Pratica Medica & Aspetti Legali
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Dermatologia in ambito lavorativo
Get PDFThe main skin diseases in an occupational context are irritant and allergic contact dermatitis. These conditions are a very common cause of ill-health related to occupation. Despite a decrease of notifications to INAIL for occupational skin diseases in recent years, their burden is still high, so dermatologist may often be called for a consultation, giving his opinion about indemnity of the worker. This paper gives an overview of legal aspects concerning occupational dermatitis
La centralità della volontà del paziente incapace in una recente sentenza della Corte di Cassazione
Get PDFA recent judgement by the Court of Cassation about a request – by the legal guardian of an incompetent patient in permanent vegetative state – of suspension of artificial nutrition and hydration, gives important instructions about informed consent, right of self-determination, and right to refuse treatment in competent and incompetent patients, with particular regard to the role of legal guardian and to the validity of advance care directives
Dermatologia e invalidità
Get PDFPsoriasis is a skin disease, characterized by the presence of sharply demarcated plaques, typically appears as raised areas of inflamed skin covered with silvery white scaly skin. Its overall prevalence is approximately 2-3%. Although the etiology of psoriasis is not known, genetic, enviromental and immunologic factors appear to influence the susceptibility of the disease. Psoriasis can involve an invalidating state in its more serious shapes, like artropatic, amicrobic pustular and erythrodermic psoriasis. The authors propose a medical-legal classification of the disease, finalized to define of its invalidating degree and a connected practical case to the problem list, often underestimated
Errori medici legati alla prescrizione di farmaci
Get PDFErrors that occur during the medical practice are often preventable. Beyond the risk for the patients, medical errors can mine the relationship of trust between patients and doctors. About 80% of office consultation end with a drug prescription. The risk of error during this procedure is high in general practice setting. We describe a case of a drug prescription error: the case report underlines the role of the whole systems, its processes and conditions, in the medical error. We require a change in medical culture, that should involve teams as well as organizations: the aim is identify and learn from errors, developing tools to prevent medical errors and improve patients safety, without a punitive approach
Profili bioetici dell’utilizzo del placebo in medicina
Get PDFPlacebo is defined as an inert substance or inactive treatment. It is usually used in clinical trials as a control and its effect is so significant that the “gold standard” of research design is the double-blind, placebo-controlled study. The question thus arises whether placebos should be used therapeutically. In the proposed case, the deceptive use of placebo on a teenager in USA allowed his mother to bring to court a doctor and three nurses for malpractice. This paper, from the bioethics point of view, discusses the clinical and ethical perspectives of the placebo use in clinical practice
Consenso informato: dal buio alla luce. Andata e… pericoloso ritorno?
Get PDFOver the last years, the principle of informed consent has gained considerable importance in the doctrinal elaboration and approaches, as well as juridical interpretations, thereby influencing the everyday activities of the medical profession. It tends to reflect the concept of autonomy and decisional auto determination of the person requiring medical or surgical interventions. The correct informed consent requires that the healthcare provider gives the patient all the information necessary for a knowledgeable decision on the proposed procedure. In order for the patient to be presented with sufficient information to make an informed decision, several elements are necessary, regarding diagnosis, purpose of proposed treatment, possible risks and benefits of proposed treatment, possible alternatives to proposed treatment and possible risks of not receiving treatment. Informed consent is still the object of continuous explorations. In this article, the Author analyses the doctrine of informed consent in the Italian contest, describing some decisions of the Court that are useful to explore all the aspects of the subject
La Sindrome del Burn-out: responsabilità professionale e profili giuridici
Get PDFThe Author, after a rapid clinic and gnoseologic setting of the BOS (Burn-Out Syndrome), and particularly focusing on the etiologic features and the relational peculiarities, discusses the clinic case of a 36 years-old nurse affected by BOS, analyzing and evaluating its medico-legal aspects, particularly referring it to professional responsibility. Subsequently, some normative important references are proposed as to give a more exhaustive comprehension of the case and of its concerning legal implications. Finally, some useful management and legal general indications are provided to prevent this currently fast growing occupational-related phenomenon
Farmacovigilanza e segnalazione di sospetta reazione avversa (ADR): strumento utile per l’attività del medico e per migliorare la salute del cittadino
Get PDFReporting of suspected Adverse Drug Reactions (ADRs), that is to say an unwanted and negative event associated with the use of a medication, is an important problem that involves health professionals. Reducing and preventing ADRs can contribute in decreasing Hospital costs and improving patients safety. For this reason, it is essential for the physicians to reach a deep knowledge of such reactions, to prevent some of the medication errors connected to drugs prescription. Many cases, from thalidomide to cerivastatin and rofecoxib, are emblematic. Not only the pre-marketing, but also the post-marketing stage, can help to discover important previously unavailable data about major adverse events
Il pericolo ancora sottovalutato delle interazioni tra farmaci. Un caso clinico esemplificativo
Get PDFTreatment of hypercholesterolemia has been shown to reduce mortality in patients with coronary artery disease. Patients with severe lipid abnormalities may require high-dose statin therapy, at times used in combination with additional agents. The occurrence of rhabdomyolysis is one of the rare side-effects of the cholesterol-lowering agents. During the use of simvastatin, the risk of this side-effect might be increased when macrolides are used concomitantly. The interacting mechanism likely was inhibited cytochrome P450 (CYP) 3A4 metabolism and possibly P-glycoprotein transport of simvastatin as well. We present a patient who developed rhabdomyolysis during the concomitant use of simvastatin and erythromycin. Coprescribing of medications not compatible with statins occurs frequently: to prevent future events, it is crucial that clinicians recognize the interaction risk associated with coprescribing, to assure that the risk of untoward effects is mitigated