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Federal Posting Requirements

Robert Blanchard — Wed, 21 Nov 2007 09:50:04 GMT

One impediment to an injured worker receiving fair compensation is the employee lack of knowledge about the laws an rules that apply in the workplace. If an injured worker does not know that there should be compensation for certain injuries (carpal tunnel syndrome, for example), the claim for benefits may not be timely filed. Interestingly, Federal law requires the posting of information about a number of topics, but workers compensation is not one of them. State laws govern the posting of worker compensation rights.
Federal law currently requires posting about the following:

1. New Federal Minimum Wage (Fair Labor Standards Act) - With the minimum wage due to go up each year through 2009, employers are required to display a poster prescribed by the Wage and Hour Division of the Department of Labor.
2. USERRA Notice - covers the Uniform Services Employment and Reemployment Rights Act, which protects the employment and benefits rights of workers in the military.
3. Equal Employment Opportunity - provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. (OFCCP)
4. Occupational Safety and Health (OSHA) - informs employees of the protections of the Occupational Safety and Health Act and its amendments.
5. Polygraph Protection - explains the Polygraph Protection Act on its promises as prescribed by the Secretary of Labor.
6. Family and Medical Leave - informs employees how to file a complaint and summarizes the major provisions. This must be posted even if there are no eligible employees.

Originally posted at InjuryBoard by Robert Blanchard

Jury Voir Dire

Robert Blanchard — Tue, 26 Sep 2006 11:03:50 GMT

Voir Dire is the beginning of the jury trial, where potential jurors are questioned and then selected to sit on a case.

Voir dire is not only about uncovering bias and learning about your jurors; it is also your jurors' first opportunity to learn about your case. In previous jury tips, I have often stressed how critical the jurors' first impressions of your case are, how quickly jurors build a framework of your case, and how influential this framework is in shaping how they view the evidence and their verdict decisions (see www.yournextjury.com/jurytip.htm for these tips).
In those tips I have emphasized that 80-90% of jurors are closed to persuasion and locked into their verdicts by the end of opening statements. Keep in mind, however, that your opening statement is not your first opportunity to begin persuading jurors. A properly done voir dire can guide jurors to frame the case in your terms, make them more receptive to your themes, and highlight aspects of the case that will give your strengths added importance in their minds throughout trial. All of this can be done without arguing a position, discussing case information directly, or even using direct pre-conditioning techniques, using a subtle persuasive technique called exposition.

The principle of exposition, as it applies to voir dire, is to let jurors know what the case is about through the topics and phrasing of the voir dire questions themselves. In a theatrical or literary context, exposition is a narrative device used at the beginning of a play, story, or film to give the audience necessary background information and introduce them to the characters, the conflict, and the plot. Keep in mind that you are telling a story during voir dire, and consider how clearly that story is coming through.

In a case about a car accident, a voir dire session revolving around questions about occupations, hobbies, former jury experience, feelings about lawsuits and damages, and opinions about vague principles and values presents jurors with a confusing, disjointed story that leaves them confused about what your case is about. Failing to use exposition wastes a golden opportunity to guide your jurors in building their framework about what the case is about and, more importantly, to persuade them about what is important.

Spend time thinking about not only the topics that you want the jury to focus on, but also about the order of your voir dire questions. The order of the topics you bring up should mirror your introduction of topics, evidence, and themes in your opening statement. For example, a strong expository voir dire in a breach of contract case might begin with questions about experiences with business deals and contracts, delve into experiences and feelings about broken contracts, highlight evidence by asking the jurors if they have ever been involved in dispute with a vendor who refused to remedy faulty products or services, and move into questions about lost revenues, business valuations, and damages. By the end of voir dire, your jurors should know what the case is about, what the defendant or plaintiff did wrong, how the plaintiff was harmed (or was not), and how damages should be defined.

