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Promuovere il coinvolgimento dei pazienti per migliorare la sicurezza in chirurgia
Background: Patient safety has become essential with increasing complexity of health systems and the consequent increase in patient damage. Clinical risk management aims to prevent and reduce the risks, errors and damages that occur to patients during health care. The direct involvement of patients in care pathways can be both an important source of information on potential risks and a resource for improving safety. Objective: To improve patient safety in surgery by promoting the active involvement of patients admitted to an orthopedic department. Method: After check-in, a checklist was administered to the patients, consisting of 21 items that took into consideration the good practices to be applied in surgery. The checklists returned by the patients at the end of their stay were analyzed to identify any areas for improvement. Results: From July 2019 to September 2019, the checklists were administered to 76 patients who underwent hip or knee arthroplasty, admitted to an orthopedic ward. 63% of the delivered checklists were returned by the patients. The analysis made it possible to verify that good practices for safety in surgery are effectively applied by health personnel. However, some critical areas were identified on which to intervene with improvement actions. Conclusions: This work demonstrates that patient involvement can help improve the safety of the surgical path, in order to prevent potential adverse events. Further studies are needed with sufficient sample power to validate the findings of this work.
Limitazione della responsabilità sanitaria in tempi di emergenza da COVID-19
[Abstract non presente. Si riporta l'inizio dell'editoriale] Nell’odierno contesto storico, gravato da un’emergenza sanitaria senza precedenti, ci si domanda sotto quali forme la responsabilità medica debba essere inquadrata e quali siano le singole responsabilità che possano essere addebitate all’esercente la professione sanitaria, di cui all’art. 7 della legge 8 marzo 2017, n. 24, e alla struttura sanitaria...
La valutazione medico-legale delle ipoacusie in ambito assistenziale (invalidità civile e sordità civile) e previdenziale INPS
The authors address the issue of hearing loss assessment for civil incapacity and INPS social security disability benefits. The purpose of this work is to compile an easy-to-use handbook for the public and for doctors unfamiliar with legal medicine who need to address the complex issue of performing a medical-legal assessment of hearing loss for INPS social security disability and civil incapacity. General practitioners often incorrectly fill out INPS online application forms to obtain subsidies from Local Health Authorities (ASL / ASP) for the purchase of hearing aids for entitled citizens recognised as legally disabled due to loss of hearing. Frequently, instead of «civil incapacity», doctors select the term «legal deafness», introduced in 2006 as the legislative definition for deaf-mute individuals, i.e. persons with congenital deafness or hearing impairments acquired during childhood that have affected the normal learning of speech.
Responsabilità civile del medico: responsabilità da inadempimento o probatio diabolica? Il punto di vista della III Sezione Civile della Corte di Cassazione nella sentenza n° 12264 del 30.05.2014.
[Medical Liability: liability by frustration or probatio diabolica? The point of view of the3rd Civil Section of the Supreme Court in the judgment n. 12264 of the 30.05.2014] The Authors analyze, under a judicial and medico-legal profile, the judgment n. 12264 of the 30.05.2014 of the 3rd Civil Section of the Supreme Court. In this judgment, they examine the omissive behavior by a physician of an ASL who, for the entire length of the pregnancy and having performed the proper diagnostic tests, failed to notice foetal malformations which resulted in birth defects such as agenesis of two fingers and femoral hypoplasia. The verdict brought a new criterion for distributing the evidential responsibilities of the concerning parties, the expecting mother and the physician, establishing that «it’s the accusing party’s responsibility to allege and demonstrate, if in fact informed of the malformations of the conceived foetus, she would have interrupted the pregnancy, since such proof can’t be deduced only by the fact of requesting to be subjected to examinations with the purpose to verify the existence of eventual foetal anomalies».
