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BMJ Open 2018 Dec 14;8(12):e025230. Epub 2018 Dec 14.

Department for Clinical Neurosciences, Western General Hospital, Edinburgh, UK.

Introduction: Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. Read More

BMJ 2018 Dec 6;363:k5100. Epub 2018 Dec 6.

Oxford.

Mayo Clin Proc 2018 Dec;93(12):1842-1847

Division of General Internal Medicine, Mayo Clinic, Rochester, MN.

Medicolegal realities surrounding "medical marijuana" or "medical cannabis" are rapidly evolving in the United States. Clinicians are increasingly being asked by patients to share information about or certify them for medical cannabis. In order to engage in informed discussions with patients or be comfortable certifying them in states with medical cannabis laws, clinicians may benefit from an understanding of the current state of medical knowledge about medical cannabis. Read More

Spine J 2018 Dec 7. Epub 2018 Dec 7.

Emory University School of Medicine, Department of Orthopaedics.

Background Context: Exposure of unintended levels (defined as a spinal segment outside the intended surgical levels) is unnecessary and potentially adds to operative time and patient morbidity. Wrong-level surgery (defined as decompression, instrumentation, or fusion of a spinal segment not part of the intended surgical procedure) clearly adds to morbidity as well as putting the surgeon at medicolegal risk.

Purpose: To describe a localization technique for posterior lumbar spine surgery to minimize both unintended-level exposure and wrong-level surgery. Read More

Forensic Sci Int 2018 Nov 11. Epub 2018 Nov 11.

Edinburgh Unit For Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, 4 Teviot Place, EH8 9AG, United Kingdom; Forensic Pathology Division Crete, Hellenic Republic Ministry of Justice and Human Rights, Heraklion, Crete, Greece.

Establishing a biological profile of skeletal remains is a key task of forensic anthropologists. Sex estimation is essential in forensic examination, as other elements of the biological profile, such as age at death or stature, are sex dependent. Visual assessment is considered low-cost and quick, therefore it is a commonly applied method of sex estimation. Read More

Med J Aust 2018 Dec;209(11):488

Flinders University, Adelaide, SA

Am J Forensic Med Pathol 2018 Nov 29. Epub 2018 Nov 29.

Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.

Cytochrome p450 family 2, subfamily D, polypeptide 6 (CYP2D6) may be used to infer the metabolizer phenotype (MP) of an individual as poor, intermediate, extensive/normal, or ultrarapid. Metabolizer phenotypes may suggest idiosyncratic drug responses as contributing factors to cause and/or manner of death in postmortem investigations. Application of CYP2D6 has used long-range amplification of the locus and restriction enzyme digestion to detect single-nucleotide variants (SNVs) associated with MPs. Read More

J Forensic Sci 2018 Dec 4. Epub 2018 Dec 4.

Forensic Science SA, GPO Box 2790, Adelaide, 5001.

A 32-year-old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Read More

CMAJ 2018 Dec;190(48):E1404-E1405

Health Law Institute and Department of Pharmacology, Faculty of Medicine (Herder), Dalhousie University, Halifax, NS; Division of Clinical Pharmacology and Toxicology, and Medicine, Pediatrics, and Health Policy, Management and Evaluation (Juurlink), University of Toronto; Divisions of General Internal Medicine and Clinical Pharmacology & Toxicology (Juurlink), Sunnybrook Health Sciences Centre, Toronto, Ont.

Br J Gen Pract 2018 Dec;68(677):581

UCL Medical School, UCL, London. Email:

Thyroid 2018 Nov 28. Epub 2018 Nov 28.

University Hospital Essen, Department of Endocrinology and Metabolism, and Division of Laboratory Research, Essen, Germany ;

Background: The American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer (DTC) are highly influential practice recommendations. The latest revision appeared in 2015 ("ATA 2015"). These guidelines were developed predominantly by North American experts. Read More

World Neurosurg 2018 Nov 23. Epub 2018 Nov 23.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Introduction: Medical malpractice litigation is an issue of major concern in neurosurgery, with 19.1% of neurosurgeons facing a claim annually. Neurosurgery possesses the greatest risk of malpractice of any specialty, likely due to the complex clinical environment and disease severity. Read More

J Surg Res 2018 Dec 11;232:209-216. Epub 2018 Jul 11.

Department of Surgery, Center for Health Outcomes and Policy, University of Michigan Institute for Health Policy and Innovation (IHPI), Michigan Medicine, Ann Arbor, Michigan.

Background: Physicians are encouraged through formalized systems to discuss their own errors with peers for the purposes of quality improvement. However, no clear professional norms exist regarding peer review when physicians discover errors that occurred at other institutions before referral. Our objective was to determine specialist physicians' attitudes and practices regarding providing feedback to referring physicians when prereferral errors are discovered. Read More

AJR Am J Roentgenol 2018 Dec;211(6):W297

1 NorthShore University HealthSystem, Skokie Hospital, Skokie, IL.

CMAJ Open 2018 Oct-Dec;6(4):E561-E566. Epub 2018 Nov 19.

