1
|
Etemady M, Hajizadeh M, Gidaszewski B, Swain JA, Chua SC, Khajehei M. Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure. World J Obstet Gynecol 2023; 12:33-44. [DOI: 10.5317/wjog.v12.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.
Collapse
Affiliation(s)
- Mike Etemady
- School of Health Sciences, University of Sydney, Sydney, Australia, Sydney 2000, NSW, Australia
| | - Melika Hajizadeh
- Stotts College, Acknowledge Education, Sydney 2000, NSW, Australia
| | - Beata Gidaszewski
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
| | - Julie Ann Swain
- Women's and Newborn Health, Westmead hospital, Westmead 2145, NSW, Australia
| | - Seng Chai Chua
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Clinical School, Western Sydney University, Sydney 2145, NSW, Australia
| | - Marjan Khajehei
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney 2145, NSW, Australia
| |
Collapse
|
2
|
Isbister JP, Pearse BL, Delaforce AS, Farmer SL. Patients' Choice, Consent, and Ethics in Patient Blood Management. Anesth Analg 2022; 135:489-500. [PMID: 35977359 DOI: 10.1213/ane.0000000000006105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The goal of patient blood management (PBM) is to optimize clinical outcomes for individual patients by managing their blood as a precious and unique resource to be safeguarded and managed judiciously. A corollary to successful PBM is the minimization or avoidance of blood transfusion and stewardship of donated blood. The first is achieved by a multidisciplinary approach with personalized management plans shared and decided on with the patient or their substitute. It follows that the physician-patient relationship is an integral component of medical practice and the fundamental link between patient and doctor based on trust and honest communication. Central to PBM is accurate and timely diagnosis based on sound physiology and pathophysiology as the bedrock on which scientifically based medicine is founded. PBM in all disease contexts starts with the questions, "What is the status of the patient's blood?" "If there are specific abnormalities in the blood, how should they be managed?" and "If allogeneic blood transfusion is considered, is there no reasonable alternative therapy?" There are compelling scientific reasons to implement a nontransfusion default position when there is clinical uncertainty and questionable evidence of clinical efficacy for allogeneic blood transfusion due to known potential hazards. Patients must be informed of their diagnosis, the nature, severity and prognosis of the disease, and treatment options along with risks and benefits. They should be involved in decision-making regarding their management. However, as part of this process, there are multifaceted medical, legal, ethical, and economic issues, encompassing shared decision-making, patient choice, and informed consent. Furthermore, variability in patient circumstances and preferences, the complexity of medical science, and the workings of health care systems in which consent takes place can be bewildering, not only for the patient but also for clinicians obtaining consent. Adding "patient" to the concept of blood management differentiates it from "donor" blood management to avoid confusion and the perception that PBM is a specific medical intervention. Personalized PBM is tailoring the PBM to the specific characteristics of each patient. With this approach, there should be no difficulty addressing the informed consent and ethical aspects of PBM. Patients can usually be reassured that there is nothing out of order with their blood, in which case the focus of PBM is to keep it that way. In some circumstances, a hematologist may be involved as a patient's blood advocate when abnormalities require expert involvement while the primary disease is being managed.
Collapse
Affiliation(s)
- James P Isbister
- From the Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bronwyn L Pearse
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Departments of Surgery, Anaesthesia and Critical Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alana S Delaforce
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.,Mater Research Institute-UQ, South Brisbane, Queensland, Australia
| | - Shannon L Farmer
- Discipline of Surgery, Medical School, The University of Western Australia, Perth, Western Australia.,Department of Haematology, Royal Perth Hospital, Perth, Western Australia
| |
Collapse
|
3
|
The Impact on Healthcare Workers of Italian Law n. 24/2017 “Gelli–Bianco” on Patient Safety and Medical Liability: A National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148448. [PMID: 35886299 PMCID: PMC9318787 DOI: 10.3390/ijerph19148448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023]
Abstract
Italian “Gelli–Bianco” law (law n. 24 enacted by the Italian Government on 8 March 2017) introduced innovative changes and regulations regarding patient safety and healthcare workers’ (HCWs) liability. We promoted a national survey to evaluate the effect of the law on HCWs. The questionnaire was edited and distributed using the free online tool “Google Forms” (Google LLC). The mode of administration chosen for the questionnaire was telematic self-completion. In particular, the questionnaire was sent to several portals of information, websites, in the scientific and medical sectors. Four hundred forty-five subjects participated in the survey. The differences in categorical variables for Gelli–Bianco Law reading with professional variables were analyzed in a univariate analysis using the Chi-square test and Fisher’s exact test. Reading the law is significantly and positively related to knowledge and communication of adverse events and sentinel events, checklist adoption, and participation in educational activities on risk management. The law’s implementation and promotion is a reliable educational tool for increasing patient safety culture and involving HCWs in risk management activities. Knowledge of the law, related education, and understanding of its application are still inadequate; therefore, educational programs regarding patient safety, risk management, and the contents of the law itself must be vigorously promoted to achieve clinical governance goals.
