bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of neurological surgeons with malpractice lawsuits
Authors: Gadjradj Pravesh S. , Ghobrial Julian B. , Harhangi Biswadjiet S. 
Published: November 2020

OBJECTIVEAs a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits.METHODSA survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one’s own practice of medicine.RESULTSThere were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53–6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80–5.20) were both independently associated with higher odds of considering leaving the practice of medicine.CONCLUSIONSThe current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.
Damned if you monitor, damned if you don’t: medical malpractice and intraoperative neuromonitoring for spinal surgery
Authors: Hatef Jeffrey , Katzir Miki , Toop Nathaniel , Islam Monica , Clark Trevor , Roscoe Catherine , Khan Safdar , Mendel Ehud 
Published: November 2020

OBJECTIVEThe aim of this study was to identify trends in medical malpractice litigation related to intraoperative neuromonitoring.METHODSThe Westlaw Edge legal research service was queried for malpractice litigation related to neuromonitoring in spine surgery. Cases were reviewed to determine if the plaintiff’s assertion of negligence was due to either failure to use neuromonitoring or negligent monitoring. Comparative statistics and a detailed qualitative analysis of the resulting cases were performed.RESULTSTwenty-six cases related to neuromonitoring were identified. Spinal fusion was the procedure in question in all cases, and defendants were nearly evenly divided between orthopedic surgeons and neurosurgeons. Defense verdicts were most common (54%), followed by settlements (27%) and plaintiff verdicts (19%). Settlements resulted in a mean $7,575,000 damage award, while plaintiff verdicts resulted in a mean $4,180,213 damage award. The basis for litigation was failure to monitor in 54% of the cases and negligent monitoring in 46%. There were no significant differences in case outcomes between the two allegations of negligence.CONCLUSIONSThe use and interpretation of intraoperative neuromonitoring findings can be the basis for a medical malpractice litigation. Spine surgeons can face malpractice risks by not monitoring when required by the standard of care and by interpreting or reacting to neuromonitoring findings inappropriately.
Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits
Authors: Garg Kanwaljeet , Sharma Ravi , Raheja Amol , Tandon Vivek , Katiyar Varidh , Dash Chinmaya , Bhatnagar Rishi , Khullar Mohan Kumar , Raju Bharath , Nanda Anil , Kale Shashank S. 
Published: November 2020

OBJECTIVEDespite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.METHODSAn anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.RESULTSA total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).CONCLUSIONSThis survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.
Informed consent in neurosurgery: a systematic review
Authors: Shlobin Nathan A. , Sheldon Mark , Lam Sandi 
Published: November 2020

OBJECTIVEInformed consent has served as a main principle of medical ethics and laws in the United States. The 1986 American Association of Neurological Surgeons Code of Ethics implied medicolegal liability for the failure to obtain informed consent without providing practical guidance regarding the application of informed consent to individual patient encounters in a medicolegal environment. Here, the authors aimed to identify baseline patient recall after discussions with neurosurgeons and their capacity to provide informed consent, describe the effects of interventions to improve patient comprehension, and elucidate the role of informed consent in malpractice litigation in neurosurgery. Their findings may guide neurosurgeons in discussions to properly inform patients and reduce the risk of litigation.METHODSA systematic review was conducted to explore informed consent within neurosurgery and its application to medicolegal liability using the PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.RESULTSOf 1428 resultant articles, 21 were included in the review. Baseline patient recall was low, particularly for risks and alternatives of treatments, and even decreased over time. Cognitive impairment was noted as a factor limiting the ability to provide informed consent. Interventions incorporating a combination of modalities in informed consent discussions, a specialized consent form with points for neurosurgeons to check off upon discussion, interactive websites, question prompt lists, and illustrations were found to be effective in improving patient knowledge. Lack of informed consent was a common factor for malpractice litigation. Spine surgery was particularly prone to costly lawsuits. Payments were generally greater for plaintiff verdicts than for settlements.CONCLUSIONSThe application of informed consent to patient encounters is an important facet of clinical practice. Neurosurgeons have a duty to provide patients with all pertinent information to allow them to make decisions about their care. The authors examined baseline patient comprehension and capacity, interventions to improve informed consent, and malpractice litigation; it appears that determining the proper capacity to provide informed consent and considering informed consent as a process that depends on the setting are important. There is room to improve the informed consent process centered on baseline patient health literacy and understanding as well as clear communication using multiple modalities.
Mobile Phone Dependence among Undergraduate Students of a Medical College of Eastern Nepal: A Descriptive Cross-sectional Study
Authors: Thapa Kriti , Lama Sami , Pokharel Rita , Sigdel Rambha , Rimal Surya Prasad 
Published: November 2020