La valutazione della disabilità ai fini del riconoscimento dell’indennità di accompagnamento nel soggetto ultra-sessantasettenne
Older people, the fastest growing part of population, are at the highest risk of acquired disability or cognitive decline and, as a consequence, their claim to receive support services, among which the Attendance Allowance for permanent personal assistance, is increasing. This benefit was introduced in the Italian Civil Incapacity system with the law 18/1980 and some relevant innovations were added with the Law 508/1988 and the Decree 509/1988. From a medico-legal point of view, these regulations, define on the one hand the necessary requirements to get a pension (non-contributory), that is physical and or mental disease determining the incapacity for work and, for infra-18 and over-65-year olds, require the “persistent difficulties” to carry out the “tasks and activities” proper to their age. On the other hand, the Law n. 508/1988 identifies also the necessary conditions to get the Attendance Allowance, for those who are unable to get around and/or are unable to carry out daily life activities without the permanent help of a caregiver. Therefore, these regulations specifically provide, first of all, the recognition of the highest level of severity of the “persistent difficulties” concerning the “tasks” and “activities” of the over 65s (prerequisites) and then the judgment for the Attendance Allowance. However, there are considerable difficulties with the assessment of this kind of disability. In fact, we have specific references about incapacity for work indicating the evaluation path and the guide for the rating of permanent impairment (Ministerial Decree 5 February 1992), but there aren’t specific normative and assessment indications about the ability to perform “tasks and activities” in over-65-year-olds (age requirement has become over 67s since January 2019) which allows the risk of a wide evaluating discretion. Italian institutions, like Ministry of Health or INPS (Italian Institute of Social Security) and others officially involved, have attempted to explain and clarify the above-mentioned rating process, but with unsatisfactory results and in some cases even with regressive ones, producing real distortions and interpretative stretches. The author, therefore, after presenting the medico-legal issues for the evaluation of older adults’ disability based on the current regulations, also criticizes the widely found practice of using an atypical, not multidisciplinary, comprehensive geriatric assessment made only for this purpose and elaborate by a single specialist. In fact, the results of a geriatric assessment, like any other Health Certification, is useful to complete the medical history of the subject alleging disability and, therefore, it must be validated by a proper and extensive medico-legal evaluation.
Evoluzione metodologica dell’invalidità civile in Italia: confronto ragionato tra i sistemi valutativi tabellari, di legge e non, che si sono succeduti negli anni
The authors describe the evolution from 1980 to the present of the tables that describe invalidating states, on which the medical-legal judgments of civil disability in Italy are based. The first part of the work briefly describes the main disabilities, grouped by both body system and percentage value range, that can be found in the tables attached to the main documents applied, or applicable, to the sector: those issued alongside the Ministerial Decree n. 282 of 1980, those that accompanied the Ministerial Decree of February 1982 (still in force today) and those proposed by the Italian Institute of Social Security (INPS) in 2012, which have not yet entered into force. The second part of the paper has two aims. On the one hand, it seeks to underline the change in the pre-eminent type of disability featured in the tables: from osteoarticular diseases, which were the most significant type in the 1980 tables, to neoplastic diseases, which are the most prevalent overall in the 2012 tables. On the other hand, the authors highlight that the tables themselves have evolved, moving towards a more precise definition (both clinical and instrumental) of the organ damage causing the reduction in general working capacity. In the 1980 tables, disability was often evaluated empirically rather than based on the use of functional indices or systematic classification. In the 2012 INPS proposed tables, evaluations of the reduction in working capacity are often based on specific functional parameters for the various organs (EF for the heart, FEV1 for the respiratory system, GFR for the urinary system) or on standardized disability evaluation scales (NYHA classes for heart diseases, EDSS or the Hoehn & Yahr classification for neurological disorders, MMSE or CDR for dementia, the Child-Pugh classification for cirrhogenic hepatopathies).
Il PDTA-HIV nella gestione del paziente cronicizzato: una proposta di documento condiviso
[Clinical / care pathways in the management of the chronically ill patient with HIV: proposal for a shared document] Abstract non presente. Si riporta l'inizio dell'editoriale La malattia HIV/AIDS ha visto nell’ultimo periodo un radicale cambiamento nelle prospettive di vita delle persone HIV+ e con esso il delinearsi di uno scenario del tutto differente rispetto alle loro esigenze ed aspettative...