Collapse
|
4
|
Fiore V, Rastrelli E, Madeddu G, Ranieri R, De Vito A, Giuliani R, Di Mizio G, Bolcato M, De Matteis G, Ialungo AM, Dell'Isola S, Starnini G, Babudieri S. HCV spread among female incarcerated population and treatment pathways to viral elimination in Italian prison settings: clinical perspectives and medico legal aspects. BMC Infect Dis 2022; 22:601. [PMID: 35799126 PMCID: PMC9264562 DOI: 10.1186/s12879-022-07565-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is more frequent among incarcerated people than in general population. In the DAAs era, the short schedules and the low risk of adverse reactions, increased the number of HCV treatments. However, the most part of literature reports lack of incarcerated women inclusion in studies on field. Our aim is to assess the screening execution, HCV prevalence, and DAAs treatment among incarcerated women. A focused insight on quick vs standard diagnosis and staging approach will be also provided.
Methods Incarcerated women from 4 Italian regions’ penitentiary institutes were included. HCV screening was executed with HCV saliva test (QuickOral Test®) or phlebotomy. Stage of liver fibrosis was evaluated with FIB-4 value or fibroscan®, based on physicians’ decision. Treatment prescription followed national protocols. Results We included 156 women, 89 (57%) were Italian, mean age was 41 ± 10 years, and 28 (17.9%) were people who inject drugs (PWIDs). Overall, the HCV seroprevalence was 20.5%. Being PWID and on opioid substitution therapy (OST) were significantly associated with serological status (p-value < 0.001). Of them, the 75.5% of patients had active infection, the most frequent genotype was 3a (50%). Among them, 4 (16.6%) and 6 (25%) had psychosis or alcohol abuse history. The 62.5%, 25% and 12.5% had low, intermediate, and advanced fibrosis, respectively. Out of the 24 HCV-RNA positive patients, the 75% underwent to DAAs treatment. The sustained virological response (SVR12) was achieved in 88.8% of cases. When evaluating the influence of quick diagnosis and staging methods vs standard phlebotomy and fibroscan® on SVR12, FIB-4 use showed higher performance for retainment in treatment during prison staying (p = 0.015), while the use of quick saliva test had no influence on the outcome (p = 0.22). Conclusion HCV seroprevalence and active infections are very high among incarcerated women. More tailored interventions should be focused on HCV diagnosis and treatment in female prison population. The use of quick staging methods (FIB-4) is useful to increase SVR12 achievement without delays caused by the fibroscan® awaiting.
Collapse
Affiliation(s)
- Vito Fiore
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy.
| | - Elena Rastrelli
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giordano Madeddu
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Roberto Ranieri
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea De Vito
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Ruggero Giuliani
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Magna Graecia, University of Catanzaro, Catanzaro, Italy
| | - Matteo Bolcato
- Legal Medicine, University of Padua, 35121, Padova, Italy
| | - Giuseppe De Matteis
- Health Protection for Adults and Youth Unit, Penitentiary Institute, Salerno, Italy
| | - Anna Maria Ialungo
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Serena Dell'Isola
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giulio Starnini
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| |
Collapse
|
5
|
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]
|
6
|
Health in Prison: Does Penitentiary Medicine in Italy Still Exist? Healthcare (Basel) 2021; 9:healthcare9111511. [PMID: 34828555 PMCID: PMC8624787 DOI: 10.3390/healthcare9111511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the detailed legislative developments that have occurred within the context of prison medicine in Italy, problems of a management nature continue to affect prisoner health and management, which in turn impact the prison system’s ability to offer prisoners a real opportunity for rehabilitation. Certain behavioral aspects reported in prisons may alter and negatively impact the normal doctor-patient relationship, including elements that hinder the therapeutic alliance and impede proper clinical risk prevention and management. However, practical steps may be taken in connection with the analysis of flows and healthcare services that may enable prison administrations to bring about a true, modern restructure of the prison system.
Collapse
|
7
|
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.