With each question you ask, think about more than the answers your jurors give you; think also about the message that each question sends to the jury. Each question implicitly tells your jurors that the topic of the question is an important topic in the trial, and may tell them even more than that. Questions may give jurors information about the actions of the litigants, and may even give jurors the impression that you are concerned or nervous about certain topics. Lingering too long on a topic, no matter how important (plaintiff attorneys, this often includes feelings about frivolous lawsuits and tort reform), sends the message to many jurors that you are overly concerned and nervous about the topic and is a red flag to many that this reveals a weakness in your case.

When listening to your questions, jurors will assume that the situations your questions present are identical to those involved in the case, so make sure to highlight your strongest evidence, your client's strongest conduct, and the opposing litigant's worst actions in your questions. Defense attorneys, ask your jurors how they feel about an employee who takes 38 unrelated sick days off from work in a year, or how they feel about a plaintiff in an employment lawsuit who applies for only 3 jobs in a year without success and remains unemployed for 18 months. Plaintiff attorneys, ask your jurors if their employer has ever passed them up for promotion in favor of a less-qualified employee of a different race or gender, if their doctor has ever failed to respond to an emergency phone call, or if their contractor has ever gone over budget on their home improvement project without providing adequate justification. These questions not only uncover potential biasing experiences and opinions, they also give the jurors a strong, persuasive sense of what your case is about.

Exposition during voir dire takes a great deal of care and thought, especially when your primary goal is to learn about your jurors and uncover biases. If properly done, jurors will be far more receptive to your matching opening statement and your trial themes, and will be far more likely to view the case in your terms throughout trial.

Originally posted at InjuryBoard by Robert Blanchard

Three Injured in Pensacola Car Accident

Shannon Weidemann — Tue, 11 Mar 2008 16:21:49 GMT

A car accident in Pensacola on Thursday sent three people to the hospital. The accident involved two cars traveling on Mobile Highway. One car flipped and landed on top of the other car.

The first

car was stopped, facing west on Boulder Avenue, then pulled out into the path of McClain's vehicle, which was traveling north on Mobile Highway, troopers said. McClain's vehicle collided with the driver's side of Wiseman's vehicle, causing it to skid sideways and flip.

There were two people in the first car and one in the second. They were all taken to Sacred Heart Hospital to be treated for their injuries. Two of the people were listed in serious condition. The driver of the first car was cited with violating the right of way.

If you would like to learn more about car accidents, please visit InjuryBoard's Car Accident information page.

Originally posted at InjuryBoard by Shannon Weidemann

Digitek Recall shows FDA Inept

Robert Blanchard — Mon, 19 May 2008 21:52:55 GMT

The FDA appears late to the party again. This time widely prescribed piolls were made too large and so they had, you guessed it, too much of the medication in each dose.

Digitek pills manufactured by Actavis Totowa, distributed by Mylan Pharmaceuticals and sold under the labels “Bertek” or “UDL” have been recalled because they may contain double the dose of the active ingredient. Digitek is used to treat heart failure and abnormal heart rhythms. Tablets with twice the appropriate dose pose a risk of digitalis toxicity, symptoms of which include nausea, vomiting, dizziness, abnormal vision, low blood pressure, cardiac instability, slow heart rate and even death. Individuals with poor renal function are particularly susceptible to digitalis toxicity.

It is not yet known how many lots may have been affected so all lots are subject to this recall. Those suffering from digitalis toxicity may experience severe flu-like symptoms and, depending on the severity, may require hospitalization and intensive medical intervention.

Originally posted at InjuryBoard by Robert Blanchard

Knee Injuries Are Common in PI Practice

Robert Blanchard — Wed, 20 Dec 2006 12:00:29 GMT

Anterior Cruciate Ligament Injury (ACLI) usually happen from low-velocity, noncontact, deceleration injuries or from contact injuries with a rotational component. Some sports may also produce injury to the anterior cruciate ligament (ACL) secondary to twisting, valgus stress, or hyperextension all directly related to contact or collision.

We have all seen the signigicance of the ACL in athletes who require stability in running, cutting, and kicking. The ACL injury has also been linked to an increased rate of degenerative changes and meniscal injuries. For these reasons, between 60,000-75,000 ACL reconstructions are performed annually in the United States.
An estimated 200,000 ACL-related injuries occur annually in the United States, with approximately 95,000 ACL ruptures. Approximately 100,000 ACL reconstructions are performed each year. The incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing, and soccer. When the frequency of participation is considered, a higher prevalence of injury is actually seen more in women than men, at a rate 2.4-9.7 times greater for females.

