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 dentist's 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.

Análisis de sentencias judiciales relativas a negligencias médicas emitidas contra traumatólogos entre 1995 y 2011 / Analysis of judicial sentences issued against traumatologists between 1995 and 2011 as regards medical negligence

Introducción y objetivos. La Traumatología y Cirugía Ortopédica es una de las especialidades más reclamadas por su amplitud y complejidad. Nuestro objetivo es determinar las características de las reclamaciones presentadas contra médicos especialistas en Traumatología, considerando todas aquellas variables que puedan tener influencia tanto en el planteamiento de la demanda como en la resolución del proceso. Material y métodos. Se ha realizado un análisis de 303 sentencias judiciales (1995-2011) recogidas en el archivo de sentencias judiciales sanitarias de la Escuela de Medicina Legal de Madrid que se nutre de la base de datos de Westlaw Aranzazi. Resultados. La jurisdicción civil fue la más empleada. El proceso específico más reclamado fueron los trastornos osteoarticulares seguidos de las alteraciones vasculonerviosas y de las infecciones. La lesión reclamada ocurrió con más frecuencia en miembros inferiores sobre todo rodilla. La causa general de reclamación más frecuente fue el error terapéutico quirúrgico seguido del error diagnóstico. En el 14,9% fue el defecto de información. Existió condena en el 49,8% de los casos siendo la indemnización mayoritariamente menor de 50.000 euros. Conclusiones. Concluimos que la Traumatología y Cirugía Ortopédica es una especialidad proclive a las reclamaciones por mala praxis. El número de condenas a traumatólogos es elevado pero las indemnizaciones suelen ser menores de 50.000 euros. El motivo fundamental de las reclamaciones es el error terapéutico quirúrgico siendo pues el acto quirúrgico fundamental y donde se deben extremar las precauciones. Las condenas por deficiente información son elevadas siendo fundamental una adecuada comunicación médico-paciente y rellenar correctamente el consentimiento informado (AU)

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 (AU)

[Analysis of judicial sentences issued against traumatologists between 1995 and 2011 as regards medical negligence]. / 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.

Proposal for a 'surgical checklist' for ambulatory oral surgery.

The authors propose a new checklist model adapted for ambulatory oral surgery procedures based on the 'surgical checklist' proposed by the WHO. The proposed document contains 18 items divided into two sets: those that must be verified before beginning surgery and those that must be verified after its completion, but prior to the patient's departure from the site where the surgery is performed. A checklist is an easy-to-use tool that requires little time but provides order, logic and systematization taking into account certain basic concepts to increase the level of patient safety. The authors think that the result is a checklist that is easy to complete and ensures that key patient safety-related matters are dealt with in this field of surgery.

Consecuencias de las reclamaciones judiciales sobre los médicos afectados / Consequences of lawsuits on affected doctors

Objetivos. Determinar las consecuencias que una reclamación judicial tiene para la vida personal y la práctica profesional de los médicos afectados. Material y métodos. Estudio transversal, descriptivo, realizado sobre 169 encuestas cumplimentadas por médicos que han sido objeto de una reclamación judicial en España durante el período 2002-2005. Resultados. La reclamación supuso una vivencia personal mala o muy mala en el 98,8%. Un 85,1% reconoce una repercusión en su vida familiar. El 84% ha variado su forma de trabajar y el 57,4% reconoce repercusión en su vocación. En el 6% hubo resolución judicial desfavorable. Conclusiones. Se evidencian importantes repercusiones en los médicos después de una reclamación judicial, tanto en su vida personal y familiar, como en la forma de afrontar el ejercicio de la medicina(AU)

Objectives. To determine the consequences of a judicial claim on the private life and professional practice of affected doctors. Material and methods. A cross-sectional, descriptive study was performed on the basis of 169 surveys filled out by physicians subjected to a lawsuit in Spain in the period including 2002-2005. Results. The claim produced a bad or very bad personal experience in 98.8%. A total of 85.1% admitted repercussions on family life, 84% made some change in the way they worked, and 57.4% admitted effects on their vocation. There was an unfavorable court ruling in 6%. Conclusions. There were important repercussions on doctors after a lawsuit, both on their private and family life, as well as the way they approach medical practice(AU)

[Consequences of lawsuits on affected doctors]. / Consecuencias de las reclamaciones judiciales sobre los médicos afectados.

