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Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high-quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The faculty reported the following relevant financial relationships with ineligible entities related to the educational content of this CE activity:
Natasha Schimmoeller, MD has nothing to disclose The PIM and ObGProject planners and others have nothing to disclose
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
ACOG Clinical Consensus on the Treatment of Urinary Tract Infections in Pregnancy
SUMMARY:
Urinary tract infections (UTIs) are one of the most common infections in pregnancy, occurring in about 8% of all pregnancies and range from asymptomatic bacteriuria to acute pyelonephritis. They are associated with adverse pregnancy outcomes such as preterm birth and low birth weight, therefore the timely identification and treatment of these is essential. Anatomic changes during pregnancy increase the risk for UTIs, such as ureteral dilation, the mechanical compression of ureters by the uterus causing urinary stasis, contributing to bacteria colonization and ascending infection. E coli remains the most common identified pathogen. Given the high rates of antibiotic resistance to this organism, the selection of first line therapy must avoid antibiotics such as amoxicillin and ampicillin. Treatment of symptomatic bacteriuria decreases the risk of pyelonephritis, which can cause significant maternal complications such as DIC and ARDS, as well as fetal complications such as preterm birth. Patients with hemoglobinopathy have higher rates of cystitis and asymptomatic bacteriuria.
Recommendations
Asymptomatic Bacteriuria (ASB)
Screen once early in pregnancy
If culture ≥100,000 CFU/mL treatment should be started with antiobiotics adjusted once culture results are available if necessary
Cefalexin: 250 to 500 mgs q6hr po 5 to 7 days
Fosfomycin: 3 g po once
Amoxicillin: 500 mg po q8hr for 5 to 7 days | 875 mg po q12hr for 5 to 7 days | Avoid starting prior to culture results due to high resistance
Amoxicillin-clavulanate: 500 mg po q8hr for 5 to 7 days | 875 mg po q12hr for 5 to 7 days | Avoid starting prior to culture results due to high resistance
‘Reasonable to offer’ if no other alternatives available
Nitrofurantoin: 100 mgs q12hr po 5 to 7 days
Sulfamethoxazole-trimethoprim: 800/160 mgs q12hrs po 5o to 7 days
Insufficient evidence for repeat screening following treatment
Presence of Group B strep
Treat if ≥100,000 CFU/mL
If <100,000 CFU/mL do not treat but it is an indication for group B streptococcus prophylaxis at the time of delivery
Note: Low risk for anaphylaxis, cephalosporin treatment is appropriate | High risk for anaphylaxis should be treated with alternative regimen
Acute Cystitis
Initiate treatment for symptomatic relief based on the following
Clinical signs: Dysuria | Hematuria | Frequency | Nocturia
Urinalysis: Consistent with UTI
Confirmed by urine culture of ≥100,000 organisms
Treatment regimen is the same as ASB (see above)
If symptoms persist
Repeat cultures
Consider daily prophylaxis preferably single daily dose if recurrent infection (≥2 UTIs during pregnancy)
Effective on June 27, 2023, the Pregnant Workers Fairness Act (PWFA) is a new law that requires covered employers to provide “reasonable accommodations” to a worker’s known limitations related to pregnancy, childbirth, or related medical conditions, unless the accommodation will cause the employer an “undue hardship”. Covered employers are private and public sector employers with at least 15 employees, Congress, federal agencies, employment agencies, and labor organizations. The law is limited to accommodations only. Other laws cover discrimination against workers on the basis of pregnancy, childbirth, or related medical conditions. It also does not replace other state or federal law that protect pregnant workers.
Reasonable accommodations could include but are not limited to
The ability to sit or drink water
Receive closer parking
Flexible hours
Appropriately sized uniforms and safety apparel
Additional break time to use the bathroom, eat, and rest
Take leave or time off to recover from childbirth
Be excused from strenuous activities and/or activities that involve exposure to compounds not safe for pregnancy
The employer and worker must discuss the accommodation before the worker is required to accept it. The employer cannot deny a job or other employment opportunities to a qualified worker based on the need for a reasonable accommodation.
Employers are required to provide reasonable accommodations unless they would cause an undue hardship on the employer’s operations. Therefore, an employer must demonstrate significant difficulty or expense before denying the accommodation.
