[Organ donation and organ assessment after primary circulatory death and secondary brain death]. / Organspende und Organassessment nach primärem Herz-Kreislauf-Stillstand und sekundärem Hirntod.

BACKGROUND: The global organ shortage is the biggest obstacle to expand urgently needed liver transplantation activities. In addition to donation after brain death (DBD), donation after primary circulatory death (DCD) has also been introduced in many European countries to increase the number of donated organs. OBJECTIVE: This article summarizes the legal and ethical aspects of DCD, the practical donation process of DCD, the clinical results of DCD liver transplantation with a special focus on organ assessment before a planned DCD liver transplantation. RESULTS: In Europe 11 countries have active DCD liver transplantation programs and a total of 1230 DCD liver transplantations were performed in Europe in 2023. The highest proportion of DCD liver transplantations were recorded in Belgium (52.8%), the Netherlands (42.8%) and Switzerland (32.1%). The adequate selection of donors and recipients is crucial in DCD transplantation and the use of DCD livers particularly depends on the preparedness of the healthcare system for routine machine perfusion. The leaders are Belgium, France and Italy which implant around 68-74% of DCD organs. With an adequate organ assessment, the long-term results of DBD and DCD liver transplantations are comparable. To assess mitochondrial damage and thus organ quality, hypothermic oxygenated machine perfusion (HOPE) was introduced and has the secondary benefit of mitochondrial protection through oxygenation. The establishment of aerobic metabolism in mitochondria under hypothermia leads to a reduction of toxic metabolites and the restoration of ATP storage, which subsequently leads to a reperfusion light during implantation. CONCLUSION: Expanding the donor pool with DCD donors can counteract the global organ shortage. With adequate patient selection and routine organ assessment short-term and also long-term outcomes of DBD and DCD liver transplantation are comparable.

Design of a new 3D printed all-in-one magnetic smartphone adapter for fundus and anterior segment imaging.

PURPOSE: To describe and validate a 3D-printed adapter tool which could be used with either a slit lamp or a condensing lens, interchangeable between devices through magnetic fastening, in order to provide physicians a quick, easy and effective method of obtaining clinical photos. MATERIALS AND METHODS: Three specialists, with at least 4-year experience in ophthalmology, gave a rate of image quality obtained by our device and the diagnostic confidence grade. The 3 specialists conducted each 13 or 14 examinations with the smartphone and magnetic adapter. At the end of evaluation, they rated with the Likert scale the ease of use of the device in obtaining clinical images of the anterior segment and ocular fundus respectively. RESULTS: Data of quality perception and confidence demonstrated high values not dissimilar to the "de visu" eye examination. Moreover the instrument we designed turned out to be very user friendly. CONCLUSION: Our adapter coupled with a modern smartphone was able to obtain 4k images and videos of anterior segment, central and peripheral fundus, in an easy and inexpensive way.

Methadone-Induced Hypoglycemia in a Hospitalized Patient.

Methadone is used as an agent for chronic pain and management of opioid use disorder. While similar pharmacologically to other opioids, methadone does have unique characteristics, including long half-life, low cost, and high oral bioavailability. While advantageous in some ways, methadone is associated with unique adverse effects not seen with other opioids (ie, hypoglycemia). In this case, we describe a patient in his late-60s with opioid use disorder on chronic methadone who presents with symptoms of generalized weakness, fatigue, and decreased appetite for 2 days. The hospital course was complicated by hypoglycemia, without obvious cause other than methadone-induced hypoglycemia. The patient was managed with supportive care to maintain normoglycemia. He was continued on methadone and instructed to follow-up with his opioid treatment program to assess for dose de-escalation to minimize future hypoglycemia risk. While other case reports of methadone-induced hypoglycemia highlight the risk of this adverse effect, our case highlights the importance of assessing methadone as a cause of hypoglycemia and provides discussion around the legality of dose de-escalation at discharge from an acute care setting.

[ChatGPT: aid to medical ethics decision making?] / ChatGPT: Hilfe bei der medizinethischen Entscheidungsfindung?

BACKGROUND: Physicians have to make countless decisions every day. The medical, ethical and legal aspects are often intertwined and subject to change over time. Involving an ethics committee or arranging an ethical consultation are examples of potential aids to decision making. Whether and how artificial intelligence (AI) and the large language model (LLM) of the company OpenAI (San Francisco, CA, USA), known under the name ChatGPT, can also help and support ethical decision making is increasingly becoming a matter of controversial debate. MATERIAL AND METHODS: Based on a case example, in which a female physician is confronted with ethical and legal issues and presents these to ChatGPT to come up with answers, the first indications of the strengths and weaknesses are ascertained. CONCLUSION: Due to the rapid technical development and access to ever increasing quantities of data, the utilization should be closely observed and evaluated.