OBJECTIVES: To determine the consequences of a judicial claim on the private life and professional practice of affected doctors. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed on the basis of 169 surveys filled out by physicians subjected to a lawsuit in Spain in the period including 2002-2005. RESULTS: The claim produced a bad or very bad personal experience in 98.8%. A total of 85.1% admitted repercussions on family life, 84% made some change in the way they worked, and 57.4% admitted effects on their vocation. There was an unfavorable court ruling in 6%. CONCLUSIONS: There were important repercussions on doctors after a lawsuit, both on their private and family life, as well as the way they approach medical practice.

Valoración de los cambios histológicos pulpares para la determinación de la data de la muerte / Assessment of changes in dental pulp tissue in order to determine the time of death

La determinación de la data de la muerte es un problema fundamental en la medicina forense necesaria para esclarecer las circunstancias que rodearon a este acontecimiento. Existen numerosos métodos macroscópicos y microscópicos de distinta fiabilidad para intentar aproximarse a esadata. En este artículo se propone una metodología basada en los cambios histológicos pulpares postmortem. Para ello se estudiarán las variaciones tisulares acontecidas en la cámara pulpar de 122dientes poli radiculares vitales tras la interrupción del flujo sanguíneo, en diversos intervalos de tiempo. Asumimos que debido a que los tejidos pulpares se encuentran separados del resto de tejidos orgánicos por la dentina, su proceso de cambio postmortem sería similar al producido tras la interrupción del flujo sanguíneo. Los dientes trasser exodonciados y prefijados, fueron preparados para la observación microscópica convencional(corte, fijación y tinción).Como principales resultados observamos una pérdida gradual del parénquima pulpar y de su organización, en función del tiempo transcurrido(horas, días, semanas). La variación estructural de la sustancia orgánica de la cámara pulpar ha demostrado ser un elemento útil para la determinación valoración de la data de la muerte durante el primer intervalo postmortal (AU)

The determination of the time of death is a fundamental problem in forensic medicine and something that is required in order to clarify the circumstances surrounding a death. Many macroscopic and microscopic methods – some more reliable than others – are used to estimate this time. This article proposes a methodology based on postmortem changes in dental pulp tissue. Variations in the tissue within the pulp chamber of 122 multirooted teeth after the blood flow had stopped were analysed at different time intervals. We assumed that because the pulp tissue is separated from other body tissues by the dentine, the post-mortem change process would be similar to that which occurs after the blood flow stops. After being extracted and prefixed, the teeth were prepared for conventional microscopic observation (sectioning, fixing and staining).The main results observed were a gradual loss of the pulp parenchyma and its organization, in accordance with the amount of time that elapsed(hours, days, weeks). The structural variation in the organic substance of the pulp chamber proved to be a useful element for determining the time of death during the first post-mortem interval (AU)

[Analysis of judicial sentences against neurosurgeons resolved in second court of justice in Spain in the period from 1995 to 2007]. / Análisis de las sentencias judiciales contra neurocirujanos resueltas en segunda instancia en España entre 1995 y 2007.

OBJECTIVES: With the aim of identifying the factors related to sentences against neurosurgeons, we have analyzed all the sentences issued in the second court of justice in Spain against neurosurgeons in the period from 1995 to 2007. MATERIAL AND METHODS: Of a total of 1899 sentences of the second or last appeal, during the period from 1995 to 2007 issued in Spain, 61 were chosen which fulfill the criteria to be included in our study. 25 variables were included on the record of compiled data. A complete descriptive and comparative study was elaborated, as well as an analysis of the type of suits, circumstances, and professionals involved. RESULTS: In a third of the cases, complete malpraxis was identified. In regards to the sentences, they were absolved in approximately half the cases, resolved with one fifth of the cases being penal, and four fifths with compensation. Indemnity quantities range from 60,000 to 600,000euro. Deficiency of information or consent was noted in 17% of lawsuits. 62.5% of operations in our sample were on the anatomic region of the vertebral column followed in frequency by the cranial region with 28.6%. Consequences of surgical procedure included major permanent sequelae in 40% of the cases and death in 22%. CONCLUSIONS: It is wise to invest time to deal with patients, including the verbal informed consent, which must be confirmed by the written informed consent form. It is also important to leave a written proof of medical praxis, both related to surgical records and to diagnosis and follow-up of the patient. Procedures with a lower life-threatening risk should not be underestimated, since they comprise the greatest demanded group. The greatest amount of demands is related to economic reimbursement, especially in private practice.

