Patient Safety in Dental Practice: Lessons to Learn About the Risks and Limits of Professional Liability.

INTRODUCTION: Health professionals should work with the notion of risk involved in the health care process. Dental practice risk is of particular interest because it encompasses both aesthetic and functional components. Focusing on guidelines suggested by the World Health Organization and objectives on patient safety, this study has 2 objectives: to present Portuguese medicolegal data on corporal damage evaluation related to iatrogenic sequelae during dental practice and to present updated evidence on patient safety. MATERIALS AND METHODS: A retrospective study was performed by analysing data from the database of the Laboratory of Forensic Dentistry of the Faculty of Medicine, University of Coimbra, Portugal, from 2013 to 2018. RESULTS: One hundred seven medicolegal files were selected according to the inclusion and exclusion criteria. Iatrogenic sequelae (73.8%, 79 out of 107) were categorised as risks (60 out of 79) and malpractice (19 out of 79). The risk was associated mostly with mandibular dysfunction and orthodontic treatment (62.2%). Malpractice was mostly associated with neurological deficit and implant rehabilitation (47.4%). DISCUSSION AND CONCLUSION: Greater attention to these data by professionals was emphasised, especially when considering patient safety and health care quality. This article presents the Portuguese data on professional liability in the field of dental practice, categorising iatrogenic sequelae into risks and malpractice, as well as the oral rehabilitation procedure and timeline.

Cardiac injuries caused by trauma: Review and case reports.

Assessment of suspected cardiac injuries in a trauma setting is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. In this article, we review the supporting literature for the pathophysiology, classification and evaluation of cardiac injuries caused by trauma. We also describe 4 cardiac trauma patients seen at a tertiary referral hospital.

Biological Evidence Management for DNA Analysis in Cases of Sexual Assault.

Biological evidence with forensic interest may be found in several cases of assault, being particularly relevant if sexually related. Sexual assault cases are characterized by low rates of disclosure, reporting, prosecution, and conviction. Biological evidence is sometimes the only way to prove the occurrence of sexual contact and to identify the perpetrator. The major focus of this review is to propose practical approaches and guidelines to help health, forensic, and law enforcement professionals to deal with biological evidence for DNA analysis. Attention should be devoted to avoiding contamination, degradation, and loss of biological evidence, as well as respecting specific measures to properly handle evidence (i.e., selection, collection, packing, sealing, labeling, storage, preservation, transport, and guarantee of the chain custody). Biological evidence must be carefully managed since the relevance of any finding in Forensic Genetics is determined, in the first instance, by the integrity and quantity of the samples submitted for analysis.

[Medical-legal conduct with individuals in judicial or police custody]. / Actuación medicolegal en personas en custodia judicial o policial.

The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities.

Actuación medicolegal en personas en custodia judicial o policial / Medical-legal conduct with individuals in judicial or police custody

La problemática asistencial de personas en custodia así como la muerte en custodia son aspectos relevantes para la medicina legal y forense, en relación con la posibilidad de responsabilidad penal, civil y administrativa de los profesionales sanitarios y/o instituciones públicas o privadas que puedan tener en custodia sujetos privados de libertad. Un estado de derecho debe garantizar que en estos casos se cumplan la legislación estatal y los tratados y compromisos internacionales relacionados con los derechos humanos, y el tratamiento especial de personas privadas de libertad en centros hospitalarios o de detención. Mención particular merece la actuación médico forense en las muertes en situaciones de reducción y/o contención en el momento de la detención de un sujeto por miembros de las fuerzas y cuerpos de seguridad, o en centros asistenciales por personal de seguridad o asistencial. En estos casos, tanto el tratamiento asistencial inmediato posterior a los hechos como el estudio médico forense deberán ser particularmente cuidadosos. Estas situaciones, habitualmente mediáticas, provocan alarma social y conllevan actuaciones judiciales que puede derivar en responsabilidades especialmente graves (AU)

The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities (AU)

Aldicarb poisoning: one case report.

The carbamate aldicarb (Temik) is a highly toxic (LD50 = 0.9 mg/kg oral in rats) insecticide often used in agriculture. The authors present a fatal intoxication case with aldicarb, in a 24-year-old male, under police custody in the island of S. Tome and Prince (STP), in Africa. He was found 3 h after his arrest, lying on the floor of his cell, unconscious, frothing at the mouth, and entered into the hospital already dead. Aldicarb analysis was carried out by high-performance liquid chromatography, with a post-column derivatization system (with o-phthaldialdehyde and 2-mercaptoethanol, under alkaline conditions at 80 degrees C) with fluorescence detection at lambda(ex)= 339 nm and lambda(em) = 445 nm. The toxicological analysis revealed toxic concentrations of aldicarb in the post-mortem samples: blood (6.2 microg/ml), stomach (48.9 microg/g), liver (0.80 microg/g), kidney (8.10 microg/g), heart (6.70 microg/g) and urine (17.50 microg/ml). It was also detected to be the same substance in a grey granulate powder supplied by criminal authorities of that country, as a probable substance ingested by the victim. The toxicological analysis results, the autopsy findings and the information given, allowed us to conclude that death occurred due to an aldicarb acute intoxication. Although the case suggested a suicide, particularly based on the known information and on the high aldicarb concentration found in the stomach, it was not possible to indicate precisely its etiology (suicide or homicide).