122 research outputs found
Three-Dimensional Bioprinting of Human Organs and Tissues: Bioethical and Medico-Legal Implications Examined through a Scoping Review
Three-dimensional bioprinting is a rapidly evolving technology that holds the promise of
addressing the increasing demand for organs, tissues, and personalized medicine. By employing
computer-aided design and manufacturing processes, 3D bioprinting allows for the precise deposition
of living cells, biomaterials, and biochemicals to create functional human tissues and organs. The
potential applications of this technology are vast, including drug testing and development, disease
modeling, regenerative medicine, and ultimately, organ transplantation. However, as with any
groundbreaking technology, 3D bioprinting presents several ethical, legal, and regulatory concerns
that warrant careful consideration. As the technology progresses towards clinical applications, it is
essential to address these challenges and establish appropriate frameworks to guide the responsible
development of 3D bioprinting. This article, utilizing the Arksey and O’Malley scoping review
model, is designed to scrutinize the bioethical implications, legal and regulatory challenges, and
medico-legal issues that are intertwined with this rapidly evolving technology
Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion
Abstract: Background: Endovascular aneurysm repair (EVAR) has become an accepted alternative to open repair (OR) for the treatment of abdominal aortic aneurysm (AAA) despite “hostile” anatomies
thatmay reduce its effectiveness. Guidelines suggest refraining fromEVAR in such circumstances, but in
clinical practice, up to 44% of EVAR procedures are performed using stent grafts outside their instruction for use (IFU), with acceptable outcomes. Starting from this “inconsistency” between clinical practice and guidelines, the aim of this contribution is to report the technical results of the use of EVAR in challenging anatomies as well as the ethical aspects to identify the criteria by which the “best interest” of the patient can be set. Materials and Methods: A literature review on currently available evidence on standard EVAR using commercially available endografts in patients with hostile aortic neck anatomies was conducted.
Medline using the PubMed interface and The Cochrane Library databases were searched from
1 January 2000 to 6May 2021, considering the following outcomes: technical success; need for additional procedures; conversion to OR; reintervention; migration; the presence of type I endoleaks; AAA-related mortality rate. Results: A total of 52 publications were selected by the investigators for a detailed review.
All studies were either prospective or retrospective observational studies reporting the immediate,
30-day, and/or follow-up outcomes of standard EVAR procedures in patients with challenging neck
anatomies. No randomized trials were identified. Fourteen different endo-grafts systems were
used in the selected studies. A total of 45 studies reported a technical success rate ranging from
93 to 100%, and 42 the need for additional procedures (mean value of 9.04%). Results at 30 days: the incidence rate of type Ia endoleak was reported by 37 studies with a mean value of 2.65%;
31 studies reported a null migration rate and 32 a null conversion rate to OR; in 31 of the 35 studies
that reported AAA-related mortality, the incidence was null. Mid-term follow-up: the incidence rate
of type Ia endoleak was reported by 48 studies with a mean value of 6.65%; 30 studies reported a null
migration rate, 33 a null conversion rate to OR, and 28 of the 45 studies reported that the AAA-related
mortality incidence was null. Conclusions: Based on the present analysis, EVAR appears to be a safe
and effective procedure—and therefore recommendable—even in the presence of hostile anatomies, in patients deemed unfit for OR. However, in order to identify and pursue the patient’s best interest, particular attention must be paid to the management of the patient’s informed consent process, which— in addition to being an essential ethical-legal requirement to legitimize the medical act—ensures that clinical data can be integrated with the patient’s personal preferences and background, beyond the therapeutic potential of the proposed procedures and what is generically stated in the guidelines
Electronic unified therapy record as a clinical risk management tool in the Italian healthcare system
Digitization of health records is still struggling to take hold in the Italian
healthcare context, where medical records are still largely kept manually on
paper. Besides being anachronistic, this practice is particularly critical if applied
to the drug chart. Poor handwriting and transcription errors can generate
medication errors and thus represent a potential source of adverse events. In
the present study, we attempt to test the hypothesis that the application of a
computerizedmedical recordmodelmay represent a useful tool formanaging
clinical risk and medical expenditure. We shall do so through the analysis
of the preliminary results of the application of such a model in two private
hospitals in Northern Italy. The results, although preliminary, are encouraging.
Among the benefits of digitizing drug records, we recorded a greater accuracy
and adequacy of prescriptions, a reduction in the overall workload for nurses
(no longer required to manually transcribe the list of drugs from one chart
to another), as well as an optimization of the management of drug stocks
by hospital pharmacies. The results in terms of clinical risk reduction will
be monitored through a prospective cohort study that will take place in the
coming months
Are telemedicine systems effective healthcare solutions during the COVID-19 pandemic?
