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Dissertations / Theses on the topic 'Medico legal'
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1
Barit, Shimon. "The medico-legal investigation of death in custody - a review of cases admitted to the Pretoria Medico-Legal Laboratory, 2007-2011." Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/30694.
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The universally controversial issue of deaths in custody is especially pertinent to South Africa. This study was prompted due to the increasingly diminishing ability for a concerted effort at tackling this issue by all parties involved. The 5 year retrospective, descriptive case audit performed at the Pretoria Medico-Legal Laboratory aimed to evaluate the current medico-legal investigation of deaths in custody in Pretoria, South Africa. Over half of the deaths (52%) occurred as a result of police action, 30% in police custody and 18% in correctional services custody. Gunshot wounds and hangings were the number 1 and 2 most common causes of death, respectively, with homicide and suicide being the 2 most common manners of death, respectively. The principal conclusion from the results is the presence of a flawed and malfunctioning medico-legal investigation system. The introduction of a formal protocol is urgently required to provide a framework for these investigations.Dissertation (MSc)--University of Pretoria, 2013.
Forensic Medicine
MSc
Unrestricted
2
Brosseron, Lise Soares Barbosa. "Pulmonary thromboembolism and sudden unexpected death. Medico-legal review." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/60805.
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NOTTEAU, FAGOT ISABELLE. "Le hammer syndrome : aspect medico-legal et devenir professionnel." Lille 2, 1989. http://www.theses.fr/1989LIL2M143.
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Brosseron, Lise Soares Barbosa. "Pulmonary thromboembolism and sudden unexpected death. Medico-legal review." Dissertação, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/60805.
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Jowett, Stephanie. "Legal barriers to consent for medical treatment of trans and gender diverse youth: A comparative and medico-legal analysis." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/203611/1/Stephanie_Jowett_Thesis.pdf.
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Legal and clinical complexities continue to develop surrounding medical treatment for trans and gender diverse youth in Australia. This thesis employed a comparative and medico-legal lens to evaluate the law in Australia against medical knowledge regarding consent to treatment of trans and gender diverse youth. These analyses determined whether Australian law is congruent with medical science, and whether law reform is needed. The law in England and Wales was also analysed to determine whether any differences may inform Australian law reform. The thesis drew conclusions for law reform and optimal clinical practice for trans and gender diverse youth.
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HUARD, MICHEL. "Semeiologie de l'epaule douloureuse : nouvelles techniques d'exploration, interet medico-legal." Lille 2, 1988. http://www.theses.fr/1988LIL2M233.
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LIENS, DAVID. "Rupture d'une prothese de hanche en service : aspect medico-legal." Lyon 1, 1994. http://www.theses.fr/1994LYO1M107.
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Givel, Brice. "Aptitude professionnelle et premiere crise d'epilepsie de l'adulte : aspect medico-legal." Angers, 1989. http://www.theses.fr/1989ANGE1000.
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POULAT, PILLON BRIGITTE. "L'activite de l'institut medico-legal de lyon entre 1985 et 1988." Lyon 1, 1991. http://www.theses.fr/1991LYO1M063.
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Cavallari, Jason Robert. "Upcast Eyes: Medico-Legal Discourse, Spectacle, and Deviance in France, 1870-1914." Thesis, Boston College, 2009. http://hdl.handle.net/2345/989.
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Thesis advisor: Paul BreinesThis dissertation attempts to problematize the question of agency in disciplinary societies by examining the symbolic importance in fin-de-siècle French culture of the abject deviants who were the target of medico-legal discourse in the Third Republic. In particular, I develop three main propositions. First, I am making a broad anthropological claim that the power implicitly given to deviants to establish boundaries between normality and abnormality paradoxically enabled them to shift borders of cleanliness and pollution in public discourse. Whereas others have argued that borderline deviants are powerless in their abjection, I propose the opposite: by giving deviants the power to shape the order of the Third Republic, medico-legal authorities unwittingly gave them precisely that -- enormous power. Second, I contend that this power largely took shape within the context of the rise of consumer society and urban spectacle. Spectacularization and widespread accessibility to information engendered a populace capable of suspicion, resistance, and resignification. Others have interpreted the spectacularization of narratives of deviance as being foisted upon passive consumers lacking intellectual agency and therefore accepting these narratives as the standards for bourgeois behavior. I suggest instead that spectacularization provided the precondition of possibility for the invention of a resistant and even potentially revolutionary populace. Third and finally, I make the claim that those who are seen are also capable of seeing, and hence, of questioning, negotiating, and redefining. Others, particularly those influenced by the work of Michel Foucault, have argued that "the public" was a docile, passive crowd, stripped of agency, helplessly accepting of ideas of republican virtue embodied by medico-legal discourses of deviance and the clinical gaze. In particular, the paradigm of the "panopticon" has perhaps overly influenced notions of bourgeois society. In the panoptic society, being self-conscious of always being (hypothetically) seen, actors police themselves to the point of inaction. I contend that this position assumes the desirability of a "correct" form of behavior to which all others must conform. Therefore, I argue for a very different conception of bourgeois society. If we look not to the panopticon, but rather to venues of spectacularization and consumer culture, we will see that, contrary to the marginalization implied by the panoptic model, deviance was celebrated as a symbol of freedom and release from the deterministic medico-legal gaze and helped to create multiple competing "scopic regimes." As a result, the consumer culture of the grands boulevards was not a sterile, depoliticized world of uncritical engagement defined by passive observation and consumption of spectacle and commodity, but rather a culture that celebrated spectacle as a venue for re-infusing the public sphere with social and political ambiguity against the rigid boundaries erected by the medico-legal discourses of the Third Republic
Thesis (PhD) — Boston College, 2009
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: History
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Beuzart, Pascale. "Infanticide : aspect medico-legal d'hier et d'aujourd'hui a partir de 8 cas cliniques." Reims, 1993. http://www.theses.fr/1993REIMM087.
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Carvalho, Marcus Vinicius Ribeiro. "Identificação do agente infeccioso HIV nos cadaveres do Instituto Medico Legal da cidade de Volta Redonda." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290626.
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Orientadores: Darcy de Oliveira Tosello, Eduardo Daruge JuniorDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O procedimento necroscópico realizado no Instituto Médico Legal (IML) é cercado de riscos biológicos dos quais precisam ser identificados e estudados para se produzir conhecimentos que justifique a utilização de medidas de biossegurança. O objetivo do trabalho é avaliar a existência do agente etiológico HIV em cadáveres, no intuito de determinar se a pesquisa necroscópica é fator de risco de transmissão para a equipe. O estudo ocorreu na área de Odontologia Legal e Deontologia da FOP-UNICAMP e no SML de Volta Redonda - RJ onde realizou-se a coleta de sangue da câmara atrial cardíaca de 50 cadáveres que deram entrada no período de 18 de maio a 26 de junho de 2009. O procedimento para análise imunológica foi feito pelo teste rápido de HIV e pelo ensaio imunoenzimático (ELISA). Das 50 amostras coletadas, nove foram inadequadas para o teste. E das 41 amostras testadas houve um único resultado positivo para HIV no teste ELISA e no teste rápido. Há riscos de contaminação pelo HIV para a equipe do IML nos procedimentos de necropsia, desde que não se respeitem às diretrizes de biossegurança para os atos operatórios. Tendo este trabalho detectado a presença do HIV em 2,4% das amostras efetivamente examinadas.
Abstract: The carried through autopsy procedure in the Institute of Forensic Medicine (IML) is surrounded biological risks which need to be identified and studied to produce knowledge that justifies the use of biosecurity measures. The objective of this study is to evaluate the existence of the agent HIV in cadavers in order to determine whether the research necroscopic is a risk factor for transmission to the team. The study took place in the area of forensic dentistry and ethics of FOP-UNICAMP and SML Volta Redonda - RJ which held the blood collection chamber atrial rate of 50 corpses received in the period from May 18 to June 26 2009. The procedure for the immunological analysis was done by the rapid test for HIV and by enzyme immunoassay (ELISA). Of the 50 samples, nine were inadequate for testing. And of the 41 samples tested there was a single positive result for HIV ELISA and rapid test. There are risks of HIV infection to the staff of IML in autopsy procedures, provided they do not comply with the biosafety guidelines for surgical procedures. Having this work detected the presence of HIV in 2.4% of the samples actually tested.
