The criminal liability of the medical team considering the recent orientation of the Italian Court of Cassation

This article aims to analyze the thematic of medical team liability considering the recent Italian Supreme Court case-law, highlighting the various problems linked to the identification of the responsibility of each member of the team. The participation of several subjects in the execution of medical treatment makes the question of criminal liability very complex, especially when it comes to inauspicious events, such as injuries or death, occurring during medical treatment. The question concerns the exact identification of the duty of care and vigilance of the medical team and whether this duty is in line with the principle of individual criminal responsibility guaranteed by Article 27 of the Italian Constitution. In this regard, the case-law has elaborated the so-called “principle of reasonable confidence”, according to which the division of labour that belongs to each member should involve a delimitation of his responsibility, limited only to what is within his competence, except in case of the person who organizes, directs, and controls the team. Precisely, based on this principle, the Italian Supreme Court in 2018 reasserted that in the medical team is necessary to identify the role played by each member, thus avoiding resorting to objective responsibility.

Symptomatic haemophilia A: management during pregnancy and the postpartum period

As an X linked disorder, the presence of severe symptomatic haemophilia A is an extremely rare disorder in women. Therefore there are no high-level evidence-based guidelines when it comes to pregnancy. Although there have been advances in the fields of prenatal counselling and maternal-fetal care, the management of these gestations continues to embody a challenge for any medical team. We report the successful management of a pregnant woman with symptomatic haemophilia A, from pregnancy to the postpartum period. Our aim is to enhance knowledge on this topic, and further improve outcomes for these mothers and their offspring.

Reflections of Healing Narratives

This narrative discusses research illustrating how writing assists patients in healing from both emotional and physical pain. An English professor and physical therapist collaborated to design a survey that uses writing prompts to assess goal setting for physical therapy patients. Advice for patients, such as keeping a pain journal of symptoms to share with a medical professional, demonstrates how writing helps the healing process while leading to collaboration between a patient and the medical team.

The Relationship between Government Information Supply and Public Information Demand in the Early Stage of COVID-19 in China—An Empirical Analysis

Accurate and effective government communication is essential for public health emergencies. To optimize the effectiveness of government crisis communication, this paper puts forward an analytical perspective of supply–demand matching based on the interaction between the government and the public. We investigate the stage characteristics and the topic evolutions of both government information supply and public information demand through combined statistical analysis, text mining, text coding and cluster analysis, using empirical data from the National Health Commission’s WeChat in China. A quantitative measure reflecting the public demand for government information supply is proposed. Result indicates that the government has provided a large amount of high-intensity epidemic-related information, with six major topics being the medical team, government actions, scientific protection knowledge, epidemic situation, high-level deployment and global cooperation. The public’s greatest information needs present different characteristics at different stages, with “scientific protection knowledge”, “government actions” and “medical teams” being the most needed in the outbreak stage, the control stage and the stable stage, respectively. The subject of oversupply is “medical team”, and the subject of short supply is “epidemic dynamics” and “science knowledge”. This paper provides important theoretical and practical value for improving the effectiveness of government communication in public health crises.

What Is Preparedness and Capacity of Intensive Care Service in Indonesia to Response to COVID-19? A Mixed-method Study

BACKGROUND: Pandemics can increase disease spread, as well as unpredictable and highly in patient demand, which can have a negative impact on hospital capacity and the overall functioning of the health-care system. The preparedness and capacity of intensive care services to respond to COVID-19 in Indonesia are remain unknown. AIM: This study aimed to investigate the preparedness and capacity of intensive care services in Indonesia to respond to the initial stage of the COVID-19 pandemic. METHODS: A mixed-method research design was used in this study using in-depth interviews and an online survey. An in-depth interview was conducted with the medical team (intensive care consultant and an anesthesiologist) who is actively involved in the provision of COVID-19 services in 15 national referral hospitals. The online survey was conducted to all medical teams that provide direct care to the COVID-19 patients. A total of 459 (response rate was 95.2%) agreed to join the survey. The content analysis technique was used to analyze qualitative data and a descriptive analysis was used to describe issues encountered in providing health services to COVID-19 patients. RESULTS: The analysis preparedness and capacity of intensive care service in Indonesia to respond to the initial stage of the COVID-19 pandemic resulting in 4 themes with 12 sub-themes. The four themes were limited quality and quantity of standardized intensive care unit (ICU) isolation room (inadequate zoning systems, adequacy of the standardized ICU isolation room, the readiness of the hospital infrastructure, and telemedicine facilities are not yet widely used, including in the COVID-19 isolation room), limited medical service support (lack of personal protective equipment (personal protective equipment [PPE], re-used PPE, lack of availability of medical devices), limitations in the medical team’s quality and quantity management (lack of number and distribution of expert doctors and medical team screening for ICU), and command systems (task shifting, effective communication, and leadership). CONCLUSION: Medical team encounters several difficulties, particularly related to the quality of facilities, staff preparedness, and systems for the provision of services to COVID-19 patients with critical conditions. There is a critical need for well-defined pathways, legal protection, and occupational health for medical teams providing services in the aftermath of a pandemic.

