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Following the establishment of Nepal's first medical college in 1972, forensic medicine was introduced in 1978. To date, 25 medical colleges in the country have included forensic medicine as a compulsory subject in the undergraduate medical curriculum. Although this subject has been introduced into the medical curriculum, the outcome is unsatisfactory, as reflected by the poor medico-legal reports prepared by newly graduated medical students. Forensic medicine education is therefore at a critical juncture with challenges while paving the way for opportunities to improve. In this analysis, we examined the current state of forensic medicine education for the undergraduate medical programme in the country. For this purpose, we used Schwab's five commonplaces in the curriculum. We then evaluated the curriculum from the perspective of Schubert's curricular image frameworks. We noted significant differences in the curriculum content, teaching methods, and practical training across the curriculum. An acute shortage of qualified teachers, limited resources, and inconsistent curriculum updates have further complicated the situation. The current curriculum does not address cultural sensitivity, which should not be overlooked during medico-legal practices. Following the curriculum evaluation, we find room for improvement and propose recommendations. First, the forensic medicine curriculum should be standardized and uniform to address national needs. There should be uniformity and improvement in practical hands-on training. The manpower should be trained to work in rural settings with limited resources so that the overall justice system of the country can improve. Recent technological advances should be incorporated into the curriculum and interdisciplinary collaboration encouraged. Allocating more scholarship/sponsorship seats for postgraduate programmes and recruiting skilled graduates to be evenly distributed regionally would be important steps toward strengthening the country's medico-legal proceedings and justice system. [ABSTRACT FROM AUTHOR]

Background/Objectives: Artificial intelligence (AI) is gaining an increasing amount of influence in various fields, including medicine. In radiology, where diagnoses are based on collaboration between diagnostic devices and the professional experience of radiologists, AI intervention seems much easier than in other fields, but this is often not the case. Many times, the patients orient themselves according to the doctor, which is not applicable in the case of AI. Another limitation rests in the controversies regarding medico-legal liability. In the field of radio-imaging in Romania, the implementation of AI systems in diagnosis is at its beginning. An important aspect of this is raising awareness among the population about these assistive AI systems and, also, awareness of the technological evolution of AI among medical staff. This narrative review manuscript analyzes the existing literature data regarding the medico-legal aspects of AI application in radiology, highlighting the controversial aspects and the lack of statutory legislative regulations in Romania. Methods: A detailed search was conducted across three electronic databases including MEDLINE/PubMed, Scopus, and Web of Science, with 53 papers serving as the literature corpus of our review. Results: General requirements for artificial intelligence systems used in radiology have been established. In the radiological diagnostic process, there are five levels of AI system implication. Until now, completely autonomous AI systems have not been used. Regarding liability in the case of malpractice, at the currently accepted legislative level, most of the time, the radiologist is liable for their own fault or non-compliant use of diagnostic AI systems. Controversies arise in the case of radio-imaging diagnosis in which AI systems act autonomously. Conclusions: In order for AI diagnostic radio-imaging systems to be implemented, they must meet certain quality standards and be approved. The radiologist must know these systems, accept them, know their limits, and validate them in accordance with their degree of involvement in radiological diagnosis. Considering the evolution of technology in the Romanian medical system, including radiology, in the future, an alignment with the legal standards established/proposed at the European level is desired. [ABSTRACT FROM AUTHOR]

ABSTRACT: This report highlights a rare occurrence of inferior alveolar nerve (IAN) injury resulting from calcium hydroxide extrusion during endodontic treatment. The patient experienced severe pain and paresthesia in the lower right lip following root canal treatment due to the inadvertent overflow of calcium hydroxide into the IAN canal. No surgical intervention was performed, and the patient received non-steroidal anti-inflammatory analgesics and vitamin B complex injections to manage the symptoms. At 6 months, complete resorption of the root canal material occurred, resulting in further reduction in paresthesia. After a 2-year follow-up, the complete disappearance of paresthesia occurred. The importance of the preoperative radiographs is highlighted. The lack of radiographic assessment at the patient's request led to calcium hydroxide overflow. [ABSTRACT FROM AUTHOR]

