Query: medico legal

title: Modafinil and orexin system: interactions and medico legal considerations.
abstract: Modafinil (Mo) is increasingly being used as an enhancement drug rather than for its therapeutic effects. The effects of this drug have been examined in attention deficit disorders, depression, mental fatigue, and in enhancing concentration. The drug possesses wakefulness promoting properties which are mediated through the interaction of orexinergic system with the activated sympathetic nervous system. Mo exerts a synergistic effect on the orexin system, controls energy expenditure and strengthens the ability of the individual to exercise. Some view Mo as a drug that enhances sports performance, since it induces a prolonged wakefulness and decreasing the sense of fatigue. These characteristics being similar to conventional stimulants have allowed Mo to emerge as a novel stimulant requiring medico legal considerations. However, more studies are needed to better understand the mid and long term effects of the drug on user/abuser.

title: The effect of the medico legal evaluation on asylum seekers in the Metropolitan City of Milan, Italy: a pilot study
abstract: In the present day situation, the clinical forensic documentation of an asylum seeker's narrative and his or her examination, together with the physical and psychological findings, may have very important effects on the outcome of the request for political asylum. Since 2012, the Municipality of Milan, the University Institute of Legal Medicine, and other institutions have assembled a team with the task of examining vulnerable asylum seekers and preparing a medical report for the Territorial Commission for International Protection (Prefecture, Ministry of Interiors) who will assess the application. We compared medico legal reports and outcomes of 57 cases which were evaluated by the Commission after having undergone a medico legal evaluation through the Istanbul Protocol criteria and examined, in particular, which medico legal variables seem associated to the outcome. The results show that forensic assessment seems to have a significant and interesting correlation with the final assessment given by the Commission. For example, the higher the level of consistency, according to the Istanbul Protocol, the more frequently protection is granted. These data show how important clinical forensic medicine can be in such scenarios and how the presence of clinical forensic experts should be encouraged in such evaluations, as has been recently enshrined in Italy in the guidelines of a Ministerial Decree of April 3rd, 2017 for the assistance and the rehabilitation as well as the treatment of psychiatric disorders in refugees and asylum seekers who have undergone torture, rape, and other severe forms of psychological, physical, or sexual violence.

title: Guidelines examination of victims of sexual assault harmonization of forensic and medico legal examination of persons
abstract: Sexual assault is a complex situation with medical, psychological, and legal aspects. Forensic experts play a major role in terms of forensic and gynecological medical examination and evidence collection in order to maintain the chain of custody. Victims should be examined by a specially trained medico legal examiner in order to avoid multiple examinations in the surroundings that do not meet minimum health standards. The evolution and treatment of sexual assault victims are time intensive and should optimally be provided by a team that includes a forensic medical doctor. These guidelines will be of interest to forensic medical doctors who will have responsibility for the examination and assessment of victims of sexual violence and can be used as a day to day service document and/or a guide to develop health service for victims of sexual violence.

title: Back to the Future Part 1. The medico legal autopsy from ancient civilization to the post genomic era
abstract: Part 1 of the review "Back to the Future" examines the historical evolution of the medico legal autopsy and microscopy techniques, from Ancient Civilization to the Post Genomic Era. In the section focusing on "The Past" the study of historical sources concerning the origins and development of the medico legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on "The Present" the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in "The Future" section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.

title: An evaluation of a new tool to aid judgements of credibility in the medico legal setting
abstract: Clinical psychologists and other health professionals are often requested to act as expert witnesses in Court. They are required to assess, and report upon, the reliability of the accounts of physical and psychological symptoms made by their clients. This study investigated the effectiveness of a checklist drawing upon relevant literature on lying and malingering to aid the detection of exaggeration of physical symptoms.  Sixty four participants were cast as interviewers and assigned to either a 'checklist' or 'no checklist' condition. Another 64 volunteers were assigned to either a 'truth teller' or 'malingerer' role and, after undergoing a cold pressor procedure, were interviewed about their experience. The interviewers with a checklist drawn from the literature were asked to rate the presence of 28 checklist items on 5 point Likert scales and to indicate whether or not they believed their interviewee was truthful or exaggerating his or her symptoms. The interviewers without the checklist were asked to simply indicate whether their interviewee was truthful or exaggerating.  Evaluators who were not given the checklist did not classify their interviewees at a level significantly better than chance. Those using the checklist achieved an overall hit rate of 70% Signal detection analysis supported the finding that those with the checklist showed greater discriminability. Nine checklist items significantly discriminated between truth tellers and malingerers. Furthermore, the total checklist score was significantly higher for exaggerated accounts than for truthful accounts.  Results suggest that a checklist based on the literatures into lying and malingering warrants further investigation. Such a tool would be useful as an aid for expert witnesses called to provide informed opinion on the likelihood that a claimant is exaggerating, malingering or otherwise misrepresenting difficulties.

