl-Auget, I.; Carli, P.; Telion, C.; Carosella, E.; Castagnet, X.; Romet, G.; Ducousso, R.; Challeton de Vathaire, C.; Gourmelon, P.; Herbelet, G.; Martin, J.C.; Chicorp, J.; Cosset, J.M.; Court, L.; Lallemand, J.; Facon, A.; Goldstein, P.; Fleutot, J.B.; Geneau, C.; Kolodie, H.; Vrousos, C.; Lachenaud, L.; Maison, D.; Masse, R.; Massiot, P.; Menthonnex, P.; Origny, S.; Peton Klein, D.; Pasnon, J.; Quesne, B.; Rougy, C.; Sapori, JM.; Talbot, JN.; Van Rechem, M.

    2008-01-01

    This guide proposes a set of thematic sheets which address the following topics: generalities (intervention strategy, categories of casualties, definitions, emergency medical care organisation), taking into care in case of irradiation (generalities, clinical observation, additions examinations, localized acute external irradiation), cross-examination and description of circumstances, behaviour in case of contamination (general principles, rescuers protection, first gestures, etc.), behaviour in case of radio-combined lesions, reception in proximity medical structures and in a hospital. Some technical sheets are also proposed. They address how to handle a radio-contaminated casualty, how to undress a lying or a valid casualty, protection means (clothes, masks, gloves), dosimetry means, detection means, specific antidotes and other medicines

  19. Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

    Directory of Open Access Journals (Sweden)

    Fabiana Kotovicz

    2018-01-01

    Full Text Available Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. Results: Four overarching themes regarding health care for refugee patients were identified: 1 difficulty balancing the dynamic of autonomy versus support for refugees; 2 educational needs of refugee families outpacing available resources; 3 challenges for refugees developing trust; and 4 diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits. Conclusions: Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.

  20. The timing of drug funding announcements relative to elections: a case study involving dementia medications.

    Directory of Open Access Journals (Sweden)

    Sudeep S Gill

    Full Text Available Following initial regulatory approval of prescription drugs, many factors may influence insurers and health systems when they decide whether to add these drugs to their formularies. The role of political pressures on drug funding announcements has received relatively little attention, and elections represent an especially powerful form of political pressure. We examined the temporal relationship between decisions to add one class of drugs to publicly funded formularies in Canada's ten provinces and elections in these jurisdictions.Dates of provincial formulary listings for cholinesterase inhibitors, which are drugs used to treat Alzheimer's disease and related dementias, were compared to the dates of provincial elections. Medical journal articles, media reports, and proceedings from provincial legislatures were reviewed to assemble information on the chronology of events. We tested whether there was a statistically significant increase in the probability of drug funding announcements within the 60-day intervals preceding provincial elections.Decisions to fund the cholinesterase inhibitors were made over a nine-year span from 1999 to 2007 in the ten provinces. In four of ten provinces, the drugs were added to formularies in a time period closely preceding a provincial election (P = 0.032; funding announcements in these provinces were made between 2 and 47 days prior to elections. Statements made in provincial legislatures highlight the key role of political pressures in these funding announcements.Impending elections appeared to affect the timing of drug funding announcements in this case study. Despite an established structure for evidence-based decision-making, drug funding remains a complex process open to influence from many sources. Awareness of such influences is critical to maintain effective drug policy and public health decision-making.

  1. The timing of drug funding announcements relative to elections: a case study involving dementia medications.

    Science.gov (United States)

    Gill, Sudeep S; Gupta, Neeraj; Bell, Chaim M; Rochon, Paula A; Austin, Peter C; Laupacis, Andreas

    2013-01-01

    Following initial regulatory approval of prescription drugs, many factors may influence insurers and health systems when they decide whether to add these drugs to their formularies. The role of political pressures on drug funding announcements has received relatively little attention, and elections represent an especially powerful form of political pressure. We examined the temporal relationship between decisions to add one class of drugs to publicly funded formularies in Canada's ten provinces and elections in these jurisdictions. Dates of provincial formulary listings for cholinesterase inhibitors, which are drugs used to treat Alzheimer's disease and related dementias, were compared to the dates of provincial elections. Medical journal articles, media reports, and proceedings from provincial legislatures were reviewed to assemble information on the chronology of events. We tested whether there was a statistically significant increase in the probability of drug funding announcements within the 60-day intervals preceding provincial elections. Decisions to fund the cholinesterase inhibitors were made over a nine-year span from 1999 to 2007 in the ten provinces. In four of ten provinces, the drugs were added to formularies in a time period closely preceding a provincial election (P = 0.032); funding announcements in these provinces were made between 2 and 47 days prior to elections. Statements made in provincial legislatures highlight the key role of political pressures in these funding announcements. Impending elections appeared to affect the timing of drug funding announcements in this case study. Despite an established structure for evidence-based decision-making, drug funding remains a complex process open to influence from many sources. Awareness of such influences is critical to maintain effective drug policy and public health decision-making.

