I am a partner at STARR, GERN, DAVISON & RUBIN, P.C., a firm that traces its origins to 1926. I focus on Medical Malpractice and Construction Accident litigation, but represent catastrophically injured clients in a wide spectrum of personal injury matters.
On November 1, 2012, Starr, Gern, Davison & Rubin was one of nine law firms in New Jersey recognized as a Tier 1 Best Law Firm by U.S.News and World Report in the field of Plaintiffs Medical Malpractice.
I am a client focused attorney. The people I represent are carbon copied on every correspondence and are continuously informed about what is going on in their litigation. I take and promptly return telephone calls and I am available to my clients after hours through my cell phone. My firm believes the practice of law is a service industry, and our clients are our best advertisers.
I will meticulously prepare you for every stage of the litigation process. My firm has the financial wherewithal to prosecute complex cases to conclusion. We consistently work with a network of medical and technical experts throughout the United States to assist us in representing our clients. Finally, we utilize state of the art technology in and out of the courtroom to advance your interests.
I am published in the area of medical malpractice, patient safety and complex litigation. I am on the Editorial Board of Medical Malpractice Law and Strategy. I sit on the Medical Malpractice Subcommittee of the New Jersey Bar Association. Finally, I am a lifetime member of the Multi-Million Dollar Advocates Forum and I have been nominated by my peers in the field of medical malpractice in the annual Super Lawyers survey since 2010.
About John Ratkowitz
Admitted: 1995, New Jersey
Professional Webpage: njmedicallawyer.com/about/
Honors and Awards:
- The National Trial Lawyers: Top 100 is an invitation-only organization composed of the premier trial lawyers from each state in the nation who meet stringent qualifications as civil plaintiff and/or criminal defense trial lawyers. Selection is based on a thorough multi-phase process which includes peer nominations combined with third-party research. Membership is extended solely to the select few of the most qualified attorneys from each state who demonstrate superior qualifications of leadership, reputation, influence, stature and public profile., The National Trial Lawyers Top 100 Trial Lawyers, 2013
- U.S.News and World Report recognized Starr Gern as a Tier 1 Best Law Firm in the field of Plaintiffs Medical Malpractice., Tier 1 Best Law Firm - Plaintiffs Medical Malpactice, U.S. News and World Report, 2012
- The Multi-Million Dollar Advocates Forum was established in 1993 and is one of the most prestigious groups of trial lawyers in the United States. Membership is limited to attorneys who have won multi-million dollar verdicts and settlements. There are over 4000 members throughout the country. Fewer than 1% of U.S. lawyers are members., Life Member, Multi-Million Dollar Advocates Forum, 2010
- Avvo rates John at 10 - Superb, which is among the highest qualified trial lawyers in New Jersey, Avvo Rating of 10 - Superb
- Essex County County Bar Association
- Medical Malpractice Subcommittee, New Jersey State Bar Association
- New Jersey State Bar Association
- Association of Trial Lawyers of America
- Seton Hall University School of Law Inns of Cour
Pro bono/Community Service:
- Member - The ABA Military Pro Bono Project.
The ABA Military Pro Bono Project accepts case referrals from military attorneys on behalf of junior-enlisted, active-duty military personnel and their families with civil legal problems, and it places these cases with pro bono attorneys where the legal assistance is needed. The Project is also the platform for Operation Stand-By, through which military attorneys may seek attorney-to-attorney advice to better assist their servicemember clients., 2011
- Board of Directors, Arts Unbound. 542/544 Freeman Street, Orange, NJ 07050. Arts Unbound is a non-profit organization dedicated to the artistic achievement of youth, adults and senior citizens with disabilities. They provide professional classes in the visual arts and exhibitions in their gallery and throughout the state of NJ., 2008
- Board of Editors, Medical Malpractice Law and Strategy. 1617 JFK Blvd., Philadelphia, PA 19103. Medical Malpractice Law and Strategy is a monthly periodical which publishes scholarly articles and keeps lawyers and physicians current on judicial, legislative and medical developments that can impact the area of medical malpractice., 2008
Scholarly Lectures and Writings:
- In-Hospital Falls. Medical Malpractice Law and Strategy, Vol. 31, Number 2, (November 2013). I initially published this article with my associate, Robert Sanfilippo, on November 1, 2013. Many patients who are admitted to a hospital are a fall risk because of an injury, illness or because of medication they must take. Accepted standards of care require hospitals to assess each patient on admission and implement fall prevention measures to prevent injuries to patients. This article discusses published accepted standards of care in place to avoid falls in hospitals.
- Avoidable vs. Unavoidable Pressure Ulcers: A Summary of the Federal Regulations. Medical Malpractice Law and Strategy, Vol. 30, Number 12, (2013) I published this article on September 1, 2013. Pressure sores, also known as pressure ulcers and bed sores, develop in the elderly and infirm when range of motion is restricted and limited. Pressure sores can be devastating injuries, and are frequently the subject of litigation against nursing homes and hospitals. In most circumstances, a well developed plan of care can avoid these complications. This article discusses when pressure sores are deemed preventable under Federal Regulations.
