Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.903
Filtrar
3.
Unfallchirurg ; 123(1): 16-21, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31940058

RESUMO

Damage to health caused by complications and errors is part of the reality of medical treatment. In order to avoid further negative consequences in the event of legal claims as a result of excessive processing times or unjustified refusals, a good cooperation between the physician and claims management in the clinic and the legal processor in liability insurance is required. In order to avoid false assumptions in claims processing, a critical analysis of the facts of the case is necessary. In addition, findings from claims management must be recorded and effectively implemented in the clinical practice.


Assuntos
Imperícia , Médicos , Gestão de Riscos , Humanos , Seguro de Responsabilidade Civil , Responsabilidade Legal
4.
JAMA ; 323(4): 352-366, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990319

RESUMO

Importance: The tort liability system is intended to serve 3 functions: compensate patients who sustain injury from negligence, provide corrective justice, and deter negligence. Deterrence, in theory, occurs because clinicians know that they may experience adverse consequences if they negligently injure patients. Objective: To review empirical findings regarding the association between malpractice liability risk (ie, the extent to which clinicians face the threat of being sued and having to pay damages) and health care quality and safety. Data Sources and Study Selection: Systematic search of multiple databases for studies published between January 1, 1990, and November 25, 2019, examining the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality. Data Extraction and Synthesis: Information on the exposure and outcome measures, results, and acknowledged limitations was extracted by 2 reviewers. Meta-analytic pooling was not possible due to variations in study designs; therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures: Associations between malpractice risk measures and health care quality and safety outcomes. Exposure measures included physicians' malpractice insurance premiums, state tort reforms, frequency of paid claims, average claim payment, physicians' claims history, total malpractice payments, jury awards, the presence of an immunity from malpractice liability, the Centers for Medicare & Medicaid Services' Medicare malpractice geographic practice cost index, and composite measures combining these measures. Outcome measures included patient mortality; hospital readmissions, avoidable admissions, and prolonged length of stay; receipt of cancer screening; Agency for Healthcare Research and Quality patient safety indicators and other measures of adverse events; measures of hospital and nursing home quality; and patient satisfaction. Results: Thirty-seven studies were included; 28 examined hospital care only and 16 focused on obstetrical care. Among obstetrical care studies, 9 found no significant association between liability risk and outcomes (such as Apgar score and birth injuries) and 7 found limited evidence for an association. Among 20 studies of patient mortality in nonobstetrical care settings, 15 found no evidence of an association with liability risk and 5 found limited evidence. Among 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. Among 12 studies of other measures (eg, patient safety indicators, process-of-care quality measures, patient satisfaction), 7 found no association between liability risk and these outcomes and 5 identified significant associations in some analyses. Conclusions and Relevance: In this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes. Although gaps in the evidence remain, the available findings suggested that greater tort liability, at least in its current form, was not associated with improved quality of care.


Assuntos
Responsabilidade Legal , Imperícia/legislação & jurisprudência , Qualidade da Assistência à Saúde , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Imperícia/estatística & dados numéricos , Obstetrícia/normas , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias
5.
Urologe A ; 59(1): 87-98, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31728563

RESUMO

The juridification of medicine affects all disciplines, including urology. Therefore, in this discipline it can well happen that patients not only feel wrongly treated or complain that a treatment was not performed lege artis but also demand compensation or even bring criminal charges. From the patient point of view, the doctor is often more likely to blame for a complication that has arisen or for a hoped for but failed treatment success, than that it is accepted that a complication is typical for the intervention, which, despite the greatest medical care, unfortunately can become reality and is a fateful course. Insurance against claims for damages can be taken out. Not to be underestimated, however, is the personal burden of the accusations with which doctors are confronted by patients, relatives, expert witnesses and courts and against which one must defend oneself. This can mean additional work in addition to the normal medical workload. Therefore, the legal pitfalls in urology should be known.


