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Carpal Tunnel Syndrome in the Extreme Elderly
Carpal tunnel syndrome (CTS), when seen in the very elderly, is usually severe and is not reliably diagnosed by ultrasound. Nerve conduction studies and electromyography are the most sensitive and specific tests to make accurate diagnosis of CTS.
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Amyloid, Tau, Neurodegeneration Diagnostic Framework to Predict Memory Decline Before the Onset of Dementia
In a population-based longitudinal study of older individuals without dementia, the inclusion of imaging biomarkers for amyloid, tau, and neurodegeneration modestly improved the ability to predict memory decline compared to a model that only used clinical data and APOE genotype.
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Cognitive-Motor Dissociation in Patients Admitted to ICUs After Acute Brain Injuries
In a large, prospective, single-center study, more than one in six patients with acute brain injuries may have cognitive-motor dissociation (CMD) (e.g., they harbor capacity to modulate their brain activity in response to motor commands while remaining behaviorally unresponsive at the bedside). Some acute CMD patients were found to have a much higher chance for recovery of neurological functions and for reaching independent levels of activities of daily living by 12 months after brain injury.
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Neuropathy After Total Knee Arthroplasty
In a large series of cases from the Mayo Clinic, 54 cases of new neuropathy occurred in 14,450 total knee arthroplasties. Most were isolated peroneal neuropathies. No specific risk factors were identified in this series.
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Prevalence of Refractory Juvenile Myoclonic Epilepsy
Juvenile myoclonic epilepsy (JME) is a common form of generalized epilepsy. Although the prognosis of JME is not clear, it is assumed to have a good response to treatment. The authors of this meta-analysis found a higher than expected prevalence of refractoriness in JME, which will affect how neurologists counsel patients with JME.
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Appellate Court Rejects Loss-of-Chance Argument for Patient Who Suffered Stroke
This case reveals a potent defense for physicians and care providers: A patient must prove causation when raising a malpractice allegation. A plaintiff must prove that the physician or care provider’s conduct is a substantial factor in causing the harm, which means that it must be more than a remote or trivial factor. However, it does not have to be the only cause of the harm. If the harm would have occurred without the physician or care provider’s conduct, then the conduct was not a substantial factor in causing harm.
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Patient Loses Eye to Improper Sterilization of Surgical Equipment; Awarded $3.5 Million
The lessons from this case include the importance of proper sterilization, as well as the legal procedures and appeal options. The appellate court noted that the hospital did not dispute the possibility that a breach in the sterilization process had occurred; instead, the hospital focused its challenge on the fact that the patient had not presented convincing evidence demonstrating that the breach in sterilization practices had caused the infection.
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Future for Risk Managers Will Require Flexibility, Learning
Risk managers seeking to improve their careers must evolve continually with the changing healthcare landscape. There are new technologies to consider, along with value-based reimbursement models, that are dependent on quality patient outcomes. Healthcare delivery models continue to bring new and sometimes unfamiliar services and exposures to an organization.
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Address Metadata With Protocol for Subpoenas
A strict protocol for responding to subpoenas can reduce the risks that come with inadvertently releasing too much information, or the wrong information. Experts have found that the best practice for responding to subpoenas or authorizations for production of medical records in legal cases is to set up a special department or designate an employee as the legal health information management representative. All requests for records in a legal case would be funneled through a person or persons trained in the legal issues and with ready access to the legal department or outside legal counsel when questions arise.