Mestrado
Odontologia Legal e Deontologia
Mestre em Biologia Buco-Dental
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Secker, Barbara L. "Medico-legal jurisdiction over human decision-making, a philosophical constructionist analysis of mental competence." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ59048.pdf.
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Evert, Lucinda. "Unidentified bodies in forensic pathology practice in South Africa : demographic and medico-legal perspectives." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/24911.
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Unidentified bodies in the forensic setting constitute a global problem. Though this should be of great concern to many governments, very little data on the extent of this phenomenon is available in international literature and few countries require that statistics on the number of unidentified deceased be kept. To determine the extent of this phenomenon in South Africa, a study into the number of unidentified deceased at the Pretoria Medico-Legal Laboratory and their demographic profile was undertaken. The study has indicated that between 7% and 10% of bodies remain unidentified at the Medico-Legal Laboratory in Pretoria. Publications further indicate that a total of 846 bodies remained unidentified at Medico-Legal Laboratories in Gauteng for the period January 2010 to August 2010. This number is very high when compared to international literature. Of great concern is the fact that these statistics do not include the cases in which persons die in hospital facilities from natural causes without an identity, which are not referred to the Forensic Pathology Service for investigation. The true extent of the problem may thus be far greater than imagined. Determining the true extent of this phenomenon in South Africa is therefore important, as these unidentified bodies have many social and economic consequences. Not only are families unaware that their loved ones have passed away, but they are also unable to bury and mourn them. Unidentified bodies at Medico-Legal Laboratory facilities also impacts on the service delivery capability of the government departments involved in the investigation of such cases. The drafting of additional legislation for the management of unidentified bodies is therefore required. A need to establish and enforce specific protocols to be followed in the event of unidentified bodies has also been identified. The creation of a National Unidentified Decedent website and DNA database is recommended as they will greatly assist in reducing the number of unidentified bodies throughout South Africa. It is however only through coordinated efforts and interdepartmental cooperation that these proposals will be successful. AFRIKAANS : Ongeïdentifiseerde liggame in die forensiese omgewing is ‘n wêreldwye probleem. Alhoewel dit ‘n bron van kommer vir meeste regerings behoort te wees, is baie min data oor die omvang van hierdie verskynsel beskikbaar in die internationale literatuur, met min lande wat vereis dat amptelike statistieke oor onbekende oorledenes versamel word. Om die omvang van hierdie verskynsel in Suid Afrika te bepaal, is ‘n studie na die aantal onbekende liggame by die Regsgeneeskundige Laboratorium in Pretoria en hul demografies profiel onderneem . Die studie het getoon dat tussen 7% en 10% van alle liggame wat deur die Regsgeneeskundige Laboratorium in Pretoria opgeneem word, onuitgeken bly. Publikasies dui ook aan dat 846 liggame ongeïdentifiseerd was by Regsgeneeskundige Laboratoriums vir die tydperk Januarie 2010 to Augustus 2010. Hierdie getal is aansienlik hoër as díe wat in die internasionale literatuur gesien word. ‘n Groot bron van kommer is die feit dat hierdie statistieke nie gevalle insluit waar die oorledene in ‘n hospitaal gesterf het as gevolg van natuurlike oorsake, sonder dat hul identiteit bekend is. Die ware omvang van die problem kan dus veel groter as geskat wees. Die bepaling van die omvang van hierdie verskynsel in Suid Afrika is belangrik, omdat ongeïdentifiseerde liggame beide sosiale en ekonomiese gevolge het. Nie net is families onbewus daarvan dat hul geliefdes gesterf het nie, maar kry hul ook nie die geleentheid om hul geliefdes te begrawe en oor hul afsterwe te rou nie. Ongeïdentifiseerde liggame by Regsgeneeskundige Laboratoriums het ook ‘n invloed op die diensleweringskapasiteit van die verskeie staatsdepartemente wat betrokke is by die ondersoek van sulke gevalle. Die opstel van addisionele wetgewing wat die bestuur van ongeïdentifiseerde liggame reguleer is dus nodig. Die behoefte aan spesifieke protokolle vir die hantering van sulke gevalle is ook geïdentifiseer. Daar word verder aangeraai dat ‘n Nasionale Onuitgekende Liggaam webwerf en DNS databasis geskep word in ‘n poging om die aantal ongeïdentifiseerde liggame in Suid Afrika te verminder. Dit is egter slegs deur middel van gekoördineerde pogings en interdepartmentele samewerking wat hierdie voorstelle sukses sal behaal. CopyrightDissertation (MSc)--University of Pretoria, 2011.
Forensic Medicine
unrestricted
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Haegele, Joseph. "A mechanism based approach to evaluating adverse drug reactions in a medico-legal setting." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12408.
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Thesis (M.S.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.The following thesis is an evaluation of the various mechanistic underpinnings of adverse drug reactions, including prescription drug-drug, drug-food, and dru gsupplement interactions, as well as "type B" adverse drug reactions, and adverse drug reactions arising from medication errors. The mechanisms associated with each of these categories are presented and supported through published studies and case reports. Furthermore, the aforementioned adverse drug reactions are associated with risk factors and severe, or fatal, adverse drug reactions are assessed within a medico-legal context for their relevance and prevalence. It was found that there is an insufficient amount of published data, especially within the United States, to determine the overall degree to which fatal adverse drug reactions may influence post-mortem analysis and outcomes of medico-legal investigation.
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Moreira, Ana Paola Latorre. "Padronização dos prontuarios utilizados por peritos odonto-legistas nos institutos medico-legais em procedimentos de identificação humana." [s.n.], 2004. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290604.
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Orientador: Dagmar de Paula QueluzDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A incumbência de identificar um corpo humano é uma tarefa cujo grau de dificuldade pode variar de uma comprovação em questão de segundos até as raias da impossibilidade, de acordo com a quantidade e qualidade das informações ante e post-mortem adquiridas pela equipe de peritos. Uma linha de ação bem definida e padronizada pode agilizar em muito esta árdua missão, principalmente nas situações em que o cadáver encontrar-se em estado avançado de decomposição, carbonizado, esqueletizado, afogado, fragmentado, ou, ainda, quando houver a necessidade de trocas de informações dentárias entre órgãos de diferentes Estados. Tendo em vista tal necessidade, buscou-se avaliar os procedimentos utilizados em identificações de rotina pelos odonto-Iegistas dos Institutos Médico-legais do Brasil e propor um protocolo padronizado para estas atividades, sendo este inserido em um software para registro e comparação de informações ante e post-mortem de seres humanos. Para tanto, contatou-se os diretores de Institutos Médico-legais dos 26 Estados e Distrito Federal, visando a verificar a presença do perito odonto-Iegista em seus respectivos quadros de pessoal. Apurou-se que destes, apenas 14 responderam positivamente, aos quais solicitaram-se informações sobre suas condutas nas identificações. Dez Institutos Médico-legais retomaram tais informações, e destes, sete formulários vieram com informações úteis à proposta. Constatou-se, pela análise do material recebido, que há diferentes tipos de condutas, havendo, também, carência no detalhamento de informações registradas. Evidenciou-se que uma possível troca de informações entre Estados seria difícil, em virtude de terminologias e odontogramas diferentes, além da falta de informatização por parte de praticamente todos os Institutos Médico-legais. Formulou-se um prontuário de cadáver abrangente e de fácil interpretação, proporcionando eficácia e simplicidade ao processo de identificação
Abstract: The levei of complexity in the process to identify a human body can vary from the simplicity of seconds up to almost impossible identification. This degree of difficulty varies according the quality and quantity of information ante and postmortem collected by the forensic experts. A well defined and standardized line of action for this task can help a lot in the execution of the forensic team mission, especially when the body is in an advanced stage of decomposition or it is burned, fragmented or whenever there is a need to exchange dental data with agencies from different States. Based on this necessity, this job has analised the criteria and procedures used in routine identification by the forensic dentists in the Brasilian Forensic Institutes, and suggested a standardized protocol, which data can be introduced in a software that allows the register and comparison of ante and postmortem information. The research started verifying what States in Brazil have the Dental forensic expert, in order to request from them the most number of information on their examination procedures, professional conduct and investigation techniques. 10 of 14 States which confirmed that they have Dental forensic expert sent research material for this study. From these 10 States, 07 had useful information for this research. The comparative study was very useful for the process to analise differences between the many methodologies used by the professionals and to help in determining a stardardized procedure. It was evidenced that an exchange of information and data collection among ali the States would be very difficult due different terminology and odontograms, further on scarcity of data by many of the informants. The study ended with the compilation of ali the collected data in a broad system that can be used in a very easy and simply way in order to organize the application of the new methodology for identification of bodies proposed by this paper
Mestrado
Mestre em Odontologia Legal e Deontologia
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Råsten, Almqvist Petra. "Sudden infant death syndrome : a medico-legal study of related cardiovascular, toxicological and genetic findings /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-167-5.