The Equal Employment Opportunity Commission (EEOC) will be charged with investigations under this act.
ISPD Guidance on the Use of Non-Invasive Prenatal Testing for Chromosomal Conditions in Singleton Pregnancies
SUMMARY:
The ISPD consensus statement addresses screening using NIPT for the detection of chromosomal conditions in singleton pregnancies. NIPT for the three most common aneuploidies can be used as either a first line screening test for all pregnant individuals or as a follow up screen for those at high risk by serum analyte screening. A baseline sonogram to document viability, gestational dating, and to evaluate the number of fetuses should be performed prior to screening.
What Is Cell-free DNA Screening?
NIPT is a blood test that utilizes cell-free DNA technology to predict the risk for fetal genetic disorders during pregnancy
In 2011, NIPT was introduced as a screen for T21 (Down syndrome)
Today, NIPT for prenatal screening cover the most common aneuploidies (T21, T13 and T18), as well as sex chromosomes and may also include some microdeletions and single gene genetic disorders
How Does It Work?
DNA fragments can be found floating in the blood of all individuals
In every pregnant person, there is DNA from
Maternal fragments
Fragments of placental DNA felt to reflect the fetal contribution
Fetal Fraction
The percentage of fetal DNA found in maternal blood is known as the fetal fraction | Typical range 3% to 13% of maternal cfDNA
The fetal fraction is critical to the success of testing | Minimum required approximately 2% to 4%
Sensitivity drops with lower fetal fraction and if too low, test failure will result
Testing is usually performed at about 10 weeks gestation, but can be performed until term
Indications
Common fetal aneuploidies
Trisomy 13, 18, and 21
NIPT is the most accurate screening test for these aneuploidies and can therefore be offered in primary or contingent screening models
Sex chromosome aneuploidies
May be added after appropriate counseling
Insufficient data to implement for
Rare autosomal trisomies
Submicroscopic deletions
Duplication/deletion syndrome
Laboratory Issues
False positive results can occur
Pathways should be established to manage a ‘no call’ result, in which a result cannot be obtained due to a low fetal fraction
No call results are associated with aneuploidies or other adverse outcomes
Can be associated with a maternal malignancy or fibroids
Diagnostic testing should be offered with chromosomal microarray if
Fetal anomaly is seen
Nuchal translucency measurement is ≥3.5 mm
KEY POINTS:
NIPT for screening for fetal aneuploidy screening
Should be implemented as a first line screening test for the common aneuploidies (T21, T13 and T18)
Should be offered to an individual found to be at high risk for aneuploidy
Sex chromosome aneuploidy screening can be added if appropriate prenatal counseling is performed
Pretest counseling should be available
Downstream clinical services should be available for a screen positive test result
Confirm positive screening results with invasive testing
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Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high-quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The faculty reported the following relevant financial relationships with ineligible entities related to the educational content of this CE activity:
Andrei Rebarber, MD has nothing to disclose The PIM and ObGProject planners and others have nothing to disclose
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
ASRM Guideline: Preimplantation Genetic Testing for Monogenic Disorders
SUMMARY:
Preimplantation genetic testing (PGT) for monogenic disorders (M) is a form of preimplantation genetic diagnosis. It is an adjunct to assisted reproductive technology (ART) using in vitro fertilization (IVF) to evaluate embryos by genetic testing, preventing the inheritance of serious disorders in the majority of cases. Because of the wider use of prenatal and preconception genetic carrier screening, more disorders are being identified by PGT-M.
What is Preimplantation Genetic Testing?
Most often, it consists of a biopsy performed at the blastocyst stage, allowing 5 to 10 cells to be removed for further genetic testing. The goal is to identify unaffected embryos for transfer. There are different types of testing, depending on genetic disorder that is being assessed.