P-EGS04 Assessment of Malnutrition in emergency laparotomy patients. A QIP highlighting simple measures can improve early recognition and optimisation of high-risk patients

Background Early recognition of high-risk malnourished patients is important for optimisation of nutritional status leading to better outcomes. The accurate recording of malnutrition universal screening tool (MUST) results is vital in this regard. This quality improvement project (QIP) aimed to review the quality of nutritional assessment of emergency laparotomy patients against the National Institute for Health and Care Excellence (NICE) guidelines and outline area of improvement. Methods The QIP was conducted at Royal Oldham Hospital in 2019-2020 over a seven-month period. Fifty random patients were included in the first audit cycle over a 4-month period, followed by implementation of recommended changes and a re-audit of 30 patients over a 2-month period. The initial MUST scores which were calculated and documented by nursing staff were identified as the nursing staff MUST score (NSMS). To assess the accuracy of NSMS, we developed a MUST rescoring method which was performed by a senior member of the medical team and was identified as the medical team MUST rescore (MTMR). Results The initial audit showed a significant difference between NSMS and MTMR scores. According to MTMR, 23 patients (46%) had an inaccurate MUST score assessment by the nursing staff. A multidisciplinary approach using a standard online calculator were recommended. The second phase of the QIP showed an obvious improvement in the accuracy of MUST assessment. Our interventions improved the accuracy rate of MUST scores significantly (27, 54% vs 29, 96.6%, P = 0.00005). Conclusions A multidisciplinary team approach and online calculator are useful in improving the accuracy of MUST assessment in emergency laparotomy patients. This helped early involvement of the dietitian leading to improvement in morbidity and mortality.

Survival of mechanically ventilated ward patients and association with organisational factors: a multicentre prospective study

ObjectivesDetermine 90-day mortality of mechanically ventilated ward patients outside the intensive care unit (ICU) and its association with organisational factors.DesignMulticentre prospective observational study of mechanically ventilated ward patients. Modified Poisson regression was used to assess association between nurse to patient ratio (NPR) and 90-day mortality, adjusted for designated medical team, Society of Critical Care Medicine (SCCM) triage priority and centre effect. NPR was divided into low (1:9.6 to 1:10), medium (1:6 to 1:8) and high (1:2.6). Sensitivity analysis was conducted for pneumonia with or without acute respiratory distress syndrome (ARDS) to assess magnitude of association.Setting7 acute public hospitals in Hong Kong.ParticipantsAll 485 mechanically ventilated patients in wards from participating hospitals between 18 January 2016 and 17 April 2016 were recruited. Three hundred patients were included after excluding patients with limitation of therapy within 24 hours of intubation.Main outcomes90-day mortality, Mortality Prediction Model III Standardised mortality ratio (MPMIII0 SMR).Results201 patients died within 90 days after intubation (67.0%, 95% CI 61.5% to 72.1%), with MPMIII0 SMR 1.88, 95% CI 1.63 to 2.17. Compared with high NPR, medium and low NPRs were associated with higher risk of 90-day mortality (adjusted relative risk (RRadj) 1.84, 95% CI 1.70 to 1.99 and 1.64, 95% CI 1.47 to 1.83, respectively). For 114 patients with pneumonia with or without ARDS, low to medium NPR, too sick to benefit from ICU (SCCM priority 4b), no ICU consultation and designated medical team were associated with risk of 90-day mortality (RRadj 1.49, 95% CI 1.40 to 1.58; RRadj 1.60, 95% CI 1.49 to 1.72; RRadj 1.34, 95% CI 1.27 to 1.40; RRadj 0.85, 95% CI 0.78 to 0.93, respectively).ConclusionThe 90-day mortality rates of mechanically ventilated ward patients were high. NPR was an independent predictor of survival for mechanically ventilated ward patients.