Morire di contenzione: riflessioni di deontologia e di infermieristica legale sulla vicenda di Francesco Mastrogiovanni
Talking about physical containment, in a nursing framework, means exploring a particular world, with many “I would like, but I can not”, that often speaks us about the moral and professional distress of the team involved in the “containment process”, because this, in fact, limits the freedom of the assisted person. And this limit of rights, jarring with nursing values, often represents a perceived “necessary pain” in different nursing settings. Organizational asphyxia, lack of motivation about change, ineffective leadership, knowledge deficits, lack of role identities and awareness are often promoters of incessant dangerous conditions, which turn procedures from “necessary pain” into real crimes. Francesco Mastrogiovanni’s story is, unfortunately, the proven evidence that the malign and uncritical customs have dramatic consequences
"Malasanità": breve osservazione a proposito di un singolare quesito posto ai Consulenti Tecnici d’Ufficio in un caso di accertamento tecnico preventivo ex art. 8 della cosiddetta Legge Gelli-Bianco
["Malasanità": brief observation on a singular question posed to Technical Consultants in a case of prior technical assessment pursuant to art. 8 of the so-called Legge Gelli-Bianco] Abstract non presente. Si riporta l'inizio dell'editoriale Nel luglio del 2018 il Giudice di un Tribunale riceveva istanza di accertamento tecnico preventivo ex art. 8 della cosiddetta Legge Gelli Bianco (Legge n. 24/2017) [1], che, come è noto, impone, a chi voglia esercitare di fronte al Giudice «un’azione risarcitoria derivante da responsabilità sanitaria, di tentare prima un percorso negoziale al fine di verificare la possibilità di evitare il processo» [2]. Nel caso in questione, il Giudice adíto, ai Consulenti Tecnici d’Ufficio (CTU) nominati poneva il seguente quesito: «Accertare l’entità delle lesioni e postumi permanenti residuate al signor XY a seguito della mala sanità, il nesso di causa tra le lesioni lamentate e l’operato dei sanitari Usl, nonché la congruità delle spese mediche, la necessità di spese mediche future in modo da addivenire ad una composizione della lite».
Profili di responsabilità infermieristica in un caso di amputazione dell’avambraccio da errata pratica infusionale in neonato prematuro
[Nursing responsibility profiles in a case of forearm amputation by wrong infusion practice in a premature newborn] This article refers to the case of a premature newborn twin (23 weeks of gestation + 6). Of the two brothers, only one survived, in a highly compromised state of health that led to a notable and dramatic series of clinical events: infectious complications, chronic renal failure, viscera herniation, intestinal perforation, and thrombocytopenia, treated with various infusions of platelet concentrates. During an infusion of platelet concentrate, an extravasation occurred with important tissue infarction. The lesion created, secondary to ischemic necrosis, evolves into dry necrosis, from the hand to the whole forearm, and leads to the amputation of the right forearm, despite the various attempts, pharmacological and surgical, experienced to avoid the extrema ratio. The purpose of this article is to analyze what happened considering scientific clinical evidence and the profile of responsibilities related to nursing practice.
La mediazione trasformativa nell’era della patient revolution. Un modello per la gestione del rischio clinico e legale nelle ASL italiane
[Transformative mediation in the era of the patient revolution. A model for the management of clinical and legal risk in Italian health facilities] Nowadays, too many patients do not perceive that their doctors are exclusively dedicated to care them. This is probably because current health systems are too focused on physicians and diseases, rather than on patients. Such systems are also expensive, fragmented, inefficient and often cynical, generating not only the anger but also the willingness to bring legal claims from many patients. Many scholars, in fact, claim that "too much medicine" can bring more harm than good to the patients and to the health systems themselves, therefore promoting a more sober and respectful medicine. This is the vision of the "patient revolution" and the idea that inspires some other movements that aim to break the vicious circle of greed and cynicism that damages not only patients but also health professionals. Within the same vicious circle, an exponential increase in litigations takes place, as an additional negative effect of the system focused on the disease and on the doctors instead of on the patient. In the present article, we assume that a greater participation of the patient in the choices concerning his/her own health is the fertile ground in which concrete solutions can be found to many problems arising from the current medicine. We therefore analyze the main advantages of active patient participation, which in turn generate a reduction in health conflicts. Based on this analysis, we propose a model in which through various approaches, tools and methods - starting from the upstream prevention of the conflicts - we can also manage them downstream, for the benefit of both patients and health professionals. Finally, we show that within this framework, transformative mediation is an essential approach for weakening many legal disputes and repairing the relational damage generated upstream, where communication has failed or is completely lacking in the clinical practice.
