Biomedical subjects

Talia Halamish-Shani

Publications and source records attributed to Talia Halamish-Shani.

4 recordsLinked to original sources

PubMed2004

Perianesthetic dental injuries: analysis of incident reports.

STUDY OBJECTIVE: To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem. DESIGN: Retrospective chart review of a large professional liability insurer. INTERVENTIONS: Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company. MEASUREMENTS AND MAIN RESULTS: There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients. CONCLUSIONS: In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.

Adolescent↗

PubMed2004

[Informed consent--a simulation workshop for surgeons and gynaecologists].

BACKGROUND: Informed consent as part of the Israeli Patient's Rights Act (1996) is poorly known and only partly followed among physicians in Israel. PURPOSE: A one-day workshop on informed consent was designed with a dual purpose: a) to instruct on the legal requirements for obtaining consent to surgery for physicians in the surgical disciplines, and b) to practice effective and humane physician-patient relationships. METHODS: Sixty-one residents and senior staff took part in 6 sessions of a one-day workshop. Participants watched twice and performed twice videotaped simulated consent conversations with standardized patients. Six professional actors personified patients with common surgical problems and different characters and behaviours. Each participant was challenged with medical problems in her/his discipline. Following the first simulation, the participants attended a group discussion concerning legal requirements for informed consent, and expectations of patients and physicians in terms of communication skills and patient-physician relationships. Three types of feed-back were employed: a) non-professional personal feedback from the actors; b) personal feedback from a communication specialist using one of the videotaped encounters; and c) group discussions of each of the 6 types of simulations with examples from the encounters. RESULTS: Feedback from the participants was positive and showed interest and need of knowledge of the law as well as of communicative skills. CONCLUSIONS: There is a place, among residents and senior physicians, for experiential learning of how to effectively and humanely obtain informed consent.

Education, Medical, Continuing↗

PubMedDate not supplied

Risk management aspects of implant dentistry.

PURPOSE: To categorize and review complications related to implant dentistry that have resulted in legal actions. MATERIALS AND METHODS: The records of 61 patients (39 women and 22 men) were retrospectively evaluated according to a structured form. Ages ranged from 28 years to 78 years (mean 49 +/- 12 years). The time lag in months between actual damage and legal action ranged from 0 months to 60 months (mean 12.7 months). RESULTS: Implant type, length, width, and locations varied widely and had no impact on the liability report. Half of the lawsuits were filed as a result of actual body damage (loss of sensation, oroantral fistula, life-threatening bleeding); 35% of the lawsuits were filed because of late complications; and 15% were related to immediate complications not leading to actual body damage. The dental consultants acknowledged liability in 41 of 61 cases. The clinician's errors that led to the reported complication were classified as preoperative in 39 of 41 cases. The doctor's attitude was considered positive in 40 cases and negative in 17 cases. DISCUSSION AND CONCLUSIONS: Clinicians should report as soon as possible to their insurance companies to get professional help. The main causes for lawsuits are actual body injury and major disappointment. Practitioners should dedicate a significant part of the entire treatment time to preoperative diagnosis and planning.

Adult↗

PubMedDate not supplied

Medicolegal aspects of altered sensation following implant placement in the mandible.

PURPOSE: Altered mandibular sensation following implant surgery may result in liability claims. Therefore the authors conducted a retrospective analysis of all liability claims related to persistent altered sensation following placement of mandibular implants reported to the Medical Consultants International (MCI) Company from 1992 to 1999. MATERIALS AND METHODS: Reports related to persistent altered mandibular sensation in 16 patients (12 women and 4 men) who underwent implant surgery in Israel were examined. The MCI files were retrospectively evaluated according to a structured form. The parameters studied included patient age and gender, implant location and length, imaging modality, and the time between actual damage and filing of a claim (ie, letter of demand or lawsuit). RESULTS: The time in months between actual damage and filing of claim ranged from 0 to 60 months (mean 21.5 months). No cases were found involving transient changes in sensation. The female/male ratio was 3:1. Implant length was equal to or longer than 13 mm in 6 of 7 implants placed in the molar region. In the premolar area, nerve injury was evident in 6 of 7 cases where implants shorter than 12 mm were used. CONCLUSIONS: Transient nerve injury rarely results in legal action. Maximum effort should be devoted to accurately determining the appropriate implant length in the mandible.

Adult↗