- Discovery in Medical Malpractice Cases: A Critical Analysis of the Self-Critical Analysis Approach. 156 N.J.L.J. 236 (1999). I published this article in the New Jersey Law Journal with my partner, Amos Gern, on April 19, 1999. When an unusual incident involving a patient occurs at a health care facility, it may be the subject of peer review by a committee created within the hospital. This kind of review is likely if the incident caused the patient to file a medical malpractice complaint. Peer review analysis and the reports from morbidity and mortality committees contain a great deal of factual information relevant to a medical malpractice case. Notwithstanding, defendants have been largely successful in shielding these materials during discovery by arguing that these documents are protected by the so-called self-critical analysis privilege. This article analyzed the development of federal case law that dealt with the self-critical analysis privilege and argues that courts should not allow hospitals to shield relevant evidence from disclosure by incorrectly applying the doctrine.
- Medical Malpractice: Making the Most of Pretrial Discovery, 181 N.J.L.J. 524 (2005). I published this with my partner, Amos Gern in the New Jersey Law Journal, August 8, 2005. Essentially, the article discusses the importance of being vigilant in pretrial discovery when prosecuting medical malpractice cases.
- The Role of Informed Consent In Defensive Medicine. Medical Malpractice Law and Strategy, Vol. 28 No. 10. (July 2008). This article critiques the argument that medical malpractice causes doctors to practice defensive medicine. Medical providers and insurance companies often argue that health care costs are unnecessarily increased due to the practice of defensive medicine. Despite this, here are many reasons to question the scope of the problem of defensive medicine. First, initial steps to quantify it were based solely on surveys of physicians. Second, an examination of the health care landscape revealed that there were many forces that would motivate doctors to over-order diagnostic tests and procedures. Third, although some states have now enacted tort reform, data from studies suggest that limiting a medical malpractice victim's right of redress does not significantly impact physician behavior. Finally, most consequential medical decisions are being made by doctors and patients, and bringing patients into the process has resulted in more decisions that err on the side of caution.
- The Relevance of Never Events in Medical Malpractice Litigation. Medical Malpractice Law and Strategy, Vol. 27, No.126 (September 2010). I wrote this article with my associate, Robert Sanfilipo, Esq. Never events are medical mistakes that are considered so base that insurance companies and Medicare have taken the position that they will not reimburse health care providers for care related to these events because the cause of the harm was entirely avoidable. Amazingly, the government and insurance industry's public stance in these errors has not stopped doctors from defending these claims in court.
- To Err is Human, But This is Something Else. Medical Malpractice Law & Strategy, Vol. 28, No. 4 (January 2011). I published this article on January 1, 2011. It deals with the lack of progress in the patient safety movement. I wrote it on the ten year anniversary of To Err is Human, which was a study performed by the National Institute of Health which revealed that the United States had a medical malpractice problem of epidemic proportions. Unfortunately, literature indicates that despite the alarming conclusions of Too Err is Human, the health care industry still has a long way to go to implementing basic safety measures to protect patients.
- Medical Malpractice - Winning the Expert Shell Game. 185 N.J.L.J. 1057 (2006). I published this article in the New Jersey Law Journal with my partner, Amos Gern, on September 18, 2006. Defendants in medical malpractice cases often hire multiple overlapping experts and then strategically fail to call the ones who testify poorly in depositions. This is unfair because it increases the costs of a litigation and it removes some of the most important evidence in a litigation from the jury's consideration. I published this paper in the New Jersey Law Journal with my partner, Amos Gern, as a guideline for attorneys about how to deal with this situation.
- The Consequences of Truth: Compulsory Medical Error Reporting in New Jersey. Medical Malpractice Law and Strategy, Volume 26, Number 9 (June 2011) I published this article on June 1, 2011. It (a) examines physicians' ethical obligation to report medical errors to their patients, (b) discusses the literature which analyzes why they fail to do that, (c) explains how New Jersey made an ethical requirement into a statutory one with the passage of the Patient Safety Act, N.J.S.A. 26:2H-12.23, and (d) suggests how statutory mandatory error reporting in New Jersey may impact the culture of health care and medical malpractice litigation.
- Winning the Morality Play in the Battle of the Experts. I published this article in Medical Malpractice Law & Strategy, Vol. 27, No. 6., March 2010. This paper was also the subject of a lecture. The paper discusses (a) the ethical requirements for expert testimony and (b) how to use these requirements during depositions and trial to demonstrate that defense experts conduct bias analyses.
- Shoulder Dystocia and the Duty of Informed Consent. Medical Malpractice Law and Strategy, Vol. 29, Number 6, (March 2012). This article deals with the subject of a physician's duty of informed consent when caring for a mother whose baby may be subject to shoulder dystocia at the time of delivery.
- The Standard of Care in Commercial Construction Site Safety Management. 213 N.J.L.J. 953 (2013). I published this article in the New Jersey Law Journal on September 16, 2013. It discusses the published literature that requires general contractors and subcontractors to take a proactive approach to safety management on commercial construction sites to protect workers from injuries.
