Ethical Challenges in Health Care Policy during COVID-19 Pandemic in Italy

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system

Evaluation about clinical risk knowledge in Italian medicine students: How to implement the concept of healthcare quality among future doctors

The aim of the study is to offer to all the future health providers an opportunity of education in the specific field of patient's safety and clinical risk management. The study develops a complete picture of the knowledge of a whole class of future physicians about clinical risk theme, involved 1228 students of a medicine course. We elaborated a survey (18 explorative questions) that evaluated the levels about basic concepts in clinical risk management and investigated the future doctors' opinion about the use of these instruments. The results emphasize a deep delay compared to international standards about basic notions. We propose as future target both monitoring the notional trend about investigated themes of the survey and sensitizing the future health operators and decision makers about basic clinical risk concepts. Moreover, we try to give the timing of fundamental steps to improve the awareness and the management of Clinical Risk

Patient Safety Walkaround: a communication tool for the reallocation of health service resources: An Italian experience of safety healthcare implementation

The study aims to evaluate the use of Patient Safety Walkaround (SWR) execution model in an Italian Hospital, through the adoption of parametric indices, survey tools, and process indicators.In the 1st meeting an interview was conducted to verify the knowledge of concepts of clinical risk management (process indicators). One month after, the questions provided by Frankel (survey tool) were administered.Each month after, an SWR has been carried trying to assist the healthcare professionals and collecting suggestions and solutions.Results have been classified according to Vincent model and analyzed to define an action plan. The amount of risk was quantified by the risk priority index (RPI).An organizational deficit concerns the management of the operating theatre.A state of intolerance was noticed of queuing patients for outpatient visits. The lack of scheduling of the operating rooms is often the cause of sudden displacements. A consequence is the conflict between patients and caregivers. Other causes of the increase of waiting times are the presence in the ward of a single trolley for medications and the presence of a single room for admission and preadmission of patients.Patients victims of allergic reactions have attributed such reactions to the presence of other patients in the process of acceptance and collection of medical history.All health professionals have reported the problem of n high number of relatives of the patients in the wards.Our study indicated the consistency of SWR as instrument to improve the quality of the care

Violence in forensic psychiatric facilities. A risk management perspective

Violence against healthcare workers is a global phenomenon. Psychiatric settings are among the places at greatest risk of being a victim of aggression. Several strategies aimed at preventing violence in healthcare settings and implement protective measures have been proposed. Nevertheless, forensic psychiatric settings have been poorly investigated from the point of view of clinical risk management, especially in Italy. The recent process of deinstitutionalization of forensic psychiatric patients in Italy, with the replacement of former forensic psychiatric hospitals with small regional-based community structures (REMS), deserves particular attention in terms of clinical risk management. We propose in the following contribution a methodology that allows to measure the risk of violent behavior in different psychiatric forensic settings, from the point of view of clinical risk management. This includes a proposed adaptation of the Modified Overt Aggression Scale (MOAS) for the specific purpose. The use of such approach, including the calculation of a structure’s “risk score” could allow comparisons between different facilities as well as the implementation of strategies aimed at minimizing the frequency of violent acts, as well as activating the most suitable measures to prevent the

An unusual suicide by carbon monoxide intoxication: 91% HbCO saturation in a sealed setting

Carbon monoxide (CO) is the most common lethal poison in every community yet studied. Accidental or suicidal CO poisoning has been reported as the most frequent manner of death. In the case we report here, a man was found dead inside his house with a strong smell of burning. The house presented no signs of effraction, and a lot of scotch tape was placed around the windows and doors edges as well as the keyholes to avoid any passage of air. Near the bed, there was an extinguished brazier with combusted carbon. After the external examination of the body a toxicological analysis was performed. The results pointed out 91% HbCO saturation in absence of signs of intermediate intoxication on the body or on the scene. This article aims to outline the importance of performing a multidisciplinary approach that includes an accurate crime scene investigation and a proper toxicological assessment, to evaluate the cause of death in cases of suspected CO inhalation suicide. The crime scene investigation together with the very high levels of HbCO saturation detected, suggest a possible correlation between time of exposure, source of CO, and saturation levels

Post-mortem persistence of SARS-CoV-2: a preliminary study

Since the beginning of March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been the cause of millions of deaths worldwide. The need to better define the pathogenesis of coronavirus disease 19 (Covid-19) as well as to provide the correct statistical records concerning deaths related to this virus, inevitably involves the role of forensic pathology and routine autopsy practice. Currently, some data on macroscopic and microscopic features in autopsies performed in suspected Covid-19 cases are reported in the literature. The persistence of SARS-CoV-2 in cadavers has not yet been elucidated and only a few reports have emphasized the importance of evaluating the Virus RNA in post-mortem tissues. In this preliminary study, we observed that SARS-CoV-2 survives in multiple cadaver tissues many days after death despite some extreme conditions of post-mortem body preservation. The results of this on-going analysis could help improve the safety of working practices for pathologists as well as understanding the possible interaction between microbiological agents and the cadaver tissue's supravital reactions

