Litigation in Cardiovascular Surgery: Risk Management Considerations in the Italian Context

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Hello,

Thanks for submitting this important review article on an often under published aspect in CardioThoracic surgery titled "Litigation in cardiovascular surgery: risk management considerations" to this journal. It is an important article worthy of publication however i feel lot of it is undermined by linguistic issues with lost in translation issue. 

1. Please review the draft with Native English speaking language expert as these are spelling mistakes , inappropriate use of hyphen and incorrect figure of speech usage in the draft.E.g. com-plaint, organis-ational as used in abstract are just some of the examples.

2. The draft is primarily around the standard practices in Italy, however in certain parts of the world the medical negligence is not only sued for consumer litigations but is also for Criminal negligence amounting to criminal proceedings. These aspects of global considerations also need to be addressed in the draft in view of global reach of the journal.

3.Use of audio-visual tools and novel documentation technologies in real time apart from classical paper based consenting and documentation can also be highlighted appropriately in the manuscript.

Thanks

Comments on the Quality of English Language

Hello,

 

1. Please review the draft with Native English speaking language expert as these are spelling mistakes , inappropriate use of hyphen and incorrect figure of speech usage in the draft.E.g. com-plaint, organis-ational as used in abstract are just some of the examples.

 

Author Response

We would like to thank the Editors and Reviewers for the comments and suggestions which gave us the opportunity to make the manuscript more consistent and clearer.

Considering the extensive English revision, the manuscript changes tracked with Word track processor are difficult to read. Then we provide a clear version highlighting in green the main changes addressed.

point-by-point response:

Thanks for submitting this important review article on an often under published aspect in CardioThoracic surgery titled "Litigation in cardiovascular surgery: risk management considerations" to this journal. It is an important article worthy of publication however i feel lot of it is undermined by linguistic issues with lost in translation issue.

Many thanks. An extensive revision of the language was carried out.

1. Please review the draft with Native English speaking language expert as these are spelling mistakes , inappropriate use of hyphen and incorrect figure of speech usage in the draft. E.g. com-plaint, organis-ational as used in abstract are just some of the examples.

An extensive revision of the language was carried out. Some typos were related to layout format and were then revised.

2. The draft is primarily around the standard practices in Italy, however in certain parts of the world the medical negligence is not only sued for consumer litigations but is also for Criminal negligence amounting to criminal proceedings. These aspects of global considerations also need to be addressed in the draft in view of global reach of the journal.

Many thanks. Considering also other reviewers' suggestions, we have revised the text (in the introduction and discussion) to better explain criminal and tort law issue for malpractice. Those are highlighted in green.

3.Use of audio-visual tools and novel documentation technologies in real time apart from classical paper based consenting and documentation can also be highlighted appropriately in the manuscript.

Many thanks. We take the opportunity to integrate the text in the discussion section regarding informative issues. Those are highlighted in green.

Sincerely,

vittorio bolcato

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors of the work surgeries-3272215, I would like to make some constructive observations about your work.

 

Lines 2-3 Title of the work, I suggest including that the study focuses on Italy

Line 68 the objective of the work is written in the past tense

Lines 68-39 I suggest not including biographical citations in your objective

Lines 77-80 incorrect use of punctuation marks. When using two ellipses (:), it starts a list of things or objects that are separated by commas (,), the end of the list can be with a semicolon (;) or a full stop (.). Please correct the paragraph

Lines 80-81 the same as lines 77-80

Lines 102-104 the statement requires a bibliographic citation

Lines 104-107 the statement requires a bibliographic citation or change the wording as a suggestion

Lines 106-107 incorrect use of punctuation marks. Ellipses (:) are used to describe a list of ideas, objects, etc. Each element of the list is separated by commas (,); to end the list you can use a period (.) or a period or comma (;).

Lines 142-145 please make the bibliographical citations separately, in this case the citation [29]

Lines 186-189 the assertion requires a bibliographical citation

Lines 204-207 the assertion requires a bibliographical citation

Lines 207-209 the assertion requires a bibliographical citation

Lines 210-212 the assertion requires a bibliographical citation or change the wording as a suggestion

Lines 222-226 the assertion requires a bibliographical citation

Lines 261-262 the assertion requires a bibliographical citation

Lines 348-359 please conclude your work forcefully

Line 358 I suggest omitting the word “aimed”.

Author Response

We would like to thank the Editors and Reviewers for the comments and suggestions which gave us the opportunity to make the manuscript more consistent and clearer.