- "Proving Damages: Successful Strategies from Winning Cases." Lecture, New Jersey Association of Justice - Four Concurrent Seminars, Edison, New Jersey (2007).
- "Deposition Preparation and Winning Cases in Discovery." Speaker. New Jersey Association for Justice Annual Convention. (2009).
Verdicts and Settlements:
- Confidential Settlement on Behalf of Bloomfield, New Jersey Woman Who Suffered From Pressure Sore While a Recovering From Spinal Surgery. The plaintiff underwent multi-level spinal surgery in June 2011. She was admitted to a rehabilitation hospital and after six weeks she was diagnosed with a pressure ulcer on her sacrum and bilateral pressure ulcers on her heels. She was then discharged from that facility to a long term care nursing home. The plaintiffs contended that a lack of continuity of care resulted in an exacerbation of the pressure sore, so that it went from a Stage II pressure sore to a Stage IV pressure sore. , 2015
- $1,060,000 Settlement on Behalf of 72 Year Old Livingston, New Jersey, Resident Who Lost Vision as a Result of a Stroke Occurring During Surgery. On September 30, 2013, I settled all claims against my client's cardiologist, the last defendant in the case, during trial in Newark, New Jersey. The settlement occurred a week into the trial, just before the defendant was scheduled to testify. , 2013
- $1.2 Million Dollar Settlement on Behalf of Estate of Bergen County Man Who Died When Multiple Defendants Failed to Diagnose Subacute Bacterial Endocarditis. On March 22, 2013, I settled a case involving multiple defendants who failed to diagnose my client's husband with subacute bacterial endocarditis for $1.2 million dollars. The defendant physicians repeatedly failed to communicate the results of diagnostic tests to each other, and unfortunately the decedent died from his disease., 2013
- Settlement of $400,000 Plus Negation of $100,000 Workers Compensation Lien for Morris County Ironworker After Closing Arguments During Trial in Morris County, New Jersey. After a week long trial, my client, an ironworker who required spinal surgery after a fall, settled his case right before the jury began deliberations for $400,000. I would have liked to have gone to verdict, but the client was satisfied with the proposed settlement and the decision about whether a case should be settled is always the client's., 2013
- Confidential medical malpractice settlement on behalf of a 28-year-old Brick, New Jersey, resident who suffered neurological damage following orthopedic surgery to his knee.In this case, I obtained a settlement on behalf of a 28-year-old resident of Brick, New Jersey, who suffered damage to his peroneal nerve after he experienced swelling in a leg cast following knee surgery. Peroneal nerve injury caused by casting is a known and avoidable complication., 2011
- $20.5 million dollar medical malpractice verdict for patient blinded in one eye following negligent retinal surgery. (Co-counsel to Amos Gern). This was the first medical malpractice case I worked on. This was the first medical malpractice case I ever worked on. The defendant physician was a retinal surgeon who also provided expert testimony in medical malpractice cases and had published extensively on the subject of how to avoid medical malpractice verdicts. I second chaired the trial for Amos Gern, Esq., who is now my partner. When you second chair a trial, you work mostly behind the scenes helping prepare for each day in Court. At the time the verdict was returned, it ranked among the highest in state history.
- Confidential medical malpractice settlement on behalf of a New Providence, New Jersey resident who lost vision following heart surgery. (Co-counsel to Amos Gern). n this case, we represented a Veteran who lost vision following heart surgery. The plaintiff became anemic while in the hospital. He saw different doctors from the heart surgery practice because his operating surgeon went on vacation. Lab results were not timely communicated and the patient eventually lost vision because a transfusion was not performed despite severe anemia.
- $600,000 medical malpractice settlement following two days of trial on behalf of resident of New Egypt, New Jersey who suffered vision loss following negligent retinal surgery. (Co-counsel to Amos Gern). In this case, a resident of Jackson, New Jersey, resolved a claim against a retinal surgeon after two days of trial. The defendant failed to perform timely surgery on the plaintiff, and this delay resulted in compromised vision.
- Confidential medical malpractice settlement during trial on behalf of resident of Monroe Township, New Jersey whose doctor negligently failed to diagnose bacterial endocarditis. In this case, the plaintiff, a resident of Lakehurst, New Jersey, lost vision as a result of a stroke while undergoing spinal surgery on November 27, 2000. The defendant anesthesiologist utilized an anesthesia technique known as induced hypotension, and during the operative procedure the plaintiff's blood pressure was allowed to drop too low, causing an ischemic stroke to occur. The case settled following discovery just prior to being scheduled for trial.
- $1 million medical malpractice settlement on behalf of infant suffering traumatic birth injury as a result of inadequate response to ominous fetal monitoring strips. In this case, we were able to resolve a traumatic birth injury case on behalf of an infant who suffered from profound asphyxia. The plaintiff suffered from aspiration pneumonia and gastroesophageal reflux and failure to thrive and required the insertion of a gastronomy tube. She then went on to develop a spastic quadriplegia and developmental delay. This was a tragic case made worse by the doctors inadequate insurance coverage. The case resolved following the deposition of the defendant and birth delivery team.