Assuntos
Imperícia/legislação & jurisprudência , Urologia/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Humanos , Seguro de Responsabilidade Civil/economia , Seguro de Responsabilidade Civil/legislação & jurisprudência , Responsabilidade Legal/economia , Imperícia/economia , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Relações Profissional-Família , Urologia/economia
6.
Eur J Vasc Endovasc Surg ; 58(5): 771-776, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530500

RESUMO

OBJECTIVES: Patient treatment within the Swedish medical service system can claim negligence injuries to the malpractice insurance review board and request financial compensation. The aim of this paper was to analyse the consequences of a negligence claim after arterial surgery between two periods with increasing use of endovascular treatment. METHODS: This was a retrospective cohort study of the arterial surgery negligence claims from two three year periods 2005-2007 (Period A) and 2012-2014 (Period B) from the County Council's Mutual Insurance Company. The analysis was restricted to aortic, carotid, and lower limb arterial diseases. The magnitude of surgery for vascular diseases was obtained from the Swedish vascular register (Swedvasc). RESULTS: The number of patients undergoing arterial procedures increased from 16 628 to 20 709 (p = .01). There was an increase of 54% in the number of negligence claims between the periods. In Period A, the number of compensated claims was 22 out of 83 (29%) and in Period B 60 out of 151 (41%) (p = .06). Patients treated for aortic disorders and peripheral arterial surgery received compensation with increasing frequency whereas carotid diseases decreased. Claimants treated for aortic disorders were compensated in four out of 23 (17%) and 21 out of 54 (39%) in the two periods (p = .07), and after lower limb arterial surgery in six out of 34 (18%) and in 24 out of 71 (34%) (p = .09). After carotid surgery the corresponding figures were 12 out of 26 (46%) and 14 out of 25 (46%) (p = .48). The increasing use of endovascular procedures (but not in carotid artery surgery) did not seem to influence the pattern of negligence claims. CONCLUSIONS: Between the two three year periods there has been an increase in negligence claims but not in compensated ones. The increased use of endovascular procedures has not influenced the pattern of compensated negligence claims.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares , Revisão da Utilização de Seguros , Seguro de Responsabilidade Civil , Imperícia , Doenças da Aorta/economia , Arteriopatias Oclusivas/economia , Compensação e Reparação/legislação & jurisprudência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Revisão da Utilização de Seguros/tendências , Imperícia/estatística & dados numéricos , Imperícia/tendências , Suécia
7.
Bull Hosp Jt Dis (2013) ; 77(3): 200-205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487486

RESUMO

BACKGROUND: Workers Compensation claims have been previously associated with inferior clinical outcomes. However, variation in inpatient stays for orthopedic trauma injuries according to insurance type has not been previously examined. METHODS: We investigated the differences according to insurance for tibial shaft fractures in regard to length of stay and disposition. Using the New York SPARCS database, we identified 1,856 adult non-elderly patients with an isolated tibial shaft fracture who underwent surgery. Patients were stratified by insurance type, including private, Medicaid, Workers Compensation, and no-fault, which covers medical expenses related to automobile or pedestrian accidents. RESULTS: Compared to private insurance (mean: 2.7 days), length of stay was longer for no-fault (mean: 3.9 days; adjusted difference +33%, p < 0.001) and Medicaid (mean: 3.5 days; adjusted difference +22%, p < 0.001), but not significantly different for Workers Compensation (mean: 3.5 days; adjusted difference +4%, p = 0.474). Compared to private insurance (rate: 3.5%), disposition to a facility was significantly higher for no-fault (rate: 10.1%; adjusted odds ratio [OR] = 3.3, p < 0.001) and Medicaid (rate: 7.6%; OR = 2.2, p = 0.003), but was not significantly different for Workers Compensation (rate: 6.3%; OR = 1.8, p = 0.129). CONCLUSIONS: Patients with no-fault insurance, but not Workers Compensation, are subject to longer hospital stays and are more likely to be discharged to a facility following operative fixation of an isolated tibial shaft fracture. These findings suggest that financial, social, and legal factors influence medical care for patients involved in automobile accidents with no-fault insurance.