  2. IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety.

    Science.gov (United States)

    Caron, Alexandre; Chazard, Emmanuel; Muller, Joris; Perichon, Renaud; Ferret, Laurie; Koutkias, Vassilis; Beuscart, Régis; Beuscart, Jean-Baptiste; Ficheur, Grégoire

    2017-03-01

    The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety. To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases. We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement. IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data. IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  3. [VR and AR Applications in Medical Practice and Education].

    Science.gov (United States)

    Hsieh, Min-Chai; Lin, Yu-Hsuan

    2017-12-01

    As technology advances, mobile devices have gradually turned into wearable devices. Furthermore, virtual reality (VR), augmented reality (AR), and mixed reality (MR) are being increasingly applied in medical fields such as medical education and training, surgical simulation, neurological rehabilitation, psychotherapy, and telemedicine. Research results demonstrate the ability of VR, AR, and MR to ameliorate the inconveniences that are often associated with traditional medical care, reduce incidents of medical malpractice caused by unskilled operations, and reduce the cost of medical education and training. What is more, the application of these technologies has enhanced the effectiveness of medical education and training, raised the level of diagnosis and treatment, improved the doctor-patient relationship, and boosted the efficiency of medical execution. The present study introduces VR, AR, and MR applications in medical practice and education with the aim of helping health professionals better understand the applications and use these technologies to improve the quality of medical care.

  4. Factors associated with anti-tuberculosis medication adverse effects: a case-control study in Lima, Peru.

    Science.gov (United States)

    Chung-Delgado, Kocfa; Revilla-Montag, Alejandro; Guillen-Bravo, Sonia; Velez-Segovia, Eduardo; Soria-Montoya, Andrea; Nuñez-Garbin, Alexandra; Silva-Caso, Wilmer; Bernabe-Ortiz, Antonio

    2011-01-01

    Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89), anemia (OR = 2.10; IC95%: 1.13-3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6), and smoking (OR = 2.00; 95%CI: 1.03-3.87) were independently associated with adverse drug reactions. Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.

  5. Factors associated with anti-tuberculosis medication adverse effects: a case-control study in Lima, Peru.

    Directory of Open Access Journals (Sweden)

    Kocfa Chung-Delgado

    Full Text Available BACKGROUND: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. METHODOLOGY AND RESULTS: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR and 95% confidence intervals (95%CI. A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35, overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89, anemia (OR = 2.10; IC95%: 1.13-3.92, MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6, and smoking (OR = 2.00; 95%CI: 1.03-3.87 were independently associated with adverse drug reactions. CONCLUSIONS: Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.

  6. Improving Patient Safety with X-Ray and Anesthesia Machine Ventilator Synchronization: A Medical Device Interoperability Case Study

    Science.gov (United States)

    Arney, David; Goldman, Julian M.; Whitehead, Susan F.; Lee, Insup

    When a x-ray image is needed during surgery, clinicians may stop the anesthesia machine ventilator while the exposure is made. If the ventilator is not restarted promptly, the patient may experience severe complications. This paper explores the interconnection of a ventilator and simulated x-ray into a prototype plug-and-play medical device system. This work assists ongoing interoperability framework development standards efforts to develop functional and non-functional requirements and illustrates the potential patient safety benefits of interoperable medical device systems by implementing a solution to a clinical use case requiring interoperability.

  7. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    Science.gov (United States)

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. The Value of Nonmedical Academic Libraries to Medical Libraries: A Case in Point

    Science.gov (United States)

    Drake, Paul B.

    2010-01-01

    While the National Library of Medicine created the National Network of Libraries of Medicine (NN/LM) as a network to provide medical and health information, historically few nonmedical academic libraries have participated. University medical libraries and hospital libraries have been the major focus of the Network. Recently, the NNLM has…

  9. 20 CFR 416.993 - Medical evidence in continuing disability review cases.