[Ethical and legal aspects of violence against women]. / Aspectos éticos y legales de la violencia sobre la mujer.

Caring for female victims of violence presents health professionals with situations that require careful consideration due to the conflicts raised between the fundamental principles of bioethics. During this process, intermediate courses of action should be adopted in which none of the affected principles is totally compromised, yet always take into account due compliance with legal and deontological regulations. Within these conflicts, the possible impact on the autonomy of the victim must be taken into consideration, conditioned by the relationship of dominance with respect to their aggressor, a fundamental characteristic of gender violence. However, the fact that there is a legal obligation to issue an injury report or to communicate a well-founded suspicion of abuse is not enough to ignore the fact that the person, in this case the victim, must be a participant in the process. As such, the doctor has the obligation to inform his or her patient about this legal requirement, dedicating all the time and attention necessary to ensure that the victim understands the purpose and benefits of complying with this. In any case, and beyond the appropriate adaptation of the professional's conduct to current precepts, the ethical principle of care must be adhered to, by which the best thing the professional can do is to provide the victim with the means to avoid the repetition of new attacks, implementing prevention measures that have their origin in the accurate diagnosis of the situation of violence and in the communication of this to the authorities.

Tuberculosis in Spain: An opinion paper / Tuberculosis en España: Un documento de opinión

This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Il lustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapul monary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observa tion in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal impli cations of this disease are not a minor issue and our situation in this regard has been reviewed (AU)

El presente documento es el resultado de las deliberacio nes del Comité sobre Patógenos Emergentes y COVID-19 del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) en re lación a la situación actual de la tuberculosis, particularmente en España. Hemos revisado aspectos tales como la evolución de su incidencia, las poblaciones actualmente más expuestas y los circuitos sanitarios para la atención a estos pacientes en España. Se ha discutido también la tuberculosis latente, la rea lidad de la enfermedad extrapulmonar en el siglo XXI y los me dios de que en la práctica diaria se dispone para el diagnóstico tanto de las formas latentes como de las activas. La aportación de la biología molecular que ha cambiado la perspectiva de es ta enfermedad ha constituido otro de los temas de debate. El documento trata de poner en perspectiva tanto los fármacos clásicos y sus cifras de resistencia como la disponibilidad e in dicaciones de los nuevos. Junto a esto, se ha discutido la rea lidad de la observación directa en la administración de fárma cos antituberculosos. Toda esta revolución está posibilitando el acortamiento del tiempo de tratamiento de la tuberculosis tema que ha sido igualmente revisado. Si todo se hace bien, el riesgo de recaída de la tuberculosis es pequeño pero existen te. Por otra parte, muchas situaciones especiales han merecido discusión en este documento como por ejemplo la tuberculosis en edad pediátrica y la tuberculosis como causa de preocupa ción en cirugía y cuidados intensivos. Se ha discutido tanto la situación de la vacuna BCG y sus indicaciones presentes, co mo el futuro de nuevas vacunas que permitan alcanzar el viejo sueño de erradicar esta enfermedad. Finalmente, las implica ciones éticas y medicolegales que esta enfermedad plantea no son un tema menor y se ha revisado nuestra situación en este particular (AU)

Técnicas de manejo de conducta en odontopediatría: aspectos éticos y legales / Behavioral management techniques in pediatric dentistry: ethical and legal aspects