Assuntos
Acidentes de Trânsito/economia , Fixação de Fratura , Seguro de Responsabilidade Civil/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fraturas da Tíbia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Feminino , Fixação de Fratura/economia , Fixação de Fratura/reabilitação , Fixação de Fratura/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Fraturas da Tíbia/economia , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Estados Unidos
8.
Environ Sci Pollut Res Int ; 26(25): 25749-25761, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267387

RESUMO

Making good environmental damage caused by industrial accidents and restoring impaired ecosystems may be associated with high costs. The European Environmental Liability Directive requires that environmental damage is prevented or remediated and confers financial liability on operators responsible for the activities that caused the damage. The directive encourages adoption of financial risk instruments for environmental liability, ensuring that operators stand up for their responsibilities. We analyse the risk financing instruments for environmental liability in Italy, with emphasis on waste treatment and disposal plant management in Venice Metropolitan City, where financial guarantees and environmental insurance are mandatory. The regional legislation obliges operators of waste treatment plants to seek financial protection through financial guarantees and environmental insurance. We have conducted online survey and in-depth interviews with both suppliers and users of financial protection instruments. On national level, the relatively high environmental consciousness is countered by a low perception of risk and subsequently very low penetration of financial security instruments. Among the identified barriers, we have singled out a limited knowledge of cumulative and long-lasting impacts of industrial activities on environment and ecosystems. Financial and insurance are well developed, but a deep support for specific risk identification and coverage lacks. A closer cooperation between public and private sector can be an opportunity to foster the adoption of these instruments and to improve the coverage of public costs for environmental restoration, due to unattended liability.


Assuntos
Seguro de Responsabilidade Civil , Cidades , Custos e Análise de Custo , Ecossistema , Declarações Financeiras , Humanos , Seguro de Responsabilidade Civil/legislação & jurisprudência , Itália , Setor Privado
9.
Anesth Analg ; 129(1): 255-262, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30925562

RESUMO

BACKGROUND: Closed malpractice claim studies allow a review of rare but often severe complications, yielding useful insight into improving patient safety and decreasing practitioner liability. METHODS: This retrospective observational study of pain medicine malpractice claims utilizes the Controlled Risk Insurance Company Comparative Benchmarking System database, which contains nearly 400,000 malpractice claims drawn from >400 academic and community medical centers. The Controlled Risk Insurance Company Comparative Benchmarking System database was queried for January 1, 2009 through December 31, 2016, for cases with pain medicine as the primary service. Cases involving outpatient interventional pain management were identified. Controlled Risk Insurance Company-coded data fields and the narrative summaries were reviewed by the study authors. RESULTS: A total of 126 closed claims were identified. Forty-one claims resulted in payments to the plaintiffs, with a median payment of $175,000 (range, $2600-$2,950,000). Lumbar interlaminar epidural steroid injections were the most common procedures associated with claims (n = 34), followed by cervical interlaminar epidural steroid injections (n = 31) and trigger point injections (n = 13). The most common alleged injuring events were an improper performance of a procedure (n = 38); alleged nonsterile technique (n = 17); unintentional dural puncture (n = 13); needle misdirected to the spinal cord (n = 11); and needle misdirected to the lung (n = 10). The most common alleged outcomes were worsening pain (n = 26); spinal cord infarct (n = 16); epidural hematoma (n = 9); soft-tissue infection (n = 9); postdural puncture headache (n = 9); and pneumothorax (n = 9). According to the Controlled Risk Insurance Company proprietary contributing factor system, perceived deficits in technical skill were present in 83% of claims. CONCLUSIONS: Epidural steroid injections are among the most commonly performed interventional pain procedures and, while a familiar procedure to pain management practitioners, may result in significant neurological injury. Trigger point injections, while generally considered safe, may result in pneumothorax or injury to other deep structures. Ultimately, the efforts to minimize practitioner liability and patient harm, like the claims themselves, will be multifactorial. Best outcomes will likely come from continued robust training in procedural skills, attention paid to published best practice recommendations, documentation that includes an inclusive consent discussion, and thoughtful patient selection. Limitations for this study are that closed claim data do not cover all complications that occur and skew toward more severe complications. In addition, the data from Controlled Risk Insurance Company Comparative Benchmarking System cannot be independently verified.


