[Analysis of judicial sentences issued against traumatologists between 1995 and 2011 as regards medical negligence]. / Análisis de sentencias judiciales relativas a negligencias médicas emitidas contra traumatólogos entre 1995 y 2011.

INTRODUCTION AND OBJECTIVES: Traumatology and Orthopaedic Surgery is one of the specialities with most complaints due to its scope and complexity. The aim of this study is to determine the characteristics of the complaints made against medical specialists in Traumatology, taking into account those variables that might have an influence both on the presenting of the complaint as well as on the resolving of the process. MATERIAL AND METHODS: An analysis was performed on 303 legal judgments (1995-2011) collected in the health legal judgements archive of the Madrid School of Medicine, which is linked to the Westlaw Aranzadi data base. RESULTS: Civil jurisdiction was the most used. The specific processes with most complaints were bone-joint disorders followed by vascular-nerve problems and infections. The injury claimed against most was in the lower limb, particularly the knee. The most frequent general cause of complaint was surgical treatment error, followed by diagnostic error. There was lack of information in 14.9%. There was sentencing in 49.8% of the cases, with compensation mainly being less than 50,000 euros. CONCLUSIONS: Traumatology and Orthopaedic Surgery is a speciality prone to complaints due to malpractice. The number of sentences against traumatologists is high, but compensations are usually less than 50,000 euros. The main reason for sentencing is surgical treatment error; thus being the basic surgical procedure and where precautions should be maximised. The judgements due to lack of information are high, with adequate doctor-patient communication being essential as well as the correct completion of the informed consent.

Consecuencias de las reclamaciones judiciales sobre los médicos afectados / Consequences of lawsuits on affected doctors

Objetivos. Determinar las consecuencias que una reclamación judicial tiene para la vida personal y la práctica profesional de los médicos afectados. Material y métodos. Estudio transversal, descriptivo, realizado sobre 169 encuestas cumplimentadas por médicos que han sido objeto de una reclamación judicial en España durante el período 2002-2005. Resultados. La reclamación supuso una vivencia personal mala o muy mala en el 98,8%. Un 85,1% reconoce una repercusión en su vida familiar. El 84% ha variado su forma de trabajar y el 57,4% reconoce repercusión en su vocación. En el 6% hubo resolución judicial desfavorable. Conclusiones. Se evidencian importantes repercusiones en los médicos después de una reclamación judicial, tanto en su vida personal y familiar, como en la forma de afrontar el ejercicio de la medicina(AU)

Objectives. To determine the consequences of a judicial claim on the private life and professional practice of affected doctors. Material and methods. A cross-sectional, descriptive study was performed on the basis of 169 surveys filled out by physicians subjected to a lawsuit in Spain in the period including 2002-2005. Results. The claim produced a bad or very bad personal experience in 98.8%. A total of 85.1% admitted repercussions on family life, 84% made some change in the way they worked, and 57.4% admitted effects on their vocation. There was an unfavorable court ruling in 6%. Conclusions. There were important repercussions on doctors after a lawsuit, both on their private and family life, as well as the way they approach medical practice(AU)

[Consequences of lawsuits on affected doctors]. / Consecuencias de las reclamaciones judiciales sobre los médicos afectados.

OBJECTIVES: To determine the consequences of a judicial claim on the private life and professional practice of affected doctors. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed on the basis of 169 surveys filled out by physicians subjected to a lawsuit in Spain in the period including 2002-2005. RESULTS: The claim produced a bad or very bad personal experience in 98.8%. A total of 85.1% admitted repercussions on family life, 84% made some change in the way they worked, and 57.4% admitted effects on their vocation. There was an unfavorable court ruling in 6%. CONCLUSIONS: There were important repercussions on doctors after a lawsuit, both on their private and family life, as well as the way they approach medical practice.

[Analysis of judicial sentences against neurosurgeons resolved in second court of justice in Spain in the period from 1995 to 2007]. / Análisis de las sentencias judiciales contra neurocirujanos resueltas en segunda instancia en España entre 1995 y 2007.