PGT-M
Most complex form of PGT
PGT-M should always be considered an optional test
Indications
Severe childhood onset conditions
Constitutes the majority of indications for PGT-M
Generally there is a lack specific treatment or intervention, such as Tay Sachs disease
HLA matching
PGT-M is used to identify embryos that have a compatible human leukocyte antigen (HLA) match to become a potential HLA matched stem cell donor to a recipient sibling affected with a specific hematopoietic disorder
PGT-M is then also used to test the embryos for the same disorder to prevent an affected embryo from being transferred
HLA are autosomal recessive, therefore, each sibling has a chance of a 25% match with another sibling, given the same parents
Adult-onset conditions
PGT-M can be used to identify significant adult-onset conditions, such as HBOC
Key Points
Genetic counseling
Pretest genetic counseling is essential and should include information about the potential identification of incidental findings
Patients may benefit from genetic counseling once PGT-M results are available, to help guide decision making regarding embryo transfer
Prenatal diagnosis should be offered to all patients who have undergone PGT-M both to confirm the testing results and to screen for other genetic conditions not tested for with PGT-M
PGT-M is not recommended for disorders in which there is no clinical utility, such as variants of unknown significance (VUS)
Female sexual dysfunction is relatively prevalent. Approximately 43% of American women report sexual problems. However, women are unlikely to report sexual dysfunction with providers unless asked. Dysfunction includes various conditions which report personal distress in one or more of the following areas: desire, arousal, orgasm, or pain.
Severe fear or anxiety about pain anticipating, during and/or resulting from vaginal penetration
Tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
Substance/Medication-Induced Sexual Dysfunction
Disturbance in sexual function that occurs during or soon after changes in substance and/or medication known to have the capacity to induce sexual changes
Other Specified or Unspecified Sexual Dysfunction
Distressing symptoms characteristic of sexual dysfunction that do not meet the criteria of one of the DSM-5 defined categories
Pregnancy-related sexual dysfunction
Menopausal-related sexual dysfunction
Possible Etiologies
Hypertension
Diabetes
Chronic high blood glucose is linked to decreased desire, arousal, and orgasm
Medications
Postpartum period
Medication
Psychiatric drugs, including but not limited to: Antidepressants | Lithium |Risperidone
Cardiovascular drugs
Antihistamines
Naproxen
Clinical Considerations and Recommendations
Screening
Initiate a clinical discussion of sexual function during routine care visits
If possible sexual dysfunction presents, an extended visit may be required including
Comprehensive sexual history
Physical examination to evaluate for gynecologic etiologies
Laboratory testing typically not necessary
Diagnosis
Made according to the DSM-5 and classified as female sexual dysfunction when symptoms persist for at least 6 months
Exception: substance and/or medication-induced sexual dysfunction
Symptoms must result in significant personal distress
Women often experience more than one type of female sexual dysfunction simultaneously
A woman may still benefit from evaluation and treatment even if their symptoms do not meet DSM-5 criteria
Treatment
Psychologic Interventions
Sexual skills training | Cognitive-behavioral therapy | Mindfulness-based therapy | Couples therapy
Patient should consult a mental health professional having expertise in treating female sexual dysfunction
Estrogen Therapy
Low-dose vaginal estrogen therapy is preferred for female sexual dysfunction due to genitourinary syndrome of menopause (GSM)
Vaginal tablets | Gels | Creams | Rings
All equally effective
Low-dose systemic hormone therapy can be a viable alternative
Transdermal Testosterone
Mixed evidence on the safety and efficacy of androgen therapy for female sexual dysfunction
Testosterone is not FDA approved for female sexual dysfunction
Sildenafil Citrate
Should not be used outside of clinical trials
Filbanserin
A serotonin receptor agonist/antagonist
FDA approved for treatment option for hypoactive sexual desire disorder in premenopausal women without depression
Alcohol use during treatment creates an increased risk of syncope and hypotension
Bupropion
A norepinephrine-dopamine reuptake inhibitor
May improve symptoms for antidepressant-induced female sexual dysfunction
Dilation
Several prescription and OTC products available
Aid to alleviate vaginismus or correct vaginal stenosis
Physical Therapy
May benefit women with dyspareunia due to vaginismus or general pelvic floor dysfunction
Medications
Intravaginal prasterone is FDA approved for post-menopausal women experiencing moderate-to-severe dyspareunia
Lubricants
Lubricants do not cure underlying causes of female sexual dysfunction
May help alleviate dyspareunia due to vaginal dryness
KEY POINTS:
Dysfunction includes various conditions in which personal distress is reported in ≥1 of the following areas
Desire | Arousal | Orgasm | Pain
Initiate a clinical discussion of sexual function during routine care visits
Diagnoses made according to the DSM-5 classified female sexual dysfunction when symptoms persist for at least 6 months
A person may still benefit from evaluation and treatment even if their symptoms do not meet DSM-5 criteria
An advisory panel was selected to review current literature regarding nonhormone therapy based on levels of evidence. In the treatment of vasomotor symptoms in women within ten years of menopause and who are not candidates for or who decline hormone therapy, evidence-based nonhormone options such as behavioral therapies, medications such as SSRIs or gabapentin, and weight loss should be discussed and considered.