Background: Medico-legal complaints against physicians are a significant source of anxiety and could be associated with defensive medical practices that may correlate with poor patient outcomes. Little is known about patient concerns brought to regulatory bodies and courts against dermatologists in Canada. Objective: To characterize factors contributing to medico-legal complaints brought against dermatologists in Canada. Methods: The Canadian Medical Protective Association (CMPA) repository was queried for all closed cases involving dermatologists over the past decade. Aggregate, anonymized data was reviewed and case outcomes, patient harm, and contributing factors were extracted. Results: Nearly one-fifth of all dermatologists who are CMPA members have been named in at least one medico-legal case between 2013 to 2022. A total of 396 civil-legal actions or College complaint cases involving dermatologists were closed at the CMPA during this timeframe. The most common patient allegations were deficient assessment (34%), diagnostic error (28%), and unprofessional manner (22%). Nearly half of patients experienced a harmful event, the majority of which were asymptomatic or mild. The most frequently identified contributing factors related to providers were poor clinical decision making (n = 73), lack of situational awareness (n = 67), and conduct and boundary issues (n = 59). Team factors included a breakdown of communication with patients (n = 124). Conclusions: Improved communication with patients for informed consent, treatment plans, clinical follow-up, and documentation of thorough clinical patient assessments can improve patient satisfaction and health outcomes, and mitigate dermatologists' medico-legal risk. [ABSTRACT FROM AUTHOR]

SUMMARY: Following the COVID-19 pandemic, assessments by video link became a standard and acceptable form of medico-legal evaluation. The various challenges to achieving an accurate and robust medico-legal assessment via a remote platform are explored in this clinical reflection. It is concluded that any limitations to a remotely undertaken assessment must be highlighted to the court and an in-person assessment considered as a reasonable alternative in some cases. [ABSTRACT FROM AUTHOR]

SUMMARY: To make a valid will, a person should be able to understand the nature and consequences of doing so, the extent of their estate and the claims others may have on it. No disorder of mind should be present that would affect their testamentary decisions, and clinicians are therefore often asked to give an opinion on whether a person has testamentary capacity. This article discusses the legal issues involved, with reference to UK case law (in particular, the legal test of Banks v Goodfellow (1870)), and outlines the requirements of testamentary capacity assessment (including retrospective assessments), the clinician's responsibilities when requested by a solicitor to make an assessment of capacity ('the golden rule') and what they might expect if appearing in court to give expert witness regarding testamentary capacity. Fictitious case studies are presented illustrating certain points in testamentary capacity assessment. [ABSTRACT FROM AUTHOR]

SUMMARY: The past 5 years have seen numerous court judgments and changes to rules and procedures that relate to the work of expert psychiatric witnesses in the British Isles. This article outlines these changes, pointing out their implications for the expert witness, and highlights pertinent judgments in over 100 court and tribunal cases. [ABSTRACT FROM AUTHOR]

Background: The ruling n. 38485, 20 June 2019, of the Italian Supreme Court, III criminal section, addressed by the perspective of the law the very sensitive and new issue of telemedicine. Objective: This commentary deals with the issue of authorization of telemedicine activities by the health authority, starting from the Italian Court of Criminal Cassation, III section, decision n. 38485/2019. The case law explored the authorization of a health point, which carries out telemedicine services. Methods: Starting from the perspective discussed by Italian health regulations, the paper examines how the health act could be defined, with the possibilities offered by telecommunications, and how it now relates legally to the physical place where it takes place. Results: Even if telemedicine opens the way to virtual spaces of health practice, the Ministry of Health Italian Guidelines pose functional and logistical issues to guarantee users' safety and health care system accountability. Then, functional requirements for health legitimate practice, and their continuous monitoring, together with the responsibilities of the service centers, health professionals and health facilities, are discussed. Conclusion: The questioning of States' health law, in a broad health system such as that of the Europe, characterized by autonomous health regulations, is extremely important for cross-border health policy with telemedicine, as overall regulatory compliance in health care is the ground criterion for risk prevention and patient safety, to be properly verified. [ABSTRACT FROM AUTHOR]