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Purser, Kelly. "Competency and capacity : the legal and medical interface." Thesis, University of New England, 2013. https://eprints.qut.edu.au/62920/1/RESUB_Complete_thesis_FINAL_Dec_2012.pdf.
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Balancing the competing interests of autonomy and protection of individuals is an escalating challenge confronting an ageing Australian society. Legal and medical professionals are increasingly being asked to determine whether individuals are legally competent/capable to make their own testamentary and substitute decision-making, that is financial and/or personal/health care, decisions. No consistent and transparent competency/capacity assessment paradigm currently exists in Australia. Consequently, assessments are currently being undertaken on an ad hoc basis which is concerning as Australia’s population ages and issues of competency/capacity increase. The absence of nationally accepted competency/capacity assessment guidelines and supporting principles results in legal and medical professionals involved with competency/capacity assessment implementing individual processes tailored to their own abilities. Legal and medical approaches differ both between and within the professions. The terminology used also varies. The legal practitioner is concerned with whether the individual has the legal ability to make the decision. A medical practitioner assesses fluctuations in physical and mental abilities. The problem is that the terms competency and capacity are used interchangeably resulting in confusion about what is actually being assessed. The terminological and methodological differences subsequently create miscommunication and misunderstanding between the professions. Consequently, it is not necessarily a simple solution for a legal professional to seek the opinion of a medical practitioner when assessing testamentary and/or substitute decision-making competency/capacity.
This research investigates the effects of the current inadequate testamentary and substitute decision-making assessment paradigm and whether there is a more satisfactory approach. This exploration is undertaken within a framework of therapeutic jurisprudence which promotes principles fundamentally important in this context. Empirical research has been undertaken to first, explore the effects of the current process with practising legal and medical professionals; and second, to determine whether miscommunication and misunderstanding actually exist between the professions such that it gives rise to a tense relationship which is not conducive to satisfactory competency/capacity assessments. The necessity of reviewing the adequacy of the existing competency/capacity assessment methodology in the testamentary and substitute decision-making domain will be demonstrated and recommendations for the development of a suitable process made.
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De, Villiers Katherine. "Assessing the functionality and value of introducing Death Investigators into forensic pathology service in South Africa." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/78212.
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In modern society the medico-legal investigation of death is a prerequisite for the administration of justice and for the betterment of public health. These investigations require a high level of skill, professionalism and ethics and have far reaching effects. South Africa’s high level of unnatural deaths, combined with limited human and fiscal resources, specifically a scarcity in practicing Forensic Medical Practitioners, a lack of adequate training of Forensic Officers and members of the South African Police Service, discrepancies in available statistics and a lack of accreditation and quality control, to name a few, leave the South African medico-legal system overburdened. Death investigation needs to evolve and improve constantly and improvements in death investigation need to occur across a wide spectrum of parameters.
In the United States of America, to combat systemic issues such as those experienced in South Africa, Death Investigators have been introduced in a supportive capacity and as an extension of services rendered by Forensic Medical Practitioners. These investigators, who are not medical practitioners but may have some level of training or vocational experience within the medical or investigative field, attend and help to analyse death scenes, collect relevant ante-mortem data, assist during autopsies, expedite special investigations, liaise with other stakeholders and provide testimony if warranted. Multiple benefits are associated with the introduction of these death investigators, with the collection of relevant (pre-autopsy) information which will assist and direct the Forensic Medical Practitioner probably being the most pertinent in the context of this research.
The aim of this study was to assess the functionality and value of introducing such Death Investigators into forensic pathology service in South Africa. Specifically, this research focused on the nature and scope of information currently being provided to Forensic Medical Practitioners prior to conducting an autopsy and assessed whether the introduction of these investigators would improve the quality of pre-autopsy information.
To determine this, participating Forensic Medical Practitioners were asked to evaluate the quality of information currently provided to them prior to conducting an autopsy and to evaluate the quality of information contained in a Death Investigator worksheet that was completed hypothetically for the same case, as an example of the type of information that would be collected by a Death Investigator. Additionally, the disposition of Forensic Medical Practitioners and external stakeholders to the proposed introduction of Death Investigators was assessed through a questionnaire process.
Findings of this research showed that there is a significant deficit in the quality of pre-autopsy information being provided to Forensic Medical Practitioners at present. The current pre-autopsy information received an average information quality score of 21.4%. However, the Death Investigator worksheets received and average information quality score of 84.9% representing a marked improvement. Forensic Medical Practitioners had a favourable disposition to the proposed introduction of Death Investigators and agreed that Death Investigators would provide an improved knowledge and understanding of the circumstances and setting of the death, which in turn would , enhance their ability to strategise a post-mortem approach, to request appropriate special investigations and to better interpret their autopsy findings.
Overall, the results of this research suggest that the introduction of Death Investigators would add value, specifically by improving the gathering of appropriate information and would be welcomed by Forensic Medical Practitioners. While this research was conducted in Pretoria, it was done on the premise that the poor-quality pre-autopsy information experienced in Pretoria, is probably, to a greater or lesser extent experienced in other medico-legal laboratories in South Africa. It is recommended, that a multi-centre audit of pre-autopsy information quality is undertaken to verify the results found at the Pretoria Medico-legal Laboratory. Furthermore, to facilitate the introduction of Death Investigators as a new professional category, it is recommended that a working group be convened to further interrogate the added-value potential of this introduction as well as to determine prerequisite educational requirements and acceptable recognised prior learning, and to develop guidelines and scope of practice documents. It is also recommended that should this introduction come to fruition, provision be made to accommodate such Death Investigators on a professional board affiliated with the Health Professions Council of South Africa, to guide training and qualification requirements, advise on best practice and professional standards against which Death Investigators can be held accountable.Dissertation (MSc (Medical Criminalistic))--University of Pretoria, 2020.
Forensic Medicine
MSc (Medical Criminalistic)
Unrestricted
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Taylor, Bettina. "A Retrospective, Observational Study of Medico-legal Cases against Obstetricians and Gynaecologists in South Africa's Private Sector." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33055.