Vasomotor Post Menopausal Symptoms
Vasomotor symptoms (VMS)
Defined as hot flashes and night sweats
Incidence
Mean 7 to 10 years
30% >10 years
Standard Management
Hormone therapy
First line recommended treatment
Underutilized therapy
Contraindications
Estrogen sensitive tumors
Coronary artery disease/myocardial infarction history
Stroke
Venous thromboembolism
Recommended Nonhormone Techniques and Therapies
Mind-Body Techniques
Clinical hypnosis
Cognitive behavior therapy
Prescription Medications
SSRIs and SNRIs demonstrate mild to moderate improvement
Ecitalopram 10 to 20 mgs/day
Paroxetine salt 7.5 mg/day
Paroxetine 10 to 25 mg/day
Citalopram 10 to 20 mg/day
Desvenlafaxine 100 to 150 mg/day (start at 25 to 50 mg/day)
Venlafaxine 37.5 to 150 mg/day (start at 37.5 mg/day)
Gabapentin
900 to 2400 mg/day in divided doses (start with 100 to 300 mg at night, add 300 mg at night, then an AM dose of 300 mg)
Fezolinetant
Neurokinin B antagonist
45 mg/day
Oxybutynin
2.5 to 5.0 mg twice daily or 15 mg extended release daily
Long term use may be associated with cognitive decline in older adults
SUMMARY: Listeria infection is primarily a foodborne illness resulting from consumption of food contaminated with Listeria monocytogenes. Maternal infection may present as a non-specific, flu-like illness. Fetal and neonatal infections risk severe consequences.
Background
Listeriosis is a foodborne illness resulting from consumption of food contaminated with Listeria
Listeria is an aerobic and facultative anaerobic, gram-positive bacillus
Incidence of listeriosis associated with pregnancy is 13 times that of the general population
Maternal and Perinatal Outcomes
Maternal infection may be asymptomatic
Symptomatic infection generally presents as a non-specific, flu-like illness
Mild myalgias or mild nausea or diarrhea
Fetal and neonatal infections include severe risks
Fetal loss | Preterm labor | Neonatal sepsis | Meningitis | Death
Approximately 1/5 pregnancies with listeriosis will result in spontaneous abortion or stillbirth
Prevention
Women are advised to avoid high-risk foods during pregnancy
Hot dogs | Lunch meats | Cold cuts
Refrigerated pate and meat spreads
Refrigerated smoked seafood
Raw, unpasteurized milk or soft cheeses
Unwashed raw produce
CDC LISTERIA PREVENTION
Tap Below to See CDC Page
Management
Asymptomatic
Consumption of a product that was recalled or had implicated listeria contamination
No testing or treatment is indicated
Advise patient to return if she becomes symptomatic within 2 months of eating the implicated product
Exposed, Mildly Symptomatic but Afebrile
Minor GI or flu-like symptoms
Can manage expectantly (as asymptomatic above) or
Blood cultures can be ordered
Instruct laboratory of diphtheroid morphology and not to confuse with contaminant
Positive blood cultures: Standard antimicrobial treatment (see below)
Fetal surveillance
Individualize based on concern regarding infection and clinical findings
Exposed, Febrile with Symptoms Consistent with Listeriosis
Exposed pregnant woman with a fever > 38.1°C (100.6°F) and signs and symptoms consistent with listeriosis but no other etiology
Test and treat concurrently for presumptive listeriosis
Diagnosis is made primarily be blood culture
Placental cultures should be obtained in the event of delivery
Notify state public health department following diagnostic confirmation
If blood cultures negative and symptoms resolve, can stop antibiotics
Fetal surveillance
Advised if listeriosis diagnosed or highly suspected
Antibiotic Treatment
IV ampicillin: ≥ 6g/day for 14 days to 21 days
IV Gentamicin is frequently added to the regimen
Allergy to ampicillin and/or penicillin
Trimethoprim with sulfamethoxazole
KEY POINTS:
Listeriosis is an illness resulting from consumption of food contaminated with Listeria
Listeriosis presents severe risks to maternal and fetal health and survival
Asymptomatic patients do not require treatment or testing
Symptomatic afebrile patients should be monitored and consider obtaining blood cultures
Symptomatic febrile patients should undergo testing by blood culture and treatment with IV ampicillin
Stool culture is not recommended for the diagnosis of listeriosis
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Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high-quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The faculty reported the following relevant financial relationships with ineligible entities related to the educational content of this CE activity:
Tracy Shevell, MD has nothing to disclose The PIM and ObGProject planners and others have nothing to disclose
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Oregon Court Strikes Jury Instructions regarding Guarantee of Results in Medical Malpractice Case
As part of the patient-physician relationship, consent for treatment is given. Physicians explain the risks, benefits, and limitations of treatment Nowhere in that consent is a guaranteed good outcome given. It is not possible.