Assuntos
Assistência Ambulatorial/legislação & jurisprudência , Analgesia Epidural/efeitos adversos , Analgésicos/efeitos adversos , Compensação e Reparação/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Manejo da Dor/efeitos adversos , Dor/prevenção & controle , Segurança do Paciente/legislação & jurisprudência , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Bases de Dados Factuais , Feminino , Humanos , Injeções , Seguro de Responsabilidade Civil/economia , Masculino , Imperícia/economia , Pessoa de Meia-Idade , Segurança do Paciente/economia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
10.
J Clin Anesth ; 57: 66-71, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30875520

RESUMO

STUDY OBJECTIVE: To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics. DESIGN: In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2007 and 2016. SETTING: Closed claims from inpatient and outpatient settings related to neuraxial anesthesia for surgical procedures and obstetrics. PATIENTS: Forty-five claims were identified for analysis. These patients underwent a variety of surgical procedures, included both children and adults, and with ages ranging from 6 to 82. INTERVENTIONS: Patients receiving neuraxial anesthesia (spinals, epidurals) for surgery or obstetrics. MEASUREMENTS: Data collected includes patient demographics, alleged injury type/severity, surgical specialty, likely contributors to the alleged damaging event, and case outcome. Some of the data were drawn directly from coded variables in the CRICO database, and some were gathered from narrative case summaries. MAIN RESULTS: Settlement payments were made in 20% of claims. Reported adverse outcomes ranged from temporary minor to permanent major injuries. Most closed claims were classified as permanent minor injuries. The greatest number of claims involved residual weakness and radiculopathy resulting from epidurals. The largest contributing factor to these injuries was noted to be "Technical Knowledge/Performance" of the anesthesia provider followed by "Missing or Documentation Error." Over half of the claims arose from obstetric patients (31%) and patients undergoing orthopedic surgery (27%). CONCLUSIONS: Patients with pre-existing radiculopathy or comorbidities may warrant more thorough informed consent about the increased risk of injury. Additionally, prompt follow-up, monitoring, and documentation of post-operative symptoms, such as weakness or radiculopathy, are crucial for improving patient safety and satisfaction. More timely communication with the patient and the surgical team regarding residual neurologic symptoms is important for earlier diagnosis of injury.


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Revisão da Utilização de Seguros/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Radiculopatia/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Epidural/economia , Anestesia Obstétrica/economia , Raquianestesia/efeitos adversos , Raquianestesia/economia , Benchmarking/economia , Benchmarking/legislação & jurisprudência , Benchmarking/estatística & dados numéricos , Criança , Comunicação , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Seguro de Responsabilidade Civil/estatística & dados numéricos , Masculino , Imperícia/economia , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Relações Médico-Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Radiculopatia/epidemiologia , Radiculopatia/etiologia , Radiculopatia/prevenção & controle , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
11.
Scand J Surg ; 108(1): 30-35, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29966500

RESUMO

BACKGROUND AND AIMS:: The Swedish National Patient Insurance Company (LÖF) can compensate patients who believe they have been exposed to an avoidable injury or malpractice in healthcare. Its register covers 95% of Swedish healthcare providers. MATERIAL AND METHODS:: Data on patients operated for primary or incisional ventral hernia in Sweden between 2010 and 2015 and who had filed a claim, were retrieved from LÖF. A total of 290 cases were identified and included. Files include a copy of records, relevant imaging, and an expert advisor's opinion. RESULTS:: Inadvertent enterotomy occurred during 25 repairs and in these cases, laparoscopic repair was clearly overrepresented ( p < 0.001). Complications related to the surgical site (infection and ugly scar) were predominantly related to open repairs ( p < 0.001). Twenty percentage (57/290) of the claims were directly related to an anesthetic mishap. Univariate ordinal regression showed that the odds of receiving a high reimbursement was significantly increased if laparoscopic repair was performed p < 0.001 (odds ratio: 0.37; 95% confidence interval: 0.21-0.65). Sixty-three percentage of claims were filed by women. CONCLUSION:: Inadvertent enterotomy is overrepresented, and the probability that a claim filed for an avoidable injury leads to high reimbursement is greater if laparoscopic repair is performed rather than open ventral hernia repair. The high amount of injuries related to general anesthesia during umbilical hernia repair may be reduced with an increased proportion executed in local anesthesia.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Doença Iatrogênica/epidemiologia , Imperícia/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Feminino , Hérnia Ventral/epidemiologia , Herniorrafia/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Seguro de Responsabilidade Civil/estatística & dados numéricos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino , Imperícia/legislação & jurisprudência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Estudos Retrospectivos , Autorrelato , Suécia/epidemiologia
14.
J Vasc Surg Venous Lymphat Disord ; 6(4): 541-544, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29909860

