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Revalidation and medico-legal practice after retirement 退休后的再认证和医疗法律实践
1区 医学 Q1 Medicine Pub Date : 2015-08-01 DOI: 10.1302/2048-0105.44.360365
M. Foy
Traditionally, many consultant orthopaedic surgeons have retired from clinical practice and supplemented their pensions in retirement by continuing their medico-legal practice. The longevity of this custom has varied enormously from surgeon to surgeon. There has been no clear monitoring of the situation after retirement in terms of currency or quality of work, other than the fact that if solicitors/insurers continued to issue instructions to the individual then it was presumed that the quality and content of the reports and expert opinion provided were fit for purpose.Then along came revalidation in 2012. I discussed some of the prevalent issues on the subject in an article published in this journal a year ago.1 This brief article should be seen as an update and considered together with the earlier piece.It has been difficult to get a clear position statement from the GMC on this matter, but my understanding remains that if an orthopaedic surgeon is interviewing and examining patients (claimants), he/she is required to maintain GMC registration and hold a licence to practice. In order to do this, the surgeon needs to undergo annual appraisal and revalidate every five years in exactly the same way as they would be required to do when in active (NHS or private) practice. The MDU2 appears quite clear on this, …
传统上,许多骨科顾问医生已经从临床实践中退休,并通过继续他们的医疗法律实践来补充他们的退休养老金。这一习俗的持续时间因外科医生而异。对于退休后的情况,除了律师/保险公司继续向个人发出指示外,并没有就薪酬或工作质素作出明确的监察,则可推定所提供的报告和专家意见的质素和内容符合目的。然后在2012年出现了重新验证。我在一年前发表在这个杂志上的一篇文章中讨论了一些关于这个主题的流行问题这篇简短的文章应该被视为一个更新,并与之前的文章一起考虑。在这个问题上很难从GMC得到明确的立场声明,但我的理解仍然是,如果矫形外科医生正在采访和检查患者(索赔人),他/她必须保持GMC注册并持有执业执照。为了做到这一点,外科医生需要进行年度评估,并每五年重新验证一次,就像他们在活跃的(NHS或私人)实践中所要求的那样。MDU2在这一点上表现得很清楚……
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引用次数: 0
Democracy, healthcare and the modern era 民主,医疗和现代
1区 医学 Q1 Medicine Pub Date : 2015-06-01 DOI: 10.1302/2048-0105.43.360334
B. Ollivere
As more and more of Europe moves towards multiparty politics, it is becoming increasingly common for coalition governments to decide healthcare policy. The results of the UK election will be known when this editorial is in print – but will it really make a difference to those practicing orthopaedic surgeons in the UK?It is somewhat ironic that the US healthcare economy is being pushed further towards an affordability model (with, amongst other initiatives, ‘Obamacare’ and reforms to insurance) whilst the NHS is being pushed ever so slowly towards a ‘free market’ approach – potentially repeating the mistakes of our American cousins.There can never be such a thing as ‘market forces’ in state-funded healthcare. The …
随着越来越多的欧洲国家走向多党制政治,由联合政府决定医疗保健政策正变得越来越普遍。当这篇社论出版时,英国大选的结果就会揭晓——但这真的会对英国的整形外科医生产生影响吗?有点讽刺的是,美国医疗保健经济正进一步向可负担模式(在其他倡议中,“奥巴马医改”和保险改革)推进,而NHS却在缓慢地向“自由市场”模式推进——可能会重复我们美国表兄弟的错误。在国家资助的医疗保健中,永远不可能有“市场力量”这样的东西。…
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引用次数: 0
AAOS Meeting Roundup AAOS会议综述
1区 医学 Q1 Medicine Pub Date : 2015-06-01 DOI: 10.1302/2048-0105.43.360346
Philip J York, C. Mauffrey
Amid the lights and sounds of the Vegas Strip, this year’s American Academy of Orthopaedic Surgeons (AAOS) meeting provided an energy-filled opportunity to gather and share the latest techniques, research and exciting technologies in orthopaedic surgery. For most, the days started with a cup of coffee in hand, heading to CME lectures or specialty-specific paper presentations which were then defended during collegial question-and-answer sessions, leading into the lunch hour with countless gourmet restaurants within sight of the convention hall. And of course, after the afternoon sessions there was the opportunity to reunite over dinner and drinks with old colleagues and previous co-residents. The occasional walk through the technological expo revealed a hall packed with the latest and greatest implants and techniques from some familiar names, and some new startup companies hoping to pique some interest.A clear highlight of the week was the changing of the guards as previous Academy president Dr Frederick M. Azar handed over the …
