Medicolegal Complications Research Articles

Professional consensus on orthodontic risks: what orthodontists should tell their patients. A cross-sectional study at Saidu college of dentistry, Swat

The importance of transparent communication regarding orthodontic risks during the informed consent process in paramount in terms of ensuring a strong orthodontist-patient relationship. Conducted on a national scale in Pakistan, the current study was planned to establish a consensus among orthodontic professionals regarding critical risks involved in such a discussion. The cross-sectional survey involving 132 orthodontists across Pakistan led to the emergence of 10 key risks, including relapse, treatment duration and gingivitis. However, the study's sole focus on orthodontists' perspectives limited its insights, overlooking invaluable input from patients' experiences. Nevertheless, the consensus underscored the significance of addressing these risks to ensure informed consent and patient autonomy. Going forward, it is imperative to customise this evidence-based information according to individual patient needs, and maintain an ongoing dialogue regarding potential risks, fostering a collaborative approach to orthodontic care and decision-making. Key Words: Orthodontic risks communication, Patient education and safety, Medico-legal complications, Informed consent.

Analysing the psychosocial construct of temporomandibular disorders: Implications for orthodontics

Analysing the psychosocial construct of temporomandibular disorders: Implications for orthodontics

Transmural Migration of Gossypiboma into Stomach:A Case Report

Gossypiboma is the term given to retained abdominal sponges. The statistics of its incidence is more likely to be underestimated because most of the time such cases are not reported due to the fear of medicolegal complications. Such cases causes serious morbidity and even mortality if not diagnosed. We present a case report of a rare phenomena that involved transmural migration of gossypiboma into stomach with a brief review of literature. Gossypiboma was left in abdominal cavity during open cholecystectomy and later was removed on exploratory laparotomy from the stomach. Patient recovered well with no morbidity.

ChatGPT in medicine: an overview of its applications, advantages, limitations, future prospects, and ethical considerations.

This paper presents an analysis of the advantages, limitations, ethical considerations, future prospects, and practical applications of ChatGPT and artificial intelligence (AI) in the healthcare and medical domains. ChatGPT is an advanced language model that uses deep learning techniques to produce human-like responses to natural language inputs. It is part of the family of generative pre-training transformer (GPT) models developed by OpenAI and is currently one of the largest publicly available language models. ChatGPT is capable of capturing the nuances and intricacies of human language, allowing it to generate appropriate and contextually relevant responses across a broad spectrum of prompts. The potential applications of ChatGPT in the medical field range from identifying potential research topics to assisting professionals in clinical and laboratory diagnosis. Additionally, it can be used to help medical students, doctors, nurses, and all members of the healthcare fraternity to know about updates and new developments in their respective fields. The development of virtual assistants to aid patients in managing their health is another important application of ChatGPT in medicine. Despite its potential applications, the use of ChatGPT and other AI tools in medical writing also poses ethical and legal concerns. These include possible infringement of copyright laws, medico-legal complications, and the need for transparency in AI-generated content. In conclusion, ChatGPT has several potential applications in the medical and healthcare fields. However, these applications come with several limitations and ethical considerations which are presented in detail along with future prospects in medicine and healthcare.

Commentary: Post-pandemic lessons learnt regarding triage, mitigation, and management of emergency ocular conditions.

Commentary: Post-pandemic lessons learnt regarding triage, mitigation, and management of emergency ocular conditions.

Successful Outcome in Posttraumatic Superficial Femoral Artery Pseudoaneurysm following Distal Femur Fracture

A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.

Case report of the duplex vermiform appendix: A rare presentation in an elderly patient.

Introduction and importanceDuplex appendix is a rare anatomical entity with incidence rate of 0.004 and 0.009%. Diagnosis is often missed despite growth in radiological investigations. Missed appendiceal anomalies can lead to undesirable medicolegal implications.Case presentationHere we discuss a case of a 76-year-old-male who initially presented to his primary care physician with right-sided abdominal pain for several weeks. A colonoscopy was performed and demonstrated a lesion arising from the appendicular orifice. The patient underwent staging imaging including Computerised Tomography of the abdomen and pelvis which demonstrated a dilated appendix. The patient underwent a laparoscopic right hemicolectomy. He made an uneventful recovery post-operatively and at his follow-up review at 4 weeks and 2 months.DiscussionWhile duplex appendix has been reported in the literature, to our knowledge this is the first case report to describe duplicated appendix presenting as a colonic mass in an elderly patient.ConclusionIntra-operative examination of the cecum is paramount to rule out appendiceal anomalies and prevent medicolegal complications.