    Science.gov (United States)

    2010-04-01

    ... evidence. Before deciding that your disability has ended, we will develop a complete medical history... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Medical evidence in continuing disability... SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Continuing Or...

  10. Teaching and Learning of Medical Biochemistry According to Clinical Realities: A Case Study

    Science.gov (United States)

    Jabaut, Joshua M.; Dudum, Ramzi; Margulies, Samantha L.; Mehta, Akshita; Han, Zhiyong

    2016-01-01

    To foster medical students to become physicians who will be lifelong independent learners and critical thinkers with healthy skepticism and provide high-quality patient care guided by the best evidence, teaching of evidence-based medicine (EBM) has become an important component of medical education. Currently, the teaching and learning of…

  11. Implementation of an Interorganizational System: The Case of Medical Insurance E-Clearance

    Science.gov (United States)

    Bose, Indranil; Liu, Han; Ye, Alex

    2012-01-01

    The patients receiving treatment from a hospital need to interact with multiple entities when claiming reimbursements. The complexities of the medical service supply chain can be simplified with an electronic clearance management system that allows hospitals, medical insurance bureau, bank, and patients to interact in a seamless and cashless…

  12. The Cooperative Sharing of Audiovisual Materials in Medical Schools; a Network Approach. Case Study 1.

    Science.gov (United States)

    National Medical Audiovisual Center of the National Library of Medicine, Atlanta, GA.

    The evolution of medical schools from their post-Renaissance Italian prototypes to present modern facilities has been marked by a variety of philosophies, methodologies, and pedagogical styles. Pressures to improve medical curriculum led to the educational media movement of the 1950's. By 1970, the Association of Professors of Gynecology and…

  13. Physician Opinions about an Anatomy Core Curriculum: A Case for Medical Imaging and Vertical Integration

    Science.gov (United States)

    Orsbon, Courtney P.; Kaiser, Rebecca S.; Ross, Callum F.

    2014-01-01

    Pre-clinical anatomy curricula must provide medical students with the knowledge needed in a variety of medical and surgical specialties. But do physicians within specialties agree about what anatomical knowledge is most important in their practices? And, what is the common core of anatomical knowledge deemed essential by physicians in different…

  14. Successfully Sustaining Sex and Gender Issues in Undergraduate Medical Education: A Case Study

    Science.gov (United States)

    van der Meulen, Francisca; Fluit, Cornelia; Albers, Mieke; Laan, Roland; Lagro-Janssen, Antoine

    2017-01-01

    Although several projects have addressed the importance of gender health issues in medical education, the sustainability of change efforts in medical education has rarely been addressed. Understanding the possible facilitators or barriers to sustainability may help to develop future interventions that are effective in maintaining gender health…

  15. Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders

    Science.gov (United States)

    Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J.; Mathews, Shanaaz

    2011-01-01

    Background Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. Methods We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. Findings In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction. Conclusion The findings raise important questions about the role of forensic medicine in these cases. PMID:22194868

  16. Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders.

    Directory of Open Access Journals (Sweden)

    Naeemah Abrahams

    Full Text Available BACKGROUND: Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners; and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. METHODS: We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. FINDINGS: In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20, weapon recovered 1.36 (95% CI:0.58-2.15 and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00. None of the forensic medical activities increased the likelihood of a conviction. CONCLUSION: The findings raise important questions about the role of forensic medicine in these cases.

  17. Case-based e-learning to improve the attitude of medical students towards occupational health, a randomised controlled trial.

    Science.gov (United States)

    Smits, P B A; de Graaf, L; Radon, K; de Boer, A G; Bos, N R; van Dijk, F J H; Verbeek, J H A M

    2012-04-01

    Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes.

  18. Time-series-based hybrid mathematical modelling method adapted to forecast automotive and medical waste generation: Case study of Lithuania.

    Science.gov (United States)

    Karpušenkaitė, Aistė; Ruzgas, Tomas; Denafas, Gintaras

    2018-05-01

    The aim of the study was to create a hybrid forecasting method that could produce higher accuracy forecasts than previously used 'pure' time series methods. Mentioned methods were already tested with total automotive waste, hazardous automotive waste, and total medical waste generation, but demonstrated at least a 6% error rate in different cases and efforts were made to decrease it even more. Newly developed hybrid models used a random start generation method to incorporate different time-series advantages and it helped to increase the accuracy of forecasts by 3%-4% in hazardous automotive waste and total medical waste generation cases; the new model did not increase the accuracy of total automotive waste generation forecasts. Developed models' abilities to forecast short- and mid-term forecasts were tested using prediction horizon.