Compiti e funzioni del medico competente e modalità di svolgimento della professione alla luce della legislazione vigente
[The competent physician for the assessment of risks at work: tasks, functions and conduct in the light of current legislation] Abstract non presente. Si riporta l'inizio dell'editoriale Nella normativa italiana già con il Regio Decreto 530 del 1927 all’art. 6 viene introdotta la figura del medico di fabbrica, e precisato che nelle lavorazioni industriali nelle quali si adoperino o si producano sostanze tossiche o infettanti indicate in un apposito elenco i lavoratori dovranno essere visitati da un medico competente...
Sicurezza in sala operatoria: utilizzo della tecnica FMEA/FMECA nel percorso diagnostico pre-analitico del campione biologico dalle sale operatorie ai laboratori
[Safety in the operating room: use of the FMEA/FMECA proactive analysis technique in the pre-analytical diagnostic pathway of the biological sample from the operating room to laboratories] The inaccurate management of biological samples is one of the errors that can occur in the operating room: it can lead to a loss, incorrect labeling or storage of the sample, causing serious consequences for the patient. Proactive analysis of this high-risk process can reduce the possibility of this type of errors, improving patient safety and reliability of activities. A risk analysis technique employing proactive logic is the Failure and Effects Analysis/ Failure Mode, Effects, and Criticality Analysis (FMEA/FMECA). This paper describes an inter-professional and inter-facility project in which the FMEA / FMECA has been applied to the biological sample path from the operating room to the destination laboratories in two healthcare facilities in Bologna: the University Hospital S. Orsola Malpighi (AOU BO) and the Rizzoli Orthopedic Institute (IRCCS IOR). The aim of the project was to improve the safety and the reliability of the routine and urgent diagnostic procedure in these healthcare facilities. Two different working groups, belonging to the two healthcare facilities and composed of operating room doctors and nurses, have implemented the methodological steps of the FMEA/FMECA technique. At the end of the analysis process, 16 failure mode (FM) were identified at the AOU BO and 21 at the IRCCS IOR. Each FM was assigned a risk priority index (RPI) and the main causes and improvement actions to be planned were identified. Interventions were therefore undertaken to improve the safety and reliability of the riskiest welfare practices. A re-evaluation of the RPIs at 6 months-1 year from the improvement interventions will be carried out. The FMEA / FMECA technique gave the opportunity to the professionals involved to approach the adverse event through a new approach, which is the proactive method of risk analysis, using methods and tools for the improvement of patient safety that are independent, at least in part, from the study of the adverse event or near miss, representing an important step towards a real culture of security.
Failure Mode and Effects Analysis/Failure Mode
Nel merito dei rapporti medico legali vigenti tra le assicurazioni sociali: la gestione della malattia, la surrogazione e il cumulo tra prestazioni previdenziali nella loro concreta applicazione.
The article looks at the relationships between the two main Italian Social Security Insurance Institutes: the National Institute of Social Security (INPS) and the National Institute for Insurance against Accidents at Work (INAIL). The aim of the article, resulting from the daily working practices of the two Authors, is to examine the various sectors in which the two institutions are often confronted: the management of compensable illness, the subrogation, and the cases of accumulation of social security benefits provided by the two institutions for disabled persons. Some practical examples are reported in order to facilitate the reader the easy understanding of the issues addressed.
National Institute of Social Security (INPS)
National Institute for Insurance against Accidents at Work (INAIL)
Accumulation of social security benefits
Una nuova relazione europea analizza il rischio correlato ai tumori professionali
[A new European report analyzes the risks related to occupational cancer] Abstract non presente. Si riporta l'inizio dell'editoriale Il 4 febbraio 2015 è stata celebrata la giornata mondiale contro il cancro, e in questa occasione l’Agenzia europea per la sicurezza e la salute sul lavoro (EU-OSH) ha diffuso la sua relazione sui tumori lavoro-correlati, che rappresentano ancora un importante problema di salute in tutta Europa, e non solo, soprattutto in relazione all’esposizione dei lavoratori a sostanze cancerogene.