Assessment of Clinical Awareness of Cardiopulmonary Resuscitation Among Dental Undergraduate Students in the Vidarbha Region

Background: Cardiopulmonary resuscitation (CPR) is an important link in the chain of survival during the early minutes of cardiac arrest. Prompt identification and immediate help increase the chances of survival for victims. As dental students start working on patients from their 3rd year of professional life, important life-threatening situations and lifesaving skills should be known to them. Aims and Objectives: The aim of the present study was to assess the awareness of CPR among dental students from 3rd and final year. Materials and Methods: In this study, students of 3rd year and final year of dental colleges of the Vidarbha region were included to access the basic knowledge regarding basic life science skills while performing CPR through a questionnaire that consisted of 20 questions. The questionnaire was circulated among students in Google forms and responses were noted. After excluding the incomplete response, the results were then analyzed. Results: The results were expressed in appropriate graphs and tables. It was observed that the participants included were lacking about complete knowledge of CPR. Among 206 students who responded, a large number of them (around 94%) had not heard of basic life support (BLS)/CPR. Rescue breathing in infants was not known to around 85% of students, chest compression and ventilation ratio in a child was known by only about 11% of students, and the first response in suspected foreign body obstruction was not known to about 90% of the students. The overall result was not favorable and the students had low confidence in performing BLS/CPR. Conclusion: The result of the current study indicates a strong need for emphasis on both theoretical and practical training in CPR for undergraduate dental students. This might prove beneficial to save more lives while avoiding medicolegal complications which may occur in the dental clinic also, thus benefiting both the patient and the dental practitioners as well.

Prediction score to assess morbidity/mortality of patient after fracture proximal 1/3rd femur

Fractures around the hip joint in the elderly is a major health concern with respect to perioperative and post operative morbidity, especially in the 1-year postoperative period. The prospective and retrospective study was carried out at Krishna Institute of Medical Sciences, Karad, over a period of 1 year. Various comorbidities play a detrimental role in the postoperative outcome of these fractures. 100 patients of the gediatric age group with fracture around the hip joint were studied and followed for about a year to assess 1-year morbidity. An attempt is made to categorize all the comorbidities and create a Comorbidity Index. The Predictors included in the Comorbidity Index are age, pre-fracture mobility, anaemia, gender, diabetes mellitus, hypertension, ischemic heart disease, renal disease, dementia, alcohol dependence, tobacco chewing, serum protein levels, previous surgeries, stroke, antiplatelet drug intake, duration between operation and death and cause of death. The outcome of the Comorbidity Index determines the deceased patients had an average of 13.73 Comorbidity Index Score, whereas the non-deceased patients had an average of 4.95 Comorbidity Index Score. This score can also be helpful in providing counselling to the patient and the patient's relative about the patient's outcome for surgery. This score will also prove useful in reducing medico-legal complications and will be documented and explained to the patient's relatives.

