1,720,969 research outputs found
Perspectives on Patient Safety and Medical Malpractice: A Comparison of Medical and Legal Systems in Italy and the United States
No full textOBJECTIVES:
Italy is experiencing a crisis of malpractice litigation with important repercussions on the insurance industry (e.g., lower profits), physicians (e.g., defensive medicine), and the courts (e.g., work backlog, lengthy proceedings). We searched for common ground between legal systems in Italy and the United States and considered the implications for international collaborations in patient safety.
METHODS:
We examined the judicial frameworks of medical malpractice litigation in two countries with different legal foundations: the United States (a public-private system governed by common law) and Italy (a publicly financed healthcare system governed by civil law).
RESULTS:
We found important differences and similarities across the two systems that suggest a high compatibility for future comparisons and collaborations. Although many Italian hospitals maintain risk management programs, the U.S. emphasis on patient safety and quality has not yet been integrated into Italian healthcare systems.
CONCLUSIONS:
Based on our findings, we propose that the Italian system might benefit from assertively adopting some concepts from the U.S. system. In particular, we consider the role of the law and Italian medicolegal experts as key facilitators for the integration of patient safety and risk management units within Italian healthcare facilities
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Regulatory models of adult consent to the use of biological material in research biobanks [Modelli regolatori del consenso del maggiorenne all'uso del materiale biologico in biobanche di ricerca]
No full textLa conservazione di tessuti umani presenta notevoli potenzialità terapeutiche connesse all’enorme quantità di informazioni contenute nei campioni, che possono essere impiegati per moltissimi ed imprevedibili scopi di ricerca.
Il presente articolo esamina gli aspetti etici connessi alla donazione di tessuti umani e la relativa disciplina normativa sia dell’Unione europea sia di alcuni dei suoi Stati (Italia, Spagna, Regno Unito, Francia, Norvegia e Svezia).
Una regolamentazione uniforme in questa materia appare necessaria in quanto la ricerca su materiali biologici può portare a scoperte scientifiche che migliorerebbero la salute di molte persone, incrementando così la produttività e riducendo i costi pubblici del Servizio sanitario in ciascuno Stato membro.
Invece, un tema così delicato non è ancora disciplinato uniformemente all’interno dell’Unione europea. In particolare, la direttiva europea n. 2004/23/EC, da un lato, ribadisce l’importanza dell’informazione ma, dall’altro, non modifica le discipline dei singoli Stati in materia di consenso.
Al riguardo, il panorama normativo europeo si presenta alquanto disomogeneo perché alcuni Stati ammettono un consenso generico ai futuri usi del materiale biologico, mentre altri lo escludono radicalmente. All’interno di questi due modelli regolatori estremi è possibile individuare approcci maggiormente bilanciati, che sono seguiti dalla maggioranza dei Paesi. Ma anche nell’ambito della medesima impostazione di bilanciamento, le specifiche regole in materia di consenso variano notevolmente da uno Stato all’altro. Ciò è tanto più evidente se si considera il caso in cui il medico intende utilizzare i campioni per fini di ricerca diversi da quelli indicati al momento del consenso e non è possibile raggiungere i donatori per informarli.
In mancanza di una riforma europea, una maggiore uniformità regolatoria potrebbe essere raggiunta attraverso l’art. 8 della Convenzione europea sui diritti umani, che garantisce la vita privata dell’individuo dalle intromissioni dell’Autorità pubblica
Incremento del ricorso al taglio cesareo: sintomo di un eccessivo ricorso alla medicina difensiva?
No full textIntroduzione: La giurisprudenza, in materia di responsabilità professionale, ha subito un’evoluzione che l’ha condotta a valutare l’operato del medico in maniera più critica ponendosi sempre più dalla parte del paziente a scapito dell’operato dei sanitari. Questo atteggiamento ha indotto i medici a cercare di tutelarsi ricorrendo alla medicina difensiva, ovvero una medicina la cui condotta non ha il fine di tutelare la salute del paziente bensì il fine di evitare ai sanitari di incorrere in eventuali responsabilità medico legali seguenti alle cure mediche prestate.
Obiettivi: Il presente contributo ha lo scopo di ricercare le cause dell’eccessivo incremento del taglio cesareo (TC) in Italia e se questo risponda a reali necessità cliniche o sia segno del dilagare della medicina difensiva, con particolare riferimento alla casistica giurisprudenziale italiana in materia e alla recente emanazione delle linee guida.
Metodi : Gli autori hanno analizzato: 1) i dati del Ministero della Salute, CeDAP 2009, pubblicati nel 2012; 2) i dati contenuti nel rapporto pubblicato dall’Agenzia di Sanità Pubblica della Regione Lazio nel febbraio 2012; 3) le linee guida per il taglio cesareo del 2011-2012. Inoltre hanno effettuato una revisione sistematica delle pronunce giurisprudenziali italiane in caso di mancato o ritardato taglio cesareo.
