1,720,971 research outputs found
Sindrome delle apnee ostruttive del sonno e rischio di incidenti stradali: doveri del medico e possibili responsabilità del paziente
No full textObstructive Sleep Apnea Syndrome (OSAS) is the most common sleep disorder associated with excessive daytime sleepiness (EDS), and it is estimated to affect 1,600,000 people in Italy. Untreated OSAS is significantly associated with an increased risk of driving accidents. This article reviews the main professional duties of physicians dealing with patients with OSAS, and the patient’s potential liability in case of sleep-related road accidents. Physician’s duties were divided into the following: 1. duties related to certification according to the law 120/2010 and the Decree 22 December 2015; and 2. duties related to patient education about the risks related to EDS and about his/her potential liability in case of driving accidents. The latter issue was reviewed in light of several Italian Supreme Court decisions about the criminal and civil liability in case of motor vehicle crashes due to sudden “sleep attack”. Finally, since in Italy there is not a specific law requiring physicians to report the drivers affected by OSAS associated with EDS, circumstances in which physicians may (or have to) inform driving licence authorities are discussed. Indiscriminate reporting of patients is not recommended, but it should be limited to selected and actually dangerous patients
Esistenza di bias cognitivi nell'attività medico-legale. Una revisione degli studi sperimentali
No full textSuperficial vein thrombosis: differential diagnosis of circumscribed skin discolorations at autopsy
No full textI REGISTRI COMUNALI ITALIANI DELLE DICHIARAZIONI ANTICIPATE DI TRATTAMENTO: CARATTERISTICHE, EFFICACIA E LIMITI (THE ITALIAN MUNICIPAL REGISTRIES OF ADVANCE DIRECTIVES: CHARACTERISTICS, EFFECTIVENESS AND LIMITS)
No full textRIASSUNTO
OBIETTIVI. Per colmare il vuoto legislativo sulle Dichiarazioni Anticipate di Trattamento (DAT), alcuni comuni italiani hanno istituito dei registri per raccogliere le DAT o le certificazioni dell’avvenuta compilazione. L’obiettivo di questo studio era indagare la disponibilità e le caratteristiche di tali registri nei maggiori comuni italiani e determinare quante persone ne hanno usufruito.
MATERIALI E METODI. Sono stati presi in considerazione i 118 capoluoghi di provincia (15.506.964 residenti adulti). Per quelli che avevano un registro delle DAT sono state raccolte informazioni riguardo a: 1. servizi di informazione/assistenza; 2. numero di utilizzatori; 3. caratteristiche del registro (tipologia, requisiti per usare il registro, persone a cui è consentito l’accesso); 4. istruzioni che era possibile includere nelle DAT e possibilità di modificarle o revocarle.
RISULTATI. Nel settembre 2014, 30 capoluoghi di provincia (8.835.097 residenti adulti) avevano un registro delle DAT. In 12 (40%) erano presenti dei servizi di informazione/assistenza. Aveva utilizzato un registro delle DAT lo 0.041% dei residenti adulti (range 0,013-0,078%). Le caratteristiche dei registri e le istruzioni erano molto variabili e solo 3 (10%) erano accessibili a professionisti sanitari. La possibilità di modifica e revoca era prevista in 23 casi (77%).
ABSTRACT
AIM. In recent years, in order to fill the lack of national legislation regarding advance directives (ADs), Italian municipalities have created registries to collect residents’ ADs or certifications for ADs. We aimed to investigate the availability and characteristics of AD registries in the most populated Italian towns, and to determine how many citizens used these registries.
MATERIALS AND METHODS. We surveyed all 118 Italian provincial capitals (15,506,964 adult residents). For towns with an AD registry, we collected information about: 1. AD-related information/assistance services; 2. number of people who used the registry; 3. registry characteristics (i.e., type, requirements to use the registry, people who were allowed access to the information); 4. which instructions it was possible to include in the ADs, and the possibility of modifying or revoking them.
RESULTS. By September 2014, 30 provincial capitals (8,835,097 adult residents) had created AD registries. AD-related services were present in 12 municipalities (40%). The proportion of citizens who used the registries was 0.041% of adult residents (range 0.013-0.078%). The registry rules varied widely and only 3 registries (10%) were directly accessible to healthcare providers. The option to modify or revoke ADs was provided in 23 cases (77%).
DISCUSSION. Limited availability, lack of consistency and inability of healthcare providers to access registries are likely to make this bottom-up attempt to safeguard personal autonomy ineffective, highlighting the urgent need for legislation about ADs in order to guarantee to all Italian citizens to have a voice in decisions about their future care
Parental fitness questioned on the grounds of narcolepsy: Presentation of two cases
Full text linkWe report two cases of fathers whose parental fitness was questioned during divorce and custody litigation because of narcolepsy type 2 and type 1, respectively. These cases highlighted both the existence of a narcolepsy-related stigma and the need to involve sleep experts in custody assessments when concerns about the parental fitness are related to a sleep disorder, expanding the field of interest of the growing âsleep forensics"
Narcolepsy features in young patients
No full textNarcolepsy is a lifelong central hypersomnia characterized by excessive daytime
sleepiness, cataplex y, sleep paralysis, hypnagogic hallucinations, and disrupted noc-
turnal sleep. Behavioral and psychiatric comorbidities are often associated clinical
features. It is divided into t wo subt ypes, narcolepsy t ype -1, and narcolepsy t ype -2,
depending on the presence of cataplex y and the cerebrospinal fluid hypocretin-1 l evels.
An autoimmune process, along with environmental factors, has been hypothesized to
cause the disease. Among children and adolescents, incidence in Europe falls bet ween
0.14 and 0.3 in 100,000, with a reported increase in the incidence af ter the 2009 H1N1
pandemic influence and vaccination. Currently, specific pediatric diagnostic criteria
and cut-off instrumental values are lacking. Clinical presentation of the disease may
differ between children and adults, and misdiagnoses or diagnostic delays are still an
issue. The treatment is based on behavioral and pharmacological therapy, but drugs in
children a re prescribed off-l abel. Overall, pathogenic mechanism of narcolepsy and
data on drug efficac y in chil dren are still li mited: more research is needed to develop
new drugs and to reach approval of current treatments in the pediatric population
Varicella fulminante e fattori concausali: analisi di un caso e considerazioni medico-legali
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