History:
Most ACL injuries may be diagnosed through a careful history emphasizing mechanism of injury coupled with a good physical examination. A previous ligamentous injury may be the cause of instability. An audible pop often accompanies this injury, which often occurs while changing direction, cutting, or landing from a jump (usually a hyperextension/ pivot combination). Within a few hours, a large hemarthrosis develops. Patients usually are unable to return to play, secondary to pain, swelling, and instability or giving way of the knee. High energy traumatic injuries are often associated with other ligamentous and meniscal injuries. The classic "terrible triad" (ACL, MCL, and medial meniscus tears) involves a valgus stress to the knee with resultant acute injury to the ACL and MCL; however, the medial meniscus tear is now thought to occur later, as a result of chronic ACL deficiency.
Physical:
An organized, systematic physical examination is imperative when examining any joint. Immediately after the acute injury, the physical examination may be very limited due to apprehension and guarding by the patient. The basic examination should include the following:
The examiner should begin with inspection, looking for any gross effusion or bony abnormality. An immediate effusion indicates significant intra-articular trauma. According to Noyes et al, in the absence of bony trauma, an immediate effusion is believed to have a 72% correlation with an ACL injury of some degree.
Assess the patient's range of motion (ROM), especially looking for lack of complete extension, secondary to a possible bucket-handle meniscus tear or associated loose fragment.
Palpation of bony structures may suggest an associated tibial plateau fracture.
Palpation of the joint lines to evaluate a possible associated meniscus tear. Palpation over the collateral ligaments to suggest any possible injury (sprain) of these structures. Up to 50% of ACL ruptures have associated meniscal injuries; acute injuries are likely to have associated injuries of the MCL and meniscus.
Ligamentous laxity may be difficult to detect in the acute situation. The Lachman test is the most sensitive test for acute ACL rupture. Since the Lachman test must be performed when the patient is relaxed, it is often better to conduct this test prior to manipulating the painful knee.
Lab and Imaging Studies:
Arthrocentesis is performed less frequently today because of the advent of other less invasive and more specific diagnostic tests, especially MRI. MRI has a sensitivity of 90-98% for ACL tears. MRI also may identify bone bruising, which is present in approximately 90% of ACL injuries.
Treatment:
Before surgical treatment strengthening of the quadriceps and hamstrings, as well as ROM (range of motion) exercises is undertaken. Performance of ROM helps reduce the amount of effusion and regain motion and strength.
Generally, the recommendation is that surgical intervention be delayed at least 3 weeks following injury to prevent the complication of arthrofibrosis. The methods of surgical repair may be categorized into 3 groups, primary repair, extra- articular repair, and intra-articular repair. Primary repair is not recommended except for bony avulsions, which are mostly seen in adolescents. Because the ACL is intra- articular, the ligamentous ends are subjected to synovial fluid, which does not support ligamentous healing. Extra- articular repair generally involves a tenodesis of the iliotibial tract. This may prevent a pivot shift but has not been shown to decrease anterior tibial translation.
Intra-articular reconstruction of the ACL has become the criterion standard for treating ACL tears. Bone-patella-bone autografts are currently popular because they yield a significantly higher percentage of stable knees with a higher rate of return to preinjury sports. The major pitfall of these grafts is their association with postoperative anterior knee pain (10-40%). Hamstring tendon grafts are associated with a faster recovery and less anterior knee pain. Critics believe that these are more susceptible to graft elongation. Recent literature has supported a greater tensile strength with the use of braided quadruple hamstring grafts. However, this finding has not been confirmed in vivo, and the graft may be limited by the type of fixation.
Allografts have also been very popular because of their efficiency, their ability to provide bony fixation, and the lack of associated patella morbidity. However, they are associated with a risk of viral transmission. Allografts are best used in revisions. These have also fallen out of favor by some because several deaths linked to clostridial infections from inadequate sterilization techniques have been reported, which led to increased research into sterilization techniques to ensure safety. In addition, concerns exist regarding what effects the immunologic response and delayed revascularization and remodeling may have on clinical outcomes. Although allografts are generally accepted as having less associated morbidity, no proof of this is present in the literature.
