[Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid.] / Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid.

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation.

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural.

Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid / Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. MÉTODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation

Utilidad de análisis modal de fallos y efectos para mejorar la seguridad en el movilización del paciente crítico intubado / Usefulness of failure mode and effects analysis for improving mobilization safety in critically ill patients

Abstract Introduction: Patient safety has become a core value in health organizations, requiring the use of significant resources in order to avoid accidents during hospital stay. Health care can create risks, and patient safety is the most important objective in care quality. Failure Mode and Effects Analysis (FMEA) is a preventive tool that helps anticipate potential errors and adverse events, setting up barriers to prevent them from happening, or mitigating their effects or, in the event they do happen, mitigating their impact on the most vulnerable link in health care, namely, the patient. Objectives: To analyze, using the FMEA tool, mobilization of intubated critical ill patients in the Intensive Care Unit. Method: A brainstorming session was held within the service to identify the most frequent potential errors in the process. Subsequently, the FMEA method with its different phases was applied, prioritizing risk according to the RPN (Risk Priority Number) index and selecting improvement actions for those with an RPN greater than 300. Results: The result was the identification of 101 failure modes, of which 46 exceeded the RPN of 300. As a result of this work, 63 improvement actions have been proposed for those failure modes with NPR scores above 300. Conclusion: The conclusion of the study is that FMEA was a useful tool for anticipating potential failures in the process and proposing improvement actions for those that exceeded an RPN of 300.

Resumen Introducción: La seguridad del paciente ha adquirido un valor estratégico en las organizaciones sanitarias, empleando numerosos recursos para evitar accidentes durante la estancia hospitalaria. La asistencia sanitaria puede generar un riesgo y la seguridad del paciente es el objetivo más importante de la calidad asistencial. AMFE es una herramienta preventiva, lo que supone una anticipación a los posibles errores y eventos adversos, poniendo barreras para que no sucedan o si lo hacen mitigar sus efectos sobre la parte más vulnerable de la atención sanitaria, el paciente. Objetivos: Analizar, a través de la herramienta AMFE (Análisis Modal de Fallos y Efectos), la movilización del paciente crítico intubado en la Unidad de Cuidados Intensivos. Método: Para ello se realizó una tormenta de ideas dentro del servicio para decidir los posibles errores más frecuentes en el proceso. Posteriormente, se aplicó el método AMFE, con sus fases, priorizando el riesgo conforme al índice NPR (Numero de Priorización de Riesgo), seleccionando acciones de mejora en los que tienen un NPR mayor de 300. Resultados: Como resultado hemos obtenido 101 modos de fallo de los cuales 46 superaban el NPR de 300. Tras nuestro resultado, se han propuesto 63 acciones de mejora en aquellos modos de fallo con puntuaciones NPR superiores a 300. Conclusiones: La conclusión del estudio es que AMFE permite anticiparnos a los posibles fallos del proceso para proponer acciones de mejora en aquellos que superan un NPR de 300.

El listado de verificación como herramienta para la realización de informes periciales a particulares en las reclamaciones por hechos relativos a los accidentes de tráfico / The checklist as a tool for drawing up expert reports issued to individuals concerning road traffic accident claims

No disponible

Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013) / Study of financial compensation in rulings against obstetricians and gynaecologists in Spain (1987-2013)

Introducción. En indemnizaciones por mala praxis, la obstetricia y la ginecología ocupa un lugar destacado. Analizamos las sentencias de un largo periodo (1987-2013) centrándonos en la cuantía de las indemnizaciones y su evolución. En España existen pocos análisis económicos de esta especialidad y específicamente que muestren aquellos eventos adversos que soportan las indemnizaciones más elevadas. Material y métodos. Se trata de un análisis retrospectivo de las sentencias judiciales en las vías civil y contencioso-administrativa, contra obstetras y ginecólogos tomadas de bases de datos jurídicas en el periodo de estudio. Las variables consideradas han sido las indemnizaciones en los casos de condena, el evento adverso juzgado y el año de la sentencia. El software estadístico SPSS 19.0 permitió obtener tablas de distribución de Fisher, de normalidad y el t test para comparación de diferencias entre grupos. Resultados. De 431 casos, 244 terminaron en condena (56,6%). La obstetricia soportó las indemnizaciones más elevadas (p, 0,01) y una probabilidad de ser condenado del 57.5%. Los eventos relacionados con daño o muerte fetal presentaron las indemnizaciones más elevadas y fueron la causa más común entre las indemnizaciones, superiores a 300.000 Euros. Globalmente, en el 78,7% (193) de los casos con condena, la cantidad fue inferior a 300.000 Euros. Los máximos, así como la media y la mediana de las indemnizaciones, fueron aumentando a lo largo del periodo de estudio. Conclusiones. Las demandas en el entorno de la obstetricia y los daños relacionados con el feto soportan las indemnizaciones más elevadas, con tendencia a incrementarse. Las indemnizaciones extremas no son infrecuentes (AU)