Risultati/Discussione e Conclusioni: I dati a nostra disposizione rilevano un incremento del tasso di tagli cesarei in Italia ponendola al primo posto in Europa per il ricorso a tale tecnica chirurgica. In particolar modo si è evidenziata una distribuzione nazionale non uniforme: difatti risulta più utilizzata nell’Italia meridionale, nelle strutture private piuttosto che nelle pubbliche e l’incidenza aumenta con l’aumentare dell’età della gestante. Dati ancor più dettagliati sono quelli forniti dalla regione Lazio che oltre a confermare quanto sopra riportato, evidenziano l’incremento delle nascite mediante TC soprattutto nei giorni feriali. Tuttavia l’incremento del TC non risulta essere accompagnato da un aumento dei benefici materni e/o fetali tali da giustificare il suo maggior utilizzo.
I dati esaminati testimoniano un comportamento clinico assistenziale non adeguato che più che il bene salute, va a tutelare altro; la volontà della paziente e del medico oltre eventuali interessi delle strutture sanitarie: 1) la volontà della paziente in quanto preferisce partorire in piccole strutture private dove opera, nei giorni feriali, il proprio ginecologo di fiducia; 2) la volontà dei ginecologi di assecondare la propria paziente, evitarle le ansie del parto naturale, evitare a se stesso un eventuale rischio di incorrere in contenzioso per mancato o ritardato TC; 3) eventuali interessi delle strutture sanitarie che vedono aumentare l’entità dei propri rimborsi per prestazione sanitaria.
Una maggior informazione per la gestante sulle complicanze del TC e l’utilizzo delle linee guida relative al TC a nostro avviso possano limitare il ricorso alla medicina difensiva e tutelare la salute sia della gestante che del nascituro.Background: in the field of professional liability the case law evaluates the doctor’s performance critically placing itself at the patient’s side at the expense of the physician. This attitude has convinced the doctors to try to protect themselves using the practice of defensive medicine.
The defensive medicine does not want to protect the patient’s health but its aim is to avoid legal medical liability following the medical cares.
Objectives: this paper has the purpose of searching the causes of the increase of caesarean section in Italy and if this is a clinical need or if it is a sign of the spread of defensive medicine, in particular with reference to the Italian case law and the recent issue of the guidelines.
Methods: the authors analyzed: 1) the data of the Ministry of Health, CeDAP 2009, published in 2012; 2) the data published by the Agency for Public Health of the Lazio Region in February 2012; 3) the guidelines for caesarean section in 2011-2012.
They also carried out a systematic review of the Italian case law in case of failed or delayed caesarean section.
Results/Discussion and Conclusions: the available data show an increase of caesarean section in Italy, putting it at the first place in Europe for the use of this surgery. In particular, the national distribution is not uniform: in fact, it is more used in southern Italy and in private structures than in public ones and the incidence increases with the increasing age of the mother.
The Lazio Region has several detailed data: they confirm what we have just said, and they underline an increase of births during working days. However, the increase in caesarean section is not associated with an increase in maternal and/or fetal benefits. The analyzed data attest that medical care is not appropriate; it does not protect health, but it protects the will of both the patient and the doctor and possible interests of health facilities:
1) patient prefers to give birth in small private clinics where the gynecologist works during working days; 2) the gynecologists satisfy their patient’s wishes to avoid anxieties of natural childbirth and to prevent the risk of contentious due to failed or delayed caesarean section; 3) possible interests of health facilities that see an increase of their refunds for health service.
We think that the use of guidelines related to caesarean section and much information given to the mother about complications of caesarean section would limit the use of defensive medicine and would protect the health of both the pregnant woman and the unborn child
The role of fillers in aesthetic medicine: medico-legal aspects
Full text linkIn recent years there has been an exponential increase of fillers use in aesthetic medicine. The popularity of this anti-wrinkle product is based on their capacity to offer significant improvement in the aesthetic field, particularly to skin rejuvenating processes with non-invasive and less expensive techniques, if compared to the surgical methods (i.e. surgical lifting). The great number of fillers on the market is composed of a large heterogenic number of biomaterials. The aim of this review was to provide an overview and a classification of the filling materials that are most commonly used. A synthesis of the literature concerning fillers and related side effects was also reported. The law decree no. 23 of 1998, converted in the law no. 94 of 1998 and the principal judgments of the Italian Court of Cassation have been examined with the medico-legal issues related to fillers use in medicine. With respect to their degradation, filler materials may be classified as temporary (degradable), semi-permanent and permanent (not degradable). The temporary fillers such as hyaluronic acid and collagen are completely degraded by the surrounding tissue in a few months. The permanent fillers, such as the ones derived from silicon oil and minerals are not biodegradable and may cause serious and irreversible side effects. Their use requires a physician with a high level of specialization to perform the treatment, a deep knowledge of face anatomy and a great degree of experience
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