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Scognamiglio P, Morena D, Di Fazio N, Delogu G, Iniziato V, La Pia S, Saviano P, Frati P, Fineschi V. Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability. Front Psychiatry 2023; 14:1244101. [PMID: 37663598 PMCID: PMC10469623 DOI: 10.3389/fpsyt.2023.1244101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Due to recent events, professional liability for psychiatrists in Italy is currently a matter of lively debate. Specifically, overwhelming pressure on psychiatrists' duties has been brought by regulatory developments, such as the closure of forensic psychiatric hospitals, with the consequent return of offenders to community-based care, and the mental health consequences of the pandemic. According to Italian courts, psychiatrists are not only responsible for diagnostic and therapeutic appropriateness but also for the effects of their interventions on patients, and their behaviors. The aim of this study was to explore the attitude and behaviors of Italian psychiatrists regarding defensive medicine and professional liability. A total sample of 254 psychiatrists was surveyed by means of a quantitative online questionnaire. Most psychiatrists reported practicing defensive medicine (no. 153/254, 60.2%) and felt that their position of guarantee compromised their work in healthcare for patients (no. 138/253, 54.3%). Age correlated inversely with acknowledgment of defensive practices (r = -0.245, p < 0.001), with younger physicians more prone to defensive medicine (p = 0.013), particularly for patients at risk of suicide or violence. Psychiatrists in 'closed' settings (hospital wards, residential and rehabilitation centers, mental health service units in prison) reported more malpractice claims (p = 0.037) and complaints (p = 0.031), as well as a greater propensity to act defensively. In the treatment of patients with violent behavior, suicidal ideation, dual diagnoses, and criminal convictions, defensive practices were associated more with perceived legal risks (r = 0.306, p < 0.001) than actual legal involvement (p > 0.05). Anxiety, anger, and restlessness were common reactions to legal complaints, involving no. 50/254 (19.7%) respondents, with 40% reporting impaired functioning. Most psychiatrists (no. 175/253, 68.9%) were concerned about both civil and criminal laws regarding their professional responsibility, but many were not fully informed about recent legislative regulations and younger physicians resulted scarcely trained in risk management (p < 0.001). In conclusion, our findings suggest that defensive medicine is a common phenomenon among psychiatrists and their position of guarantee drives this attitude. Education on legal implications and risk management should be provided starting from the university and continuing over time, to improve the knowledge of young and senior doctors on professional liability and inform their decision-making processes. This would also reduce defensive practices and improve the quality of healthcare. Considering the concerns of younger physicians, as well as of professionals working in acute and high-intensity medical care facilities, there is also an urgent need for a revision of the medical liability to ensure the sustainability of the National Health Service.
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Affiliation(s)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Silvestro La Pia
- Department of Mental Health, ASL Napoli 3 Sud, Torre del Greco, Italy
| | - Pasquale Saviano
- Department of Mental Health, ASL Napoli 3 Sud, Torre del Greco, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Candido G, Cascini F, Lachman P, La Regina M, Parretti C, Valentini V, Tartaglia R. Effects of the Italian Law on Patient Safety and Health Professional Responsibilities Five Years after Its Approval by the Italian Parliament. Healthcare (Basel) 2023; 11:1858. [PMID: 37444691 DOI: 10.3390/healthcare11131858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The application of the Italian law No. 24/2017, which focused on patient safety and medical liability, in the Italian National Health Service has been evaluated by a survey conducted five years after the promulgation of the law. The law required the establishment of healthcare risk management and patient safety centers in all Italian regions and the appointment of a Clinical Risk Manager (CRM) in all Italian public and private healthcare facilities. This study demonstrates that five years after the approval of the law, it has not yet been fully implemented. The survey revealed a lack of adequate permanent staff in all the Regional Centers, with two employees on average per Center. Few meetings were held with the Regional Healthcare System decision-makers with less than four meetings per year. This reduces the capacity to carry out functions. In addition, the role of the CRMs is weak in most healthcare facilities. More than 20% of CRMs have other roles in the same organization. Some important tasks have reduced application, e.g., assessment of the inappropriateness risk (reported only by 35.3% of CRM) and use of patient safety indicators for monitoring hospitals (20.6% of CRM). The function of the Regional Centers during the COVID-19 pandemic was limited despite the CRMs being very committed. The CRMs units undertake limited research and have reduced collaboration with citizen associations. Despite most of the CRMs believing that the law has had an important role in improving patient safety, 70% of them identified clinicians' resistance to change and lack of funding dedicated to implementing the law as the main barriers to the management of risk.