- Confidential medical malpractice settlement on behalf of stroke victim who lost vision as a result of drop of blood pressure during spinal surgery. In this case, the plaintiff, a resident of Lakehurst, New Jersey, lost vision as a result of a stroke while undergoing spinal surgery on November 27, 2000. The defendant anesthesiologist utilized an anesthesia technique known as induced hypotension, and during the operative procedure the plaintiff's blood pressure was allowed to drop too low, causing an ischemic stroke to occur. The case settled following discovery just prior to being scheduled for trial.
- $675,000 settlement on behalf of ironworker suffering multiple spinal fractures. (Co-counsel to Amos Gern). Our client was an ironworker who fell from steel on a commercial construction site and fractured his spine. The case settled at mediation. The evidence showed that the general contractor failed to provide adequate fall protection for the ironworkers working for subcontractors on the jobsite. There was evidence that the plaintiff consumed a substantial amount of beer at lunch prior to his fall.
- $1.2 million medical malpractice verdict following negligent stenting procedure. (Co-counsel to Amos Gern). In this case, a Morris County, New Jersey, resident received a $1.2 million dollar verdict after he suffered loss of tissue in his left foot as a result of negligent arterial stenting and a MRSA infection.
- Confidential settlement on behalf of a Jersey City, New Jersey woman. The plaintiff underwent negligent cosmetic surgery. This was a negligent plastic surgery case that settled right after the defendant’s deposition. The client came to us because she was not pleased with the outcome of breast augmentation surgery. She advised that the surgeon assured her that breast implants would correct a sagging problem, but the surgery only made this worse. Invariably, these kinds of cases are difficult to prove, but we filed suit when the surgeon provided us with a second medical chart that was entirely fabricated (unbeknownst to the surgeon, the client obtained a copy of her real chart prior to contacting our office). After we exposed the fact that the doctor falsified his records, the case resolved.
- Confidential medical malpractice settlement on behalf of estate of pediatrician who died following negligent failure to diagnose breast cancer. This was a tragic case involving a pediatrician who died after her OBGYN failed to diagnose her with breast cancer, despite multiple complaints of a lump. The OBGYN kept telling our client that the lump that she had was dense breast tissue because she was a petite woman. When through self-exam the client found evidence of swollen lymph nodes, the OBGYN again suggested she was over-reacting. Five months later, when the lump had grown and she now felt pain in the area of her nipple, the defendant finally referred our client for an ultrasound. By then, she already had metastatic disease to her liver.
- Confidential medical malpractice settlement on behalf Cedar Grove, New Jersey, resident injured by negligent spinal surgery. n this case, a 70-year-old former Marine from Cedar Knolls, New Jersey, suffered complications following negligent spinal surgery. The evidence suggested that the surgeon misplaced the hardware he was attempting to insert, and then dropped a screw. The screw fell because it had no purchase when it was installed because the surgeon missed the bone. The client had to undergo a second surgery to find the dropped screw and revise the hardware, and he was left with permanent nerve damage.
- Confidential settlement at trial in case filed on behalf of 14 year-old resident of Livingston, New Jersey who received negligent orthopedic surgery of the left elbow. This was a medical malpractice case involving a 14-year-old boy from Livingston, New Jersey, who suffered an elbow injury while riding a razor scooter. The front wheel of his scooter struck a pothole and he fractured his elbow after landing on his hands while stopping his forward momentum. His injury was then complicated when a pediatric orthopedic surgeon took inadequate preoperative x-rays. This led to an incomplete understanding of the kind of fracture the boy suffered, which necessitated additional surgery and resulted in a compromised outcome.
- $3.9 million dollar settlement at trial on behalf of two ironworkers injured when they were thrown to railroad tracks after general contractor failed to follow its own safety procedures. While my primary focus is on medical malpractice cases, I also represent individuals injured during construction site accidents. This is a very specialized area of the law which requires an understanding of pertinent OSHA safety regulations, the various other professional standards applicable to construction site safety, and a working knowledge of how commercial construction sites are managed and operated. This is an area that I follow and also publish in. In this case, two ironworkers suffered injuries when the manlift they were operating was flipped to the train tracks below a passenger train platform that they were working on. The general contractor failed to perform a load-bearing analysis prior to authorizing the use of these vehicles.
- Confidential Settlement on Behal of 64-Year-Old Resident of Monroe Township who Suffered Stroke as a Result of a Failure to Diagnose Endocarditis. In this case, a 64-year-old resident of Monroe Township, New Jersey, suffered a mild stroke as a result of endocarditis. The plaintiff’s primary care doctor treated him for Lyme disease. Although the plaintiff's lab studies were available on September 5, 2002, the defendant did not review them until September 16, 2002. Despite the fact that the test results came back negative for Lyme disease, the defendant continued to treat the plaintiff for that condition throughout the remainder of September and into October 2002. The plaintiff had an excellent recovery. We settled the case at trial. After opening arguments, I called the defendant as my first witness. After about forty minutes of cross-examination, he settled the case.