Introduction. Malpractice payouts occupy an important place in Obstetrics and Gynaecology. We analysed a long period (1987-2013) of court sentences focusing on compensation amount and the way compensation has changed. In Spain there are not many economic analyses on Obstetrics and Gynaecology, specifically on the main adverse events that lead to catastrophic payouts. Material and methods. A retrospective analysis of a legal database on court sentences in civil and administrative litigation against obstetricians and gynaecologists during the study period was performed. The adverse event under examination, the year of the ruling, and the payouts for malpractice were the variables analysed. Statistical analysis was performed using SPSS Statistics 19.0, F-distribution and normal distribution tables as well as the Student's t-test to compare differences between groups. Results. We recovered 431 cases, 244 of which resulted in a conviction (56.6%). Obstetrics involved the highest payouts (p=0.01) and a 57.5% chance of being convicted. The accusations with the highest payouts involved fetal death or fetal injury, which were the most common cause of payouts exceeding Euros 300,000. Overall, 78.7% (193) of convictions involved a payout below Euros 300,000 and the mean, median and maximum payouts increased steadily during the study period. Conclusions. Obstetric claims and fetal-related injury involve the highest payouts, with an increasing trend. Catastrophic payouts are common (AU)

Utility of Failure Mode and Effect Analysis to Improve Safety in Suctioning by Orotracheal Tube.

OBJECTIVE: The objective of the study was to use the Failure Mode and Effect Analysis (FMEA) tool to analyze the technique of secretion suctioning on patients with an endotracheal tube who were admitted into an intensive care unit. MATERIALS AND METHODS: Brainstorming was carried out within the service to determine the potential errors most frequent in the process. After this, the FMEA was applied, including its stages, prioritizing risk in accordance with the risk prioritization number (RPN), selecting improvement actions in which they have an RPN of more than 300. RESULTS: We obtained 32 failure modes, of which 13 surpassed an RPN of 300. After our result, 21 improvement actions were proposed for those failure modes with RPN scores above 300. CONCLUSIONS: FMEA allows us to ascertain possible failures so as to later propose improvement actions for those which have an RPN of more than 300.

Evaluación de las sentencias en vía civil contra obstetras y ginecólogos en España (1987-2013) / Evaluation of judgments in the civil right against obstetrics and gynecologists in Spain (1987-2013)

Objetivo: la Ginecología ocupa un papel destacado por el número de demandas judiciales. Los daños en los que el afectado es el feto o el recién nacido, suponen las situaciones más conflictivas en el ámbito de la responsabilidad de la especialidad. El objetivo de nuestro estudio es buscar si existe un perfil del condenado, mediante el estudio de sentencias en altas instancias judiciales. Material y Métodos: se analizaron las sentencias desde 1987 hasta 2013. Se utilizaron tablas de distribución de Fisher, de normalidad y el t-Test para comparación de diferencias entre grupos y la prueba no paramétrica de Mann-Withney para comparación de muestras independientes. Se realizó un estudio multivariante seguido de análisis de conglomerados para estimar las variables más influyentes. Resultados: globalmente el 54,3% de los casos terminaron en condena, entre ellos 107 (57%) de 182 eventos relacionados con daño o muerte fetal. El resultado condenatorio de la sentencia previa, el daño cerebral permanente y que el evento ocurriera en la sanidad pública, fueron las variables que más peso tuvieron en el resultado de la sentencia condenatoria. El tiempo medio desde el suceso demandado hasta la sentencia definitiva fue de 7,8 años. Conclusiones: los daños relacionados con el feto, aportan las situaciones de mayor riesgo legal en la especialidad de Obstetricia y Ginecología. Los tiempos medios de resolución de los procedimientos en sede judicial son elevados (AU)