Synthetic grafts and ligament augmentation devices have also been used. Synthetic grafts are no longer acceptable, because of their high rate of complications, including failure and aseptic effusions. Intra-articular reconstruction may be performed through a 2-incision technique or a single-incision endoscopic technique; the latter is currently more popular. This procedure requires graft stabilization with some type of fixation hardware for all of the graft options. The stabilization may be performed with metal interference screws, bioabsorbable screws, endobuttons, and cross pins. Each device has its own benefits.
Rehabilitation follows operative management. One special point is that the use of knee braces remains a highly controversial topic; braces are well accepted by patients, but most biomechanical studies do not support their use. Studies have shown that functional bracing can limit anterior translation of the tibia at low loads. Furthermore, most braces have been found to decrease the reaction time of the hamstring muscles.
Other Treatment:
Nonoperative treatment may be considered in elderly patients or in less active athletes who may not be participating in any pivoting type of sports (e.g.: running, cycling). The goal is to obtain a full ROM and strength compared with the uninjured knee. This modality of treatment requires modification of activity levels and avoidance of physically demanding occupations. Arthroscopy may also be considered for persons who are poor candidates for reconstruction but have a mechanical block to ROM. The goal of this procedure is to debride the remaining stump to increase motion. Patients with significant arthritis are also thought to be poor candidates unless they are experiencing recurrent instability.
Complications:
The current failure rate for ACL reconstruction is approximately 8%. The 3 major categories of failure in an ACL reconstruction are (1) arthrofibrosis (due to inflammation of the synovium and fat pad), (2) pain that limits motion, and (3) recurrent instability, secondary to significant laxity in the reconstructed ligament. These factors may be related to the surgical procedure (e.g.: malpositioned tibial or femoral tunnels, misplaced hardware, inadequate notchplasty).
Anterior placement of a tibial tunnel may result in graft impingement. If a tunnel is placed too posteriorly on the femoral side, the posterior cortex of the femur may be violated.
A graft also may fail due to a lack of incorporation, secondary to rejection or stress shielding.
Trauma from re-injury or aggressive rehabilitation also may cause graft failure. The incidence of graft re-rupture is approximately 2.5%.
Other complications include patella fractures and patella-tendon ruptures. Reflex sympathetic dystrophy, postoperative infection, and neurovascular complications are rare (each accounting for less than 1% of complications). The rate of postoperative deep venous thrombosis is approximately 0.12%.
Prognosis:
Patients treated with surgical reconstruction of the ACL have long-term success rates of 82-95%. Recurrent instability and graft failure is seen in approximately 8% of patients. Knee scores of those treated nonoperatively have fair/poor results up to 50% of the time. As many as 40% of patients treated nonoperatively had no episodes of giving way. The knee scores in this group may be too sensitive, not accurately representing the clinical situation. Patients with ACL ruptures, even after successful reconstruction, are at risk for osteoarthrosis. The goal of surgery is to stabilize the knee, decrease the chance of future meniscal injury, and delay the arthritic process.
Medical/Legal Concerns:
Medical/legal issues from ACL injury and graft replacement generally arise from complications during surgery. Initial misdiagnosis of ACL injury also can be a source of potential litigation. Obtain a complete history from the patient.
The mechanism of injury for ACL tear is fairly consistent. A thorough physical examination helps the physician confirm the diagnosis, and an MRI identifies additional possible injuries to other ligaments or cartilage.
Potential for a lawsuit arising from improper physical therapy also exists. If the therapist is too aggressive in rehabilitation exercises and rupture of the ACL graft occurs, some patients might consider litigation.