  19. Predictive factors of adrenal insufficiency in patients admitted to acute medical wards: a case control study

    Directory of Open Access Journals (Sweden)

    Oboni Jean-Baptiste

    2013-01-01

    Full Text Available Abstract Background Adrenal insufficiency is a rare and potentially lethal disease if untreated. Several clinical signs and biological markers are associated with glucocorticoid failure but the importance of these factors for diagnosing adrenal insufficiency is not known. In this study, we aimed to assess the prevalence of and the factors associated with adrenal insufficiency among patients admitted to an acute internal medicine ward. Methods Retrospective, case-control study including all patients with high-dose (250 μg ACTH-stimulation tests for suspected adrenal insufficiency performed between 2008 and 2010 in an acute internal medicine ward (n = 281. Cortisol values Results 32 patients (11.4% presented adrenal insufficiency; the others served as controls. Among all clinical and biological parameters studied, history of glucocorticoid withdrawal was the only independent factor significantly associated with patients with adrenal insufficiency (Odds Ratio: 6.71, 95% CI: 3.08 –14.62. Using a logistic regression, a model with four significant and independent variable was obtained, regrouping history of glucocorticoid withdrawal (OR 7.38, 95% CI [3.18 ; 17.11], p-value p-value 0.044, eosinophilia (OR 17.6, 95% CI [1.02; 302.3], p-value 0.048 and hyperkalemia (OR 2.41, 95% CI [0.87; 6.69], p-value 0.092. The AROC (95% CI was 0.75 (0.70; 0.80 for this model, with 6.3 (0.8 – 20.8 for sensitivity and 99.2 (97.1 – 99.9 for specificity. Conclusions 11.4% of patients with suspected adrenal insufficient admitted to acute medical ward actually do present with adrenal insufficiency, defined by an abnormal response to high-dose (250 μg ACTH-stimulation test. A history of glucocorticoid withdrawal was the strongest factor predicting the potential adrenal failure. The combination of a history of glucocorticoid withdrawal, nausea, eosinophilia and hyperkaliemia might be of interest to suspect adrenal insufficiency.

  20. The role of encapsulated knowledge in clinical case representations of medical students and family doctors

    NARCIS (Netherlands)

    Rikers, Remy MJP; Loyens, Sofie MM; Schmidt, Henk G

    2004-01-01

    BACKGROUND: Previous studies on the development of medical expertise, predominantly using measures of free recall and pathophysiological explanations, have shown ambiguous results concerning the relationship between expertise level and encapsulated knowledge. PURPOSE: To investigate differences in

  1. Biochemistry for Medical Students: A Flexible Student-Oriented Approach. AMEE Case Study No. 3

    Science.gov (United States)

    Macqueen, D.; And Others

    1976-01-01

    A personalized account of some experiences in the Department of Biochemistry at the University of Dundee during a radical revision of the course for medical students is offered. Innovations of the course are described in detail. (LBH)

  2. Biases in medication prescribing: the case of second-generation antipsychotics.

    Science.gov (United States)

    Makhinson, Michael

    2010-01-01

    The shift from first-generation antipsychotic medications to second-generation antipsychotic medications initially caused a wave of excitement about the potential for improved and broader efficacy of these medications concurrent with an improved side-effect profile. Recent data from high-quality research analyses have subsequently raised significant questions about these claims. This research evidence has, however, not altered prescribing behavior in a way that would be expected from fully rational evaluation of the evidence. Prescribing decisions represent poorly understood, complex behaviors influenced by a number of external and internal forces, some of which may be elucidated by advances in social and cognitive psychology. In this article, the decision to prescribe first- versus second-generation antipsychotic medications is examined, and specific social psychological biases and individual cognitive biases are hypothesized to be significant influences on clinicians. These biases may perpetuate disparity between research evidence and clinical practice.

