The Present Legal Status Regarding the Utilization of Mechanical or Pharmacological Restraints in Psychiatric and Social-Health Settings.

No abstract present.

Physical restraints in nursing homes: A qualitative study with multiple stakeholders.

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.

Professional Liability in Plastic Surgery: A Change of Scenario in Medical Professional Liability in Spain.

The epidemic of complaints and/or litigation, both in and out of court, for cases of alleged malpractice has increased dramatically. In Spain, claims related to plastic surgery are gaining more and more interest. Methods: The Council of Medical Associations of Catalonia database was used to analyze claims related to plastic surgery from 1986 to 2021. Results: 1039 claims (9.8% over 10,567 total claims) were studied. Both the total number of claims (P = 0.016; R2=0.16) and the number of claims for plastic surgery (P < 0.0005; R2=0.732) showed an upward trend during the period of study. In the period from 2000 to 2021, the behavior was different; while the number of total claims stabilized (P = 0.352; R2 = 0.043), plastic surgery claims continued to show a time-related tendency to increase (P < 0.0005; R2=0.484). The distribution was 50.12% out of court. Ten unique procedures accounted for 84.5% of the total number of claims. Liability was observed in 21.46% of the closed claims, with differences between civil (20.34%), criminal (6.89%), and out-of-court (25.53%) procedures. Regarding compensation amounts, out-of-court cases had an average of 33,169.44 euros paid; civil cases, 29,153.37 euros; and criminal cases, 37,186.88 euros. Conclusions: The increase in the number of cases can only be related to an increase in the activity carried out by plastic surgeons. There has been a change in Spain in terms of the most sought-after medical specialty, with plastic surgery having displaced the perennially most sought-after specialty, orthopedic surgery and traumatology.

Clinical Safety Recommendations for Testicular Torsion: Analysis of 101 Claims Settled with Compensation in Spain and France.

INTRODUCTION: The study aimed to analyze testicular torsion (TT) claims settled with compensation to have data available as the basis for making recommendations to decrease clinical risk and prevent claims. TT is a urological emergency with a high rate of orchiectomy, representing one of the main reasons for urological claims. METHODS: Data were analyzed from personal majority policy and from the public sector of Catalonia (Spain), as well as data from the main medical civil liability insurance firm at healthcare centers in France in the period from January 1, 2000 to December 31, 2018. RESULTS: Fifty Spanish and 51 French cases were analyzed. Statistical differences were logged in the two settings analyzed in performing ultrasounds, in the area where primary care was provided and with regard to settlement amounts. Diagnosis was late in 76.2% of cases. DISCUSSION: The medical action time from the onset of symptoms and Doppler testicular ultrasound in cases of questionable differential diagnoses is key to prognoses to save the testicles. Properly filling out the emergency report and the rest of medical records are essential for receiving correct medical care and defending possible claims.

The Impact of Malpractice Claims on Physicians' Well-Being and Practice.

OBJECTIVES: Malpractice litigation causes extreme stress. We examine the psychological impact of malpractice claims on physicians' well-being and the consequences on patient care. METHODS: A confidential telephone survey, administered to physicians with both open and closed claims from the previous year, explored symptoms, well-being changes, needs, impairments, and practice changes. RESULTS: Of the 282 respondents, more than half (56.38%) reported a notable psychological reaction to the malpractice claim, with no differences between the open and closed claims (P = 0.2477) or between closed claims with and without a payout (P = 1). Physicians facing criminal proceedings were more likely to experience a notable psychological impact (P = 0.0206). Almost half of the respondents (45.39%) acknowledged practice changes: viewing patients as potential plaintiffs (45.39%), paying more attention to recordkeeping (42.19%), obtaining medicolegal training (37.94%), ordering more tests (36.17%), and avoiding specific kinds of patients (21.63%) or procedures (19.85%). Acknowledging a psychological impact was positively and significantly associated with professional practice changes (P < 0.0001), and the mean number of symptoms was significantly higher among those who acknowledged practice changes (P = 0.0001). CONCLUSIONS: Our results confirm the psychological impact of a malpractice claim and that impacted physicians are more likely to change their care practices, involving defensive medicine practices. Therefore, care for physicians facing malpractice claims needs to be considered under the umbrella of health care quality. Timely mental health referral paths could help mitigate the psychological impact and avoid the pernicious effects of negative practice changes.

[Medico-legal aspects and professional liability of telemedicine in urology.] / Aspectos médico-legales y responsabilidad profesional médica de la telemedicina en urología.

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).