Canadian Medical Protective Association (Yang, Zhang, Hines, Calder); Ottawa Hospital Research Institute (Calder); Department of Emergency Medicine (Calder), University of Ottawa, Ottawa, Ont.

Background: Few empirical studies have validated the relation between medicolegal risk and hospital patient safety performance. We sought to determine whether there was a relation between in-hospital patient safety events and medicolegal cases involving Canadian physicians.

Methods: In this ecological study, we used Poisson regression to compare data from the Canadian Institute for Health Information's Discharge Abstract Database and the database of the Canadian Medical Protective Association (CMPA) of medicolegal cases over 10 years (2005/06 to 2014/15). Read More

Toxicol Rep 2018 6;5:1107-1113. Epub 2018 Oct 6.

Laboratory of Clinical Virology, Medical School, University of Crete, 71003, Heraklion, Crete, Greece.

Since ancient times the concept of dose response, from a toxicological perspective, has been a matter of concern. Already by the 8th century BC and over the years, many enlightened people have attempted to interpret this phenomenon, observing and coming across its results and practical implementation through exposure to chemical substances, either from natural or synthetic sources. Nowadays, the environmental exposure of human populations to chemicals in terms of quantity and quality might differ. Read More

J Knee Surg 2018 Nov 16. Epub 2018 Nov 16.

Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Malignant bone tumors are rare conditions that may be encountered by nononcologic surgeons only a few times in their careers, but a delay in diagnosis or a misinterpretation of data can have limb and life-threatening consequences. Prior literature suggests that unplanned resection of sarcoma was associated with an increased risk of local recurrence, decreased 10-year survival, and increased amputation rate compared with planned resection. In addition to patient morbidity, missed diagnoses and unplanned excisions of malignant tumors lead to increased cost of treatment and higher likelihood of subsequent medicolegal action. Read More

J Cutan Med Surg 2018 Nov 16:1203475418814228. Epub 2018 Nov 16.

1 Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada.

Background:: The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. Read More

Clin Pract Cases Emerg Med 2018 Nov 18;2(4):283-285. Epub 2018 Oct 18.

Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington.

In this article, we present two medicolegal cases illustrating medical and diagnostic pitfalls that can lead to litigation for missed testicular torsion. Testicular torsion (TT) is a urologic emergency with potentially devastating consequences and costs, for providers and patients alike. TT occurs in approximately 4. Read More

Pract Neurol 2018 Nov 13. Epub 2018 Nov 13.

Nuffield Orthopaedic Hospital, Oxford Centre for Enablement, Oxford, UK.

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. Read More

J Med Entomol 2018 Nov 12. Epub 2018 Nov 12.

Department of Life Sciences, Centre for Functional Ecology, University of Coimbra, Calçada Martim de Freitas, Coimbra, Portugal.

The study of the arthropod fauna involved in carcass decomposition is crucial for medicolegal forensic purposes. This knowledge is especially needed in countries with high levels of criminality and where the arthropod fauna is still under-recorded and not well known, such as Angola. We present data from the first survey on sarcosaprophagous flies and beetles in Angola, conducted in Luanda over a 17-d period, in the wet summer season. Read More

Clin Orthop Relat Res 2018 Dec;476(12):2322-2324

W. Z. W. Teo, Senior Research and Writing Fellow, BalBrenner Law Center, Chapel Hill, NC, USA L. H. Brenner, B. S. Bal, BalBrenner Law Center, Chapel Hill, NC, USA.

Am J Forensic Med Pathol 2018 Nov 12. Epub 2018 Nov 12.

School of Humanities, University of Tasmania, Hobart, Tasmania, Australia.

Scurvy is a multisystem condition that arises from vitamin C deficiency. As humans cannot synthesize vitamin C, serum and tissue levels depend on bioavailability, utilization, and renal excretion. Deficiencies result in defective collagen formation with swelling of gums, leg ulceration, and bleeding manifestations. Read More

J Hand Surg Eur Vol 2018 Nov 8:1753193418805959. Epub 2018 Nov 8.

2 Hand Therapy Department, Kent and Canterbury Hospital, Canterbury, UK.

Grip strength is used as a measure of capacity in disability and personal injury claims. Although seemingly an objective measure, it is widely recognized that it is fallible to the effects of sub-maximal effort. We have developed an extended test protocol that uses the five positions of a Jamar dynamometer. Read More

Cephalalgia 2018 Nov 8:333102418812091. Epub 2018 Nov 8.

2 University of Oxford, Oxford, UK.

Aim: To explore post traumatic headache characteristics and risk factors in compensation claimants by observational retrospective cohort analysis.

