Legal Medicine

法律医学
  • 文章类型: Journal Article
    作为全面分析的一部分,本案例报告提供了一个可能的儿童虐待案例,可以作为法医和法医调查的基础。此案涉及一名大约两个月大的婴儿的死亡。在2021年5月底儿科医生的常规检查中,发现孩子的头围正常为31厘米。没有发现其他异常。2021年6月19日,孩子去世,尸检显示头围为44厘米,硬膜下血肿是死因。出现了关于谁可能虐待孩子以及何时虐待孩子的问题。唯一的证据是孩子的父母在2021年6月13日,也就是孩子死亡前六天拍摄的低质量手机视频,可以看到孩子躺在枕头上。有必要确定该视频中的孩子是否已经有不自然的头围。本研究提出了一种新颖的工作流程,演示了如何分析和处理低质量视频以回答上述问题。工作流程演示了从数字图像和视频材料创建3D场景。这些3D场景可用于对象测量并支持法医和医学调查。在目前的情况下,只有低质量的智能手机图像可用,所呈现的工作流程用于创建孩子躺在枕头上的3D场景。在这个3D场景中,可以确定孩子的头围。这些测量结果支持体检医师的发现(日期为2021年6月24日),并证实了2021年6月13日可能发生的虐待儿童的怀疑。创新的方法使得有可能根据特定的时间点确定可能滥用的证据,在这种情况下,孩子的私人镜头。它还展示了3D场景重建在复杂的法医和医学场景中的潜力。
    As part of a comprehensive analysis, this case report presents a possible case of child maltreatment that can serve as a basis for forensic and medical examiner investigations. This case concerns the death of an infant who was approximately two months old. During a routine examination by the pediatrician at the end of May 2021, the child was found to have a normal head circumference of 31 cm. No other abnormalities were noted. On June 19, 2021, the child died, and an autopsy revealed a head circumference of 44 cm and a subdural hematoma as the cause of death. Questions arose as to who might have abused the child and when. The only evidence was a low-quality cell phone video taken by the child\'s parents on June 13, 2021, six days before the child\'s death, in which the child could be seen lying on a pillow. It was necessary to determine whether the child in this video already had an unnatural head circumference. This study presents a novel workflow that demonstrates how to analyze and deal with low quality video to answer questions like the above. The workflow demonstrates the creation of 3D scenes from digital image and video material. These 3D scenes can be used for object measurement and to support forensic and medical investigations. In the present case, where only low quality smartphone images were available, the presented workflow was used to create a 3D scene of the child lying on the pillow. In this 3D scene, it was possible to determine the child\'s head circumference. These measurements support the findings of the medical examiner (dated June 24, 2021) and confirm the suspicion that possible child abuse had already taken place on June 13, 2021. The innovative approach makes it possible to identify evidence of possible abuse based on a specific point in time, in this case the child\'s private footage. It also demonstrates the potential of 3D scene reconstruction in complex forensic and medical scenarios.
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  • 文章类型: Journal Article
    虽然临床牙科已经无缝地整合了数字革命,法医牙科的技术能力存在差距。该研究旨在比较两种不同的三维记录格式的叠加精度,即口内扫描仪和锥形束计算机断层扫描,在法医鉴定的背景下。样本由随机选择的20至50岁男女的成年人(n=10)组成。在使用Mediti700无线扫描仪和带有InVivo软件的iCAT断层扫描仪获取数据之后,使用MeditScanClinic软件通过叠加对记录进行分析和比较,以评估解剖鉴定细节的技术精度.观察者内部和观察者之间的分析后,通过牙齿和骨骼记录的叠加获得的结果可以对个体进行准确的比较和识别。这种方法可以区分正匹配和负匹配,实现排除结果,并提供一种潜在的解决方案,以克服人类识别中缺乏标准化程序的问题。
    While clinical dentistry has seamlessly integrated the digital revolution, there is a gap in the technological capabilities of forensic dentistry.The study aimed to compare the superimposition accuracy of two different three-dimensional record formats, namely the intraoral scanner and cone beam computer tomography, in the context of forensic identification.The sample consisted of randomly selected adults (n=10) of both sexes aged between 20 and 50 years. Following the acquisition of data using the Medit i700 wireless scanner and the iCAT Tomograph with InVivo software, the records were analysed and compared through superimposition using Medit Scan Clinic software to assess the technical precision of anatomical identification details.The results obtained through the superimposition of dental and bone records following intra- and inter-observer analysis enabled an accurate comparison and identification of an individual. This method can differentiate between positive and negative matches, achieving exclusion results and offering a potential solution to overcoming the absence of a standardisation procedure in human identification.