OBJECTIVES: With the aim of identifying the factors related to sentences against neurosurgeons, we have analyzed all the sentences issued in the second court of justice in Spain against neurosurgeons in the period from 1995 to 2007. MATERIAL AND METHODS: Of a total of 1899 sentences of the second or last appeal, during the period from 1995 to 2007 issued in Spain, 61 were chosen which fulfill the criteria to be included in our study. 25 variables were included on the record of compiled data. A complete descriptive and comparative study was elaborated, as well as an analysis of the type of suits, circumstances, and professionals involved. RESULTS: In a third of the cases, complete malpraxis was identified. In regards to the sentences, they were absolved in approximately half the cases, resolved with one fifth of the cases being penal, and four fifths with compensation. Indemnity quantities range from 60,000 to 600,000euro. Deficiency of information or consent was noted in 17% of lawsuits. 62.5% of operations in our sample were on the anatomic region of the vertebral column followed in frequency by the cranial region with 28.6%. Consequences of surgical procedure included major permanent sequelae in 40% of the cases and death in 22%. CONCLUSIONS: It is wise to invest time to deal with patients, including the verbal informed consent, which must be confirmed by the written informed consent form. It is also important to leave a written proof of medical praxis, both related to surgical records and to diagnosis and follow-up of the patient. Procedures with a lower life-threatening risk should not be underestimated, since they comprise the greatest demanded group. The greatest amount of demands is related to economic reimbursement, especially in private practice.

Análisis de las sentencias judiciales contra neurocirujanos resueltas en segundainstancia en España entre 1995 y 2007 / Analysis of Judicial Sentences Against Neurosurgeons Resolved in Second Court of Justice in Spain in the Period from 1995 to 2007

Objetivos. Con el fin de identificar los factoresrelacionados con las condenas judiciales contra neurocirujanos,el presente estudio analiza todas las sentenciasemitidas en segunda instancia en España contraneurocirujanos en el periodo de 1995 al 2007.Material y método. De un total de 1899 sentencias desegunda instancia o última durante el periodo de 1995a 2007 emitidas en España se han escogido 61 que cumplenlos criterios de inclusión para nuestro estudio. Sehan cumplimentado 25 variables en la ficha de recogidade datos. Se ha realizado con ellas un completo estudiodescriptivo y comparativo, además de un análisis de latipología de las demandas, las circunstancias y los profesionalesimplicados.Resultados. En un tercio de los casos se apreció completamal praxis. En relación a las condenas, se absolvióaproximadamente en la mitad de los casos, siendo lasresueltas con condena 1/5 de ellas de carácter penaly 4/5 indemnizatorias. Las cuantías indemnizatoriaspredominan en el rango de 60.000 a 600.000 euros.En un 17% de las demandas se apreció deficiencia enla información o el consentimiento. El 62,5% de lasintervenciones de nuestra muestra se produjeron en laregión anatómica de la columna vertebral siguiéndoleen frecuencia la región craneal con un 28,6%. De lasconsecuencias del procedimiento quirúrgico las secuelaspermanentes mayores constituyen el 40% de loscasos y el fallecimiento el 22%.Conclusiones. Es rentable dedicar tiempo a la relacióncon el paciente, incluyendo el consentimiento informadoverbal, que debe ser refrendado por la (..) (AU)

Objectives. With the aim of identifying the factorsrelated to sentences against neurosurgeons, we haveanalyzed all the sentences issued in the second courtof justice in Spain against neurosurgeons in the periodfrom 1995 to 2007.Material and methods. Of a total of 1899 sentences ofthe second or last appeal, during the period from 1995to 2007 issued in Spain, 61 were chosen which fulfill thecriteria to be included in our study. 25 variables wereincluded on the record of compiled data. A completedescriptive and comparative study was elaborated, aswell as an analysis of the type of suits, circumstances,and professionals involved.Results. In a third of the cases, complete malpraxiswas identified. In regards to the sentences, they wereabsolved in approximately half the cases, resolved withone fifth of the cases being penal, and four fifths withcompensation. Indemnity quantities range from 60,000to 600,000€. Deficiency of information or consent wasnoted in 17% of lawsuits. 62.5% of operations in oursample were on the anatomic region of the vertebralcolumn followed in frequency by the cranial regionwith 28.6%. Consequences of surgical procedure includedmajor permanent sequelae in 40% of the cases anddeath in 22%.Conclusions. It is wise to invest time to deal withpatients, including the verbal informed consent, whichmust be confirmed by the written informed consent form.It is also important to leave a written proof of (..) (AU)

[Painful neuropathy in the diabetic foot syndrome: a review]. / Revisión sobre el dolor neuropático en el síndrome del pie diabético.

