scholarly journals Medical Malpractice and Trigeminal Neuralgia: An Analysis of 49 Cases

2020 ◽  
Author(s):  
Andre E. Boyke ◽  
Ishan Naidu ◽  
Sharon Lam ◽  
Mohammed Ali Alvi ◽  
Edward R. Bader ◽  
...  

Abstract BackgroundOur study aims to fill the vacancy of litigation studies related to trigeminal neuralgia management, and to give healthcare providers the necessary information needed to better understand the potential litigious outcomes that often follow certain treatment methods.MethodsWe queried the Westlaw Edge legal database to identify litigation cases related to the management of trigeminal neuralgia for the years 1985-2019 using the following search criteria: (trigeminal & neuralgia), (tic & douloureux) and (microvascular & decompression). Key variables extracted included the following: plaintiff medical complaints, trial outcome, payout, and demographic characteristics. Continuous variables were compared between cases in favor of defendant and cases in favor of plaintiff using t-test or Wilcoxon rank sum test. Categorical variables were compared using chi-square or Fischer’s exact test.Results49 cases met the inclusion criteria – for those cases surgical complication (42.9%) and failure to diagnose (32.7%) were cited as the most common alleged reasons for filing a malpractice claim. Cranial nerve deficits (34.7%) and loss of consortium (12.2%) were the most frequent post-operative complaints. Verdicts ruled in favor of the defendant in 61.2% of cases, and for the plaintiff in 26.5% of cases with a mean payout of $1,982,428.46. Dental specialists were included in the most cases, 63.3%, and the average payout was $415,908, while Neurosurgical specialists were involved in 20.4% of cases with an average payout of $618,775. Cases where the verdict was in favor of the plaintiff were more likely to be older than cases with a verdict in favor of the defendant (p=0.03). ConclusionsOver one-half of the cases resulted in a defendant’s verdict with surgical complications cited as the most common reason for litigation. Dentistry and neurosurgery were listed as the most common individual physician specialties for defendants, also contributing to the largest average payouts based on specialty (for specialties > 1 occurrence). Cranial nerve deficits and loss of consortium were the most common plaintiff post-operative complaints. A key implication of this study is the need for more extensive discussions between physician and patient regarding informed consent, especially when neurosurgical interventions are required.

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David Rosenbaum-Halevi ◽  
Sujan T Reddy ◽  
Alyssa D Trevino ◽  
Muhammad Bilal Tariq ◽  
Mahan Shahrivari ◽  
...  

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Víctor O. Costa ◽  
Eveline M. Nicolini ◽  
Bruna M. A. da Costa ◽  
Fabrício M. Teixeira ◽  
Júlia P. Ferreira ◽  
...  

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann–Whitney U test was taken for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes ( p  = <0.001) and increases in serum creatinine ( p  = 0.009), LDH ( p  = 0.057), troponin ( p  = 0.018), IL-6 ( p  = 0.053), complement C4 ( p  = 0.040), and CRP ( p  = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years ( p  = 0.001). Hypertension ( p  = 0.064), heart disease ( p  = 0.048), and COPD ( p  = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission ( p  = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU ( p  = 0.027), as well as bilateral opacifications ( p  = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.


Author(s):  
C. Griggs ◽  
M. Schmaedick ◽  
C. Gerall ◽  
W. Fan ◽  
C. Orlas ◽  
...  

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Haris Kamal ◽  
Nour Abdelhamid ◽  
Liang Zhu ◽  
Sean Savitz ◽  
James Grotta ◽  
...  

Background: Intravenous tPA (IV tPA) has been the mainstay for reperfusion therapies for acute ischemic stroke (AIS) patients for 2 decades. Many contraindications from the initial NINDS trial were derived from experts’ consensus and not tested in the trial. Many AIS patients present with thrombocytopenia (< 100,000) and may be excluded from treatment in spite of lack of strong evidence. Some clinicians opt to treat these patients weighing the benefits and risks along with the lack of strong evidence behind this exclusion. We sought to evaluate the safety in AIS patients with low platelets receiving IV tPA as compared to those who do not. Methods: Restrospective chart review of all patients presenting with AIS between 1/2006 to 7/2016 at our center. We analyzed patients who had platelets <100,000 among this cohort and stratified them into those who were treated with IV tPA and those who received antiplatelet therapy only. Demographic data, medical history, medications, presence of sICH after treatment, presenting NIHSS were collected. Two sample Wilcoxon rank sum test was used to compare continuous variables between the two groups, and chi-square test or Fisher’s exact test used to compare categorical variables. Results: 21 patients were treated with IV tPA while 122 patients were treated with antiplatelets. Table 1 lists the demographic variables of the two groups with and without IV tPA. Patients included had moderate thrombocytopenia with very few <50,000. No significant differences were found in presenting NIHSS, race, gender, and history of atrial fibrillation between the two groups except platelets (p=0.0128), age (p=0.0462) and glucose (p=0.0279). Table 2 lists the outcome variables of mRS and symptomatic ICH. There was no petechial or sICH among 21 treated patients. Conclusion: While limited by small numbers and lack of randomization, our data suggest that IV tPA is safe in patients with moderately reduced platelet counts.