在拉斯维加斯大道的灯光和声音中,今年的美国骨科医师学会(AAOS)会议提供了一个充满活力的机会来收集和分享骨科手术的最新技术,研究和令人兴奋的技术。对大多数人来说,一天的开始是手里拿着一杯咖啡,去参加CME的讲座或专门的论文报告,然后在学院问答环节进行辩护,然后进入午餐时间,在会议厅的视野内有数不清的美食餐厅。当然,在下午的会议之后,有机会与老同事和以前的合作伙伴一起吃饭和喝酒。偶尔走进科技展,你会发现大厅里挤满了最新、最伟大的植入物和技术,这些植入物和技术来自一些熟悉的名字,以及一些希望引起人们兴趣的新创业公司。本周一个明显的亮点是前学院主席弗雷德里克·m·阿扎尔博士将…
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引用次数: 0
Vitamin D: effects on muscle function, falls and fractures 维生素D:对肌肉功能、跌倒和骨折的影响
1区 医学 Q1 Medicine Pub Date : 2015-06-01 DOI: 10.1302/2048-0105.43.360355
O. Sahota
Clinical studies evaluating the effects of vitamin D alone or in combination with calcium on physical function, falls and fractures have been inconsistent. Vitamin D has, however, been the focus of much orthopaedic, trauma and endocrine research. Playing a central role in muscle and bone metabolism, some studies on Vitamin D therapies offer the tantalising suggestion of a reduction in falls and fractures simply with vitamin D supplementation. We review the background and evidence behind vitamin D.
临床研究评估维生素D单独或与钙联合对身体功能、跌倒和骨折的影响一直不一致。然而,维生素D一直是许多骨科、创伤和内分泌研究的焦点。维生素D在肌肉和骨骼代谢中发挥着核心作用,一些关于维生素D治疗的研究提供了一个诱人的建议,即仅仅补充维生素D就可以减少跌倒和骨折的发生。我们回顾了维生素D的背景和证据。
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引用次数: 2
The scaphoid fracture 舟状骨骨折
1区 医学 Q1 Medicine Pub Date : 2015-06-01 DOI: 10.1302/2048-0105.43.360349
A. Clarke
When scaphoid fractures are missed, the consequences for patient and clinician may be considerable. This may be as a consequence of nonunion and if so, reconstructive surgical fixation often with bone grafting may be required. Other longer-term implications such as post-traumatic osteoarthritis (often referred to as scaphoid nonunion advanced collapse - SNAC wrist) may necessitate salvage surgery such as partial or total wrist fusion. In either of these circumstances the cost to the individual for their employment and to the wider health economy will be keenly felt.This article is intended to bring together some of the recent relevant literature on the missed scaphoid fracture and to present a current medico-legal case which illustrates the importance of repeated examination, good records and keeping the possibility of a scaphoid fracture in mind.Wrist pain after injury is very common. The fall onto the outstretched hand is the most typical method of injury, but a direct blow to the hand, such as from a football, may provide sufficient force to fracture the scaphoid. All medical staff in contact with such patients, whether in Minor Injury Units (MIUs), Emergency Departments (EDs), GP surgeries or other primary care providers, need to have high clinical suspicion and must maintain good examination records. The key examination points of the painful wrist should document anatomical snuffbox tenderness (ASB), longitudinal compression of the thumb (LTC), scaphoid tubercle tenderness (STT) and painful ulnar deviation of the wrist (PUD).1 Each of these …
当遗漏舟状骨骨折时,对患者和临床医生的后果可能是相当大的。这可能是不愈合的结果,如果是这样,可能需要重建手术固定,通常需要植骨。其他长期影响,如创伤后骨关节炎(通常称为舟状骨不连晚期塌陷- SNAC手腕)可能需要补救性手术,如部分或全部手腕融合。在这两种情况下,个人的就业成本和更广泛的卫生经济成本都将被敏锐地感受到。本文旨在收集一些最近关于舟状骨骨折漏诊的相关文献,并提出一个当前的医学-法律案例,说明反复检查、良好记录和牢记舟状骨骨折可能性的重要性。受伤后手腕疼痛是很常见的。摔倒在伸出的手上是最典型的伤害方式,但是直接打击手,比如从足球上,可能会提供足够的力量使舟状骨骨折。所有与此类患者接触的医务人员,无论是在轻伤病房(MIUs)、急诊科(EDs)、全科医生手术室还是其他初级保健提供者,都需要高度的临床怀疑,并必须保持良好的检查记录。腕关节疼痛的重点检查点应包括解剖性鼻烟壶压痛(ASB)、拇指纵向压迫(LTC)、舟状骨结节压痛(STT)和腕关节尺侧偏痛(PUD)每一个…
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引用次数: 0
Ankle replacement:: where are we now? 踝关节置换:我们现在在哪里?
