Pub Date : 2017-06-01DOI: 10.1302/2048-0105.63.360527
A. Das, F. Shivji, B. Ollivere
Hip fracture continues to be the most common serious injury in the elderly population, with the United Kingdom National Hip Fracture Database reporting over 64 000 such injuries in the last calendar year.1 The most recent annual registry report reflects and highlights the socioeconomic challenges faced by our, and all healthcare systems, globally. Patients are getting older, but also fitter. Carers of nonagenarians are often themselves in their 70s, and the state is left undertaking the lion’s share of the carer’s responsibility. These significant numbers of injured patients result in the use of 1.5 million bed days and a total care bill of over £1 billion. In the United Kingdom, this equates to a single injury requiring approximately 1% of the total NHS budget.1 Studies estimating future trends have predicted significant increases in annual hip fracture incidence in the context of an ever-ageing population,2-4 with suggested figures as high as 100 000 hip fractures annually in the United Kingdom by 2033, and associated inflation-adjusted costs of up to £5.6 billion in total care.2 This is set against a continuing programme of austerity and value in the majority of developed nations’ healthcare systems. In parallel with rising numbers of cases, there is rising complexity. Baker et al3 found a trend of increasingly complex medical comorbidities and social needs, and surmised that the hip fracture-related healthcare bill would rise disproportionately to incidence changes alone, resulting from the greater cost of treating these higher-demand patients. The last decade has seen the implementation of several NICE quality standards, rigorous audit and best practice tariffs, with the aim of better patient and cost-effective treatment pathways. This investment in care has had the effect of improving outcomes and reducing length of stay while simultaneously cutting total healthcare delivery costs. …
{"title":"Hip fractures: The state of the art in 2017","authors":"A. Das, F. Shivji, B. Ollivere","doi":"10.1302/2048-0105.63.360527","DOIUrl":"https://doi.org/10.1302/2048-0105.63.360527","url":null,"abstract":"Hip fracture continues to be the most common serious injury in the elderly population, with the United Kingdom National Hip Fracture Database reporting over 64 000 such injuries in the last calendar year.1 The most recent annual registry report reflects and highlights the socioeconomic challenges faced by our, and all healthcare systems, globally. Patients are getting older, but also fitter. Carers of nonagenarians are often themselves in their 70s, and the state is left undertaking the lion’s share of the carer’s responsibility. These significant numbers of injured patients result in the use of 1.5 million bed days and a total care bill of over £1 billion. In the United Kingdom, this equates to a single injury requiring approximately 1% of the total NHS budget.1\u0000\u0000Studies estimating future trends have predicted significant increases in annual hip fracture incidence in the context of an ever-ageing population,2-4 with suggested figures as high as 100 000 hip fractures annually in the United Kingdom by 2033, and associated inflation-adjusted costs of up to £5.6 billion in total care.2 This is set against a continuing programme of austerity and value in the majority of developed nations’ healthcare systems. In parallel with rising numbers of cases, there is rising complexity. Baker et al3 found a trend of increasingly complex medical comorbidities and social needs, and surmised that the hip fracture-related healthcare bill would rise disproportionately to incidence changes alone, resulting from the greater cost of treating these higher-demand patients.\u0000\u0000The last decade has seen the implementation of several NICE quality standards, rigorous audit and best practice tariffs, with the aim of better patient and cost-effective treatment pathways. This investment in care has had the effect of improving outcomes and reducing length of stay while simultaneously cutting total healthcare delivery costs. …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"25 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83521265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1302/2048-0105.63.360539
B. Ollivere
There has been a bit of a kerfuffle in the UK with the recent #hammeritout campaign, organised by the British Orthopaedic Trainees Association, in response to an electronic survey completed by around half the membership concerning undermining, bullying and harassment in the surgical workplace. This has not yet occurred in other western workplaces, but the issues raised are just as relevant. What has followed has been a series of uncomfortable conversations, and these are difficult conversations to have from every perspective. The headline results (available at www.bota.org.uk/hammer-it-out/) have been felt to be relevant to other specialties with campaigns in general surgery, anaesthetics and max fax well on their way. The initial response to survey results, such as 43% of …