Diabetes mellitus (DM) is the most common cause of neuropathy in the western world. Recent studies estimate prevalence around 28,5% but results vary depending on measure used to define diabetic neuropathy. Early detection and careful attention to risk factors determining diabetic foot may avoid or delay complications. Pain generation is due to biologic causes as well as physical and emotional ones. Neuropathy may result in amputation through different ways including loss of one or more functions in peripheral nerves. Glycaemic control, symptom control and feet care are standard measures that affect all health professionals implied in diabetic patients attention. Deeper knowledge of pathogenic mechanisms should result in new treatments which seem to be more effective if administered early, when abnormalities are more likely to be reversible.

Revisión sobre el dolor neuropático en el síndrome del pie diabético / Painful neuropathy in the diabetic foot syndrome: a review

La diabetes mellitus (DM) es la causa más común de neuropatía en el mundo occidental. Se ha estimado una prevalencia del 28,5 por ciento, que varía en función de las medidas utilizadas para definir la neuropatía diabética. Un rápido reconocimiento y una adecuada atención de los factores de riesgo que condicionan el pie diabético pueden prevenir o retardar la aparición de complicaciones. La generación de dolor neuropático no se debe sólo a causas biológicas, sino que están involucradas respuestas físicas y emocionales. La neuropatía puede conducir a la amputación por varios caminos, los cuales incluyen la pérdida de alguna de las funciones de los nervios periféricos. El control de la glucemia, de los síntomas, el cuidado de los pies son estándares de referencia e involucran a todo el equipo de salud dedicado a la atención integral de los pacientes con DM. El conocimiento de los mecanismos patogénicos abre una puerta para futuros tratamientos. Probablemente sean éstos más efectivos cuanto más tempranamente se apliquen en el curso de la neuropatía, cuando la afectación nerviosa es reversible todavía (AU)

[Risk of infections and glycemic control in type 2 diabetes mellitus]. / Riesgo de infecciones y control metábolico en pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Although association between Diabetes Mellitus (DM) type 2 and prevalence of infections is a frequently considered issue in current literature there is few evidence of it. The objective of this study has been to analyse the infection risk in DM type 2 patients according to their glycemic control level (Hb Aic%). PATIENTS AND METHOD: In this cohort-study of 740 patients, we evaluated the incidence rates of infectious episodes in DM2-type diabetic patients during a period of 5 years, from May, 1997 to May, 2002. RESULTS: The average period of follow-up was 4.26 years. We found no significant correlation (p=0.33) between higher levels of HbAic% and presentation of infections. Data clearly show a direct correlation between risk of infection and number of associated chronic diseases (p=0.035), age (p=0.007) and diabetes duration (0.012). We also found an unexplained association between more aggressive treatment and higher glycemic levels (Hb Aic%) (p=0.0001) and also higher infection risk (0.038). CONCLUSIONS: Although there is no association between risk of infection and glycemic control (Hb Aic%) among analysed patients, this study shows a clear correlation between risk of infection and number of complications or number of associated chronic diseases.

Riesgo de infecciones y control metabólico en pacientes con diabetes mellitus tipo 2 / Risk of infections and glycemic control in type 2 diabetes mellitus

Fundamento y objetivo: La asociación entre diabetes mellitus (DM) tipo 2 y la prevalencia de infecciones es una situación frecuente a considerar en la practica clínica. Sin embargo, la evidencia de esta mayor susceptibilidad en los diabéticos para contraer infecciones es escasa. El objetivo de este estudio ha sido analizar el riesgo de infección en pacientes DM tipo 2 según el grado de control glucémico (Hb Aic por ciento).Pacientes y método: Estudio de cohortes históricas sobre 740 pacientes. Se evaluaron las tasas de incidencia de episodios infecciosos en diabéticos tipo 2 durante un periodo de 5 años, desde mayo de 1997 hasta mayo de 2002.Resultados: La media de seguimiento en los diabéticos fue de 4,26 años. No se encontraron diferencias significativas en la presentación de infecciones en relación al control metabólico de los pacientes (p=0,33).Existe un mayor riesgo de infección en diabéticos con un número de procesos crónicos asociados elevado (p=0,035). Existe un mayor riesgo de infección cuanto más elevada es la edad del paciente (p=0,007) y a más años de evolución de la enfermedad (p=0,012). Se observó que los pacientes tratados con medidas higiénico-dietéticas sin otro tratamiento farmacológico tenían mejores controles de Hb Aic por ciento (p=0,0001), y menor riesgo de infecciones (p=0,038) que los tratados con insulina más ADO combinados. Conclusiones: No existe correlación entre el grado de control glucémico (Hb Aic por ciento) con la frecuencia de infecciones en los pacientes diabéticos estudiados. Sí aparece un mayor riesgo de infección en aquellos con un número de procesos crónicos asociados elevado (AU)