Il trauma cranico di interesse clinico e medico legale

Nelle casistiche cliniche e medico legali alcune lesioni obiettivabili sul paziente vivente ovvero su un cadavere possono ingenerare difficoltà interpretative circa la natura giuridicamente rilevante del meccanismo di formazione. Un ambito di studio che propone spesso questa problematica è rappresentato dalla emorragia cerebrale potenzialmente ascrivibile ad una natura traumatica da condotta illecita altrui ovvero non traumatica. Gli Autori propongono una revisione narrativa della letteratura che permette di riconoscere nell’analisi del tipo di emorragia ovvero della lesività associata, utili ed aggiornati strumenti di supporto in merito ad una definizione della fattispecie considerataIn clinical and legal cases some injuries found in living patient or dead body can give rise to difficulties of interpretation regarding the nature of the legally relevant formation mechanism. A field of study that offers often this issue is the brain hemorrhage that it could be traumatic or no traumatic. The authors propose a narrative review of the literature that enables us to recognize in the analysis of the kind of bleeding or type of associated lesions, useful and updated support tools for settlement of the case in question

Gambling and the need for new responses in public health with an addiction “sine substantia”

Background. The Gambling Disorder (GD) was recently defined as a behavioral addiction by the “The Diagnostic and Statistical Manual of Mental Disorders IV”( DSM-V) since the clinical, neurobiological and psychopathological similarities led it to be defined it as an addiction “sine substantia”. The aim of this study is to formulate an “identikit” of the gambler, to evaluate a possible association between GD / emotional specific factors and the correlation between GD / substance abuse, GD / suicide. Method. In the study, 41 subjects were included (31 males and 10 females) and all were diagnosed with GD. A questionnaire was distributed containing 24 questions deriving from South Oaks Gambling Screen and the DSM-IVTR. Results. The study showed that 51% of the respondents makes use of alcohol and / or drugs; that 73% of the patients started playing in order to relieve feelings of dysphoria and suffering consequences on work as well as family life (51%). A great deal of the respondents were indebted (39%) to the extent of needing to ask for loans from usurer (17%). Furthermore, 41% of the respondents in the sample showed that GD could be transformed into an alarming risk of suicide. Discussion. The correlation between GD and drug abuse may depend on the brain function and the neural circuits that support impulsive behavior and the gratification mechanisms. Emotional experiences (stress, low level of education, divorce, poor social support) could constitute a possible risk factor that increases the GD. The committed offenses related to gambling could be explained by “loss of control”. Conclusion. The results of the present study contributes to the body of knowledge regarding the size of phenomenon from a statistical and epidemiological point of view, suggesting the necessity for targeted information on the risks connected to GD in order to capture early warning signs which enables the intervention with suitable strategies

La responsabilità professionale nell’utilizzo dei mezzi di contenzione nella gestione dell’evento caduta in ambiente ospedaliero [Risk factors correlating event falling to eventual medico-legal responsability]

Introduzione. Le cadute in ambito ospedaliero rappresentano un problema di notevole impatto sulla qualità della vita dei pazienti, potendo determinare un incremento della morbilità e della mortalità e allungamento dei tempi di ospedalizzazione . Obiettivo. Analizzare, attraverso la descrizione di un campione i fattori di rischio estrinseci dell’evento caduta correlandoli ad eventuali responsabilità medico-legali. Metodo. È stato condotto uno studio retrospettiva su un campione di 131 pazienti (60% maschi, 30% femmine) afferenti alla Unità Operativa Complessa (U.O.C.) Pronto Soccorso e Osservazione Breve Intensiva (O.B.I.) del Policlinico Di Tor Vergata. È stata creata una scheda che consentisse di raccogliere i dati relativi alle caratteristiche dei pazienti e le circostanze dell’evento caduta; inoltre è stata effettuata dal personale infermieristico una stratificazione del rischio- caduta al momento del ricovero, mediante la Scala di Conley. Risultati. Le cadute sono avvenute perlopiù nella stanza del paziente (60%), nel 21% dei casi in presenza del personale sanitario e nel 64% dei casi il letto era in posizione di sicurezza. Discussione. Nel nostro campione le sponde di sicurezza sono state apposte nel 58% dei casi ed è significativo osservare che nel 36% i pazienti sono caduti nel tentativo di alzarsi, di scendere dalla barella e di scavalcare tali sponde. Le sponde di sicurezza rappresentano una misura di prevenzione del rischio ma da adottare solo dopo un’attenta valutazione preliminare del paziente. Esse infatti potrebbero esporre i pazienti ad ulteriori rischi nel tentativo di scavalcarle.Introduction. Falls within the hospital environment constitute a severe problem and induce a notable negative impact upon the patients. They may lead to an increased morbidity and/or mortality with an extended period at the hospital. Aims. Analyze, through the description of a sample of extrinsic risk factors correlating event falling to eventual medico-legal responsibility. Methods and Materials. The retrospective study used data derived from a total of 131 patients (60% males and 40%, females) who were obtained from the Unit of Complex Operations (U.O.C.), and Emergency Unit and Short-term Intensive Observation ( O.B.I.), from the Polyclinic of the Tor Vergata . A questionnaire/record was designed that registered the patients’ characteristics and falling-accident circumstances. The questionnaire-register was completed by nursing staff who performed a falls risk assessment using the Conley scale. Results. Falling-accidents occurred in the patients room in 60% of the cases, in 21% of the hospital staff were present, and the patient’s bed was locked in the safety position in 64% . Disscussion. The present study revealed that the use of the safety rail occurred in 58% of the falling-accident cases and it important to observe that in 36% of the cases the patients fell during his/her attempt to leave the bed, or stepping down from the stretcher or climbing up the bedsides. The safety rails are useful measures for risk prevention but only acted upon after careful each patient’s preliminary assessment . Indeed, they could expose patients to additional risks in an attempt to step over

Psychopathology and neoplastic disease: medico-social and medico-legal considerations

The cognitive disability associated with stress in patients presenting cancer disease may exert a significant impact on the psychological health of the individual and even deteriorate the clinical diagnosis. The present study consists of a review of the available literature and an analysis of the association between psychopathologic disease and cancer by selecting useful contributions to the medicosocial discussion of the topic. Interesting considerations have emerged on the epidemiology and pathogenesis of the association between psychopathology and cancer that initiated possibilities towards a greater accuracy in the assessment of the patient that is not only limited to oncologic problems and outcomes