A CLINICAL AUDIT TO ASSESS THE QUALITY OF DENTAL RADIOGRAPHIC REPORTS

<h3>Background</h3> Radiography forms an integral part of dental and maxillofacial practice, but its reporting continues to pose a variety of problems for practitioners. Chief among these are medicolegal complications and the detriment to patient care that arises from a lack of comprehensive record keeping. <h3>Objective(s)</h3> This audit objectively assessed the completeness and variation of radiographic reports written by undergraduate dental students from year 2 to year 5, including dental core trainees (DCTs) and consultants. We aimed to provide recommendations enabling higher-quality reporting. <h3>Study Design</h3> Conducted at the Royal London Dental Hospital (UK), 100 radiographic reports were randomly selected for each of the chosen groups, and the data were collected retrospectively using clinical case notes. Based on national and international guidelines, we compiled a list of 10 criteria, against which all reports were judged. The data were recorded in a dichotomous manner for each criterion to minimize ambiguity. Each report was subsequently scored of ten (with equal weighting of each criterion) and the average for the group calculated. <h3>Results</h3> Data analysis revealed that less than 1% of reports met all criteria. On average, 5 criteria were met; however, there exists considerable variation between groups. A slight tendency for more comprehensive reporting with undergraduate seniority was noted, in opposition to a substantial drop at the DCT level and again at the consultant level. <h3>Discussion/Conclusions</h3> The data demonstrate a concerning lack of comprehensive reporting across all groups, especially at the higher-ranking levels. Possible explanations include a reduction in senior input and feedback; awareness of the importance of record keeping; time available for each patient encounter; and knowledge of current guidance and policy. Following these results, we recommend regular auditing of radiographic reports by every department and local publication of updates to guidelines and legislation. Raising awareness of this issue will help improve reporting standards, thereby allowing greater patient care and protection from litigation.

Inpatient Endoscopy Biopsy Follow-Up: A Quality Improvement Study

Introduction: Mucosal biopsies are often obtained during inpatient endoscopies to aid diagnosis such as in infections, inflammatory conditions, or malignancies. It is estimated that up to 40% of patients will have pending test results at discharge. The rate at which these results are communicated with patients or their outpatient providers is not well studied and the responsibility of communicating these results after discharge is not clearly defined. Thus, many results may go unaccounted for which can lead to missed diagnoses, patient anxiety, and poor patient outcomes. The goal of our study was to address this issue at our institution. Methods: We retrospectively reviewed 100 inpatient endoscopies. Discharge summaries were reviewed to determine if histopathology results were pending at discharge. If so, we reviewed all chart encounters starting from the date the results were finalized and for the next 30 days looking for chart documentation demonstrating that patients were notified of their results or that attempts were made to notify them. Our institution implemented an EMR update in February 2018, which automatically routed all final pathology results to the in-baskets of the attending gastroenterologist that supervised the inpatient endoscopic procedure. After this we reviewed another 100 charts to ascertain if histopathology results were communicated. We compared the follow-up rate pre- and post- EMR update. Results: Prior to the update, 70% of finalized pathology results were communicated to patients. Of the 30 non-reported cases: 17 (47%) showed non-specific or chronic inflammation, 8 (27%) had no abnormal diagnostic findings, 3 showed hyperplastic polyps, and 2 had tubular adenomas. Following the EMR update, 93% of pathology results were communicated to patients, demonstrating a 23% increase in the rate of follow-up (95% CI: 12.4-33.2, p < 0.0001). Conclusion: Pathology results that are not communicated with patients and the primary care team can lead to poor patient outcomes and medicolegal complications. We found a 30% lack of adequate follow up in our health system, though no serious diagnosis went uncommunicated. By implementing a systemwide intervention, we reduced this to 7%. These improvements on the EMR framework and structure can be expanded to include other pending test results (imaging, labs, etc.) for patients after their discharge.1068 Figure 1 No Caption available.

Medicolegal Complications of Apnoea Testing for Determination of Brain Death.

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

The Medical and Medico-legal Complications of Bulimia Nervosa : Treatments and Complications

Background: Bulimia nervosa (BN) is a chronic mental health disorder that can be associated with numerous medical complications. Patients with BN are often impulsive, and they often engage in activities that are harmful towards themselves and others. Keywords: Bulimia nervosa, purging, hypokalemia, laxative abuse, pseudobartter’s edema, self-harm.

Primum non nocere - The effects of sodium hypochlorite on dentin as used in endodontics.

The antimicrobial and tissue-dissolution capacities of NaOCl render it a well-accepted agent for root canal debridement. These highly desirable properties, however, appear to be intertwined with the untoward effect of collagen matrix degradation within mineralized dentin. Because of its small size, the hypochlorite anion is capable of infiltrating mineralized collagen and destroying the collagen fibrils, producing a mineral-rich, collagen sparse ghost mineral matrix with reduced flexural strength. Findings from the present work challenge the biosafety of NaOCl when it is used in high concentrations and for lengthy time periods during root canal treatment, and laid the background work for future biomaterials design in debridement of the canal space.