Background: Medico-legal cases in a particular health set up is an important and unavoidable bulk. It requires proper dealing in both examination and documentation. Classification and tabulation of these cases under certain categories is crucial for evaluating the current pattern. This categorisation benefits the law-and-order authorities to enact norms and policies accordingly. Methods: This is a retrospective study conducted at Rohilkhand Medical College and Hospital, Bareilly by the department of Forensic Medicine & Toxicology in collaboration with the Medical Record Section. Medico-Legal Cases examined by doctors attending in the casualty of the hospital were taken. Medico-legal case file and electronic medical record data saved in the (MRD) medical records department were looked for cases segregated as Medico-Legal Cases with Medico-Legal Reports for a duration of one year from 01-July-2023 to 30-June-2024.Both percentage and numbers of the evaluated data are mentioned. Results: Total 456 cases were reported during 01-July-2023 to 30-June-2024. Among the 456 cases reported, 32.00% were among the age group of 21-30 years. Most of the medicolegal cases registered were of males (73.50 %). The number of cases from rural areas were more (73.00%). Road Traffic accidents (RTA) accounted for 64.70% of the cases followed by poisoning/drug reaction cases (13.20%). Among the RTA cases, the age group of 21-30 years were the most vulnerable. Conclusion: Evaluation of the Medico-legal Cases needs focused observation and meticulous recording with proper documentation. Heath care staffs including doctors should undergo proper training so that the faults and mistakes can be minimised, thus aiding the legal authorities to manage this bulk efficiently. [ABSTRACT FROM AUTHOR]

Background. Dupuytren's disease (DD) is a chronic and progressive fibroproliferative disease consisting of the progressive pathological fibrosis of the palmar fascia leading to permanent flexion and deficit of extension, with marked deformity and severe disability. Among treatment options, conservative and infiltrative therapies, physiotherapy, or surgery, with less invasive surgical options, are reported. The therapeutic planning, shared with the patient, must consider the severity of the disease, surgical risks, the functional, aesthetic, and occupational consequences, and the risk of recurrence. Case report. We describe a complicated clinical case that led her to a claim for compensation under presumed medical professional liability profiles. A female patient, 32-years-old, suffering from early symptomatic DD in the left non-dominant hand, underwent to palmar fasciotomy complicated by severe paraesthesia. In the re-surgery, vascular and nerve injury was found, leading to permanent disabling sequelae. Discussion. The early stage of DD, although symptomatic, without previous medical or infiltrative therapy, in a young subject with insulindependent diabetes and a high risk of recurrence contraindicated the surgical approach, especially palmar fasciotomy, according to the best evidence. The vascular-nervous lesion in the hand palm indicated a censurable surgical execution technique. The technical consultation ascertained the causal relationship between impairments and surgical malpractice, followed by compensation. Conclusion. The analysis of this case highlights the value of informed clinical practice to provide optimal care and mitigate the risks associated with the management of DD. The choice of possible treatment options must be tailored to the patient in accordance with the best evidence. Clin Ter 2024; 175 (5):333-336 doi: 10.7417/ CT.2024.5138 [ABSTRACT FROM AUTHOR]

Abstract Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution.

Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution. [ABSTRACT FROM AUTHOR]

While there has been notable research activity in the field of clinical neuropathology over the recent years, forensic approaches have been less frequent. This scoping literature review explored original research on forensic neuropathology over the past decade (January 1, 2010, until February 12, 2022) using the MEDLINE database. The aims were to (1) analyze the volume of research on the topic, (2) describe meta-level attributes and sample characteristics, and (3) summarize key research themes and methods. Of 5053 initial hits, 2864 fell within the target timeframe, and 122 were included in the review. Only 3–17 articles were published per year globally. Most articles originated from the Europe (39.3%) and Asia (36.1%) and were published in forensic journals (57.4%). A median sample included 57 subjects aged between 16 and 80 years. The most common research theme was traumatic intracranial injury (24.6%), followed by anatomy (12.3%) and substance abuse (11.5%). Key methods included immunotechniques (31.1%) and macroscopic observation (21.3%). Although a number of novel findings were reported, most were of preliminary nature and will require further validation. In order to reach breakthroughs and validate novel tools for routine use, more research input is urged from researchers across the world. It would be necessary to ensure appropriate sample sizes and make use of control groups. [ABSTRACT FROM AUTHOR]

This paper deals with changes in code status policy in Ontario and endorses a new College of Physicians and Surgeons of Ontario (CPSO) policy. We argue that the recent policy changes in this area necessitate an active educational strategy around end-of-life care to prevent harm to dying patients. [ABSTRACT FROM AUTHOR]

