1,720,979 research outputs found
Fertility preservation in female cancer sufferers: (only) a moral obligation?
No full textPurpose Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways. Materials and Methods A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010-2021 period. Results Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data. Conclusions Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others
Medicolegal issues in power morcellation: cautionary rules for gynecologists to avoid unfavorable outcomes
Full text linkPower morcellation in laparoscopic surgery enables specialists to carry out minimally invasive procedures such as hysterectomies and myomectomies by cutting specimens into smaller pieces using a rotating blade and removing pieces through a laparoscope. Unexpected uterine sarcoma treated by surgery involving tumor disruption could be associated with poor prognosis. The current study aims to shed light on power morcellation from a medicolegal perspective: the procedure has resulted in adverse outcomes and litigation, and compensation for plaintiffs, as published in various journals cited in PubMed and MEDLINE, Cochrane Library, EMBASE, and GyneWeb. Considering the claims after the US Food and Drug Administration warnings on morcellation, the current study broadens the scope of research by including search engines, legal databases, and court filings (DeJure, Lexis Nexis, Justia, superior court of New Jersey, and US district court of Minnesota) between 1995 and 2019. Legal records show that courts determine professional responsibility regarding complications, making it essential to document adherence to safety protocols and specific guidelines, when available. Sound medical practices and clearly stated institute best practices result in better patient outcomes and are important when unfavorable clinical outcomes occur; adverse legal decisions can be avoided if there are grounds to prove professional conformity with specific guidelines and the unpredictability of an event
How the legislation on medically assisted procreation has evolved in Italy
No full textThirteen years since the enactment of Law n.40, 19th February 2004, several rulings from the European Court of Human Rights (ECHR), the Italian Constitutional Court, as well as from single local tribunals have substantially modified the regulations governing medically assisted procreation Such changes have impacted the following issues: The upper limit of embryos which may be lawfully produced; the option for cryopreservation of such embryos; heterologous fertilization; preimplantation genetic diagnosis; and the option for fertile couples diagnosed with genetically transmitted diseases to avail themselves of medically assisted procreation procedures. This paper elaborates on each ruling and on possible grounds for incompatibility between the Italian regulatory framework and the Constitution and the European Convention on Human Rights. (EConHR). The paper highlights the many criticisms which several scholars have voiced towards each of the above-mentioned motives. The indicated regulatory evolution has considerably reduced the amount of limitations and prohibitions, thus making the legislation much better suited to preserve women’s health and the right to parenthood. Both aspects are constitutionally safeguarded under Italy’s founding document. No ruling denies that embryos should be protected as well. A large number of the restrictions and prohibitions, under provisions of Law 40/2004, remain valid. The Italian Constitutional Court has stated that such prohibitions which prevent scientific experimentation on embryos as well as the suppression of those embryos are unhealthy as a result of a preimplantation diagnosis. The general scope of the principles, spelled out by the Constitutional Court, might lay the groundwork for further rulings aimed at broadening the possibility to harness medically assisted procreation procedures
The issue of delivery room infections in the italian law. A brief comparative study with english and french jurisprudence
No full textDelivery room infections are frequent, and many of them could be avoided through higher standards of care. The authors examine this issue by comparing it to English and French reality. Unlike England, in Italy and France the relationship established between health facility, physician and patient is outlined in a contract. In England, the judges' decisions converge toward a better and higher protection of the patient-the actor-and facilitate the probative task. In case of infections, including those occurring in the delivery room, three issues are evaluated: the hospital's negligent conduct, damages if any and causal nexus. Therefore, the hospital must demonstrate to have taken the appropriate asepsis measures according to current scientific knowledge concerning not only treatment, but also diagnosis, previous activities, surgery and post-surgery. In order to avoid a negative sentence, both physicians and hospital have to demonstrate their correct behavior and that the infection was caused by an unforeseeable event. The authors examine the most significant rulings by the Courts and the Supreme Court. They show that hospitals can avoid being accused of negligence and recklessness only if they can demonstrate to have implemented all the preventive measures provided for in the guidelines or protocols
Episiotomy: a medicolegal vicious cycle
No full textThe present study aims to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. Court data and trial records have been taken into account as well, via searches into legal databases and search engines (Justia, Lexis, Jurist.org, Venice Courthouse, etc...). The review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data
Diagnostic Accuracy of MRI in Primary Cervical Cancer
No full textIntroduction: Magnetic resonance imaging (MRI) studies obtained during the initial staging of patients affected by
uterine cervical cancer were compared to the final histological report after surgery. Methods: Data were retrieved from
published papers. Results: MRI detection of lymph node metastases shows a sensitivity of 49.3% (1209 patients) and a
specificity of 87.7% (1182 patients). Parametrial involvement detection has 66.2% sensitivity (1288 patients) and
83.6% specificity (1282 patients). MRI tumor size evaluation shows significant error. Even detection of over 1 cm di-
ameter primary tumor can fail. MRI appears promising in the detection of myometrial and endometrial involvement.
Conclusions: Primary uterine cervical cancer evaluation with routine MRI has a limited accuracy especially in the de-
tection of lymph node involvement and parametrial invasion. It is not sensitive enough to replace histology of dissected
nodes and parametria. Tumor size estimation is imprecise. Detection of myometrial and endometrial invasion using
MRI might be possible. Awareness of MRI limitations is crucial in primary cervical cancer staging
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
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