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Goldust M, Landau M, Grant-Kels JM. Upholding the principle of "do no harm" in esthetics. Clin Dermatol 2024; 42:413-414. [PMID: 38735631 DOI: 10.1016/j.clindermatol.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Mohamad Goldust
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marina Landau
- Arena Dermatology and Department of Plastic Surgery, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida, College of Medicine, Gainesville, Florida, USA.
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2
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Capasso E, Marisei M, Macculi M, Di Lorenzo P. Case report: "Scared to deaf": medical-legal evaluation of a suspected post -traumatic stress disorder". Front Psychiatry 2024; 15:1422002. [PMID: 38974915 PMCID: PMC11224450 DOI: 10.3389/fpsyt.2024.1422002] [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: 04/23/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
The case concerns the alleged failure by the resisting administration to fulfill obligations arising from the contract and employment relationship, as well as the violation of safety regulations leading to the workplace accident reported by an Airforce Sergeant. Following the accident, the soldier complains of developing barotraumatic hearing loss with tinnitus and reactive post-traumatic stress disorder to the traumatic event. The case provides an opportunity to analyze the relevance of forensic medical assessment and its integration with psychodiagnostic examination for the correct nosographic classification aimed at evaluating and quantifying biological damage.
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Affiliation(s)
| | | | - Marco Macculi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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3
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Frosina G. Advancements in Image-Based Models for High-Grade Gliomas Might Be Accelerated. Cancers (Basel) 2024; 16:1566. [PMID: 38672647 PMCID: PMC11048778 DOI: 10.3390/cancers16081566] [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: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
The first half of 2022 saw the publication of several major research advances in image-based models and artificial intelligence applications to optimize treatment strategies for high-grade gliomas, the deadliest brain tumors. We review them and discuss the barriers that delay their entry into clinical practice; particularly, the small sample size and the heterogeneity of the study designs and methodologies used. We will also write about the poor and late palliation that patients suffering from high-grade glioma can count on at the end of life, as well as the current legislative instruments, with particular reference to Italy. We suggest measures to accelerate the gradual progress in image-based models and end of life care for patients with high-grade glioma.
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Affiliation(s)
- Guido Frosina
- Mutagenesis & Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy
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4
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Bolcato V, Franzetti C, Fassina G, Basile G, Martinez RM, Tronconi LP. Comparative study on informed consent regulation in health care among Italy, France, United Kingdom, Nordic Countries, Germany, and Spain. J Forensic Leg Med 2024; 103:102674. [PMID: 38502996 DOI: 10.1016/j.jflm.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
The information and subsequent expression of will, so-called informed consent, have become the essential element of health right, understood as the right to autonomous choice in health, based on the fiduciary relationship between physician and patient. This gradually leads European Countries to adopt special legislations and to issue frequent judgments on the subject. However, new challenges in daily clinical practice call for further study of legal solutions. The authors analyse and compare the regulations on informed consent in health care of Italy, France, the United Kingdom, the Nordic Countries, Germany, and Spain. The health and legal contexts, existence of special regulations on informed consent and their characteristics are discussed. Informed consent resulted a mandatory requirement. Clear communication about treatment, therapeutic alternatives, and major risks, discussed in conversation, but preferably documented in writing, are agreed upon. The possibility of dissent and withdrawal of consent are also included. There is a growing interest in involving and regulating the entire health team in information and consent. Lowering the age of consent for minors or analysing the maturity of minors are attempts to increase their participation in health decisions. On another side, the protection of adult incapables persons requires greater involvement of family and fiduciaries to better adapt to changing health needs. Health policy must take responsibility for training health professionals and citizens about the value of health information and communication as a shared choice in care planning, to strengthen the bond of trust with the healthcare system and users.
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Affiliation(s)
- Vittorio Bolcato
- Unit of Legal Medicine, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Chiara Franzetti
- Forensic Medicine Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Fassina
- Forensic Medicine Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Unit of Legal Medicine, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy.
| | - Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopaedics Institute, Milano, Italy; Head Section of Legal and Forensic Medicine Clinical Institute San Siro, Milan, Italy
| | - Rosa Maria Martinez
- Office of Forensic Sciences, Bellinzona, Republic and Canton of Ticino, Switzerland
| | - Livio Pietro Tronconi
- Forensic Medicine Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola RA, Italy
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5
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Giusti M, Vannini IE, Persiani N. Governance models for historical hospitals: evidence from Italy. BMC Health Serv Res 2024; 24:293. [PMID: 38448903 PMCID: PMC10918959 DOI: 10.1186/s12913-024-10640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/25/2024] [Indexed: 03/08/2024] Open
Abstract
Many hospitals and health care organizations over the centuries have inherited handcrafts of artistic value, objects of worships, donations from pilgrims, votive offerings, legates as a result of their centuries-old activity in the social and health care of their community. The value of these artistic assets and the role in the territory of these hospitals have transformed them into cultural heritage over time, introducing the issue of the coexistence of cultural and care management. Therefore, the aim of this paper is to identify governance models of what we will call historical hospitals, that is, hospitals that because of their history, their assets, and their artistic heritage, far from being places only dedicated to provision of health care services represent cultural heritage. To pursue this research objective, five Italian historical hospitals were selected and identified as significant case studies for their historic and artistic relevance. Through the analysis of these case studies the paper identifies models of governance of historical hospitals and the reasons of their adoption.
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Affiliation(s)
- Martina Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ilaria Elisa Vannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Niccolò Persiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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6
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da Prato EB, Cartier H, Margara A, Molina B, Tateo A, Grimolizzi F, Spagnolo AG. The ethical foundations of patient-centered care in aesthetic medicine. Philos Ethics Humanit Med 2024; 19:1. [PMID: 38317236 PMCID: PMC10845625 DOI: 10.1186/s13010-024-00151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor-patient relationship.
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Affiliation(s)
| | | | | | | | - Antonello Tateo
- Private Practice, Pavia, Italy
- Private Practice, Milan, Italy
| | | | - Antonio Gioacchino Spagnolo
- Institute of Bioethics and Medical Humanities, Faculty Member, Catholic University of the Sacred Heart, Rome, Italy
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7
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Porteri C, Ienco G, Piccinni M, Pasqualetti P. Towards the implementation of law n. 219/2017 on informed consent and advance directives for patients with psychiatric disorders and dementia. Physicians' knowledge, attitudes and practices in four northern Italian health care facilities. BMC Med Ethics 2024; 25:7. [PMID: 38184541 PMCID: PMC10771689 DOI: 10.1186/s12910-023-00997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND On December 2017 the Italian Parliament approved law n. 219/2017 "Provisions for informed consent and advance directives" regarding challenging legal and bioethical issues related to healthcare decisions and end-of life choices. The law promotes the person's autonomy as a right and provides for the centrality of the individual in every scenario of health care by mean of three tools: informed consent, shared care planning and advance directives. Few years after the approval of the law, we conducted a survey among physicians working in four health care facilities specific for the care of people suffering from psychiatric disorders, cognitive disorders and dementia located in the North of Italy aiming to investigate their perceived knowledge and training need, attitudes regarding law n. 219/2017 provisions, and practices of implementation of the law. METHODS A semi-structured questionnaire was developed on an online platform. The invitation to participate in the survey was sent by email to the potential participants. Information was collected by means of the online platform (Google Forms) which allows to export data in a spreadsheet (Windows Excel) to perform basic statistical analysis (frequency distributions, bar chart representation). RESULTS Twenty-five out of sixty physicians participated in the survey. None of the respondents value their knowledge of the law as very good, 10 good, 13 neither poor nor good, 1 poor and 1 very poor. All the respondents want to learn more about the law (21 yes and 4 absolutely yes). The majority of respondents agrees with the content of the law as a whole (3 absolutely agree, 13 agree), and on each provision. The question on the clarity of the concept of capacity in the law received mixed answers and this impacted on the physicians' opinion regarding the legitimacy in principle for our groups of patients to realize shared care planning and write advance directives. Thirteen physicians neither introduced the theme of shared care planning nor arranged for shared care planning and the main reason for this was that no patient was in a clinical situation to require it. When shared care planning is realized, a variability in terms of type and number of meetings, mode of tracking and communication is registered. CONCLUSIONS Our survey results indicate a need for more clarity regarding the interpretation and implementation of the law in the patient groups under study. There are in particular two related areas that deserve further discussion: (1) the question of whether these patient groups are in principle legitimized by the law to realize shared care planning or write advance directives; (2) the notion of capacity required by the law and how this notion can be declined in real-life situations.