{"title":"Team working, ethos and the uncomfortable conversation","authors":"B. Ollivere","doi":"10.1302/2048-0105.63.360539","DOIUrl":"https://doi.org/10.1302/2048-0105.63.360539","url":null,"abstract":"There has been a bit of a kerfuffle in the UK with the recent #hammeritout campaign, organised by the British Orthopaedic Trainees Association, in response to an electronic survey completed by around half the membership concerning undermining, bullying and harassment in the surgical workplace. This has not yet occurred in other western workplaces, but the issues raised are just as relevant.\u0000\u0000What has followed has been a series of uncomfortable conversations, and these are difficult conversations to have from every perspective. The headline results (available at www.bota.org.uk/hammer-it-out/) have been felt to be relevant to other specialties with campaigns in general surgery, anaesthetics and max fax well on their way. The initial response to survey results, such as 43% of …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"414 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76624362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1302/2048-0105.63.360531
M. Foy
The Consumer Protection Act (1987) (CPA) makes a producer strictly liable for personal injury, death or damage caused by a defective product. Although fault is not a requirement, the consumer (patient) must prove the defect, the injury and a causal link between them. This was tested in the medical field in the case of A vs National Blood Authority (NBA) in 2001.1 A total of 117 claimants brought an action for damages under the Act arising from their infection with hepatitis C as a result of blood transfusions received after March 1988. It was claimed that the infected blood was a “defective” product within the meaning of the Act and that they were entitled to receive blood that was free from infection. The NBA argued that as there was no test for hepatitis C until April 1991, the presence of the virus in the blood could not have been expected to be detected before that time. The court found in favour of the claimants in what was perceived to be a harsh decision at the time. In an 82-page judgement, it was argued under the Act and the European Union product liability safety directive, that the blood products were defective and that the public was entitled to expect that transfused blood should be free of infection, even though there was no reasonable means that the NBA could have used to identify the infection. After this case, it was generally accepted that it was much easier for patients to prove that a product was defective, and more difficult for manufacturers to escape liability by showing that they had done all that could be expected of them. This brings us on to consideration of the case of Wilkes vs DePuy International Ltd,2 a matter in the field of orthopaedics that …
{"title":"Product liability in prosthetics: Changes in the law 2016","authors":"M. Foy","doi":"10.1302/2048-0105.63.360531","DOIUrl":"https://doi.org/10.1302/2048-0105.63.360531","url":null,"abstract":"The Consumer Protection Act (1987) (CPA) makes a producer strictly liable for personal injury, death or damage caused by a defective product. Although fault is not a requirement, the consumer (patient) must prove the defect, the injury and a causal link between them. This was tested in the medical field in the case of A vs National Blood Authority (NBA) in 2001.1 A total of 117 claimants brought an action for damages under the Act arising from their infection with hepatitis C as a result of blood transfusions received after March 1988. It was claimed that the infected blood was a “defective” product within the meaning of the Act and that they were entitled to receive blood that was free from infection.\u0000\u0000The NBA argued that as there was no test for hepatitis C until April 1991, the presence of the virus in the blood could not have been expected to be detected before that time. The court found in favour of the claimants in what was perceived to be a harsh decision at the time. In an 82-page judgement, it was argued under the Act and the European Union product liability safety directive, that the blood products were defective and that the public was entitled to expect that transfused blood should be free of infection, even though there was no reasonable means that the NBA could have used to identify the infection. After this case, it was generally accepted that it was much easier for patients to prove that a product was defective, and more difficult for manufacturers to escape liability by showing that they had done all that could be expected of them.\u0000\u0000This brings us on to consideration of the case of Wilkes vs DePuy International Ltd,2 a matter in the field of orthopaedics that …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"245 1","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80591799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1302/2048-0105.62.360517
Tanvir R. Khan