Prévention des insatisfactions postopératoires et des éventuelles complications médico-juridiques

The purpose of this work is to better understand the reasons for post-surgical instability and what makes up the bed of medico-legal complications. Beyond technical competence, it is essential to observe a very high degree of rigor in listening to the real motivations in order to give the most accurate possible surgical indications and in particular to know to detect and never to operate certain patients who, whatever we do, will always be dissatisfied. The quality of information is one of the essential elements of prevention: information is part of the care and there is no therapeutic success without a successful relationship between a caregiver and a carereceiver. Before the surgery, it is essential to pre-establish written proof of the proper delivery of the information by signing a receipt and an informed consent document. However, the information does not stop at the time of the operative gesture and it is necessary to be able to provide complete and timely information about any post-surgical complications. Furthermore, aesthetic medicine is well understood and rigorously implemented, contributes to the prevention of surgical and medico-legal complications, reducing the heaviness of certain surgical gestures. The question of e-reputation should in no way be neglected. From this point of view, prevention consists in controlling as much as possible the Internet environment. Indeed, where, in the past, in the presence of a dissatisfied patient awaited us, the fear of word-of-mouth or trial is added to the risk of harm E-reputation whose implications can be very damaging. At a time when the intensive use of the Internet allows anyone to get out of anonymity, we must also control these tools at the risk of sacrificing our expertise at the coronation of amateurs.

First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment.

BackgroundThe purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain.MethodsA cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral.ResultsFour clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications.ConclusionCluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial and medical complications.

What′s the deal with dental records for practicing dentists? Importance in general and forensic dentistry

Dental records are essential for dentist and patient protection, and its maintenance is considered an ethical and legal obligation of the dentist: Ethical, because it satisfies the duty of care that the dentist has toward his patient and legal, as it is an investment for future protection against medico-legal complications. In addition to its legal and ethical role, the dental fraternity in India is slowly waking up to its importance in forensic dentistry. Dentists could play a vital role in assisting forensic investigators in providing information that would help in the identification of perpetrators or victims of crime and natural or manmade disaster situations. This information would be easily available and accessible through well-maintained patient records under dental care.

Anatomoradiological identification of intrasutural bones for importance of cranial fracture

Intrasutural bones are often found within sutures and fontanelles of the skull. It is important that the anatomy of these bones in the field of non-accidental injury with respect to medicolegal complications. Skull fracture lines are critical in their differential diagnosis, and the features of bone formations, their appearance and position give us a more definitive diagnosis. Intrasutural bone location, its number and symmetry were investigated in totally 300 adult skulls. 27 intrasutural bones were identified as interparietal (2%), preinterparietal (3%) and sutural bones (4%) were in the lambdoid sutures. It was detected that the interparietal and preparietal bones were single, and the sutural ones were in a multiple number. The sutural bones were superposed in significant structures such as sagittal sinus and sinus sigmoideus. The ones that should be paid attention to in the differential diagnosis of the skull fracture lines are preinterparietal and interparietal bones in larger sizes. These findings prompted us to report these cases as their presence can lead to confusion in diagnosis in cases of skull fractures.

To err is human: Quality management practices in surgical oral pathology, a safety net for medico-legal complications

Reading a slide and rendering a diagnosis is not only a science but also requires us to appreciate the constant artifact that is introduced in a controlled manner by tissue processing and obtaining a stained tissue section. There are a number of steps involved in getting the final stained tissue section and all these procedures if not performed properly have the potential to give rise to erroneous picture on the slide. Simple errors in judgments can lead to wrong diagnosis and unwarranted treatment. Such mistakes can put us at risk for Medico-Legal problems. The subject of Medico-Legal issues and practice of pathology has been neglected and amount of information available to the practicing professional in India is scarce. This paper focuses on standardized procedures for the various histopathology laboratory exercises. The paper highlights the importance of proper record maintenance with reporting protocols. A list of do's and don’ts for an Oral Pathologist is provided to help him/her in reducing the probable Medico-Legal issues. It does not in any way address the issue of individual competence and diagnostic abilities: That is an aspect for each individual to introspect upon and take remedial action.

Efficacy of left cardiac sympathetic denervation has an unforeseen side effect: Medicolegal complications

Efficacy of left cardiac sympathetic denervation has an unforeseen side effect: Medicolegal complications