  3. The Effectiveness of Streaming Video on Medical Student Learning: A Case Study

    OpenAIRE

    Bridge, Patrick D.; Jackson, Matt; Robinson, Leah

    2009-01-01

    Information technology helps meet today’s medical students’ needs by providing multiple curriculum delivery methods. Video streaming is an e-learning technology that uses the Internet to deliver curriculum while giving the student control of the content’s delivery. There have been few studies conducted on the effectiveness of streaming video in medical schools. A 5-year retrospective study was conducted using three groups of students (n_1736) to determine if the availability of streaming vide...

  4. A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course.

    Science.gov (United States)

    Li, Chih-Huang; Kuan, Win-Sen; Mahadevan, Malcolm; Daniel-Underwood, Lynda; Chiu, Te-Fa; Nguyen, H Bryant

    2012-07-01

    Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis. A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist. 98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8 ± 12.0% vs 65.4 ± 12.2%, pdidactic lectures followed by simulation experience.

  5. The alarming reality of medication error: a patient case and review of Pennsylvania and National data.

    Science.gov (United States)

    da Silva, Brianna A; Krishnamurthy, Mahesh

    2016-01-01

    A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy. Medication reconciliation including an 'indication review' for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider-patient relationship.

  6. Offshoring of healthcare services: the case of US-India trade in medical transcription services.

    Science.gov (United States)

    Kshetri, Nir; Dholakia, Nikhilesh

    2011-01-01

    - The issue of offshore outsourcing of healthcare services is a critical but little-examined problem in healthcare research. The purpose of this study is to contribute to filling this void. A library-based study was carried out of the development of the Indian medical transcription offshoring industry. Findings- Cost-saving potential and the degree of outsourceability are higher for medical transcription compared with most services. Offshoring experience, typically in a low-value BPO, helps to enhance productivity and international linkages required for the success of medical transcription. Research limitations/implications - An important area of future research concerns comparing India's factor endowments in medical transcription outsourcing with other services. Further research is also needed to examine how India differs from its regional competitors in terms of factors endowments associated with these services. Another extension would be to investigate the drivers of offshoring of higher value services such as radiological readings. Practical implications - ICT infrastructures needed for outsourcing require much less investment compared with leading capital-intensive industries. The development patterns of the Indian medical and offshoring industries indicate that India may attract higher skilled medical functions in the future. The Indian offshoring industry is shifting its focus from BPO to knowledge process outsourcing (KPO). Developing countries need to shift to greater automation and greater levels of skill training to retain and reinforce their comparative advantages. This paper's greatest value stems from the fact that it examines the drivers of a new but rapidly growing healthcare industry.

  7. The Prevalence of Traditional Malpractice during Pregnancy, Child Birth, and Postnatal Period among Women of Childbearing Age in Meshenti Town, 2016

    Directory of Open Access Journals (Sweden)

    Haileyesus Gedamu

    2018-01-01

    Full Text Available Background. Cultural practices, beliefs, and taboos are often implicated in determining the care received by mothers during pregnancy and child birth which is an important determinant of maternal mortality. Objective. To assess prevalence of cultural malpractice during pregnancy, child birth, and postnatal period among women of childbearing age in Meshenti town, Amhara region, northwest Ethiopia, in 2016. Methods. Community based cross-sectional study was conducted among women of reproductive age group interviewed during the study period from May 10 to June 17, 2016. Total sample size was 318 women of reproductive age group. Systematic sampling technique was conducted. Result. Overall, 50.9% of the respondents had cultural malpractices during their pregnancy. Out of 318 women, 62 (19.5% practiced nutrition taboo, 78 (24.5% practiced abdominal massage, 87 (29.7% delivered their babies at home, 96 (32.8% avoided colostrums, 132 (45.2% washed their baby before 24 hr after delivery, and 6 (6.9% cut the cord by unclean blade. Conclusion and Recommendation. The findings of this study show that different traditional malpractice during perinatal period is still persisting in spite of modern developments in the world. Health education and promoting formal female education are important to decrease or avoid these cultural malpractices.

  8. Context, evidence and attitude: the case for photography in medical examinations of asylum seekers in the Netherlands.