Other Outstanding Achievements:
- On November 1, 2012, Starr, Gern, Davison & Rubin was one of nine law firms in New Jersey recognized as a Tier 1 Best Law Firm by U.S.News and World Report in the field of Plaintiffs Medical Malpractice. The U.S.News – Best Lawyers® “Best Law Firms” rankings is based on an annual evaluation of client critiques, peer review from leading attorneys in the field. Firms are ranked in in part based on their expertise, responsiveness, integrity, and cost-effectiveness. A first tier ranking includes those firms that scored within a certain percentage of the highest-scoring firm(s).
- Patient Safety Index - January 2016 - Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 30 days or so: The Centers for Disease Control and Prevention issued a recommendation that men with a pregnant partner should abstain from sex or use a condom if they live in or visited an area where mosquitos are spreading the Zika virus. Additionally, the CDC also recommended that pregnant women who have visited countries and territories plagued by the virus, mostly in Latin America, should be tested even if they do not exhibit symptoms of infection. The Centers for Disease Control and Prevention recommended that hospitalized patients, patients with severe, complicated or progressive illness and patients at high risk for complications due to influenza be treated with antiviral medication irrespective of the outcome of rapid influenza diagnostic test results. The reasons for this are that (a) there have been reports of severe influenza with some deaths and (b) RIDT results have a high potential for false negatives. A study published in Pediatrics found that exposure to beta-2 adrenergic agonists during pregnancy (used in asthma drugs) may increase the risk for autism spectrum disorders in children. The American College of Physicians and the Centers for Disease Control and Prevention released a new clinical guideline on antibiotic use in adults with acute respiratory tract infections. Except for confirmed bacterial infections like streptococcal pharyngitis or acute bacterial sinusitis, antibiotics should not routinely be used. A study published in Emerging Infectious Diseases revealed red flags about the effectiveness of a vaccine for whooping cough after an outbreak in a Florida preschool. A study published in Pediatrics demonstrated that children with allergic rhinitis and allergic persistent wheezing at age 4 years may have increased risk for anxiety and depression. A study published in the Journal of Allergy and Clinical Immunology found that adults with asthma have a 70% increased risk for developing shingles. The authors suggested that clinicians should consider vaccinating asthmatics at 50 years old. The American College of Surgeons and American Geriatrics Society issued joint best practice recommendations for geriatric perioperative care. In a study published in Neurology, researchers discovered that the distribution of amyloid plaque in traumatic brain injury (TBI) survivors overlaps the distribution that exists in Alzheimer patients, but in TBI survivors the distribution also involves the cerebellum which is not typically involved in Alzheimer’s. The study also concluded that in TBI patients the amyloid burden appears to increase over time, suggesting a progressive neurodegenerative process following TBI. A study published in Gut suggested that patients with alcohol-induced liver lesions had more Bifidobacteria and Streptococci and less Atopobium than patients with no liver problems. Accordingly, differences between alcoholics who develop severe liver damage and those who do not might be partly due to differences in their gut microbes. An updated analysis of the NAPOLI-1 trial confirmed the survival benefit of liposomal irinotecan in combination with fluorouracil and leucovorin in patients metastatic pancreatic cancer. A study published in JAMA Pediatrics indicated that teens diagnosed with depression are not getting the appropriate follow-up care that they need. An article published in the Annals of Internal Medicine concluded that 51 percent of the people who suffer from Sudden Cardiac Arrest experience warning symptoms within four weeks before the attack. Eighty percent of patients experienced symptoms at least one hour before SCA, and 34 percent had symptoms more than 24 hours before SCA. Chest pain and dyspnea were the most common symptoms. A study published in the American Heart Journal concluded that use of morphine increased the risk of death in acute coronary syndromes., Patient Safety Index - January 2016
- - PATIENT SAFETY INDEX DECEMBER 2015 - Here are noteworthy healthcare issues that have appeared in the news and medical journals throughout the last 30 days or so:
An article appearing in Pediatric Infectious Diseases concluded that it is reasonable to allow children treated with amoxicillin by 5:00 pm to attend school the next morning after diagnosed with streptococcal pharyngitis.Heretofore, a 24 hour wait-time following antibiotic treatment was the standard protocol.
New guidelines for the pharmacologic treatment of rheumatoid arthritis have been issued by the American College of Rheumatology which update and expand recommendations published in 2012.
The American Heart Association published updated guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
The US Preventive Services Task Force issued new recommendations for diabetes screening. Previously, the USPSTF recommended screening for diabetes in adults with hypertension, but now screening is recommended as part of a patient’s cardiovascular risk assessment in patients between 40 and 70 years old who have a body mass index (BMI) ≥25 kg/m.
A study published in the British Journal of Sport Medicine concluded that eccentric training is more effective than standard physical therapy for treating hamstring muscle and tendon injuries and that platelet-rich plasma injections had no therapeutic impact on acute hamstring injuries.
A study published in JAMA showed a reduction in blood pressure in patients suffering from sleep apnea who utilized mandibular advancement devices. The measurable benefit was the same that was found in patients utilizing continuous positive airway pressure devices.
In a study published in the Journal of Clinical Oncology, patients previously treated with conventional chemotherapy enjoyed significantly longer median progression-free survival (4.2 versus 1.5 months), when treated with Trabectedin or Dacarbazine for metastatic liposarcoma or leiomyosarcoma.
