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Biomedical subjects

M Lloyd

Publications and source records attributed to M Lloyd.

103 records · Page 6Linked to original sources
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Career Mobility↗
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Differences in the obstetric malpractice claims filed by Medicaid and non-Medicaid patients.

BACKGROUND: Many physicians believe Medicaid patients are more likely than non-Medicaid patients to file malpractice claims. This study examines the accuracy of this belief in regard to obstetric malpractice claims. METHODS: Claims filed between January 1982 and June 1988 from the major malpractice insurer in Washington State were used to compare obstetric malpractice claims filed on behalf of Medicaid and non-Medicaid patients. RESULTS: Eleven percent (7/62) of all closed obstetric claims were filed by Medicaid patients, whereas 19 percent of all births in Washington State were to Medicaid patients between 1982 and 1988. Failure to diagnose or treat a fetal condition was the most commonly alleged negligence in both Medicaid and non-Medicaid groups. Most claims in both groups were settled before the cases went to court; a substantial minority of claims were dropped. The mean cost of Medicaid claims ($406,984) was three times that of non-Medicaid claims ($133,743), suggesting that paid Medicaid claims were more severe than paid non-Medicaid claims. CONCLUSIONS: Medicaid patients appear no more likely to file obstetric malpractice claims than non-Medicaid patients. The low likelihood of filing claims, coupled with large settlements, suggests that Medicaid patients may have less access to legal services than non-Medicaid patients.

Female↗
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Defensive medicine and obstetrics.

OBJECTIVE: To test the hypothesis that physicians with greater malpractice claims exposure, either through personal experience or in their practice environment, will use more prenatal resources and have a higher cesarean delivery rate than physicians with lesser claims exposure. DESIGN: Retrospective cohort study using county malpractice defendant rate data from the Washington State Physicians Insurance and Exchange Association and prenatal care, delivery method, and self-reported obstetric suit experience data from the Content of Obstetrical Care Study database. SETTING: Washington State obstetric practices. PARTICIPANTS: Stratified random samples of obstetrician-gynecologists and family physicians. MAIN OUTCOME MEASURES: The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery. RESULTS: After controlling for patient, physician, and sociodemographic characteristics, we found no difference in prenatal resource use or cesarean delivery rate for low-risk patients between physicians with more and less exposure to malpractice claims. CONCLUSIONS: This study does not support an association between the malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or ceserean deliveries for the care of low-risk obstetric patients.

Cesarean Section↗
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Prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome.

OBJECTIVE: To assess the prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome. METHODS: A group of 147 patients with the antiphospholipid syndrome (124 female, 23 male) were studied. All patient histories were carefully reviewed and each patient was interviewed at least once. Particular attention was paid to clinical manifestations of the antiphospholipid syndrome at the time of subungual splinter haemorrhages. Patients who had evidence of infective endocarditis confirmed by echocardiogram and a positive blood culture were excluded from the study. RESULTS: Six out of 147 patients developed subungual splinter haemorrhages. Amongst 80 patients (54%) with a history of venous thrombosis, only one developed subungual splinter haemorrhages during a lupus flare in the post-partum period. This sign was found in 4 out of 67 patients with arterial occlusions; in 2 of these the occlusion manifested as a cerebrovascular accident. Another patient with a history of lupus and recurrent miscarriages developed subungual splinter haemorrhages during a lupus flare. CONCLUSION: Subungual splinter haemorrhages appeared to be relatively uncommon in our group of patients with the antiphospholipid syndrome. The differences in clinical setting and response to different treatment regimes in these cases suggest varied aetiopathologies and may reflect a number of different types of vascular insult.

Adolescent↗
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Immunosuppressive therapy in lupus nephritis.

OBJECTIVE: To evaluate the outcomes and side effects of immunosuppressive therapy in patients with lupus nephritis. PATIENTS AND METHODS: Thirty-nine patients with lupus nephritis assessed between 1988 and 1993 with a median follow-up of 46 months (range 12-60 months) were studied. Lupus nephritis was biopsy-proven in 37 patients. Patients received a median of 3 (500 mg) weekly pulses of intravenous cyclophosphamide followed either by azathioprine (n = 32) or oral cyclophosphamide (n = 7). All patients received oral prednisolone. The time from biopsy to renal insufficiency, defined by doubled serum creatinine and/or end stage renal failure, was used to assess outcome. RESULTS: There were significant improvements in the median changes of all major laboratory parameters. Serum creatinine levels did not change significantly. The prednisolone dose was significantly reduced during the follow-up period. OUTCOME: renal function remained stable in 26 (67%) and deteriorated despite therapy in 13 (33%) patients. 6/13 (42%) of these patients had impaired renal function at the time of biopsy. The adverse effects of intravenous cyclophosphamide seen were Herpes zoster (1), transient leucopenia (2), rash (1) and fatal septicaemia (1); of azathioprine urinary infections (3), leucopenia (5), rash (1) and increased liver enzymes (1); and of oral cyclophosphamide ovarian failure (4), Herpes zoster (3), haemorrhagic cystitis (1), and fatal septicaemia (1). CONCLUSIONS: Therapy with weekly low dose intravenous pulse cyclophosphamide to induce remission, followed by azathioprine appears to be useful in preserving renal function in patients with diffuse proliferative lupus nephritis. In comparison to other studies, the reduced incidence of ovarian failure using this regimen was striking.

Administration, Oral↗
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Blood pressure measurement and antihypertensive therapy in acute stroke.

Inappropriate management of high blood pressure in acute stroke can adversely affect outcome. We examined blood pressure evaluation and antihypertensive therapy during the first week post-stroke in 40 patients at a district general hospital with no stroke unit. In the first 24 hours, median frequency of blood pressure recording was 3 (range 1-12). After day 1, 11 (28%) had no blood pressure readings for one or two consecutive days. The side of measurement was not recorded in any patient. None of the 22 hypertensives (55%) had a bilateral measurement to exclude interarm inequality, and only 3 (7%) of all patients had postural readings to exclude orthostatic hypotension. Fourteen (35%) received antihypertensive therapy without meeting recommended indications; some even had low blood pressure. As most stroke patients are managed in general medical wards rather than stroke units, a greater awareness of these important aspects of blood pressure evaluation and therapy are needed among medical and nursing staff.

Aged↗