With an increasing incidence of orthopaedic procedures performed worldwide, the quantity of data collected, including “Big Data”, is also rising. Widening indications for surgery, a growing number of implant options and variety of operative techniques, as well as an increasing need to demonstrate cost effectiveness, necessitate the use of robust analysis techniques to assess outcomes. Traditionally, analysis of outcomes in orthopaedic surgery involves survival methods, where the outcome of interest is ‘time to event’, which is usually revision or re-operation. For arthroplasty, this represents the time from the date of insertion of the implant until the date on which the revision is performed and patients whose outcomes are not known or have died are censored. Revision is generally taken as the primary indicator of failure of a joint replacement. Although revision/re-operation is dependent on many factors, including the fitness for surgery of the patient, it provides a firm endpoint for analysis, particularly in epidemiological studies. One of the strengths of survival analysis is the handling of incomplete data or follow-up. If an event is not seen within the timeframe observed or reported, there would be incomplete observations, known as censored events. ‘Right’ censoring is the most common and occurs either if a subject does not experience the event during the study period, is lost to follow-up or withdraws from the study. Death is another reason for censoring. The ‘risk set’ at a specific time point is defined as the individuals/implants that at that time are at risk of experiencing the event (e.g. revision). These are the individuals that have survived up to …
{"title":"Survival analysis of time-to-event data in orthopaedic surgery: Current concepts","authors":"Tanvir R. Khan","doi":"10.1302/2048-0105.62.360517","DOIUrl":"https://doi.org/10.1302/2048-0105.62.360517","url":null,"abstract":"With an increasing incidence of orthopaedic procedures performed worldwide, the quantity of data collected, including “Big Data”, is also rising. Widening indications for surgery, a growing number of implant options and variety of operative techniques, as well as an increasing need to demonstrate cost effectiveness, necessitate the use of robust analysis techniques to assess outcomes.\u0000\u0000Traditionally, analysis of outcomes in orthopaedic surgery involves survival methods, where the outcome of interest is ‘time to event’, which is usually revision or re-operation. For arthroplasty, this represents the time from the date of insertion of the implant until the date on which the revision is performed and patients whose outcomes are not known or have died are censored. Revision is generally taken as the primary indicator of failure of a joint replacement. Although revision/re-operation is dependent on many factors, including the fitness for surgery of the patient, it provides a firm endpoint for analysis, particularly in epidemiological studies.\u0000\u0000One of the strengths of survival analysis is the handling of incomplete data or follow-up. If an event is not seen within the timeframe observed or reported, there would be incomplete observations, known as censored events. ‘Right’ censoring is the most common and occurs either if a subject does not experience the event during the study period, is lost to follow-up or withdraws from the study. Death is another reason for censoring.\u0000\u0000The ‘risk set’ at a specific time point is defined as the individuals/implants that at that time are at risk of experiencing the event (e.g. revision). These are the individuals that have survived up to …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"11 1","pages":"37-39"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80422361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1302/2048-0105.62.360514
A. Singh, R. Collins, J. Wimhurst
A data request was made from the Health and Social Care Information Centre (HSCIC) regarding patients who had undergone a primary total knee replacement (TKR) at the Norfolk and Norwich Hospital in 2014. In total, 576 patients had received post-operative PROMs questionnaires in 2014. Complete information was available for 195 patients, which forms the basis of this analysis. The patient letters and the pre-operative assessment documentation on our electronic system (Bluespier) were then reviewed. The comorbidities that the clinician felt would apply to that patient were recorded from the list provided in the Oxford Knee Score (OKS) and were then compared with what the patients had recorded. In total, there were 189 additional comorbidities identified from our notes review. Of these, 95 would alter the predicted OKS score in 77 patients. There was a significant change in average predicted OKS score from 33.7 ± 3.9 to 32.3 ± 4.0 (p = 0.02) in the 77 patients who had additional OKS-altering comorbidities. When looking at the case-mix adjustment, the original mean adjustment was -0.83 (± 1.1). After adjusting for clinician-reported comorbidities, there was a significant change in the mean to -1.40 (± 1.4) (p < 0.0001). After the relevant recalculations were carried out, the adjusted average health gain went from 15.254 to 15.907. This is an improvement of 0.653. The small change of ensuring accurate comorbidity recording can have an impact on the adjusted average health gain for a hospital. This is important information: patients report comorbidities differently to clinicians, and often overrate their health. Despite the limitation of this comorbidity data, hospital performance data, which are publically available, are based on this case-mix and comorbidity adjustment. Care clearly needs to be taken in the interpretation of these case mix-adjusted scores. The PROMs (Patient-Reported Outcome Measures) programme, embedded within the NJR, …