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Affiliation(s)
- Corinna Porteri
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, Brescia, 25125, Italy.
| | - Giulia Ienco
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, Brescia, 25125, Italy
| | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies - SPGI, Università di Padova, Padua, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Medical Statistics, Sapienza Università di Roma, Rome, Italy
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Giusti M, Persiani N. Art therapy in Alzheimer's disease. An opportunity of collaboration between intersectoral public and private organizations in the co-design of health and social care services. Front Psychiatry 2023; 14:1198613. [PMID: 38098624 PMCID: PMC10720310 DOI: 10.3389/fpsyt.2023.1198613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction The World Health Organization (WHO) has recognized art therapy as an effective supportive mechanism for the maintenance and restoration of mental health. In recent years, art therapy has been integrated in the assistance pathways of older people affected by neurocognitive disorders according to the demonstrated benefits, as no conflicts with pharmacologic treatments and the reduction of anxiety and stress. The shortage of organizational, economic, and professional resources in social-health public organizations does not allow for guaranteeing the provision of these services without the help of the private ones, not exclusively belonging to social-health sector. This research aims to investigate how the collaboration between public and private organizations of different sectors in the co-provision of non-pharmacological approaches guarantees the economic sustainability and the quality improvement of the provided services. Methods The Alzheimer Café of Prato was selected as a significant case study. Results and Discussion Art therapy programs intended for taking care of older people in the first stages of the Alzheimer's disease have been developed, planned, supplied, and managed over the years as a result of the integration of resources, ideas, and professionals provided both by public and private sectors, the social-health sector, and cultural organizations. Conclusions The peer-to-peer co-responsibility of all organizations (public and private, from the cultural sector as well as the social and health sector) involved in the co-design of art therapy programs, not limiting their actions to only co-financing and/or co-delivery of the service, enabled the achievement of the economic sustainability of the services and the improvement of their quality.
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Affiliation(s)
- Martina Giusti
- Department of Clinical and Experimental Medicine, School of Human Sciences, University of Florence, Florence, Italy
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9
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Bolino G, D’Antonio G, Sorace L, Fazio ND, Volonnino G, Russa RL, Arcangeli M, Frati P. The "Criminal Shield": Criminal Liability for Healthcare Professionals during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:2661. [PMID: 37830698 PMCID: PMC10572230 DOI: 10.3390/healthcare11192661] [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: 09/04/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
The Sars-CoV-2 pandemic has had important economic, health, political, and jurisprudential implications all over the world. According to innovations already introduced by Law 24/2017, with Decree Law no. 44 of 1 April 2021 and the subsequent conversion law no. 71 of 2021, Italy is the only country in which ad hoc rules have been introduced to limit the professional liability of healthcare professionals during the health emergency. The "criminal shield" can be defined as the Legislator response to the extreme pressure on healthcare professionals during the pandemic.
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Affiliation(s)
- Giorgio Bolino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Gianpiero D’Antonio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Letizia Sorace
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
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10
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Dowling T, Kennedy S, Foran S. Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State? Br J Community Nurs 2023; 28:376-383. [PMID: 37527224 DOI: 10.12968/bjcn.2023.28.8.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
AIM This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives. BACKGROUND New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community. METHODS Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised. FINDINGS The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified. CONCLUSION Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult's advance decision-making and advance healthcare directives.
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Affiliation(s)
- Teresa Dowling
- Postgraduate Researcher, Department of Nursing and Healthcare, South East Technological University, Ireland
| | - Sara Kennedy
- Head of Department, Department of Nursing and Healthcare, South East Technological University, Ireland
| | - Sinéad Foran
- Lecturer, Department of Nursing, Dublin City University, Ireland
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11
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Porteri C, Ienco G, Turla EM, Petrini C, Pasqualetti P. Italian law n. 219/2017 on consent and advance directives: survey among Ethics Committees on their involvement and possible role. BMC Med Ethics 2022; 23:114. [PMID: 36384647 PMCID: PMC9670375 DOI: 10.1186/s12910-022-00858-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of-life choices. The law does not contain an explicit reference to Ethics Committees (ECs), but they could still play a role in implementing the law. Methods A questionnaire-based survey was performed among the ECs of the Italian Institute for Research and Care belonging to the Network of neuroscience and neurorehabilitation, with the aim of (1) knowing whether the ECs participated and, if so, how in the process of implementation of law n. 219/2017 in the referring institutes; (2) investigating the point of view of the ECs regarding their possible involvement in the process; (3) exploring the contribution ECs can provide to give effective implementation to the law principles and provisions. Results Seventeen ECs out of thirty took part in the survey; the characteristics of the responding and non-responding committees are similar, so the responding ECs can be regarded as representative of all ECs in the Network. Nine ECs did not discuss the law in anyway: the main reason for this is that the referring institutions (6) and the health care professionals (3) did not ask for an EC intervention. Nevertheless, the large majority of the ECs believe that their involvement in the implementation of the law as a whole is appropriate (8) or absolutely appropriate (6), while 3 of them are neutral. No EC believes that the involvement is inappropriate. The aspect of the law on which the 14 ECs converge in considering the EC involvement appropriate/absolutely appropriate is the one related to the health facilities obligation to guarantee the full and proper implementation of the principles of the law. Conclusions Our survey confirms that ECs believe they can play a role in the implementation of law n. 219/2017, although this does not entirely correspond to what the committees have actually done in reality. This role could be better exercised by ECs specifically established for clinical practice, which would have a composition, functioning and a mandate better suited to the purpose. This supports the call for a national regulation of ECs for clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00858-w.
