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3.
Medicine (Baltimore) ; 99(3): e18770, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011467

RESUMO

Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.


Assuntos
Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Medicina Legal/métodos , Erros Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Autopsia , Feminino , Humanos , Lituânia , Masculino , Estudos Retrospectivos
6.
Eur. j. anat ; 24(1): 69-74, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186067

RESUMO

Although the cystic artery commonly originates from a right hepatic artery, variations in the origin and course of the cystic artery occur in 24.5% of people. The explanation for the variations of the cystic artery is found in the developmental pattern of the biliary system. Thus, the various origins of the cystic artery and its course concerning the Calot's triangle require the attention of surgeons in order to avoid iatrogenic injury of the bile ducts and vessels. Hence, the course of the cystic artery regarding hepatobiliary ducts has also to be noted by surgeons during cholecystectomy


No disponible


Assuntos
Humanos , Artéria Hepática/anatomia & histologia , Variação Anatômica , Sistema Biliar/anatomia & histologia , Ductos Biliares/anatomia & histologia , Cistos/etiologia , Doença Iatrogênica/prevenção & controle , Erros Médicos/prevenção & controle , Colecistectomia , Ductos Biliares/lesões , Ductos Biliares/cirurgia
7.
Unfallchirurg ; 123(1): 6-15, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31690984

RESUMO

BACKGROUND: The number of treatment error procedures against physicians in Germany has been relatively constant at a high level for years, even though the allegation of a faulty medical procedure is confirmed statistically only in approximately one quarter of the cases. OBJECTIVE: Frequent and typical sources of error that can lead to the assertion of patient claims in the context of a medical treatment. MATERIAL AND METHODS: Evaluation of existing statistics of individual courts and arbitration boards. RESULTS: From a legal point of view the most common mistakes under the medical liability law can be divided into seven categories, which are the subject of dispute in almost all judicial or extrajudicial treatment error procedures. Due to the civil legal evidence situation thereby errors in disclosure of information take the top spot. CONCLUSION: Even by observing a few legal requirements, numerous liability traps can be avoided in the context of medical treatment.


Assuntos
Responsabilidade Legal , Imperícia , Alemanha , Humanos , Advogados , Erros Médicos , Negociação
8.
Eur J Dent Educ ; 24(1): 71-78, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31518469

RESUMO

BACKGROUND: Despite efforts to promote the effective use of the WHO surgical safety checklist, wrong tooth extractions have continued to occur within dentistry. METHOD: A training initiative combined methods of teaching comprising of a presentation, video and simulation to deliver LocSSIP training at an Oral Surgery Department of a UK dental hospital. Participant feedback was analysed to determine their perception of using combined methods to deliver the training. RESULT: Overall feedback was very positive with regard to relevance of the training, and its ability to meet the learning needs of all participants. Participants advocated that there should be regular re-training and incorporation of this training into the local induction programme. Almost About 94% of staff members Strongly Agreed or Agreed that they would recommend this format of training to other departments. CONCLUSION: Effective training is essential to maintain safe clinical practice within health care, and training methods that are inclusive of various learning styles are well received.


Assuntos
Lista de Checagem , Erros Médicos , Odontologia , Humanos , Segurança do Paciente , Extração Dentária
9.
Ann R Coll Surg Engl ; 102(2): 144-148, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31755728

RESUMO

INTRODUCTION: Statutory duty of candour was introduced in November 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. However, it can be difficult to determine when the process should be implemented. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons. MATERIALS AND METHODS: All full (consultant) members of the Society of British Neurological Surgeons were electronically invited to participate in an online survey. Surgeons were presented with 15 cases and asked to decide in the case of each one whether they would trigger the process of duty of candour. Cases were stratified according to their likelihood and severity. RESULTS: In all, 106/357 (29.7%) members participated in the survey. Responses varied widely, with almost no members triggering the process of duty of candour in cases where adverse events were common (greater than 10% likelihood) and required only outpatient follow-up (7/106; 6.6%), and almost all members doing so in cases where adverse events were rare (less than 0.1% likelihood) and resulted in death (102/106; 96.2%). However, there was clear equipoise in triggering the process of duty of candour in cases where adverse events were uncommon (0.1-10% likelihood) and resulted in moderate harm (38/106; 35.8%), severe harm (57/106; 53.8%) or death (49/106; 46.2%). CONCLUSION: There is considerable nationwide variation in the interpretation of definitions regarding the threshold for duty of candour. To this end, we propose a framework for the improved application of duty of candour in clinical practice.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Segurança do Paciente/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Medicina Estatal/organização & administração , Estudos Transversais , Inglaterra , Implementação de Plano de Saúde , Humanos , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Neurocirurgiões/legislação & jurisprudência , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/legislação & jurisprudência , Neurocirurgia/organização & administração , Relações Médico-Paciente , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/organização & administração , Medicina Estatal/legislação & jurisprudência , Inquéritos e Questionários/estatística & dados numéricos
10.
J Surg Res ; 246: 614-622, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30528925

RESUMO

BACKGROUND: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. METHODS: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. RESULTS: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's "Anticipated Critical Events" section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. CONCLUSIONS: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's "Anticipated Critical Events" section.