Introducción: la profesión odontológica es una actividad orientada al cuidado de personas, entre ellos los niños, que necesitan un cuidado más específico estando en pleno desarrollo físico y emocional. Al trabajar con los niños se tiene que lidiar con la ansiedad con la que el pequeño entra por primera vez a la consulta. Para solucionar este problema, se han descrito diferentes técnicas cuya elección depende de la edad, de las necesidades del paciente y de la habilidad profesional. Estas técnicas se pueden agrupar en tres grupos: técnicas farmacológicas, técnicas comunicativas y técnicas no comunicativas. Objetivo: revisar la evidencia científica sobre los aspectos éticos y legales de las técnicas de manejo de conducta en odontopediatría. Material y método: se realizó una búsqueda en las bases de datos de PubMed/ Medline, Google Scholar y Scopus de acuerdo a unos criterios de inclusión y exclusión. Resultados: los resultados determinan que el empleo de las técnicas de manejo de conducta disminuye los niveles de ansiedad durante el tratamiento dental. El bajo nivel socioeconómico y educativo, y la utilización frecuente de videojuegos aumentan la ansiedad dental mientras la realización de deporte y una vida saludable la disminuyen. Conclusiones: entre las técnicas de manejo de conducta del paciente pediátrico, las de gestión comunicativa son las más aceptadas por los padres. Aunque no hay ninguna prohibición legal en el uso de técnicas farmacológicas o no comunicativas, estas la mayoría de las veces son rechazadas por los padres. (AU)

Introduction: The dental profession is an activity oriented to the people care, including children, who need more specific care being in full physical and emotional development. When working with children you have to deal with the anxiety with which the child first enters the consultation. To solve this problem, different techniques have been described whose choice depends on the age, patient needs and professional skills. These techniques can be grouped into three groups: pharmacological techniques, communicative techniques and noncommunicative techniques. Objective: To review scientific evidence on the ethical and legal aspects of behavioral management techniques in pediatric dentistry. Material and method: A search was performed in the databases of PubMed/ Medline, Google Scholar y Scopus, according to inclusion and exclusion criteria. Results: The results determine that the use of behavioral management techniques decreases anxiety levels during dental treatment. The low socioeconomic and educational level and the frequent use of video games increase dental anxiety while the performance of sports and a healthy life decrease it. Conclusions: Among the pediatric patient behavior management techniques, those with communicative management were the most accepted by parents. Although there is no legal prohibition on the use of pharmacological or non-communicative techniques, these are most often rejected by parents. (AU)

Las reservas de material sanitario estratégico. Reflexiones legales y económicas / [Reserves of strategic medical supplies. Legal and economic reflections]

En este trabajo se presenta un análisis de los principales problemas que plantean las reservas de material sanitario estratégico. Entre otras cuestiones se aborda las referidas a la identificación de la agencia responsable de crear tales reservas, qué se ha de reservar, cómo se han de gestionar las reservas, la trascendencia del enfoque conjunto, así como la necesidad de establecer estrategias adecuadas para emergencias y catástrofes que puedan tener impacto en la salud pública. (AU)

This paper presents an analysis of the key issues posed by strategic healthcare material reserves. Among other matters, it addresses those related to identifying the agency responsible for creating such reserves, what should be reserved, how reserves should be managed, the significance of a collaborative approach, as well as the necessity to establish appropriate strategies for emergencies and disasters that may impact public health. (AU)

Implicaciones jurídicas de los sistemas de notificación y registro de eventos adversos en la esfera sanitaria / [Legal implications of notification and registration systems for adverse events in the healthcare sphere]

La notificación de eventos adversos constituye uno de los instrumentos esenciales de cara a la consecución de mejoras significativas en materia de seguridad del paciente. El presente trabajo pretende concretar las implicaciones jurídicas de las pautas sentadas a nivel internacional (OMS, Consejo de Europa y UE) de cara al establecimiento de un marco legal nacional favorable a la notificación de eventos adversos en la esfera sanitaria. (AU)

The reporting of adverse events is one of the key elements in achieving significant improvements in the field of patient safety. Based on international guidelines (WHO, Council of Europe and EU) this paper aims to analyse their juridical implications when settling a national legal framework for reporting adverse events in the sphere of healthcare. (AU)

Técnicas de manejo de conducta en odontopediatría: aspectos éticos y legales / Behavioral management techniques in pediatric dentistry: ethical and legal aspects