Objective: Gynecology plays a prominent role in the number of lawsuits. The damages, in which the affected is the fetus or the newborn, are the most conflictive situations in the field of responsibility of the specialty. The objective of our study is to find out if there is a profile of the convicted, through the study of sentences in high judicial court. Material and Methods: we analyzed the sentences from 1987 to 2013. We used Fisher distribution tables, normality and t-Test for comparison of differences between groups and the non-parametric Mann-Withney test for comparison of independent samples. We performed a multivariate study followed by cluster analysis to estimate the most influential variables. Results: Overall, 54.3% of the cases ended in a conviction judgment, including 107 (57%) of 182 events related to fetal damage or fetal death. A previous conviction ruling, permanent brain damage and an event originated in the public health system, were the variables that had the greatest weight in the result of the conviction. The average time from the first complaint to the final sentence was 7.8 years. Conclusions: Damages related to the fetus, will be the main concern and represent the highest legal risk in Obstetrics and Gynecology. It takes a high average time to get a final sentence (AU)

Análisis de reclamaciones judiciales contra obstetras y ginecólogos en España. Estudio específico de la vía penal (1987-2013) / Analysis of court claims filed against obstetricians and gynaecologists in Spain. Specific study of the criminal court system (1987-2013)

Objetivo. En España las reclamaciones judiciales contra ginecólogos resueltas por vía penal son escasas, menos del 3%. Esta vía conlleva sanción económica y penas de cárcel y de inhabilitación. El objetivo es estudiar las sentencias resueltas por vía penal, por ser de consecuencias más graves y obtener un perfil del condenado. Material y métodos. Análisis retrospectivo de las sentencias judiciales penales contra ginecólogos desde 1987 hasta 2013. Hemos utilizado tablas de distribución de Fisher, de normalidad y el t-Test para comparación de diferencias entre grupos y la prueba no paramétrica de Mann-Withney para comparación de muestras independientes. Para la caracterización de dos grandes grupos, el de «condenado» y «no condenado», realizamos estudio multivariante mediante análisis de correspondencias múltiples seguidas de análisis de conglomerados para agrupar. Resultados. De 85 casos el 54,6% de las reclamaciones judiciales procedían de actos médicos del sector público, aunque el mayor número de condenas, el 59,3%, lo fue por demandas sobre hechos ocurridos en el ámbito de la sanidad privada. La probabilidad de condena en sucesos relacionados con el parto fue del 36,6% (20 de 55) frente al 16,6% (5 de 30) de episodios de otro origen. En el 69,2% de los casos de procedimientos penales por daño neurológico (encefalopatía neonatal) la sentencia fue condenatoria y con las indemnizaciones más elevadas. El tiempo medio trascurrido entre el incidente y la condena fue de 5,7 años. Con una condena previa, la posibilidad de confirmación en instancias superiores fue del 71,9%. Una absolución se confirmó en el 96,2% de las ocasiones. Conclusiones. Aunque es elegida para iniciar el procedimiento pocas reclamaciones se resuelven en vía penal. La mayoría se deben a complicaciones durante el parto y en un tercio se condena. Lo más probable es que se confirme la sentencia previa cuando esta fue absolutoria (AU)

Introduction. Court claims against gynaecologists in the Spanish criminal court system are a rare occurrence (less than 3%). These can lead to financial penalties, imprisonment and disqualification. Our aim is to study the court sentences issued in such cases, as these involve the most serious convictions, and to obtain a profile of those convicted. Material and methods. A retrospective analysis of the sentences against gynaecologists during the period from 1987 to 2013. We used F-distribution tables, normal distribution tables and Student's t-test to compare differences between groups, and the Mann-Whitney nonparametric test for comparison of independent samples. In order to define two broad groups, those of 'convicted' and 'not convicted', we performed a multivariate study analysis followed by cluster analysis to determine similar sentences. Results. Of the 85 cases, 56.4% of complaints came from procedures in the public sector, but the highest rate of convictions (59.3%) was based on complaints originating in the private healthcare sector. The likelihood of conviction in events related to childbirth was 36.6% (20 out of 55) versus 16.6% (5 out of 30) in incidents of another origin. 69.2% of cases of criminal proceedings for permanent neurological damage (neonatal encephalopathy) concluded in a criminal conviction and had the highest financial compensation. The average time elapsed between the incident and the sentence was 5.7 years. With a prior conviction, the possibility of confirmation at higher levels was 71.9%. An acquittal was confirmed in 96.2% of cases. Conclusions. Of the court claims filed against gynaecologists based on their professional activity, very few are decided upon in the criminal courts. Most are due to complications during childbirth, and one-third ends with a conviction. A judgment of acquittal is most likely to be confirmed when this was the case with the previous one (AU)