Assuntos
Lista de Checagem/normas , Relações Interprofissionais , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente/normas , Erros Médicos/prevenção & controle , Salas Cirúrgicas/normas , Equipe de Assistência ao Paciente/normas , Organização Mundial da Saúde
11.
Radiol Clin North Am ; 58(1): 105-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731895

RESUMO

Central venous catheters (CVCs) are commonly used in patients in a variety of clinical settings, including the intensive care unit, general ward, and outpatient settings. After placement, the radiologist is frequently requested to evaluate the location of CVCs and deem them suitable for use. An understanding of the ideal location of catheter tips as well as the approach to identifying malpositioned catheter tips is essential to prevent improper use, recognize and/or prevent further injury, and direct potential lifesaving care. An approach to CVC placement based on tip location can be helpful in localization and guiding management.


Assuntos
Cateteres Venosos Centrais , Veias Jugulares/diagnóstico por imagem , Erros Médicos , Radiografia Torácica/métodos , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos
12.
Niger J Clin Pract ; 22(12): 1706-1714, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793478

RESUMO

Background: Dental extraction is a common procedure that is subject to complications and errors including extraction of the wrong tooth. This study aimed to determine the prevalence and identify the causes of wrong tooth extractions and explore the attitude of dentists after extraction of a wrong tooth. Methods: A questionnaire was adapted to fit the needs of this project and was distributed among all the dentists in four teaching dental clinics. The questionnaire was available in both the English and Arabic languages. Results: Of the 486 questionnaires, 186 questionnaires were returned (response rate of 37%) and used for the analysis. The prevalence of wrong tooth extraction was 21.1%. The three most common reasons for extracting a wrong tooth were miscommunication (31.6%), inadequate referral (28.9%), and exhaustion of an overworked dentist (28.9%). Surprisingly, only 50% informed the patient and documented the incident in the patient's chart. Few dentists apologized to their patients or offered any kind of solution or compensation. Conclusion: Wrong tooth extraction is a prevalent yet preventable problem. Most of the common causes of this problem appear to be more system rather than individual related. There is a pressing need to implement the universal protocol for the prevention of wrong site, wrong procedure, and wrong person surgery.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Odontólogos/psicologia , Erros Médicos/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Clínicas Odontológicas , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Encaminhamento e Consulta , Arábia Saudita
13.
Lakartidningen ; 1162019 Dec 02.
Artigo em Sueco | MEDLINE | ID: mdl-31794048

RESUMO

This study reviewed 102 decisions on error reports in ophthalmic health care in Sweden between March 2017 and October 2018. The study included children, adults, women and men. We found that there was a clear association between long waiting times for ophthalmic health care and negative visual outcomes. As a result of care delay, 71 percent of the patients had moderate vision loss and 17 percent of the patients experienced severe vision loss. Patients with glaucoma and wet macular degeneration accounted for the majority of the patients with negative outcomes. Timely follow-up and prompt treatment are critical to patients' visual outcomes.


Assuntos
Erros Médicos/estatística & dados numéricos , Oftalmologia/normas , Tempo para o Tratamento , Adulto , Idoso , Criança , Feminino , Glaucoma/epidemiologia , Humanos , Degeneração Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Suécia/epidemiologia , Resultado do Tratamento , Transtornos da Visão/epidemiologia , Listas de Espera
15.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 472-478, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041354

RESUMO

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.


RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Apoio Nutricional/normas , Erros Médicos/estatística & dados numéricos , Registros Eletrônicos de Saúde , Cuidado do Lactente/normas , Padrões de Prática Médica , Brasil , Recém-Nascido Prematuro/fisiologia , Estudos Prospectivos , Apoio Nutricional/estatística & dados numéricos , Erros Médicos/prevenção & controle , Segurança do Paciente , Cuidado do Lactente/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição
16.
Rev. bras. cir. plást ; 34(4): 485-496, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047909