Considering the extensive English revision, the manuscript changes tracked with Word track processor are difficult to read. Then we provide a clear version highlighting in green the main changes addressed.

point-by-point response:

Reviewer 2: Dear authors of the work surgeries-3272215, I would like to make some constructive observations about your work.

Many thanks

Lines 2-3 Title of the work, I suggest including that the study focuses on Italy

We have modified the text adding “in the Italian context”

Line 68 the objective of the work is written in the past tense

We have revised the text in present tense.

Lines 68-69 I suggest not including bibliographical citations in your objective

Thank you, it was a mistake. We have revised.

Lines 77-80 incorrect use of punctuation marks. When using two ellipses (:), it starts a list of things or objects that are separated by commas (,), the end of the list can be with a semicolon (;) or a full stop (.). Please correct the paragraph

Lines 80-81 the same as lines 77-80

We have modified the text accordingly.

Lines 102-104 the statement requires a bibliographic citation

Lines 104-107 the statement requires a bibliographic citation or change the wording as a suggestion

Lines 106-107 incorrect use of punctuation marks. Ellipses (:) are used to describe a list of ideas, objects, etc. Each element of the list is separated by commas (,); to end the list you can use a period (.) or a period or comma (;).

We have modified the text accordingly and are highlighted in green.

Lines 142-145 please make the bibliographical citations separately, in this case the citation [29]

Lines 186-189 the assertion requires a bibliographical citation

Lines 204-207 the assertion requires a bibliographical citation

Lines 207-209 the assertion requires a bibliographical citation

Lines 210-212 the assertion requires a bibliographical citation or change the wording as a suggestion

Lines 222-226 the assertion requires a bibliographical citation

Lines 261-262 the assertion requires a bibliographical citation

We have referenced the paragraphs mentioned. New references are highlighted in green.

Lines 348-359 please conclude your work forcefully

We have revised the text to be more concise and focused, together with English editing.

Line 358 I suggest omitting the word “aimed”.

We have revised the text accordingly.

sincerely

vittorio bolcato

Reviewer 3 Report

Comments and Suggestions for Authors

This is an important topic and not frequently discussed in Journals. 

It would be good to concisely start with the New Italian information that seems to have prompted this review. 

I would include a table to summarize the key factors effecting malpractice risk. 

I would work to making the wording more concise and brief.

Regards your considerations regarding legal risk which include patient education, quality surgeon and facility standards, I would more clearly emphasize the importance of discussion of risk with patient and family. and most importantly how one communicates with the family and the patient post a complication. This is often difficult for the physician who is uncomfortable but an honest patient and family discussion describing what happened and ideally able to be referred back to the pre surgical discussion as a possible complication. This post discussion is critically important to demonstrate your concern and reiterate that the procedure was performed correctly. I would believe this is most important to discuss in the manuscript. 

I appreciate the opportunity to review your material.

Comments on the Quality of English Language

Far too wordy. Most be shortened.

Author Response

We would like to thank the Editors and Reviewers for the comments and suggestions which gave us the opportunity to make the manuscript more consistent and clearer.

Considering the extensive English revision, the manuscript changes tracked with Word track processor are difficult to read. Then we provide a clear version highlighting in green the main changes addressed.

point-by-point response:

Reviewer 3: This is an important topic and not frequently discussed in Journals.

Many thanks

It would be good to concisely start with the New Italian information that seems to have prompted this review.

Considering also other reviewers’ suggestions, we have integrated the introduction and revised the section on responsibilities. Changes are highlighted in green.

I would include a table to summarize the key factors effecting malpractice risk.

Many thanks for the suggestions, we have provided a summary table with the key strategies,  highlighted in green.

 

I would work to making the wording more concise and brief.

We have extensively revised the text accordingly together with English editing..

Regards your considerations regarding legal risk which include patient education, quality surgeon and facility standards, I would more clearly emphasize the importance of discussion of risk with patient and family. and most importantly how one communicates with the family and the patient post a complication. This is often difficult for the physician who is uncomfortable but an honest patient and family discussion describing what happened and ideally able to be referred back to the pre surgical discussion as a possible complication. This post discussion is critically important to demonstrate your concern and reiterate that the procedure was performed correctly. I would believe this is most important to discuss in the manuscript.

Many thanks. We agree on the centrality of communication issue, so we have integrated the specific section in the discussion, with further references. Some considerations were taken comparing with a literature on communication gaps and issues for malpractice in radiology field. Changes are highlighted in green.

I appreciate the opportunity to review your material.

Many thanks.

Far too wordy. Must be shortened.

We have extensively revised the text accordingly, also through overall language revision.

Sincerely,

vittorio bolcato