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Valente EP, Mariani I, Covi B, Lazzerini M. Quality of Informed Consent Practices around the Time of Childbirth: A Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127166. [PMID: 35742415 PMCID: PMC9222941 DOI: 10.3390/ijerph19127166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022]
Abstract
Background: Few studies have explored consent request practices during childbirth. Objective: We explored consent request practices during childbirth in a referral hospital and research centre in Italy, capturing both women and health workers’ perspectives. Methods: Data were collected using self-administrated questionnaires between December 2016 and September 2018. Nine key maternal and newborn procedures were analysed. Associations between consent requests and women characteristics were explored by multiple logistic regression. Results: Among 1244 women, the rate of consent requests varied widely, with caesarean section (CS) showing the highest rate (89.1%) and neonatal conjunctivitis prophylaxis presenting the lowest rate (11.4%). Information provided on “risks/benefits” and “reasons” for procedures by health staff was most often not comprehensive for procedures of interest (range 18.6–87.4%). The lack of informed consent is not specifically linked to any pattern of women characteristics. According to 105 health workers, adequate protocols and standard forms for consent requests were available in 67.6% and 78.1% of cases, respectively, while less than one third (31.4%) reported having received adequate training and supportive supervision on how to deliver informed consent. Conclusions: Study findings align with previous evidence showing that consent request practices during childbirth need to be largely improved. More research is needed to investigate effective strategies for improvement.
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13
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Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12051056. [PMID: 35626212 PMCID: PMC9139983 DOI: 10.3390/diagnostics12051056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Cervical spine manipulations (CSM) have been performed for centuries and are a widely practiced intervention to manage cervical spine musculoskeletal disorders. We aimed to perform an overview of the literature concerning the effects and the adverse events of CSM in the Physical and Rehabilitation Medicine (PRM) field with a forensic medicine perspective. Methods: A search in the scientific literature (PubMed, Google Scholar, PEDro and Cochrane) was carried out from inception until October 2020. Results: Fourteen articles were included in this narrative summary. The possible development of side effects requires a careful mandatory balance of benefits and risks even when there is an indication for this approach. Moreover, a qualified professional is essential to perform CSM–a non-invasive therapeutic procedure that can be potentially harmful. Conclusions: In conclusion, it is essential to perform the diagnosis, to treat, and to manage complications within the PRM field, both for the reduction of malpractice claims and, most importantly, for the safety of the patient.
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Euthanasia and assisted suicide: An in-depth review of relevant historical aspects. Ann Med Surg (Lond) 2022; 75:103380. [PMID: 35242326 PMCID: PMC8857436 DOI: 10.1016/j.amsu.2022.103380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms. The history of euthanasia and assisted suicide has been traumatic. The church and research have been decisive in the definition of euthanasia. The legal framework on the use of euthanasia and assisted suicide has been strengthened.
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15
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Turillazzi E, Maiese A, Frati P, Scopetti M, Di Paolo M. Physician-Patient Relationship, Assisted Suicide and the Italian Constitutional Court. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:671-681. [PMID: 34674155 DOI: 10.1007/s11673-021-10136-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator.
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Affiliation(s)
- E Turillazzi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy.
| | - A Maiese
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
| | - P Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Di Paolo
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
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16
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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.
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17
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Nutraceuticals for Peripheral Vestibular Pathology: Properties, Usefulness, Future Perspectives and Medico-Legal Aspects. Nutrients 2021; 13:nu13103646. [PMID: 34684646 PMCID: PMC8538675 DOI: 10.3390/nu13103646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023] Open
Abstract
Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.