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Affiliation(s)
- Giuseppe Candido
- Department of Engineering Sciences, Guglielmo Marconi University, 00193 Rome, Italy
| | - Fidelia Cascini
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Peter Lachman
- Department of Quality Improvement, Royal College of Physicians of Ireland, D02 X266 Dublin, Ireland
| | - Micaela La Regina
- S.C. Clinical Governance and Risk Management, Ligurian Health and Social Care Company 5, Via Fazio 30, 19121 La Spezia, Italy
| | - Chiara Parretti
- Department of Engineering Sciences, Guglielmo Marconi University, 00193 Rome, Italy
| | | | - Riccardo Tartaglia
- Department of Engineering Sciences, Guglielmo Marconi University, 00193 Rome, Italy
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Di Fazio N, Scopetti M, Delogu G, La Russa R, Foti F, Grassi VM, Vetrugno G, De Micco F, De Benedictis A, Tambone V, Rinaldi R, Frati P, Fineschi V. Analysis of Medico-Legal Complaint Data: A Retrospective Study of Three Large Italian University Hospitals. Healthcare (Basel) 2023; 11:healthcare11101406. [PMID: 37239691 DOI: 10.3390/healthcare11101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Identifying hospital-related critical, and excellent, areas represents the main goal of this paper, in both a national and local setting. Information was collected and organized for an internal company's reports, regarding civil litigation that has been affecting the hospital, to relate the obtained results with the phenomenon of medical malpractice on a national scale. This is for the development of targeted improvement strategies, and for investing available resources in a proficient way. (2) Methods: In the present study, data from claims management in Umberto I General Hospital, Agostino Gemelli University Hospital Foundation and Campus Bio-Medico University Hospital Foundation, from 2013 to 2020 were collected. A total of 2098 files were examined, and a set of 13 outcome indicators in the assessment of "quality of care" was proposed. (3) Results: From the total number, only 779 records (37.1%) were attributable to the categories indexable for the present analysis. This data highlights how, following a correct and rigorous categorization of hospital events, it is possible to analyze these medico-legal aspects using a small number of indicators. Furthermore, it is important to consider how a consistent percentage of remaining events was difficult to index, and was also of poor scientific interest. (4) Conclusions: The proposed indicators do not require standards to be compared to, but provide a useful instrument for comparative purposes. In fact, in addition to comparative assessment between different business realities distributed throughout the territory, the use of outcome indicators allows for a longitudinal analysis evaluating the performance of an individual structure over time.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Federica Foti
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo M Grassi
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
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Vetrugno G, Foti F, Grassi VM, De-Giorgio F, Cambieri A, Ghisellini R, Clemente F, Marchese L, Sabatelli G, Delogu G, Frati P, Fineschi V. Malpractice Claims and Incident Reporting: Two Faces of the Same Coin? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316253. [PMID: 36498327 PMCID: PMC9739332 DOI: 10.3390/ijerph192316253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 05/27/2023]
Abstract
Incident reporting is an important method to identify risks because learning from the reports is crucial in developing and implementing effective improvements. A medical malpractice claims analysis is an important tool in any case. Both incident reports and claims show cases of damage caused to patients, despite incident reporting comprising near misses, cases where no event occurred and no-harm events. We therefore compare the two worlds to assess whether they are similar or definitively different. From 1 January 2014 to 31 December 2021, the claims database of Policlinico Universitario A. Gemelli IRCCS collected 843 claims. From 1 January 2020 to 31 December 2021, the incident-reporting database collected 1919 events. In order to compare the two, we used IBNR calculation, usually adopted by the insurance industry to determine loss to a company and to evaluate the real number of adverse events that occurred. Indeed, the number of reported adverse events almost overlapped with the total number of events, which is indicative that incurred-but-not-reported events are practically irrelevant. The distribution of damage events reported as claims in the period from 1 January 2020 to 31 December 2021 and related to incidents that occurred in the months of the same period, grouped by quarter, was then compared with the distribution of damage events reported as adverse events and sentinel events in the same period, grouped by quarter. The analysis of the claims database showed that the claims trend is slightly decreasing. However, the analysis of the reports database showed that, in the period 2020-2021, the reports trend was increasing. In our study, the comparison of the two, malpractice claims and incident reporting, documented many differences and weak areas of overlap. Nevertheless, this contribution represents the first attempt to compare the two and new studies focusing on single types of adverse events are, therefore, desirable.