Collapse
|
8
|
Beverina I, Aloni A, Brando B. Impact of gender parity on preoperative anaemia prevalence and Patient Blood Management practice. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:396-402. [PMID: 33196412 PMCID: PMC8486601 DOI: 10.2450/2020.0158-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anaemia is a common finding in the preoperative setting, affecting around one-third of patients for whom major surgery is programmed. Moreover, preoperative anaemia has been shown to worsen patient outcome and increase length of hospital stay and costs. In the field of preoperative anaemia correction, a recent Consensus statement suggested reviewing the classic World Health Organization (WHO) criteria in adults by aligning the haemoglobin cut-off to 13 g/dL for both genders. The aim of our study was to assess the differences in terms of prevalence, transfusion rate, transfusion trigger, and blood losses according to gender in a mixed population of surgical patients. MATERIAL AND METHODS We reviewed data of 610 consecutive patients undergoing elective major surgery at a tertiary care hospital during a 9-month period. Transfusion rate and transfusion triggers were recorded, analysed and stratified by haemoglobin class, with a particular focus on the 12.0-12.9 g/dL range. RESULTS Since the anaemia threshold was redefined at 13 g/dL for both genders, its prevalence rose from 26.4 to 39.5% (161/610 vs 241/610; p<0.001) in the overall population and from 22.7 to 49.3% (68/300 vs 148/300; p<0.001) in women. Eighty women (26.7%) fell in the haemoglobin 12.0-12.9 g/dL range, and this category was the most represented among transfused women (34.0%). There was no statistical difference in transfusion triggers or overall transfusion rate between genders. Subjects of both genders were transfused at the same haemoglobin level (8.1 g/dL), but women reached the transfusion trigger after less red cell mass loss than men, i.e. 377 mL (249-472 mL) vs 528 mL (356-717 mL), respectively (p<0.001). DISCUSSION Treatment of pre-surgical anaemia is one of the core principles of Patient Blood Management. Aligning the haemoglobin threshold between genders in the management of pre-surgical anaemia may result in a lower transfusion rate, but in an increased workload for medical staff in the preoperative phase.
Collapse
Affiliation(s)
- Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Alessandro Aloni
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Bruno Brando
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| |
Collapse
|
9
|
Bolcato M, Shander A, Isbister JP, Trentino KM, Russo M, Rodriguez D, Aprile A. Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of patient blood management. Vox Sang 2021; 116:1023-1030. [PMID: 33826768 PMCID: PMC9291028 DOI: 10.1111/vox.13106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
This article provides an ethical and medico-legal analysis of ruling no. 465 of 30 May 2018 issued by the Court of Termini Imerese (Palermo) and confirmed on appeal on 11 November 2020, which, in the absence of similar historical precedents in Europe, convicted a medical doctor of a crime of violent assault for having ordered the administration of a blood transfusion to a patient specifically declining blood transfusion on religious grounds. We analyse the Court's decision regarding the identification of assault in performing the blood transfusion and its decision not to accept exculpatory urgent 'necessity' as a defence. In addition, we present an updated revision of the current standard of care in transfusion medicine as well as the ethical principles governing the patient's declining of transfusion. In doing so, we highlight that respect for the patient's self-determination in declining transfusions and respect for the professional autonomy of the doctor protecting the safety and life of the patient could be equally satisfied by applying the current peer-reviewed evidence.
Collapse
Affiliation(s)
- Matteo Bolcato
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine Pain Management and Hyperbaric Medicine Team, Health Research Institute, Englewood Medical Center, Englewood, NJ, USA
| | - James P Isbister
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Kevin M Trentino
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Marianna Russo
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Daniele Rodriguez
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| |
Collapse
|
10
|
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.
Collapse
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.)
| |
Collapse
|
11
|
Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View. Healthcare (Basel) 2020; 9:healthcare9010017. [PMID: 33375544 PMCID: PMC7824087 DOI: 10.3390/healthcare9010017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/28/2023] Open
Abstract
The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas.
Collapse
|
12
|
Bolcato M, Rodriguez D, Aprile A. Risk Management in the New Frontier of Professional Liability for Nosocomial Infection: Review of the Literature on Mycobacterium Chimaera. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197328. [PMID: 33036499 PMCID: PMC7579562 DOI: 10.3390/ijerph17197328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022]
Abstract
Background: Mycobacterium chimaera (MC) is of recent origin and belongs to the large family of non-tuberculous mycobacteria. In recent years, it has shown a high infectious capacity via the aerosol produced by operating room equipment, such as heater–cooler units (HCU). The infection has a long latent period and high mortality rate. Genetic and epidemiological studies have shown that there is a clear link between the infection and a specific HCU model manufactured by LivaNova/Sorin. There is, therefore, a strong possibility that contamination occurs during device construction. The objective of this article is to describe the characteristics of this particular infection in view of the medico–legal implications on professional liability, specifically focusing on current evidence regarding contamination prevention. Methods: we have analyzed the clinical characteristics and data from the autopsic investigations performed on a patient who died as a result of MC infection, in addition to analyzing all pertinent recommendation documents available internationally. We searched for all articles in the literature available on MEDLINE between 1995 and 30 July 2020, using the search words “Mycobacterium chimaera”. We then analyzed those articles and reported only those that provide useful information regarding prevention techniques for containing dissemination and contamination. Results: the literature review produced 169 results that highlight the need to develop systems to mitigate and eliminate the risk of MC infection in operating rooms such as physical containment measures, e.g. device replacement, use of safe water, providing patients with information, and training healthcare professionals. Conclusions: from a medico–legal viewpoint, this particular situation represents a new frontier of professional liability, which includes manufacturers of electromedical equipment. In order to comprehend the true extent of this silent global epidemic, the development of an organic, preventative monitoring system is essential.
Collapse
|