{"title":"Differences in clinician versus patient recording of comorbidities in PROMs: Small changes, big impact","authors":"A. Singh, R. Collins, J. Wimhurst","doi":"10.1302/2048-0105.62.360514","DOIUrl":"https://doi.org/10.1302/2048-0105.62.360514","url":null,"abstract":"A data request was made from the Health and Social Care Information Centre (HSCIC) regarding patients who had undergone a primary total knee replacement (TKR) at the Norfolk and Norwich Hospital in 2014. In total, 576 patients had received post-operative PROMs questionnaires in 2014. Complete information was available for 195 patients, which forms the basis of this analysis. The patient letters and the pre-operative assessment documentation on our electronic system (Bluespier) were then reviewed. The comorbidities that the clinician felt would apply to that patient were recorded from the list provided in the Oxford Knee Score (OKS) and were then compared with what the patients had recorded.\u0000\u0000In total, there were 189 additional comorbidities identified from our notes review. Of these, 95 would alter the predicted OKS score in 77 patients. There was a significant change in average predicted OKS score from 33.7 ± 3.9 to 32.3 ± 4.0 (p = 0.02) in the 77 patients who had additional OKS-altering comorbidities. When looking at the case-mix adjustment, the original mean adjustment was -0.83 (± 1.1). After adjusting for clinician-reported comorbidities, there was a significant change in the mean to -1.40 (± 1.4) (p < 0.0001). After the relevant recalculations were carried out, the adjusted average health gain went from 15.254 to 15.907. This is an improvement of 0.653.\u0000\u0000The small change of ensuring accurate comorbidity recording can have an impact on the adjusted average health gain for a hospital. This is important information: patients report comorbidities differently to clinicians, and often overrate their health. Despite the limitation of this comorbidity data, hospital performance data, which are publically available, are based on this case-mix and comorbidity adjustment. Care clearly needs to be taken in the interpretation of these case mix-adjusted scores.\u0000\u0000The PROMs (Patient-Reported Outcome Measures) programme, embedded within the NJR, …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"43 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88838546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1302/2048-0105.62.360523
J. McQuater
Medico-legal experts instructed to write reports for use in personal injury claims may be perplexed by the number of those instructions which ask for an opinion about whether the claimant is disabled. Orthopaedic experts may be concerned that labelling the claimant as disabled could be regarded as a somewhat pessimistic approach. However, lawyers seeking an opinion on this point do so for valid technical reasons which this article will explore. Therefore, the purpose of this article is to explain why lawyers so often ask medical experts whether they consider that the claimant can properly be described as disabled according to the criteria set down in the 2010 Equality Act. It is hoped that this will enable medical experts to appreciate the significance of an opinion on this point, particularly so far as estimating claims for future loss of earnings is concerned. After outlining what might be described as the traditional method of calculating future loss of earnings, the article will turn to the modern method increasingly being adopted by the courts in appropriate cases and will seek to explain why the concept of disability is so important to that methodology. It is hoped that this analysis will help to explain why so many medico-legal instructions now raise the question of disability and will help to put such instructions into proper context. Where an injured person has continuing symptoms, even if these are not particularly significant, this may be important in terms of their future employability and may have a bearing on their future earning potential. There are, of course, cases where the injuries have an immediate, and continuing, effect on earnings and employment prospects. A more insidious problem is that encountered by the injured person who gets back to work (perhaps doing the same job) but is likely to face …
{"title":"Disability and the 2010 Equality Act: Relevance in personal injury claims","authors":"J. McQuater","doi":"10.1302/2048-0105.62.360523","DOIUrl":"https://doi.org/10.1302/2048-0105.62.360523","url":null,"abstract":"Medico-legal experts instructed to write reports for use in personal injury claims may be perplexed by the number of those instructions which ask for an opinion about whether the claimant is disabled.\u0000\u0000Orthopaedic experts may be concerned that labelling the claimant as disabled could be regarded as a somewhat pessimistic approach. However, lawyers seeking an opinion on this point do so for valid technical reasons which this article will explore.