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Thabet AM, Adams A, Jeon S, Pisquiy J, Gelhert R, DeCoster TA, Abdelgawad A. Malpractice lawsuits in orthopedic trauma surgery: a meta-analysis of the literature. OTA Int 2022; 5:e199. [PMID: 36425091 PMCID: PMC9580045 DOI: 10.1097/oi9.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/16/2022] [Indexed: 06/16/2023]
Abstract
Introduction The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Methods Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity. Results The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error. Conclusion Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent. Level of Evidence Economic and Decision Analyses Level VI.
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Affiliation(s)
- Ahmed M Thabet
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Austin Adams
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Soyoung Jeon
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, NM
| | - John Pisquiy
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
- West Virginia University, Department of Orthopedics, Morgantown, VA
| | - Rick Gelhert
- University of New Mexico, Department of Orthopaedic Surgery, Albuquerque, NM
| | - Thomas A DeCoster
- University of New Mexico, Department of Orthopaedic Surgery, Albuquerque, NM
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Geleta TA, Deriba BS. Exploring Enablers and Barriers to Utilize Printed Information, Education, and Communication Materials Among Healthcare Providers of North Shoa Zone, Oromia, Ethiopia. Healthc Policy 2022; 15:1303-1313. [PMID: 35818433 PMCID: PMC9270902 DOI: 10.2147/rmhp.s360417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Information, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020. Methods A descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings. Results The findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider’s related factors, and government-related factors. Conclusion In this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.
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Affiliation(s)
- Tinsae Abeya Geleta
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
- Correspondence: Tinsae Abeya Geleta, Email
| | - Berhanu Senbeta Deriba
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
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3
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Bolam SM, Munro L, Wright M. Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty. ANZ J Surg 2022; 92:1831-1838. [PMID: 35588267 PMCID: PMC9543849 DOI: 10.1111/ans.17781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Background The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Methods Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12‐month period in a single‐centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. Results A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. Conclusions This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritize improving documentation of informed consent for orthopaedic trauma patients to ensure a patient‐centred approach to healthcare.
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Affiliation(s)
- Scott M Bolam
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Leigh Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Wright
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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Haji A. Patients' utilisation and perception of the quality of printed health education materials in primary health care: a cross-sectional study. BJGP Open 2019; 3:bjgpopen19X101672. [PMID: 31719118 PMCID: PMC6995867 DOI: 10.3399/bjgpopen19x101672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/12/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Printed health education (HE) materials are commonly provided in primary health care (PHC). However, little is known about their use by PHC visitors. AIM This study explored patients' opinions and use of printed HE materials in order to determine an ideal output format for HE. DESIGN & SETTING This was a cross-sectional study, which was conducted in three PHC centres at King Abdulaziz Medical City in Riyadh, Saudi Arabia. METHOD Data were collected through a self-administered questionnaire. RESULTS Fifty-five point two per cent of participants obtained printed HE materials from PHC waiting areas. The majority read one or more materials and found it helpful and memorable. Seventy-seven point two per cent applied the written message, 24.0% of participants regularly read HE materials, and more than half spent time reading them in the PHC centre's waiting area. Around half (51.1%) put the material back in its place after reading it. The preferred format was card with text and graphs. The preferred content was healthy lifestyle advice. CONCLUSION Patients do use printed HE materials in a positive way. More efforts are needed to improve the quality of the materials. Different healthcare providers should contribute more in HE.
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Affiliation(s)
- Alhan Haji
- Consultant Family Medicine and Director of Health Programs and Chronic Disease Department, Administration of Public Health, General Directorate of Health Affairs in Riyadh Region, Ministry of Health, Riyadh, Saudi Arabia
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5
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Mandarelli G, Parmigiani G, Carabellese F, Codella S, Roma P, Brancadoro D, Ferretti A, Alessandro L, Pinto G, Ferracuti S. Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery. MEDICINE, SCIENCE, AND THE LAW 2019; 59:247-254. [PMID: 31366276 DOI: 10.1177/0025802419865854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.
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Affiliation(s)
| | | | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Silvia Codella
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Paolo Roma
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
| | - Domitilla Brancadoro
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | | | - Giovanni Pinto
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
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6
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Thiruchandran G, McKean AR, Rudran B, Imam MA, Yeong K, Hassan A. Improving consent in patients undergoing surgery for fractured neck of femur. Br J Hosp Med (Lond) 2019; 79:284-287. [PMID: 29727232 DOI: 10.12968/hmed.2018.79.5.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of femur fracture-specific consent form within their unit will lead to sustained adequate documentation of risks associated with surgery.
