Therapeutic stays of belarusian children in Italy: evaluation of their mental status, psychological consequences and physical health status.

BACKGROUND: Therapeutic stays are a phenomenon of temporary reception of unaccompanied foreign children from contaminated areas in Belarus, Ukraine and Russia. Aim of the study was to analyze the physical and mental health status of children in therapeutic stays in Italy and the possible presence of a state of child abuse and neglect. METHODS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group composed of 25 Belarusian children in temporary stays in Italy, and the remaining 30 to the control group composed of 30 italian children. Data were collected between July 2019 and July 2020. The evaluation included a careful medical history, an accurate physical examination and an interview, focusing on several factors that can be use as indicators of child maltreatment, intended as physical and emotional neglect. RESULTS: The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group, and the remaining 30 to the control group. Of the 25 children in the treatment group, 8 (32%) are male and 17 (68%) are female, while of the 30 children in the control group, 14 (47%) are male and 16 are female (53%). For each child, we considered the Body Mass Index (BMI), the presence of dental caries, and the showing of learning disabilities or hypoacusis. These parameters can be used as indicators of child maltreatment. The analysis of BMI in the two groups shows that the BMI in the treatment group is significantly lower than the BMI in the control group (P=0.004). In the treatment group 7 (28%) children showed some form of caries whereas in the control group no forms of caries were detected. This result itself shows quite a relevant trend, and to have a quantitative measure of its statistical significancy, we performed a permutation test. The results show that the incidence of dental caries in the treatment group is significantly higher than in the control group (P=0.0023). We used the same procedure to analyse data on the presence of learning disabilities or hypoacusis. The P values we obtained are not significant, but the results still seem to show that there might be a trend of a higher incidence of learning disabilities and hypoacusis in the treatment group, and an extensive study with a larger sample might shed more light on the topic. CONCLUSIONS: This study shows that there are indications that suggest a higher risk of child maltreatment in the group of Belarusian children, where maltreatment is understood as physical and emotional neglect to which children are subjected in the institutions and in the group homes where they live. Despite showing only partially significant results, our work could be a starting point for more extensive studies on the topic. These future studies could be extended to other larger samples and other potential maltreatment factors could be evaluated.

Bioethical implications of robotic surgery in urology: a systematic review.

INTRODUCTION: Robotic technologies are being increasingly implemented in healthcare, including urology, and holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals, patients, researchers and institutions that need to be addressed. The aim of this review was to investigate the existing literature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges and make preliminary suggestions to ensure an ethical implementation of these technologies. EVIDENCE ACQUISITION: We performed a review of the pertaining literature through a systematic search of two databases (PubMed and Web of Science) in August 2020. EVIDENCE SYNTHESIS: Our search yielded 76 articles for full-text evaluation and 48 articles were included in the narrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) robotic surgery accessibility (robotic surgery is expensive, and in some health systems may lead to inequality in healthcare access. In more affluent countries the national distribution of several robotic platforms may influence the centralization of robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers); 2) safety (there is a considerable gap between surgical skills and patients' perception of competence, leading to ethical consequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series is between 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches); 3) gender gap (no data about gap differences in accessibility to robotic platforms were retrieved from our search); 4) costs (robotic platforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand. It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higher than 10 cases per week); and 5) learning curve (a validated, structured curriculum and accreditation has been created for robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patient safety and short learning curve). CONCLUSIONS: Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in more affluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sexes. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regarding efficacy, efficiency and safety.

From Syndemic Lesson after COVID-19 Pandemic to a "Systemic Clinical Risk Management" Proposal in the Perspective of the Ethics of Job Well Done.

The syndemic framework proposed by the 2021-2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the "Systemic Clinical Risk Management" (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view.

AN ETHICAL EVALUATION METHODOLOGY FOR CLINICAL CASES / UNA METODOLOGÍA DE EVALUACIÓN ÉTICA PARA CASOS CLÍNICOS / UMA METODOLOGIA DE AVALIAÇÃO ÉTICA PARA CASOS CLÍNICOS

In the present article, we introduce an ethical evaluation methodology for clinical cases. Although rejecting proceduralism as a system, we develop a procedure that eventually could be formalized as a flow chart to help carry out an ethical evaluation for clinical cases. We clarify the elements that constitute an ethical evaluation: aim (patient's health), integration (action interconnections), and how the action is performed. We leave aside the aspect of intentions, focusing on the object of a medical action, arguing that the internal aim of a clinical action carries a moral value per se. Our evaluation system takes into account only objects and circumstances and their intrinsic morality, since we are dealing with the evaluation of a clinical case, and not with a personal and complete clinical action.

En el presente artículo se introduce una metodología de evaluación ética de los casos clínicos. Aunque se rechaza el procedimentalismo como sistema, se ha desarrollado un procedimiento que podría llegar a ser formalizado como un diagrama de flujo para ayudar a llevar a cabo una evaluación ética de los casos clínicos. Se aclaran los elementos que constituyen una evaluación ética: el objetivo (la salud del paciente), la integración de interconexiones (acción) y cómo se realiza la acción. Se dejan a un lado las intenciones para centrarse en el objeto de una acción médica; se argumenta que el objetivo interno de una acción clínica tiene un valor moral en sí. El sistema de evaluación tiene en cuenta solamente los objetos y las circunstancias y su moral intrínseca, ya que se trata de la evaluación de un caso clínico, y no de una acción clínica personal y completa.