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Bonsignore A, Bragazzi NL, Basile C, Pelosi P, Gratarola A, Bonatti G, Patroniti N, Ciliberti R. Development and Validation of a Questionnaire investigating the Knowledge, Attitudes and Practices of Healthcare Workers in the Field of Anesthesiology concerning the Italian Law on Advance Healthcare Directives: a Pilot Study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021092. [PMID: 34487082 PMCID: PMC8477106 DOI: 10.23750/abm.v92i4.11314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Advance healthcare directives are legal documents, in which the patient, foreseeing a potential loss of capacity and autonomy, makes in advance decisions regarding future care and, in particular, end-of-life arrangements. In Italy, advance healthcare directives are regulated by the Law 219 of 22 December 2017. Objectives of the study were: i) to develop and validate a questionnaire dedicated to evaluate the knowledge of the Law in a sample of 98 anesthesiologists, and ii) to shed light on the process of health-related decision-making and its determinants (age, gender, doctor/training resident, religious beliefs). A second part of the survey not analyzed in the present study, aimed to assess, through two simulated clinical scenarios, how patient' directives, relatives and the medical staff could influence physicians' clinical decision. Overall Cronbach's alpha coefficient of the questionnaire resulted 0.83. Three factors explaining up to 38.4% of total variance (communication and relationship with the patient; critical life-threatening situations and binding nature of the advance directive for the physician; and involvement of patients). Most of the doctors (58.7%) did not fully know the recent legislative provision. The lack of knowledge is critical in view of the specificity of the clinical area investigated (anesthesiology and intensive care), which has to cope with ethical issues. An adequate revision and implementation of the traditional curricula could help medical students and trainees develop the aptitudes and skills needed in their future profession.
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19
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Grautoff S. Advance directives for health care as a resource for assessing treatment goals in the Emergency Department. Am J Emerg Med 2021; 55:217-218. [PMID: 34229938 DOI: 10.1016/j.ajem.2021.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Steffen Grautoff
- Klinikum Herford, Emergency Department, Schwarzenmoorstr. 70, 32049 Herford, Germany; Kreis Herford, Sicherheit und Ordnung, Gefahrenabwehr, Wittekindstr. 7, 32051 Herford, Germany.
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20
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Completion Rates of Advance Directives in a Trauma Emergency Room: Association with Age. Emerg Med Int 2021; 2021:5537599. [PMID: 33968449 PMCID: PMC8081623 DOI: 10.1155/2021/5537599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction An advance directive (AD) is a written legal document in which a person can express wishes and preferences for medical treatment for the moment when that person is no longer able to make medical decisions because of a serious illness or injury. While ADs have emerged in public, it is unclear, how many adults in Germany have completed an AD, and frequencies differ among different patient cohorts and medical settings. The aim of this study was to evaluate how many patients visiting a trauma emergency room (ER) in an academic teaching hospital had completed an AD. Furthermore, patient characteristics were compared between patients who had completed an AD and those who had not completed an AD. Methods. Patients with a traumatic injury or disease who attended the ER of an academic teaching hospital in the period from October 2015 to March 2016 (n = 499) were surveyed for completion rates of ADs. Results. Prior to their visit to the ER, 12.8% of the included patients possessed a completed AD. Patients with a completed AD had a higher age (median age: 54 (IQR: 34–66) vs. 35 (IQR: 25–50) p < 0.001) and were less often living in an urban residential location (UR) (UR: 23.5% vs. 39.4%, p=0.029). Groups did not differ between sex (p=0.115), frequencies of high school graduates (p=0.482), and possession of a private health insurance (p=0.072), disability insurance (p=0.291), or an accident insurance (p=0.790). Conclusion. Completion rates of ADs remain low among patients visiting an ER of an academic teaching hospital in Germany. Increasing age but not factors such as sex, educational background, or insurance status were associated with a higher frequency of completed ADs.
