Andrés Santiago-Sáez

Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010.

Introduction: The effort to increase patient safety has become one of the main focal points of all health care professions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. Objectives: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. Material and Methods: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. Results: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. Conclusions: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred. Key words:Patient safety, adverse event, medical care risk, dentistry.

Retrospective evaluation of attention deficit hyperactivity disorder with the Wender Utah Rating Scale in a sample of Spanish prison inmates.

Abstract:  The aim of this study is to determine the prevalence of childhood history of attention deficit hyperactivity disorder (ADHD) in a sample of prison inmates. This is a descriptive, cross‐sectional study, which consisted of a sample of 100 inmates from penitentiary centers in Madrid. The instruments used were the Wender Utah Rating Scale (WURS), the International Personality Disorder Examination, and a questionnaire of demographic, penitentiary, and toxicological data. For statistical analysis, the SPSS program was used with confidence interval estimation of 95%. The mean score of the WURS was 65.7 points. Fifty percent of the sample surpassed the cut‐off point of 32 for the 25 best discriminative items in the Spanish validated version. A significant association was found between a childhood history of ADHD and antisocial and borderline personality disorders. The disorder was also found to be associated with autoaggressive behavior, more probability to be sanctioned in prison, and have a history of substance dependence.

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.

Utility of Failure Mode and Effect Analysis to Improve Safety in Suctioning by Orotracheal Tube

Objective: The objective of the study was to use the Failure Mode and Effect Analysis (FMEA) tool to analyze the technique of secretion suctioning on patients with an endotracheal tube who were admitted into an intensive care unit. Materials and Methods: Brainstorming was carried out within the service to determine the potential errors most frequent in the process. After this, the FMEA was applied, including its stages, prioritizing risk in accordance with the risk prioritization number (RPN), selecting improvement actions in which they have an RPN of more than 300. Results: We obtained 32 failure modes, of which 13 surpassed an RPN of 300. After our result, 21 improvement actions were proposed for those failure modes with RPN scores above 300. Conclusions: FMEA allows us to ascertain possible failures so as to later propose improvement actions for those which have an RPN of more than 300.

Decisiones al final de la vida: resultados del cuestionario validado por expertos

OBJECTIVE To assess the attitudes and knowledge in the lifes end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. METHOD A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. RESULTS The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at lifes end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. CONCLUSION Madrids people state they would like to decide what care they will receive at lifes end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid.

OriginalResponsabilidad por pérdida de oportunidad asistencial en patología oncológica maligna en la medicina pública españolaResponsibility for the loss of opportunity in malignant cancer care in the Spanish public healthcare system

OBJECTIVE The loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes. METHOD We analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014. RESULTS Of the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences. CONCLUSIONS The litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.

Responsabilidad por pérdida de oportunidad asistencial en patología oncológica maligna en la medicina pública española

OBJECTIVE The loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes. METHOD We analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014. RESULTS Of the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences. CONCLUSIONS The litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.

La doctrina del menor maduro

Andrés Santiago-Sáeza,b, María Elena Albarrána,c y Bernardo Pereaa,d aDepartamento de Toxicología y Legislación Sanitaria. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. España. bServicio de Medicina Legal. Hospital Universitario Clínico San Carlos. Madrid. España. cCentro de Salud Presentación Sabio. Móstoles. Área 8 de Madrid. Madrid. España. dComisión Científica y de Investigación. Ilustre Colegio Oficial de Médicos de Madrid. Madrid. España. drsantiago@med.ucm.es; Meaj36@gmail.com; bperea@med.ucm.es

Detecting the manipulation of digital clinical records in dental practice

INTRODUCTION Radiography provides many advantages in the diagnosis and management of dental conditions. However, dental X-ray images may be subject to manipulation with malicious intent using easily accessible computer software. METHODS In this study, we sought to evaluate a dentists ability to identify a manipulated dental X-ray images, when compared with the original, using a variant of the methodology described by Visser and Kruger. Sixty-six dentists were invited to participate and evaluate 20 intraoral dental X-ray images, 10 originals and 10 modified, manipulated using Adobe Photoshop to simulate fillings, root canal treatments, etc. RESULTS Participating dentists were correct in identifying the manipulated image in 56% of cases, 6% higher than by chance and 10% more than in the study by Visser and Kruger. CONCLUSION Malicious changes to dental X-ray images may go unnoticed even by experienced dentists. Professionals must be aware of the legal consequences of such changes. A system of detection/validation should be created for radiographic images.

Age Estimation Based on a Radiographic Study of the Growing Foot

BACKGROUND We sought to determine a predictive model of data, differentiated by sex, from a radiographic study of the skeleton of the foot as an alternative to the classic study of the hand. METHODS The study included 2,476 digital radiographs from 816 participants aged 0 to 21 years. The radiographs were from the Radiology Diagnostic Services of the Public Health System of Extremadura (Spain) from 2007 to 2011. The method used for their analysis consisted of assigning a numerical code to each ossification center of each growing bone of the foot and subsequently subjecting the data to a multivariate, decision tree, statistical analysis. RESULTS The decision tree study identified the bones that have a common age-dependent pattern of growth (as determined by a comparison of means test with P < .01) among individuals of the same sex. The quality of the decision tree predictions was evaluated in terms of the r 2 coefficient. These values were r2 = 0.897 for females and r2 = 0.890 for males, thus establishing the predictive goodness of the model of bone data to provide a specific estimate of the individuals age. CONCLUSIONS The foot is a good predictor of an individuals age from birth to complete bone maturity.