Animal welfare policies and human rights in the context of slaughter procedures

Human rights, such as to non-discrimination and freedom of religion, are internationally recognized. In the meantime, the so-called global animal law is becoming more and more important. In this context, religious slaughter is increasingly becoming a matter for debate as a number of special procedures, which avoid stunning methods, may lead to greater suffering for animals. Such procedures are common to Judaism and Islam and involve 25% of the global population, almost 2 billion people. Considering that about 94% of European public opinion in 2015 expressed concern over animal welfare, it is time to evaluate the legal perspective of these special treatments. Indeed, although they seem to violate animal welfare policies, at the same time states have a duty to uphold religious freedom (and its forms of expression) under International and European law. The aim of this study is to evaluate, through a multidisciplinary approach, the complex balance between human rights in general and animal welfare policies, which are gaining importance especially in the European Continent’s legal framework

Measuring the willingness to share personal health information: a systematic review

BackgroundIn the age of digitalization and big data, personal health information is a key resource for health care and clinical research. This study aimed to analyze the determinants and describe the measurement of the willingness to disclose personal health information.MethodsThe study conducted a systematic review of articles assessing willingness to share personal health information as a primary or secondary outcome. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. English and Italian peer-reviewed research articles were included with no restrictions for publication years. Findings were narratively synthesized.ResultsThe search strategy found 1,087 papers, 89 of which passed the screening for title and abstract and the full-text assessment.ConclusionNo validated measurement tool has been developed for willingness to share personal health information. The reviewed papers measured it through surveys, interviews, and questionnaires, which were mutually incomparable. The secondary use of data was the most important determinant of willingness to share, whereas clinical and socioeconomic variables had a slight effect. The main concern discouraging data sharing was privacy, although good data anonymization and the high perceived benefits of sharing may overcome this issue

Tutela della salute in carcere, durante la pandemia Covid-19

Being detained in jail is an acknowledged risk factor for physical and psychiatric morbidity. The impact of COVID-19 pandemicon the penitentiary system, already characterized by criticalities in terms of healthcare, including high infectious risk, has beenconsidered a source of further danger within the prison and for the community. This problem has been raised by several observers, in the absence of a shared approach between states. The Italian Government enacted a series of measures aimed at penitentiary structures, to contain and manage health and safety risks. General precautions for infections prevention have been used, including frequent hands washing and environmental cleaning and disinfection procedures. Physical distancing in jail is extremely challenging, and we deem that it was still impossible to apply it, despite the release of almost 8000 detainees, among those at greater health risk. Measures have been also ordered to limit external contacts with detainees, including a substantial or absolute suspension of visits from relatives, operators and lawyers, replaced by video meetings. Quarantine and isolation of suspect cases has also been ordered, including new prisoners. Despite unfavorable premises the analysis we did on available data indicates lower infection rate and lethality rate in prison than in general population. In this paper a synthetic framework of the sanitary problems in detention will be provided, then the data will be analyzed, providing possible interpretations potentially useful for the management of the pandemic at the community level. Infectious surveillance, compliance with sanitation standards, early treatment of suspected cases, lower mean age, efficacious isolation and quarantine strategies may explain the better outcomes in Italian penitentiary system, also in the impossibility to systematically apply physical distancing. La restrizione in ambiente intramurario è un noto fattore di rischio in termini di morbidità per patologie fisiche e psichiche. L’impatto di una pandemia quale la COVID-19 sul sistema penitenziario, caratterizzato da plurime criticità in termini di gestione sanitaria, rischia potenzialmente di determinare gravi effetti sulla salute di detenuti e operatori. A livello internazionale tale problematica è stata sollevata e descritta, in assenza di un approccio condiviso tra gli stati dell’Unione Europea. In Italia, uno dei paesi maggiormente colpiti in termini di contagi e mortalità, si è assistito all’applicazione di una serie di misure dirette alle strutture penitenziarie, atte al contenimento ed alla gestione dei rischi per la salute e la sicurezza. L’ambiente carcerario, tuttavia, notoriamente caratterizzato da sovraffollamento e gravato da fattori di rischio specifici, rende problematico adottare una serie di misure che sono state invece previste per la popolazione generale. Il distanziamento fisico in carcere è estremamente problematico, e riteniamo che sia stato impossibile applicarlo, nonostante il rilascio di quasi 8000 detenuti, tra quelli a maggior rischio per la salute. Sono state inoltre disposte misure per limitare i contatti esterni con i detenuti, compresa una sospensione sostanziale o assoluta delle visite di parenti, operatori e avvocati, sostituita da videoconferenze. Sono stati ordinati anche la quarantena e l'isolamento dei casi sospetti, compresi i nuovi detenuti. Nonostante tali sfavorevoli premesse, l’analisi dei dati da noi effettuata circa i contagi ed i decessi in carcere, sino al 1° maggio 2020, indicano un tasso di infezione paragonabile alla popolazione generale, ed un tasso di letalità significativamente inferiore. Nel presente lavoro, dopo aver fornito un inquadramento sintetico delle problematiche sanitarie in ambito detentivo, si discuteranno i dati fornendo possibili interpretazioni di potenziale utilità per la gestione a livello comunitario.&nbsp