Análisis de las sentencias judiciales contra neurocirujanos resueltas en segundainstancia en España entre 1995 y 2007 / Analysis of Judicial Sentences Against Neurosurgeons Resolved in Second Court of Justice in Spain in the Period from 1995 to 2007

Objetivos. Con el fin de identificar los factoresrelacionados con las condenas judiciales contra neurocirujanos,el presente estudio analiza todas las sentenciasemitidas en segunda instancia en España contraneurocirujanos en el periodo de 1995 al 2007.Material y método. De un total de 1899 sentencias desegunda instancia o última durante el periodo de 1995a 2007 emitidas en España se han escogido 61 que cumplenlos criterios de inclusión para nuestro estudio. Sehan cumplimentado 25 variables en la ficha de recogidade datos. Se ha realizado con ellas un completo estudiodescriptivo y comparativo, además de un análisis de latipología de las demandas, las circunstancias y los profesionalesimplicados.Resultados. En un tercio de los casos se apreció completamal praxis. En relación a las condenas, se absolvióaproximadamente en la mitad de los casos, siendo lasresueltas con condena 1/5 de ellas de carácter penaly 4/5 indemnizatorias. Las cuantías indemnizatoriaspredominan en el rango de 60.000 a 600.000 euros.En un 17% de las demandas se apreció deficiencia enla información o el consentimiento. El 62,5% de lasintervenciones de nuestra muestra se produjeron en laregión anatómica de la columna vertebral siguiéndoleen frecuencia la región craneal con un 28,6%. De lasconsecuencias del procedimiento quirúrgico las secuelaspermanentes mayores constituyen el 40% de loscasos y el fallecimiento el 22%.Conclusiones. Es rentable dedicar tiempo a la relacióncon el paciente, incluyendo el consentimiento informadoverbal, que debe ser refrendado por la (..) (AU)

Objectives. With the aim of identifying the factorsrelated to sentences against neurosurgeons, we haveanalyzed all the sentences issued in the second courtof justice in Spain against neurosurgeons in the periodfrom 1995 to 2007.Material and methods. Of a total of 1899 sentences ofthe second or last appeal, during the period from 1995to 2007 issued in Spain, 61 were chosen which fulfill thecriteria to be included in our study. 25 variables wereincluded on the record of compiled data. A completedescriptive and comparative study was elaborated, aswell as an analysis of the type of suits, circumstances,and professionals involved.Results. In a third of the cases, complete malpraxiswas identified. In regards to the sentences, they wereabsolved in approximately half the cases, resolved withone fifth of the cases being penal, and four fifths withcompensation. Indemnity quantities range from 60,000to 600,000€. Deficiency of information or consent wasnoted in 17% of lawsuits. 62.5% of operations in oursample were on the anatomic region of the vertebralcolumn followed in frequency by the cranial regionwith 28.6%. Consequences of surgical procedure includedmajor permanent sequelae in 40% of the cases anddeath in 22%.Conclusions. It is wise to invest time to deal withpatients, including the verbal informed consent, whichmust be confirmed by the written informed consent form.It is also important to leave a written proof of (..) (AU)

Análisis de las consecuencias médico-legales de las reclamaciones judiciales de pacientes. Estudio comparativo de los casos de traumatología, ginecología y obstetricia, anestesia y reanimación y odontoestomatología / Analysis of the medical-legal consequences of patient lawsuits. A comparative study of the cases of traumatology, gynecology and obstetrics, anesthesia and resuscitation, and dentistry