Introducción: la profesión odontológica es una actividad orientada al cuidado de personas, entre ellos los niños, que necesitan un cuidado más específico estando en pleno desarrollo físico y emocional. Al trabajar con los niños se tiene que lidiar con la ansiedad con la que el pequeño entra por primera vez a la consulta. Para solucionar este problema, se han descrito diferentes técnicas cuya elección depende de la edad, de las necesidades del paciente y de la habilidad profesional. Estas técnicas se pueden agrupar en tres grupos: técnicas farmacológicas, técnicas comunicativas y técnicas no comunicativas. Objetivo: revisar la evidencia científica sobre los aspectos éticos y legales de las técnicas de manejo de conducta en odontopediatría. Material y método: se realizó una búsqueda en las bases de datos de PubMed/ Medline, Google Scholar y Scopus de acuerdo a unos criterios de inclusión y exclusión. Resultados: los resultados determinan que el empleo de las técnicas de manejo de conducta disminuye los niveles de ansiedad durante el tratamiento dental. El bajo nivel socioeconómico y educativo, y la utilización frecuente de videojuegos aumentan la ansiedad dental mientras la realización de deporte y una vida saludable la disminuyen. Conclusiones: entre las técnicas de manejo de conducta del paciente pediátrico, las de gestión comunicativa son las más aceptadas por los padres. Aunque no hay ninguna prohibición legal en el uso de técnicas farmacológicas o no comunicativas, estas la mayoría de las veces son rechazadas por los padres. (AU)

Introduction: The dental profession is an activity oriented to the people care, including children, who need more specific care being in full physical and emotional development. When working with children you have to deal with the anxiety with which the child first enters the consultation. To solve this problem, different techniques have been described whose choice depends on the age, patient needs and professional skills. These techniques can be grouped into three groups: pharmacological techniques, communicative techniques and noncommunicative techniques. Objective: To review scientific evidence on the ethical and legal aspects of behavioral management techniques in pediatric dentistry. Material and method: A search was performed in the databases of PubMed/ Medline, Google Scholar y Scopus, according to inclusion and exclusion criteria. Results: The results determine that the use of behavioral management techniques decreases anxiety levels during dental treatment. The low socioeconomic and educational level and the frequent use of video games increase dental anxiety while the performance of sports and a healthy life decrease it. Conclusions: Among the pediatric patient behavior management techniques, those with communicative management were the most accepted by parents. Although there is no legal prohibition on the use of pharmacological or non-communicative techniques, these are most often rejected by parents. (AU)

Tuberculosis in Spain: An opinion paper.

This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Illustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapulmonary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observation in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal implications of this disease are not a minor issue and our situation in this regard has been reviewed.

[Legal integration of artificial intelligence into internal medicine : Data protection, regulatory, reimbursement and liability questions]. / Rechtliche Einordnung von künstlicher Intelligenz in der Inneren Medizin : Von Datenschutz und Regulatorik, Erstattungs- und Haftungsfragen.

Artificial intelligence (AI) opens up new opportunities to improve medical care in internal medicine; however, legal uncertainties in the application of AI impede its integration into the daily practice of internal medicine. To clarify the situation this paper gives an overview of the legal aspects related to AI and shows which frameworks must be adhered to in order to exploit the benefits of AI without neglecting the rights and protection of patients. The paper first addresses data protection issues which arise when sensitive health data are processed by AI. This is followed by a discussion of the key regulatory requirements for the use of AI in internal medicine. As the establishment of AI in practice also depends on sufficient funding, legal issues of reimbursement are additionally examined. Finally, the specific features that need to be considered when using AI to avoid medical liability consequences are highlighted.

[ChatGPT: aid to medical ethics decision making?] / ChatGPT: Hilfe bei der medizinethischen Entscheidungsfindung?

BACKGROUND: Physicians have to make countless decisions every day. The medical, ethical and legal aspects are often intertwined and subject to change over time. Involving an ethics committee or arranging an ethical consultation are examples of potential aids to decision making. Whether and how artificial intelligence (AI) and the large language model (LLM) of the company OpenAI (San Francisco, CA, USA), known under the name ChatGPT, can also help and support ethical decision making is increasingly becoming a matter of controversial debate. MATERIAL AND METHODS: Based on a case example, in which a female physician is confronted with ethical and legal issues and presents these to ChatGPT to come up with answers, the first indications of the strengths and weaknesses are ascertained. CONCLUSION: Due to the rapid technical development and access to ever increasing quantities of data, the utilization should be closely observed and evaluated.

The Power of Customized Clear Aligners in Closing Molar Edentulous Spaces: Clinical and Medico-Legal Considerations in a Scoping Review and Case Report.