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  • 文章类型: Journal Article
    最近发生的事件将关于报废问题的辩论带到了最前沿,特别是关于抑郁症患者的自决原则。比利时立法,事实上,允许病人请求安乐死,能够有意识地表达自己的意愿,以一种无法忍受的方式受苦,并且在继续他们的存在中找不到任何意义,即使在没有无法治愈和/或严重衰弱的条件下。最先进的是越来越多的死于安乐死的人。一个悬而未决的问题是当一种情况可以被定义为无法忍受的时候。此外,这样的评估是否一定会导致死亡,还是有其他解决方案?在我们看来,这种做法应该受到限制,以防止可能导致侵犯抑郁症患者权利的不当申请。
    UNASSIGNED: Recent events have brought the debate on end-of-life issues to the forefront, particularly regarding the principle of self-determination for depressed patients. Belgian legislation, in fact, allows for requesting euthanasia when patients, capable of expressing their own will consciously, suffer in an unbearable manner and find no meaning in continuing their existence, even in the absence of incurable and/or severely debilitating conditions. The state of the art is an increasing number of people who die from euthanasia. An open question is when a situation can be defined as unbearable. Moreover, does such an assessment necessarily lead to death, or are there other solutions? In our opinion, such a practice should be limited to prevent inappropriate applications that could lead to infringing depressed patients\' rights.
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  • 文章类型: Letter
    Cosito案强调了一个广泛辩论的生物伦理问题,即需要在通过绝食抗议保护被拘留者的生命和他们的自决权之间做出选择。最近,意大利国家生物伦理委员会被要求就此事发表意见。另一方面,媒体对此案的共鸣揭示了对这种情况提出道德和社会问题的必要性:医生是否有义务以牺牲他们的自由选择为代价来保护被拘留者的健康?有必要了解法律是否没有。219/17适用于这种情况。
    UNASSIGNED: The Cospito case has highlighted a widely debated bioethical issue regarding the need to choose between safeguarding the life of a detainee and their right to self-determination through the practice of a hunger strike. Recently, the Italian National Bioethics Committee has been called upon to give an opinion on this matter. On the other hand, the media resonance of this case has shed light on the need to pose an ethical and social question regarding such situations: does the physician have an obligation to protect the detainee\'s health at the expense of their free choice? To be able to answer, it is necessary to understand whether law no. 219/17 is applicable to this context.
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  • 文章类型: Journal Article
    (1)本文旨在提出一种远程信息处理方法,用于评估INPS医学法律委员会的社会工作者成员的残疾状态。(2)我们已着手深入研究目前的方法,并将其与新的策略进行比较,以加强与评估残疾状况在时间和无障碍方面的经验,消除了直接访问的需要。(3)拟议的协议可以应用于患者无法进行身体移动的情况,在家就诊后,当仅仅评估文件就足够了。在这两种情况下,必须与委员会进行远程会议,以填写有关社会环境部分的所需信息。该协议可以应用于不同的平台,例如Skype™,因为它是免费的,并且在全国范围内广泛使用。(4)应该注意的是,远程医疗解决方案不能完全取代面对面的互动;但是,在一些有限的情况下,他们可以优化流程和时机,避免仅通过电话移动或交互的需要。
    (1) This paper aims to propose a telematic method for assessing the state of disability by a social worker member of the Medico-Legal Commissions of INPS. (2) We have proceeded to delve into and compare the current methods with new strategies to enhance the experience linked to the assessment of the status of disability in terms of timing and accessibility, eliminating the need for a direct visit. (3) The proposed protocol can be applied in cases where patients cannot be physically moved, following a medical visit at home, and when the mere evaluation of documents is sufficient. In both cases, a remote session with the Commission is necessary to fill in the required information about the socio-environmental section. This protocol can be applied to different platforms such as Skype™ since it is free and widely used throughout the country. (4) It should be noted that telemedicine solutions cannot completely replace face-to-face interaction; however, in some limited cases, they can optimize the process and timing, avoiding the need to move or interact only by telephone.