RESUMO

OBJECTIVE: Placement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. METHODS: The legal databases LexisNexis and Westlaw were searched from 1967 to 2016 for all published legal cases in the United States involving placement of IVC filters. Keywords included "IVC," "inferior vena cava," "filter," and "malpractice." Social Security Disability claims, product liability actions, and hospital employment contract disputes were excluded. RESULTS: There were 310 search results eligible for initial review. After application of exclusion criteria, 29 cases involving medical malpractice were included in final analysis. The majority of excluded cases were insurance disputes and tax revenue cases. Overall, private practitioners were most often sued (11/29 [37.9%]), whereas 24.1% of defendants were academic hospitals (7/29), 20.7% were prisons (6/29), and 17.2% were community hospitals (5/29). The most common specialty named was vascular surgery (8/29), whereas interventional radiologists were named only twice. The most common indications for IVC filter placement were hypercoagulable state (8/29 [29.6%]), recurrent pulmonary embolism (PE; 6/29 [22.2%]), and trauma (5/29 [18.5%]). The most common underlying allegations involved failure to insert IVC filter when indicated (14/29 [48.3%]), intraprocedural negligence (5/29 [17.2%]), and failure to timely remove device (5/29 [17.2%]). Common complications included failure to prevent occurrence of PE (14/29 [48.3%]), device migration (4/29 [13.8%]), and perforation of organs or vasculature (3/29 [10.3%]). Death of the patient occurred in 41.4% of total cases (12/29). In cases in which the patient died, the most common indications for filter placement were trauma (4/12 [33.3%]) and deep venous thrombosis (3/12 [25.0%]), and the most common complication in those patients who died was the failure to prevent a subsequent PE (9/12 [75.0%]). Available verdicts favored defendants (13/14 [92.9%]). In cases with defense verdicts, the most common indications for filter placement similarly were trauma (4/13 [30.8%]) and deep venous thrombosis (3/13 [23.1%)], and the most common complication was failure to prevent PE (9/14 [64.3%]). CONCLUSIONS: Analysis of malpractice cases involving IVC filters revealed key factors associated with litigation. Overall, verdicts favored defendants. Private practitioners were most commonly sued, and the most common reasons for bringing suit were failure to insert filter, intraprocedural complications, and failure to remove filter. Deeper awareness of issues related to malpractice litigation can inform clinical practice and improve patient care and safety.


Assuntos
Remoção de Dispositivo/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Implantação de Prótese/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Filtros de Veia Cava , Centros Médicos Acadêmicos/legislação & jurisprudência , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Hospitais Comunitários/legislação & jurisprudência , Humanos , Erros Médicos/efeitos adversos , Prisões/legislação & jurisprudência , Prática Privada/legislação & jurisprudência , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Radiologistas/legislação & jurisprudência , Radiologia Intervencionista/legislação & jurisprudência , Medição de Risco , Fatores de Risco , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/mortalidade , Filtros de Veia Cava/efeitos adversos
15.
Hautarzt ; 69(6): 449-461, 2018 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-29721626

RESUMO

The dermatologist's procedure is a pivotal tool for early recognition of occupational contact dermatitis (OCD), for reporting OCD cases to the statutory accident insurance and for treating the diseases. The employer is in charge of implementing skin protection measures at the workplace. However, in terms of an individual prevention approach it may be necessary to propose targeted skin protection recommendations in specific patient cases. The patient's own skin protection behavior significantly contributes to regenerating and maintaining healthy skin. This behavior includes the use of occupational skin products, and in particular the correct use of appropriately selected protective gloves. Protective gloves are the most important personal protective measure in the prevention of OCD. Prevention services, occupational health and safety specialists, occupational physicians and centers specialized in occupational dermatology can support the identification of suitable protective measures. Nowadays, suitable protective gloves exist for (almost) every occupational activity and exposure. However, improper use in practice can become a risk factor by itself for the skin (e. g., incorrectly used gloves). Therefore, it is of utmost importance to identify application errors, to educate patients in terms of skin protection and to motivate them to perform an appropriate skin protection behavior. With particular focus on protective gloves, this article gives an overview of various types, materials and potentially glove-related allergens, presents strategies for reducing occlusion effects and discusses some typical application errors and solutions.