Successful closure of edentulous spaces with clear aligners (CAs) is influenced by many factors. CAs are tailored orthodontic devices whose predictability may have relevant medico-legal implications. This study presents a scoping review about missing molar space closure (MMSC) with CAs and a clinical case. This study aims to highlight the feasibility of molar space closure by mesialization with CAs without hybrid supports. Following PRISMA Sc-review guidelines, English-written randomized/non-randomized/observational clinical studies on PubMed, Scopus, Cochrane and Lilacs were searched. An 18-year-old patient, with upper and lower edentulous spaces due to the loss of two first molars, was rehabilitated with CAs (Sorridi®, Sorridi srl, Latina, Italy) without hybrid supports and attachments. The therapy was carried out over 10 months. Currently, there are no studies documenting MMSC by mesialization with only CAs. Existing articles document the closure of premolar or incisor spaces. The upper and lower left second molars replaced the missing first molars, and erupting third molars replaced adjacent teeth. The biomechanical effects in space closure with CAs related to extraction cases appear as priorities of clinical/medico-legal interest. Our case turns attention to this movement of CAs without attachments/hybrid supports, indicating that even such a complex treatment can be comfortable for patients and safely predictable for specialists.

Medico-Legal Implications and Regulatory Frameworks of Regenerative Orthopaedics.

Regenerative orthopaedics has revolutionized traditional medicine, which represents a giant leap in science and research. The knowledge of the medico-legal implications and regulatory framework of this branch is vital for clinicians and researchers to go forward smoothly. This systematic review of the literature should shed light on these considerations and provide a comprehensive knowledge of the various implications and laws governing practice and research. The wide plethora of knowledge in the use of regenerative orthopaedics should be complemented by updated regulations and clinicians' grasp of knowledge on regenerative medicine. The review focused on peer-reviewed published articles concerned with the topic and outlined common medico-legal issues and the current regulatory frameworks in various countries. The articles suggest that developed nations like the US have faced several lawsuits in this field, and a few countries in Europe like Italy and Germany, which were frontrunners in this field based on research, have fallen back due to emerging legal and regulatory policies. Undoubtedly, regenerative orthopaedics holds the key to future orthopaedics, but the world is skeptical of this concept, and laws and regulatory frameworks can curb it if not guided well. In India, this field has received prime attention, but at a slow pace when compared to the laws. After reviewing 113 articles, we analysed eight critically in this systematic review to emphasize the comparative global frameworks, daily medico-legal problems, and solutions for the branch of regenerative orthopaedics.

Appellate Review of Child Sexual Abuse Convictions: The Importance of Character Evidence.

This study examined the role of character evidence and other issues in criminal appeals of child sexual abuse (CSA) convictions. Character evidence includes uncharged acts and character witnesses who testify to another's reputation or opinion and is offered to prove an individual's propensities. Examining 168 appellate court opinions reviewing CSA convictions between 2005 and 2015 in Maricopa County, Arizona, we found that when specific types of evidence were at issue, they were most often character evidence issues (49%). However, appellate courts virtually never reversed convictions (n = 5), and when defendants did obtain relief, the reduction in charges or in sentences was minor. Of the small number of opinions that were published (n = 4), all focused on character evidence, including the single case reviewed by the Arizona Supreme Court. However, close examination of the published cases suggested they effected only modest change.

Legal aspects of genetic testing in the evaluation of ventricular tachycardias.

There is increasing knowledge of the genetic basis of distinct cardiac pathologies that are related to ventricular tachyarrhythmias (VT) and sudden cardiac death (SCD). The identification of genes responsible for inherited cardiac diseases has led to the organization of cardiogenetic consultations in many countries worldwide. The 2022 European Society of Cardiology (ESC) guidelines for the management of patients with ventricular arrhythmias and the prevention of SCD and the international 2022 Expert Consensus Statement on the state of genetic testing for cardiac diseases emphasize the importance of genetic testing in cardiology practice along with appropriate information provision to affected individuals and their relatives. However, the context of genetic examination raises particular ethical, practical (including economic or financial), and legal challenges. This review aims to elucidate practical considerations related to legal aspects relevant for the evaluation of patients presenting with VT in Germany.

Commentary: The Legal System Response to Child Maltreatment.

Legal actions are perhaps the most powerful responses to child maltreatment. Criminal and child protection investigation and forensic interviewing can provide the evidence needed to support a child victim's disclosure. Prosecution of child maltreatment can hold perpetrators accountable. Juvenile and family court actions can provide for children's safety and oversee their care in state custody and journey to a permanent home. This commentary introduces readers to a special issue of the journal Child Maltreatment that focuses on the legal system response to child abuse and neglect. We provide an overview of the issue's 11 research articles and additional commentary. These works provide crucial new knowledge on gaining information from child victims involved in the legal system, on the law enforcement and prosecution response to child maltreatment, and on the legal framework supporting child protection.