Originally posted at InjuryBoard by Robert Blanchard

Breast Cancer Mis-Diagnosis and Late Diagnosis

Robert Blanchard — Fri, 22 Dec 2006 12:22:30 GMT

An international panel updated their standards on the diagnosis and treatment of breast cancer, as reported in the October 2006 issue of the Journal of the American College of Surgeons (JACS).

According to the American Cancer Society, invasive breast cancer will be diagnosed in 211,240 women and will cause more than 40,000 deaths in 2005. The updated statement reflects the conclusions of a panel of 23 expert surgeons, radiologists, pathologists, and oncologists based on their own research, clinical experiences, familiarity with the professional literature, and points of consensus reached through discussion at a conference. However, the panel cautions that their conclusions should not be considered inclusive of all appropriate treatments or exclusive of other treatments reasonably directed at achieving the same results or of interventions performed in the context of clinical trials.

The overall focus of the statement is that physicians should attempt to replace traditional, invasive procedures for diagnosing breast cancer with proven, less-invasive diagnostic methods, such as minimally invasive needle biopsies of the breasts and sentinel node biopsies.

Summary of Recommendations
Mammography is the only imaging modality that should be used routinely to screen women for breast cancer. However, MRI may be used to screen younger women with a high risk of breast cancer because of a strong family history or BRCA mutation. MRI findings should be combined with other imaging data or histologic results prior to surgical planning. Diagnostic ultrasonography can be helpful in characterizing known breast masses, as it is more sensitive than mammography in evaluating tumor size.
The panel agreed that minimally invasive breast biopsy is the optimal initial method for tissue acquisition for image-detected breast lesions, in large part because the determination of cancer prior to surgery improves outcomes of breast-conserving therapy. For microcalcifications without an obvious mass, the authors recommend vacuum-assisted devices with needle sizes of 11 gauge or larger. Fine- needle aspiration is suitable for lymph-node evaluation but less so for evaluation of breast lesions.
Biopsy specimens should be labeled by surgeons to preserve three-dimensional orientation. Radiography or ultrasonography of the surgical specimen can be useful in determining whether the target lesion was successfully removed. Two views should be used for specimen radiography.
Pathologic breast specimens should be evaluated using the Nottingham Combined Histologic Grade, which accounts for glandular differentiation, mitotic count, and nuclear grade. Ideally, these findings are combined with radiologic data at a treatment conference involving pathologists, radiologists, and surgeons.
Pathologists should read both prognostic size, determined by the extent of the largest invasive component of the tumor and helpful in predicting survival and distant metastasis, as well as the overall size of the breast tumor.
Intraoperative ultrasonography and bracketing localization wires can aid in defining the limits of resection in breast-conserving surgery, as can preoperative MRI and ultrasonography.
Sentinel lymph node biopsy is the preferred means of pathologic axillary nodal staging. However, patients should be made aware of the possibility of a false- negative result with such testing. When the sentinel lymph node reveals minimal involvement of 0.2 mm or smaller, complete axillary dissection is not necessarily indicated.
Regarding treatment of DCIS, adjunctive radiation therapy has been demonstrated to reduce rates of local failure but may not improve survival. Older age, smaller, widely excised DCIS, and low- or intermediate-grade histology mitigate against using radiation therapy following surgery for DCIS. The use of adjunctive tamoxifen for patients with DCIS is controversial, but it seems to be more helpful among patients with receptor-positive DCIS. Sentinel lymph node biopsy generally has no role in the staging of DCIS, but it should be performed in women receiving mastectomy for DCIS.
Hormonal therapy should be offered to all women with hormone-receptor-positive tumors, and the minimum period of treatment is 5 years. Patients receiving other chemotherapy should receive both an anthracycline and a taxane. However, chemotherapy in addition to hormonal therapy is less likely to provide an overall clinical benefit for women older than 60 years of age with hormone-receptor-positive tumors or for those older than the 70 years with any breast cancer.