A Qualitative Study of the Impact of COVID-19 on Hospice and Home-Based Palliative Care in Taiwan

COVID-19 has had a tremendous impact on individuals and health care, particularly among those with serious illnesses. Although Taiwan initially reported low rates of COVID-19 (20.7 cases per million in 2020), by early 2021 the Alpha variant began spreading in Taiwan, which went into a soft lockdown from May to July. This study aimed to investigate the impact of COVID-19 on Hospice and Home-Based Palliative Care (HBPC) patients, family, and medical team member in Taiwan during different COVID-related time points. From November 2020 to May 2021, we conducted semi-structured interviews with 2 patient, 5 caregivers, and 8 medical team members in the hospice and HBPC setting to elicit their views about the impact of COVID-19 on care. Content analysis was used to guide the analysis of themes. Two researchers independently coded transcripts and met to reconcile codes. Results showed varying impact across the time points. In 2020, patients, caregivers, medical team members felt little impact of COVID-19. However, in 2021, HBPC caregivers reduced the frequency of HBPC visits to lower the household COVID-19 infection risk. Hospice and HBPC team members reported that more caregivers selected HBPC over hospice. They also observed an increase in complicated grief among family survivors following the soft lockdown. The impact of the pandemic on homecare provision increased as prevalence of COVID-19 increased, impacting care and quality of hospice and HBPC. Further research is needed to better understand the impact of the pandemic on the quality of hospice /HBPC and grief experiences.

Readiness of Medical Teams Caring for COVID-19 in the Intensive Care Units: A National Web-Based Survey in Indonesia

BACKGROUND: The coronavirus disease 2019 (COVID)-19 pandemic is a challenge for the intensive care unit (ICU) medical team. It requires management of space, stuff (medical equipment including drugs), staff, and system readiness (4S) to deal with the surge in the number of patients. AIM: This survey aims to describe the current readiness efforts among ICU medical team at the COVID-19 referral hospitals in Indonesia; space, stuff readiness, staff, and systems readiness. METHODS: We conducted a cross-sectional national web-based survey of ICUs across referral hospitals during pandemic COVID-19 in Indonesia from June to October 2020. The medical teams survey included 53 questions in multiple parts addressing five dimensions. A linear regression model was applied to determine the factors related with readiness. RESULTS: A total of 459 participants (83.6%) agreed to join in this study. The participants’ average age was 40.43 years (SD = 5.78). About 62.53% were male, 51.20% had bachelor degree, and 55.77% lived outside of Java Island. The mean of total score of medical team readiness was 2.76 (SD = 0.320) and the highest (maximum score) mean score of medical team readiness domain was stuff (2.81, SD = 7.72). Education, working experience, training, perception of risk of contracting COVID-19, and residence had a substantial effect on the readiness, with R2 values of 0.378, p < 0.05. CONCLUSIONS: This study provides an initial view of current preparedness efforts among a group of ICUs in Indonesia’s leading hospital during the first wave of pandemic. Interventions must be developed and implemented quickly to increase the medical team’s readiness to care for a future pandemic.

Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors

Adolescent and young adult (AYA) survivors of cancer have diverse psychosocial and medical needs, including those related to fertility and sexual health. Much of the focus of care around issues such as fertility and sexual health tends to be filtered through a biomedical lens. However, it is essential that health care providers assess and support AYA survivors using a biopsychosocial and contextual framework to ensure the most comprehensive and accurate understanding of AYA survivor needs, especially those related to psychosexual health. A trusting relationship between the multi-disciplinary medical team and the AYA survivor that allows for open discussion about the physical and psychosocial components of sexual health is key to providing best care and outcomes.