Pratica Medica & Aspetti Legali
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“Codice psichico” e “Codice giuridico”
No full text["Psychic Code" and "Legal Code"]The paper analyses the similarities between the so-called “Psychic Code” and the “Legal Code”. In this perspective, the first Code – from which the second is derived – is owned and produced by the “Paternal function”, a symbolic and historical dimension which provides the “Law” to the children, giving prohibitions and limits of their mental processes, and conditioning the consequent behaviour. This educational model is internalised by taking the task and the role of “moral conscience” of the individual, psychodynamic organization that will guide the individual action, while providing for the penalty to the violations of the “Internal Rules” (guilt). This particular profile assumed by the “Psychic code” to the very common “Legal code”, a dimension that is organised and operates starting from the rules to which a community has adopted. If the main function of this dimension is law enforcement, and the possible sanction at the time of its transgression, it also assumes an important symbolic meaning. The period defined as “postmodern”, among other phenomena, also saw the disappearance of the “Father”, his symbolic dimension, his authority, his ability to impose rules. If the “Psychic Code” fades and loses credibility, even the “Legal Code” follows the same path, with negative consequences
La gestione del rischio iatrogeno nell’anziano
Full text linkIatrogenic risk in the elderly is the consequence of an incorrect use of drugs. It may be caused by comorbidities, polypharmacy and pharmacokinetic and pharmacodynamic changes. Factors influencing the effect of a drug are closely linked to genetic polymorphism of hepatic enzymes, drug-drug, drug-disease and drug-food interactions, smoke and alcohol. In this article we will try to focus on the possible factors influencing iatrogenic damage; we will also describe some case reports on adverse drug events in the elderly. Finally, we analyze if there are guidelines driving doctors in the appropriate prescription of drugs for a better management of iatrogenic risk. According to the last evidences, a rationale approach to pharmacological management of elderly people consists in individualizing and simplifying treatment, choosing the most appropriate drug, starting from low dosage and gradually increasing it. The best outcome is to obtain the greatest effect by the lowest possible dosage. Reducing the number of drugs, in order to have a better compliance, and considering possible and sometimes dangerous interactions is another reasonable outcome. At the moment there are no guidelines for facing comorbidities; Beers criteria, which define the use of potentially inappropriate drugs in the elderly, together with a multidisciplinary cooperation among doctors, pharmacists and nurses, may be useful tools for a good management of iatrogenic risk in elderly people
Depressione, stile psicotico e bassa autostima nell’ideazione e nei comportamenti suicidari
Full text linkPsychiatric disorders are the most important risk factor for suicidal behaviour. Many studies have shown that the suicide plays a crucial role in the structuring of self-injurious behaviours implemented to psychiatric patients. Numerous researchers reported that depressive symptoms, low self-esteem, and “psychotic style or psychoticism”, are the most important conditions involved in suicidal ideation and suicidal behaviour. In this area a significant aspect of clinical interest is the suicidal ideation. The present study aimed to evaluate the prevalence of suicidal ideation among a sample of psychiatric patients, and in general population. The total sample consisted of 1,130 females (mean age = 34.9; sd = 13.8) and 686 males (mean age = 38.6; sd = 13.5). The study sample included anxiety disorders – AD (n = 493; 27.1%), depressive disorders – DD (n = 768; 42.3%), somatoform disorders – sd (n = 370; 20.4%), and general population – GP (n = 185; 10.2%). All subjects were required to complete the MMPI test, including the MMPI scales for depression (D), schizophrenia (Sc), and Low Self-Esteem (LSE). Two indices were also obtained from the MMPI to measure suicidal ideation: the Threat Suicide (TS) scale, and the response to the item 339 («Most of the time I wish I was dead»: true = 1; false = 0). Each subject of the sample is characterised by a personal clinical profile organised by the absence/presence of the three scales (normal or pathological), together with positivity or negativity of the two indices. The statistical analysis were performed by logistic regression (LR), analysis of variance, Chi-square (χ2), and linear regression (Pearson’s r). Data emerging from this study support the validity of three scales used for assessment of suicidal risk. The results also showed the strong relationship between depression, suicidal ideation, and suicidal behaviour, compared to the other analysed groups, together with less suicidal risk highlighted by the general population
La legislazione italiana sulla fecondazione assistita: tra norme restrittive e interpretazioni giuridiche
Full text linkThe Italian Law 40/2004 regulates assisted reproduction technology; it states that no more than three embryos must be created at any one time; that all the embryos created must be transferred together, and that embryo cryopreservation is forbidden. Six years after its promulgation, the debate over this issue is still heated. On 8 May 2009, the Italian Constitutional Court declared that some parts of the law are unconstitutional. The article highlights the key points of the law and their implications, underlining the importance of coming to an agreement between the parties to the case, with the final aim of protecting both women’s and children’s health
Una metodologia per calcolare indici di rischio quantitativi dalle richieste di risarcimento delle aziende ospedaliere
Full text linkIn the last years, the need of preventing medical injuries associated to clinical practice has pushed towards the implementation of risk management strategies in clinical environments. At the same time, the insurance costs that Health Care Organizations (HCOs) have to pay for the coverage of medical injuries steadily increased. Compensation claims for medical injuries are related both to clinical adverse events and to monetary compensations, so they can be exploited to analyze the HCOs risk areas. To this end we developed a probabilistic method, based on an approach developed in financial risk management, to obtain quantitative risk indexes from medical injuries compensation claims. This method was successfully applied to the analysis of the compensation claims data of the Azienda Ospedaliera of Lodi allowing to better understand the risk structure of the Azienda Ospedaliera and of its departments
Rischi e problematiche medico-legali in epilessia
Full text linkFor patients with epilepsy coping with the reaction of other people can sometimes be the most difficult part of living with the disease. In many Countries social implications of epilepsy have determined the institution of legislative interventions to patient’s rights. Therefore the clinician’s responsibility includes helping patients in knowing their rights and the most important laws that have special relevance for people with epilepsy. This article discusses legislative aspects, referring to the Italian law, concerning epilepsy management. Many areas of the life of a person with epilepsy are considered, such as driving, employment, and recreational pursuits
Eventi avversi a prodotti erboristici e integratori vegetali: un problema emergente
Full text linkIn the last decades herbal medicine is becoming more and more popular worldwide. Due to their natural origin, herbal products are perceived as safe and are generally used as self-medication. On the contrary several adverse reactions are reported after their use: here we describe the hepatotoxicity after consumption of green tea. Toxicity of herbal preparations can arise from their chemical components, from lack of quality, but mostly is related to their incorrect use. A growing problem is represented by pharmacological interaction between herbal components and conventional drugs. The Italian Surveillance System, active in Italy from April 2002, collects spontaneous reports of suspected adverse reactions to natural health products: up to now about 350 reports have been collected. Health care professionals should have a knowledge of herbal products in order to give patients correct information about the efficacy and the safety of these products and discourage self-medication
Grave reazione avversa a trattamento farmacologico antitubercolare
Full text linkDespite intensified global efforts, the number of cases of tuberculosis worldwide is increasing. In patients treated with antimycobacterial agents, major adverse events are generally uncommon. Here we report a case of acute renal failure and immune hemolytic anemia in a patient receiving antitubercular therapy. Rifampicin-related renal toxicity is a well-defined clinical entity, probably with an underestimated incidence. It typically occurs after reintroduction of rifampicin in previously treated patients. Immune hemolytic anemia, liver injury and gastrointestinal symptoms are often associated, and their presence complicates the clinical appearance. If early recognized, renal prognosis is usually favorable. In patients with increased risk, clinical surveillance or alternative treatments may be appropriate