1区 医学 Q1 Medicine Pub Date : 2015-04-01 DOI: 10.1302/2048-0105.42.360318
C. Lever, A. Robinson
Ankle replacements have improved significantly since the first reported attempt at resurfacing of the talar dome in 1962. We are now at a stage where ankle replacement offers a viable option in the treatment of end-stage ankle arthritis. As the procedure becomes more successful, it is important to reflect and review the current surgical outcomes. This allows us to guide our patients in the treatment of end-stage ankle arthritis. What is the better surgical treatment – arthrodesis or replacement?
自1962年首次报道距骨穹窿重铺以来,踝关节置换术有了显著改善。我们现在所处的阶段是踝关节置换术是治疗终末期踝关节关节炎的可行选择。随着手术越来越成功,反思和回顾当前的手术结果是很重要的。这使我们能够指导患者治疗终末期踝关节关节炎。什么是更好的手术治疗-关节融合术还是置换?
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引用次数: 3
Somatoform disorders in litigation: causation and prognosis 诉讼中的躯体形式障碍:病因与预后
1区 医学 Q1 Medicine Pub Date : 2015-04-01 DOI: 10.1302/2048-0105.42.360333
L. Neal
Orthopaedic experts will be familiar with litigated accidents in which there is a relatively minor soft-tissue injury that does not explain the persistent severity of pain and the ensuing marked disability. They will also usually be aware that 90% of patients with chronic low back pain do not have any reliable evidence of a significant structural causative defect or injury.1The International Association for the Study of Pain (IASP) definition of pain emphasises the importance of psychological factors in its perception: pain is regarded as an unpleasant sensory and emotional experience. Many people report pain in the absence of tissue damage or any likely pathophysiological cause and this usually happens for psychological reasons. Pain is always a psychological state.2 This article examines how claimants with medically unexplained pain may be diagnosed by psychiatrists, and the implications for their treatment and prognosis are discussed.The diagnosis of psychiatric disorders is generally made with reference to the current edition of the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association3 or the International Classification of Diseases published by the World Health Organization.4 Both of these classification systems are recognised by the British courts and neither is regarded as more valid.However, the relatively new diagnosis of a Somatic Symptom Disorder3 is of little utility in personal injury litigation. The accompanying text in the DSM states that “the reliability of determining a somatic symptom is medically unexplained is limited” and on this basis the presence or absence of a medical explanation is irrelevant to the diagnosis. However, in court, the psychiatrist that continued to entertain a probable persisting medical cause would be acting outside their area of expertise if, for example, an orthopaedic expert had already excluded a physical cause. The Somatic Symptom Disorder diagnosis is …
骨科专家将熟悉的诉讼事故中,有一个相对较小的软组织损伤,不能解释持续严重的疼痛和随之而来的显著残疾。他们通常也会意识到,90%的慢性腰痛患者没有任何可靠的证据表明存在重大的结构性缺陷或损伤。国际疼痛研究协会(IASP)对疼痛的定义强调了心理因素在疼痛感知中的重要性:疼痛被视为一种不愉快的感觉和情感体验。许多人在没有组织损伤或任何可能的病理生理原因的情况下报告疼痛,这通常是由心理原因引起的。痛苦永远是一种心理状态这篇文章探讨了如何索赔与医学上无法解释的疼痛可能被精神科医生诊断,并对他们的治疗和预后的影响进行了讨论。精神疾病的诊断通常参考美国精神病学协会出版的最新版《诊断与统计手册》(DSM)或世界卫生组织出版的《国际疾病分类》。这两种分类系统都得到英国法院的认可,但两者都不被认为更有效。然而,相对较新的躯体症状障碍的诊断在人身伤害诉讼中用处不大。DSM附带的文本指出,“确定医学上无法解释的躯体症状的可靠性是有限的”,在此基础上,有无医学解释与诊断无关。然而,在法庭上,精神科医生如果继续接受一个可能存在的医学原因,那么他的行为就超出了他的专业领域,例如,一个骨科专家已经排除了身体原因。躯体症状障碍的诊断是…
