1,721,081 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
I 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
Esistenza di bias cognitivi nell'attività medico-legale. Una revisione degli studi sperimentali
No full textMedicolegal Aspects of Disability in Narcolepsy
No full textNarcolepsy is a severe, chronic, disabling disease affecting almost all personal and social activities. Sleep disorder specialists deal with the disabling burden of narcolepsy since their first approach to the patient. The disease continues to be a burden throughout the patient’s life as pharmacological and behavioral treatments only seldom control the variety of symptoms. Empirical data showed that from one fourth to half of people with narcolepsy are forced to modify or leave a job due to the disease, which may also cause higher absenteeism due to disability and accidents, as well as being more likely subjected to unemployment and early retirement with high social and economic costs. Excessive daytime sleepiness seems to be the main symptom associated with work disability, but cataplexy may be even more disabling in cases with many cataplectic attacks. Since people with narcolepsy experience a wide range of occupational problems, both clinicians and researchers are interested in how to help their patients to hold down a job, return to work, and, if necessary, receive benefits for work disability.
This chapter considers the medicolegal aspects of work disability in narcolepsy, summarizing essential issues clinicians and researchers have to address in providing medical information to assist disability determination in people with narcolepsy
Applicability and usefulness of the Declaration of Helsinki for forensic research with human cadavers and remains
No full textBodies of deceased persons and human remains and their specimens (i.e., organs, bones, tissues, or biological samples) are essential in forensic research but ad hoc worldwide-recognized ethical standards for their use are still lacking. Such standards are needed both to avoid possible unethical practices and to sustain research in the forensic field. Pending consensus within the forensic science community regarding this topic, with this article we aim to stimulate a debate as to the applicability and usefulness of the Declaration of Helsinki in the field of forensic research involving human cadavers and remains. Considering the fundamental differences compared to clinical research involving human beings and the different moral obligations involved, we focus on the risks, burdens, and benefits of research, ethics committee approval, and informed consent requirements. The Declaration of Helsinki framework allows forensic researchers to focus on substantial ethical principles promoting the consistency, integrity, and quality of research. Consensus regarding ethical standards and the adoption of national and supranational laws that clearly regulate the use of human cadavers and remains, including those from autopsies, continues to be of primary importance for the forensic science community
Do you agree with the doctor's decision to continue treatment?: A scenario-based study of hospital nurses in Italy
No full textINTRODUCTION: A lack of social consensus on the duty to comply with a patient's request to forgo treatment was reported in Italy, but little is known about the nurses' attitudes regarding this issue. MATERIALS AND METHODS: Questionnaire including two clinical scenarios regarding doctor's decision to not comply with a competent patient's request to forgo treatment was administered to all nurses (n = 487) of an Italian medium-sized hospital. RESULTS: Eighty-five percent of nurses completed the study. Although 83% of participants supported a general right to self-determination, around 40% of them agreed with the doctor's decision in both scenarios. The multivariate analyses adjusted for gender, age, length of professional experience, and care setting showed that the agreement with the doctor's decision was significantly associated with nurses' personal background beliefs about self-determination and quality of life. DISCUSSION AND CONCLUSIONS: Many nurses have difficulty in accepting a patient's request to forgo treatment. Increasing ethical reflection and discussion at both educational and professional level, and introducing ethical consultation services would be essential to develop a consistent approach to end-of-life decisions in Italian hospitals
Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis
Full text linkObjective: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. Methods: The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. Results: The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1) plans already made; 2) end-of-life care and decision-making; 3) opinions and attitudes toward ACP; and 4) how, when, about what, and with whom to do ACP. Conclusion: Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. Practical implications: In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities
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"
Elder abuse awareness in Italy: analysis of reports to the Prosecutor Office of Bologna
No full textBACKGROUND:
In Italy, the prevalence of elder abuse is estimated from 10 to 12.7 %. Even if the elderly are not specifically protected by the Italian Penal Code, it contains several articles punishing crimes against disadvantaged groups in which elders may be included. Article 572 about mistreatment of family members or cohabitants, and article 643 about circumvention of incapable best fit elder abuse or neglect and financial fraud and exploitation, respectively.
AIMS:
To evaluate the prevalence of reported elder abuse in Bologna and province (Italy) compared to available data on prevalence obtained by population-based surveys.
METHODS:
Reports to the Prosecutor Office about articles 572 and 643 in the period from 2000 to 2013 were collected and analyzed according to victim's age at the report time.
RESULTS:
For article 572 a total of 3,713 reports were found. The prevalence of reports ranged from 0.005 to 0.024 % for victims older than 65 years. Concerning article 643 a total of 786 reports were detected, with a prevalence ranging from 0.007 to 0.016 % for victims older than 65 years.
DISCUSSION AND CONCLUSION:
A large gap was found between reported crimes related to elder abuse and the estimated prevalence of elder abuse in Italy. Our results showed that in Italy efforts to improve strategic approa
LA PIANIFICAZIONE ANTICIPATA DELLE CURE: LA PAROLA AGLI ANZIANI OSPITI NELLE CASE RESIDENZA
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