Case Results: Medicolegal reports on 116 consecutive compensation claimants aged 41.9 ± 15. Read More

J Forensic Sci 2018 Nov 8. Epub 2018 Nov 8.

City and County of Honolulu Department of the Medical Examiner, 835 Iwilei Street, Honolulu, 96817, HI.

Microbes can be used effectively as trace evidence, at least in research settings. However, it is unknown whether skin microbiomes change prior to autopsy and, if so, whether these changes interfere with linking objects to decedents. The current study included microbiomes from 16 scenes of death in the City and County of Honolulu and tested whether objects at the scenes can be linked to individual decedents. Read More

Am J Forensic Med Pathol 2018 Nov 7. Epub 2018 Nov 7.

From the Forensic Medicine and Toxicology and Radiology Departments, Faculty of Medicine, Minia University, El-Minia, Egypt.

Sex determination is an initial and essential component of any medicolegal investigations. However, sometimes only cranial remains are available. The objective of this study was to determine sex using 12 craniofacial measurements in multidetector computed tomographic images of 150 Egyptian subjects (80 men and 70 women), with age ranging from 18 to 60 years. Read More

Acad Pediatr 2018 Nov - Dec;18(8):928-934. Epub 2018 Jul 7.

Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center (LA Mallory), Portland, Me. Electronic address:

Objective: Children entering foster care after discharge from the hospital are at risk for adverse events associated with the hospital-to-home transition. Education of foster caregivers regarding transitional care needs is key. However, little is known about the unique needs of foster caregivers as they transition from hospital to home with a new foster child or how hospital-based health care teams can better support foster caregivers. Read More

J Surg Educ 2018 Nov 2. Epub 2018 Nov 2.

Department of Surgery, Yale School of Medicine, New Haven, Connecticut.

J Knee Surg 2018 Nov 5. Epub 2018 Nov 5.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, United Kingdom of Great Britain and Northern Ireland.

Tissues from a periprosthetic joint infection (PJI) of the knee contain a heavy neutrophil polymorph (NP) infiltrate (> 5 NPs per high-powered field [HPF] by Musculoskeletal Infection Society [MSIS] criteria). PJI of the knee can be treated by a two-stage procedure and our aim was to determine whether the MSIS histological criteria for PJI diagnosis are valid in a second-stage revision knee arthroplasty. Periprosthetic tissues from 45 second-stage revision knee cases were analyzed histologically by hematoxylin-eosin and chloroacetate esterase (CAE) staining for the identification of NPs. Read More

Forensic Sci Med Pathol 2018 Nov 3. Epub 2018 Nov 3.

School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China.

Fatal subarachnoid hemorrhage (SAH) caused by anterior communicating artery (ACoA) rupture is a rare event in medicolegal practice. Anatomical variations of the ACoA tend to make its anatomical structure, and as a result, blood flow through it, more complicated, which may increase hemodynamic stress and cause weak spots in the affected blood vessels. Variant ACoAs are prone to rupture in the event of a blunt-force trauma. Read More

Hum Biol 2018 Jan;90(1):5-10

3 Department of Anthropology, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.

Hum Biol 2018 Jan;90(1):77-82

1 Department of Anthropology, University of Tennessee, Knoxville, Tennessee, USA.

World J Hepatol 2018 Oct;10(10):780-784

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey.

To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy (LDH) has been reported in the English language medical literature. We present two cases in which grade I neuroendocrine tumors (NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-year-old male underwent LDH for his brother suffering from HBV-related chronic liver disease (CLD). Read More

JNMA J Nepal Med Assoc 2018 Mar-Apr;56(211):678-682

Department of Forensic Medicine, Devdaha Medical College, Rupandehi, Nepal.

Introduction: Teenage pregnancy is an issue that needs to be addressed for a better health of the women and the society. The present analysis is undertaken to find out the incidence of teenage mothers who have had hospital delivery and focuses upon the various reasons for teenage pregnancy with a brief discussion upon the associated medicolegal and social aspects.

Methods: A cross sectional study was carried out in a tertiary hospital in western region of Nepal. Read More

J Elder Abuse Negl 2018 Oct 30:1-10. Epub 2018 Oct 30.

c Goldfarb School of Nursing , Barnes Jewish College , St. Louis, Missouri , USA.

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Read More

Am J Clin Dermatol 2018 Nov;19(Suppl 1):15-23

Department of Dermatology, Universidad del Desarrollo, Clínica Alemana, Manquehue Norte 1410, Vitacura, Santiago, Chile.