    Science.gov (United States)

    Park, Rebekah; Oomen, Janus

    2010-07-01

    Can photographs of scars serve as evidence of torture? Amnesty International's Medical Examination Group in the Netherlands (AI-MEG) has, for more than a decade, been photographing torture scars to supplement the testimonies of asylum seekers who have been denied refuge. AI-MEG only intervenes at this point, when asylum seekers face extradition. Proving allegations of torture is of vital importance, as asylum seekers face rising anti-immigrant sentiment in European countries. All victims examined by AI-MEG present a combination of mental, physical and emotional scars. We summarize five cases where AI-MEG used photography in their medical examinations, and consider the ethical role physicians play in helping asylum seekers obtain refuge. Though photographs cannot capture all forms of trauma, as visual documents, they are a compelling form of concrete evidence of torture. In this way, photographs complement verbal testimonies and help doctors and immigration authorities to see and understand physical scars left by various forms of torture. AI-MEG explains in medical terms the connections between the visible late sequelae of torture and victims' testimonies. They then assess whether or not the physical scars are consistent with the forms of torture recounted by victims, using the terminology of the Istanbul Protocol (1999), the United Nations-adopted manual of guidelines that explains how to document torture. This paper outlines the medical examination process and argues for the use of photography as medical evidence on behalf of asylum seekers. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. [The implementation of innovative medical technologies: biological pharmaceuticals for the treatment of psoriasis--a case study].

    Science.gov (United States)

    Tal, Orna; Lomnicky, Yosef

    2012-06-01

    Advanced health systems worldwide strive to adopt new technologies that will ensure improved health and better clinical outcomes. The implementation of new medical technologies is affected by medical factors as well as economic and social forces, influencing both the individual and the health care providers. Chronic disease management is a major challenge to governments, as a result of the cumulative effects of chronic morbidity, life expectancy, quality of life and the national burden of disease due to accelerating medical expenditure. Psoriasis, a common chronic disease, for which advanced technologies were recently implemented, was chosen as a case study. The distribution of utility of various technologies for the treatment of psoriasis over the past nine years was analyzed to categorize "patterns of behavior" in accordance with the lifecycle of medical technology described in the Literature. It is expected that these changing trends will produce overall economic consequences, on direct expenditure combined with a reduction in some health services. Analyzing these clinical and economic trends, may add important considerations for the adoption of emerging medical technologies, presenting an important tool for policymakers at at all levels.

  10. The diffusion of medical technology, local conditions, and technology re-invention: a comparative case study on coronary stenting.

    Science.gov (United States)

    Hashimoto, Hideki; Noguchi, Haruko; Heidenreich, Paul; Saynina, Olga; Moreland, Abigail; Miyazaki, Shunichi; Ikeda, Shunya; Kaneko, Yoshihiro; Ikegami, Naoki

    2006-12-01

    Innovation of medical technology is a major driving force behind the increase in medical expenditures in developed countries. Previous studies identified that the diffusion of medical technology varied across countries according to the characteristics of regulatory policy and payment systems. Based on Roger's diffusion of innovation theory, this study purported to see how local practice norms, the evolving nature of diffusing technology, and local clinical needs in addition to differences in politico-economic systems would affect the process of innovation diffusion. Taking a case of coronary stenting, an innovative therapeutic technology in early 1990s, we provided a case study of hospital-based data between two teaching high-tech hospitals in Japan and the US for discussion. Stenting began to be widely used in both countries when complementary new technology modified its clinical efficacy, but the diffusion process still differed between the two hospitals due to (1) distinctive payment systems for hospitals and physicians, (2) practice norms in favor of percutaneous intervention rather than bypass surgery that was shaped by payment incentives and cultural attitudes, and (3) local patient's clinical characteristics that the technology had to be tailored for. The case study described the diffusion of stent technology as a dynamic process between patients, physicians, hospitals, health care systems, and technology under global and local conditions.

  11. CRYOTHERAPY: A NON-SURGICAL MANAGEMENT OPTION FOR SEVERE, MEDICALLY REFRACTORY SPASMS AFTER SPINAL CORD INJURY: TWO CASE REPORTS

    Directory of Open Access Journals (Sweden)

    Luxwell Jokonya

    2017-12-01

    Full Text Available Introduction: Neuromodulation in its various forms is emerging as a promising method of dealing with chronic pain and movement disorders. The scale of ablative vs augmentative procedures seems to be tilting towards augmentative procedures. We observed 8 patients who had failed medical treatment for muscle spasm respond to the cold application. Case summary: We report 2 cases of complete traumatic spinal cord injury patients, who developed severe, medically intractable muscle spasms. We applied cryotherapy to their legs with significant improvement. Outcome measurements: The spasm frequency score dropped immediately from a 4 to 0 in one patient. The other dropped from a 2 to 1 on day one then disappeared by day 7. Spasm severity dropped significantly on the first day in both cases. Conclusion: Cryotherapy as a form of neuromodulation, Is an effective, simple but safe way to symptomatically manage severe medically refractory muscle spasms in spinal cord injured patients. It becomes an important adjunct in the management of these patients in resource-limited settings where surgical options are not readily available.

