European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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We hypothesized that there has been an increase in the number of successful litigation claims in pediatric surgery in England. Our aim was to report the incidence, causes, and costs of clinical negligence claims against the National Health Service (NHS) in relation to pediatric surgery. ⋯ Out of 112 clinical negligence claims in pediatric surgery, 93 (83%) were finalized-73 (65%) were settled and damages paid to the claimant and 20 (18%) were closed with no payment, and 19 (17%) remain open. The median payment was £13,537 (600-500,000) and median total cost borne by NHSLA was £31,445 (600-730,202). Claims were lodged at a median interval of 2 (0-13) years from time of occurrence with 55 (75%) cases being settled within the 3 years of being received. The commonest reasons for claims were postoperative complications (n=20, 28%), delayed treatment (n=16, 22%), and/or diagnosis (n=14, 19%). Out of 73, 17 (23%) closed claims resulted in case fatality. Conclusion: Two-thirds of all claims in pediatric surgery resulted in payment to claimant, and the commonest reasons for claims were postoperative complications, delayed treatment, and/or diagnosis. Nearly a quarter of successful claims were in cases where negligence resulted in case fatality. Pediatric surgeons should be aware of common diagnostic and treatment shortfalls as high-risk areas of increased susceptibility to clinical negligence claims.
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The ideal repair of esophageal atresia (EA) is primary anastomosis with closure of the fistula if present. Long gap or local circumstances prompt other procedures that occasionally lead to disastrous complications. The aim of this study was to analyze the management of these complications in a tertiary referral center. ⋯ When repeated complications appear after EA repair, radical surgical attitudes may be justified. If esophageal continuity cannot be reestablished, the native esophagus may have to be discarded and replaced. Many complications should be expected, but the end result can be good. These patients should be referred to centers with large experience in the management of this complex condition.
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Fast-track concepts in pediatric surgery were established in a university hospital in consecutive studies within several years. They significantly reduced the length of hospitalization compared with German institutions without fast-track protocols. The aim of this study was to assess the implementation process of fast-track in a German nonacademic department of pediatric surgery without previous fast-track experience. ⋯ Fast-track concepts can be applied in a nonacademic department of pediatric surgery without previous fast-track experience and with excellent patient/parent satisfaction. However, the G-DRG system interferes with concepts of early discharge of patients. Modifications of the reimbursement modalities within the German health care system seem to be mandatory.
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Many hospitalized patients are affected by medication errors (MEs) that may cause discomfort, harm, and even death. Especially, children are considered to be at high risk of experiencing harm due to MEs. More insight into the prevalence, type, and severity of harm caused by MEs could help reduce the frequency of these harmful events. The primary objectives of our study were to establish the prevalence of different types of MEs and the severity of harm caused by MEs in hospitalized children from birth to 18 years of age. In addition, we investigated correlations between harmful MEs and characteristics of the collected data from 426 hospitalized children admitted, and the medication process. ⋯ Surgical pediatric patients seem to be at high risk for harmful MEs. Although the harm was considered minor in most cases, it still caused discomfort for the patients, and the high prevalence is a source of concern. Interventions to prevent the MEs should focus on the prescription and administration of nonopioid analgesics and antiemetic drugs.
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The aim of this study was to investigate the effects of dimethyl sulfoxide (DMSO) on stricture formation in corrosive esophageal burns. ⋯ Our results suggest that DMSO can decrease the occurrence of stricture formation and could represent a beneficial alternative therapy for the treatment of corrosive esophagitis.