Pratica Medica & Aspetti Legali
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203 research outputs found
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Le patologie da stress lavoro-correlato: peculiarità della diagnosi clinico-eziologica
No full text[Work-related stress diseases: peculiarities of clinical and aetiological diagnosis]Work-related stress is the adverse reaction people have to excessive pressures or other types of demand placed on them at work. Its prevalence is growing, probably because of changes in the workplace and work organization related to globalization. Its definition, diagnosis and aetiology are difficult to delimitate. The Authors report an analysis, based on data of the Pisa Centre, on possible causes of this disorder. The analysis highlights that most of the cases of work-related stress are related to the presence of adjustment disorders and suggests that in many cases this disorder may represent the first step of other psychiatric disorders related to occupational stress. From a legal point of view, it’s difficult to establish standard and objective criteria in order to classify this disorder as a professional disease
Tecnologia per un sistema più sicuro e meno complesso in chirurgia
No full text[Technology for a safer and less complex system in surgery]The surgical patients’ path in the operating block is characterised by the transition through different rooms and by the management by several workers of the medical staff. The number of required steps may affect the efficiency of the system, and new engineering methods are underway in order to improve the overall management of surgical interventions. The case of the hospital of Forlì is here analysed: the introduction of a technological system, involving a personal digital assistant, is here described, together with the outcomes obtained by means of this tool. Of paramount importance are the results obtained, i.e. the reduction of the unscheduled interventions, the decrease in the overtime work, and the zeroing of the major mistakes
Memorie traumatiche precoci e disturbo post traumatico da stress. Uno studio sperimentale
No full text[Early traumatic memories and Post Traumatic Stress Disorder (PTSD). An experimental study]INTRODUCTION. This paper has analyzed the Post-Traumatic Stress Disorder (PTSD) in order to address clinical and psychopathogenetic aspects of the disorder. An extensive literature supports the presence of a strong link between childhood trauma and dissociative symptoms, indicating this link as the primary or predominant source of PTSD. In addiction, several studies have shown that – exposed to the same traumatic conditions – not all people develop a Post Traumatic Stress Disorder, a problem not addressed by clinical research. METHODS. The study aimed at verifying the existence of a correlation between childhood traumatic memories (sexual, psychological, and emotional abuse, exposure to family violence), and the further development of this anxiety disorder. Moreover, the research wanted to obtain a psychopathology profile of PTSD. Subjects were required to fill the Minnesota Multiphasic Personality Inventory (MMPI), including the PTSD-Keane scale, and some MMPI special scales. RESULTS. This research has verified a statistical relationship (logistic regression) between traumatic childhood events and the development of the Post Traumatic Stress Disorder. In addition, the results obtained from the sample of psychiatric patients indicate a strong disorganization of the personality of patients with PTSD symptomatology. DISCUSSION. The data show that childhood trauma organize a basic vulnerability which increases 10 times the risk to develop this pathology after a traumatic experience
La normativa regionale in materia di fragilità
No full text[Regional laws on frail elderly]Abstract non presente. Si riporta l\u27inizio dell\u27editoriale:In linea generale, le leggi nascono come mediazione tra interessi di gruppi sociali per normare i bisogni e le risposte a tali bisogni, le azioni e i comportamenti, individuali e sociali, e per determinare l’allocamento risorse. Dal punto di vista della struttura, nelle leggi è possibile individuare: i principi e i valori; rimandi alla normativa precedente; la descrizione per cui…; la tesi prevalente che sostanzia la necessità di legiferare; la decisione presa. A queste regole generali si attengono anche le leggi in materia sanitaria.Descriveremo qui brevemente, a partire dalle principali norme nazionali, i decreti che a livello della Regione Piemonte regolamentano la cura e l’assistenza degli anziani
Mediazione in sanità. L’arbitrarietà dell’atto medico di imaging ionizzante, il consenso informato e l’opportunità stragiudiziale del D. Lgs. n. 28/2010
No full text[Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010]Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient’s autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called “event-based” approach. This practice mortifies the patient’s right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny’s health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a “process-based” approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent
Criteri diagnostici e valutazione medico legale in 35 traumi distorsivi di caviglia denunciati nella Sede INAIL di Genova – Sampierdarena
No full text[Diagnostic criteria and medical-legal evaluation of 35 ankle sprain cases reported to INAIL, Genova, Sampierdarena, Italy]Ankle sprain are one of the most common injuries, occuring frequently during working activities. Therefore it represent a frequent motivation for a medical-legal evalutation and consequent request for compensation to the Italian National Insurance Institute for Work (INAIL). This evaluation requires not only an adequate anamnesis, but also specific examinations in order to establish the correct management. Aim of this article is to identify its diagnostical and medical legal criteria. We report 35 cases observed in ambulatorial session and undergone clinical, radiological and ecographical or NMR valuation. 22/35 showed ligaments lesions of different gravity and underwent forensic medicine evaluation. We can conclude that careful clinical examination combined with a correct diagnostic assessment allow a more adequate valuation of permanent damage in ankle sprain
La potestà prognostica del medico di controllo e la qualità nelle cure
No full text[The prognostic responsibility of the "medico di controllo" and the quality of treatment]In Italy the “medico di controllo” is the physician checking diagnosis, prognosis and fitness for the job of an ill worker absent from work, whose disease is certified by the general practitioner. Unfortunately, this control is too often limited to assessing the presence of the worker at home. This article describes in detail the responsibilities of this class of physicians, analysing the actions to be done in the light of case law and INPS policies, such as the possibility for the workers to contest the judgement of the physician, the VMC/REF form to fill, the actions to do in case the worker is away from home, etc
La responsabilità del medico in caso di malattia provocata dall’utilizzo off label dei medicinali
No full text[Physician responsibility in case of disease caused by off label drug use]To be marketed in Italy, every drug requires a previuos marketing authorization (AIC). Furthermore, the summary of product characteristics reports specific indications about the drug authorized usage. However the off label use of drugs, i.e. to prescribe approved medications for other than their intended indications, is allowed in selected cases, and only if the drug is included in the lists of AIFA (the Italian Drugs Agency). In such cases, the physician must inform the patient about risks and possible side effects, and must obtain the petient’s signed informed consent. Here we discuss the clinician’ liability in case of side effects related to off label use. In particular, we report a proceeding in which the physician was considered responsible with fraud or guilt in different levels of jurisdiction
Nursing malpractice: qualche riflessione sul fenomeno
No full text[Nursing malpractice: some considerations on the phenomenon]The phenomenon of medical error is wide known, and many strategies, such as clinical risk management, have been developed in order to stop it. Among these corrective actions, a greater attention has been paid to nursing malpractice, defined as «all adverse events that arise from purely practical nursing, or the participation of registered nurses in collaborative problem-solving». The solution of the problem of nursing malpractice consists in promoting cultural change. We are ready for this challege, by sharing the results with other health care professionals, respecting the competences and the value of all people, catching up the goal “to defeat the error in medicine”. Trust should be part of the solution: it comes to a measurable factor, which consists in collaborating with courage and speaking out