Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism

Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data

Ethics and/or aesthetics? reflections on cosmetic surgery for adolescents

Cosmetic surgery entails various ethical issues, even more so in cases involving adolescent patients. Cosmetic surgeons need to take into account how modern societies consider physical appearance an essential component of everyday life, as well as the vulnerability of youths and adolescents. For that reason, it is imperative to thoroughly assess the psychological and emotional states, in addition to the motivations, of minor patients. That goal can be achieved through the use of the DAS-59, (the Derriford Appearance Scale)1 , an effective and dependable tool devised to evaluate the psychological difficulties and distress experienced by people living with problems of appearance. Prior to undergoing cosmetic surgery procedures, adolescents should be required to go through adequate counseling, over multiple sessions and extended to their family members as well, on account of the complex issues inherent in evaluating the risk-benefit ratio and a prospective patient's decision-making capability. A concerted effort on the part of surgeons, psychiatrists or psychologists is key in determining the real motivations behind a minor's decision to opt for cosmetic surgery in the first place. Possible psychiatric conditions may in fact prevent a minor from making a free, informed decision. From an ethical standpoint, cosmetic surgery procedures should be geared to serve the best interest of the minor patient, who may experience distress over his or her body image, from a health and psychological balance perspective and improve his or her social, affective and working life. Besides, cosmetic surgery should not be overly invasive compared to its potential benefits. Those procedures aimed at achieving ″ideal beauty″ are not desirable and ought to be banned. By virtue of such criteria, the authors have set out to evaluate the ethical admissibility of some aesthetic treatments. Thus, doctors should not consent to any request coming from their patients, but rather, intervene only in presence of an objective physical flaw or deformity, e.g. protruding ears, which have a potential to negatively affect social life and interactions

Recent trends in analytical methods to determine new psychoactive substances in hair

New Psychoactive Substances (NPS) belong to several chemical classes, including phenethylamines, piperazines, synthetic cathinones and synthetic cannabinoids. Development and validation of analytical methods for the determination of NPS both in traditional and alternative matrices is of crucial importance to study drug metabolism and to associate consumption to clinical outcomes and eventual intoxication symptoms. Among different biological matrices, hair is the one with the widest time window to investigate drug-related history and demonstrate past intake. The aim of this paper was to overview the trends of the rapidly evolving analytical methods for the determination of NPS in hair and the usefulness of these methods when applied to real cases. A number of rapid and sensitive methods for the determination of NPS in hair matrix has been recently published, most of them using liquid chromatography coupled to mass spectrometry. Hair digestion and subsequent solid phase extraction or liquid-liquid extraction were described as well as extraction in organic solvents. For most of the methods limits of quantification at picogram per milligram hair were obtained. The measured concentrations for most of the NPS in real samples were in the range of picograms of drug per milligram of hair. Interpretation of the results and lack of cut-off values for the discrimination between chronic consumption and occasional use or external contamination are still challenging. Methods for the determination of NPS in hair are continually emerging to include as many NPS as possible due to the great demand for their detection

The reform of the Italian legislation on childhood immunization

Upon the proposal of the Italian government, Law n. 191/2017 has been enacted, meant to considerably raise the number of mandatory vaccinations, while leaving several others merely "recommended" (non-mandatory). Such a reform has proven necessary in light of the latest epidemiologic data reflecting a steady decrease in the rates of immunization coverage in most Italian regions over the past few years, including mandatory vaccinations. Court rulings that held vaccinations may have caused autism, or even a child's death, have probably contributed to decrease in coverage. Early interventions to mandate immunization had been put in place at the regional level, yet the Italian Government and Parliament have opted for a national piece of legislation devised to make mandatory vaccinations a requirement to gain access to the preschool system or day care services. The authors elaborate on the reform's contents and shed a light on the medical, ethical and legal elements underpinning the mandate to immunize children. As a matter of fact, possible risks arising from vaccinations are rare, and largely offset by the benefits to both the children and society at large. On the heels of the reform in question, the doctor-patient relationship is still at the forefront. In fact, citizens need to understand the value and usefulness of non-mandatory, recommended vaccines as well. Therefore, it appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible

Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome

Gamma-hydroxybutyrate (GHB) is a short chain fatty acid endogenously produced within the central nervous system (CNS) and acts as a precursor and metabolite of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Although, it is an illegal recreational drug of abuse, its sodium salt (sodium oxybate) has been utilized as a medication for a number of medical conditions. The first aim of this review was to focus on current applications of sodium oxybate for the treatment of narcolepsy, with a particular emphasis on the key symptoms of this disorder: cataplexy and excessive daytime sleepiness (EDS). Secondly, the effectiveness of sodium oxybate therapy for the treatment of alcohol withdrawal syndrome (AWS) and the maintenance of alcohol abstinence has been assessed. Nowadays, sodium oxybate is the first-line treatment for narcolepsy and it is highly effective in meliorating sleep architecture, decreasing EDS and the frequency of cataplexy attacks in narcoleptic patients. Sodium oxybate currently finds also application in the treatment of AWS and the maintenance of alcohol abstinence in alcoholics. Most of the studies evaluating the efficacy of GHB in the treatment of AWS use a dosage of 50 mg/kg divided in three or four administrations per day. Human studies showed that GHB (dose of 50 mg/kg, divided in three administrations per day) is capable to increase the number of abstinent days, reduce alcohol craving and decrease the number of drinks per day. However, there is limited randomized evidence and, thus, GHB cannot be reliably compared to clomethiazole or benzodiazepines. Some randomized data suggest that GHB is better than naltrexone and disulfiram regarding abstinence maintenance and prevention of craving in the medium term i.e. 3-12 months. It is recommended that GHB should be used only under strict medical supervision, since concerns about the abuse/misuse of the drug and the addiction potential have been arisen