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South Africa is experiencing a medico-legal crisis that is threatening the delivery of essential health care services, especially relating to maternal and fetal health. In the private sector, professional indemnity premiums for obstetricians to provide insurance cover in the event of medico-legal challenges have increased more than 10-fold in a 10-year period. In the State, exponential increases in contingent liabilities for claims due to alleged negligence are usurping health care budgets allocated towards the delivery of health care, with about half of these claims relating to obstetrics and gynaecology and three quarter of latter to cerebral palsy for reasons of alleged hypoxic brain injury of the newborn. Despite the ominous implications of these developments for the supply side of health care, there is a scarcity of information in terms of contributing factors. Whilst many assume that the main driving force of burgeoning professional indemnity premiums for obstetricians and gynaecologists in the private sector have also been as a result of claims for cerebral palsy, there are no empirical data to explain developments over recent years and guide risk management interventions in this regard. To understand claim trends and identify potential predictors of patient dissatisfaction that result in engagement of the regulatory and legal system in the private sector, obstetric and gynaecological medico-legal data recorded by Constantia Insurance Limited, a local professional indemnity provider, were analysed. Other than confirming a steep increase in medico-legal notifications for obstetric- and gynaecology-related complaints from about 2003 to 2012, a high proportion of number of claims and paid settlements for gynaecology relative to obstetric-related cases was noted. This is contrary to international and public sector experiences, where number of demands relating to obstetrics consistently exceed those associated with gynaecological care. This finding, together with the fact that the majority of pay-outs on behalf of doctors related to surgical complications, especially unintended intraoperative injuries to internal organs and vessels, calls for further research into the clinical outcomes of private gynaecological practice, as well as potential review of aspects of surgical training standards and accreditation in gynaecology and consideration of surgical mentorship programmes. The latter is particularly relevant in the context of surgical registrars having expressed concerns about their readiness to practice independently following specialist graduation. Whereas claims for severe neurological injury of the newborn constituted less than 15% of all claims settled on behalf of obstetricians and gynaecologists entered into the study, they accounted for about half of all known paid settlements relating to pregnancy-related care. Whilst not dominating in terms of claim frequency overall, they nevertheless are an important focus area for risk management interventions, given the high quantum of demand typically associated with these cases. In this regard, more research into the etiology of errors is required, including the contribution of nursing and other system failures that could not be quantified adequately as part of this research project. Another important finding was the disproportionate contribution of medico-legal risk by a small cohort of practitioners, which suggests a need for doctor-focused support and interventions, including effective peer review and regulatory oversight by the Health Professions Council. To reverse the high financial burden of professional indemnity fees and fear of litigation amongst private sector obstetricians and gynaecologists, multidimensional risk management interventions, which include enhancements at the point of care, are required. If medicolegal trends and their negative consequences are to be reversed, medico-legal hotspots should become an important source of information and consideration in the development of solutions aimed at preventing human error and strengthening the healthcare system in terms of improved patient safety and satisfaction.
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Wichers, Ansie. "Firearm fatalities examined at Salt River Medico-Legal Laboratory in 2009 and their investigative outcome by 2014." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21373.
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South Africa has a very long history of gun violence, particularly politically motivated. The politically motivated gun violence did subside after 1994, however there was an increase in criminal gun violence. In 2004 Dr Liebenberg from the University of Cape Town conducted a study on the victimology and investigative outcomes of firearm deaths of 1999 in the Salt River Medico - Legal Laboratory drainage area. There were some compelling results, including a remarkably low conviction rate of 7.21%. In 2000 new legislation was enacted, which is the Firearms Control Act (1) of 2000 and from 2001 to 2005 there was a 13.6% decrease in firearm homicides which was consistent after the introduction of the new act, likely due to the decrease in the number of firearms in circulation. Because of the changes in firearm legislation and reported crime rates, it was decided to conduct a follow - up study one decade later, looking at the investigative outcomes of firearm deaths to see whether the decreased contribution of firearms in homicides and crime made an impact on the investigative and judicial process of the Salt River Medico - Legal Laboratory cases. In 2009 there were 281 firearm deaths investigated at Salt River Medico - Legal Laboratory as opposed to 532 in 1999. In 1999, 89.29% of firearm deaths were due to homicide as opposed to 86.12% in 2009. In 1999 the majority of firearm homicide victims were Black and Coloured males between the ages of 21 and 30 years, this is similar to what is seen in 2009, however there were fewer Coloured victims in 2009. In both years homicides occurred more often on weekends, at night time. In 1999 there were peaks in May and then from October through to December. In 2009 however, the peaks were in March, May and August. One might thin k that with such a large decrease in the number of firearm deaths (not considering other crime trends), the criminal justice system might have fewer cases to investigate and prosecute and that the investigative outcomes (particularly conviction rate) of th ese cases might improve. Even though there was a significant drop in the number of firearm deaths in 2009, there has been no improvement in the conviction rate, with 2009 having a rate of 5.69%. The number of cases still being investigated was also similar at 104 cases (37.01%) for 2009 versus 182 cases (34.54%) for 1999. In 2009 only 58 (20.64%) cases completed the judicial process by 2014, which includes the 16 cases (5.69%) that ended in a guilty verdict, 18 (6.41%) cases where a suspect was acquitted (not guilty) and also 24 (8.54%) cases that were withdrawn in court. Of the 281 cases for 2009, 10 (3.56%) were still in court, which was significantly less than the 59 (11.20%) cases in 1999. From 2009 there were 87 cases that reached an impasse (30.96%) by 2014, as opposed to the 114 (21.63%) cases from 1999 by 2004, which is a statistically significant difference.
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Nkwanyana, Thabani Silomo. "The socio-political and medico legal and socio political practice of medicine in South Africa post 1994." Diss., University of Pretoria, 2016. http://hdl.handle.net/2263/60078.
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Africa?s socio-political and medico-legal landscapes have dramatically changed since 1994 with the dawn of democracy and peaceful transition from apartheid South Africa to a Constitutional democracy, and the birth of the democratic South Africa. Considerable social progress has been made towards reversing the discriminatory practices that prevailed in most, if not all, aspects of life before 1994. The dawn of democracy brought with it changes in the healthcare policy and design andmade it to almost become intuitive to think that human rights, equality and access to healthcare should be entitlements we should all enjoy, without exceptions, prejudice, fear or favour. But this has not been without challenges especially with regards to access to healthcare, health privilege, equality, distributive justice and medical ethics.Our healthcare system has evidently continued to be marked with the inequalities, poor service delivery and lack of resources, corruption, prejudice and reversal of fortunes. Majority of people, especially Blacks and Coloureds in South Africa are still underserved and disadvantaged compared with their White and Asian counterparts. Arguably, there also have been increasing tensions in the medico-legal space, especially in the sphere of access to health care, health provision and management, quality of health care, medical malpractice and negligence, and medical research, experimentation and bio-ethics. At the same breath, and despite government commitment to equal medical care for all, regardless of financial or political considerations, the quality and accessibility of health services in South Africa are, in some instances, still dependent on the ability to afford, socio-political standing, political connectedness or status. It is not uncommon for some persons to get more attentive, responsive, and reputedly, competent health and medical care than it is available to general public and the majority. For celebrities, the rich or high-ranking officials, preferential treatment is still routinely provided and there still seem to be imposition of politics and ideology on the practice of medicine and ethics. This paper thus intends to explore the other ugly heads that have since surfaced with the dawn of democracy in the sphere of medical ethics and law.Mini Dissertation (MPhil)--University of Pretoria, 2016.
Public Law
MPhil
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Alde, Lorenzo. "Ossos do oficio: processo de trabalho e percepcoes de saude no Instituto Medico-Legal do Rio de Janeiro." Rio de Janeiro : [s.n.], 2003. http://teses.cict.fiocruz.br/pdf/aldelm.pdf.
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Tucker, Cherón. "A medico-legal examination of homosexual women and their children : ethical consideration and the role of the clinical psychologist." Master's thesis, University of Cape Town, 1986. http://hdl.handle.net/11427/14819.
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Bibliography: leaves 250-284.Past and present legal and medical proscriptions towards female homosexuality were reviewed, and the role of the women's movement and gay liberation organisations were considered in effecting social change. The legal predicaments of homosexual mothers seeking child custody was noted and the concerns of the court outlined and used to organise a comprehensive review of the literature on aetiology, personality adjustment, psychiatric status, life style and mothering capabilities of gay women. The effects on children raised by a homosexual mother were evaluated and it was noted that this experience cannot be separated from the child's experience of the effects of divorce and absent fathering amongst other things. A case study was presented, and the concerns of the court were found to be generally unwarranted and most difficulties experienced by the child seemed to be secondary problems relating to social prejudice and stigmatization. Ethical considerations were documented concerning the role of the psychologist in terms of social reform, research, community involvement, modes of therapy, legal reform and child custody disputes. Future directions were considered.
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Symon, Andrew. "The rise and fall of perinatal litigation : a medico-legal examination of allegations of negligence in childbirth since 1980." Thesis, University of Edinburgh, 1997. http://hdl.handle.net/1842/21561.
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There are many different reasons why people sue, and while a brain damaged child was by far the most common reason, this head of claim accounted for only a quarter of the cases. Clinical information showed how cerebral palsy is often an unexpected outcome. This constitutes a potential worry for all staff involved in perinatal care, and has implications for the levels of investigation and intervention. Stillbirths, non-Central Nervous system (CNS) birth injuries and neonatal deaths were all fairly common reasons for suing on behalf of a baby. For mothers perineal trauma was the most common, but caesarean section also featured prominently, as did allegations about retained products of conception, and epidural/spinal anaesthesia. It was possible to describe success rates by head of claim, information not previously available. It is apparent that clinicians believe that more investigations and operations are being conducted as a direct fear of the possibility of litigation. This higher level of intervention is at odds both with the 'consumer' demand for more natural childbirth, and the aim of obstetricians to reduce the number of caesareans. A matter for concern was the high prevalence of staff who believed they had had insufficient training in the interpretation of cardiotocographs. It was intriguing that the views of respondents about defensive clinical practice (including the consideration of leaving the specialty) were not positively associated with a direct experience of litigation. One of the most prominent features of legal actions is the time they take. While delays in initiating an action are beyond the scope of health managers, delays within the health system were, unfortunately, commonplace, and largely due to poor record keeping and administration. It is possible that the shorter time it has taken to conclude legal actions originating since the mid-1980s indicates that legal departments are becoming more efficient, but there is still a strong requirement for pursuers to be patient and resolute. Perinatal litigation is an unpredictable area; the multitude of reasons for suing in this areas of health care make simple descriptions and simplistic prescriptions inappropriate. However, the data presented in the thesis provide detailed information for a much more informed approach to both risk and claims management.
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Mighall, Robert. "The brigand in the laboratory : a study of the discursive exchange between Gothic fiction and nineteenth-century medico-legal science." Thesis, University of Wales Trinity Saint David, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.683119.
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Legros, Dominique. "Certificat de deces et probleme medico-legal : a propos de 216 morts subites recensees en 1987 au samu de troyes." Reims, 1989. http://www.theses.fr/1989REIMM044.
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VANPOULLE, LABOULET CATHERINE. "Aspect medico-legal de l'utilisation des produits de contraste : a propos de 43 cas repertories et revue de la litterature." Amiens, 1994. http://www.theses.fr/1994AMIEM103.
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VERKINDT, LORTHIOIR SYLVIE. "Accueil et examen medico-legal des victimes d'agressions sexuelles : experiences du service de gynecologie obstetrique de l'hopital louis mourier a colombes." Lille 2, 1992. http://www.theses.fr/1992LIL2M181.
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Oliever, Lorraine Anneline. "The medico-legal investigation of unexplained deaths in Pretoria, South Africa : the role of death investigators as a new professional subgroup." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/31099.
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In 2009, the South African population was estimated at 49.32 million. The Department of Home Affairs had 612 462 registered deaths in 2006, with approximately 122 492 of these being due to other than natural causes. It is estimated that this number may have remained fairly constant or increased slightly over the past few years. During 2009 and 2010 there were only 35 practising forensic pathologists in South Africa. Furthermore , according to the South African Police Service, over 2 million serious crimes were reported over the 2008-2009 period, whilst there were approximately 153 981 police officers in service. When it is considered that these cases fall within the realm of the forensic pathologists, it should be of great concern that so few qualified specialists exist within the country. South Africa not only has a high occurrence of deaths amongst young adults which can be attributed to trauma and other non-natural causes as well as HIV/AIDS, but urbanisation, an influx of foreigners and an increase in unemployment may also have an influence on the mortality rate of young, working age adults. However, there appears to be a discrepancy in mortality statistics between data released by Statistics South Africa, and the National Population Registry which is maintained by the Department of Home Affairs. This study was undertaken in order to bring about the realisation that professionals are needed in order to bridge a gap in the medico-legal investigation of deaths in South Africa. Approximately half of the cases of sudden unexpected deaths that were reviewed over the fifteen months from January 2009 until March 2010 were due to natural causes, with approximately 37% being signed out as under investigation. In approximately 50% of the cases reviewed, the forensic pathologist was contacted to attend the scene of death, with only half of these scenes being attended by the forensic pathologist on call. Attendance of the post-mortem by the Investigating Officer in charge of the case was poor, with approximately 80% of the post mortem examinations being conducted without the Investigating Officer present. It is believed that medico-legal death investigators would greatly improve the investigation of sudden deaths in South Africa. The institution of medico-legal death investigators would minimise the case load of all the role players, as well as reducing the confusion related with the medico-legal significance of deaths. It is also believed that medico-legal death investigators would minimise and eventually eliminate the gap that currently exists between the departments that are involved with the investigation of deaths. It would thus be advantageous for medico-legal death investigators to fall under the jurisdiction of both the Department of Health and the South African Police Service.AFRIKAANS : In 2009 was die Suid Afrikaanse bevolking geskat op 49.32 miljoen, in 2006, was daar 612 462 sterftes wat by die Departement van Binnelandse Sake geregistreer is, ongeveer 122 492 was as gevolg van ander dan natuurlike oorsake. Dit kan beraam word dat hierdie getal onveranderd gebly het of effens toegeneem het oor die afgelope paar jaar. Daar was egter net 35 forensiese patoloë wat praktiserend was in Suid Afrika in 2009 en 2010. Verder het die Suid-Afrikaanse Polisiediens berig dat meer as 2 miljoen ernstige misdade gerapporteer was vir die tydperk 2008-2009, terwyl daar net sowat 153 981 poliesiebeamptes in diens was. Wanneer dit beskou word dat hierdie gevalle in die gebied van die forensiese patoloog val, moet dit n groot bekommernis wees dat daar so min bekwaamde spesialiste in die land bestaan. Suid Afrika het 'n hoë voorval van sterftes onder jong volwassenes te danke aan trauma en ander onnatuurlike oorsake sowel as MIV en vigs. Verstedeliking, 'n infloei van binnelanders en 'n toename in werkloosheid kan almal 'n invloed op die sterftesyfer van die jong verkende volwassenes hê. Daar is 'n verskil in mortalitiet statistieke tussen Statistieke Suid Afrika, en die Nasionale Bevolking Register wat in stand gehou word deur die Departement van Binnelandse Sake. Hierdie studie was aangeneem om die verwesenliking uit te voer dat beroepspelers nodig is om die gaping oor te brug wat in die geregtelike mediese ondersoek van sterftes in Suid Afrika plaas vind. Ongeweer halfte van die gevalle van skielike onverwagse sterftes wat vanaf Januarie 2009 oor vyftien maande hersien is, is as gevolg van natuurlike oorsake, terwyl ongeveer 37% onder ondersoek was. In ongeveer die helfte van die gevalle wat hersien was, was die forensiese patoloog gekontak om 'n sterftoneel by te woon, en omtrent net die halfte van hierdie tonele is bygewoon deur die forensiese patoloog. Die bywooning van nadoodse ondersoeke deur die ondersoekbeapte wat toesig oor die geval het was treurig, met ongeveer 80% nadoodse ondersoeke wat gedra was sonder dat die ondersoekbeampte teenwoordig was. Dit is oortuig dat geregtelike mediese doodsondersoekbeamptes die ondersoek van sterftes in Suid Afrika baie sou verminder, die instelling van geregtelike mediese doodsondersoekbeamptes sou die werklos van die rolspelers verminder, sowel as die verrwarring wat verband hou met die geregtelike mediese ondersoek van sterftes verminder. Dit is oortuig dat geregtelike mediese doodsonderdoekbeamptes die gaping wat tans plaasvind met ondersoeke na die sterftes uiteindelik sou uitskakel of verminder, dit sou dus voorledig wees as geregtelike mediese doodsondersoekbeamptes onder die regsgebied van albei die Departement van Binnelandse Sake en die Suid Afrikanse Poliesiediens sou wees.
Dissertation (MSc)--University of Pretoria, 2011.
Forensic Medicine
Unrestricted
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Bennett, Tracy. "Exploring the Medico-legal death scene investigation of sudden unexpected death of infants admitted to Salt River mortuary, Cape Town, South Africa." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30064.
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A death scene investigation (DSI) forms an integral part of the inquiry into death, particularly for sudden unexpected death of infants (SUDI). Global guidelines exist for DSI, however, it is unclear how many countries adhere to them, and to what extent they are followed. Therefore, a systematic literature review was undertaken to assess the scope of SUDI DSI performed internationally. It was found that national protocols have been established in some countries, and have shown value in guiding medico-legal examinations. Further, South Africa did not routinely perform DSI for SUDI cases, nor was there a protocol. This was largely attributed to the burden of SUDI cases as well as the lack of resources. Therefore, this study aimed to suggest realistic and feasible ways to improve DSI for local SUDI cases. This research study consisted of three phases: 1) A twoyear review of medico-legal case files from SUDI cases investigated at Salt River Mortuary; 2) The prospective observation of DSI for ten SUDI cases, using a semi-structured checklist; and 3) he distribution and analysis of a survey regarding SUDI DSI to all registered, qualified forensic pathologists in South Africa. The results showed that the SUDI death scenes were assessed in 59.2% of cases at Salt River Mortuary, with inconsistent levels of documentation or photography. Death scenes were never investigated in cases where the infant was pronounced dead on arrival at a medical facility. In both scene observations (n=10) and retrospective analysis (n=454) only one case incorporated a re-enactment, but the majority of infants were moved prior to DSI. The findings support the need for a standardised approach to DSI, coupled with specialised training for staff. Based on the available resources, this should focus on the establishment of guidelines pertaining to photography, handling medicine and scene reconstruction, as well as accurate use of relevant documentation.
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Hassan, Huda Mustafa A. "An evaluation of the stability and prevalence of alcohol and related biomarkers in biological matrices with applications to the interpretation of medico-legal cases." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/3002/.
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Ethanol is a poison that adversely affects the health of individuals and is detrimental to society as a whole. Analysis of ethanol in biological matrices is the most frequent test carried out in forensic toxicology laboratories with application across a range of cases types including fatalities, road traffic accidents, criminal investigations and workplace drug testing. The interpretation of ethanol concentrations in post mortem samples can be challenging in relation to medico-legal investigations. The source of ethanol can be as a result of the ingestion of an alcoholic beverage or it may have been formed after death. The stability of alcohol is also adversely affected by the presence of bacteria, high temperatures and unsuitable storage containers. A robust and sensitive method was developed for the analysis of common volatiles such as ethanol, methanol, isopropanol, acetone and n-propanol using headspace gas chromatography coupled with a flame ionization detector (HS-GC-FID). The method was validated in accordance with ISO/IEC 17025, and was used to investigate the stability of volatiles in blood when stored under different conditions, and to investigate the prevalence of volatiles in different biological matrices collected post-mortem. Storage of blood samples in the freezer within sample vials containing preservative and antioxidant improved the stability of all volatiles with the exception of methanol which remained stable under all conditions investigated. The identification of ethanol or acetone in vitreous humour was found to be a suitable alternative matrix in cases where femoral blood was unavailable or ethanol production was suspected. The concentration of ethanol in bile correlated well with femoral blood but to a lesser extent than vitreous humour. Urine was not a suitable matrix for estimating blood ethanol concentrations. Alcohol biomarkers, Beta-Hydroxybutyrate (BHB) and fatty acid ethyl esters (FAEEs) have been reported as useful markers for, investigating the role of alcoholic ketoacidosis (AKA) in post-mortem cases, and foetal exposure to chronic maternal alcohol consumption, respectively. Methods were developed and validated in accordance with ISO/IEC 17025 for BHB in blood and urine using gas chromatography - mass spectrometry (GC/MS), and for FAEEs in meconium by liquid chromatography - tandem mass spectrometry (LC/MS/MS). Post-mortem case samples submitted to the Forensic Medicine and Science (FMS) toxicology laboratory for routine tests were analysed for BHB using the validated method. The findings highlighted the importance of measuring BHB in blood in all cases where the deceased has a history of alcohol misuse and where the cause of death cannot be determined following the post-mortem. The role of alcoholic ketoacidosis in the cases analysed in this study was significantly under-reported. Meconium samples collected from infants born at the Princess Royal Maternity Hospital, Glasgow, were analysed for FAEEs, using the validated method to investigate the prevalence of each FAEE (ethyl laurate, ethyl myristate, ethyl palmitate, ethyl stearate, ethyl oleate, ethyl linoleate, ethyl linolenate, and ethyl arachidonate). The study found evidence of chronic maternal alcohol consumption in approximately one third of the cases tested, in contrast to self-reported use and highlights the importance of screening for the presence of FAEEs in meconium. The identification of suitable biomarkers of excessive maternal alcohol consumption during pregnancy, carried out as part of screening program, in addition to clinical evaluation would help to diagnose and support newborns with Foetal Alcohol Spectrum Disorder (FASD). The method developed for the analysis of BHB in blood and urine was successfully adapted and validated for analysis of structurally similar drugs such as Beta-hydroxy-Beta-methylbutyrate (HMB), a legal dietary supplement, in plasma and urine collected from 8 subjects, pre- and post-administration of a 3g dose of HMB. A significant increase was observed in urine and plasma following administration of of HMB. The method was then applied to the analysis of post-mortem blood and urine to investigate the concentrations of exogenous and endogenous levels of γ-hydroxybutyrate (GHB).
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Kauppila, Riitta. "Sudden and unexpected natural and violent deaths in females in comparison to deaths in males : a medico-legal autopsy study in the province of southern Finland during the years 1985, 1992, and 1999." Helsinki : University of Helsinki, 2003. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/kauppila/.
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Opperman, Johan Frank. "A study to determine the forensic quality of records and record keeping by dentists in the greater Cape Town area." University of the Western Cape, 2018. http://hdl.handle.net/11394/6405.
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Magister Chirurgiae Dentium - MChD (Maxillo-Facial & Oral Surgery)South African dentists have a legal and ethical obligation to maintain complete and comprehensive dental records. In addition to the legal and ethical requirements, dental records are also important in the case of medico-legal issues, quality assurance processes and forensic purposes. Valuable forensic evidence contained in dental records are used in the identification of victims of mass disasters, personal victim identification e.g. in severely decomposed or skeletonized remains where DNA or other biometric data are not available. The victim identification process is highly dependent on complete, legible and accurate dental records. A review of the literature however shows that dental record keeping practices are sub-optimal worldwide. There is a paucity of studies in South Africa regards to dental record keeping practices. The aim of this study was to assess the record keeping practices of a sample of private practicing dentists in Cape Town and surrounding towns, for forensic dental purposes. Knowledge and awareness regards to forensic odontology as well as adherence to the guidelines prescribed by the Health Professional Council of South Africa were also assessed. This was a cross-sectional descriptive study, employing a researcher-administered questionnaire and a dental checklist for forensic valuable items in the dental file. The results were entered in a MS Excel spreadsheet and statistically analysed using IMB SPSS Statistics. This study concluded that most of the dental records kept by Cape Town dentists are near to optimal and would be helpful during forensic odontology investigations. However, shortcomings in record keeping practices exists which may compromise the forensic accuracy of their dental records. The study also shows a significant difference in dental record keeping practices by dentists practicing in lower income areas in Cape Town, compared to those practicing in economic affluent areas. The dentists in this study adhered to most of the guidelines prescribed by the Health Professional Council of South Africa however, important medico-legal information was missing from most dental records. This study hopes to contribute to future comprehensive studies in the broader South Africa to determine the validity of dental records for forensic odontology purposes.
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ROUDEL, BRUNO. "Intoxication aigue par la strychnine : aspects toxicologique, clinique, therapeutique, medico-legal et incidence de la reglementation en vigueur a propos des cas traites par le centre anti-poisons de clermont-ferrand de 1975 a 1989." Clermont-Ferrand 1, 1992. http://www.theses.fr/1992CLF13043.
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BIOGEAU, CAMBON REGINE. "Activite medico-legale du medecin generaliste : cas particulier d'un groupe medical." Limoges, 1988. http://www.theses.fr/1988LIMO0163.
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MOISANT, FRANCOISE. "Organe dentaire et identification medico-legale." Nice, 1993. http://www.theses.fr/1993NICE7502.
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Ingravallo, Francesca <1975>. "Criteri di valutazione medico-legale della narcolessia." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2008. http://amsdottorato.unibo.it/965/.
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Impairment due to narcolepsy strongly limits job performance, but there are no standard criteria to
assess disability in people with narcolepsy and a scale of disease severity is still lacking. We
explored: 1. the interobserver reliability among Italian Medical Commissions making disability and
handicap benefit decisions for people with narcolepsy, searching for correlations between the
recognized disability degree and patients’ features; 2. the willingness to report patients to the
driving licence authority; 3. possible sources of variance in judgement. Fifteen narcoleptic patients
were examined by four Medical Commissions in simulated sessions. Raw agreement and
interobserver reliability among Commissions were calculated for disability and handicap benefit
decisions and for driving licence decisions. Levels of judgement differed on percentage of disability
(p<0.001), severity of handicap (p=0.0007) and the need to inform the driving licence authority
(p=0.032). Interobserver reliability ranged from Kappa = - 0.10 to Kappa = 0.35 for disability
benefit decision and from Kappa = - 0.26 to Kappa = 0.36 for handicap benefit decision. The raw
agreement on driving licence decision ranged from 73% to 100% (Kappa not calculable).
Spearman’s correlation between percentages of disability and patients’ features showed correlations
with age, daytime naps, sleepiness, cataplexy and quality of life. This first interobserver reliability
study on social benefit decisions for narcolepsy shows the difficulty of reaching an agreement in
this field, mainly due to variance in interpretation of the assessment criteria. The minimum set of
indicators of disease severity correlating with patients’ self assessments encourages a disability
classification of narcolepsy.
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MARTELLI, VINCENT JACQUES. "Reparation medico-legale des fractures orbito-malaires." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20150.
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VICENT, CAROLINE. "Aspects medico-juridiques du transsexualisme." Nice, 1990. http://www.theses.fr/1990NICE6013.
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Daly, Brenda Marie. "Legal accountability and medical negligence cases." Thesis, University of Ulster, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422196.
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Peters, Sybille [Verfasser]. "Medico-legale Aspekte des medizinischen Kinderschutzes / Sybille Peters." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2021. http://d-nb.info/1228859779/34.
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Jönsson, Anna K. "Drug-related morbidity and mortality : Pharmacoepidemiological aspects." Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10460.
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Adverse drug reactions (ADRs) constitute a significant health problem with consequences for the patient as well as for society. Suspected ADRs have been reported to occur in about 2-14% of hospitalised patients. In about 5% of deceased hospitalised patients suspected ADRs may have caused or contributed to the fatal outcome. When a pharmaceutical drug is approved for marketing, the drug has been tested only on a limited number of patients (often <6000) for a limited time period in a controlled environment. Hence mostly common ADRs are detected in these trials. Moreover, certain patient groups, for example patients with co-morbidities, elderly patients, children and pregnant women are often not included in these studies. Thus, it is important to closely monitor the use of drugs after marketing to observe new effects and detect new ADRs. The aim of this thesis is to describe the pattern of pharmaceutical substance use related to morbidity and mortality and to investigate two serious ADRs. We have studied the incidence of fatal ADRs, fatal intoxications, cerebral haemorrhage related to warfarin treatment and venous thromboembolism (VTE) related to treatment with antipsychotic drugs. Observational studies form the basis for this thesis. Data from the Swedish Cause of Death Register, medical case records, the Swedish database on ADRs, the forensic pathology and forensic toxicology databases, and Swedish and Danish hospital discharge registers, Danish prescription registers, and civil registry systems were used. In Paper I we found that 3% of all fatalities in a Swedish population were related to a suspected ADR. Of the deceased hospitalised patients, 6% were related to a suspected ADR. Haemorrhage was the most commonly observed fatal suspected ADR, accounting for almost two-thirds of the events and anticoagulantia was the most common drug group associated with fatal suspected ADRs (almost 50%). A suspected intoxication could have contributed to the fatal outcome in 0.6% of the deceased. Among the fatal intoxications in Swedish medico-legal autopsies studied in Paper II, on average four substances were detected per case. The five most commonly detected substances in individuals with a fatal intoxication were ethanol, propoxyphene, paracetamol, diazepam and flunitrazepam. Among patients diagnosed with cerebral haemorrhage, 10% (59 cases) were treated with warfarin at onset of symptoms (Paper III). Of these, 7 cases (12%) were considered to have been possibly avoidable since the patients were treated with concomitant drugs that have the potential to enhance warfarin effects. The results from Paper IV and Paper V in combination with the published literature suggest that patients treated with antipsychotic drugs have an increased risk for VTE. Compared with non-users, an adjusted odds ratio for VTE of 2.0 was found for users of any antipsychotic drugs in a Danish population. In a medico-legal autopsy series, an adjusted odds ratio for fatal pulmonary embolism of 2.4 and 6.9 was found for users of first-generation low-potency antipsychotics and second-generation antipsychotics, respectively. In summary, drug-related morbidity and mortality is a significant problem and suspected ADRs contribute to a substantial number of deaths. Fatal intoxications are relatively common and it is important to observe changes in patterns of substances associated with fatal intoxications to be able to discover new trends and monitor effects of preventive work. A significant proportion of warfarin-related cerebral haemorrhage was caused by drug-drug interactions and was considered possible to avoid. Users of antipsychotic drugs may increase the risk of VTE.Idag finns det säkra och effektiva behandlingar mot många sjukdomar. Läkemedel är den vanligaste behandlingsformen i sjukvården och under 2006 hämtade sex miljoner svenskar (68%) ut ett eller fler recept på ett apotek i Sverige. Även om läkemedelsbehandling har många positiva effekter kan även oönskade och skadliga effekter vid läkemedelsbehandling uppkomma, dvs. läkemedelsbiverkningar. Innan ett läkemedel kommer ut för försäljning har man studerat effekter och biverkningar på ett begränsat antal individer (ofta <6000) under en begränsad tidsperiod där patienterna övervakas noga. Dessutom är det i regel enbart patienter med få andra sjukdomar och läkemedel som ingår i dessa studier. Därför är oftast enbart de vanligaste biverkningarna kända när ett läkemedel börjar säljas till allmänheten. När ett läkemedel blir tillgängligt för ett stort antal patienter är det därför viktigt att man med olika metoder fortsätter att följa läkemedlets effekter och biverkningar. Tidigare har man visat att ungefär 2-14% av inläggningar på sjukhus beror på läkemedelsbiverkningar. Dessutom kan biverkningar ha bidragit eller orsakat dödsfallet i ungefär 5% av de som avlider på sjukhus. Biverkningar orsakar mycket lidande för patienten och kostar samhället både tid och pengar. Om det skulle vara möjligt att förhindra några av dessa sjukhusinläggningar eller dödsfall skulle man vinna mycket. Det är svårt att uppskatta hur många biverkningar som kan förhindras. Genom att studera faktorer som kan öka risken för en oönskad effekt kan man bättre anpassa behandlingen till den enskilde patienten och därmed förhindra biverkningar. Syftet med den här avhandlingen är att beskriva mönster av läkemedelsrelaterade sjukdomar och dödsfall, och att undersöka risken för två allvarliga läkemedelsbiverkningar. Förekomsten av misstänkta läkemedelsbiverkningar, vilka faktorer som kan öka risken för att få en läkemedelsbiverkan, samt vilka läkemedel och biverkningar som förekommer har studerats. Detta gjordes utifrån uppgifter hämtade från dödsorsaksregistret, svenska biverkningsregistret, journaler, rättsmedicinska register, slutenvårdsregister och receptregister. Genom att utnyttja sådan information har vi i närmare detalj studerat förekomsten av dödsfall där ett eller flera läkemedel kan ha haft betydelse för dödsfallet, förgiftningsdödsfall, blödningar i samband med blodförtunnande medicinering och blodproppar i samband med antipsykotisk medicinering. I de arbeten som ingår i avhandlingen har vi funnit att en läkemedelsbiverkan misstänks ha bidragit eller orsakat dödsfallet i ungefär 3% av de som avlidit i en svensk population (Arbete I). Blödningar står för nästan två tredjedelar av dessa biverkningar och blodförtunnande medel misstänks vara inblandade i nästan hälften av de misstänkta läkemedelsbiverkningarna. I den här svenska populationen avled 0,6% till följd av misstänkt läkemedelsförgiftning. Bland rättsmedicinskt undersökta förgiftningsdödsfall påvisades i genomsnitt fyra substanser per fall (Arbete II). De fem vanligaste påvisade substanserna i studien var alkohol, dextropropoxifen, paracetamol, diazepam och flunitrazepam. Bland patienter som får hjärnblödning behandlades 10% vid blödningstillfället med ett blodförtunnande medel, warfarin (Arbete III). I 7 fall (12%) skulle hjärnblödningen möjligen kunna ha förhindrats då patienterna samtidigt behandlades med andra läkemedel som kan ha ökat blödningsrisken. Den sammantagna bilden av den litteratur som finns publicerad och resultatet av Arbete IV och Arbete V, tyder på att patienter som behandlas med antipsykotiska preparat har en ökad risk för att få blodpropp. Flera faktorer har föreslagits som kan förklara den ökade risken för blodpropp bland patienter som behandlas med antipsykotika som har med sjukdomen att göra och/eller behandlingen med antipsykotiska läkemedel. Sammanfattningsvis visar detta avhandlingsprojekt att läkemedelsbiverkningar är ett väsentligt sjukvårdsproblem som bidrar till ett betydande antal dödsfall. Förgiftningsdödsfall med läkemedel är också relativt vanliga och det är viktigt att bevaka effekter av preventiva åtgärder och se om de substanser som används ändras över tid. En del läkemedelsrelaterade biverkningar skulle kunna förhindras då t.ex. en betydande andel av warfarinrelaterade hjärnblödningar beror på läkemedelsinteraktioner. Förekomsten av venösa blodproppar verkar vara förhöjd bland patienter som behandlas med antipsykotiska läkemedel, men fler studier behövs för att avgöra detta och vad det i så fall beror på.
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DESFOSSES, TOSTIVINT NOELIE. "Sevices a personnes agees : problemes medico-legaux." Nantes, 1988. http://www.theses.fr/1988NANT166M.
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Peters, Mike [Verfasser]. "Medico-legale Aspekte in der präklinischen Notfallmedizin / Mike Peters." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1111558736/34.
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CALMES, LAURENS DOMINIQUE. "La reparation medico-legale des traumatismes de la mandibule." Nice, 1992. http://www.theses.fr/1992NICE6513.
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YVES, JOCELYNE. "Aspects legaux, medico-legaux et psychopathologiques du viol." Lyon 1, 1993. http://www.theses.fr/1993LYO1M116.
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Vanhook, Patricia M., John Orzechowzeki, Trish Aniol, and Rachel Clifton. "Developing a Medical-Legal Partnership in Rural Appalachia." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7430.
Full textAbstract:
The National Nurse-led Care Consortium hosts this webinar highlighting the recently formed medical-legal partnership in East Tennessee. This session will focus on developing a Medical Legal Partnership (MLP) practice in a rural setting, where the distance between legal and health partners is up to five hours, and the availability of services for low-income patients is scarce. Using tele-technology to communicate between partners, and elevating the combined health and legal priority of children’s healthcare insurance access and optimization, the East Tennessee MLP has tackled some of the common challenges of rural MLPs, and brought new solutions to rural MLP practice.
This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (under grant number U30CS09736, a National Training and Technical Assistance Cooperative Agreement (NCA) for $1,350,000, and is 100% financed by this grant). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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Orzechowzeki, John, and Patricia M. Vanhook. "Developing a Medical-Legal Partnership in Rural Appalachia." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7431.
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Salsi, Giancarlo <1969>. "La violenza sull'anziano: Aspetti medico-legali di una problematica sommersa." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2014. http://amsdottorato.unibo.it/6542/.
Full textAbstract:
L’abuso dell’anziano è una condizione estremamente diffusa e ha un grande costo umano e finanziario. La dimensione reale del problema del maltrattamento dell’anziano non è stata correttamente definita, in particolare i casi segnalati ufficialmente di abuso sono solo la "punta dell'iceberg". In questi anni il problema è stato riconosciuto a livello internazionale come un fenomeno comune, che viene sottostimato e degno di attenzione da parte della comunità scientifica. In Italia non ci sono molti dati, la prevalenza degli abusi e maltrattamenti può essere circa il 5% e il problema è ampiamente sottovalutato, perché sono scarse le segnalazioni di abusi. Le evidenze disponibili dimostrano che l'abuso sugli anziani in Italia costituisce una questione pubblica, tuttavia, la legislazione e le politiche per affrontare il fenomeno sono scarse, riflettendo la mancanza di una strategia nazionale coerente e globale. Il codice civile italiano non contiene alcun riferimento esplicito a persone anziane, e pochi sono anche gli articoli del codice penale che riguardano le persone anziane. Gli articoli più rilevanti interessate sono le seguenti: art. 572: "Maltrattamenti contro familiari e conviventi" e art. 643: "circonvenzione di persone incapaci". Il presente studio ha lo scopo di analizzare la situazione attuale del fenomeno nel nostro Paese, al fine di valutare la dimensione del problema e le relazioni di abuso e maltrattamenti tra vittime, caregiver e operatori sanitari alle autorità.Elder abuse is an extremely widespread condition and has a big human and financial price. The real dimension of the problem of elder maltreatment has not been properly defined, notably the officially reported cases of abuse are only the “tip of the iceberg”. In these years the problem has been recognized on an international level as a common phenomenon, which is underestimated and worthy of attention by the scientific community. In Italy there are not a lot of data, the prevalence of elder abuse and mistreatment may be around 5% and the problem is widely underestimated because there are few reports of abuse. The evidence available shows that elder abuse in Italy constitutes a public issue; nevertheless, legislation and policies tackling the phenomenon are scattered, reflecting the lack of a coherent and comprehensive national strategy. Moreover the elderly are not specifically protected by law. The Italian Civil Code does not contain any explicit reference to elderly people, very few articles of the Penal Code consider elderly people. The most relevant articles concerned are: art. 572: “Mistreatment of family members or children” and art. 643: “Circumvention of incapacitated persons”. The present study aim to analyze the actual situation of the phenomena in our country in order to evaluate the dimension of the problem and the reports of elder abuse and mistreatment by the victims, caregivers or health operators to the authorities.