  12. Analysis of lawsuit cases in the Department of Surgery in Korea

    Science.gov (United States)

    Jung, Ji Yun; Kim, So Yoon; Kim, Dong Gyu; Kim, Choong Bai; Chi, Kyong-Choun; Kang, Won Kyung

    2018-01-01

    Purpose The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. Methods A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion. Results An average of 3.2 years was spent from the date of the incident occurring to the end of the litigation procedures. The average amount awarded in judgments for damages was 59,708,983 ± 67,307,264 (range, 1,700,000–365,201,482) Korean won. Cases were found involving the following opinion of the court: violation of duty of care (49 cases), violation of informed consent (7 cases), violation of duty of care and informed consent (5 cases), and settlement, reconciliation, and others (32 cases). By analyzing defendants' negligence in court opinions, diagnosis (30.8%) was the most common, followed by post-operation management (27.7%). Conclusion Physicians have to conduct treatment and surgery based on exact diagnosis and be careful to observe patients' conditions and symptoms after surgery. It is essential to identify the current status and characteristics of medical litigation for reducing further litigation and improving patient safety. In order to create a safe medical environment, national efforts should be made not only by individuals but also at the national level. PMID:29520344

  13. Undiagnosed tuberculosis as clinical, epidemiological and medicolegal problem: Report of two cases

    Directory of Open Access Journals (Sweden)

    Savić Slobodan

    2006-01-01

    Full Text Available The authors present two cases of undiagnosed tuberculosis in order to point out clinical, epidemiological and medicolegal importance of such cases. The first patient was a 29- year old woman, who died after 10-day hospital treatment, but true nature of her disease remained undiscovered. Due to her known marital problems, as well as numerous bruises developed as a consequence of hemorrhagic syndrome, violent death caused by injuries inflicted by her husband was suspected. Medicolegal autopsy and microscopic examination revealed fatal tuberculosis of the lungs, and small and large intestines. In another case, a 35-year old male died suddenly and unexpectedly, being found dead in his flat where numerous blood traces were noticed during the scene investigation. Therefore, possible homicide was suspected. Medicolegal investigation proved pulmonary tuberculosis as a cause of natural death. Presented cases point out the fact that even nowadays both pulmonary and extrapulmonary tuberculosis may remain clinically undiscovered, even when this disease is a cause of death. Hence, physicians should always keep in mind possible tuberculosis, especially in patients with long-lasting typical symptoms and signs. In both reported cases, the individuals suffered from cavernous pulmonary tuberculosis being thus a permanent source of infection. From medicolegal point of view, described cases represent examples of so called suspicious natural death. On the other hand, the fact that fatal tuberculosis remained clinically undiagnosed may make physicians be accused of medical negligence and malpractice.

  14. Barriers of Developing Medical Tourism in a Destination: A Case of South Korea

    Science.gov (United States)

    ROKNI, Ladan; AVCI, Turgay; PARK, Sam Hun

    2017-01-01

    Background: This study aimed to determine the efficient factors that potentially lead to the barriers of developing medical tourism in South Korea. Methods: To explore the current medical tourism trend, a qualitative procedure was adopted. Besides analyzing the current situation of medical tourism in Korea through a systematic searching on the available information and publications, in-depth-interviews were conducted to collect data from relevant authorities and representatives of medical tourism associations in this country. Results: The result revealed, although government have supported this industry, that lack of specialty and expertise among the health care practitioners in the scope of cross cultural communication, seems to be the core barrier to development of medical tourism in Korea. Demands for convenient promotional activities, policy making and action regulation are the other effective factors. Discussion: Several strategies are required in order to address and combat these barriers, such as governmental support for cultural training, cooperative efforts to encourage health practitioners involved to enhance their cultural and linguistic competence in international scale. PMID:28845404

  15. Barriers of Developing Medical Tourism in a Destination: A Case of South Korea.

    Science.gov (United States)