European Agency for Safety and Health at Work (EU-OSH)
Primo bilancio del Paediatric Committee dell’EMA sulle nuove procedure per lo sviluppo di medicinali ad uso pediatrico
[First assessment of the Paediatric Committee of the EMA on new procedures for the development of medicinal products for pediatric use] Abstract non disponibile. Si riportano di seguito le parti iniziali dell'articolo: Nel 2012 il Paediatric Committee (PDCO) dell’European Medicines Agency (EMA) ha reso noto un primo bilancio dell’attività a 5 anni dall’entrata in vigore del Regolamento pediatrico, che predisponeva una serie di nuovi adempimenti a carico delle aziende farmaceutiche, con l’obiettivo di migliorare la disponibilità di dati e studi clinici sui medicinali ad uso pediatrico.
Open Access: un nuovo modello di comunicazione per “Pratica Medica & Aspetti Legali”
[Open Access: a new communication model for "Pratica Medica & Aspetti Legali"] Abstract non presente. Si riporta l'inizio dell'editoriale: Negli ultimi 20 anni, il mondo delle riviste scientifiche ha attraversato una vera e propria rivoluzione, resa possibile, e necessaria, da una parte dall’emergere e dall’affermarsi della rete Internet e, dall’altra, dalla crisi del modello tradizionale basato sull’accesso esclusivo alle riviste tramite abbonamenti, divenuti troppo gravosi economicamente per le università e le biblioteche pubbliche [...]
Alcuni primi rilievi di interesse medico legale in merito alla Legge n. 24 del 2017 sulla responsabilità sanitaria
[Some early reliefs of legal medical interest regarding Law no. 24 of 2017 on healthcare liability] In this paper, the author describes the new Italian law (law n. 24/2017) about health care security and health professionals liability. This law states that the rule of heath professionals is strictly regulated by evidence-based clinical practice guidelines or similar recommendations. Nevertheless, the new law tends to impose to the hospital and health and social care structures (public and private) a strict liability for the health professionals fault. Health professionals liability insurance coverage is assured by health and social care structures. Reducing litigation costs through alternative and mandatory dispute resolution process is the most important target of this law.
La malattia comune nei lavoratori agli albori di un cambiamento epocale: l'INPS quale gestore unico della malattia indennizzabile
The article looks at the history of medical inspection visits in Italy, and describes in detail, the regulations that have been passed over the years relating to the management and control of common compensable illnesses: in the private sector, which has always been run by the National Institute for Social Security (INPS) which manages the system using its own "listed" occupational health physicians; and in the department of public administration which, until August 2017, saw management entrusted to the same public administrations with the help of medical staff from the Local Health Authority (so called Aziende Sanitarie Locali - ASL), who were operating in the capacity of official medical inspectors. As of 1 September 2017, in accordance with Legislative Decree No. 75 of 27 May 2017, the INPS will conduct all management and inspection of compensable common illnesses, in both the private and the public sectors. A nascent "single official medical inspection center" is thus taking its first insecure steps, against a backdrop of organizational uncertainties and the recognition of an increased workload for an entity which, for many years, has handled invalidity support in Italy.
INPS (Italian National Institute for Social Security)
La tutela previdenziale della tubercolosi extra-lavorativa: sorpassati concetti medico-legali a fondamenta delle indennità per una malattia ancora in auge
The Author briefly summaries the legislative history of Italian social security cover for extra-occupational tuberculosis, and lists the economic benefits that the National Institute of Social Security (INPS) reserves for the individuals who are insured with it and suffer from this disease, describing both the administrative and health requirements. Thus, the publication attempts to place the purely conceptual medical-legal aspects on which social security for extra-occupational tuberculosis is based under the microscope of rational criticism; in this way, the medical and legal foundations for the prevalence of morbidity are examined, to reveal the anachronistic principles of a protection that, with current changes in social, geopolitical and labour dynamics, remains based on laws from the 1930s and 1970s, and the principles they expressed.