A framework to assess the sustainability of additive manufacturing for spare parts

Additive manufacturing (AM) is a promising technology for the optimization of the spare parts supply chain. A complete evaluation of whether it is advantageous to switch to this technology for spare parts management should include a comprehensive assessment of its sustainability in addition to its techno-economic viability. General analyses of the economic, environmental, and social impacts of AM have been conducted, but assessments of the sustainability effects of AM in the spare parts field is limited to specific industries. Thus, based on the literature, we designed a framework that can support a life cycle evaluation of the emerging application of AM technology. It represents a methodological approach that covers all the stages of the spare parts life cycle and the three dimensions of sustainability. It has been designed to support both researchers and practitioners who are considering AM for the manufacturing of spare parts. Copyright (C) 2022 The Authors

Effects of a delay in feed delivery on behaviour, milk yield and heamatological parameters of dairy cows

This study aimed to evaluate the effects of a delay (at 09:30 instead of 07:30 h) in Total Mixed Ration (TMR) delivery on the behaviour, milk yield, and haematological parameters in dairy cows. Twelve healthy Italian Holstein cows, divided into two homogeneous groups of six each, were involved. The TMR delay was applied either for one (on Tuesday; single delay, SD) or for three consecutive days (Tuesday to Thursday; repeated delay, RD) to one group at a time while the other acted as control. A week of pause was interposed between treatments and the order of the treatment was randomised. Behaviour was observed by instantaneous scan sampling every 2 min during seven half-hour periods on Tuesday and Thursday and blood samples were taken at 14:30 h on these days. Milk yield was recorded daily. Data were analysed by a mixed models for repeated measurements. The delay caused a marked increase in activities towards the feeding rack prior to feeding on day 1 when delay was applied both as SD (P<0.01) and RD (P<0.05). On the third day of delay, pre- and post-meal agonistic behaviour increased in delayed cows (P<0.01). Milk yield and blood parameters were not affected by the delay. Results suggest that a two hours delay in feeding can affect behaviour in cows, increasing behavioural patterns, which may be a sign of mild frustration

Sex- and Gender-Specific Drug Abuse Dynamics: The Need for Tailored Therapeutic Approaches

Sex and gender have been gaining ever greater attention due to their associated risks, dynamics, patterns and protective factors underlying substance abuse and addiction. Such differentiations and the clarification of complexities thereof take on even greater relevance in light of drug abuse scope worldwide. According to the 2022 World Drug Report released by the United Nations Office on Drugs and Crime (UNODC), in 2020 an estimated 284 million people worldwide aged 15–64 had used a drug within the last 12 months. The authors have set out to shed a light on determinants and contributing factors of drug abuse based on sex and gender and outline policy and medicolegal remarks aimed at delineating sex- and gender-based approaches towards drug abuse therapeutic interventions that are both therapeutically and ethically/legally viable and grounded in an evidence-based set of standards. Neurobiological data suggest that estrogen may facilitate drug taking by interacting with reward- and stress-related systems. In animal research, the administration of estrogen increases drug taking and facilitates the acquisition, escalation, and reinstatement of cocaine-seeking behavior. From a medicolegal perspective, it is of utmost importance to take into account the whole picture constituting each patient profile, which certainly includes gender factors and contributors, when outlining a therapeutic approach. Failure to do so could lead to negligence-based malpractice allegations, in light of the scientific findings representing best practices with which clinicians need to comply when caring for SUD patients

Ecotoxicity of Plastics from Informal Waste Electric and Electronic Treatment and Recycling

Plastic materials account for about 20% of waste electrical and electronic equipment (WEEE). The recycling of this plastic fraction is a complex issue, heavily conditioned by the content of harmful additives, such as brominated flame retardants. Thus, the management and reprocessing of WEEE plastics pose environmental and human health concerns, mainly in developing countries, where informal recycling and disposal are practiced. The objective of this study was twofold. Firstly, it aimed to investigate some of the available options described in the literature for the re-use of WEEE plastic scraps in construction materials, a promising recycling route in the developing countries. Moreover, it presents an evaluation of the impact of these available end-of-life scenarios on the environment by means of the life cycle assessment (LCA) approach. In order to consider worker health and human and ecological risks, the LCA analysis focuses on ecotoxicity more than on climate change. The LCA evaluation confirmed that the plastic re-use in the construction sector has a lower toxicity impact on the environment and human health than common landfilling and incineration practices. It also shows that the unregulated handling and dismantling activities, as well as the re-use practices, contribute significantly to the impact of WEEE plastic treatments

Episiotomy: an informed consent proposal

Purpose: Since every obstetric surgical procedure requires gaining informed consent from patient, we have set out to evaluate whether such requirement also applies to episiotomy. Material and methods: To that end, we have conducted a thorough search of relevant scientific literature on multidisciplinary databases (Scopus, PubMed, PubMed, Central, Research Gate, Google Scholar) and articles that were published from 1989 to March 2019. The search keys used were: "episiotomy," "informed consent," "complications," "malpractice." Results: The sources that we have ultimately drawn upon, whilst acknowledging the need for a targeted informed consent for episiotomy, do not deal with the specifics of what such consent should include, in terms of information provided and related aspects. Therefore, the authors have laid out an episiotomy-targeted consent form, drawing upon opinions and indications from scientific societies and institutions, in order to properly reflect and document the patient's acceptance or refusal of the procedure. Conclusions: Valid consent documentation may well prove instrumental in staving off or reducing complications, malpractice and liability, and in order to safeguard health care operators from obstetric malpractice allegations