Informes periciales por presunta responsabilidad médica en Bogotá

SUMMARYBackgroundInformation on medical liability lawsuits is critical for the formulation and implementation of policies, programs and actions pertaining to patient safety. There is no systematic information at present in the Colombian health sector regarding adverse outcomes resulting in professional liability lawsuits.ObjectiveTo characterize the cases of alleged professional liability analyzed in the Bogota Chapter of the Clinical Forensics Group of the National Legal Medicine and Forensic Sciences Institute of Colombia between 2006-2010.MethodsA descriptive, uni and bivariate analysis of the forensic expert reports available was conducted.ResultsInformation was gathered for 402 cases. 77 % occurred in Bogota, 69.2 % were associated with women, the mean age was 36.4 years, and the private healthcare providers accounted for 52 % of the total. 80 % of the lawsuits were filed against the State and directly against the practitioners, and 59 % were criminal cases. The percentage of medical specialties involved most frequently was distributed as follows: 41 % in obstetrics and gynecology, 45 % in other surgical areas, 6 % in clinical areas and 5 % in pediatrics. The most frequent diagnoses were: fetal death of unexplained cause, accidental puncture or laceration during a procedure. 45 % of forensic reports were prepared by clinical or surgical specialists. The conclusion in 225 reports was that the case was the result of a complication, whereas in 165 the conclusion referred to a deviation from standard practice

Forensic expert report on alleged medical liability in Bogotá

Antecedentes. La información sobre las demandas por responsabilidad profesional médica es clave para la formulación y ejecución de las políticas y programas alrededor de la seguridad del paciente. Actualmente, el sector de la salud en Colombia no posee información sistemática sobre los resultados adversos que conducen a demandas por responsabilidad médica. Objetivo. Caracterizar los casos por presunta falla en la responsabilidad profesional entre 2006-2010, en el Grupo de Clínica Forense, Regional Bogotá perteneciente al Instituto Nacional de Medicina Legal y Ciencias Forenses de Colombia. Métodos. Análisis descriptivo uni y bivariado de los informes periciales disponibles. Resultados. Se recolectó la información de 402 casos. El 77 % de los casos fue de la ciudad de Bogotá. 69,2 % en mujeres. El promedio de edad fue de 36,4 años. Los prestadores de salud privados fueron el 52 %. El 80 % de las demandas fueron contra el Estado y directamente contra los profesionales, el 59 % de las demandas fueron penales. El tipo de especialidades médicas más frecuentes en los casos analizados fueron 41 % en ginecológica y obstetricia, 45 % en otras áreas quirúrgicas, 6 % en áreas clínicas y 5 % en pediatría. Los diagnósticos más frecuentes fueron la muerte fetal de causa no especificada, la punción o laceración accidental durante un procedimiento. 45 %, de los informes fueron hechos por especialistas clínicos o quirúrgicos. En 225 informes se concluyó que se trataba de una complicación y en 165 que la atención se apartaba de la norma de atención.Background. Information on medical liability lawsuits is critical for the formulation and implementation of policies, programs and actions pertaining to patient safety. There is no systematic information at present in the Colombian health sector regarding adverse outcomes resulting in professional liability lawsuits. Objective. To characterize the cases of alleged professional liability analyzed in the Bogota Chapter of the Clínical Forensics Group of the National Legal Medicine and Forensic Sciences Institute of Colombia between 2006-2010. Methods. A descriptive, uni and bivariate analysis of the forensic expert reports available was conducted. Results. Information was gathered for 402 cases. 77 % occurred in Bogota, 69.2 % were associated with women, the mean age was 36.4 years, and the private healthcare providers accounted for 52 % of the total. 80 % of the lawsuits were filed against the State and directly against the practitioners, and 59 % were criminal cases. The percentage of medical specialties involved most frequently was distributed as follows: 41 % in obstetrics and gynecology, 45 % in other surgical areas, 6 % in Clínical areas and 5 % in pediatrics. The most frequent diagnoses were: fetal death of unexplained cause, accidental puncture or laceration during a procedure. 45 % of forensic reports were prepared by Clínical or surgical specialists. The conclusion in 225 reports was that the case was the result of a complication, whereas in 165 the conclusion referred to a deviation from standard practice

Forensic expert report on alleged medical liability in Bogotá

Antecedentes. La información sobre las demandas por responsabilidad profesional médica es clave para la formulación y ejecución de las políticas y programas alrededor de la seguridad del paciente. Actualmente, el sector de la salud en Colombia no posee información sistemática sobre los resultados adversos que conducen a demandas por responsabilidad médica. Objetivo. Caracterizar los casos por presunta falla en la responsabilidad profesional entre 2006-2010, en el Grupo de Clínica Forense, Regional Bogotá perteneciente al Instituto Nacional de Medicina Legal y Ciencias Forenses de Colombia. Métodos. Análisis descriptivo uni y bivariado de los informes periciales disponibles. Resultados. Se recolectó la información de 402 casos. El 77 % de los casos fue de la ciudad de Bogotá. 69,2 % en mujeres. El promedio de edad fue de 36,4 años. Los prestadores de salud privados fueron el 52 %. El 80 % de las demandas fueron contra el Estado y directamente contra los profesionales, el 59 % de las demandas fueron penales. El tipo de especialidades médicas más frecuentes en los casos analizados fueron 41 % en ginecológica y obstetricia, 45 % en otras áreas quirúrgicas, 6 % en áreas clínicas y 5 % en pediatría. Los diagnósticos más frecuentes fueron la muerte fetal de causa no especificada, la punción o laceración accidental durante un procedimiento. 45 %, de los informes fueron hechos por especialistas clínicos o quirúrgicos. En 225 informes se concluyó que se trataba de una complicación y en 165 que la atención se apartaba de la norma de atención.Background. Information on medical liability lawsuits is critical for the formulation and implementation of policies, programs and actions pertaining to patient safety. There is no systematic information at present in the Colombian health sector regarding adverse outcomes resulting in professional liability lawsuits. Objective. To characterize the cases of alleged professional liability analyzed in the Bogota Chapter of the Clínical Forensics Group of the National Legal Medicine and Forensic Sciences Institute of Colombia between 2006-2010. Methods. A descriptive, uni and bivariate analysis of the forensic expert reports available was conducted. Results. Information was gathered for 402 cases. 77 % occurred in Bogota, 69.2 % were associated with women, the mean age was 36.4 years, and the private healthcare providers accounted for 52 % of the total. 80 % of the lawsuits were filed against the State and directly against the practitioners, and 59 % were criminal cases. The percentage of medical specialties involved most frequently was distributed as follows: 41 % in obstetrics and gynecology, 45 % in other surgical areas, 6 % in Clínical areas and 5 % in pediatrics. The most frequent diagnoses were: fetal death of unexplained cause, accidental puncture or laceration during a procedure. 45 % of forensic reports were prepared by Clínical or surgical specialists. The conclusion in 225 reports was that the case was the result of a complication, whereas in 165 the conclusion referred to a deviation from standard practice

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc