Medical Malpractice and Corticosteroid Use

Nash, John J.; Leach, Matthew E.; Poetker, David M.

doi:10.1016/j.otohns.2010.06.009

Cited by 40 publications

(87 citation statements)

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“…Nonetheless, this database has still been proven of value in analyses characterizing the medicolegal aspects of a wide variety of topics. 9,18,31,34,39,45,51,[54][55][56][60][61][62] …”

Section: Discussionmentioning

confidence: 99%

“…This database has been proven to be of value in a previous analysis of otolaryngologist expert witnesses, 18 as well as a variety of other topics of interest to both neurological surgeons and otolaryngologists. 28,31,34,45,[54][55][56]60,62 WestlawNext is composed of publicly available court records that are collected by commercial vendors, who vary by jurisdiction. Some jurisdictions may include only cases submitted voluntarily by legal counsel.…”

Section: Methodsmentioning

confidence: 99%

“…Some jurisdictions may include only cases submitted voluntarily by legal counsel. 34,45 However, we have previously contacted Westlaw concerning this issue; research support staff indicated that many jurisdictions contain nonvoluntarily submitted cases, which are frequently labeled "Anonymous," "Confidential," or "John Doe v Jane Doe." 18 An online search with the names of neurological surgeons serving as expert witnesses in these cases along with the term "neurosurgery" or "neurosurgeon" was conducted.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in neurological surgery

Eloy¹,

Svider

Folbe

et al. 2014

JNS

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Object. Expert witnesses provide a valuable societal service, interpreting complex pieces of evidence that may be misunderstood by nonmedical laypersons. The role of medical expert witness testimony and the potential professional repercussions, however, have been controversial in the medical community. The objective of the present analysis was to characterize the expertise of neurological surgeons testifying as expert witnesses in malpractice litigation.Methods. Malpractice litigation involving expert testimony from neurological surgeons was obtained using the WestlawNext legal database. Data pertaining to duration of a surgeon's practice, scholarly impact (as measured by the h index), practice setting, and the frequency with which a surgeon testifies were obtained for these expert witnesses from various online resources including the Scopus database, online medical facility and practice sites, and state medical licensing boards.Results. Neurological surgeons testifying in 326 cases since 2008 averaged over 30 years of experience per person (34.5 years for plaintiff witnesses vs 33.2 for defense witnesses, p = 0.35). Defense witnesses had statistically higher scholarly impact than plaintiff witnesses (h index = 8.76 vs 5.46, p < 0.001). A greater proportion of defense witnesses were involved in academic practice (46.1% vs 24.4%, p < 0.001). Those testifying on behalf of plaintiffs were more likely to testify multiple times than those testifying on behalf of defendants (20.4% vs 12.6%).Conclusions. Practitioners testifying for either side tend to be very experienced, while those testifying on behalf of defendants have significantly higher scholarly impact and are more likely to practice in an academic setting, potentially indicating a greater level of expertise. Experts for plaintiffs were more likely to testify multiple times. Surgical societies may need to clarify the necessary qualifications and ethical responsibilities of those who choose to testify.

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“…Nonetheless, this database has still been proven of value in analyses characterizing the medicolegal aspects of a wide variety of topics. 9,18,31,34,39,45,51,[54][55][56][60][61][62] …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in neurological surgery

Eloy¹,

Svider

Folbe

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…According to EPOS2012, a short course of oral steroids improves symptoms and causes reductions in polyp size and should be considered for severe NP (3) . However, oral steroids cause several adverse effects; here amongst disruption of the hypothalamic-pituitary-adrenal axis, hyperglycemia and glucose intolerance, gastrointestinal ulcer and osteoporosis (3,4) . The percentage of CRSwNP patients treated with systemic steroids and the burden of osteoporosis in these patients is unknown.…”

Section: Introductionmentioning

confidence: 99%

The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review

Winblad¹,

Larsen²,

Håkansson³

et al. 2017

Rhin

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Background: Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), and osteoporosis is a well-known complication to steroid treatment, associated with significant morbidity. Nevertheless, the burden of steroid induced osteoporosis is unknown in patients with CRSwNP. We aimed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP, and provide recommendations on future research and guidelines.Methodology: Cochrane Review Database, EMBASE, Ovid Medline, and PubMed were searched for studies including adult patients with CRSwNP treated with oral steroids. Outcomes were Bone Mineral Density (BMD) and prevalence of fractures in relation to dose and duration of oral steroids. In addition, we reviewed general guidelines for treatment with oral steroids. Results:We identified two studies (n=243) that met the inclusion criteria. Doses and durations of oral steroids were >5 mg/day for ≥3 months and 1 mg/kg body weight/day for 6 to 10 days for ≥4 courses/year. The prevalence of low bone mass was 39% and 61%, respectively. It was not possible to quantify the overall risk of osteoporosis induced by oral steroids from the studies. No studies evaluated prevalence of fracture. Conclusions:Registry studies and randomized controlled trials would be needed to assess the risk of osteoporosis in CRSwNP patients and future guidelines should include recommendations regarding preventive treatment and recommendations on doses and durations of oral steroids.

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“…In one study by Varshney et al [8], although their immediate efficacy and tolerability were comparable, an overall patient preference was for fluticasone propionate formulation rather than ciclesonide. In a recent retrospective review of litigation trends related to the administration of corticosteroids and the reported complications [9] it was advised that physicians should obtain informed consent prior to steroid therapy.…”

Section: Introductionmentioning

confidence: 99%

Importance of CT Scan of Paranasal Sinuses in the Evaluation of the Anatomical Findings in Patients Suffering from Sinonasal Polyposis

Varshney

Biswas

et al. 2015

Indian J Otolaryngol Head Neck Surg

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Sinonasal polyps are benign lesions arising from nose and/or sinuses mucosa. Paranasal sinuses computed tomogram (CT) scan are important for functional endoscopic sinus surgery (FESS) as their information assist the surgeon in pre-operative planning. This study aimed to show importance of CT scan in evaluation of anatomical variations to prove a correlation with disease process and extent of disease in sinonasal polyposis patients. A study was done from Sept, 2010 to Sept, 2011 with 33 patients presenting with nasal polyps. All recruited patients, after thorough history, general examination and thorough ENT examination, were examined by nasal endoscopy and sinus CT scans. All scans were carried out using a 3 mm thickness in axial and coronal planes with sagittal reconstruction. An analysis was then carried out to see anatomical variations and disease extent in CT scans. Maxillary sinus was the most commonly and most severely affected sinus, while the sphenoid sinus was the least involved sinus. Ostiomeatal complex (OMC) was found to be blocked in 84.85 % cases. There were few anatomic variations (57.58 %) found as hypertrophied uncinate process (30.30 %), septal deviation (21.21 %), skull base type-2, Concha bullosa, Haller's cell, Paradoxical middle turbinate, Onodi cell, pneumatized crista galli and dehiscent skull base. Hyperdense and heterogeneous opacification in paranasal sinuses was seen in 12.12 % patients. Importance of CT scans is to know anatomical variations as etiology, fungal etiology, to know extent of polyposis and anatomical variations to prevent complications during FESS and Navigation sinus surgery.

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Medical Malpractice and Corticosteroid Use

Cited by 40 publications

References 0 publications

Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in neurological surgery

Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in neurological surgery

The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review

Importance of CT Scan of Paranasal Sinuses in the Evaluation of the Anatomical Findings in Patients Suffering from Sinonasal Polyposis

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