Prior to November 2022, Oregon juries in medical malpractice cases were instructed “Physicians are not negligent merely because their efforts were unsuccessful. A physician does not guarantee a good result by undertaking to perform a service.” This instruction evolved from a series of cases where it was established that a physician does not guarantee a cure. Despite that lack of guarantee, a patient could still sue a physician for medical malpractice, alleging a bad outcome due to the physician’s failure to follow a particular standard of care that caused injury to a patient.
In November 2022, the appellate court of Oregon in Martineau v. Willamette Medical Center ruled that this instruction should no longer be part of the uniform civil jury instruction. The court found issue with the instruction as it obscures the fact that the correct focus is on application of
the standard of care. In addition, the meaning of “result” has a broader meaning than “cure”. Therefore, the statement that “[a] physician does not guarantee a good result by undertaking
to perform a service” is incorrect when stated—as it is in the instruction—as a universal principle.
Let’s turn to the underlying medical facts. Mr. Martineau sought care in the emergency room for chest pain and other complaints. One physician examined him and ordered a chest X-ray that the radiology physician read. The ordering physician however reviewed the X-ray and electrocardiogram of a different patient. He concluded that that the patient did not have an urgent cardiovascular problem or need further testing immediately. To the contrary, Mr. Martineau did have an urgent cardiovascular problem and died the next day.
The plaintiff personal representative of Mr. Martineau filed a lawsuit for wrongful death or, in the alternative, the loss of chance of recovery followed, alleging medical malpractice by the ordering physician, emergency room group, and the radiology physicians. The jury returned a verdict in favor of the defendants.
The appellate judges found two problems with the instruction. First, it takes away from the focus on the standard of care which is the issue to be decided because the guarantee of a good “result” is incorrect as a universal principle. Second, any benefit that it would add to a jury’s understanding of the law was significantly outweighed its potential to confuse a jury. In summary, the statement is likely to mislead a jury and should not have been given by the court.
Next, the appellate court considered where the error was harmless or detrimental. The plaintiff’s theory was that defendants negligently failed to recognize the urgency of the decedent’s condition when he came to the emergency room. If they had, they would have determined he needed a CT scan and performed emergency surgery to save his life.
In summary, the risk of giving the jury the instructions that a good result was not promised might cause the jury to reason that the defendants’ duty did not require them to order a CT scan because the CT scan was the “good result”. The CT scan was the primary focus of the plaintiff’s case.
In its decision, the appellate court deemed the error was not harmless because the instruction was misleading. The jury could have reasoned that even though the radiology defendants’ and the ER defendants’ did not meet the standard of care, the defendants nevertheless were not negligent because a good result was not promised. The difference between a result and care are exemplified in this case. The defendant physicians were obligated to evaluate the deceased patient in accord with a standard of care that included testing and a CT scan.
The AMA vehemently opposes the striking down of this jury instruction regarding the nonguaranteed of a good result. “Medical negligence liability [should] remain based on legal fault, and not medical results.” If the decision were to stand, it opens the door for juries to succumb to their sympathies about the plaintiff and injuries rather than to focus on the legal standard of care.” Recently, the appellate court decision was submitted for review by the Supreme Court of Oregon. The AMA and Oregon Medical Association have submitted an amicus brief asking for the appellate decision to be reversed.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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