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  • 文章类型: Journal Article
    年龄估计是人类学和法医牙科学实验室的主要挑战,以及在司法环境中,作为人类识别的工具之一。这项研究的目的是评估基于牙齿颜色变化的精确测量的年龄估计方法的有用性。根据系统审查和荟萃分析的首选报告项目的建议,并符合Cochrane标准建议(PROSPERO注册号CRD42022343371)进行了系统审查。在以下数据库中进行了电子搜索:Pubmed,WebofScience,Medline,当前内容连接,SciELO,KCI-韩国期刊数据库,德文特创新指数和俄罗斯引文指数。搜索策略共产生18篇文章。按年龄分层的CIEL*a*b*颜色变量结果的随机荟萃分析模型(小于30岁,30-60年,60岁及以上)进行了这项系统评价中包括的18项研究中的9项。根据我们的结果,颜色测量的性别和位置是影响颜色估计的最重要因素。所有研究都是通过分光光度法在健康的前牙中进行的,分光光度法是最常用的颜色测量方法,CIEL*a*b*是最常用的分析参数。基于年龄作为因变量的研究显示R2值在0.28和0.56之间,在离体牙齿中更高。以年龄为自变量的研究显示R2值在0.10到0.48之间。随机模型显示了L*的高度异质性,所有年龄组的a*和b*参数,这可以通过年龄范围的差异和颜色测量的非标准化条件来解释。这篇系统综述强调了对测量牙齿颜色的年龄估计研究进行规范的必要性,以便在不同的取证环境中应用此方法。
    Age estimation is a major challenge in anthropology and forensic odontology laboratories, as well as in judicial settings, as one of the tools used in human identification. The aim of this study was to evaluate the usefulness of age estimation methods based on the accurate measurement of tooth color changes. A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and in compliance with Cochrane criteria recommendations (PROSPERO registration number CRD 42022343371). An electronic search was performed in the following databases: Pubmed, Web of Science, Medline, Current Contents Connect, SciELO, KCI-Korean Journal Database, Derwent Innovations Index and Russian Citation Index. The search strategy yielded a total of 18 articles. A randomized meta-analysis model of the results for the CIE L*a*b* color variables stratified by age (less than 30 years, 30-60 years, 60 years and older) was performed with 9 of the 18 studies included in this systematic review. According to our results, sex and location of color measurement are the most influential factors in color estimation. All studies were carried out in healthy anterior teeth by spectrophotometry as the most commonly used method for color measurement, with CIE L*a*b* being the most commonly analyzed parameters. Studies based on age as a dependent variable showed R2 values between 0.28 and 0.56, being higher in ex vivo teeth. Studies based on age as an independent variable showed R2 values ranging from 0.10 to 0.48. The random model showed high heterogeneity for the L*, a* and b* parameters in all age groups, which is explained by discrepancies in age range and non-standardized conditions for color measurement. This systematic review highlights the need to protocolize age estimation studies that measure tooth color, in order to apply this method in different forensic settings.
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  • 文章类型: Journal Article
    少年犯中精神症状的高患病率是一个很好的国际发现。这项研究旨在发现违反法律和被拘留的青少年中情绪障碍的患病率及其与严重犯罪行为的关系。共有123名14至17岁的男囚犯接受了采访和评估。在当前发作的样本中,有15%被诊断出情绪障碍,在一生中,有31%被诊断出情绪障碍。使它们在依赖性障碍和破坏性障碍之后排名第三。犯有暴力犯罪的青少年的心理病理学特征证实了其他研究报告,该人群中情绪障碍的患病率很高。已经发现了影响青少年犯罪形成的几个因素,包括缺乏家庭结构,社会不平等,缺乏优质的学校教育,酒精和药物滥用/成瘾和破坏性疾病。目前的结果证实了情绪障碍是另一个这样的因素。
    The high prevalence of psychiatric symptoms among juvenile delinquents is a well-replicated international finding. This study aimed to find the prevalence of mood disorders and their relationship with serious criminal acts in a population of adolescents in conflict with the law and in custody. A total of 123 male inmates aged 14 to 17 years were interviewed and assessed. Mood disorders were diagnosed in 15% of the sample for current episode and 31% for lifetime, making them third most prevalent after dependence disorders and disruptive disorders. The psychopathological profile of the adolescents who had committed violent crimes corroborates other studies reporting a high prevalence of mood disorders in this population. Several factors have been found to influence the formation of juvenile delinquency, including absence of family structure, social inequality, lack of quality school education, alcohol and drug abuse/addiction and disruptive disorders. The present results confirm mood disorders as another such factor.
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  • 文章类型: Journal Article
    进行了全面分析,考虑到区块链技术(BT)在数字健康中的属性,向法警讲话,隐私,和监管方面的考虑。遵守个人数据保护和医疗保健监管准则进行了分析和比较GDPR(欧洲),HIPAA(美国),CCPA(加利福尼亚州),PIPEDA(加拿大),1988年《隐私法》(澳大利亚)APPI(日本),和LGPD(巴西)。卫生系统等问题,加强和调整政策取向和举措,并强调数据分析在制定卫生政策中的作用。该研究解决了法律框架与区块链之间的冲突,比较和建议解决方案,如修订法律和整合合规机制。此外,它试图通过整合医疗保健和法律领域来提高IT健康素养。法律之间正在进行的合作,健康,IT专家对于设计有效平衡隐私权和数据保护的系统至关重要,同时最大限度地发挥区块链等颠覆性技术的优势。
    A comprehensive analysis was performed, considering blockchain technology (BT) properties in digital health, addressing medicolegal, privacy, and regulatory considerations. Adherence to personal data protection and healthcare regulatory guidelines were analyzed and compared for GDPR (Europe), HIPAA (United States), CCPA (California), PIPEDA (Canada), the Privacy Act of 1988 (Australia), APPI (Japan), and LGPD (Brazil). Issues such as health systems, strengthening and aligning policy orientations and initiatives, and emphasizing the role of data analysis in shaping health policies were explored. The study addressed conflicts between the legal frameworks and blockchain, comparing and suggesting solutions like the revision of laws and the integration of compliance mechanisms. Additionally, it sought to enhance IT-health literacy by integrating the healthcare and legal domains. Ongoing collaboration between legal, health, and IT experts is essential for designing systems that effectively balance privacy rights and data protection while maximizing the benefits of disruptive technologies like blockchain.
