Social Aspects of Dementia Prevention from a Worldwide to National Perspective: A Review on the International Situation and the Example of Italy

At the moment, dementia is affecting around 47 million people worldwide, with a forecast amount of 135 million affected people in 2050. Dementia is a growing health concern worldwide with no treatment currently available, but only symptomatic medication. Effective interventions in the prevention and management of dementia are urgently needed to contain direct and indirect costs of this disease. Indeed, the economic impact of dementia is a vast and continually growing figure, but it is still difficult to quantify. Due to an increase in both the disease spreading and its direct and indirect costs, national and international action plans have to be implemented. As a virtuous example, the Italian national plan for dementia has been summarized. Faced with an increasingly less sustainable disease impact at national and international levels, the plan suggests that it is certainly the entire welfare model that should be rethought, strengthening the network of services and providing interventions to support affected people and their caregivers. Alongside this synergistic approach, scientific research could play a crucial role for pharmacological and nonpharmacological treatments capable of delaying the state of loss of self-sufficiency of the patient, with a significant impact on social and health costs

Editors' Introduction

That swing of the pendulum, with which our time was represented, (Heller 1990), and which either moves forwards denying "what has been" or nostalgically back to the past and therefore eager to recover what has been broken, seems to perpetuate itself in the most sensitive beings. When exhausted by the endless and incessant struggle between what is fleeting and what remains, they take refuge in the  kingdom  of "high culture" (Heller 1999) in order to find a stable home in which to shelter themselves from the uncertainty of these continuous oscillations (Costanzo 2007)..

Comment on "The static evolution of the new Italian code of medical ethics"

The manuscript by Montanari Vergallo et al. appears primarily important because it resubmits the discussion on the relationshi between law and ethica norm in medical practice, as being responsible for promoting professional conduct or slowing it down and depriving it of its meaning

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

The National Ethics Committee: a truly valuable asset for clinical trials?

Advances in biomedicine, increased patient autonomy, and higher average life expectancy, have contributed to raising a multitude of questions relating to Clinical Ethics. Though these aspects stand on their own, national or community-level legislation that is unable to meet Ethical demands, or satisfies them only partially, it will never be able to satisfy aims and interests of a rapidly changing society. The Ethical protection of the individual in the context of life and health has been entrusted to independent, impartial bodies: Territorial Ethics Committees. In 2015, Minacori et al1 posed the following question: Research Ethics Committees and clinical research in Italy: where are we going? After analyzing the Italian legislation regulating Ethics Committees and their practices, the authors noted that though the November 2012 Law had harmonized Territorial Ethical Committee activities at a national level, it neglected to address certain critical points such as the differing deadlines by which the Committees were required to present their opinions, and the drastic reduction of the Committees themselves which had, in fact, hampered their activity. What’s more, problems arose from the need for Committee members to receive specific training2 and delays in presenting opinions in research institutes extraneous to those in which the Ethical issue had originally arisen

Telemedicine as a Strategic Tool to Enhance the Effectiveness of Care Processes: Technological and Regulatory Evolution over the Past Two Decades

Digital innovation represents one of the largest areas of investment in healthcare. The application of technologies pertaining to the ever-evolving infrastructure of information and communication technology (ICT) aims to making the many processes and services related to healthcare delivery more effective and efficient. In the complex and articulated panorama of e-health, telemedicine certainly represents one of the key strategic tools to support and improve numerous care processes. For many of these processes, distance is a critical factor for access to care. For this reason, e-health has become the subject of numerous interventions and initiatives by international policies for decades now

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

Medical assistance at the sea: legal and medico-legal problems

Background: In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship’s captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship’s captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations. Responsibility of the ship captain: In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient’s condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices. Responsibility of the physician: The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship’s captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision. Conclusions: The ship’s captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated

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