Pratica Medica & Aspetti Legali
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Aspetti critici delle nanotecnologie nella sperimentazione clinica e ruolo del Comitato di Etica
No full text[Critical aspects of nanotechnologies in clinical trials, and the role of Ethics Committee]There is no doubt that nanotechnologies are wonderful and extraordinary technologies; they are the expression of human ability to manipulate the matter in order to manufacture new tools with higher properties. As enabling technologies, on one side nanotechnologies represent an important mean, but on the other present incertitude, at least in accordance with the current knowledge about them. In the complex relation between risks and benefits, the Ethics Committee (EC) may play a key, if not decisive, role, because it represents the public guarantor of the respect of the rights and the welfare of patients, contributing to improve knowledge about human health participating to clinical trials
La procreazione medicalmente assistita tra diritto e clinica: il ruolo del medico
Full text linkIn Italy, assisted reproduction is regulated by a variety of sources, the most important being Law 40/2004. The paper discusses how the tight legal framework allocates ample discretion to physicians who play a major role in various aspects of assisted reproduction – namely in implementing a gatekeeping role whenever a couple applies for access to assisted reproduction, in choosing the techniques that better suits the couple, and in performing preimplantation embryo testing aiming to select which embryo (or embryos) is suitable for implantation. The paper also highlights the professional, legal and ethical responsibility of physicians that arises whenever a couple seeks treatment for infertility or sterility
Implicazioni medico-legali delle linee guida cliniche
Full text linkClinical guidelines are defined as «systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances». Their aim is to help the physician in making clinical decisions, improving the quality of patient care, and promoting efficient use of economic resources. The paper explores legal, deontological and ethical aspects of guidelines in the Italian context. In Italy, adherence to the guidelines is not considered legally binding for the physician. Anyway guidelines can be used by the Court in medical malpractice litigation. In fact, assuming that clinical guidelines express the reasonable standard of care, they can be considered a tool for assessment of the questionable conduct. To avoid that guidelines might be considered merely as an instrument of defensive medicine, it is essential that clinicians become aware of their importance in improving clinical practice
Caduta accidentale di una paziente sottoposta a riduzione chirurgica di frattura di femore: analisi delle cause profonde
Full text linkIntroduction. Inpatient falls in hospital is a relevant problem. The first essential step is to know the risks to prevent them, through reactive or proactive analysis. In this study we used the Root Causes Analysis (RCA) to analyze an accidental fall of a 79-year-old patient after a surgical intervention for a femoral fracture. The aim of the analysis is to evaluate the effect of this method on sanitary professionals. Material and methods. The study was conducted at the Operative Unity of Orthopaedics and Traumatology, “Beato Matteo Institute”, Vigevano. RCA was realised in the following steps: creation of the team, individuation of the causes, collection and evaluation of the information, identification of the solutions and the proposals of improvement. Results. The RCA showed the following causes: incomplete assessment of the patient, lacking professional skills, lacking of procedures and safety systems, risk factors connected both to the patient and the environment. The improvement proposals were: education and information of professionals, education of patient and caregivers, nursing interventions, environmental strategies and signalling systems. Discussion. RCA is an useful tool for risk management and it allowed to highlight causes and corrective actions of the accidental fall. Furthermore, this case allowed to underline advantages and disadvantages of this method. Advantages were the involvement of different professionals and sharing of objectives of systems improvement; the importance of the introduction of new instruments for risks identification and specific education to use them. Among the disadvantages we can list: difficulties in finding all the informations to correctly analyse the case, perception of too much bureaucracy in the procedure, and fear of a “punitive” use of the information collected
Problemi etici dell’assistenza al neonato ad alto rischio
No full text[Ethical problems in the management of high risk newborn]Recent progress in neonatal care have significantly improved the prognosis and chances of survival of critically ill or extremely preterm neonates and have modified the limits of viability. However, in some circumstances, when the child’s death can only be briefly postponed at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and his/her parents, it may not be appropriate to utilize all the armamentarium of neonatal intensive care. In such circumstances the limitation of intensive treatments (withholding or withdrawing) could represent a more human and reasonable alternative. This article examines and discusses the ethical principles underlying such difficult decisions, the most frequent situations in which these decisions might be considered, the role of parents in the decisional process and what are the opinions and behaviours of neonatologists of numerous European neonatal intensive units
Progetto “Qualità e sicurezza” nel percorso chirurgico
Full text linkIn September 2009, ACOI (the Association of Italian hospital surgeons) started an important project called “Quality and safety in surgery”. The aim of the project was to define goals and standard in surgical practice aimed at improving patients’ safety. The article describes this project, highlights the models and areas of intervention, and suggests roles and functions of the “surgeon of the future”. Finally, the Author underlines the role of the Surgeons’ Association in promoting changes in organisation and mentality, and a safety culture
Il collocamento mirato delle persone con disabilità psichica: i supporti normativi e le strategie di intervento
No full text[Targeted employment of persons with psychic disability: normative supports and interventional strategies]This article describes the instruments and systems which support the introduction of disabled persons, and in particularly those with psychic disease, in the job market. In Italy, these aspects are regulated by the law n. 68/99, and is managed by the public services for the employment organized by the Italian Provinces. The article then specifically describes the projects and plans developed by the Province of Torino
Tipologie di errori diagnostici in radiologia
No full text[Diagnostic errors in radiology]Radiology is one of the medical branches most liable to claims of medical negligence. Radiological errors can be divided into three main categories: perceptual, cognitive and system errors. The etiology of radiological error is multi-factorial. This article describes the types of errors in radiology, with a specific focus on diagnostics mistakes, which are the most common cause of litigation in this field. Every radiologist should understand the causes of error in diagnostic radiology, as well as the elements of negligence that form the basis of malpractice litigation