The making of a professional digital caregiver: personalisation and friendliness as practices of humanisation

The aim of this paper is to explore how a digital caregiver, developed within a Swedish interdisciplinary research project, is humanised through health-enhancing practices of personalisation and friendliness. The digital caregiver is developed for being used in older patients’ homes to enhance their health. The paper explores how the participants (researchers and user study participants) of the research project navigate through the humanisation of technology in relation to practices of personalisation and friendliness. The participants were involved in a balancing act between making the digital caregiver person-like and friend-like enough to ensure the health of the patient. Simultaneously, trying to make the patients feel like as if they were interacting with someone rather than something—while at the same time not making the digital caregiver seem like a real person or a real friend. This illustrates the participants’ discursive negotiations of the degree of humanisation the digital caregiver needs in order to promote the health of the patient. A discursive conflict was identified between a patient discourse of self-determination versus a healthcare professional discourse of authority and medical responsibility: whether the digital caregiver should follow the patient’s health-related preferences or follow the healthcare professionals’ health rules. Hence, a possible conflict between the patient and the digital caregiver might arise due to different understandings of friendliness and health; between friendliness (humanisation) as a health-enhancing practice governed by the patient or by the healthcare professionals (healthcare professionalism).

Factors that determine the professional longevity of researchers

The study aims to assess the characteristics of health, psychological status, lifestyle, social and living conditions as factors affecting the professional success of researchers. We used content analysis of literary data and the method of expert assessments. The factors that have a high impact on the professional success of researchers include age, quality of life, premature aging, cognitive load and activity, emotional status, physical inactivity. Among the average significant factors are job satisfaction, childbearing, educational growth, stress resistance, career growth, work on the household farm, medical responsibility, material security, corporate and family health-saving environment, lifestyle, personal qualities, psycho-psychological, information and energy loads, emotional stress, academic title, intellectual activity cardiovascular and cerebrovascular diseases, alternation of physical and mental work (change of mono-load to complex). It is necessary to study further the factors that determine the success of the professional activity of researchers. There is a significant number of problems and many negative aspects associated with scientific training. According to the agreed opinion of experts, there are priority ranking places by such problems as in the first place - a decrease in cognitive functions; in the second place - a reduction in the effectiveness of scientific activity and premature aging; in the third place - the presence of low medical responsibility; in the fourth place - a frequent decrease in physical activity; in the fifth-place - emotional burnout, the fact of low material security, the formation of violations of psychological characteristics, premature termination of scientific activity. The factors that have a high impact on the professional success of researchers include age, quality of life, premature aging, cognitive load and activity, emotional status, physical inactivity. Among the average significant factors are job satisfaction, childbearing, educational growth, stress resistance, career growth, work on the household farm, medical responsibility, material security, corporate and family health-saving environment, lifestyle, personal qualities, psycho-psychological, information and energy loads, emotional stress, academic title, intellectual activity cardiovascular and cerebrovascular diseases, alternation of physical and mental work (change of mono-load to complex).

Experience of work of multidisciplinary hospital in conditions of mass admission of patients with COVID-19

Objective. Generalization of management decision-making experience and analysis of organizational measures taken during the preparation of a multidisciplinary hospital for mass admission of infectious patients with COVID-19. Materials and methods. The materials of the study included the generalized data on the results of work of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. The current guidelines, defining the key spheres of work of the head of medical organization and practical results of their implementation are analyzed. Results. The article analyzes the main activities of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. It is established that a set of measures, including preparatory preventive solutions, timely planning, re-profiling into a multidisciplinary infectious hospital with reserve beds (including resuscitation beds), creation of mobile teams to provide medical care in the foci of the territorial area of medical responsibility, timely training and reallocation of medical personnel to maximize the effective use of staff resources, reasonable routing of infectious patients, introduction of a three-level system for providing medical care to patients with COVID-19, made it possible to effectively use the available forces and resources of a multidisciplinary hospital during the COVID-19 pandemic. Conclusions. The measures taken proved to be effective, allowing a full provision of emergency medical care throughout the epidemic period, and resuming the provision of planned care in a full volume without reducing the safety of patients' stay in the hospital. Differentiation of patients flows, constant monitoring of the body temperature in both patients and medical workers themselves, constant use of PPE and motivated disinfection, regular check of employees for coronavirus infection (nasopharyngeal smear for COVID-2019 as well as blood ELISA for this infection) permitted to minimize the risks of spreading coronavirus infection in conditions of medical organization.

Forensic Implications of Anatomical Education and Surgical Training With Cadavers

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.

A Five-Year Survey for Plastic Surgery Malpractice Claims in Rome, Italy

(1) Introduction: Medical malpractice claims against both health institutions and physicians are a crucial topic in Italy, as well as in other countries, particularly regarding civil proceedings. Our study reports an analysis of all of the malpractice judgments concerning plastic surgery decided in the Civil Court of Rome between 2012 and 2016. (2) Methods: the database of the Observatory Project on Medical Responsibility (ORMe) was analyzed, which collects all of the judgments of the Civil Court of Rome, that is, the first instance district court. Therefore, neither the jurisprudence of the second level court nor that of the Supreme Court was taken into account. (3) Results: 144 judgments concerning plastic surgery were delivered in the five-year period of 2012–2016 (corresponding to 10.6% of total professional liability verdicts of the Civil Court of Rome in the same period). In 101/144 cases (70.14%), the claim was accepted. A total of €4,727,579.00 was paid in compensation for plastic surgery malpractice claims, with a range from a minimum amount of €1555.96 to a maximum amount of €1,425,155.00 and an average compensation of €46,807.71 per claim that was significantly lower compared to other surgical disciplines. (4) Conclusions: Our data confirm that the analyzed branch has a high litigation rate, with a prevalence of convictions for cosmetic procedures over reconstructive ones, both for malpractice and for violation of the informed consent. Plastic surgery is also confirmed among those branches in which the professionals are more frequently sued compared to health institutions.

Development and validation of the ethical challenges in clinical situations-questionnaire (ECCS-Q) by involving health-care providers from a tertiary care health setting

Background and rationale Clinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ (HCP’s) viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess the HCP’s perspective regarding different ethically challenging situations encountered in the Indian settings. Methods The questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation. Results The questionnaire comprised of 11 items (accounts 57% variance; having an α = 0.68) representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q. Conclusions Ethical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena.

Applications of Blockchain in the Medical Field: Narrative Review (Preprint)

BACKGROUND As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice. OBJECTIVE This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed. METHODS We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology. RESULTS We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy. CONCLUSIONS Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.