Nivolumab was approved by the FDA for treatment of advanced renal cell carcinoma.
A study published in Gastroenterology demonstrated that the risk of progression of acute pancreatitis to chronic pancreatitis is greater in smokers, alcoholics and men.
A study published in JAMA revealed that self-harm emergencies increase in patients after undergoing bariatric surgery.
An article published in the Lancet suggested that “tight control” (review every 4 weeks combined with escalation of treatment if minimal disease activity criteria not met) improves outcomes in newly diagnosed patients with psoriatic arthritis disease.
A study published in the British Journal of Sports Medicine demonstrated that wearing cleats that increase the shoe-surface traction in football players doubles the risk of lower extremity injuries.
A study published in the American Journal of Sports Medicine suggested that taking supplements to maintain levels of serum 25-hydroxyvitamin D levels might help avoid lower extremity fractures in distance runners and military personnel.
An article published in JAMA concluded that patients in the United Sates undergoing myocardial perfusion imaging to diagnose and manage coronary artery disease are exposed to higher risks from radiation, due to the failure of laboratories to adhere to radiation dose best practices.
According to a retrospective cohort study published online in JAMA Internal Medicine, two thirds of women receiving medication for osteoporosis did not actually need this treatment.
A study published in the January 2016 issue of Retina concluded that communications between ophthalmologists and primary care physicians increased adherence to published diabetic eye examination recommendations of the American Academy of Ophthalmology. Diabetic retinopathy affects an estimated 28.5% of patients who are over 40 years even though early detection can reduce the risk of the disease.
Failures in medical device safety resulted in a proposal by the FDA to begin notifying members of the public about emerging signals of a possible device risk at a point in time before a determination is made that a risk actually exists.
, PATIENT SAFETY INDEX
- -PATIENT SAFETY INDEX OCTOBER 2015- Here are noteworthy healthcare issues that have appeared in the news and medical journals throughout the last 30 days or so:
Issac Itzkoff, of the New York Times, reported that comedian Robin Williams was battling Lewy body dementia at the time of his suicide. Lewy body dementia causes an Alzheimer’s-like slippage in memory and thinking as well as stiffness and movement problems such as the kind seen in Parkinson’s disease. It can also cause hallucinations which often involve seeing animals, children or miniature people. The condition results in steady decline, an average of 10% or more a year and there is no cure.
A study appearing in the American Journal of Psychiatry demonstrated that schizophrenia may be caused by inflammation in the brain which can be discovered through PET scans which measure the levels of activity of immune cells in the brain. The authors suggest that the next step is to determine whether anti-inflammatory treatment in patients who are predisposed to the disease can prevent the disorder.
An article published in Trends in Pharmacological Sciences surveyed advances in “exercise pills” which seek to mimic the effects produced by physical exercise.
An article published in Science discussed the development of artificial skin that acts as a mechanoreceptor in conjunction with an organic transistor circuit that can simulate the sensation of touch. The hope is that this technology will aid in the design of large area organic electronic skin with neural integrated touch feedback for replacement limbs.
A study published in the Journal of Antimicrobial Chemotherapy demonstrated that washing hands with antibiotic soap proved no more effective than regular soap at killing bacteria.
A study published in the Lancet discussed the development of (PrEP) that contains tenofovir-emtricitabine and acts as a prophylactic against the development of HIV.
An article appearing in JAMA discussed a new drug, marketed under the name Nuedexta, containing dextromethorphan hydrobromide and quinidine sulfate, which has been proven effective in quelling agitation and aggression in patients with Alzheimer’s disease.
A study published by the American Academy of Pediatrics found that injuries from airsoft and paintball guns can sometimes be severe. 83% of the injuries were related to the eye and 10% of children injured by these kinds of devices sustained injuries that resulted in lasting functional deficits.
Researchers at the University of Liverpool reported that treatment with a metabolic hormone called GLP-1 helped obese people lose weight.
Sanofi US is voluntarily recalling all Auvi-Q epinephrine injectors because of inaccurate dosage deliveries.
Idarucizumab (Praxbind) was approved as a reversal agent for the thrombin inhibitor dabigatran by the FDA for patients requiring emergency surgery.
The American Heart Association recommended the same hand positioning that is normally used for chest compressions in pregnant women during resuscitation after cardiac arrest. Previous guidelines suggested a more cephalad hand position in pregnancy to adjust for elevation of the diaphragm by the gravid uterus.
An article published in JAMA demonstrated that pediatric trauma patients treated at pediatric trauma centers have a much lower mortality rate than pediatric trauma patients treated in other hospitals. Children treated in adult or mixed trauma centers had an estimated 57 and 45 percent increased risk of dying.
The American Cancer Society has developed new revised recommendations for breast cancer screening. The ACS now recommends that screening begin at age 45, that women aged 45 to 54 years be screened annually and that women age 55 years and older be screened biennially if they have a life expectancy of at least 10 years. The guidelines indicate that a clinical breast examination is not necessary.