On 9 January 2020, China’s Centres for Disease Control and
Prevention (CDC) reported that a novel coronavirus causing a
severe acute respiratory syndrome (SARS-CoV-2) had been
identified as the causative agent of an aggressive respiratory
disease, later referred to as coronavirus disease 2019 (COVID19).1 As of 18 January 2021, there have been over 90 million
reported cases of COVID-19 and the virus has been responsible for nearly 2.5 million deaths.2 The COVID-19 emergency
has required continued contingency plans, making it necessary
to both rethink the current approach to healthcare as well as
how to adapt to the emerging needs of healthcare in the context
of a pandemic. We have learned how to mitigate the spread of
the virus by implementing social distancing measures, enforcing
proper mask compliance, and reducing face-to-face contact in a
health setting unless absolutely necessary. Community spread
from the virus must be prevented to minimise the risks of
infection for health professionals. In this respect, essential
telemedicine services may help safeguard public health in significant ways.3
T
Pressure Ulcers from the Medico‐Legal Perspective: A Case Report and Literature Review
Abstract: Introduction: The identification of professional liability profiles related to the
development of pressure injuries is a very thorny issue from a medico‐legal perspective. This is
because no matter how strict the applied prevention protocols applied may be, the development of
such injuries is largely dependent on endogenous factors. This paper aims to investigate the medicolegal
issues related to this topic through the exposition of one case of medico‐legal litigation and a
traditional review of the literature. Methods: We performed a literature search using three databases
(Pubmed, Scopus, and Web Of Science), restricting the search to the period between 2001 and 2021.
We used “pressure ulcers” and “jurisprudence” as the main keywords. From an initial library of 236
articles, our selection resulted in 12 articles, which were included in the review. Results: We
identified the ever‐increasing expectations of patients and the concept of automatic attribution of
responsibility when a pressure ulcer develops as the primary reasons for the increase in litigation
over the past 20 years. The related corrective measures are numerous: a strict adherence to
guidelines, an adequate documentation of preventive measures, a risk assessment, family
involvement, and a successful collaboration between physicians and government institutions.
Conclusion: The biological complexity of the pathogenetic development of pressure ulcers makes
the subject very delicate from the medico‐legal point of view. In principle, it is possible to state that
a very large proportion of such injuries are preventable, but that there remains a percentage of them
that cannot be prevented. In such cases, only a proper documentary demonstration of the adequacy
of preventive measures can exclude liability profile
Commentary: Tele-COVID-19: Does it improve the provision of health services?
Since the first Coronavirus Disease-19
(COVID-19) outbreak in the urban area of Wuhan
(China) in December 2019, the entire society has
been facing an unprecedented situation posing
several challenges. The declaration of Covid-19
as pandemic by the World Health Organization
(WHO) on March 11, 2020, depicted the necessity
of changes in everyday life management as we
usually intended1
. Due to the lack of an effective
cure, prolonged isolation, restrictive measures,
physical distancing represented the mandatory
emergency measures to contrast, or at least try
to contain, the uncontrolled spread of this dead-
ly disease2
. Several emergency measures were
adopted worldwide by the governments, with
the promulgation of emergency decrees and the
temporary restructuration of the public health
system, to face the resources shortage, especially
in the most affected countries3,4
Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates
Metabolic syndrome (MetS) is a common and complex disorder combining hypertension, obesity, dyslipidemia, and insulin resistance. MetS represents a risk factor for changes in cognitive functions in older age, and several studies have suggested that MetS may be linked to dementia. This article reviews the main evidences about the relationship between MetS and neurodegenerative disease. Starting from an epidemiological point of view, the article analyzes medico-social aspects related to MetS, considering the reduction of work capacity and the condition of disability that it involves. Some authors affirm that on the basis of current Italian legislation, it is possible to consider the syndrome as a disability. This is because all the diseases that make up MetS are high-risk clinical pathological conditions. For these reasons, a joint action is required to contain the incidence of MetS, the high social costs, and the loss of productivity related to the syndrome. In conclusion, healthcare initiatives could be adopted in order to increase the understanding of the pathogenic contributions of each element on MetS and how they can be modified. These actions will be useful to reduce healthcare costs and can lead to more effective prevention of metabolic disease, thus promoting good health.
Abbreviations: MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps
Factors affecting mental health of seafarers on board merchant ships: A systematic review
Merchant ships represent a peculiar working environment with several challenges and risks. The specific situation on board of ships may affect the mental health of seafarers more remarkably than ashore workers. A systematic review of the literature has been carried out to identify the main causes of mood disorders among seafarers and the impact that these disorders have on their health. This review has analyzed the scientific literature published between January 2006 and December 2021 using the search engines PubMed, Web of Science (WoS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Social isolation, distance from families, fatigue, stress and long work shifts represent the main causes of mood disorders among seafarers. Strategies aimed at improving conditions of cohabitation on board, and a greater consideration of these problems are key for improving the mental health of workers at sea. © 202
Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs
GHL is a small molecule and is present in human CN
Long-term care insurance in Italy: medico-legal and socio-economic profiles
Long-term care insurance (LTCI) plays a crucial role in providing substantial aid in non-self-sufficient situations and complementing existing state protection mechanisms. With an aging population and increasing demand for healthcare services LTC policies have become indispensable. While individual LTCI policies face adoption challenges, group insurances offer a more streamlined alternative. However, realizing the full potential of these insurances necessitates targeted legislative intervention to improve accessibility and ensure sustainability. This article explores the evolution of LTCI policies in Italy, offering an overview of the current landscape and highlighting the socio-economic and medico-legal factors shaping the present scenario. By providing this analysis, we seek to offer insights into the dynamic evolution of LTCI policies and the crucial role of legislative measures in enhancing their effectiveness and accessibility
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