Assuntos
Dermatite Ocupacional , Dermatologia , Exposição Ocupacional , Luvas Protetoras , Humanos , Seguro de Responsabilidade Civil , Fatores de Risco
16.
Ann Vasc Surg ; 51: 25-29, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29758323

RESUMO

BACKGROUND: The objective of the study was to analyze causes and outcomes of malpractice claims against vascular surgeons in the United States. METHODS: Cases entered into the Westlaw database from January 1, 1999 to December 31, 2014 were reviewed. Search terms "vascular" and "surgeon" were used. Data were compiled on the allegation, subject matter, and outcome of each case. Additional data including demographics of the defendant were obtained from the U.S. News Health reports on practicing physicians. RESULTS: Of a total of 785 cases identified from the Westlaw database using the search terms "vascular" and "surgeon", 485 (61.8%) were identified where a vascular surgeon was the defendant or expert witness. Of these, 135 (27.8%) had a vascular surgeon identified as a defendant. Among these 135 cases, 88 (65.2%) were found for the defendant with 31 (23%) and 15 (11.1%) being found for the plaintiff or settled, respectively. Of the 31 cases found for the plaintiff, the median award was $750,000 and mean award was $1,830,000. Mean time from incident to verdict was 4.8 years. The most common procedures which led to litigation were open or endovascular peripheral revascularization (PR) (14.8%), carotid interventions (CIs) (11.85%), aortic interventions (AI) (11.1%), vascular trauma (9.63%), dialysis access (8.15%), and venous surgery (5.93%). The most common allegation was "failure to diagnose and treat" (48.9%), followed by complication of open surgery (31.85%) and negligent procedure (25.19%). The most common injuries reported were death (31.85%), major amputation (23.7%), neurovascular injury (14.8%), and bleeding (5.9%). CONCLUSIONS: Analysis of vascular surgery malpractice litigation in the Westlaw database revealed details regarding the subject matter and outcomes of these cases. Through this closed claims analysis, the most common procedures leading to litigation were found to be PR, CI, and AI and not thoracic outlet syndrome procedures as commonly believed. Furthermore, the most common allegations were a "failure to diagnose and treat" and "open surgical complication". Analysis of the salient features and outcomes in these cases can provide a framework for heightened awareness of issues which lead to malpractice claims and can ultimately improve patient care and safety.


Assuntos
Compensação e Reparação/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Bases de Dados Factuais , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Erros Médicos/economia , Segurança do Paciente/legislação & jurisprudência , Medição de Risco , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/mortalidade
18.
J Forensic Leg Med ; 58: 74-77, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29772451

RESUMO

INTRODUCTION: In recent years, dental malpractice claims seems to have increased dramatically worldwide without a clear explanation. The aim of our work is to shed more light on this phenomenon to better understand its magnitude and trend, and to point out possible critical factors that, if changed, can mitigate it. MATERIAL AND METHOD: 458 cases of dental malpractice sentenced by the civil court of Rome, Italy, from 2001 to 2015, were collected. Useful information was extracted, reported in a grid and statistically analyzed. Data was compared between years and overall evaluated. RESULTS: Multiple information were obtained, among which: the number of dental malpractice claims has decreased in most recent years; Dental professionals are found guilty in 74% of cases; the average compensation granted is 18.820,15 €; only 47,7% of the insured dentist found guilty was fully covered by their insurance. CONCLUSIONS: Contrary to what we expected, dental malpractice claims in court have decreased in recent years. The limit liability of dental professional insurances is high compared to the average compensation granted and the insurance doesn't always cover all the expenses for the presence of peculiar clauses in the contract.