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21
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Cotogni P, Stragliotto S, Ossola M, Collo A, Riso S. The Role of Nutritional Support for Cancer Patients in Palliative Care. Nutrients 2021; 13:306. [PMID: 33498997 PMCID: PMC7911232 DOI: 10.3390/nu13020306] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
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Affiliation(s)
- Paolo Cotogni
- Department of Anesthesia, Pain Management and Palliative Care, Intensive Care and Emergency, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Silvia Stragliotto
- Medical Oncology 1, Veneto Institute of Oncology-IRCCS, 35128 Padova, Italy;
| | - Marta Ossola
- Clinical Nutrition and Dietetics Unit, Department of Internal Medicine, Molinette Hospital, 10126 Turin, Italy;
| | - Alessandro Collo
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
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Corpses against science death: new Italian law titled ‘Rules relating to the directives of one’s body and tissues post-mortem for study, training, and scientific research purposes’. Ann Anat 2021; 233:151595. [DOI: 10.1016/j.aanat.2020.151595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
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Di Fazio N, Romano S, Del Fante Z, Santoro P, Fineschi V, Frati P. European Countries' Different Legal Orientation About End-of-Life Issues in Patients Affected With Neurological/Psychiatric Diseases: Does Italian Law n.219/2017 Provide Adequate Options for This Fragile Category of Patients? Front Psychiatry 2021; 12:675706. [PMID: 34630172 PMCID: PMC8497821 DOI: 10.3389/fpsyt.2021.675706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Romano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Zoe Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Santoro
- 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.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed Mediterranean Neurological Istitute, Pozzilli, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed Mediterranean Neurological Istitute, Pozzilli, Italy
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Bolcato M, Russo M, Feola A, Della Pietra B, Tettamanti C, Bonsignore A, Ciliberti R, Rodriguez D, Aprile A. The Motion of the Italian National Bioethics Committee on Aggressive Treatment towards Children with Limited Life Expectancy. Healthcare (Basel) 2020; 8:E448. [PMID: 33139649 PMCID: PMC7712670 DOI: 10.3390/healthcare8040448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
The motion of the Italian National Bioethics Committee entitled "Aggressive treatment or therapeutic obstinacy on young children with limited life expectancy" comprises a premise that rejects therapeutic obstinacy and makes 12 recommendations. Recommendation no. 1 states the general rules: it ascribes a cardinal role to a shared care plan, it supports pain management therapy and pain relief, it opposes ineffective and disproportionate clinical treatment and defensive medicine. The other recommendations are correlated to the enacting of a national law establishing clinical ethics committees in paediatric hospitals; participation of parents and their fiduciaries in the decision-making processes; recourse to courts only as extrema ratio in the event of irremediable disagreement between the medical team and the family members; accompaniment at the end of life also through continuous deep sedation combined with pain therapy; access to palliative care; the need to reinforce research on pain and suffering in children; clinical trials and research studies conducted in children; the training of doctors, healthcare personnel and psychologists, to support parents in emotional and practical terms; the facilitation of the closeness of parents to children in extremely precarious clinical conditions; the relevant role of the associations of parents of sick children. Comments are made, in particular, about the innovative recommendations respectively relating to the adoption of care planning, the establishment, by law, of clinical ethics committees in paediatric hospitals and the limitation of recourse to courts-only as extrema ratio-in the event of irremediable disagreement between the medical team and the family members.
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Affiliation(s)
- Matteo Bolcato
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.R.); (D.R.); (A.A.)
| | - Marianna Russo
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.R.); (D.R.); (A.A.)
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.F.); (B.D.P.)
| | - Bruno Della Pietra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.F.); (B.D.P.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (C.T.); (A.B.)
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (C.T.); (A.B.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.R.); (D.R.); (A.A.)
| | - Anna Aprile
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.R.); (D.R.); (A.A.)
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De Panfilis L, Rossi PG, Mazzini E, Pistolesi L, Ghirotto L, Noto A, Cuocolo S, Costantini M. Knowledge, Opinion, and Attitude About the Italian Law on Advance Directives: A Population-Based Survey. J Pain Symptom Manage 2020; 60:906-914.e4. [PMID: 32619672 DOI: 10.1016/j.jpainsymman.2020.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT Advance directives are legal documents which individuals draw up to declare their treatment preferences and to appoint well-informed proxies to safeguard patient autonomy in critical situations when that individual is temporarily or no longer able to communicate these preferences. On December 22, 2017, the Italian Parliament approved the first law on end of life ("Provisions for informed consent and advance directives" L.219/2017), after a heated public and political debate lasting almost 20 years. OBJECTIVE The aim of this study was to investigate the awareness, knowledge, opinions, and attitudes regarding Italian Law 219/2017 and advance directives among the Italian population 15 months after its entry into force. METHODS A nationwide population-based survey was conducted by a certified public opinion survey company. A sample size of 2000 interviews was planned. A structured questionnaire was developed to investigate awareness, opinions, and attitudes concerning the law by a multiprofessional research team. The agreed-on version was pretested on a sample of 70 selected participants. RESULTS The sample included 2000 valid interviews; 70.1% of respondents declared they had heard about the law on informed consent and advance directives. Respondents were asked to express their overall opinion on the law's utility and importance: 88% declared that the law was quite or very important and 76% had a positive attitude toward making/registering advance directives. CONCLUSION The principles of Italian Law 219/2017 are aligned with the ethical sentiment of the vast majority of the Italian population. It is crucial to stimulate discussion to increase knowledge and awareness to increase the number of advance directives.