Objetivo: Establecer una base de datos homogénea sobre reclamaciones legales de pacientes; analizar estas reclamaciones y los daños derivados de ellas; y realizar un análisis descriptivo y comparativo entre algunas de las especialidades más representativas. Metodología: Se han estudiado 1899 sentencias judiciales de los tribunales españoles de segunda o tercera instancia correspondientes a los ámbitos jurisdiccionales penal civil y contencioso-administrativo. Resultados: Las especialidades médicas más reclamadas son la cirugía ortopédica y traumatología y la ginecología y obstetricia. En ambas, la proporción de sentencias condenatorias ronda el 50%. Con respecto a las cuantías indemnizatorias, las indemnizaciones más cuantiosas son las correspondientes a anestesiología y reanimación, seguidas de las de ginecología y obstetricia, y en último lugar las de odontoestomatología. Conclusión: los datos son de relevancia a la hora de determinar la cobertura de los seguros profesionales de responsabilidad civil de cada una de las especialidades (AU)

Objetive: To establish a homogeneous database of patient legal claims; analyze these claims and the damage derived from them; and to perform a descriptive and comparative analysis of some of the most representative medical specialties. Methods: A total of 1899 Spanish civil-penal and administrative contention court sentences were studied. Results: The most claimed medical specialties were orthopedic surgery and traumatology, and gynecology and obstetrics. In both cases the condemning sentences represented about 50%. Regarding the compensation sums, the largest corresponded to anesthesia and resuscitation, followed by gynecology and obstetrics, and dentistry in last position. Conclusion: The data obtained are relevant for defining the professional civil liability insurance coverage of each of the medical specialties (AU)

Actualización en Medicina de Familia. Intercepción postcoital: levonorgestrel, actualidad de un fármaco / Up-date In Family Medicine. Postcoital contraception: current usage of levonorgestrel

Desde el primer uso de un fármaco como método anticonceptivo de urgencia (sin indicación en ficha técnica para este uso específico) hasta el momento actual, en que se utiliza levonorgestrel, no sólo han variado los fármacos y las pautas de administración, sino que también han evolucionado las leyes y el conocimiento por parte de usuarios y profesionales. Por parte de los usuarios, son la mayor accesibilidad y el mayor conocimiento en temas relacionados con la salud, en general, y la anticoncepción, en particular, los que han hecho que se hayan incrementado las demandas en lo referente a anticoncepción postcoital. En el caso de los profesionales han contribuido el desarrollo de nuevas tecnologías que han hecho más fácil el acceso a esta información y el desarrollo en los últimos años de los diferentes programas de promoción y prevención de la salud, así como el mayor conocimiento científico sobre el fármaco

Since a drug was first used as an emergency contraceptive method (without indication in the data sheet for this specific use) up to current times, in which levonorgestrel is used, not only the drugs and the usage guidelines have changed but also the laws and the knowledge which the patients and professionals have. The greater access and knowledge which the patients have on health-related issues in general and contraception in particular have increased demands in postcoital contraception. Professionals have contributed to the development of new technology which has made access to this information and development in recent years to different programs of promotion and prevention in health care as well as increased scientific knowledge on the drug

Consentimiento informado en Implantología Oral. Propuesta de documentos / Informed consent in Oral Implantology. Proposal of documents

La Implantología es una de las áreas de la Odontoestomatología más afectadas por los problemas legales derivados de la Ley Básica Reguladora de la Autonomía del Paciente y ello por varias razones: por ser una actividad claramente quirúrgica, por haber sido encuadrada dentro de la llamada “medicina satisfactiva” y por pertenecer casi exclusivamente a la práctica privada de la odontoestomatología. Tiene además la peculiaridad de que los procedimientos quirúrgicos y prostodóncicos están íntimamente relacionados, y es, en ocasiones, muy complejo deslindar la responsabilidad que corresponde a cada uno de estos actos. En el presente artículo nos centraremos en las repercusiones que sobre esta área de la odontoestomatología tiene la reciente Ley Básica Reguladora de la Autonomía del Paciente en lo que a la información y al consentimiento se refiere. También haremos una propuesta de documentos que, a nuestro juicio, cumplen con los requisitos señalados por la legislación actual (AU)

