scholarly journals Forensic Implications of Anatomical Education and Surgical Training With Cadavers

2021 ◽  
Vol 8 ◽  
Author(s):  
Carmelo Pirri ◽  
Carla Stecco ◽  
Andrea Porzionato ◽  
Rafael Boscolo-Berto ◽  
René H. Fortelny ◽  
...  

Anatomical education and surgical training with cadavers are usually considered an appropriate method of teaching, above all for all surgeons at various levels. Indeed, in such a way they put into practice and exercise a procedure before performing it live, reducing the learning curve in a safe environment and the risks for the patients. Really, up to now it is not clear if the nonuse of the cadavers for anatomical education and surgical training can have also forensic implications. A substantial literature research was used for this review, based on PubMed and Web of Science database. From this review, it is clear that the cadaveric training could be considered mandatory, both for surgeons and for medical students, leading to a series of questions with forensic implications. Indeed, there are many evidences that a cadaver lab can improve the learning curve of a surgeon, above all in the first part of the curve, in which frequent and severe complications are possible. Consequently, a medical responsibility for residents and surgeons which perform a procedure without adequate training could be advised, but also for hospital, that has to guarantee a sufficient training for its surgeons and other specialists through cadaver labs. Surely, this type of training could help to improve the practical skills of surgeons working in small hospitals, where some procedures are rare. Cadaver studies can permit a better evaluation of safety and efficacy of new surgical devices by surgeons, avoiding using patients as ≪guinea pigs≫. Indeed, a legal responsibility for a surgeon and other specialists could exist in the use of a new device without an apparent regulatory oversight. For a good medical practice, the surgeons should communicate to the patient the unsure procedural risks, making sure the patients' full understanding about the novelty of the procedure and that they have used this technique on few, if any, patients before. Cadaver training could represent a shortcut in the standard training process, increasing both the surgeon learning curve and patient confidence. Forensic clinical anatomy can supervise and support all these aspects of the formation and of the use of cadaver training.

Author(s):  
Hans-Ludwig Kröber

Modern psychiatry uses a theoretical concept of ‘disorder’: it describes various impaired functions without distinguishing pathological disorders from non-pathological disorders, or even from disorders similar to an illness. Of course, this usage eliminates neither illnesses nor the subjective experience of being ill, but it has implications for forensic psychiatry and for the assessment of a person’s legal responsibility. Having schizophrenic delusions constitutes a categorically different state from having only wishful illusions or a vivid imagination. In the context of medicine and psychiatry, we certainly encounter stages that signal fundamental differences. These differences are easily detected when assessing psychotic disorders or similar states, but a lot of differences also arise when assessing perpetrators with personality disorders or simply antisocial behavior. Where, in these states, are the borders that demarcate full responsibility from substantially reduced social responsibility?


2021 ◽  
Vol 57 (2) ◽  
pp. 274-280
Author(s):  
David C. Paulus ◽  

Researchers interested in evaluating the biomechanics and human factors associated with using a new product recognize that skill development with the novel design is time-dependent. A learning curve is a plot that shows the time to complete a task using the product decreases as the number of training repetitions increases. A novel thumb-operated trigger system (Iron Horse, Blackwater Worldwide™) has been developed for the AR-15 style rifle with the intent to shorten the learning curve. The purpose of this research effort is to quantify the learning curve for the new device and to compare it to that of a standard mil-spec AR-15 trigger system. A previously-trained shooter dry-fire trained with both rifle systems for twenty consecutive days alternating lower receivers each day. The rifles were equipped with a gyroscopic instrument (Mantis X™) that tracked the movement of the firearm during the trigger pull process. The instrument has a timer to record the reaction time to an auditory signal for each shot, records the magnitude and direction of movement of the firearm, and calculates an accuracy score. There was not a significant difference (p>0.05) between the thumb operated and mil-spec triggers’ cycle times. However, the accuracy scores with the thumb operated trigger were significantly higher (p<0.05) than those with the mil-spec trigger.


1995 ◽  
Vol 76 (2) ◽  
pp. 427-434 ◽  
Author(s):  
Geoffrey R. McKee

Legal responsibility for acts presumes that a person's behavior is rationally intentional and under voluntary control. Automatism, a type of insanity defense, contends that the person's conscious, voluntary control of behavior has been impaired by a mental disorder. In a recent case in South Carolina, automatism was offered as a defense to adultery, an at-fault grounds for divorce. On appeal, the State Supreme Court recognized the novel application of mental impairment defenses in domestic litigation and remanded the case for rehearing. Implications of the ruling for clinical and forensic practice in family court are discussed.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emily J. Hotton ◽  
◽  
Mary Alvarez ◽  
Erik Lenguerrand ◽  
Julia Wade ◽  
...  

Abstract Background The Odon Device™ is a new device for assisted vaginal birth that employs an air cuff around the fetal head for traction. Assisted vaginal birth (AVB) is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for AVB (forceps and ventouse) are often not used in settings where there is most clinical need often due to lack of training and resources, resulting in maternal and neonatal morbidity and mortality which could have been prevented. This is often due to a lack of trained operators as well as difficulties in the sterilisation and maintenance of AVB devices. This novel, single use device has the potential to mitigate these difficulties as it is single use and is potentially simpler to use than forceps and ventouse. All the studies of the Odon Device to date (pre-clinical, preliminary developmental and clinical) suggest that the Odon Device does not present a higher risk to mothers or babies compared to current standard care, and recruitment to intrapartum research exploring the device is feasible and acceptable to women. The first study in which the Odon Device was used in clinically indicated conditions (the ASSIST Study) reported a lower efficacy than those reported with established devices. The reasons need to be explored, specifically focussing on learning curve, the technique of the doctors using this new device and potential modifications to device design. A follow-on clinical study to further investigate the efficacy and safety of the Odon Device in its indicated use, the ASSIST II Study, is therefore being undertaken. Methods The primary feasibility outcome is study feasibility (recruitment and retention rates) whilst the primary clinical outcome successful vaginal birth completed with the Odon Device. Key secondary feasibility outcomes include participant withdrawal, compliance in data collection and acceptability of the device to women and operators. Secondary clinical outcomes include maternal, neonatal and device outcomes. Safety data will be reviewed following every birth exploring maternal, neonatal and device risks. Using A’Hern approach for sample size calculation, we aim to recruit 104 women requiring an assisted vaginal birth for a recognised clinical indication. Assuming an AVB success rate of 65% or more, a one-sided alpha risk of 5% and power of 90%. Discussion The data from the ASSIST II Study will provide the information required regarding acceptability, recruitment, outcome data collection, device design, technique of device use and operator learning curve in order to design a future randomised controlled trial of the Odon Device versus current modes of assisted vaginal birth. Trial registration ISRCTN registration: 38829082 (prospectively registered July 26, 2019)


2006 ◽  
Vol 88 (2) ◽  
pp. 48-51 ◽  
Author(s):  
Guy Hirst ◽  
Denis Wilkins

The following two articles identify similarities between professional air crew and surgeons, both being leaders of multidisciplinary teams and holding ultimate legal responsibility. In the first article, British Airways training captain Guy Hirst illustrates the non-adversarial teamwork inherent in effective crew resource management with confidential reporting of adverse incidents and the care with which flight instructors are selected and nurtured. Denis Wilkins, a senior surgeon, demonstrates in the second article that nobody takes responsibility for the 'signing off' of trainees for any particular surgical procedure. There are, of course, differences in the training environments of the professions. Advance flying training requires a student pilot to put an aircraft into critical situations and to demonstrate the ability to recover. Mostly, this can be performed repetitively either at sufficient altitude or in the safety of a simulator. In surgery, one cannot purposely put a patient 'at risk' to enable trainees to demonstrate their skills at 'recovery' and surgical simulators are in their infancy and do not achieve priority in a cash-strapped NHS. The authors recognise the need for properly selected trainers who are remunerated accordingly. Having been both a flying instructor and a surgical trainer, I can testify that both professions require patience, rapid reactions and the ability to remain calm. These papers are fascinating and timely in the era of introduction of new surgical curricula. Surgical training requires considerable funding at grass-roots level to catch up with the standards of aviation.


2021 ◽  
Vol 35 (S1) ◽  
Author(s):  
Alejandro Quiroga‐Garza ◽  
Pablo Zarate‐Garza ◽  
Francisco Guerrero‐Mendivil ◽  
Milton Muñoz‐Leija ◽  
Yolanda Salinas‐Alvarez ◽  
...  

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