This review presents the main challenges encountered when diagnosing unusual variants of malignant melanoma with the aim of raising awareness to allow application of the most appropriate treatment strategies. Although these melanomas are often rare, their misdiagnosis potentially jeopardizes patients' health and survival, and has medicolegal implications. The clinical and histologic presentations of melanoma vary greatly, and assessment of uncommon melanomas can be difficult for practitioners because of their scarcity and resemblance to other dermatologic entities. Read More

Orthop Rev (Pavia) 2018 Sep 26;10(3):7693. Epub 2018 Sep 26.

Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, RI, USA.

Spinal epidural abscesses (SEA) can be challenging to diagnose and may result in serious adverse outcomes sometimes leading to neurologic compromise, sepsis, and even death. While SEA may lead to litigation for healthcare providers, little is known about the medicolegal factors predicting case outcome of SEA related litigation cases. Three large medicolegal databases (VerdictSearch, Westlaw, and LexisNexis) were queried for SEA-related malpractice cases. Read More

J Am Acad Psychiatry Law 2018 Sep;46(3):351-358

Dr. Morris is a Resident in Psychiatry, Stanford University School of Medicine, Stanford, CA.

American general psychiatry residents are significantly involved in legal hearings related to mental health. Training to become a psychiatrist involves considerable exposure to medicolegal matters, and psychiatry residents frequently participate in high-stakes legal hearings concerning their patients. Although psychiatry residents are physicians, residents are also trainees who may lack full medical licensure, board certification, or basic preparation to testify in legal settings. Read More

Neurol Res Int 2018 1;2018:3050278. Epub 2018 Oct 1.

King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.

Background And Objectives: Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. Read More

Br J Ophthalmol 2018 Oct 25. Epub 2018 Oct 25.

Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.

Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. Read More

AJR Am J Roentgenol 2018 Nov;211(5):W275-W276

1 NorthShore University HealthSystem, Skokie Hospital, Skokie, IL.

Br J Oral Maxillofac Surg 2018 Nov 16;56(9):777-778. Epub 2018 Oct 16.

Leeds South and East Clinical Commissioning Group. Electronic address:

Clin Orthop Relat Res 2018 Nov;476(11):2282-2283

J. Rickert, President, The Society for Patient Centered Orthopedics, Bloomington, IN, USA P. E. Levin, Professor of Orthopaedic Surgery, Vice-chairman, Department of Orthopaedic Surgery Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA M. Piasio, Senior Medical Director, Medical Management, UPMC Health Plan, Pittsburgh, PA, USA T. Boniface, Professor and Chairman of Orthopaedic Surgery, North East Ohio Medical University, Rootstown, OH, USA T. Grogan, Orthopaedic Surgeon, Private Practice, Los Angeles, CA, USA R. Rutherford, Orthopaedic Surgeon (Retired), Coeur d'Alene, ID, USA.

Br J Radiol 2018 Nov 1:20180416. Epub 2018 Nov 1.

2 Department of Diagnostic Radiology and Nuclear Medicine, VA Maryland Health Care System , Baltimore, MD , USA.

There have been tremendous advances in artificial intelligence (AI) and machine learning (ML) within the past decade, especially in the application of deep learning to various challenges. These include advanced competitive games (such as Chess and Go), self-driving cars, speech recognition, and intelligent personal assistants. Rapid advances in computer vision for recognition of objects in pictures have led some individuals, including computer science experts and health care system experts in machine learning, to make predictions that ML algorithms will soon lead to the replacement of the radiologist. Read More

J Midwifery Womens Health 2018 Nov 15;63(6):660-667. Epub 2018 Oct 15.

Introduction: Professionally-related stress among midwives has been demonstrated in a global context to have deleterious effects on their professional, physical, and psychological health. Despite global interest in the subject, there has been no study about professional stress in a cohort of US midwives.

Methods: A convergent parallel mixed-methods design was used. Read More

Forensic Sci Int 2018 Nov 29;292:e20-e24. Epub 2018 Sep 29.

DIMEC, University of Bologna, Department of Medical and Surgical Sciences, 40126 Bologna, Italy.

Major interplaying causes of heat stroke (HS) and fatal hyperthermia are climate, physical activity, artificial extreme ambient temperatures, confinement in a small compartment, and effects of drugs and chemicals, combined with predispositions and complications. A common and unfortunate cause of HS is vehicular hyperthermia (VH) death. Hyperthermia in a vehicle is a type of environmental thermal disorder, involving victim's susceptibility, confinement with restraint, and possible influences of drugs and poisons, including exhaust gas containing complex fumes, carbon dioxide and monoxide. Read More

Clin Orthop Relat Res 2018 Nov;476(11):2284

B. S. Bal, BalBrenner/Orthopaedic Law Center, Chapel Hill, NC, USA.

Med Clin (Barc) 2018 Oct 5. Epub 2018 Oct 5.

Área de Praxis, Servicio de Responsabilidad Profesional, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España.

Forensic Sci Med Pathol 2018 12 2;14(4):460-468. Epub 2018 Oct 2.

Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands.

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. Read More