Telemedicine as a Medical Examination Tool During the Covid-19 Emergency: The Experience of the Onco-Haematology Center of Tor Vergata Hospital in Rome

Background: Our study analysed the outpatient activity of the onco-hematology Complex Operative Unit (UOC) of Tor Vergata Hospital, Rome coronavirus disease 2019 (Covid-19) center, where, as a result of the sudden and unexpected emergency, healthcare services were provided through telemedicine procedures that can be considered very close to Telehealth. Aim of the study: our retrospective study aimed to assess the widespread use of telemedicine in terms of feasibility and safety related to adverse events, a crucial experience which will make it possible to predict any effective use of such a method in patients with hematological disorders even after the end of the Covid-19 emergency. Materials and methods: At the Day Hospital clinic, from 8 March to 31 May 2020, an outpatient group received 3828 medical teleconsultations and 11,484 additional contacts following the first examination; each patient examined through the telematic method required an average of three supplementary contacts via e-mail or telephone. Results: The follow-up lasted 145 days, and all the events that occurred were monitored. In total, we recorded 16 clinical adverse events, 5 of which classified as major events, and 11 as minor events. Conclusion: The 3828 telematic clinical examinations and the 11,484 additional contacts following the first examination carried out by the onco-haematology UOC of Tor Vergata Hospital, proved how telemedicine, albeit in its basic form, was a key tool in facing the sanitary emergency caused by the sudden spread of Covid-19. An experience that can be considered reliable enough to be replicated in possible post-Covid-19 emergencies. From a medical forensic point of view, the main issues to consider are informed consent, personal data management and professional responsibility profiles

Medical Liability: Review of a Whole Year of Judgments of the Civil Court of Rome

Background: Complaints about medical malpractice have increased over time in Italy, as well as other countries around the world. This scenario, perceived by some as a "malpractice crisis", is a subject of debate in health law and medical law. The costs arising from medical liability lawsuits weigh not only on individual professionals but also on the budgets of healthcare facilities, many of which in Italy are supported by public funds. A full understanding of the phenomenon of medical malpractice appears necessary in order to manage this spreading issue and possibly to reduce the health liability costs. Methods: The retrospective review concerned all the judgments drawn up by the Judges of the Civil Court of Rome, XIII Chamber (competent and specialized section for professional liability trials) published between January 2018 and February 2019. Results: The analysis of data concerning the involved parties showed that in 84.6% of the judgments taken into account, one or more health facilities were sued, while in 58.2% of cases, one or more health workers were present among the defendants. When healthcare providers are the only ones to be summoned, it is dentists and aesthetic doctors/plastic surgeons who undergo most of the claims. In the overall period analyzed, the amount paid was 23,489,254.08 EUR with an average of 163,119.82 EUR. Conclusion: The evidence provided by the reported data is a useful tool to understand medical malpractice in Italy, especially with regard to the occurrence of the phenomenon at a legal level, an aspect still hardly mentioned by existing literature

LAW n.219/17: Reflecting on shared care plan

The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility

Iatrogenic injury of the spinal accessory nerve in selective superficial parotidectomy

The spinal accessory nerve, also known as accessory nerve, is the eleventh cranial nerve. It is responsible for the motor innervation of the sternocleidomastoid and trapezius muscle. The sternocleidomastoid muscle tilts and rotates the head, while the trapezius muscle, connecting to the scapula, elevate the shoulder girdle and retract the girdle dorsally. Spinal accessory nerve injury commonly occurs during neck dissection surgery, either elective or therapeutic procedure, performed to treat head and neck carcinoma. The Authors described the case of a 50-year-old man who underwent surgery for a parotid neoformation. After the superficial left parotidectomy emerged neck pain, weakness of the trapezius muscle and functional impotence of the left shoulder. Following diagnostic tests, was properly diagnosed an iatrogenic accessory nerve injury. The main purpose is to determine possible predictive factors related to the occurrence of accessory nerve injury during superficial parotidectomy and the possibility to recognize the error immediately after surgery when surgical repair has the great chance of success. Probably the awareness of the possibility of a iatrogenic injury and its consequences, even during reconstruction using the SMAS flap after superficial parotidectomy, would avoid delays in diagnosis and treatment

p MATRICIDE DURING COVID-19 PANDEMIC: AN UNUSUAL CASE OF FAMILY VIOLENCE

The need to limit the spread of the virus in the population has forced many countries to impose strict measures of social distancing and home isolation. These measures, although necessary, have caused unprecedented social disruption. One of the most worrying effects of this social crisis is the increase in episodes of family violence which can be extremely serious up to the killing of family members. Matricide is a fairly rare event worldwide. Many authors have over time attempted to figure out the origins of a pathological condition - but not limited to - underlying such crimes often executed through particularly brutal criminal acts against the victims. In this study we present a case of a 66-year-old woman who was killed with multiple stab wounds from a diving knife and then burned. It was determined that the victim was murdered by her 36-year-old son, unemployed for about a year and with a history of alcohol abuse, had a suspected diagnosis of bipolar disorder in treatment with antidepressant drugs. On the victim's body there were 31 stab wounds, localized mostly to the skull, face and thorax. Some of the typical characteristics highlighted in the literature regarding individuals who commit matricide are actually found in this case. This correspondence underscores the need to recognize and, in some cases, prevent the possible occurrence of such an eventuality within a family

Policies and Toxicological Screenings for No Drug Addiction: An Example from the Civil Aviation Workforce

Introduction: Since 2008, Italian legislators, with the aim of ensuring public safety, have made it mandatory for an occupational doctor (OD) to assess specific categories of workers to exclude those who may have consumed drugs of abuse. Due to the relevance of work activities relating to the civil aviation and airport sector, a policy based on the use of training and information tools, as well as a health surveillance protocol, has been undertaken since 2009. Materials and methods: A total of 61,008 workers at a commercial airline underwent health surveillance between 2009 and 2019. Following <= 24 h notification, their urine was screened for opiates, cocaine, cannabinoids, amphetamines, methamphetamines, and methylenedioxymethamphetamine (MDMA) using an immunochemical test. Positive results were confirmed using Gas Chromatography-Mass Spectrometry (GC/MS) or Liquid Chromatography -Mass Spectrometry (LC/MS). In confirmed cases, the workers were declared unfit and sent to a specialized laboratory for a second level analysis. Results: Positive results, initially >1%, have halved in the last four years (<0.5%). The percentage of positive results was consistently very low among pilots and, moreover, the rare positive cases detected were due to a cross-reactivity phenomena. The highest and most discontinuous percentages seen occurred in the population undergoing a pre-employment examination. Regarding the types of substance used, a prevalence of cannabis (58.52%) and cocaine (35.2%) use was observed. Conclusions: The data presented indicate that the air transport sector, in all its components (ground workers and air crews), has a very limited number of substance abusers, and this number tends to decrease over time and with work seniority. Another aspect of particular interest, and which is more specific to toxicology, concerns the detection of cross-reactivity in urinary immunochemical screening between the antibodies to drugs of abuse and certain other drugs, such as anti-inflammatories or antibiotics; as well as foods, and other commonly used substances