Background: Parents are anxious and apprehensive about the health of their children. A standardised, reproducible and meticulous parental counselling is helpful to both the parents and the treating doctors, as well as markedly reduces instances of scrimmage and medico-legal litigations. The aim of this study is to assess the psychosocial and medico-legal outcomes of parental counselling-in-continuum (PCiC) in paediatric surgery. Materials and Methods: The study was conducted at two government-run Tertiary Healthcare Centres in North India. The study design involves prospective feedback-based study. It included all the admitted paediatric surgery patients. Periodic multisession PCiC was done for each patient by three paediatric surgery teams from 2011 to 2021. At the time of discharge, feedback was taken to assess the psychosocial outcome of PCiC, and the medico-legal outcome was calculated based on the number of litigations. Results: A total of 22,353 admissions were done in paediatric wards at these institutes. 1574 cases were managed conservatively and 20,779 patients who underwent surgeries were included in the study. 4758 (22.89%) were emergency procedures and 16,021 (77.11%) were elective procedures. Parents rated the counselling efforts excellent in 18,285 (81.80%), good in 3162 (14.14%), satisfactory in 876 (3.91%) and poor in 30 (0.13%) cases with zero medico-legal litigations and 12 incidents of scrimmage. Conclusions: PCiC, being a novel concept, should form a centerpiece of paediatric surgical management as it maximally enhances the patient satisfaction level and protects the treating paediatric surgical team from scrimmage and medico-legal litigations. [ABSTRACT FROM AUTHOR]

Monitoring long‐term alcohol use and/or abstinence is essential in clinical and medico‐legal cases. Analysis of ethyl glucuronide (EtG) in hair provides information on alcohol consumption over several months. However, there is a lag time between ethanol consumption, incorporation of EtG in the hair bulb and hair growing out of the scalp. Phosphatidylethanol (PEth) 16:0/18:1 analysis in whole blood has a detection window of 2–4 weeks, allowing for the detection of recent alcohol consumption. In this study, 2340 paired samples (of hair and venous whole blood from 1170 individuals) were analysed for EtG in hair (hEtG) and PEth 16:0/18:1 in venous whole blood. PEth 16:0/18:1 and hEtG results were subdivided into three categories according to the consensus of SoHT (hEtG) and PEth‐NET (PEth): abstinence/low, moderate or excessive alcohol consumption. For hEtG analysis, 446 individuals presented abstinence/low alcohol consumption, of which 2% were classified as excessive alcohol users through PEth 16:0/18:1 analysis. This suggests excessive alcohol consumption in the weeks before sample collection. Out of 483 individuals classified as heavy alcohol users based on hEtG analysis, 14% showed abstinence/low alcohol consumption for PEth 16:0/18:1 analysis, implying that these subjects stopped drinking 2–4 weeks before sample collection. Our results show that the analysis of the two different biomarkers can lead to a more accurate categorisation of individuals. Therefore, we emphasize that for the retrospective investigation of alcohol use, it is necessary to include two alcohol use biomarkers with different detection windows. [ABSTRACT FROM AUTHOR]

Objectives: The development of desmoid tumors (DT) is associated with trauma, which is an aspect with medicolegal relevance. The objective of this study was to analyze the proportion and type of trauma (surgical, blunt/fracture, implants), its lag time, and mutations of the CTNNB1 gene in patients with sporadic DT. Methods: We analyzed a prospectively kept database of 381 females and 171 males, median age at disease onset 37.7 years (females) and 39.3 years (males) with a histologically confirmed DT. Patients with germline mutation of the APC gene were excluded. Details of the history particularly of traumatic injuries to the site of DT were provided by 501 patients. Results: In 164 patients (32.7%), a trauma anteceding DT could be verified with a median lag time of 22.9 months (SD, 7.7 months; range, 9‐44 months). A prior surgical procedure was relevant in 98 patients, a blunt trauma in 35 patients, a punctuated trauma (injections, trocar) in 18 patients, and site of an implant in 10 patients. In 220 patients, no trauma was reported (43.9%), and 58 females (11.6%) had a postpregnancy DT in the rectus abdominis muscle. In 42 patients (8.4%), data were inconclusive. The distribution of mutations in the CTNNB1 gene (codon 41 vs. 45) was similar in patients with and without a history of trauma before DT development. Conclusions: A significant subgroup of patients suffers from a trauma‐associated DT, predominantly at a prior surgical site including implants to breast or groin, accounting for 77.9% of the cases, whereas blunt trauma was responsible in 22.1%. We found no data to support that trauma‐associated DT have different molecular features in the CTNNB1 gene. A significant proportion of patients develop a desmoid tumor (DT) after surgical or blunt trauma with an interval to the incident of almost 2 years. DT at a prior surgical site including implants in breast or groin region is the predominant location. Trauma‐associated DT does not show different molecular features in the CTNNB1 gene compared with nontraumatic DTs. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries are consistently difficult to objectively measure. This creates significant challenges for medical and legal practitioners who each apply the Glasgow Coma Scale-based traumatic brain injury severity classifications of "mild", "moderate" and "severe". It can be difficult to medically define an often-subjective traumatic brain injury, where the law requires objective evidence of injuries. This descriptive review aims to elucidate the intended purpose of the Glasgow Coma Scale in traumatic brain injury assessment by doctors and attorneys. We highlight two different Glasgow Coma Scale uses, demonstrating a disconnect between the clinical traumatic brain injury adjectival classifications used in medicine and law. The Glasgow Coma Scale-based adjectival traumatic brain injury classifications create a diagnostic label which can affect a patient long after their initial medical assessment, representing a de facto diagnosis to the legal profession which may affect a patient's potential legal financial recovery. [ABSTRACT FROM AUTHOR]