2018 ◽  
Vol 34 (08) ◽  
pp. 581-589 ◽  
Author(s):  
Marzia Salgarello ◽  
Akitatsu Hayashi ◽  
Giuseppe Visconti

Background Venules have been usually neglected in the literature on lymphaticovenular anastomosis (LVA). The aim of this study was to analyze the flow dynamic of recipient venules in LVA and their impact on the surgical outcomes. Patients and Methods Data from 128 patients affected by extremity lymphedema, who underwent LVA, were collected in two institutions from August 2014 to May 2016. Recipient venules were classified according to their flow dynamic into backflow, slack, and outlet (BSO classification). Quantitative (lower extremity lymphedema/upper extremity lymphedema index) and qualitative outcomes (needing of compression garment and compression garment class) were evaluated. Chi-square test or Fisher's exact test was used for categorical variables and independent-samples t-test for continuous variables. The association between lymphatic collector degeneration status (normal, ectasis, contractile, sclerotic type [NECST]) and BSO classification with the outcomes was analyzed by the Mantel–Haenszel test. Results On a total of 128 patients, 37 suffered from upper and 91 from lower limb lymphedema. An average number of four LVA were performed for each patient (range: 2–8). A significant association was observed between NECST and BSO categories and the outcomes were evaluated. Patients with contractile and sclerotic collectors had 2.24 times the odd of having poor composite outcome compared with those with normal-to-ectasis collectors (p < 0.05). Patients with backflow venules had 3.32 times the odd of having poor composite outcome compared with those without outlet or slack pattern (p < 0.05). Conclusion The subtype of recipient venule flow dynamic has a significant impact on the surgical outcome of patients undergoing LVA for the treatment of lymphedema, regardless of the lymphatic collector degeneration status. Locating favorable venules in the preoperative mapping might enhance the surgical outcomes.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e20504-e20504
Author(s):  
Nicolas Anthony Othieno-Abinya ◽  
Malkit Singh Riyat ◽  
Raymond Omollo ◽  
Gladwell Wantiru Gichuru

e20504 Background: More than 60% of gastrointestinal stromal tumours (GISTs) arise from the stomach and about 20% from the small intestines. About 95% of GISTs express kit receptor tyrosine kinase (CD117) which is used for purposes of diagnosis and targeted treatment. However, kit expression alone is not specific for GIST, nor does it necessarily imply kinase activation. Poor prognostic features include involvement of the liver, and other bulky sites of disease. Methods: Patients with CD117-positive leiomyosarcomas arising in the abdomen and treated through the Glivec International Patient Assistance Program (GIPAP) clinics in Nairobi were studied. Details taken included sites involved by disease at diagnosis, stage, sites of metastases, whether the tumour had been resected or not, and outcome of treatment with imatinib. Data were summarized using proportions where the variables were categorical while mean (SD) or median (range) was used for continuous variables. Comparisons for categorical variables were done using chi square tests (or Fishers exact test for cell counts less than 5). The statistical level of significance was set to 5%. Results: In total 54 patients were included. Males were 36 (66.7%) and females 18 (33.3%). Age range was 25-86 years, median 50. Stomach was involved primarily in 22 of 47 cases evaluable (46.8%). The liver was primarily involved in 3 (6.4%) and liver metastases in 7 (15%). None of 8 patients (0%) with evaluable liver involvement regressed or stabilized on treatment for at least 6 months compared with 10 of 14 (71.4%) from the stomach, 7 of 7 (100%) from small bowel, and 7 of 13 (53.8%) with mesenteric/omental involvement. These differences were statistically significant (p = 0.001). Conclusions: Apparent lack of response by tumours involving the liver could suggest that the kit expression here may not be the factor activating the kit target in this subset of patients, or they could be of exon 9 mutation predominantly. Mutational analysis studies may shed more light in this issue.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aysha Chaudhary ◽  
Jessica Paters ◽  
Mindy Flanagan ◽  
Rachel Pfafman ◽  
Jeanne Carroll ◽  
...  

Objective: This retrospective study examined the relationship between post-COVID (PC) fatigue and the presence of chronic illnesses. Materials and Methods: Electronic health records of 122 Parkview PC Clinic patients were reviewed for demographics (age, gender, race), chronic illnesses (diabetes, hypothyroidism, hypertension, congestive heart failure, anemia, cancer, orthostatic hypotension), obesity (weight, BMI), complaint of fatigue, and activities affected by fatigue. Data was analyzed using Chi-square tests for categorical variables (or Fisher’s exact test for small cell sizes) and t-tests for continuous variables. Open thematic coding of activities most affected by PC fatigue was performed. Results: 95 out of 122 patients (77.9%) were found to have PC fatigue. Except for measures related to obesity, none of the chronic illnesses assessed were correlated with the presence of fatigue. The weight of PC fatigue patients was significantly higher than those without fatigue (p=0.04). Examination of BMI and obesity status also indicated significantly higher BMI (p=0.01) and levels of obesity (p= 0.004) in PC fatigue groups compared to the PC non-fatigue groups. No significant differences were observed between the groups in either PT test. Examination of patient described activities effected by PC fatigue found work (30.4%), daily stamina (28.6%) and ability to exercise (16.7%) most impacted by PC fatigue.  Other activities affected by PC fatigue included housework (5.6%), hobbies (3.7%), shopping (1.9%) and driving (1.9%). Conclusion: 77.9% of our PC patients showed symptoms of fatigue. This is comparable with existing literature. None of the demographic variables and PT tests, or most of the chronic health conditions investigated, were correlated with the presence of fatigue in PC patients. In contrast, measures associated with obesity, including high BMI and weight, were significantly associated with increased PC fatigue presentation. Open thematic coding of qualitative variables indicated work, daily stamina, and exercise were most affected in PC patients. 