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Affiliation(s)
| | - Andrew R McKean
- Core Surgical Trainee, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Branavan Rudran
- Foundation Year 2 Doctor, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Mohamed A Imam
- Senior Upper Limb Fellow, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Keefai Yeong
- Consultant Orthogeriatrician and Quality Improvement Lead, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey
| | - Abdel Hassan
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey KT16 0QA
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D'Souza RS, Johnson RL, Bettini L, Schulte PJ, Burkle C. Room for Improvement: A Systematic Review and Meta-analysis on the Informed Consent Process for Emergency Surgery. Mayo Clin Proc 2019; 94:1786-1798. [PMID: 31486381 DOI: 10.1016/j.mayocp.2019.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare recall of complications and surgical details discussed during informed consent and perception of the consent process in patients undergoing emergent vs elective surgery. METHODS Studies were identified from PubMed, Cochrane, Web of Science, and Scopus from January 1, 1966, through April 18, 2018. Included studies compared patient recall and perception regarding informed consent in those undergoing emergent vs elective surgery. Pooled odds ratios (ORs) were calculated for recall of complications and surgical details, patient satisfaction, perception of sufficient information being delivered on surgical risks, report of having read written consent, and factors that interfered with consent. RESULTS Eleven observational studies (3178 patients) were included. The rate of recall of surgical complications (255 of 504 [50.6%] vs 321 of 446 [72.0%]; OR, 0.29; 95% CI, 0.11-0.80) was lower in patients undergoing emergent vs elective surgery. Meta-analysis revealed a decreased rate of patient satisfaction with the consent process (319 of 459 [69.5%] vs 882 of 1064 [82.9%]; OR. 0.53; 95% CI, 0.34-0.83) and fewer patients having read the consent form (130 of 395 [32.9%] vs 424 of 714 [59.4%]; OR, 0.35; 95% CI, 0.27-0.46) when undergoing emergent compared with elective surgery. Patients undergoing emergent surgery listed pain, analgesic medications, and fatigue as factors likely to interfere with consent. CONCLUSION Patients undergoing emergent surgery have poor recall of the informed consent process and surgical complications. Furthermore, patients report lower rates of satisfaction, and with fewer patients reading written consent documentation, our findings illuminate problems with the current communication process. There is a need to develop effective tools to improve informed consent in emergency surgery.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Layne Bettini
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Christopher Burkle
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Lin YK, Liu KT, Chen CW, Lee WC, Lin CJ, Shi L, Tien YC. How to effectively obtain informed consent in trauma patients: a systematic review. BMC Med Ethics 2019; 20:8. [PMID: 30674301 PMCID: PMC6343333 DOI: 10.1186/s12910-019-0347-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/14/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. METHODS We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed (1961-August 2018) that had experimental or observational study design and involved adult trauma patients. Studies involving informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. RESULTS A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. CONCLUSIONS Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients.
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Affiliation(s)
- Yen-Ko Lin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Humanities and Education, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Ting Liu
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Wen Chen
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Che Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ju Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yin-Chun Tien
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Nnabugwu II, Ugwumba FO, Udeh EI, Anyimba SK, Ozoemena OF. Informed consent for clinical treatment in low-income setting: evaluating the relationship between satisfying consent and extent of recall of consent information. BMC Med Ethics 2017; 18:69. [PMID: 29197378 PMCID: PMC5712194 DOI: 10.1186/s12910-017-0227-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 11/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatment informed consent aims to preserve the autonomy of patients in the clinician - patient relationship so as to ensure valid consent. An acceptable method of evaluating understanding of consent information is by assessing the extent of recall by patients of the pieces information believed to have been passed across. When concerns are not satisfactorily addressed from the patients' perspective, recall of consent information may be low. METHODS This study is a questionnaire - based cross - sectional interview of consecutive adult surgical patients who could give their respective medical histories and who were booked for elective major surgical procedures over a period of 7 months in a tertiary health institution in southeastern Nigeria. Four to five days after a formal consent session, during ward admission, extent of recall of information on the nature of the disease condition or diagnosis, the nature of the planned procedure and the risks involved in the planned procedure were assessed and analyzed on the background of how satisfying the consent sessions were from individual patient's perspective. RESULTS Generally, the recall of nature of disease condition and nature of planned procedure is better than recall of risks involved in the planned procedure. More specifically however, recall in these 3 domains is significantly better among the patients that affirmed that their concerns were satisfactorily addressed. CONCLUSION The findings from this study support that no effort should be spared in ensuring that the consent information are satisfying to the patients from the patients' viewpoint.
