1,720,978 research outputs found
Children's health and safety: what we learned from the COVID-19 pandemic and future policy's perspective
Full text linkThe wellbeing of minors and older adults has always been a public health target. The health and wellbeing of children, enshrined in the Convention on the Rights of the Child (CRC) in 1989, refer to multiple physical, psychological, social, and economic aspects. The main factors reventing these rights from being secured are poverty, social isolation, and persistent discrimination.
It is well-known that the health system assumes primary importance in investigating and ensuring the wellbeing of little patients. (...
Little patients, large risks: An overview on patient safety management in pediatrics settings
Full text linkPatient safety is an emerging healthcare discipline with the ultimate goal to reduce errors and harm to patients by implementing quality health services. In 1999, the well-known “To Err is Human: Building a safer health system” reported that between 2% and 4% of people die annually in United States hospitals for medical errors. Since that publication, the focus on healthcare safety has encouraged efforts by legislators, hospital government, and health professionals to promote policies and behaviors heavily to reduce errors and implement a safe provision of healthcare delivery. In 2019, the World Health Organization (WHO) declared September 17th as Patient Safety Day, confirming that as a global priority.
The increasing interest in patient safety has significant repercussions on scientific publications with an ever-increasing production of studies in the growing interdisciplinary field of public health. New concepts and new terms had born, such as “clinical risk,” which refers to the probability that a patient can be the victim of an adverse event due to medical care, although unintentionally.
The WHO proposed to adopt a “universal vocabulary” thus standardizing the terminology and allowing effective scientific research. In clinical risk, the most explored field is adult patient safety, where growing interest is shown primarily to prevent nosocomial infections, falls, and pressure injuries. Instead, a little-explored area concerns the pediatric population.
This article aims to overview the spread of pediatric clinical risk management and organizational culture for healthcare quality improvement, looking at what has been done and enhancing healthcare practices to implement inpatient safety. The authors have reviewed the main concerns on pediatric patient safety and issued the main medico-legal aspects. After summarizing the relevant literature, the authors addressed their point of view by writing an opinion article
A singular case of complex suicide by hanging with hesitation marks by axe
No full textWe present a case of complex suicide concerning a 55-year-old man who hanged himself using a rope anchored to a beam on the terrace of his apartment. Multiple parallel linear wounds were observed on his head. At the crime scene, an axe stained with blood and hair was found resting against the wall adjacent to the stairs leading to the upper floor. Forensic investigations identify the cause of death as mechanical asphyxia due to the hanging, in a complex suicide characterized by hesitation marks inflicted on the head with an axe. This specific type of complex suicide has never been described in the literature
Dura mater and survival time determination in individuals who died after traumatic brain injury: a preliminary study
No full textBackground: Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality among young people and is a matter of concern for forensic pathologists. Many authors have tried to estimate a person’s survival time (ST) after TBI using different approaches. Objective: The present study aimed to present an innovative workflow to estimate the ST after TBI by observing the inflammatory reaction of the dura mater (DM). Methods: The authors collected DM samples from 36 cadavers (20 with TBI and 16 with no history or signs of TBI). Each sample was labelled via immunohistochemistry with three different primary antibodies, CD15, CD68, and CD3, yielding 108 slides in total. The slides were digitalized and analysed using QuPath software. Results: The DM is involved in the inflammatory response after TBI. CD15 immunoreactivity allowed us to distinguish between subjects who died immediately after TBI and those with an ST of minutes or hours. CD3 immunoreactivity can be used to differentiate subjects with an ST of days from those with other STs. Moreover, the DM samples showed an acceptable diagnostic yield even in samples with signs of putrefactio
Multidisciplinary analysis of bite marks in a fatal human dog attack: A case report
Full text linkLethal injuries by animal attacks are a matter of concern for the forensic pathologist; the presented case illustrates a two dogs attack on a 61-year-old man. The authors have focused on a multidisciplinary approach involving forensic pathologists and veterinarians. Materials and Methods: The victim was cycling in the countryside when he was attacked by two dogs that came out of a large house. He was found lying in the street by the homeowners who called for help. The victim was transported to the hospital where he died five days later. According to recovery data and medico-legal autopsy findings the cause of death was septic shock. Results: Forensic pathologists and veterinarians multidisciplinary evaluation revealed lacerations, abrasions, and multiple small punctures constituting bite marks over the entire body. Six skin dowels with bite marks were taken and compared with the dental cast of the dogs. Conclusion: A comparison of the dog dental casts and the bite marks on the victim’s body allowed the identifi-cation of the animals involved in the attack
Cadaver clots: a systematic review of the literature