\u0000\u0000Therefore, the purpose of this article is to explain why lawyers so often ask medical experts whether they consider that the claimant can properly be described as disabled according to the criteria set down in the 2010 Equality Act. It is hoped that this will enable medical experts to appreciate the significance of an opinion on this point, particularly so far as estimating claims for future loss of earnings is concerned.\u0000\u0000After outlining what might be described as the traditional method of calculating future loss of earnings, the article will turn to the modern method increasingly being adopted by the courts in appropriate cases and will seek to explain why the concept of disability is so important to that methodology.\u0000\u0000It is hoped that this analysis will help to explain why so many medico-legal instructions now raise the question of disability and will help to put such instructions into proper context.\u0000\u0000Where an injured person has continuing symptoms, even if these are not particularly significant, this may be important in terms of their future employability and may have a bearing on their future earning potential.\u0000\u0000There are, of course, cases where the injuries have an immediate, and continuing, effect on earnings and employment prospects. A more insidious problem is that encountered by the injured person who gets back to work (perhaps doing the same job) but is likely to face …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"612 1","pages":"40-42"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76261671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1302/2048-0105.62.360522
B. Ollivere
The world hasn’t yet really decided what the presidency of Donald Trump will leave as its legacy but whatever it is you can be certain it won’t be the normal presidential legacy. Few observers, whatever their leaning, would argue that Trump’s policies are without controversy and there is little in the American President’s politics that we can find reflected in the views of the editorial staff here at 360 . A quite astounding phenomenon has been the development of the term ‘alternate facts’. A jaw-dropping approach which is at best misdirection and at worst flagrant lies. This phenomenon has set me thinking about probity and specifically research ethics. To coin a new phrase, ‘alternate facts papers’ are not as rare as one might think. The best estimates of the number of retracted papers would suggest …
{"title":"Evidence-based medicine in the world of ‘alternate facts’","authors":"B. Ollivere","doi":"10.1302/2048-0105.62.360522","DOIUrl":"https://doi.org/10.1302/2048-0105.62.360522","url":null,"abstract":"The world hasn’t yet really decided what the presidency of Donald Trump will leave as its legacy but whatever it is you can be certain it won’t be the normal presidential legacy. Few observers, whatever their leaning, would argue that Trump’s policies are without controversy and there is little in the American President’s politics that we can find reflected in the views of the editorial staff here at 360 . A quite astounding phenomenon has been the development of the term ‘alternate facts’. A jaw-dropping approach which is at best misdirection and at worst flagrant lies.\u0000\u0000This phenomenon has set me thinking about probity and specifically research ethics. To coin a new phrase, ‘alternate facts papers’ are not as rare as one might think. The best estimates of the number of retracted papers would suggest …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"4 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85206875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1302/2048-0105.61.360500
John W. Dale‐Skinner
Multimillion pound medical negligence claims are no longer a rarity, but receiving a solicitor’s letter can feel like a shocking blow. Although so much seems to be at stake, MDU claims handler Dr John Dale-Skinner recommends some ways in which consultant orthopaedic surgeons can help themselves. In recent years, the Medical Defence Union (MDU) has seen a disturbing rise in the number of high value claims against consultant members, including our highest settled claim to date: £9.2 million in compensation and legal costs for a patient left tetraplegic after spinal surgery. In 1995, the MDU settled one medical negligence claim for over £1 million. By 2015, there were 12 such claims. Within the private sector, orthopaedic specialists are at greater risk of a claim than, say, ophthalmologists or general surgeons. Despite what some commentators might suggest, the increase in high value claims and the rise in negligence claims generally are not caused by a fall in clinical standards. In fact, during 2015 the MDU successfully defended 80% of claims brought against our medical members. If you are unfortunate enough to receive a claim, here are the five most effective ways that you can help us to help you: 1. Notify your Medical Defence Organisation The first you are likely to know about a claim is when you receive a solicitor’s letter which sets out the allegations and is accompanied by the patient’s signed consent to release their records. This is known as a Letter Before Action and can be upsetting but do not be tempted to write to the solicitors or contact the patient directly to refute the allegations. Doing so can make the claim more difficult to manage. Instead, notify your Medical Defence Organisation (MDO) straight away; they will guide you throughout the process. 2. Get your paperwork in …