Introduction: Mobile phones are becoming increasingly indispensable in daily life of the studentswhich has resulted in mobile phone dependence. The objective of the study was to find the prevalenceof mobile phone dependence among undergraduate students of a medical college of Eastern Nepal.
Methods: A descriptive cross-sectional study was conducted from October 2016 to March 2017on a total of 390 undergraduate students aged between 17 and 25 years using stratified samplingtechnique. Students using mobile phones for more than one year was included in the study. Studentswere requested to complete a pretested self-administered questionnaire which comprised theirsocio-demographic characteristics, pattern of mobile phone usage and mobile phone addiction indexdeveloped by Leung.
Results: The prevalence of mobile phone dependence among the undergraduate students was foundto be 85 (21.8%). Mobile phone dependence was found to be related with time spend on mobile; callsper day, money spend on recharge per month and years of ownership of mobile phone. There wasno difference between males and females with regard to mobile phone dependence.
Conclusions: The present study found that mobile phone dependence was common among theundergraduate medical students. These results suggest the need to develop educational programmeto educate the students to use mobile phone meaningfully.
Histopathological Study of Skin Lesions in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Chalise Sanat , Dhakhwa Ramesh , Pradhan Sailesh Bahadur 
Published: November 2020

Introduction: Skin diseases are much common in developing countries. The spectrum varies accordingto geographic distribution, gender, age, and coexisting disorder. We conducted this study to find outthe prevalence of different skin lesions and to evaluate their frequency and site of distribution.
Methods: A descriptive cross-sectional study was done in the pathology department of KathmanduMedical college from June 2019 to November 2019 after ethical clearance. The skin biopsies wereprocessed, sectioned and stained with Haematoxylin and eosin and evaluated. A conveniencesampling method was used. Data was collected and entry was done in Statistical Packages for SocialServices version 20.0, point estimate at 95% Confidence Interval was calculated along with frequencyand proportion for binary data.
Results: Among 133 skin biopsies examined, noninfectious vesicobullous and vesicopustulardisease were found in 42 (46.6%) cases followed by microbial disease in 22 (24.5%) and noninfectiouserythematous papular and squamous disease in 21 (23.4%) cases. Spongiotic dermatitis was themost common vesicobullous disease seen in 26 (28.9%) cases. Leprosy was the commonest microbialdisease found in 7 (7.8%) cases. The commonest noninfectious erythematous papular and squamousdisease was erythema dyschromicum perstans seen in 7 (7.8%) cases. The commonest neoplasticlesion was keratinocytic tumor seen in 12 (32.5%) cases. The commonest tumor of the skin wasintradermal nevus seen in 6 (16.3%) cases.
Conclusions: Spongiotic dermatitis is a predominating non-neoplastic and overall skin lesion whichwas similar to the other studies done. Histopathological examination is the gold standard for theproper diagnosis as histomorphological features distinguish various skin lesions.
Knowledge on Diet among the Hypertensive Patients in a Tertiary Care Center Nepal: A Descriptive Cross-sectional Study
Authors: Maharjan Nabina , Maharjan Narayani , Li Rui 
Published: November 2020

Introduction: Hypertension is one of the leading causes of death and disability in both developed and developing countries. The prevalence of hypertension is increasing rapidly worldwide. The aim of the study was to determine the knowledge of diet and exercise among hypertensive patients.
Methods: This descriptive cross-sectional study was conducted using a structured questionnaire among 169 hypertensive patients at Kathmandu diabetes and thyroid center from May 2017 to July 2017 after taking ethical clearance from Nepal Health Research Council, Nepal. A convenience sampling method was used. Data was collected and entry was done in Statistical Package for the Social Sciences version 16.0 point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.
Results: Out of total 169 participants enrolled in this study, only 79 (46.7%) had good knowledge and 90 (53.3%) had poor knowledge regarding diet and exercise. The mean age of participants was 54.68±13.91 years.
Conclusions: This study revealed that the knowledge about diet and exercise among hypertensive patients is poor and this study suggests the need for a proper educational intervention to improve awareness and to control hypertension effectively.
Prevalence of Self-medication Practices for Oral Health Problems among Dental Patients in a dental college: A Descriptive Cross-sectional Study
Authors: Bhattarai Rosina , Khanal Sunita , Shrestha Sujita 
Published: November 2020