An article published in the Lancet showed that chlorhexidine-alcohol prior to intravascular catheter insertion provides greater protection against short-term catheter-related infection than povidone iodine-alcohol.
An article appearing in the New England Journal of Medicine showed that there was no difference in outcome when open fracture wounds were irrigated with high, or low pressure. The authors recommended the use of low pressure irrigation because it was less likely to cause additional tissue injury.
The American Heart Association provided new recommendations for the treatment of infective endocarditis.
A study appearing in the Journal of the American Academy of Child and Adolescent Psychiatry concluded that children treated with stimulants did not have an increased risk of onset or worsening of tics with the use of psychostimulant treatment.
An article appearing in JAMA concluded that children spending 40 minutes a day engaging in outdoor activity suffered from less myopia than those who did not.
, Patient Safety Index
- -PATIENT SAFETY INDEX SEPTEMBER 2015- Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 30 days or so:
A study published in Pediatrics indicated alcohol abuse is more prevalent in adolescent girls who have less parental supervision.
A study published in the International Journal of Behavioral Nutrition and Physical Activity demonstrated a link between increased screen time and poor grades. Children who spend more than the average 4 hours a day on screen time (TV, computers, internet and games) have poorer academic performance.
An article published in the Lancent Psychiatry concluded that teenagers identifying with the goth subculture are more at risk for depression and self-harm.
Eletroacupuncture was found to be helpful in diminishing hot flashes associated treatment of breast cancer in an article published in the Journal of Clinical Oncology.
The American Journal of Public Health published an article discussing the annual probability of attaining normal weight for obese people. The probability is 1 in 210 for men and 1 in 124 for women who are obese. Meanwhile the probability decreases to 1 in 1290 for men and 1 in 677 for women in people suffering from morbid obesity.
According to a study published in JAMA there is an association between electronic cigarette use and subsequent tobacco smoking.
The Infectious Disease Society of America published clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults.
The Advisory Committee on Immunization Practices released recommendations for the prevention and control of influenza for this year’s flu season. Vaccination was recommended for everyone over 6 months of age. Different influenza A H3N2 and influenza B antigens than were used last year were recommended.
An article published in Pediatrics demonstrated a relationship between antibiotic use and Juvenile Idiopathic Arthritis.
The American College of Physicians issued a position paper regarding the integration of behavioral health care into the practice of internal medicine., Patient Safety Index
- -PATIENT SAFETY INDEX JULY 2015 - Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 30 days or so: A study published in the American Journal of Clinical Nutrition concluded that people who consumed more fruits and vegetables had a 13% lower risk of heart disease. The CDC reported that people with health insurance are up to three times more likely to obtain recommended preventative care. Preventive services are available for nine of the ten leading causes of death in the United States. An article published in Neurology concluded that the risk of stroke in patients diagnosed with endocarditis is longer than previously thought. According to the authors of the study, the risk of stroke usually begins 4 months before a diagnosis of infective endocarditis, peaks in the month after the diagnosis, and then normalizes by 5 months afterward. The FDA issued a safety communication regarding 45 patient deaths and other adverse events related to the use of SentreHEART devices used for left atrial appendage closure. An article published in Osteoporosis International suggested a link between ischemic heart disease and osteoporosis. The authors concluded that bone health should be considered in patients diagnosed with ischemic heart disease. The FDA amended the warnings related to NSAID use and the increased risk of strokes and heart attacks. The American Thoracic Society, European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association published new guidelines for the care of Idiopathic Pulmonary Fibrosis. Updated guidelines for the treatment of Hepatitis C were published in Hepatology by The American Association for the Study of Liver Diseases. An article published in Emerging Infectious Diseases (and approved by the CDC) revealed the continuing and significant expansion of Lyme disease. In counties throughout the United States between 1993 and 1997, there were 69 counties with high incidence of Lyme disease; this number climbed to 130 counties for the period from 1998 to 2002, 197 counties in 2003 to 2007 and 260 counties in 2008 to 2012. The news is bleaker for northeastern states who saw a 320% jump in counties with high incidence, from 43 counties in the first period to 182 in the last survey. The CDC published a report indicating that the United States in in the midst of a heroin epidemic with usage rates climbing from 63% between 2002 and 2013. The biggest increases in use were seen in women and people with higher incomes. Pauline Anderson, of MedScape News, reported on oral presentations at the Alzheimer’s Association International Conference which demonstrated that physical activity reduces cognitive decline and improves neuropsychiatric symptoms in patients with dementia and may reduce Alzheimer’s disease biomarkers. A study appearing in Pediatrics raised the question of whether antibiotic use increased the risk of juvenile arthritis. An article published in PLOS Medicine disclosed that Glitazones taken by patients for Type 2 Diabetes (including Avandia and Actos) might have the unintended but beneficial effect of decreasing the risk of Parkinson’s disease.