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  • 文章类型: Journal Article
    背景:对死亡的恐惧是医疗保健学生和专业人员的常见经历,可能会影响向患者提供的护理质量,尤其是那些接受姑息治疗的人。Collett-Lester对死亡的恐惧量表是一种广泛使用的工具来评估这种恐惧,尽管其心理测量学特性尚未在职业治疗学生中得到广泛研究。本研究旨在验证职业治疗学生样本中的Collett-Lester死亡恐惧量表(CL-FODS),并探讨其对姑息治疗教育的影响。
    方法:进行了一项横断面研究,对职业治疗本科生的CL-FODS进行心理测验。结构有效性,内部一致性,并对重测可靠性进行了分析。这项研究共纳入了195名职业治疗学生。此外,参与者完成了对姑息治疗的经验和态度的简短调查。
    结果:内部一致性令人满意(α=0.888)。评估内部结构的探索性因素分析得出了四个因素。模型拟合指数为:比较拟合指数=0.89,近似均方根误差=0.06)。测试重测可靠性令人满意,并证明了0.939的组内相关系数。
    结论:西班牙语版本的CL-FODS显示出令人满意的心理测量特性;因此,评估职业治疗学生对死亡的恐惧是有帮助的。这项研究强调了解决死亡的恐惧和姑息护理教育的职业治疗本科生的重要性,以改善未来的职业态度和,因此,患者在生命结束时的护理质量。
    BACKGROUND: The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education.
    METHODS: A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care.
    RESULTS: The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939.
    CONCLUSIONS: The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.
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  • 文章类型: Journal Article
    在医疗保健中采用先进的人工智能(AI)系统正在改变医疗保健服务的格局。人工智能可以增强患者安全并改善医疗保健结果,但它提出了显着的道德和法律困境。此外,随着人工智能简化了对与医疗事故索赔相关的众多因素的分析,包括知情同意,遵守护理标准,和因果关系,职业责任的评估也可能受益于它的使用。首先分析了评估职业责任的基本步骤,本文探讨了专家证人在分析医疗事故案件时可能遇到的潜在新的医学法律问题,以及在这种情况下人工智能的潜在整合.这些变化与集成AI的使用有关,将需要法官的努力,专家,和临床医生,并可能需要新的立法规定。在评估专业责任案件时,可能需要新的专家证人。一方面,人工智能将支持专家证人;然而,另一方面,它将在医护人员的活动中引入特定的元素。这些因素将需要具有专门文化背景的专家证人。检查专业责任评估的步骤表明,人工智能在法律医学中的可能路径涉及其作为协作和集成工具的作用。在这些评估中,人工智能与人类判断的结合可以增强全面性和公平性。然而,必须采取谨慎和平衡的方法来防止该领域的完全自动化。
    The adoption of advanced artificial intelligence (AI) systems in healthcare is transforming the healthcare-delivery landscape. Artificial intelligence may enhance patient safety and improve healthcare outcomes, but it presents notable ethical and legal dilemmas. Moreover, as AI streamlines the analysis of the multitude of factors relevant to malpractice claims, including informed consent, adherence to standards of care, and causation, the evaluation of professional liability might also benefit from its use. Beginning with an analysis of the basic steps in assessing professional liability, this article examines the potential new medical-legal issues that an expert witness may encounter when analyzing malpractice cases and the potential integration of AI in this context. These changes related to the use of integrated AI, will necessitate efforts on the part of judges, experts, and clinicians, and may require new legislative regulations. A new expert witness will be likely necessary in the evaluation of professional liability cases. On the one hand, artificial intelligence will support the expert witness; however, on the other hand, it will introduce specific elements into the activities of healthcare workers. These elements will necessitate an expert witness with a specialized cultural background. Examining the steps of professional liability assessment indicates that the likely path for AI in legal medicine involves its role as a collaborative and integrated tool. The combination of AI with human judgment in these assessments can enhance comprehensiveness and fairness. However, it is imperative to adopt a cautious and balanced approach to prevent complete automation in this field.
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