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Affiliation(s)
- Giuseppe Vetrugno
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Federica Foti
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Vincenzo M. Grassi
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Fabio De-Giorgio
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Andrea Cambieri
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | | | - Francesco Clemente
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Luca Marchese
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Giuseppe Sabatelli
- Responsabile Centro Regionale Rischio Clinico Regione Lazio, 00145 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
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Yeung AWK, Kletecka-Pulker M, Klager E, Eibensteiner F, Doppler K, El-Kerdi A, Willschke H, Völkl-Kernstock S, Atanasov AG. Patient Safety and Legal Regulations: A Total-Scale Analysis of the Scientific Literature. J Patient Saf 2022; 18:e1116-e1123. [PMID: 35617635 DOI: 10.1097/pts.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to quantitatively analyze the scientific literature landscape covering legal regulations of patient safety. METHODS This retrospective bibliometric analysis queried Web of Science database to identify relevant publications. The identified scientific literature was quantitatively evaluated to reveal prevailing study themes, contributing journals, countries, institutions, and authors, as well as citation patterns. RESULTS The identified 1295 publications had a mean of 13.8 citations per publication and an h-index of 57. Approximately 78.8% of them were published since 2010, with the United States being the top contributor and having the greatest publication growth. A total of 79.2% (n = 1025) of the publications were original articles, and 12.5% (n = 162) were reviews. The top authors (by number of publications published on the topic) were based in the United States and Spain and formed 3 collaboration clusters. The top institutions by number of published articles were mainly based in the United States and United Kingdom, with Harvard University being on top. Internal medicine, surgery, and nursing were the most recurring clinical disciplines. Among 4 distinct approaches to improve patient safety, reforms of the liability system (n = 91) were most frequently covered, followed by new forms of regulation (n = 73), increasing transparency (n = 67), and financial incentives (n = 38). CONCLUSIONS Approximately 78.8% of the publications on patient safety and its legal implications were published since 2010, and the United States was the top contributor. Approximately 79.2% of the publications were original articles, whereas 12.5% were reviews. Healthcare sciences services was the most recurring journal category, with internal medicine, surgery, and nursing being the most recurring clinical disciplines. Key relevant laws around the globe were identified from the literature set, with some examples highlighted from the United States, Germany, Italy, France, Sweden, Poland, and Indonesia. Our findings highlight the evolving nature and the diversity of legislative regulations at international scale and underline the importance of healthcare workers to be aware of the development and latest advancement in this field and to understand that different requirements are established in different jurisdictions so as to safeguard the necessary standards of patient safety.