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Affiliation(s)
- Ikenna I Nnabugwu
- Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus P M B, State, Enugu, 01129, Nigeria. .,University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
| | - Fredrick O Ugwumba
- Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus P M B, State, Enugu, 01129, Nigeria.,University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Emeka I Udeh
- Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus P M B, State, Enugu, 01129, Nigeria.,University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Solomon K Anyimba
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Oyiogu F Ozoemena
- Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus P M B, State, Enugu, 01129, Nigeria.,University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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McMahon C, Denaxas S. A novel metadata management model to capture consent for record linkage in longitudinal research studies. Inform Health Soc Care 2017; 44:176-188. [PMID: 29106808 PMCID: PMC6484449 DOI: 10.1080/17538157.2017.1364251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Informed consent is an important feature of longitudinal research studies as it enables the linking of the baseline participant information with administrative data. The lack of standardized models to capture consent elements can lead to substantial challenges. A structured approach to capturing consent-related metadata can address these. Objectives: a) Explore the state-of-the-art for recording consent; b) Identify key elements of consent required for record linkage; and c) Create and evaluate a novel metadata management model to capture consent-related metadata. Methods: The main methodological components of our work were: a) a systematic literature review and qualitative analysis of consent forms; b) the development and evaluation of a novel metadata model. Discussion: We qualitatively analyzed 61 manuscripts and 30 consent forms. We extracted data elements related to obtaining consent for linkage. We created a novel metadata management model for consent and evaluated it by comparison with the existing standards and by iteratively applying it to case studies. Conclusion: The developed model can facilitate the standardized recording of consent for linkage in longitudinal research studies and enable the linkage of external participant data. Furthermore, it can provide a structured way of recording consent-related metadata and facilitate the harmonization and streamlining of processes.
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Affiliation(s)
- Christiana McMahon
- a University College London, Institute of Health Informatics , London , United Kingdom.,b Farr Institute of Health Informatics Research , London , United Kingdom
| | - Spiros Denaxas
- a University College London, Institute of Health Informatics , London , United Kingdom.,b Farr Institute of Health Informatics Research , London , United Kingdom
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Abstract
Hip fractures are a major cause of trauma related death, usually occurring in vulnerable elderly patients. There are an estimated 70,000 hip fractures in the UK per year with numbers set to rise. The estimated annual cost to the healthcare economy is in the region of £2 billion. A 17-year review examining litigation related to hip fractures was undertaken. Under a freedom of information request, data was obtained relating to all orthopaedic claims made to the NHS Litigation Authority (NHSLA) between 1995 and 2012. Data was filtered to identify cases involving hip fractures examining litigation trends related to this specific area. 10263 NHSLA orthopaedic cases were identified, of which 13.3% (n=1364) cases related to the hip and femur. Hip fractures made up 16.7% (n=229). The total cost of hip fracture litigation was over £7 million with an average cost per case of £32,700. The commonest reasons for litigation were diagnostic errors (30.6%), issues with care (24.9%) alleged incompetent surgery (15.7%) and development of pressure sores (5.7%). This study highlights the main causes of litigation in patients sustaining hip fractures, with diagnosis in the emergency department and ward presenting a significant problem. In addition, the data identifies a range of care related issues, as well as several surgical factors and highlights the importance of pressure area care. We discuss these and make suggestions on how to improve practice in this area with the aim of improving patient care and reducing litigation.
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Affiliation(s)
- Joseph Ring
- Pennie Acute Hospital Trust, North Manchester General Hospital, Delaunays Rd, Manchester M8 5RB, United Kingdom.
| | - Christopher Talbot
- Pennie Acute Hospital Trust, North Manchester General Hospital, Delaunays Rd, Manchester M8 5RB, United Kingdom
| | - Charlotte Cross
- Pennie Acute Hospital Trust, North Manchester General Hospital, Delaunays Rd, Manchester M8 5RB, United Kingdom
| | - Kunal Hinduja
- Pennie Acute Hospital Trust, North Manchester General Hospital, Delaunays Rd, Manchester M8 5RB, United Kingdom
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12
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Informing the process of consent for surgery: identification of key constructs and quality factors. J Surg Res 2017; 209:86-92. [DOI: 10.1016/j.jss.2016.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
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13
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Krzych ŁJ, Ratajczyk D. Awareness of the patients' rights by subjects on admission to a tertiary university hospital in Poland. J Forensic Leg Med 2013; 20:902-5. [DOI: 10.1016/j.jflm.2013.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 05/07/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
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Abstract
Patients often quote diseases or illnesses that either do not exist per se or are hard to prove that they exist. Often symptoms are vague and, therefore, difficult for patients to qualify in a language clinicians can understand, interpret and act upon. Physicians often perpetuate this by giving 'diagnoses of exclusion', or using poor explanations, oversimplifications, conflicting diagnostic criteria or vague historical terms that have now evolved into something else. However, the history taker must be able to interpret the subtle language barrier that exists between doctor and patient. In this short review of the literature, some commonly quoted conditions are examined more closely to try and understand further the terminology used by both patients and clinicians alike.
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Affiliation(s)
- H K S Cohen
- Department of Surgery, Northampton General Hospital, Northampton NN1 5BD, UK
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