Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England.

PURPOSE: The objective of this study was to evaluate the overall incidence and total burden of successful litigation relating to the management of spinal disease across the National Health Service (NHS) in England. METHODS: The study design comprised a retrospective review of the NHS Litigation Authority (NHSLA) database, retrieving all successful claims relating to spinal disease between 2002 and 2010--a total of 235 (144 acute, 91 elective). RESULTS: The general trend for successful claims with relation to spinal surgery has actually been decreasing steadily over the last few years. The total value of these claims during the period was £ 60.5 million, comprising £ 42.8 million (£ 28.6 million relating to acute diagnoses, £ 16.1 million for elective) in damages and £ 17.7 million in legal costs (31% relating to NHS legal costs, the remainder claimants costs). CONCLUSIONS: Spinal litigation remains a source of significant cost to the NHS. The complexity of resolving these cases is reflected in the associated legal costs.

Does it matter how we measure metatarsal length?

INTRODUCTION: Variations in the relative lengths of the metatarsal bones have been implicated as a cause of forefoot pain. Osteotomies to balance the metatarsal lengths have been described as therapy. Although measurement of metatarsal length is required for these osteotomies, there is no gold standard method to measure it radiologically. We compared the three main radiological methods to measure the second metatarsal length described in the literature. MATERIALS AND METHODS: Standing dorsoplantar radiographs of 81 feet were measured using the methods described by Coughlin, Maestro and Hardy and Clapham. Bland and Altman's method was used to compare the above techniques for reproducibility and agreement between each method. RESULTS: The three methods produced markedly different results. Coughlin's and Maestro's methods showed a relative protrusion of the second metatarsal-relatively longer than the first metatarsal by an average of 4 & 3 mm respectively. Hardy and Clapham's method, however, showed a relative retraction of second metatarsal by an average of 1 mm. Both intra-observer and inter-observer errors were smallest for the Coughlin method (the most reproducible) and largest for the Hardy/Clapham method. Significant lack of agreement was found when we compared the 3 techniques with bias for measuring the mean between methods ranging from 1mm to 5.5mm. CONCLUSIONS: Metatarsal lengths as measured by these three methods can be very variable. Thus their role in planning metatarsal osteotomies and establishing relationship of metatarsal protrusion with metatarsophalangeal joint instability and other similar conditions is questionable and require further studies.

Trends in joint arthroplasty litigation over five years: the British experience.

INTRODUCTION: Increasing numbers of joint arthroplasty are performed in Britain. While associated complications are well documented, it is not known which of those initiate malpractice claims. METHOD: A five-year period was assessed for trends to highlight areas for further improvement in patient information and surgical management. RESULTS: The National Health Service paid out almost £14 million for 598 claims. Forty per cent of this was for legal costs. The number of claims increased over time while the rate of successful claims decreased. CONCLUSIONS: A failure to consent adequately and to adhere to policies and standard practice can result in a successful malpractice claim. Protecting patients intraoperatively and maintaining high technical expertise while implementing policies and obtaining informed consent decreases the litigation burden.

Evaluation of branched ear derivatives of Triticum aestivum L.

The branched spikes of Triticum turgidum L. have a potential of producing a high number of kernels. Some of the selected lines of T. turgidum yielded up to 150 kernels per spike as compared to 60--70 kernels per spike in the common wheat cultivar Chenab-70. The best of these lines were crossed with the common wheats Chenab-70, Mexipak, and C-271. Among the lines obtained by selection from the advanced generations of the T. turgidum X Chenab-70 cross, some are similar to Chenab-70 with respect to tillering, plant shape, plant height, and leaf position, but their spikes are branched like those of the T. turgidum parent. These lines appear to be fairly homozygous. Chenab-70 produces, on the average, 60 kernels per spike, 34.8 g of grain per plant and has a 1000-kernel weight of 35 g. The number of kernels per spike, the yield of grain per plant and the 1000-kernel weight of the selected hybrid lines ranged from 25 to 133, from 8.5 to 59.6 g, and from 30.0 to 46.0 g, respectively, which shows that the chances of obtaining high-yielding new common wheat cultivars having spikes branched as those of the T. turgidum parent fairly good.