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Affiliation(s)
| | | | - Elisabeth Klager
- From the Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBIDHPS), Medical University of Vienna, Vienna, Austria
| | | | - Klara Doppler
- From the Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBIDHPS), Medical University of Vienna, Vienna, Austria
| | - Amer El-Kerdi
- From the Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBIDHPS), Medical University of Vienna, Vienna, Austria
| | | | - Sabine Völkl-Kernstock
- From the Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBIDHPS), Medical University of Vienna, Vienna, Austria
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La Russa R, Fazio V, Ferrara M, Di Fazio N, Viola RV, Piras G, Ciano G, Micheletta F, Frati P. Proactive Risk Assessment Through Failure Mode and Effect Analysis (FMEA) for Haemodialysis Facilities: A Pilot Project. Front Public Health 2022; 10:823680. [PMID: 35400067 PMCID: PMC8987154 DOI: 10.3389/fpubh.2022.823680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Haemodialysis (HD) is one of the methods for renal replacement therapy in the management of advanced chronic kidney disease through an osmosis process that allows purification of blood in the dialysis machine. The complexity of the dialytic procedure often requires the presence of a multi-specialist, multi-disciplinary team. The dialysis process is an important target for clinical risk management. Failure Mode and Effect Analysis (FMEA) is a proactive technique, considered a purposeful and dynamic tool for clinical risk management. FMEA is noted in five phases that allow a preliminary assessment of a definite process through identification and classification of risk priorities. This study represents the first of a two-phase project where FMEA is applied to HD in the setting of San Feliciano Hospital. The dialysis center performs ~12,000 dialysis sessions per year. The dialysis process is divided into different stages. A total of 31 failure modes were identified in the whole dialysis stages; more than 2/3 of the failure modes were related to the only connecting of the patient to the dialysis machine. The first phase of the study clearly remarked that the most critical step of the dialytic process is represented by the connection between the patient and the machine, as expected. Indeed, in order to have the dialysis set up, an arteriovenous fistula must be surgically created prior to the procedure and it is one of the most important issues in the HD process because of the necessity of a constant revision of it. FMEA application to HD is a useful tool, easy to be implemented and it is likely to nimbly reveal the practical and potential solutions to the critical steps of the procedure.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Valentina Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Michela Ferrara
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Nicola Di Fazio
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Piras
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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Tattoli L, Santovito D, Raciti IM, Scarmozzino A, Di Vella G. Risk Assessment and Management for Potential Living Kidney Donors: The Role of “Third-Party” Commission. Front Public Health 2022; 10:824048. [PMID: 35372186 PMCID: PMC8968079 DOI: 10.3389/fpubh.2022.824048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical “third party”, completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital “Città della Salute e della Scienza” of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the “Third-Party” Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.
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Affiliation(s)
- Lucia Tattoli
- Section of Legal Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- *Correspondence: Lucia Tattoli
| | - Davide Santovito
- Section of Legal Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ida Marina Raciti
- Clinical Risk Management Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Scarmozzino
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giancarlo Di Vella
- Legal Medicine Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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BOLCATO M, SANAVIO M, FASSINA G, RODRIGUEZ D, APRILE A. Organizational liability: new frontier of medical malpractice? Seventeen-year experience as a medico-legal observer. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Di Fazio N, Delogu G, Ciallella C, Padovano M, Spadazzi F, Frati P, Fineschi V. State-of-Art in the Age Determination of Venous Thromboembolism: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122397. [PMID: 34943633 PMCID: PMC8700147 DOI: 10.3390/diagnostics11122397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), requires a forensic age determination to ascertain their causal relationship with recent events, such as trauma or medical treatment. The main objective of this systematic review is to identify the current state-of-the-art immunohistochemical methods for age determination of fatal VTE. A literature search was performed through different databases, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Within the study, we have selected only cases represented by deceased patients for DVT and/or PTE in which thromboembolic material was collected during an autoptic examination and then subjected to a histological and an immunohistochemical investigation. Studies based on animal models were not included. We assessed bias risk. A database-based search produced a total of 19 articles. After excluding duplicate items from the selection, 14 articles were reviewed. Ten articles were excluded because they did not meet the inclusion criteria. The results have pointed out 4 studies that were included in the present analysis for a total of 157 samples of DVT and 171 PTE samples. These were analyzed using traditional histological and immunohistochemical techniques. The results must be interpreted with a critical eye because of their heterogeneity in terms of time, geography, and study design. The present review highlights the importance of associating specific immunohistochemical markers with a histological analysis for the timing of DVT/PTE fatal events. Further future experiences will hopefully endorse actual knowledge on the subject to increase the accuracy in the assessment of thrombus-embolus age.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
| | - Federica Spadazzi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (C.C.); (M.P.); (F.S.); (P.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-0649912722
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Organizational Strategies for the Management of Intravenous Iron Therapy in Non-Hospitalized Settings: A Safe Opportunity to Implement Patient Blood Management in Italy. Healthcare (Basel) 2021; 9:healthcare9091222. [PMID: 34574994 PMCID: PMC8467602 DOI: 10.3390/healthcare9091222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 01/25/2023] Open
Abstract
This article analyzes the recommendations issued by the Emilia Romagna region in July 2020 on “Organizational strategies for the safe management of intravenous iron therapy in patients in non-hospitalized settings”. The objective of these recommendations is to set up safe intravenous iron administration sites outside the hospital environment across the national territory. The document facilitates the organization of methods for intravenous iron infusion that are safe for the patient and correct from a medico-legal perspective. In addition, it opens the way for the widespread use of iron infusion in the field, providing benefits to patient quality of life. This program prevents unnecessary transfusions, reduces costs, prevents overcrowding in hospitals in the event of a pandemic, and enables patient treatment in the field, thus, saving on the use of personnel.