RESUMO

Introdução: É consenso no meio jurídico que os resultados referentes às atividades médicas sejam obrigação de meio, e não de resultado. Contudo, há grande discussão quando se trata de procedimentos estéticos. A Resolução nº 1621/2001, do Conselho Federal de Medicina, define que o objetivo do ato médico na cirurgia plástica também constitui obrigação de meio. O estudo avaliou, entre novembro de 2015 a novembro de 2017, 106 casos, para verificar se o entendimento do Judiciário se alinha à Resolução do CFM [Conselho Federal de Medicina]. Foram quantificados o número de processos e a porcentagem dos casos julgados como procedentes ou improcedentes, além de verificar as principais posições doutrinárias e jurisprudenciais que embasaram as sentenças admitidas como procedentes. Foi, ainda, quantificado o número de casos cuja decisão do magistrado foi relacionada com o posicionamento do laudo pericial médico. Métodos: Foi feita busca no banco de sentenças do site do Tribunal de Justiça do Estado de São Paulo (SP), por meio da palavra-chave "Cirurgia Plástica", de todos os processos de indenização relacionados a cirurgias plásticas estéticas. Resultados: Foram sentenciados como improcedentes 61 casos (58%). Foram sentenciados como procedentes 45 casos (42%). Em 96% dos casos (102) a sentença relacionou-se positivamente com a análise pericial. Conclusão: Foram 102 sentenças concordantes aos laudos periciais e apenas quatro casos cuja sentença divergiu do entendimento do laudo. Estes dados mostram a importância crucial da análise pericial para a definição das sentenças judiciais. Analisando todas as sentenças, observou-se que em nenhum caso os juízes levaram em conta a Resolução do CFM [Conselho Federal de Medicina].


Introduction: There is a legal consensus that the results of medical activities represent obligations of means, not results. However, there is ample discussion when it comes to aesthetic procedures. Resolution 1621/2001 of the Federal Council of Medicine also defines the objective of a medical act in plastic surgery as an obligation of means. This study evaluated 106 cases between November 2015 and November 2017 to verify whether the decisions of the Judicial Power agree with the Resolution of the Federal Council of Medicine. The number of lawsuits and the percentage of claims granted or denied were quantified, and the opinions of jurists and courts that supported the claims granted were verified. The number of cases in which the judge's decision was related to the opinion of a medical expert was also quantified. Methods: The authors searched the judgment database located on the website of the Court of Justice of the State of São Paulo (SP) for damage related to aesthetic plastic surgery, using the keyword "Plastic Surgery" for all actions. Results: A total of 61 claims (58%) were denied, and 45 (42%) were granted. In 96% of cases (102) the judgment was positively related to the expert report. Conclusion: There were 102 cases in which the judgment agreed with the expert reports and only four cases in which the judgment did not agree with the reports. These data show the crucial importance of experts' reports in defining judicial judgments. The analyses of all judgments showed that there were no cases in which the judge considered the Resolution of the Federal Council of Medicine.


Assuntos
Humanos , História do Século XXI , Administração em Saúde Pública , Cirurgia Plástica , Erros Médicos , Decisões Judiciais , Estética , Medicina Legal , Jurisprudência , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/métodos , Administração em Saúde Pública/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Medicina Legal/estatística & dados numéricos
17.
Ig Sanita Pubbl ; 75(4): 297-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887735

RESUMO

A 65-year-old woman affected by chronic pruritus in both ears was referred by her family physician to a private laboratory to undergo an ear swab test for microbiological and cultural examination. During the procedure on the right side, the patient experienced sudden pain, immediately followed by auricular fullness and dizziness. The clinician performing the swab did not perform an otoscopy and did not administer any topical or general medications. A few days later, purulent discharge appeared. Follow-up showed tympanic membrane perforation and mixed severe hearing loss. Indications for ear swab tests are currently unclear, and complications deriving from this apparently simple procedure are seldom reported.


Assuntos
Perda Auditiva/complicações , Jurisprudência , Erros Médicos , Otite Média/complicações , Perfuração da Membrana Timpânica , Idoso , Feminino , Humanos , Ruptura Espontânea
18.
Medicine (Baltimore) ; 98(50): e18377, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852149

RESUMO

INTRODUCTION: Early recognition of VATS-related complications is crucial for early interventions, treatments and better outcomes PATIENT CONCERNS:: Patient presented with post-obstructive pneumonia like symptoms 1 week after VATS pulmonary resection. DIAGNOSIS: CT scan chest showed evidence of complete consolidation of the lobe where the pulmonary segmentectomy resection took place. INTERVENTIONS: Diagnostic bronchoscopy confirmed the erroneous transection of the Superior Segment (SS) of Right Lower Lobe (RLL). Patient was then taken back for completion lobectomy and found with necrotic SS of RLL. This finding potentially could have caused significant complication if not recognized and treated early OUTCOMES:: Patient recovered well after completion lobectomy and was discharged home several days later CONCLUSION:: Erroneous bronchial transection should be suspected early in patients presenting with post-obstructive pneumonia after VATS pulmonary resection. CT scan chest and diagnostic bronchoscopy are the 2 main diagnostic tests.


Assuntos
Broncoscopia/métodos , Erros Médicos/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos
20.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
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