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引用次数: 1
Innovation or regulation – differing needs in different areas 创新还是监管——不同领域的不同需求
1区 医学 Q1 Medicine Pub Date : 2015-04-01 DOI: 10.1302/2048-0105.42.360317
B. Ollivere
The history of orthopaedic surgery is one of innovators – a star-studded cast stretching from Thomas with his splint through to Charnley with his hip and beyond. Like all histories, the history of orthopaedics is written by the victors. Think of the Judet family, and the acetabular views and decortication technique come to mind, not the poor-outcome acrylic hips. However the truth is that for every Charnley Low Friction Arthroplasty, there were many more ‘Delbet Rubber Femurs’, ‘Hey-Groves Ivory Hips’ and ‘Ring Metal-on-Metal’ hips. Innovation in the time of our forefathers was embraced and the truth is that it was acceptable to experiment on patients.This is of course no longer true. Established technologies such as hip replacement are now ‘designed’ with iterative changes hoping for ever improved results. It is easy to see why …
矫形外科的历史是创新的历史之一,从托马斯的夹板到查恩利的臀部和其他部位,明星云集。像所有的历史一样,骨科的历史是由胜利者书写的。想想Judet家族,首先想到的是髋臼视图和去皮技术,而不是效果不佳的丙烯酸髋关节。然而,事实是,对于每一个Charnley低摩擦关节置换术,有更多的“Delbet橡胶股骨”,“Hey-Groves象牙髋关节”和“环金属对金属”髋关节。在我们的祖先时代,创新是被接受的,事实是,在病人身上做实验是可以接受的。这当然不再是真的了。现有的技术,如髋关节置换术,现在“设计”了反复的变化,希望得到更好的结果。很容易看出为什么……
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引用次数: 0
Scoliosis and litigation 脊柱侧凸和诉讼
1区 医学 Q1 Medicine Pub Date : 2015-04-01 DOI: 10.1302/2048-0105.42.360332
M. J. Wilson-MacDonald
In 2010/2011, 2053 spinal infusions were carried out for scoliosis, of which 1328 were in children. In contrast there were 224 549 admissions in total for spinal disorders1 and therefore scoliosis cases proceeding to litigation are relatively uncommon. There may be other reasons for the lower incidence of litigation in scoliosis patients including the fact that almost all of these operations are carried out in tertiary centres as planned cases during daylight hours. Multidisciplinary teams of surgeons, physicians and other healthcare professionals manage the patients, and in many cases two senior surgeons operate together which may reduce the risks in these cases. Furthermore, the consenting process is generally carried out by more senior members of the team; the patients and their families are usually in no doubt that this is a major operation not without significant risk, and patients are rarely given the impression that complete correction of the deformity will take place. Although curve progression and prevention of pain are the main indications for surgery, improvement in cosmesis is also an important aim of the surgery. However, I am not aware that failure to improve appearance has been a cause for litigation. The majority of claimants in scoliosis cases are children and their families. Because many operations are carried out early in childhood, there is a very long trail of cases. Adults have to commence proceedings within three years of the perceived injury, while children have until the age of 21 to do so. In many cases the surgeon in charge of the case may be retired or may have died.The causes of allegations of negligence/breach of duty include neurological injury; failure of instrumentation or other instrumentation problems; nonunion of fusion; choice of wrong levels; failure to identify pre-operative abnormalities; failure to use spinal cord monitoring; failure …