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Fineschi V, Arcangeli M, Di Fazio N, Del Fante Z, Fineschi B, Santoro P, Frati P. Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians. Healthcare (Basel) 2021; 9:healthcare9091097. [PMID: 34574870 PMCID: PMC8472348 DOI: 10.3390/healthcare9091097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was administered through a mail-list including 600 gynecological specialists (of these 168 doctors completed the test), both in public and private settings. It was made of twenty multiple choice questions, concerning their awareness about the practice of defensive medicine and the planning and execution of CS. All doctors involved received clear and complete information about the purpose of this study and about the organizations that received their answers. Analyses of variance and regression were performed to describe differences between groups and to estimate the relationships between variables. The value of p < 0.5 was considered statistically relevant. Results: our analysis revealed that most respondents are confident with the defensive medicine definition and characteristics. This survey confirmed that gynecologists fear legal actions promoted by their patients and therefore modulate their choices by implementing professional behaviors of so-called “defensive medicine”. This relates to a greater number of medical liability judgements, which more often concern omission or delayed execution of cesarean section, rather than unskillful surgical procedures. Conclusions: there are few data to support a relation between the high rate of CS and defensive medicine. Numerous scientific studies associated this CS rate with the phenomenon of defensive medicine. This practice is constantly growing in all medical areas, especially in high-risk specialties such as obstetrics and gynecology. Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice, affecting the choice of the type of delivery to be performed.
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Affiliation(s)
- Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (N.D.F.); (Z.D.F.); (P.S.); (P.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-0649912722
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (N.D.F.); (Z.D.F.); (P.S.); (P.F.)
| | - Zoe Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (N.D.F.); (Z.D.F.); (P.S.); (P.F.)
| | | | - Paola Santoro
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (N.D.F.); (Z.D.F.); (P.S.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (N.D.F.); (Z.D.F.); (P.S.); (P.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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12
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Toccafondi G, Dagliana G, Fineschi V, Frati P, Tartaglia R. Proactive Risk Assessment through FMEA of Home Parenteral Nutrition Care Processes: A Survey Analysis. Curr Pharm Biotechnol 2021; 22:433-441. [PMID: 32532191 DOI: 10.2174/1389201021666200612171943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/14/2020] [Accepted: 05/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Home Parenteral Nutrition (HPN) is a lifesaving clinical care process. However, undetected hazards and vulnerabilities in care transitions from hospital to community care may pose risk to patient's safety. Avoidable complications and adverse events may hinder the benefits of treatment. OBJECTIVE The analysis carried out aims at framing through Human Factors and Ergonomics (HF/E) the critical issues for patient safety related to clinical care practices for HPN in healthcare organization. METHODS We present the results of a proactive risk assessment analysis based on the FMEA methodology (Failure Mode and Effects Analysis) carried out in three different areas of the regional health care system of Tuscany, Italy. The clinical risk management and patient safety unit assessed the risk perception of Healthcare Workers (HWs) in regard to patient safety and situational awareness throughout the HPN patient journey. RESULTS The analysis revealed heterogeneity in the Risk Priority Index (RPI) expressed by HWs. A lower RPI is associated with a HPN process that deploys in continuity between hospital care and community care. A higher RPI is associated with a quality and safety improvement process that is still ongoing. We also observed HWs expressing low RPI in the areas of the region where HPN has a hospital- focused approach and has limited adherence to patient safety requirements. Low RPI for HPN process may relate both to extensively deployed continuity of care and to jeopardized awareness on HPN phases and coordination. The analysis carried out enabled the definition of a common HPN workflow used as reference schema allowing for the definition of a set of recommendations for improving the quality and safety of the care processes. Moreover, the outcome of the proactive risk assessment laid the groundwork for the advancement of the patient safety regional requirements. CONCLUSION The analysis had the role of promoting the contextualization of the culture of quality and safety within the HPN process resulting in an improved awareness of the criticalities and the role of nutrition units throughout the care process.