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Affiliation(s)
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Mazzini
- Medical Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Pistolesi
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Unit of Qualitative Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Korfage IJ, Carreras G, Arnfeldt Christensen CM, Billekens P, Bramley L, Briggs L, Bulli F, Caswell G, Červ B, van Delden JJM, Deliens L, Dunleavy L, Eecloo K, Gorini G, Groenvold M, Hammes B, Ingravallo F, Jabbarian LJ, Kars MC, Kodba-Čeh H, Lunder U, Miccinesi G, Mimić A, Ozbič P, Payne SA, Polinder S, Pollock K, Preston NJ, Seymour J, Simonič A, Thit Johnsen A, Toccafondi A, Verkissen MN, Wilcock A, Zwakman M, van der Heide A, Rietjens JAC. Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial. PLoS Med 2020; 17:e1003422. [PMID: 33186365 PMCID: PMC7665676 DOI: 10.1371/journal.pmed.1003422] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. METHODS AND FINDINGS To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. CONCLUSIONS Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. TRIAL REGISTRATION ISRCTN registry ISRCTN63110516.
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Affiliation(s)
- Ida J. Korfage
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
- * E-mail:
| | - Giulia Carreras
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Caroline M. Arnfeldt Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Louise Bramley
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Linda Briggs
- Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America
| | - Francesco Bulli
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Branka Červ
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Giuseppe Gorini
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bud Hammes
- Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Marijke C. Kars
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Hana Kodba-Čeh
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Urska Lunder
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Guido Miccinesi
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Alenka Mimić
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Polona Ozbič
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Sheila A. Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Nancy J. Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Jane Seymour
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Anja Simonič
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Anna Thit Johnsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alessandro Toccafondi
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mariëtte N. Verkissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Andrew Wilcock
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marieke Zwakman
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
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Bolcato M, De Salvia A, Rodriguez D, Aprile A. Is the Italian consent to transfusion really informed? A medico-legal analysis between old ghosts and new evidence. Transfus Apher Sci 2020; 59:102823. [DOI: 10.1016/j.transci.2020.102823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
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Bolcato M, Feola A, Sanavio M, Amadasi A, Crenna S, Landi G, Tettamanti C. The state of knowledge of young Italian medicolegal doctors on the law of provisions for informed consent and advance treatment directives: a multi-centric survey two years after the enactment of Law 219 of 2017. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 92:e2021005. [PMID: 33682828 PMCID: PMC7975962 DOI: 10.23750/abm.v92i1.10129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Background. On 22 December 2017, Law No. 219 was approved in Italy entitled “Provisions on informed consent and advance treatment directives”. This article reports the results from a survey of the knowledge of medico-legal experts in Italy on these provisions, in addition to the ability of university healthcare facilities in Italy to implement the principles of this new law. Methods. A survey questionnaire was sent to members of a scientific society. The society had 357 members and represented more than 75% of doctors in training and 32 university healthcare facilities in Italy. 27 of those facilities and 45% of the society’s members participated in this enquiry. Results. The majority (68%) of those interviewed felt they had acquired an adequate knowledge of the law but only 60% of them were able to indicate how to file legally valid advance directives (60% vs. 40%); only 37% knew how to draft a shared care plan. 89% of the pool felt that legal recognition of patient self-determination enhanced the care relationship. 74% of the facilities analyzed have organized training activities on the contents of the law but only 26% have updated their informed consent forms and procedures. 60% of the facilities perform medico-legal consultation activities and in 15% of the facilities there has been resistance to applying the law. Conclusion. Many of the facilities have set up training activities but lack effective implementation of those activities. With increased knowledge and organization this could be remedied. (www.actabiomedica.it)
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Affiliation(s)
- Matteo Bolcato
- 1Department of Molecular Medicine, University of Padua, Padua, Italy.
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", via Luciano Armanni 5, 80138 Naples, Italy..
| | - Matteo Sanavio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University - Hospital of Padua, Via Falloppio 50, 35121 Padua, Italy.
| | - Alberto Amadasi
- Department of Medical and Surgical Sciences (DIMEC), Legal Medicine, University of Bologna, via Irnerio, 49 Bologna, Italy..
| | - Stefano Crenna
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 12, Pavia, 27100, Italy.
| | - Gianluca Landi
- Department of Medicine, Surgery and Neuroscience, Forensic Medicine, University of Siena, Siena Policlinic, 53100 Siena, Italy.
| | - Camilla Tettamanti
- Department of Legal and Forensic Medicine, DISSAL, University of Genoa, Via Antonio De Toni 12, 16142, Genoa, Italy.