Originally posted at InjuryBoard by Robert Blanchard

Florida Tobacco Cases Filed

Robert Blanchard — Mon, 14 Jan 2008 12:06:01 GMT

The deadline for former smokers in Florida to file their injury lawsuits against big tobacco has come and gone and estimates of the number filed are still under 10,000 total suits. That is a far cry from the 700,000 class members originally designated as entitled to damage awards. The Florida Supreme Court took away that award but did let stand the jury findings that the companies were negligent and their product was defective. It is still unclear how those findings will benefit those who have now filed individual cases, but it is certain that trial courts will not make a nullity of what the Supreme court intended to do: make it easier for individual claimants by not requiring every one of them to re-prove the obvious. Tobacco companies used to be able to tie up proceedings for years arguing against the obvious.
As for the small numbers who filed, I suppose tobacco stocks will get a bump and tobacco spokesman are already suggesting that potential claimants are "too embarassed" to make claim. That is clever jury tampering for sure. The real reason for the limited numbers was well stated by Reuters news service :

Many of the plaintiffs were elderly. A large number died and had no survivors to carry on the fight. Others were disqualified by legal deadlines that require such lawsuits be filed within a certain amount of time. Others simply didn't contact attorneys until it was too late.

See the interview of Levin Papantonio attorney Matt Schultz at CBS News.

For more information on this subject, please refer to the section on Defective and Dangerous Products.

Originally posted at InjuryBoard by Robert Blanchard

Sierra Syringes Recalled(2)

Robert Blanchard — Fri, 21 Dec 2007 14:42:59 GMT

The first news of some problem with the Sierra prefilled Heparin syringes appears to have come out on December 17, 2007. Today a voluntary recall was announced. This is a little late for those already hospitalized with serious infections. While is hope that these infections will be treatable with antibiotics, the risks of nerve damage and other complications are still looming. Medical products don't get tainted by bacterial agents unless there is some negligence on the part of the manufacturer or supplier. Also, strict liability law will apply in most states for injuries from a tainted product.
If you or someone you know has suffered an injury from these recalled syringes, please send me an email. We are speaking later today with one person who is still in the hospital and the more we learn, the more we can do to help.

Contaminated Syringes Linked to Blood Infections
U.S. health authorities are investigating a suspected link between bacteria-contaminated syringes and blood infections in 40 people in Illinois and Texas, including 20 outpatients from Rush University Medical Center in Chicago, the Associated Press reported. There have been no deaths.
Earlier this month, Rush doctors traced the infections to heparin-filled syringes used during home treatment for cancer and other health problems. Heparin is a blood thinner. The heparin-filled syringes were from a single batch produced by Sierra Pre-Filled of Angier, N.C., the AP said.
Syringes from that same batch were also sent to Colorado, Florida and Pennsylvania, but no infections have been reported in those states, said Dr. Arjun Srinivasan, of the U.S. Centers for Disease Control and Prevention, the AP reported.
The infections, caused by bacteria called Serratia marcescens, can cause fever and chills. While such infections can be serious, they generally respond well to antibiotics.
Sierra Pre-Filled has recalled the affected batch of syringes and is cooperating with the U.S. Food and Drug Administration in the investigation, the AP reported. Doctors are being alerted about the contaminated syringes and asked to watch for cases of infection.

Originally posted at InjuryBoard by Robert Blanchard

Old Surgeons Not a Problem

Robert Blanchard — Mon, 04 Dec 2006 10:05:47 GMT

When you need complex cardiovascular or cancer surgery, you have to choose a surgeon and many patients may select an older physician, assuming his experience may be needed. New research says they are right - experience helps. A study designed to address this issue used approximately 461,000 Medicare records to assess the association between age of the listed operator and surgical mortality. For some operations, such as pancreatectomy, coronary artery surgery, and carotid endarterectomy, surgeons aged 60 or older had higher mortality rates than younger surgeons. However, for other equally complex operations, such as esophagectomy, effects of the age of the surgeon were not observed. Surgical volume must also be taken into account when considering the impact of the age of the surgeon.
The conclusion of the study is that the age of the surgeon is not a major factor to surgical complications. It is unusual that an age effect was observed for a few difficult procedures but not for others of equal complexity. However, if you have to chooose a surgeon, the conclusions are reassuring: The results after surgery performed by an older surgeon are comparable to outcomes of similar procedures performed by a younger surgeon.