Little is known about the prevalence of incapacitating substances present in drug facilitated sexual assaults (DFSA). Presented here is a literature review conducted to provide background information, such as symptoms, exacerbations, and drug interactions, on drugs typically implicated in DFSA, namely gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), 1,4-butanediol (1,4-BD), ketamine, diazepam, oxycodone, methamphetamine, and alcohol.Literature found through Scopus and Pubmed was reviewed to determine the current prevalence of these substances in DFSA with a focus on Australian data.The global literature revealed that there is a wide variety of substances used in DFSA and the prevalence varied by country. For example, it was found that in Northern Ireland, opioids were most prevalent whereas in France, benzodiazepines were most prevalent. In Australia the review revealed a lack of contemporary data with the most recent report in Victoria using data collected during 2011–2013. The literature also revealed there can be an important difference between self-reported substance use and substances discovered via toxicological analysis. This can be due to the challenges of biological detection, reliability of self-reporting, and the possibility of a substance being introduced to a person's food or drink without their knowledge.This review highlights the need for the collection and analysis of current data pertaining to DFSA reports and the drugs detected, and due to the constantly evolving picture of both licit and illicit drug use an assessment of the role of prescription medications in DFSA due to drug-drug interactions as well as potential to incapacitate is warranted.

Drink spiking in social settings is one of the most pervasive forms of drug-facilitated sexual assault (DFSA). There are no current data in Australia on the rates of drink spiking or their associated assaults. There is also little known about the prevalence of different substances involved and how the current substance use trends compare to sexual assault trends. To explore this, a recalculation of sexual assault trends to estimate substance related sexual assault was performed. Data about recent trends of mental health prescriptions and sexual assault were obtained from the Australian Institute of Health and Welfare (AIHW). The analysis of these datasets highlighted that females are the highest consumers of antidepressants and benzodiazepines. Results also indicated a statistically significant positive correlation between females and a higher incidence of sexual assault (r = 0.996, p

Estimating the age-at-death of unidentified human skeletal remains is essential in medico-legal cases. Currently, the pubic symphyseal face and iliac auricular surface provide noteworthy indicators of adult ageing. However, as the pelvis may not always be available in some medico-legal cases, a need exists for substitute methods derived from other skeletal components. This study was conducted to derive a new method of estimating age-at-death using patellar morphology. The study sampled 104 paired patellae of known age-at-death and sex. Each patella was scored based on the severity of bone lipping at the base and the development of auricular marginal osteophytes. A composite scoring system was used to integrate the two scores and produce a representative score for each patella (0, 1, 2, 3). The relationship between patellar morphological changes and age-at-death was evaluated using a Spearman ranked correlation test (rho). Additionally, one-way ANOVA was used to assess age-at-death differences between composite scores. In both sex groups, age-at-death displayed a very strong, positive monotonic relationship with bone lipping (rho = 0.777 in males, rho = 0.752 in females) and auricular marginal osteophytes (rho = 0.622 in males, rho = 0.859 in females). In addition, patellar composite scores showed a stronger age-at-death correlation (rho = 0.888 in females, rho = 0.873 in males, p