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Bevilacqua G, Bolcato M, Rodriguez D, Aprile A. Shared care plan: an extraordinary tool for the personalization of medicine and respect for self-determination. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 92:e2021001. [PMID: 33682824 PMCID: PMC7975960 DOI: 10.23750/abm.v92i1.9597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND On 22 December 2017, Law No. 219 was approved in Italy. This law provides citizens with effective tools with which to express healthcare decisions: namely, advance treatment directives (ATD) and shared care plans (SCP). METHODS This article presents an analysis of 70 SCP cases carried out in a tertiary hospital in Italy during the period between 01.02.2018 and 29.02.2020 inclusive. RESULTS In 90% of cases, the objective of the plan pertained to situations regarding patients' refusal of transfusions of blood components, the majority (97%) due to their belonging to the religious movement of Jehovah's Witnesses. 46% of the sample had drafted ATDs. The course of treatment recommended by the attending physicians was confirmed in 93% of the SCP cases. Trustees were appointed in 96% of cases. In 55% of cases, patients assigned trustees with attestative functions and the remaining 45% with creative functions. The results demonstrate that each patient personally dictates his or her wishes and the role assigned to the trustee. SCP meetings serve as a useful tool for providing the patient and his or her relatives with information, and for appointing a trustee. However, it has never been necessary to solicit the intervention of the trustee following a surgical operation. CONCLUSIONS The SCP has proven to be an essential tool in achieving the objective of personalised medicine. However, there is still notable passivity in its application. Further effort is required in order for it to become a common asset in clinical practice.
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Affiliation(s)
| | - Matteo Bolcato
- 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.
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Bolcato M, Russo M, Sanavio M, Rodriguez D, Aprile A. The clinical legal medicine: a need for quality of care and patient's safety. A single center five-year experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020090. [PMID: 33525258 PMCID: PMC7927498 DOI: 10.23750/abm.v91i4.9373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Clinical legal medicine is a branch of legal medicine that takes place in a clinical setting approaching the patient's bedside and using a particular attention not only for conceptual or normative references but also for every possible medical and social aspect. MATERIAL AND METHODS The requests of medico-legal opinions received by the Department of Legal Medicine of a large university hospital were retrospectively collected over a 5-years period. The analysis focused on the recurrence rate of the requests and the most common medico-legal issues to be solved in a clinical context, differentiating between adult and minor patients. RESULTS The collected medico-legal advices amounted to 448. The most clearly involved clinical area was Medicine (54%) followed by Gynecology and Obstetrics (15.6%), Pediatrics and Surgery (10.7%). The requests concerning patient's self-determination in therapeutics choices, including refusal of proposed treatments, covered almost one-half of total casuistry. The designation of support administrator represented also a relevant issue (20.5%). In case of minors, the queries related to reporting crimes were three times higher than in adults, while the appointment of a support administrator was never requested. CONCLUSION Clinical legal medicine, through medico-legal advices, plays a primary role in contributing to the safeguarding of health and to the decision-making process of clinicians.
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Affiliation(s)
- Matteo Bolcato
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy, Via Falloppio, 50, Padova, Italia..
| | - Marianna Russo
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy, Via Falloppio, 50, Padova, Italia..
| | - Matteo Sanavio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padova,Via Falloppio, 50, Padova, Italia..
| | - Daniele Rodriguez
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy, Via Falloppio, 50, Padova, Italia..
| | - Anna Aprile
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy, Via Falloppio, 50, Padova, Italia..
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Vasyukova NO, Lukina YV, Kutishenko NP, Martsevich SY, Zvonareva OI. Medication Adherence: does Patient Participation in Randomized Clinical Trials Affect on it? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-3-386-392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article focuses on the problem of low adherence to treatment among patients, in general, and provides data on the high adherence among patients in randomized controlled trials. Low adherence remains one of the most debated and difficult problems to solve nowadays. Poor medication adherence of the patient can significantly worsen the effectiveness of treatment and leads to increased health care costs. And although the factors that improve adherence are varied, and include the skills of the doctor, the patient’s personal characteristics, the external environment, an individual approach to each patient and etc., the absence of a “gold standard” for assessing adherence in clinical practice makes it difficult to predict and significantly improve it among patients. Nevertheless, the article discusses the existing doctor-patient interaction model, which strictly regulates the algorithms and technical means to achieve the best medication adherence. Randomized clinical trials (RCT) are the basis of evidence-based medicine, the results obtained in RCT form the basis of existing clinical guidelines. While participating in RCT patients can receive comprehensive information about the disease, the effectiveness of drug therapy, possible side effects of the therapy being conducted, the research objectives and prognosis from their attending physician; patients are trained to be disciplined and adhere to the recommendations of the doctor. The RCT, for a number of objective reasons, uses a variety of methods for assessing adherence and ways to improve it, which leads to higher patient adherence then among patients in general.
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Affiliation(s)
| | - Yu. V. Lukina
- National Medical Research Center for Preventive Medicine
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