Assuntos
Odontólogos/legislação & jurisprudência , Odontólogos/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Compensação e Reparação , Feminino , Humanos , Seguro de Responsabilidade Civil/estatística & dados numéricos , Masculino , Imperícia/tendências , Roma
19.
Hautarzt ; 69(6): 462-470, 2018 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-29704211

RESUMO

In Germany, approximately 2 to 3 million employees work in outdoor professions. They are exceptionally exposed to solar ultraviolet (UV) radiation for a large part of their daily working time. Cumulative UV exposure is associated with a significantly increased risk of skin cancer for outdoor workers from various occupational groups (e. g. landscape and horticulture, agriculture and forestry, fisheries and seafaring, construction and trade, as well as sports teachers, lifeguards and mountain guides). Since 1 January 2015, squamous cell carcinoma and multiple actinic keratosis due to natural UV radiation can be recognised as occupational disease No. 5103 by the German statutory social accident insurance. Reducing cumulative UV exposure is the main prevention aspect of this type of skin damage. Therefore, technical, organisational and personal UV protection measures should be implemented in the professional and private environment. Moreover, they have to be regularly used in an appropriate way. In addition to guideline-oriented therapy, training and counselling of patients with already existing actinic skin damage or a recognised occupational disease No. 5103 is therefore of particular importance. The focus should be on improving the individual UV protection behaviour. This article gives an overview of current recommendations for UV protection in the professional environment. It outlines possible solutions for patient counselling in terms of UV protection in everyday practice.


Assuntos
Doenças Profissionais , Exposição Ocupacional , Neoplasias Cutâneas , Alemanha , Humanos , Seguro de Responsabilidade Civil , Raios Ultravioleta
20.
Ann Vasc Surg ; 50: 15-20, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29526534

RESUMO

BACKGROUND: The aim of this study was to analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving inferior vena cava filters (IVCF) to prevent future litigation and improve physician education. METHODS: Jury verdict reviews from the Westlaw database from January 1, 2000, to December 31, 2015, were reviewed. The search term "inferior vena cava filter" was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. RESULTS: A total of 156 cases were identified. Duplicates and cases in which the IVCF was incidentally included were excluded from the analysis. Forty-nine cases involving either failure to place or a complication of IVCF placement were identified. Throughout the last 15 years, there has been increased number of jury verdicts toward IVCF. The most frequent defendants were internal medicine physicians (38%), vascular surgeons (19%), and cardiothoracic surgeons (12%). The most frequent claims were denied treatment or delay in treatment (in 35% of cases), negligent surgery (in 24% of cases), and failure to diagnose and treat complications (in 24% of cases). Of these, the most frequent specific claims were failure to place IVC filter (41%), implantation failure such as misplacement and/or misaligned implant (24%), erosion of IVC/retroperitoneal bleed (6%), and discontinuation of anticoagulation prematurely (6%). Seventeen cases (35%) were found for the plaintiff, with median awards worth of $1,092,500. In the 21 cases where pulmonary embolism (PE) was involved (43% of cases), 19 were fatal (90%). Of the fatal PE cases, 8 cases ended with verdicts in favor of the plaintiff (42%). Both nonfatal PE cases were won by the defense. CONCLUSIONS: IVCF placement with subsequent PE and death results in verdicts that favor the plaintiffs. This study emphasizes that adequate and transparent communication regarding preoperative planning, decision for IVCF placement, and informed consent may reduce the frequency of litigation. Public awareness of complications related to the placement of IVCF is increasing largely and spurned by aggressive advertising and marketing by plaintiff attorneys. Conditions for which IVCF placement is contemplated carry significant risk of malpractice litigation.


Assuntos
Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Complicações Pós-Operatórias , Implantação de Prótese/legislação & jurisprudência , Tempo para o Tratamento/legislação & jurisprudência , Filtros de Veia Cava , Compensação e Reparação/legislação & jurisprudência , Diagnóstico Tardio/legislação & jurisprudência , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Erros Médicos/economia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/economia , Implantação de Prótese/instrumentação , Fatores de Risco , Tempo para o Tratamento/economia , Filtros de Veia Cava/efeitos adversos , Filtros de Veia Cava/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA