Gotowa bibliografia na temat „Medico-Legal report”

Objective: The objective of this audit was to examine whether the content of medico-legal reports regarding psychiatric injury following motor vehicle accidents was influenced by the role of the report writers. Method: The audit consisted of a retrospective review, using a novel rating scale, of archived documents from 559 consecutively examined insurance claims following motor vehicle accidents in New South Wales. Results: Treating practitioners wrote less complete reports than experts representing the plaintiff or defendant. Treating practitioners and plaintiffs' experts were more likely to diagnose posttraumatic stress disorder (PTSD) and depression, while defendants' experts were more likely to find no psychiatric disorder. Limitations of the study were that it was retrospective and examined report writing between 1989 and 1994. The completeness, rather than quality, of the medico-legal reports was measured. Conclusion: Further training and quality assurance procedures may improve medico-legal report writing. Reform of the rules regulating the content of experts' reports may reduce the extent to which the role of the report writer influences their opinion.

Abstract Introduction: The upper C1-C2 column is the subject of several erroneous diagnostics. The most common mechanisms of injuries include fall from high-impact skulls, car accidents, etc. Vertebra C1 can also be injured by mild trauma. The Japanese show that atlas fractures occur in about 2-13% of the cervical spine fractures and about 1.3% of the total spinal cord injuries. It is underlined that CT examination is the most useful diagnostic method. The Czechs show that the atlas lesions appear in 1-2% of the cervical spine lesions. Americans reported fracture of the atlas in 7% of the cervical spine fractures. Even if CT has shown its value, lateral radiography is recommended in C1-C2 fractures. When victims are children or people injured in high-speed car crashes, the reported mechanisms were the fall from a high level and the impact on the tip of the flexed skull. The Italians mention that the C1-C2 area is the most exposed diagnostic area with errors. Material and methods: given the difficulty of establishing a diagnosis of C1 type fractures, we present in this paper such a case. We highlight the value of a CT scan. The victim is a 26-year-old woman with a trauma from the wall. The main issue in this case is that the diagnosis made by the radiologist seems to be wrong, the electronic and imprinted copies are of inferior quality. A second opinion revealed a very fine fracture that seemed to come from an older date than the date when the victim claimed she was assaulted. The better the lesions, the more misleading the interpretations. Any imaginary imaging lesion, especially if it is obvious in electronic reconstructions, must be brought to the attention of the physician if they are taken into account by "image". The axial CT sections may omit some lesions under certain conditions, for example at the upper and lower poles of a spherical, ovoid or cubic structure, such as the atlas lateral mass. Conclusions: the diagnostic solution in this case is the reconstruction of the axial sections in several planes. The crack can be highlighted, in the case of a reconstructed image, only after stacking the axial images. The mechanism could be through sudden compression, during a sudden head movement, uninitiated and uncontrolled by the neck muscles, when a movement occurs over the degree of elasticity of the occiput-atlas joint, the occipital condyles compressing abruptly, unilaterally one of the atlas masses. In such clinical cases, we experience pain, muscle contraction and torticollis, on a normal neurological background.

Alors que de nombreux travaux s’intéressent à l’expertise médico-légale à partir de son rôle dans la délibération judiciaire, peu d’études portent sur l’articulation de la médecine et du droit dans le quotidien des experts. Pourtant, déposer au tribunal ne constitue qu’un aspect parmi d’autres des activités des médecins légistes. Comprendre comment ceux-ci mettent en œuvre l’interface entre la médecine et le droit implique donc de s’éloigner du tribunal pour se pencher sur la pratique quotidienne de l’expertise à l’hôpital. Dans cette optique, la présente thèse s’intéresse à la médecine légale à partir d’une enquête ethnographique menée sur un an dans trois morgues hospitalières d’Inde du Nord, ainsi que sur un travail à partir d’archives judiciaires. Elle s’appuie sur des études de cas constituées à partir de l’analyse des interactions entre médecins et policiers ou membres des familles, des temps d’examen des corps et des stratégies de rédaction des rapports médico-légaux. Tout en resituant la médecine légale indienne dans son contexte historique, sociologique et institutionnel, ce travail, au croisement d’une anthropologie médicale et d’une anthropologie du droit, a pour but d’établir comment les médecins légistes comprennent les cas médico-légaux, rédigent leurs rapports et agissent sur le réel. Le diagnostic médico-légal et sa formulation écrite apparaissent comme des élaborations, construites au fil d’un processus hybride dont l’analyse permet de saisir les enjeux épistémologiques, politiques et sociaux de la pratique médico-légale
Whereas much has been written about the role played by medico-legal evidence in judicial deliberation, few studies focus on the articulation of medicine and law in the daily lives of experts. However, testifying in courts is but one aspect of forensic medicine. Understanding how medico-legal experts implement the interface between medicine and law therefore requires moving away from the court to focus on the daily practice of forensic expertise in the hospital. In this perspective, this thesis deals with forensic medicine based on a one-year ethnographic survey conducted in three hospital mortuaries in North India, as well as on judicial records. It relies on case studies formed out of the analysis of interactions between doctors and police officers or family members, medico-legal examinations and strategies for writing forensic reports. While placing Indian forensic medicine in its historical, sociological and institutional context, this work, at the intersection of medical and legal anthropology, aims to establish how medico-legal experts understand cases, write their reports and act on reality. The medico-legal diagnosis and its written formulation appear as elaborations, built through a hybrid process whose analysis makes it possible to grasp the epistemological, political and social issues surrounding medico-legal practice

Torture is a relevant issue in human interactions for its pervasiveness, gravity and tremendous consequences. Unfortunately is still remains a reality in many countries of the world. This presentation aims approach to the concept of torture and the situation of torture in Portugal and worldwide; analyze international laws and ethical principles on documentation and investigation of torture; and address the contribution and importance of clinical forensic medical examination in these situations, how it best can be carried out and what kind of results may provide. There is no consensus about how to define torture but the most cited definitions in literature are those put forward by the World Medical Association and the United Nations. Both of these definitions include severe physical and psychological forms of suffering and require coercive intent by perpetrators with the consent or acquiescence of state authorities. The prohibition of Torture is absolute and applies to all times and in all circumstances. This prohibition is present in several international treaties and agreements. In 1984 the United Nations adopted the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment highlighting the particular attention given to this absolute prohibition, creating a legally-binding document and providing additional rules to assist in prevention and investigation of allege cases of torture. Nevertheless, between January 2009 and May 2013, Amnesty International received reports of torture and other ill-treatment committed by state officials in 141 countries, and from every world region. This only indicates cases reported to or known by the organization and does not necessarily reflect the full extent of torture worldwide. Besides forbidding it, International law also obliges states to investigate allegations of torture and to punish those responsible. It also requires that victims are able to obtain reparation. One of the major challenges in accomplishing this is to obtain sufficient evidence in cases against perpetrators. If there is no proof that torture took place, a climate of impunity can come to exist and the practice will endure. Medico-legal reports are a way of gathering evidence of torture. Even in countries where a fair trial is rare, medico-legal documentation strengthens the victims’ position since it becomes more difficult to disregard the complaint. The area of application of the medico-legal reports is not restricted to medico-legal investigation. It can be broadened to the investigation and documentation of other violations of human rights in national and international legal proceedings, and monitoring such as cases of asylum seekers, cases of forced confessions through torture, identification of therapeutic needs of victims and the need for reparation and redress by the state. There are also a role for it in activities like research, advocacy and lobbying. Therefore, participation and support of health professionals are of crucial importance for the abolition of torture and other forms of ill-treatment. Ensuring that doctors are aware of how to perform a medico-legal report and how to use it in legal proceedings is a needed step forward in the prevention of torture. Because a large of the large number and the severe suffering of many survivors, the question of torture should become a part of health care curricula.
A tortura é uma questão relevante nas interações humanas pela sua perversidade, gravidade e consequências tremendas. Infelizmente ainda continua a ser uma realidade em muitos países do mundo. O objectivo principal deste trabalho é o de proceder à elaboração de um texto que permita aos profissionais de saúde, adquirirem com a sua leitura uma rápida percepção do que é tortura e os maus tratos, do enquadramento legal destas situações e do potencial que uma adequada abordagem do ponto de vista médico pode proporcionar para uma correta identificação de tais práticas. Neste sentido, o presente trabalho procede inicialmente a uma revisão do conceito de tortura e da situação da tortura a nível mundial e ao nível de Portugal. Seguidamente, efetua uma breve análise das leis internacionais relativas à investigação e documentação de tortura e aborda as questões éticas levantadas por esta temática. Por último analisa o contributo do exame médico-legal nestas situações, como pode ser realizado e quais as mais valias que pode proporcionar. Não há consenso sobre como definir a tortura mas as definições mais citadas na literatura são as fornecidas pela Associação Médica Mundial e pela Organização das Nações Unidas. Ambas incluem formas físicas e psicológicas graves de sofrimento e exigem uma intenção coerciva por parte dos agressores, com o consentimento ou aquiescência das autoridades do Estado. A definição da Organização das Nações Unidas exige ainda que a agressão seja perpetuada especificamente por membros do, ou ao serviço do, Governo ou por forças militares ou policiais pertencentes ao Estado. Há também outras práticas que, apesar de não estarem incluídas nas definições de tortura, são um ataque à vida humana em toda a sua dignidade. Este outro tratamento cruel, desumano e degradante, que será referido neste trabalho como "maus-tratos", também tem a intenção de expor os indivíduos a condições que causam sofrimento físico ou mental significativo, mas sem um propósito específico. As pessoas vítimas desta prática, serão neste trabalho equiparadas a vítimas de tortura. A proibição da tortura e maus-tratos é absoluta e aplica-se a todos os momentos e em todas as circunstâncias. Esta proibição está presente em diversos tratados, acordos internacionais e o direito a estar livre de tortura é contemplado na Declaração Universal dos Direitos do Homem. Em 1984, as Nações Unidas adoptaram a Convenção Contra a Tortura e Outros Tratamentos Cruéis, Desumanos, Degradantes ou de Punição (CAT) destacando a particular atenção dada a esta proibição absoluta. Este é um documento juridicamente vinculativo que prevê regras adicionais para auxiliar na prevenção e investigação de alegados casos de tortura. Apesar de todas as normas e tratados que contemplam a proibição de tortura, esta continua a ser ainda uma prática comum e mundialmente disseminada. Entre Janeiro de 2009 e Maio de 2013, a Amnistia Internacional recebeu relatos de tortura e outros maus-tratos cometidos por funcionários do Estado em 141 países, e de todas as regiões do mundo. Isso só indica casos notificados ou conhecidos pela organização, e não reflecte necessariamente a extensão total da tortura em todo o mundo. Portugal não é excepção a isto. Além de proibir a prática de tortura, a lei Internacional obriga também os Estados a investigar alegações de tortura e a punir os responsáveis. Requer ainda que as vítimas possam ser ressarcidas da forma mais completa possível. Um dos principais desafios na realização disto é a obtenção de elementos de prova suficientes em casos contra os agressores. Se não há nenhuma prova de que a tortura ocorreu, um clima de impunidade pode vir a existir e a prática será perpetuada. Relatórios médico-legais são uma forma de apresentar provas de tortura. Mesmo em países onde um julgamento justo é raro, a documentação médico-legal fortalece a posição das vítimas tornando mais difícil ignorar a acusação Para mais, médicos da área dos cuidados de saúde primários são importantes detectores na identificação das vítimas. Eles podem encontrar sobreviventes de tortura em contextos de cuidados primários ou nos serviços de urgência e emergência médica, e serem quem inicia o encaminhamento para o tratamento destas vítimas e acciona os mecanismos legais necessários. A área de aplicação dos relatórios médico-legais não se restringe à investigação médico-legal. Estes podem ser utilizados na investigação e documentação de outras violações dos direitos humanos, em processos judiciais nacionais e internacionais. Podem ter ainda um papel importante em casos de requerentes de asilo, na identificação das necessidades terapêuticas das vítimas e da necessidade de reparação e reparação por parte do Estado. Há também um papel para ele em atividades como pesquisa, advocacia e lobby. Portanto, a participação e apoio de profissionais de saúde é de importância crucial para a abolição da tortura e outras formas de maus-tratos. Garantir que os médicos estão cientes de como executar um relatório médico-legal e como usá-lo em processos judiciais é um passo necessário na prevenção da tortura. Dado a grande quantidade de pessoas vítimas desta prática e o papel preponderante dos médicos na sua prevenção, a abordagem da tortura e o exame médico-legal deveriam tornar-se parte dos currículos das escolas médicas.

Intraoperative awareness (IOA) represents a range of heterogeneous experiences and is a topic of considerable relevance, not only to anaesthetists, but to all theatre staff. This chapter focuses on communications that the anaesthetist may find helpful in ameliorating or preventing adverse sequelae associated with IOA. This is a well-described, infrequent complication of general anaesthesia which can have serious long-term psychological consequences. First recognized as a medical complication in 1846, there have been numerous reports since the 1950s. Considerable research has been devoted to its understanding and prevention over the past two decades. IOA has increasingly come to the attention of clinicians, patients and the media. It is also a medico-legal issue and high compensation awards have been made. The ASA practice advisory for anaesthesiologists states that, ‘Intraoperative awareness occurs when a patient becomes conscious during a procedure performed under general anaesthesia and subsequently has recall of these events.’ This may include: sensations of weakness; inability to communicate, move or scream; auditory and tactile perceptions; feelings of helplessness; acute fear, panic and pain; believing to have been abandoned and betrayed; and being dead, or about to die. Explicit awareness (declarative memory) permits conscious recall of intraoperative events such as auditory, visual and tactile experiences, paralysis and pain. There is a striking similarity of experiences among patients, but only a minority (35 % ) may inform their anaesthetists. Explicit awareness has been the subject of the majority of investigations related to IOA and is the main topic of this chapter. Implicit awareness (non-declarative memory): information can be recollected but cannot be recalled or consciously retrieved. There is strong evidence for auditory information-processing of material relevant to the patient’s well-being, whether beneficial or threatening. The overall incidence of IOA varies, but has been reported to be between 0.1 and 0.9 % with 30 000–40 000 cases annually in the USA. However, the true incidence of recall is probably underestimated. According to a 2010 report by the ASA closed claims project, IOA occurs in less than 1 in 700 cases. Causes were largely attributed to light anaesthesia and anaesthetic delivery problems.