No presente artigo, introduz-se uma metodologia de avaliação ética dos casos clínicos. Embora rejeitemos o procedimentalismo como sistema, desenvolvemos um procedimento que poderia chegar a ser formalizado como um diagrama de fluxo para ajudar a realizar uma avaliação ética dos casos clínicos. Esclarecemos os elementos que constituem uma avaliação ética: o objetivo (a saúde do paciente), a integração de interconexões (ação) e como se realiza a ação. Deixamos de lado o aspecto das intenções e centralizamo-nos no objeto de uma ação médica, argumentando que o objetivo interno de uma ação clínica tem um valor moral em si. Nosso sistema de avaliação considera somente os objetos e as circunstâncias e sua moral intrínseca, visto que se trata da avaliação de um caso clínico, e não de uma ação clínica pessoal e completa.

Post-Human and scientific researcha: How engineering carried out the project / El posthumano y la investigación científica: como la ingeniería lleva a cabo el proyecto

We start with a definition of robot in order to understand which are legitimate robotics’ objectives. Then it is provided an outline of new robot generations and their industrial and biomedical applications. We consider the consequences of this new kind of technology on the notion of intelligence, stressing how the exteroceptive sensor systems provide a new bottom up approach to the AI debate. We consider three challenges Robotics have to face nowadays. First materials and components, which are built with technologies top-down, set huge limits in terms of weight, speed, safety and cost, not to mention reliability and durability. Second the metholdological aspects: the challenge concerns the management of complexity. How to achieve intelligent and adaptive behaviors out of the control system of the robot, which must remain intrisically simple? A third issue we address is the cultural one: the unreasonable expectations of the general public often provoked by a misunderstanding of the notion of intelligence itself. We consider then what makes human specifically human from a broader philosophic point of view, pointing out how the will is strangely absent in the AI debate. We show three advantages connected with this different perspective instead of the classical one intellect centered. First, while intellect is not used only by man, will is. Second, desire involves intellect while the reciprocal is not necessarily true. Third, looking at robotics and more specifically to cybernetics the key concept of these fields are control and govenrance, whereas both of them are specifically relate to the domain of will rather than intellect. We look then into the concept of participation as essential to the understanding of the notion of will, to overcome some roboethics’ issues related to the adoption of the still dominant rationalitsic paradigm

Después de haber propuesto una definición del concepto de robot, pasamos a considerar cuáles son los objetivos legítimos de una robótica epistemológicamente coherente. Se analizan las nuevas y emergentes tecnologías robóticas y las consecuencias que han tenido en campo biomédico e industrial, con particular atención a los efectos que tienen estas novedades en relación con el concepto de inteligencia. En particular, como la nueva sensoristica, permitiendo la construcción de extero-ceptive systems, ha promovido nuevamente el acercamiento bottom up en el debate sobre la AI. Se consideran tres problemas: el componente hardware, construido hasta hoy con tecnologías top down, poco eficaces para las necesidades bio-médicas; los aspectos metodológicos, concretamente, cómo obtener comportamientos inteligentes y adaptativos, manteniendo el control simple; la cuestión cultural, es decir, cómo responder a las expectativas crecientes y muy frecuentemente inadecuadas que el público espera de la robótica. Atendiendo a algunas razones, se prefiere plantear la cuestión de la especificidad humana apuntando no al tema de la inteligencia sino al de la voluntad: porque es mayormente específica; porque el querer implica el comprender, mientras que no es siempre verdadero lo contrario; porque la robótica nos enseña que el gobierno y el control son problemas reales de los que es necesario hacerse cargo. Profundizaremos, por tanto, la noción de participación como instrumento conceptual útil para la comprensión de la voluntad, que permite, además, superar los nudos irresueltos de la robótica, fundada hasta hoy en acercamientos racionalistas

Post-human and scientific research: how engineering carried out the project.

We start with a definition of robot in order to understand which are legitimate robotics' objectives. Then it is provided an outline of new robot generations and their industrial and biomedical applications. We consider the consequences of this new kind of technology on the notion of intelligence, stressing how the exteroceptive sensor systems provide a new bottom up approach to the AI debate. We consider three challenges Robotics have to face nowadays. First materials and components, which are built with technologies top-down, set huge limits in terms of weight, speed, safety and cost, not to mention reliability and durability. Second the methodological aspects: the challenge concerns the management of complexity. How to achieve intelligent and adaptive behaviours out of the control system of the robot, which must remain intrinsically simple? A third issue we address is the cultural one: the unreasonable expectations of the general public often provoked by a misunderstanding of the notion of intelligence itself. We consider then what makes human specifically human from a broader philosophic point of view, pointing out how the will is strangely absent in the AI debate. We show three advantages connected with this different perspective instead of the classical one intellect centered. First, while intellect is not used only by man, will is. Second, desire involves intellect while the reciprocal is not necessarily true. Third, looking at robotics and more specifically to cybernetics the key concept of these fields are control and governance, whereas both of them are specifically relate to the domain of will rather than intellect. We look then into the concept of participation as essential to the understanding of the notion of will, to overcome some roboethics' issues related to the adoption of the still dominant rationalistic paradigm.