No full textCadaveric blood is ubiquitous, and observed in various forms—liquid, coagulated, and clot-like—during autopsies. Understanding its state in postmortem vessels is essential for both scientific research and forensic investigations. Pulmonary thromboembolism (PT) is a leading cause of sudden death, often requiring medicolegal evaluation. While thrombus formation is primarily explained by Virchow’s triad, the distinction between antemortem, agonal, and postmortem clot (PMC) pathogenesis remains debated. This study aims to systematically review the literature to clarify the morphological and pathological differences among these entities in forensic practice. A systematic review of PubMed, Science Direct, Scopus, and Web of Science was conducted using predefined key terms: “clot,” “thrombus,” “chicken-fat,” “agonal,” “postmortem,” and “autopsy.” Articles were screened for relevance, and 11 studies meeting the inclusion criteria were analyzed. The review highlights a significant gap in comparative studies addressing antemortem versus postmortem clots. The literature lacks a consensus regarding their definitions, macroscopic and microscopic characteristics, pathogenesis, and relevance to determining the cause and timing of death. Existing studies present conflicting interpretations, limiting the reliability of forensic differentiation. The current understanding of antemortem, agonal, and postmortem clots remains incomplete. Our findings underscore the need for further research to establish standardized criteria for distinguishing clot types, which is crucial for forensic pathology and medicolegal evaluations
Off-Label Use of Cardiovascular Drugs in the Home Therapy of Children With Congenital or Acquired Heart Disease
No full textMost medications are not labeled for use in the pediatric population because they have not been formally studied in children. Data on off-label use of cardiovascular (CV) drugs in the home therapy of children with CV disease are scanty. The study included 325 pediatric patients with CV disease and on >= 1 CV medication who underwent >= 1 visit during 2019 at the Pediatric Cardiology outpatient clinic of Giovanni XXIII Pediatric Hospital in Bari, Italy. A total of 287 patients (88.3%) received >= 1 off-label medication, whereas 113 patients (34.7%) received >= 2 off-label medications, and 22 patients (6.7%) >= 3 off-label medications. In CV medications (n = 27) 85% were used off-label in all cases, and 92.5% were used off-label in >= 50% of patients. Adverse events occurred in 8 patients, leading to drug discontinuation in 2 of them. In all 8 cases, medications were used off-label. In multivariate analysis, congenital heart disease patients with single-ventricle physiology (odds ratio 8.4, 95% confidence interval 2.25 to 54.4) and those with heart failure (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) were at higher risk for receiving >= 2 off-label drugs. The off-label use of CV drugs in the home therapy of children with congenital or acquired heart disease is common and adverse events may occur. Patients with congenital heart disease with single-ventricle physiology and those with heart failure have a higher probability to receive >= 2 off-label medications. This study highlights the need for larger safety and efficacy trials in this specific cohort of pediatric patients. (C) 2021 Elsevier Inc. All rights reserved
Establishing the Manner of Death: A 3D Reconstruction of a Case of Hanging
Full text linkEstablishing the manner of death is one of the most challenging tasks for forensic pathologists. We present the case of a 24-year-old woman found dead in the early morning on a flyover. The body was sitting on the ground with the back leaning against a wall. The neck was encircled by a white phone charger cable knotted to the staircase’s handrail. The victim had argued with her boyfriend and tried to jump out of his car while coming home from a wedding party the night before. After that, she left home alone with her phone charger in her hand. Due to self-harm behaviors, the first hypothesis was suicide by hanging. However, the ligature crossed immediately beneath the thyroid cartilage and encircled the neck twice horizontally; the two ends of the cable overlapped, forming a cross-over point in the front-right of the neck. Then, the ligature passed obliquely through the nape, gradually disappearing, forming a gap in the mark. The mark was sharply defined, stiff, yellow, and parchment-like. The investigators performed a three-dimensional scene reconstruction using the Trimble X7 Laser Scanner and the PC-Crash Multibody System. Even though the geometry of the ligature mark in the present case raised doubts about the manner of death, the three-dimensional reconstruction confirmed that the hanging was feasible without any external intervention. © 2023 by the authors
Fat Embolism Syndrome in a Patient with Osteogenesis Imperfecta: A Case Report
Full text linkFat embolism syndrome (FES) can be challenging to diagnose by forensic pathologists. For the diagnosis of FES, there is no benchmark test. Postmortem diagnosis requires a full autopsy and specific ancillary examination. However, the high variability in the clinical presentation of FES represents a relevant issue, and there is no consensus on the postmortem assessment. This is the case of a 33-year-old man who died of FES one week after a car accident. He suffered multiple fractures, but was hemodynamically stable and showed no neurological changes. The patient died a few days after hospital discharge. Additionally, he had osteogenesis imperfecta type III, a genetic disorder associated with bone fragility. To the best of our knowledge, no study has assessed whether and how osteogenesis imperfecta contributes to the onset of FES. Despite the heterogeneous manifestations of FES, the present case met many of the proposed clinical and histological diagnostic criteria. Therefore, we briefly review FES diagnostic criteria, show the postmortem diagnostic workup, and discuss the hypothetical link between osteogenesis imperfecta and FE
Destruction of telecommunications hinders access to healthcare: A crime against humanity?
No full textTechnology infrastructures are key to both military and civilian activities and represented one of the first targets destroyed in past wars. Hence, telecommunication network outages are becoming more common in wars. However, telemedicine could be the only way to help treat military and civilian patients with routine and emergent conditions. There is no legal recognition of telemedicine as a (direct) fundamental right, although healthcare has been considered a human right since 1946
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