Introduction: Self-medication means the use of medications for the treatment of any disease ontheir own, without consulting any healthcare professional. At times self-medication can be usefulif practiced correctly by saving time and money, whereas disadvantages often occur due to lackof evaluation by trained medical professionals and delay ineffective treatment and can result inunnecessary expenses and drug dependence. This study was conducted to find out the self-medicationbehavior and its associated factors among patients visiting a dental hospital in Kathmandu.
Methods: A hospital-based, cross-sectional study was conducted on 265 patients in Kantipur DentalCollege from December 2019 to January 2020 among the patients attending the dental Out PatientDepartment. Ethical clearance was obtained from the Institutional Review Committee of KantipurDental College. A convenience sampling technique was used. Proformas were prepared in English,translated to Nepali and re-translated to English by the back-translation method. Data entry wasdone in Microsoft Excel and analysis in SPSS 20. Descriptive statistics was done.
Results: The prevalence of self-medication practice was found to be 166 (62.6%). Out of totalparticipants, 99 (59.6%) consumed medicines for few days only and the most common triggeringfactor was found to be toothache in 101 (60.8%) participants. The most common reason for selfmedication was found to be a previous experience of treating similar illnesses.
Conclusions: The prevalence of self-medication was found to be low as compared to the study donein similar settings. Self-medication practice is a sensitive issue that hasn’t been given the requiredconsideration.
Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study
Authors: Shrestha Bishow Kumar , Adhikari Shital , Thakur Binay Kumar , Kadaria Dipen , Tamrakar Kishor Kumar , Devkota Mukti 
Published: November 2020

Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion.
Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean (±SD) and frequency (percentage).
Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively.
Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.
Prevalence of Intestinal Parasitic Infestation among Public School Children of a Community
Authors: Sharma Manisha , Sapkota Jyotshna , Jha Beena , Mishra Bhavesh , Bhatt Chandra Prakash 
Published: November 2020

Introduction: Intestinal parasitic infestation is one of the major health problems in developingcountries like Nepal. This study was done to determine the prevalence rate of intestinal parasiticinfestation among school children in Duwakot VDC, Bhaktapur, Nepal.
Methods: A descriptive cross-sectional study was done in 194 public school children of Duwakotvillage development committee from August to October, 2019. Ethical clearance was obtained fromthe Institutional Review Committee (reference no. 1207201915). Simple random sampling was done.One hundred and ninety-four public school children individuals of 6 to 14 years of age were enrolled.Collected stools were examined for the presence of parasites macroscopically and microscopically.Microscopic examination was carried out by direct wet mount using normal saline (0.9%) and Lugol’siodine (0.5%) mount. The data obtained were computed and analyzed using Statistical Package forthe Social Sciences version 16.0.
Results: A total of 194 stool samples were collected from school children and examined. Theprevalence of intestinal parasitosis was 26 (13.40%). The commonest organism was Giardia lambliain 22 (11.34%) cases. Among helminthic infection, 2 (1.03%) cases each were infected by Hymenolepisnana and Hookworm respectively.
Conclusions: The prevalence rate of intestinal parasite infestation in Nepal shows considerabledecline in recent years. However, more effort is required by public health resources to minimize theproblem further.
Prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome in Pregnant Women in a Tertiary Care Hospital
Authors: Sitaula Sarita , Manandhar Tara , Dixit Thapa Baburam , Shrestha Ramesh , Dharel Dinesh 
Published: November 2020

Introduction: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome refers to biological syndrome occurring in pre-eclamptic and eclamptic women. There is a higher rate of maternal and perinatal morbidity and mortality due to the syndrome. So, the objective of the study is to find the prevalence and maternal- perinatal outcome in the syndrome.
Methods: A descriptive cross-sectional study was done in a tertiary care hospital from 1st April 2017 to 30th March 2018 after obtaining ethical clearance from the Institutional Review Committee. The inclusion criteria were patients giving consent for participation and those who delivered in our hospital. Patient with the syndrome who delivered outside and referred in the postpartum period was excluded because details of the neonate may not be available. The Statistical Package for Social Sciences version 21 was used for the analysis of the data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Results: Out of 11974 deliveries, the prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome was 83 (0.69%) at 95% Confidence Interval (59.06-78.94). Maternal complications were seen in 19 (22.9%) and common complications being acute renal failure 9 (47.37%) followed by postpartum hemorrhage 4 (21.05%). Nearly 27 (33%) of patients required maternal ICU stay and there was one maternal mortality.
Conclusions: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome is one of the major causes of maternal and perinatal morbidity and mortality. Hence early recognition and prompt management may improve maternal and fetal outcomes.