El médico ante los tribunales: análisis de las sentencias judiciales relacionadas con la responsabilidad profesional médica en España / Doctors before the courts: Analysis of court rulings related to medical professional liability in Spain

INTRODUCCIÓN: Existen pocos datos objetivos referentes al número de reclamaciones legales contra médicos, de su distribución por especialidades o de sus consecuencias (porcentaje de condenas o cuantía de las indemnizaciones). MATERIAL Y MÉTODO: Se han analizado todas las sentencias presentes en las bases de datos jurídicas (CENDOJ y Westlaw-Aranzadi) hasta el año 2010. Se seleccionaron 2.817 referidas a praxis médica y que contuviesen datos completos. RESULTADOS: La mayoría de las sentencias, el 65,2% (1.837) se dictaron en el período 2001-2010, procediendo la mayoría de la jurisdicción civil (85%). Las especialidades más reclamadas judicialmente fueron ginecología y obstetricia (13,5%), cirugía ortopédica y traumatología (12,3%), urgencias (9,7%), cirugía y medicina estética (8,1%) y enfermedades infecciosas (6%). El 46% de las sentencias apreciaron algún tipo de mala praxis por parte del médico, y la cuantía media de las indemnizaciones fue de 83.457,5 €. CONCLUSIONES: El número de sentencias motivadas por reclamaciones de mala praxis médica ha aumentado progresivamente durante el período contemplado. Las especialidades médicas más reclamadas fueron ginecología y obstetricia, y cirugía ortopédica y traumatología. Estos datos coinciden con la gran mayoría de las series similares disponibles. El porcentaje de sentencias que aprecia algún tipo de mala praxis médica (46%) es más alto que en otras series, y la cuantía media en las indemnizaciones es 2 veces y media menor que en las series de referencia norteamericanas (AU)

BACKGROUND: There are few objective data on the number of legal claims against doctors, their distribution by specialty, or their consequences (conviction rate or amount of compensation). MATERIAL AND METHOD: We analyzed all rulings present in legal databases (CENDOJ and Westlaw-Aranzadi) until 2010. The 2.817 were selected regarding medical practice and that would contain complete data.ResultsMost of sentences 65.2% (1.837) were issued in the period 2001-2010, mostly originating from civil jurisdiction (85%). The most court claimed specialties were obstetrics and gynecology (13.5%), orthopedic surgery and traumatology (12.3%), emergency department (9.7%), surgery and aesthetic medicine (8.1%), and infectious diseases (6%). The 46% of the judgments noted some kind of malpractice by the physician, and the average amount of compensation was € 83457.5. CONCLUSIONS: The number of judgments caused by medical malpractice claims has increased steadily during the period covered. The most claimed medical specialties were obstetrics and gynecology and orthopedic surgery. These data are consistent with the majority of similar series available. The percentage of sentences where some sort of medical malpractice is noted (46%) is higher than in other series, and the average amount of compensation was two and 2.5 times lower than in the American reference series (AU)

Responsabilidad profesional en odontología / Professional liability in dentistry

Pese a que es difícil disponer de datos concretos sobre casuísticas de reclamaciones legales contra los dentistas, ya que los datos están muy fragmentados y son poco accesibles, disponemos de series como los datos del Colegio de Odontólogos y Estomatólogos de la I Región, que recoge todas las reclamaciones de los pacientes motivadas por una atención odontológica presentadas ante la Comisión Deontológica del Colegio. También disponemos de series de datos sobre sentencias judiciales debidas a reclamaciones sanitarias analizadas anteriormente en estudios de la Escuela de Medicina Legal de Madrid. Según los datos derivados de estas series, es evidente que la presión legal de los pacientes está incrementando. Así es y así será en el futuro, incluso de forma más acusada. Debemos por tanto, asumirlo e intentar adoptar las medidas que minimicen este riesgo, o limiten sus consecuencias en caso de producirse. ste es el objetivo principal del presente estudio (AU)