2010/2011年共进行脊柱侧凸输液2053例,其中儿童1328例。相比之下,脊柱疾病共入院224549例1,因此脊柱侧凸的诉讼是相对罕见的。脊柱侧弯患者诉讼发生率较低可能还有其他原因,包括几乎所有这些手术都在三级中心按照计划在白天进行。由外科医生、内科医生和其他医疗保健专业人员组成的多学科团队管理患者,在许多情况下,两名资深外科医生一起手术,这可能会降低这些病例的风险。此外,同意过程通常由团队中更资深的成员执行;患者和他们的家人通常毫无疑问地认为这是一个大手术,并非没有重大风险,患者很少有完全矫正畸形的印象。虽然手术的主要适应症是弯曲的进展和疼痛的预防,但改善美容也是手术的重要目的。然而,我不知道未能改善外观已成为诉讼的原因。在脊柱侧凸的情况下,大多数索赔人是儿童及其家人。由于许多手术是在儿童早期进行的,因此有很长的病例记录。成年人必须在感知到伤害后的三年内提起诉讼,而儿童必须在21岁之前提起诉讼。在许多情况下,负责该病例的外科医生可能已经退休或已经去世。过失/违约指控的原因包括神经损伤;仪表故障或其他仪表问题;融合不愈合;选择错误的关卡;未能识别术前异常;未使用脊髓监测;失败……
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引用次数: 0
OTA Annual Meeting Roundup 在线旅行社年会综述
1区 医学 Q1 Medicine Pub Date : 2015-04-01 DOI: 10.1302/2048-0105.6.360329
D. Forward, C. Lewis
The annual meeting of the Orthopaedic Trauma Association (OTA) continues to stand out as the foremost global meeting focussed on the practice and science of orthopaedic trauma surgery. All of the global opinion leaders in orthopaedic trauma regularly present their work, alongside instructional elements, and it remains the meeting at which one will find most of the United Kingdom’s leading trauma surgeons. The UK Orthopaedic Trauma Society (OTS) is steadily bringing practice-changing meetings of this kind to the UK and, given time, it seems likely that the OTS meetings should be part of UK trauma and orthopaedic (T&O) surgeons’ calendars.The 30th anniversary 2014 OTA Annual Meeting was held between 15 and 18 October 2014 in Tampa, Florida, hosted by the irrepressible Roy Sanders, of the calcaneal fracture classification. Nearby, the white sands of Clearwater Beach and the turquoise warm water of the Gulf of Mexico posed stiff competition for the extensive educational programme which offered a combination of a large collection of instructional course lectures, symposia, and scientific exhibits representing a wide range of trauma subspecialties. The programme committee presented 150 podium presentations from over 800 submitted, along with 170 posters, for the 1340 attendees.Prior to the annual meeting, on the Wednesday afternoon and Thursday morning there was a number of pre-meeting events, which cater for the variety of trauma surgeons attending. There is a guest nation each year, which this year was Brazil; 2016 will be the UK’s turn as guest nation in Vancouver, Canada.The extensive OTA meeting includes a number of ‘pre-meeting’ events such as the pelvic surgeons’ forum hosted by Adam Starr each year, and the basic science focus forum. A standout paper from …
骨科创伤协会(OTA)年会继续作为全球最重要的骨科创伤外科实践和科学会议而脱颖而出。所有骨科创伤领域的全球意见领袖都会定期展示他们的工作,以及教学元素,在这次会议上,人们将发现大多数英国领先的创伤外科医生。英国骨科创伤学会(OTS)正在稳步地将这种改变实践的会议带到英国,如果有时间的话,OTS会议似乎应该成为英国创伤和骨科(T&O)外科医生日程表的一部分。2014年OTA 30周年年会于2014年10月15日至18日在佛罗里达州坦帕市举行,由Roy Sanders主持,讨论跟骨骨折分类。附近,清水海滩的白沙和墨西哥湾碧绿的温水形成了激烈的竞争,为广泛的教育项目提供了大量的教学课程讲座、专题讨论会和科学展览,代表了广泛的创伤亚专业。项目委员会为1340名与会者提供了来自800多份提交的150份讲台演讲和170份海报。在年会之前,周三下午和周四上午有一些会前活动,以满足各种创伤外科医生的参加。每年都有一个嘉宾国,今年是巴西;2016年将轮到英国作为嘉宾国在加拿大温哥华举办奥运会。广泛的OTA会议包括一些“会前”活动,如每年由Adam Starr主持的盆腔外科医生论坛,以及基础科学焦点论坛。一篇来自……
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引用次数: 0
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Journal of Bone and Joint Surgery
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