The Implantology is one of the areas of the Odontoestomatology more affected by the legal problems derived from the Regulating Basic Law of the Autonomy of the Patient, and it for several reasons: for being a clearly surgical activity, for being fitted within the call ‘satisfactive medicine’ and to belong almost exclusively to the private practice of the Odontoestomatology. It has in addition the peculiarity of which the surgical and prosthodontics procedures intimately are related, and is sometimes, very complex to define the responsibility of corresponds to each one of these acts. In the present article we will be centred in the repercussions that on this area of the Odontoestomatology the recent Regulating Basic Law of the Autonomy of the Patient has in which to the information and the consent it talks about. Also we will make a proposal of documents that, in our opinion, fulfill the requirements indicated by the present legislation (AU)

Propuesta de una metodología de exploración y de valoración de las secuelas de la articulación témporo mandibular (ATM) / Proposal of the after-effects of the temporomandibular joint (TMJ)exploration and valuation methodology

Las secuelas en la articulación temporomandibular (ATM) son, con frecuencia, alegadas como consecuencia de accidentes de circulación, en especial tras hiperextensiones cervicales (esguince cervical). La exploración y diagnóstico de los problemas de la ATM no son sencillos. La variabilidad de movimientos, los condicionantes dentales y el hecho de que las dos ATM estén unidas complica mucho cualquier exploración. A esto se añade que la ATM, en cuanto a área de trabajo es «tierra de nadie» entre la odontoestomatología y la medicina (exceptuando la cirugía oral y maxilofacial). Por todo lo anteriormente expuesto, los peritos médicos con frecuencia tienen problemas para valorar adecuadamente esta articulación. El presente trabajo propone una metodología reglada y sencilla para que los peritos médicos valoren adecuadamente la ATM. También propone una serie de modificaciones en el baremo de secuelas de la Tabla VI de la Ley 34/2003 que, en criterio de los autores, simplificaría y equilibraría las puntuaciones dadas a la ATM en este baremo

The after-effects in the temporomandibular joint (TMJ) are usually alleged as a result of traffic accidents, especially after cervical hyperextensions. The exploration and diagnosis of the problems regarding TMJ are not easy. The variability of the movements, the dental determining factors and the fact that both TMJs are joined, makes very complicated the exploration. It should be added talking about the working area, that TMJ is ‘no man’s land’ between odontostomatology and medicine. Due to previously said, medical experts usually have problems to value in a suitable way this joint. The present work, propose a ruled and easy methodology for the medical experts to value correctly the TMJ. It also propose some modifications in the scale of aftereffects in the VI Table, Law 34/2003, that in the authors’ opinions would simplify and balance the scorings given for the TMJ in than scale

Evaluación del método de fotocopias de modelos para el estudio antropométrico de la arcada dental / Dental arch anthropometric survey by model photocopy method assessment

Los métodos para el estudio de la arcada dental son numerosos y diversos. El método de estudio sobre fotocopias de modelos conlleva ventajas, como la sencillez y la asequibilidad, la facilidad de registro y el almacenamiento para estudios a largo plazo o la posibilidad de digitalización y tratamiento de datos para su estudio y divulgación. En una muestra de 108 registros, tanto de modelos como de fotocopias de modelos, se han realizado diversas mediciones dentales y de arcada. Mediante los métodos estadísticos usuales se ha estudiado la fiabilidad del método de medición mediante fotocopias de modelos de estudio. Según nuestros resultados, las diferencias en las mediciones realizadas sobre modelos y sobre fotocopias de modelos son mínimas. El método de estudio de la arcada dental sobre fotocopias de modelos se puede considerar como un método válido para estudios anatómicos, antropológicos y ortodóncicos. Asimismo, la fotocopia de modelos de estudio puede facilitar la conservación de los datos sobre los tratamientos realizados, que la legislación actual exige. (AU)

Estudio de la forma de arcada del adulto español / Analysis of Spanish adult dental arch form

La arcada dental y su forma es uno de los pilares de los estudios ortodóncicos. Los intentos de ajustar la forma de la arcada dental a una curva matemática predeterminada han sido numerosos y diversos. En una muestra de 108 digitalizaciones de arcada se estudia el ajuste a la parábola, la elipse y la curva catenaria. Posteriormente, se realizará una comparativa entre los ajustes a las 3 curvas. Según nuestros resultados, la arcada del adulto español puede calificarse de elipsoide, ya que en todos los casos ajusta mejor a la elipse, a continuación a la parábola y a la curva que peor ajusta es a la curva catenaria (AU)