It is difficult to provide specific data on of legal claims against dentists on a case-by-case basis due to the data being highly fragmented and not usually accessible. However, we do have available data series, such as the one from the College of Dentistry and Stomatology of Region I, which includes all patient claims motivated by a dental care submitted to the College's Ethics Committee. We also have data series relating to court judgments due to health care claims that had been previously discussed on studies carried out by the School of Legal Medicine of Madrid.Based on data derived therefrom, it is clear that the legal pressure of patients is increasing. This is how it is and how it will be in the future, perhaps even more sharply. We must therefore accept it and try to adopt measures that minimize this risk or limit its consequences, should they occur (AU)

Análisis de las sentencias judiciales en la práctica de la cardiología resueltas en segunda instancia en España entre 1992 y 2007 / Analysis of judgments in the practice of cardiology resolved on appeal in Spain between 1992 and 2007

Introducción y objetivos. El incremento de la judicialización de los asuntos sanitarios ha aumentado el interés hacia las demandas contra médicos. El objetivo es analizar las sentencias relacionadas con la práctica de la cardiología en España en época reciente. Métodos. Se han analizado las 1.899 sentencias judiciales sanitarias emitidas en España en segunda instancia o posteriores durante el periodo de 1992 a 2007. La ficha de datos consta de 25 variables administrativas, clínicas y judiciales. Al estudio descriptivo, se añaden comparaciones estadísticas entre variables cuya posible relación se juzga de interés. Resultados. Existen 32 sentencias en ámbito cardiológico, y son condenatorias el 31%, con cuantías nunca superiores a los 365.000 euros. Se ha cuadruplicado el número de denuncias en 2000-2007 comparado con 1992-1999. La patología más frecuente es el síndrome coronario (50%). Hay relación estadística (p=0,004) entre tipo de profesional implicado y causa de la demanda: las causas más frecuentes (error diagnóstico y/o mala praxis) afectaron a los no cardiólogos, mientras que las demandas por defecto de información (que alcanzan el 9,5%) recaen mayoritariamente en cardiólogos. El fallecimiento del paciente se produjo en el 75% de los casos. Conclusiones. Aunque la cardiología tiene «bajo riesgo» de demanda judicial comparada con otras especialidades, la actividad litigante aumentó notablemente en años recientes. Las causas de demanda se relacionaron con el tipo de profesional implicado, y destacan el error diagnóstico y la mala praxis por su frecuencia y el defecto de información por su novedad (AU)

Introduction and objectives. The increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. Methods. We analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. Results. There were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. Conclusions. Despite cardiology being a "low-risk discipline" compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty (AU)

Analysis of judgments in the practice of cardiology resolved on appeal in Spain between 1992 and 2007.

INTRODUCTION AND OBJECTIVES: The increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. METHODS: We analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. RESULTS: There were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. CONCLUSIONS: Despite cardiology being a "low-risk discipline" compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty.

Professional liability in oral surgery: Legal and medicalstudy of 63 court sentences

Objectives: Dentistry, like all other health care professions, has in recent years been subjected to an increase inlegal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of theirfrequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongstthese areas of activity is that of oral surgery.Study design: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance orhigher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptiveand comparative statistical study by cross-referencing certain variables provides us with a clear and accuratepicture of the lawsuit profile.Results and conclusions: Implantological surgery was the practice subject to the most claims due to surgery (55.6percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling againstthe professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18sentences), the highest amount having been €24,000, an important factor to take into account when contractingprofessional civil liability insurance (AU)

Professional liability in oral surgery: legal and medical study of 63 court sentences.

OBJECTIVES: Dentistry, like all other health care professions, has in recent years been subjected to an increase in legal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of their frequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongst these areas of activity is that of oral surgery. STUDY DESIGN: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance or higher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptive and comparative statistical study by cross-referencing certain variables provides us with a clear and accurate picture of the lawsuit profile. RESULTS AND CONCLUSIONS: Implantological surgery was the practice subject to the most claims due to surgery (55.6 percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling against the professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18 sentences), the highest amount having been €24,000, an important factor to take into account when contracting professional civil liability insurance.