{"title":"What to do when the letter arrives","authors":"John W. Dale‐Skinner","doi":"10.1302/2048-0105.61.360500","DOIUrl":"https://doi.org/10.1302/2048-0105.61.360500","url":null,"abstract":"Multimillion pound medical negligence claims are no longer a rarity, but receiving a solicitor’s letter can feel like a shocking blow. Although so much seems to be at stake, MDU claims handler Dr John Dale-Skinner recommends some ways in which consultant orthopaedic surgeons can help themselves. \u0000\u0000In recent years, the Medical Defence Union (MDU) has seen a disturbing rise in the number of high value claims against consultant members, including our highest settled claim to date: £9.2 million in compensation and legal costs for a patient left tetraplegic after spinal surgery.\u0000\u0000In 1995, the MDU settled one medical negligence claim for over £1 million. By 2015, there were 12 such claims. Within the private sector, orthopaedic specialists are at greater risk of a claim than, say, ophthalmologists or general surgeons.\u0000\u0000Despite what some commentators might suggest, the increase in high value claims and the rise in negligence claims generally are not caused by a fall in clinical standards. In fact, during 2015 the MDU successfully defended 80% of claims brought against our medical members.\u0000\u0000If you are unfortunate enough to receive a claim, here are the five most effective ways that you can help us to help you:\u0000\u00001. Notify your Medical Defence Organisation \u0000\u0000The first you are likely to know about a claim is when you receive a solicitor’s letter which sets out the allegations and is accompanied by the patient’s signed consent to release their records. This is known as a Letter Before Action and can be upsetting but do not be tempted to write to the solicitors or contact the patient directly to refute the allegations. Doing so can make the claim more difficult to manage. Instead, notify your Medical Defence Organisation (MDO) straight away; they will guide you throughout the process.\u0000\u00002. Get your paperwork in …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"29 8","pages":"41-42"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72471254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1302/2048-0105.61.360497
A. Horn, D. Eastwood
Legg-Calve-Perthes disease (LCPD) is a relatively common condition affecting around 4 in 100 000 children aged four to ten years. The extent of femoral head collapse and deformity following LCPD is the single most important factor contributing to long-term outcome.1,2 The severity of the residual deformity at skeletal maturity is most commonly described using the Stulberg classification.3 Treatment strategies during the active stage of LCPD frequently involve measures to minimise loads across the hip joint whilst maintaining movement, with the hope that this will prevent femoral head collapse and deformity. Treatment includes activity limitation, active/passive range of motion exercises and bracing, all complemented by appropriate analgesic medication. However, these strategies have not been proven to be effective in preventing femoral head collapse. In the long-term follow-up study by Larson et al,1 no difference was found between hip-related morbidity in patients that were treated with bracing, those treated with active range of motion strategies and those receiving no treatment. A recently published review also failed to demonstrate any benefit of bracing over no treatment.4 The failure of these treatment methods could possibly be ascribed to the fact that, even during slow walking, the forces acting across the hip joint far exceed body weight.5 Therefore, if, as it appears, we cannot prevent collapse of the ‘vulnerable/dead’ epiphysis, researchers will have to resort to exploring strategies that might strengthen the weakened epiphysis, rendering it more resistant to forces that lead to collapse and subsequent deformity. This article summarises the recent advances and experimental strategies directed at preventing femoral head deformity in LCPD. During the initial phase of LCPD as described by Waldenstrom,6 there is disruption of the blood flow to the femoral head with subsequent necrosis of the marrow space and deep layers of articular …
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Pub Date : 2017-02-01DOI: 10.1302/2048-0105.61.360506
B. Ollivere
The impact of a paper can be, and is, measured in many ways. This month in 360 we feature a paper from The Lancet which should be read by every orthopaedic surgeon involved in trauma care.1 This is potentially a game-changing article, a randomised control trial suggesting that one of the major “advances” in trauma care may in fact not be an advance at all. The authors conducted a technically and logistically challenging study, and randomised patients to either ATLS standard of care or immediate trauma CT scanning. It is a miraculous study with an interesting result. Whole-body CT scanning trauma patients is no better than ATLS-directed imaging in experienced hands, yet it poses a significant radiation risk. But who will read it? The paper is published in The Lancet , where only a handful …
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