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Affiliation(s)
- Giulio Toccafondi
- Centre for Clinical Risk Management and Patient Safety Tuscany Region, Florence, Italy
| | - Giulia Dagliana
- Centre for Clinical Risk Management and Patient Safety Tuscany Region, Florence, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Riccardo Tartaglia
- Centre for Clinical Risk Management and Patient Safety Tuscany Region, Florence, Italy
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13
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La Russa R, Viola RV, D’Errico S, Aromatario M, Maiese A, Anibaldi P, Napoli C, Frati P, Fineschi V. Analysis of Inadequacies in Hospital Care through Medical Liability Litigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073425. [PMID: 33806174 PMCID: PMC8037280 DOI: 10.3390/ijerph18073425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/08/2023]
Abstract
Over the past two decades, health litigation has followed an exponentially incremental trend. As insurance companies tend to limit their interest because of the high risk of loss, health facilities increasingly need to internalize dispute management. This study was conducted through a retrospective analysis of existing files concerning the civil litigation of the Sant’Andrea Hospital in Rome. All claims from 1 June 2010 to 30 June 2019 were included. Paid claims were further classified according to the areas of health care inappropriateness found. Authors indexed 567 different claims along the study period, with an average number of 59 per year (range 38–77). The total litigation involved 47 different units; more than 40% concerned 5 high-incidence wards or services. Concerning the course of disputes, 91 cases were liquidated before a judicial procedure was instituted, while 177 cases landed in a civil court. Globally, 131 different claims hesitated in compensation, for a total of 16 million 625 thousand euros, 41% of which was related to the internal medicine area. Dealing with the inappropriateness analysis, clinical performance alone involved 76 cases, for a total of 10 million 320 thousand euros, while organization defects involved 20 disputes equivalent to 1 million 788 thousand euros. The aim of this study was to enhance the clinical risk management at our facility through a litigation analysis.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
| | - Stefano D’Errico
- Department of Medicine, Surgery and Health, University of Trieste, Strada di Fiume 44, 34149 Trieste, Italy;
| | - Mariarosaria Aromatario
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (M.A.); (P.A.); (C.N.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Ospedale Santa Chiara, Via Roma 55, 56126 Pisa, Italy;
| | - Paolo Anibaldi
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (M.A.); (P.A.); (C.N.)
| | - Christian Napoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (M.A.); (P.A.); (C.N.)
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
- Correspondence: ; Tel.: +39-0649-912-722
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14
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Bolcato M, Trabucco Aurilio M, Di Mizio G, Piccioni A, Feola A, Bonsignore A, Tettamanti C, Ciliberti R, Rodriguez D, Aprile A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052484. [PMID: 33802378 PMCID: PMC7967622 DOI: 10.3390/ijerph18052484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
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Affiliation(s)
- Matteo Bolcato
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Marco Trabucco Aurilio
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
| | - Anna Aprile
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
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Ferracuti S, Barchielli B, Napoli C, Fineschi V, Mandarelli G. Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective. Int J Psychiatry Clin Pract 2020; 24:245-249. [PMID: 32362180 DOI: 10.1080/13651501.2020.1759647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation.Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 (n = 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations.Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk.Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.KEY POINTSProcedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.Standards in suicide risk evaluations are needed.Comparison between procedures can improve risk assessment and evaluation.