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15541-e15541
Author(s):  
Shilpa Tatineni ◽  
Divyesh Reddy Nemakayala ◽  
Ikponmwosa Enofe ◽  
Ling Wang ◽  
Heather Laird-Fick

e15541 Background: Esophageal cancer is diagnosed in roughly 4 per 100,000 US population. Older men are most frequently affected. Adenocarcinoma is most common and incidence is increasing. EGD with biopsy is important for diagnosis. Many patients present with metastases, limiting treatment options. EGD can identify Barrett’s esophagus, a precursor lesion for adenocarcinoma, but evaluation of biopsy specimens is difficult. This study describes findings from esophageal biopsies in a large community-based Michigan cohort. Methods: Patients aged ≥18 years undergoing EGD with esophageal biopsies in Sparrow Health System were identified. Pathology reports were abstracted for sociodemographics, procedure information, and pathologic findings. Only patients with complete data were included for analysis. Statistical comparisons were assessed by chi-square tests or Fisher’s exact test in contingency tables for categorical variables, or t-tests for continuous variables as appropriate. Results: 4,471 patients were included. 3,279 (73.3%) had benign findings, 1,117 (25%) premalignant changes, 69 (1.54%) malignancy including adenocarcinoma, poorly differentiated cancer or high-grade dysplasia, 1 (0.022%) squamous cell cancer, and 5 (0.11%) neuroendocrine tumors. The latter six were excluded from analyses.Most procedures were performed for inpatients (70.5% for benign, 72.5% malignant and 76.3% pre-malignant; p< 0.001 for all comparisons). Patients with malignancy were older than those with premalignancy [mean 69.8 (SD = 10.4) vs 62.6 (SD = 12.2) years; p< 0.001], who were older than those with benign findings [62.6 (SD = 12.2) vs 56.2 (SD = 14.7) years; p< 0.001]. Patients with premalignancy came from areas with higher average household incomes ($42,179 vs $41,247; p< 0.01). There were no other socioeconomic or sex differences between groups. Conclusions: In a community sample, esophageal malignancy was uncommon but premalignant changes common. Most procedures occurred during hospitalizations. Ensuring appropriate post-discharge follow up for premalignant changes could be challenging. Association between premalignant changes and higher average household income is intriguing and merits additional study.


2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Kelly C Cushing ◽  
Tomer Adar ◽  
Matthew Ciorba ◽  
Ashwin N Ananthakrishnan

Abstract Background Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD. Methods We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher’s exact tests. Results A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy (P = 0.003), complicated IBD (P = 0.057), and peri-operative IBD (P = 0.057). No significant advantage was detected in academic productivity. Common barriers to participation in IBD fellowships included feeling it was unnecessary (45%) and desire to begin a faculty position (42%). Conclusions This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed.


Author(s):  
Sujata Pradhan ◽  
Padmalaya Thakur

Introduction: Ovulation is the key event in Intrauterine Insemination (IUI) cycles. Monitoring ovulation prior to insemination will help to alter insemination time to improve pregnancy rate. Aim: To compare pregnancy rates and live birth rates in presence and absence of ultrasonographic features of ovulation before insemination in IUI cycles. Materials and Methods: This was a retrospective cohort study conducted in a Institute of Medical Sciences and SUM Hospital, Bhubaneswar. Three hundred eighty eight IUI cycles performed in the period of January 2017 to December 2018 were analysed. On the day of IUI prior to insemination, transvaginal ultrasonography was done 36-38 hours after ovulation trigger to document ovulation. Presumptive signs of ovulation were documented in 201 cycles (Group A) and there was no feature suggestive of ovulation in 187 cycles (Group B). In all the cycles, single insemination was performed at 38-40 hours after ovulation trigger. Baseline characteristics were compared. Mann-Whitney U test was used to compare continuous variables. Chi-square test and Fisher’s-exact test were applied to find out the differences in the categorical variables as well as the pregnancy outcomes among the groups. Pregnancy rate and live birth rate were considered as the primary outcomes. Results: Pregnancy rate (17.9% vs 18.2%, p-value=0.945) and live birth rate (17.9% vs 16.0%, p-value=0.625) were similar irrespective of ovulation status documented in ultrasonography performed before insemination. Conclusion: IUI cycle outcomes are independent of the ovulation status documented before insemination.


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