Pratica Medica & Aspetti Legali
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Stalker: una teoria psicodinamica
Full text linkStalking is a common social problem, that can cause psychological and social damage in its victims. It can be defined as a pattern of repeated, unwanted attention, harassment, and contact. This behaviour is often driven by psychiatric disorder, therefore it is important that mental health professional can have the instruments to assess and manage it properly. Starting from the data observed during the personal experience of the Author, this article outlines a structured profile of the stalker’s personality and its complexity. Psychopathological characteristics, psychosocial history and mental dynamics of the stalker are described. The aim is to provide information about factors contributing to stalking, as well as diagnostic issues that should be considered in the assessment and treatment of these patients
La gestione del malato mentale negli ambulatori medico-legali
No full text[The management of the psychiatric patient in the medical-legal ambulatories]In this article the Authors analyse the main personality disorders, following Bergeret and Kernberg classifications and basing on Freud’s theory: people with neurotic structure have defense mechanisms and inner conflicts different from those of persons with borderline or with psychotic structure. Healthcare professionals must be aware of the behaviour of psychiatric patients who may arrive in the medical-legal ambulatory. The second section of the present article is about the two kinds of social security in Italy: the one for everybody, and the one for workers only. In the social security for everybody a percentage of disability is attributed to each psychiatric patient following specific tables: depending on these percentage, the patient is entitled to the allocation of a pension. The second one follows the rules established by INAIL and INPS, and depends on the reduced or cancelled ability to work
La sala operatoria. Rischio clinico e priorità di interventi
Full text linkIn recent years the problem of adverse events in medicine, and subsequent legal claims, has been examined deeply, both in the medical literature and in the general press. Error is implicit in clinical practice, and is mostly common in surgery. This is due to the high prevalence of new and complex technologies in this field of medicine, and to the high expertise required to perform surgical operations. Some methodological procedures may be useful in avoiding such errors. The article examines the analyses and activities that should be performed routinely in the surgical environment to prevent errors and enhance patients’ safety, providing a comparison between the Italian situation and the situation of the Anglo-Saxon Countries
Aspetti del principio di costituzionalità in ambito sanitario regionale e direttive AIFA
Full text linkItalian Constitution stipulates citizens’ social rights and underlines the need of equity and efficiency in the provision of health care services. In recent years a trend towards federalism is emerging, leading to the risk of differences in patients’ treatment among Italian Regions. AIFA’s role (Agenzia Italiana del Farmaco) is to regulate and coordinate drugs prescription in order to avoid not only inequality in patients’ care, but also inadequate consumption of economic resources. The article examines the so called LEA (Livelli Essenziali di Assistenza), that are basic health parameters established to assure equity also at a regional level
Amenorrea primaria in una adolescente con iperprolattinemia: mancato riconoscimento di una sindrome di Turner
Full text linkWe report a case of a 14-year-old girl with primary amenorrhoea and hyperprolactinaemia. One year treatment with cabergoline – a dopamine agonist – caused a significant reduction in serum prolactin (PRL) concentration without a normalisation of menstrual cycle. After our examination, Turner’s syndrome (45X0/46XY mosaicism) was diagnosed. Turner’s syndrome (TS) is characterised by short stature, streak gonads, infertility, and hearth and kidney malformations. The presence of Y chromosome fragments in patients with TS is known to increase the risk of gonadoblastoma. The patient underwent prophylactic gonadectomy and received substitutive estrogenic therapy
La legge sull’interruzione volontaria di gravidanza e l’aborto tardivo
Full text linkLaw 194/78 regulates the practice of voluntary abortion in Italy. This law identifies two different kinds of abortive procedures: the first one, the therapeutic abortion sensu strictu, can be performed only if the woman’s life is at serious risk. The second one, the indirect eugenic abortion, is allowed only if the foetus has “relevant anomalies or malformations”, and it is aimed at preserving the physical and mental health of the mother. On this point the law is not clear, therefore leading to possible misunderstanding, and subsequent risks for the mother and the physicians. The article provides an overview of the law, explaining its meaning, and underlining its limits and possible interpretative errors
Ruolo e finalità della bioetica nella moderna medicina intensiva: il Gruppo di Studio di Bioetica della SIAARTI
No full text[Role and purposes of bioethics in the modern Intensive Medicine: the Bioethics Study Group SIAARTI]The Bioethics Study Group SIAARTI was officially set up in 1999. It was established to meet a need due to the changes in Intensive Medicine caused by the continuous pharmacologic and biotechnologic development in recent years. In fact a problem was posed: to balance the new intervention possibilities and the juridical and moral responsibilities raised by their management. The main purpose of BSG consists in proposing itself as mediator of a cultural process (1) defining and understanding the moral questions raised by the changes that the whole Intensive Medicine has caused about the birth, the care and the death of human beings; (2) offering to intensivists operative tools – recommendations – to solve, in clinical practice the complicated themes above mentioned. The present article runs through the moral reflection led by BSG SIAARTI in the last years, and explains the contents of these operative tools through the definition of the theoretic setting that produced them
La torsione del funicolo spermatico: criticità cliniche e medico-legali
No full text[Torsion of the spermatic cord: clinical and medicolegal critical states]Although an exhaustive statistics is not available nowadays, the torsion of the spermatic cord is a common cause of medical-legal contentious. This is due to the diversified symptoms, to the difficult differential diagnosis (e.g.: epididymitis/acute orchiepididymitis, torsion of testicular appendixes or of epididymis, strangulated hernia, hematocele, hydrocele, testicular neoplasia, symptomatic spermatocele and idiopathic scrotal oedema) and to the importance of a sudden therapeutic intervention (within few hours): in fact a late intervention leads to testicular necrosis and subsequently to orchiectomy. The article shows also the different classifications of medical errors used to establish the possible fault and indemnity for the physician to pay
Responsabilità medica in caso di prescrizione di farmaco potenzialmente dannoso in mancanza di consenso informato della paziente
Full text linkThe “informed consent” can be defined as the consent by a patient to a surgical or medical procedure after achieving an understanding of the relevant medical facts and the risks involved. This means that the physicians must inform the patient in a complete, correct, and adequate way. The informed consent is absolutely essential when possible teratogenic effects of a drug are concerned. We describe a case of a patient whom has been prescribed clomiphene to induce ovulation. The woman eventually got pregnant, but the newborn resulted affected by severe malformations. The physicians who prescribed the drug were accused of malpractice, because they did not correctly informed the woman about teratogenic risks associated with the drug. These risks are in fact well known: available data from clinical studies suggest that clomiphene treatment, especially after several cycles, might be associated with a slightly higher risk of neural tube defects and severe hypospadias in the offspring