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Affiliation(s)
- Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Rome, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy
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16
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Patient blood management implementation in light of new Italian laws on patient's safety. Transfus Apher Sci 2020; 59:102811. [DOI: 10.1016/j.transci.2020.102811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 01/26/2023]
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17
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Fineschi V. Healthcare-Associated Infections: Antibiotic Poly-therapies, Antibiotic Prophylaxis and Appropriate Policy for the Risk Management to Fight Adverse Events. Curr Pharm Biotechnol 2020; 20:606-608. [PMID: 31592746 DOI: 10.2174/138920102008190716152314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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18
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Turillazzi E, Toni C, Turco S, Di Paolo M. Finding the Victim of Abuse: A New Frontier of Physicians' Liability? Data From a Local Italian Experience on Minor Maltreatment. Front Pediatr 2020; 8:309. [PMID: 32637388 PMCID: PMC7316952 DOI: 10.3389/fped.2020.00309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/21/2022] Open
Abstract
Violence toward minors is a widespread phenomenon and effective programs are desperately needed to prevent it. Data from the literature showed that underreporting child/adolescents abuse has become a widespread phenomenon, exposing minors to additional harm from further potentially dangerous situations. It is proved that systematic screening and standardized procedures for minors presenting at emergency departments with the suspicion of abuse might increase the detection rate, reducing the risk of underreporting. In Italy a system of mandatory reporting is in place, and it is considered to be crucial in detecting abuse and preventing further harm to children. In this paper we report our experience with a regional (Tuscany) project named "Codice Rosa" (Pink code) introduced in 2014 with the aim to treat and protect the most vulnerable bracket of the population. We present data concerning the access of minors for suspected abuse at the emergency room of the local hospital, focusing on a case of omitted diagnosis leading to further violence episodes. According to our experience, since the introduction of the "Pink Code" there have been 43 cases of reported child abuse, with an increasing trend throughout these years (from 1 reported event in 2015 to 16 reported events in 2018). Despite the limited number of our population, the increasing trend in the reported events was particularly evident for bullying cases (n = 0 in 2015; n = 4 in 2018). Despite data are still limited, the procedure proved effective in preventing child abuse, though it could still be implemented. Minor abuse and maltreatment are important health issue globally which can lead to significant physical and psychological morbidity. Implementing knowledge of healthcare professionals on how to deal with child abuse and introducing educational programs on recognition, treatment and report of child abuse is mandatory not only to prevent missing diagnosis of child and minor maltreatment, but also to reduce the risk of professional liability on different bases.
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Affiliation(s)
- Emanuela Turillazzi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Toni
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sara Turco
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Marco Di Paolo
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Gallelli L, Cione E, Peltrone F, Siviglia S, Verano A, Chirchiglia D, Zampogna S, Guidetti V, Sammartino L, Montana A, Caroleo MC, De Sarro G, Di Mizio G. Hsa-miR-34a-5p and hsa-miR-375 as Biomarkers for Monitoring the Effects of Drug Treatment for Migraine Pain in Children and Adolescents: A Pilot Study. J Clin Med 2019; 8:jcm8070928. [PMID: 31252698 PMCID: PMC6679182 DOI: 10.3390/jcm8070928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRs) have emerged as biomarkers of migraine disease in both adults and children. In this study we evaluated the expression of hsa-miR-34a-5p and hsa-miR-375 in serum and saliva of young subjects (age 11 ± 3.467 years) with migraine without aura (MWA), while some underwent pharmacological treatment, and healthy young subjects were used as controls. miRs were determined using the qRT-PCR method, and gene targets of hsa-miR-34a-5p and hsa-miR-375 linked to pain-migraine were found by in silico analysis. qRT-PCR revealed comparable levels of hsa-miRs in both blood and saliva. Higher expression of hsa-miR-34a-5p and hsa-miR-375 was detected in saliva of untreated MWAs compared to healthy subjects (hsa-miR-34a-5p: p < 0.05; hsa-miR-375 p < 0.01). Furthermore, in MWA treated subjects, a significant decrease of hsa-miR-34a-5p and of hsa-miR-375 was documented in saliva and blood compared to MWA untreated ones. Altogether, these findings suggested thathsa-miR-34a-5p and hsa-miR-375 are expressed equally in blood and saliva and that they could be a useful biomarker of disease and of drug efficacy in patients with MWA.
