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Biomedical subjects

W G Brands

Publications and source records attributed to W G Brands.

9 recordsLinked to original sources
PubMed2006

The standard for the duty to inform patients about risks: from the responsible dentist to the reasonable patient.

Complaints or claims against dentists by dissatisfied patients usually consist of three parts: the dentist did not perform the treatment as s/he should have done; the dentist did not inform the patient properly about the risks involved with the treatment; the dentist did not keep records. In most cases it is not too difficult for a judge or dental board member, if necessary with the aid of an expert witness, to decide whether the treatment was indeed below standard. The same applies to dentist's record keeping. The recrimination concerning the information given is something else. This deals with the extent of the duty to inform a patient as well as the proof that sufficient information was given. These difficulties do not only appear in court, but also in dental surgeries. This article will focus on the evolution in the jurisprudence concerning the duty to inform patients about risks as well as on the recently changed guidelines of the General Dental Council (GDC) regarding informed consent. Finally some simple tests will show that informing patients about risks does not have to be a risky and time consuming business for the dentist.

Dental Records↗
PubMed2006

[The emancipated patient. A conflict between right of autonomy and encouragement to use one's right of autonomy properly].

During the last decades, patients have acquired a wide range of legal rights. Judicial courts are administering these rights to actual situations leading to new obligations for health carers. In this article, the patient's right of autonomy and the dentist's care delivering obligations are examined. Sometimes these rights and obligations are clashing, requiring a decision which comes first. Disciplinary councils are expected to determine in actual situations primarily the dentist's obligations or the patient's rights mentioned in the complaint. Subsequently, they are asked to assess possible interferences with other obligations and patient's rights. Finally, they have to indicate how rights and obligations have to be weighed up.

Ethics, Dental↗
PubMed2006

[Dental records and responsibility].

Dental records are more than a small part of the bookkeeping. In most dental practises, keeping records is the task of a dental assistant. In civil court, the dentist is in most countries liable for the mistakes of his employees. In disciplinary court however there may be doubt whether the dentist is responsible for the mistakes of his assistant. Contrary to their American colleagues, Dutch dental assistants and dental hygienists cannot be summoned before a disciplinary court. As these para-medics perform more and more dental treatment, independently or after delegation, they should be assigned there own disciplinary responsibility.

Dental Assistants↗
PubMed2004

[Developments in civil and disciplinary law. A view of the revision of the Netherlands Society for Dentistry (NMT) administration of justice].

According to some people, the renewed Dutch civil disciplinary law is not fulfilling the expectations. Some procedures seem to be reductant for accused dentists. Besides the civil disciplinary law, also the professional disciplinary law of Dutch Dental Association is questionable. The Association is planning to change the current professional disciplinary law. However, the proposed amendments may have the consequence that a Dutch dentist more frequently will be faced with a civil disciplinary law procedure or normal civil law procedure.

Dentistry↗
PubMed2002

[Complaints by complainers?].

For Dutch physicians being sued is one of their worst nightmares in professional life. Dutch dentists as a group do not seem to bother. This article shows that the light-heartedness of the dental profession is incorrect. A Dutch dentist has the same reason for being worried about the chance of facing a (disciplinary) council, about the procedure and about (disciplinary) measures as Dutch physicians have. For dentists who actually had to face a disciplinary council, their experience was very frightening and affected their professional satisfaction. Knowledge of public health legislation and a basic knowledge of legal procedures can be useful weapons in the battle against burnout.

Burnout, Professional↗
PubMed2000

Comparison between closed drainage techniques for the treatment of postoperative mediastinitis.

BACKGROUND: It is not clear which closed drainage technique is preferred as initial therapy for mediastinitis as soon as it is detected after cardiac surgery. A comparison is made between a continuous irrigation system and vacuum drainage using redon catheters. METHODS: A retrospective cohort study of patients undergoing cardiac surgery between January 1, 1989 and January 1, 1997 was made. Patients who developed a deep surgical site infection at the sternotomy site and who were treated with one of the two closed drainage techniques were included. Patient characteristics and procedure-related variables were analyzed. Also, variables related to the drainage procedure were included. Outcome parameters were treatment failure, total hospital stay, postoperative hospital stay and in-hospital mortality. RESULTS: The study population consisted of 11,488 patients, of whom 102 developed a deep surgical site infection (0.89%). The final study population consisted of 60 patients who fulfilled the inclusion criteria. From those, 29 were treated with continuous irrigation and 31 were treated with vacuum drainage. Both groups were comparable for patient characteristics and procedure-related variables. Treatment failure was more than three times as likely in the continuous irrigation group (relative risk: 3.2, 95% confidence interval: 1.3 to 7.7). Also, postoperative (p = 0.03) and total hospital stay (p = 0.03) were significantly longer in the group treated with continuous irrigation (mean prolongation of 14 and 13 days, respectively). After correcting for confounding, using multivariate analysis, the treatment method employed was found to be an independent and statistically significant variable associated with treatment failure (p = 0.04). CONCLUSIONS: Closed drainage using vacuum-drainage system is the initial therapy of choice for patients with mediastinitis after cardiac surgery, because it is associated with significantly less treatment failure and a shorter stay in hospital.

Cardiac Surgical Procedures↗
PubMed1998

Bicarbon valve -- European multicenter clinical evaluation.

OBJECTIVE: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon bileaflet valve. METHODS: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4 +/- 12.4, underwent valve implantation. OPERATIONS: aortic valve replacement (AVR), 726; mitral valve replacement (MVR), 475; double valve replacement (DVR), 150. Additional procedures: CABG, 211; TV repair, 64; other, 152. RESULTS: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24. CONCLUSIONS: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications.

Adolescent↗