INPS (Italian National Institute of Social Security)
L’anagrafe dell’handicap della Provincia autonoma di Trento: aggiornamento dei dati al 31 dicembre 2016
[The register of the handicap of the Autonomous Province of Trento: updating the data as of December 31, 2016] The Authors, examining the Italian welfare system and the contents of Law 104/92 (“Framework Law for assistance, social integration, and rights of the handicapped”), present a statistical analysis of the handicap database in Province of Trento. The Law 104/92 aims, among others, at guaranteeing the respect for human dignity, as well as the rights to freedom and autonomy of persons with disabilities, while promoting their integration in families, schools, work and society; preventing and removing negative conditions that stop the human development, the highest possible level of autonomy and participation in social life, as well as the enjoyment of civil, political and patrimonial rights; achieving a functional and social rehabilitation of people with physical and sensory impairment, while ensuring adequate services and prevention, care and rehabilitation measures, as well as a legal and economic protection; preparing adequate initiatives to overcome marginalization and social exclusion.
Il concetto medico legale di lavoro usurante in ambito previdenziale: corretta applicabilità nella pratica valutativa presso i Centri Medico Legali (CML) INPS.
[The medico-legal concept of «arduous work» in the social security medicine and its proper application in evaluation practices among the medico-legal departments (CML) of the Italian national welfare institute (INPS)] Some work categories are considered difficult for the effort they need, thus requiring a specific categorization. These work categories are defined as “arduous”. The article describes the recognition for certain job categories of the arduous status in the evaluation practice among the medico legal departments (Centri Medico Legali – CML) of the Italian national welfare institute (Istituto Nazionale della Previdenza Sociale – INPS). Frequently, the adjective “arduous” is attributed to work categories that are not defined in that way by the physicians of the INPS Institute, by the family doctors who draw up the medico legal certificates (the so called “SS3” certificates) and by the doctors who work at the so called “Patronato”, an Italian social organization which offers medical and legal services to all citizens. The article aims to define the working activities for which it is suitable to use the categorization “arduous” and highlight at the same time those work categories for which such a categorization is not always applicable. This research describes some cases observed by our medico legal department of the incorrect use of the categorization “arduous” for work activities that should not be considered as such. The purpose of the article is to provide a short guide to family doctors and physicians who work at “Patronato” on how to properly categorize a work as “arduous” in the context of the social security medicine.
Informatizzazione della checklist per la sicurezza in sala operatoria e i risultati raggiunti presso l'Istituto Ortopedico Rizzoli di Bologna
[Computerization of the checklist in the operating room safety and the results achieved at the Rizzoli Orthopaedic Institute in Bologna] Since 2010, the Rizzoli Orthopaedic Institute in Bologna has joined the project of the Emilia-Romagna «Project SOS.net: Network operating theaters safe», adopting the surgical safety checklist regional in hard copy from three surgical units. Over the years, the adoption of the checklist has been extended to all surgical units, thanks to the computerization of the same: at the Institute had in fact been initiated a process of computerization of operating rooms, which also included the introduction/editing tools for the management of clinical risk in the operating room. This change has allowed not only to integrate computationally the moment of verification, by means of the surgical safety checklist regional, with the detection of deviations from the expected standard but also to be able to have specific reporting in real time. These implementations have been accompanied by appropriate training and organizational interventions, bringing the level of adherence to the instrument until it reaches almost 100%.
Comunicazione sanitaria e social media: rischi e opportunità
[Healthcare communication and social media: risks and opportunities] Social networks represent one of the most common ways of communication in the world. Learning its wise use, and knowing the alphabet, it is one of the essential steps to be pursued with greater tenacity in health, because of the risks and benefits that these powerful tools offer. Social media have become a powerful vehicle that you have to learn to drive carefully, otherwise it could get out of hand with all the attendant risks. The risks are civil, penal, ethical, and are widely considered in the public administration codes of conduct. Still in Italy there is no trace of social networks in the codes of ethics of the health professions, however there are a number of references to the benefits that are derived from the well-set communication.