But, older surgeons - those over age 60 - who do not maintain a high surgical volume as they age are more likely to have high patient mortality rate than younger surgeons.
The researchers at the University of Michigan Health System say patients should be less concerned about the age of their surgeon and more focused on other factors that really count - like surgical volume.
These findings, published in the September issue of the Annals of Surgery, reveal that for some complex cardiovascular and cancer surgical procedures, older surgeons who continued to maintain higher surgical case loads were found to have comparable outcomes to peers ages 41 to 50.
The study also dispels the belief that younger, less experienced surgeons are more likely to have poor surgical outcomes. Instead, the researchers say young surgeons, ages 40 and under, had similar patient mortality rates to those of their more experienced peers for the eight surgical procedures studied.
"This study's results should be very encouraging not only for patients, but also for younger and older surgeons whose operative skills may previously have been the subject of scrutiny," says lead author Jennifer F. Waljee, M.D., M.P.H., general surgery resident in the Department of Surgery at the U-M Medical School.
"The bottom line is that for most procedures the age of the surgeon is not an important predictor of operative risk for a patient. The effect of surgeon age was largely limited to those surgeons with lower procedure volumes."
Previous studies that focused on primary care have suggested an inverse relationship between a surgeon's age and his or her clinical performance. They've found that older physicians are less likely to know about new treatments and medications, and tend to perform poorly on recertification exams.
Based on these recent studies, Waljee and her colleagues wondered if some of the common mental and physical affects of aging might affect older surgeons' performance in the operating room, as well.
Using data from the National Medicare Inpatient Files, the team reviewed eight major cardiovascular procedures and cancer surgical resections that were performed from 1998 to 1999 on patients between the ages 65 to 99.
For the study, surgeons were placed into three age groups: 40 years and younger, ages 41-50, and 60 years and older.
A total of 460,738 Medicare patients who underwent one of the eight surgical procedures - coronary artery bypass grafting; elective abdominal aortic aneurysm repair, aortic valve replacement, carotid endarterectomy, pancreatectomy, esophagectomy, lung resection and cystectomy - were used for this study. These procedures were chosen because they are some of the more commonly-performed procedures among Medicare patients, says Waljee.
Patient operative mortality - death before discharge or within 30 days of surgery - was reviewed for each patient. Additionally, factors such as surgeon procedure volume, hospital surgery volume and the hospital's teaching status were evaluated.
Overall, surgeons over age 60 were found to have higher patient mortality rates when compared against the rates of surgeons ages 41-50, for three of the eight procedures: pancreatectomy, coronary artery bypass grafting, and carotid endarterectomy. Surgeon age was not related to mortality for elective abdominal aortic aneurysm repair, aortic valve replacement, exophagectomy, lung resection or cystectomy.
More surprising to researchers, however, was that the younger surgeons - those under age 40 - had comparable mortality to surgeons between the ages of 41 and 50, for all eight procedures.
"We expected to see a significant difference in patient mortality at the extremes of surgeon age, but instead found very little variation among younger and older surgeons," says Waljee, a Robert Wood Johnson Clinical Scholar. "Based on these finding, we'd encourage patients not to focus on age when selecting a surgeon. Instead, other characteristics of the provider and practice setting, such as operative volume, are likely better predictors of patient outcome than surgeon age."
Waljee hopes to further explore this topic through future research to determine if specific mechanisms of aging (physical and mental stamina, vision and motor skills) affect low-volume surgeons' performance in the OR.

Originally posted at InjuryBoard by Robert Blanchard

Spinach that Kills

Robert Blanchard — Wed, 27 Sep 2006 14:33:55 GMT

The law in Florida on tainted food products is supposed to be strict liability. That means no matter who's "fault" it may be, if the food is tainted, then the company that sold it to you should be liable for your injury or death. If this actually worked, it would save a lot of court and litigant time and expense trying to run down what cow in what spinach patch gave us the first contamination of our bag of spinach. Unfortunatly, judges often don't understand strict liability and defendants wrack up a million excuses why they are not liable. We haven't had any outbreaks of e-coli infested spinach here in Florida yet, and I hope we don't.

Originally posted at InjuryBoard by Robert Blanchard