    Rokni, Ladan; Avci, Turgay; Park, Sam Hun

    2017-07-01

    This study aimed to determine the efficient factors that potentially lead to the barriers of developing medical tourism in South Korea. To explore the current medical tourism trend, a qualitative procedure was adopted. Besides analyzing the current situation of medical tourism in Korea through a systematic searching on the available information and publications, in-depth-interviews were conducted to collect data from relevant authorities and representatives of medical tourism associations in this country. The result revealed, although government have supported this industry, that lack of specialty and expertise among the health care practitioners in the scope of cross cultural communication, seems to be the core barrier to development of medical tourism in Korea. Demands for convenient promotional activities, policy making and action regulation are the other effective factors. Several strategies are required in order to address and combat these barriers, such as governmental support for cultural training, cooperative efforts to encourage health practitioners involved to enhance their cultural and linguistic competence in international scale.

  16. A comparative study on lecture based versus case based education on teaching general surgery to medical students

    Directory of Open Access Journals (Sweden)

    M. Moazeni Bistegani

    2013-06-01

    Full Text Available Introduction : various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001. In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7% in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged.

  17. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

    Science.gov (United States)

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

    2012-01-01

    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  18. Exploring the Case for a Global Alliance for Medical Diagnostics Initiative

    Directory of Open Access Journals (Sweden)

    Melissa L. Mugambi

    2017-01-01

    Full Text Available In recent years, the private and public sectors have increased investments in medical diagnostics for low- and middle-income countries (LMICs. Despite these investments, numerous barriers prevent the adoption of existing diagnostics and discourage the development and introduction of new diagnostics in LMICs. In the late 1990s, the global vaccine community had similar challenges, as vaccine coverage rates stagnated and the introduction of new vaccines was viewed as a distraction to delivering existing vaccines. To address these challenges, the international community came together and formed the Global Alliance for Vaccines Initiative (GAVI. Sixteen years after the formation of GAVI, we see evidence of a healthier global vaccine landscape. We discuss how GAVI’s four guiding principles (product, health systems strengthening, financing and market shaping might apply to the advancement of medical diagnostics in LMICs. We present arguments for the international community and existing organizations to establish a Global Alliance for Medical Diagnostics Initiative (GAMDI.

  19. Equality in Distribution of Human Resources: the Case of Iran's Ministry of Health and Medical Education.

    Science.gov (United States)

    Mobaraki, H; Hassani, A; Kashkalani, T; Khalilnejad, R; Chimeh, E Ehsani

    2013-01-01

    Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The fair allocation of human resources is one of the dimensions of equity, which was evaluated in this study. We evaluated the equity of human resources' distribution among Iran's medical science universities between 2005 and 2009 by inequality measures including Lorenze curve, Gini coefficient and Rabin hood indexes. In the distribution 60403 recruitment licenses among medical universities with 72456140 covered populations, Gini coefficient was 0.167 and Robin Hood Index 0.11. Calculations indicated Recruitment licenses are equitably distributed in MOH&ME of Iran. However a portion of recruitment licenses should redistributed for achieving perfect equal distribution among all public medical universities of Iran.

  20. Towards cultural materialism in the medical humanities: the case of blood rejuvenation

    Science.gov (United States)

    2018-01-01

    This paper argues for an approach within the medical humanities that draws on the theoretical legacy of cultural materialism as a framework for reading cultural practices and their relationship to the social and economic order. It revisits the origins and development of cultural materialism in cultural studies and literary studies between the 1970s and 1990s and considers how, with adaptation, this methodology might facilitate ideological criticism focused on material formations of health, disease and the human body. I outline three key characteristics of a medicocultural materialist approach along these lines: (a) interdisciplinary work on a broad range of medical and cultural sources, including those drawn from ‘popular’ forms of culture; (b) the combination of historicist analysis with scrutiny of present-day contexts; (c) analyses that engage with political economy perspectives and/or the work of medical sociology in this area. The subsequent sections of the paper employ a medicocultural materialist approach to examine conjectural understandings of, and empirical investigations into, the capacity of transfused human blood to rejuvenate the ageing body. I trace textual faultlines that expose the structures of power which inform the movement of blood between bodies in ‘medical gothic’ fictions from the 19th-century fin de siècle, including Mary Elizabeth Braddon's ‘Good Lady Ducayne’ (1896) and Bram Stoker's Dracula (1897). I conclude with a critique of biomedical innovations in blood rejuvenation in the era of medical neoliberalism, before considering the potential applications of medicocultural materialism to other topics within the field of the medical humanities. PMID:28495908