L’introduzione della legge 41/2016 in tema di omicidio e di lesioni personali stradali: aspetti medico-legali e analisi della giurisprudenza
[The introduction of the law 41/2016 on vehicular homicide and road traffic injuries: medical-legal issues and analysis of case law] The law n. 41/2016 has recently introduced, into the Italian penal code, articles n. 589-bis and 590-bis that concern vehicular homicide and road traffic personal injuries. Although this leads to a tightening of the penalties, today a lot of criticities still remains; in particular, the assessment of the psychophysical condition of the driver and relative applying procedures. These problematic issues have already been highlighted under a medico-legal perspective and today emerge also from an acquittal or conviction sentences that, arising from equivalent evidences, are interpreted in divergent or even antithetical ways.
La sicurezza del paziente in ambiente ospedaliero e la responsabilità professionale dei vertici strategici
[Patient safety in the hospital setting and the professional responsibilities of top managers] The authors underline the evolution of legislation concerning the creation of Hospital Companies and the reasons for the implementation of clinical risk management activities, then analyse the responsibilities involving the top figures of the top hospital management. In particular, the authors highlight the obligation and responsibilities of the strategic apex of a Hospital Company and show that, sometimes, the technical consultants – who express a medical-legal advice – underestimate the responsibility of these figures. It is a management responsibility that determines the obvious and inevitable consequences on those who work in contact with the patient and who bear the obligations and responsibilities. In some cases, the responsibility of the top figures is indisputable and obvious, but there is no awareness about the possibility of the top management involvement within the assessment evaluation.
Valenza umana della cura (care) dei pazienti in SVP e ruolo dei caregivers
[Human value of care and caregivers' role in the management of permanent vegetative state (SVP) patients] As stated by the Royal College of Physicians, «patients who remain in a vegetative or minimally conscious state following profound brain injury present a complex array of clinical and ethical challenges to those who care for them». Patients in clinical condition of Permanent Vegetative State (SVP) are unaware of self and environment, enable of language comprehension or expression; they are able to survive along provided that we are able to ensure primary care, such as eating and hydration. With regard to this existential landmark, caregiver’s role is not only legally related, as guardian of will of his/her relative but also as “mediator” between the SVP patient and heath care professionals; in fact, the caregiver emphasizes the intentionality of patient behaviors, transforming them into care needing. Moreover, since the disease does not only indicate an impairment of one or more functions of an organ, and then the body, but also covers the mind, then the psyche, the sick body reflects in this way the soul’s suffering and this suffering has an impact on family caregivers.
L’infortunio psichico da causa lavorativa
[Psychological work-related injury] In Italy the recognition of the occupational injury, caused by acute damage to the mental health of the worker, is still difficult and exceptional. The study points out the clinical case of a worker, recently published, that in the scientific literature is probably, to date, the only event of psychic damage related to work in which an occupational cause has been found and the recognition of an accident at work has been done. A worker, after a verbal, animated dispute with some colleagues and superiors, had an acute psychiatric agitation attack and went to the nearest emergency room where, on the strength of the anamnesis, the physicians diagnosed an anxiety crisis reactive to the work environment. The worker has been off work for 110 days because of an anxious and depressive syndrome, due to the verbal conflict. In a later assessment, INAIL recognized only the first 30 days of the employee’s time off as injury at work, while judging the following period off work as related to affectivity disturbance due to common disease, not related to work environment. This case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to put more attention to psychiatric health of workers.
La dignità come dotazione della persona demente
[The dignity as an endowment of the person with dementia] The author analyzes the practical dimensions of human dignity, starting from its various representations and constituent elements. In particular, the author relates the human dignity with dementigene diseases that affect the biographical identity of the person and are a real testing ground in the daily clinical practice. The article presents the rights of the person with dementia that, taken together, give to dignity a clear expressive face, and consistent with the various multilevel order and with professional medical ethics.
Nutrizione oggi: nuove tendenze, vecchi principi?
[Nutrition Today: new trends, old principles?] Abstract non presente. Si riporta l'inizio dell'editoriale La vasta diffusione di teorie e pratiche nutrizionali, sbandierate come il futuro ormai prossimo, capaci di modificare radicalmente alcuni paradigmi consolidati, ovvero certezze che sembravano inossidabili, oltre che gli approcci terapeutici tradizionali, ha gettato nella massima confusione professionisti, pazienti e popolazione generale, creando aspettative irrealistiche che spesso rasentano l’illusione di poter curare patologie complesse con interventi singoli e semplificati.