- -PATIENT SAFETY INDEX JUNE 2015- Here are patient safety issues that have appeared in the news and medical journals throughout the last 30 days or so: An article published in the June 16, 2015 edition of JAMA concluded that antibiotic treatment of patients with uncomplicated appendicitis may be as effective as an appendectomy. A study published online on PLOS One on June 10, 2015 concluded that proton pump inhibitor usage increases the risk of heart attacks. U.S. News & World Report published its annual list of Best Children’s Hospitals. Nationwide top finishers in their respective categories included: Cancer - Dana-Farber Boston Children's Cancer and Blood Disorders Center; Cardiology & Heart Surgery - Boston Children's Hospital; Diabetes & Endocrinology - Boston Children's Hospital; Gastroenterology & GI Surgery - Boston Children's Hospital; Neonatology - Children's Hospital of Philadelphia; Nephrology - Boston Children's Hospital; Neurology and Neurosurgery - Boston Children's Hospital; Orthopedics - Children's Hospital of Philadelphia; Pulmonology - Cincinnati Children's Hospital Medical Center; Urology - Boston Children's Hospital. Top finishers in proximity to New Jersey include: Cancer - Children's Hospital of Philadelphia (3); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (17); Memorial Sloan-Kettering Cancer Center (21); Children's Hospital of Pittsburgh of UPMC (22); Penn State Hershey Children's Hospital (24); and Children's Hospital at Montefiore (48). Cardiology & Heart Surgery - Children's Hospital of Philadelphia (4); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (9); Children's Hospital of Pittsburgh of UPMC (10); Penn State Hershey Children's Hospital (37); Children's Hospital at Montefiore (40). Diabetes & Endocrinology - Children's Hospital of Philadelphia (2); Children's Hospital of Pittsburgh of UPMC (3); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (11); Winthrop-University Hospital Children's Medical Center (34); Mount Sinai Kravis Children's Hospital (36). Gastroenterology & GI Surgery - Children's Hospital of Pittsburgh of UPMC (2); Children's Hospital of Philadelphia (3); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (12); Mount Sinai Kravis Children's Hospital (25); Penn State Hershey Children's Hospital (33); Children's Hospital at Montefiore (38); St. Christopher's Hospital for Children (44). Neonatology - Children's Hospital of Philadelphia (1); Children's Hospital of Pittsburgh of UPMC (10); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (18). Nephrology - Children's Hospital of Philadelphia (6); Children's Hospital of Pittsburgh of UPMC (15); Mount Sinai Kravis Children's Hospital (19); Children's Hospital at Montefiore (24); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (31); Penn State Hershey Children's Hospital (43); St. Christopher's Hospital for Children (49). Neurology and Neurosurgery - Children's Hospital of Philadelphia (3); Children's Hospital of Pittsburgh of UPMC (10); Mount Sinai Kravis Children's Hospital (25); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (27); Children's Hospital at Montefiore (37); Penn State Hershey Children's Hospital (44). Orthopedics - Children's Hospital of Philadelphia (1); Penn State Hershey Children's Hospital (27); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (38); Children's Hospital of Pittsburgh of UPMC (44); Children's Hospital at Montefiore (46). Pulmonology - Children's Hospital of Philadelphia (3); Children's Hospital of Pittsburgh of UPMC (6); Mount Sinai Kravis Children's Hospital (18); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (24); Penn State Hershey Children's Hospital (30). Urology - Children's Hospital of Philadelphia (2); Penn State Hershey Children's Hospital (15); Children's Hospital of Pittsburgh of UPMC (16); New York-Presbyterian Morgan Stanley-Komansky Children's Hospital (32); Mount Sinai Kravis Children's Hospital (34). An article published on Pediatrics suggested that anesthesia in children under 4 years old may result in decreased listening comprehension and performance IQ. There were questions about proof of causation related to the article, however. The results of a study published in the American Journal of Medicine revealed that when patients were offered an opportunity to obtain a second opinion free of charge, it resulted in a change in diagnosis 14.8% of the time, a change in treatment 37.4% of the time, or changes to both 10.6% of the time. Moreover, the changes in diagnoses resulting from second opinions sought were estimated to have a moderate/major impact in 20.9% of cases and the changes that resulted in different treatment were deemed to have a moderate/major impact 30.7% of the cases. An article published in Drug and Alcohol Dependence revealed that unauthorized use of prescription stimulants by teens peaks between 16 and 19 years, when an estimated 0.7% to 0.8% teens in this age group report using these medicines for the first time in the past twelve months. An article published in the British Medical Journal concluded that teens between 13 and 18 years old who were the victim of bullying were approximately twice as likely as teens who were not bullied to experience depression at 18 years of age. An article appearing in the Annals of Internal Medicine indicated that Borrelia miyamotoi disease -- a tick-borne infection – that can cause more severe symptoms than Lyme disease, is becoming more common and should be considered in all areas where deer tick–transmitted infections are endemic, particularly in the northeastern United States. Symptoms of Borrelia miyamotoi disease include fever, myalgia, influenza-like illness, headache, or rash. An article published in JAMA revealed that 75% of men and 66% of women in the United States were either overweight or obese between 2007 and 2012. This is represents an increase in overweight and obesity rates in the United States in surveys conducted in 1988 and 1994. A study published in JAMA indicated that men using erectile dysfunction drugs had a statistically significant increase in risk for malignant melanoma. , Patient Safety Index