title: Teledermatology and clinical photography: safeguarding patient privacy and mitigating medico legal risk
abstract: Capturing clinical images is becoming more prevalent in everyday clinical practice, and dermatology lends itself to the use of clinical photographs and teledermatology. "Store and forward" whereby clinical images are forwarded to a specialist who later responds with an opinion on diagnosis and management is a popular form of teledermatology. Store and forward teledermatology has proven accurate and reliable, accelerating the process of diagnosis and treatment and improving patient outcomes. Practitioners' personal smartphones and other devices are often used to capture and communicate clinical images. Patient privacy can be placed at risk with the use of this technology. Practitioners should obtain consent for taking images, explain how they will be used, apply appropriate security in their digital communications, and delete images and other data on patients from personal devices after saving these to patient health records. Failing to use appropriate security precautions poses an emerging medico legal risk for practitioners.

title: Iatrogenic splenic injury: review of the literature and medico legal issues
abstract: Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.

title: Medico legal perspectives on sudden cardiac death in young athletes
abstract: Sudden cardiac death (SCD) in a young athlete represents a dramatic event, and an increasing number of medico legal cases have addressed this topic. In addition to representing an ethical and medico legal responsibility, prevention of SCD is directly correlated with accurate eligibility/disqualification decisions, with an inappropriate pronouncement in either direction potentially leading to legal controversy. This review summarizes the common causes of SCD in young athletes, divided into structural (hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, congenital coronary artery anomalies, etc. electrical (Brugada, congenital LQT, Wolf Parkinson White syndrome, etc. and acquired cardiac abnormalities (myocarditis, etc. In addition, the roles of hereditary cardiac anomalies in SCD in athletes and the effects of a positive result on them and their families are discussed. The medico legal relevance of pre participation screening is analyzed, and recommendations from the American Heart Association and European Society of Cardiology are compared. Finally, the main issues concerning the differentiation between physiologic cardiac adaptation in athletes and pathologic findings and, thereby, definition of the so called gray zone, which is based on exact knowledge of the mechanism of cardiac remodeling including structural or functional adaptions, will be addressed.

title: Quality of Life and Medico Legal Implications Following Iatrogenic Bile Duct Injuries
abstract: In this review we aimed to evaluate quality of life after bile duct injury and the consequent medico legal implications. A comprehensive English language literature search was performed on MEDLINE, Embase, Science Citation Index and Google(tm) Scholar databases for articles published between January 2000 and April 2016. The last date of search was 11 April 2016. Key search words included bile duct injury, iatrogenic, cholecystectomy, prevention, risks, outcomes, quality of life, litigation and were used in combination with the Boolean operators AND, OR and NOT. Long term survival after bile duct injury is significantly impaired (all cause long term mortality approximately 21 along with the quality of life (especially psychological/mental state remains affected) Bile duct injury is associated with high rates of litigation. Monetary compensation varied from PS2500 to PS216,000 in the UK, EUR9826 EUR55,301 in the Netherlands and $628,138 $2,891,421 in the USA. Bile duct injuries have profound implications for patients, medical personnel and healthcare providers as they cause significant morbidity and mortality, high rates of litigation and raised healthcare expenditure.

title: The utility of medico legal databases for public health research: a systematic review of peer reviewed publications using the National Coronial Information System
abstract: BackgroundMedico legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS).MethodsPubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000 2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers.ResultsOf the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders.ConclusionsTo ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.