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Affiliation(s)
- Luca Gallelli
- Department of Health Sciences, University of Magna Graecia, 88100 Catanzaro CZ, Italy.
| | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, 87036 Arcavacata, Rende CS, Italy
| | - Fancesco Peltrone
- Operative Unit of Pediatric diseases, Pugliese Ciaccio Hospital, 88100 Catanzaro CZ, Italy
| | - Serena Siviglia
- Department of Health Sciences, University of Magna Graecia, 88100 Catanzaro CZ, Italy
| | - Antonio Verano
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, 87036 Arcavacata, Rende CS, Italy
| | - Domenico Chirchiglia
- Department of Neurosurgery, University of Catanzaro, Campus Germaneto, 88100 Catanzaro CZ, Italy
| | - Stefania Zampogna
- Operative Unit of Pediatric diseases, Pugliese Ciaccio Hospital, 88100 Catanzaro CZ, Italy
| | - Vincenzo Guidetti
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, "Sapienza" University, 00185, Rome RM, Italy
| | | | - Angelo Montana
- Department of Medical Science, Surgical Science and advanced Technologies "G.F, Ingrassia", University of Catania, 95124 Catania CT, Italy
| | - Maria Cristina Caroleo
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, 87036 Arcavacata, Rende CS, Italy
| | | | - Giulio Di Mizio
- Department of Medical Science, Surgical Science and advanced Technologies "G.F, Ingrassia", University of Catania, 95124 Catania CT, Italy.
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Gallelli L, Michniewicz A, Cione E, Squillace A, Colosimo M, Pelaia C, Fazio A, Zampogna S, Peltrone F, Iannacchero R, Sarro GD, Working Group GAS, Salerno M, Di Mizio G. 25-Hydroxy Vitamin D Detection Using Different Analytic Methods in Patients with Migraine. J Clin Med 2019; 8:jcm8060895. [PMID: 31234518 PMCID: PMC6617382 DOI: 10.3390/jcm8060895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/19/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the performance of different analytic methods, such as liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), high-performance liquid chromatography-ultraviolet (HPLC-UV), enzyme-linked immunosorbent assay (EIA), and chemiluminescence immunoassays (CLIA), in order to highlight whether or not there is relative superiority amongst the assays. We analyzed two groups of subjects suffering from headache and two groups of healthy subjects. Design and Methods: We performed a prospective, single-blind single-center control-group study on 220 subjects with migraine. Subjects of both sexes >10 years old and with 12 months’ history of migraine were eligible for the study. As a control group, 120 healthy subjects were chosen by their family physician. Results: LC-MS/MS evaluation documented that in all enrolled subjects (migraine and control groups), the serum vitamin D3 levels were lower with respect to the normal range (30–100 ng/mL), with a mean value of 15.4 ng/mL, without difference between sex. The mean values measured using HPLC-UV, EIA, and CLIA tests such as Liaison® and Architect® did not show significant differences compared to the values obtained using LC-MS/MS. Conclusions: In conclusion, the population generally has low values of the vitamin D3 hormone, and the suggested range should probably be revised. HPLC-UV and CLIA were found to have appropriate analytical values compared to the reference method (LC-MS/MS), so it is possible to suggest their routine use to optimize care.
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Affiliation(s)
- Luca Gallelli
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - Andzelika Michniewicz
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende Cosenza, Italy.
| | - Aida Squillace
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - Manuela Colosimo
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - Corrado Pelaia
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - Alessia Fazio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende Cosenza, Italy.
| | - Stefania Zampogna
- Department of Pediatry, "Pugliese-Ciaccio" Hospital, 88100 Catanzaro, Italy.
| | - Francesco Peltrone
- Department of Pediatry, "Pugliese-Ciaccio" Hospital, 88100 Catanzaro, Italy.
| | - Rosario Iannacchero
- Department of Neurology, "Pugliese-Ciaccio" Hospital, 88100 Catanzaro, Italy.
| | - Giovambattista De Sarro
- Department of Health Science University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, Italy.
| | - G Amp Sp Working Group
- G&SP Working Group enclosed: Giuseppe Giuliano, Giacomo Leuzzi, Antonio Scuteri, Antonio Guerra, and Francesco Corasaniti (Azienda Sanitaria Provinciale, 88100 Catanzaro, Italy), Piero Vasapollo (Azienda Sanitaria Provinciale, 88900 Crotone, Italy), Vincenzo Natale and Nazareno Brissa (Azienda Sanitaria Provinciale, 89900 Vibo Valentia, Italy)
| | - Monica Salerno
- Forensic Medicine, Department of Medical Science, Surgical Science and advanced Technologies "G.F. Ingrassia", University of Catania, 95124 Catania, Italy.
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
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