Background: The perceptions of parents/legal guardians may drive their decisions on providing informed consent for minors. Currently, no study from Saudi Arabia has assessed the perceptions of parents/legal guardians toward informed consent for pediatric surgical procedures. Objective: To determine parents' perception and understanding of pediatric informed consent for surgeries from Saudi Arabia and determining their level of participation in the decision-making process of the treatment modality. Methods: This observational cross-sectional study was conducted among parents from the Jazan region of Saudi Arabia with at least one child aged ≤ 12 years. Three aspects of surgical informed consent were evaluated: parents' awareness, attitude, and understanding of informed consent and its legal issues; the knowledge they sought during informed consent discussions; and parents' opinions about their respective roles in the decision-making process for the treatment. Results: A total of 366 responses were included in this study. More than 95% of the participants agreed that informed consent was necessary; however, 94.7% felt that regardless of their beliefs, they had to sign the form. Surprisingly, the majority (61%) believed that any relative can sign the consent form on behalf of the parents/legal guardian. Most respondents believe that pre-operative procedures (80.8%), the cost (93.9%), and the reason for the procedure and its alternatives (87.2%) should be discussed when informed consent is being sought. About 76.5% of the participants wanted to know all the information regarding the procedure; of these, 48.3% responded that they would play a role in deciding the eventual treatment modality. Conclusion: The findings of this study indicate the need to increase knowledge regarding surgical informed consent among parents in the Jazan region of Saudi Arabia. [ABSTRACT FROM AUTHOR]

The medical expertise activity is a necessary element and in close connection with the legal world, through legal medicine the possibility is realized through the application of justice in all situations in which it is applied, succeeding in accurately identifying a different aggressions applied to the victim. The examination must include the circumstances in which the act took place, the study of the person's body as well as the clothes worn at the time of the act, also the reasons and objectives of the examination, such as the examination of traumas, sexual assaults. A medico-legal specialist can also deduce classify the traumatic agent used, such as a blunt object, sharp bladed object, sharp point. The expert has the ability to determine the mechanism of injury based on the agent traumatic used. In the case in which the Forensic expert performs survey on victim's sexual assault, the forensic doctor must act as urgently as possible to take the biological samples, among the obligations a doctor has to establish the sexual maturity of the person, and to check the presence of different traumas that can be observed on the genital organ. Examination applied to the male individual being the establishment of the sexual capacity for fecundation, the inability to copulation it may be formula on the base of different factors, such as: the mental state due to fears or nervousness or due to various causes. [ABSTRACT FROM AUTHOR]

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Termination of pregnancies by itself is an extremely sensitive issue and is even characterized as an offence within Sections 312-316 of the Indian Penal Code. However, legally sanctioned exceptions have been created in the Medical Termination of Pregnancy Act, 1971 (hereinafter referred to as the "MTP Act"). Whenever congenital malformations are detected in a foetus, the relaxation of the upper statutory limit set by the MTP Act becomes the subject of intense debate. When the permissible statutory period elapses, writ petitions to judicial forums may become the last refuge of couples who wish to terminate pregnancy. Many experts question the legal legitimacy of such a relaxation since the time limit set by the statute is unambiguously precise with no scope for exceptions save for a few statutory conditions. However, the authors argue that there are certain eventualities in cases like these, which can form a class by itself and which the MTP Act doesn't take into account. The authors shall proffer new medico-legal arguments using broader constitutional values and suggest changes in the MTP Act to keep it in consonance with newer conceptions of 'mental health' and 'reproductive autonomy'. It is stated at the outset that the purpose of this article is to further enrich the medical jurisprudence on pre-natal technologies by using principles of laws discussed in Courtroom decisions. The paper shall provide a critique of the legal insights and Court precedents which have shaped discussions on the legal challenges faced in pregnancy cases where the presence of foetal anomalies forces the parents to make difficult choices regarding the continuation of their pregnancies. It is maintained that the domain of this paper shall be limited to legal principles and decisions pertaining to the Indian jurisdiction. The technical and biological variables behind the causation of genetic disorders shall be beyond the scope of this paper. [ABSTRACT FROM AUTHOR]

Abstract Introduction Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. Materials and methods We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. Results Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. Conclusion The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Background: The perceptions of parents/legal guardians may drive their decisions on providing informed consent for minors. Currently, no study from Saudi Arabia has assessed the perceptions of parents/legal guardians toward informed consent for pediatric surgical procedures. Objective: To determine parents' perception and understanding of pediatric informed consent for surgeries from Saudi Arabia and determining their level of participation in the decision-making process of the treatment modality. Methods: This observational cross-sectional study was conducted among parents from the Jazan region of Saudi Arabia with at least one child aged ≤ 12 years. Three aspects of surgical informed consent were evaluated: parents' awareness, attitude, and understanding of informed consent and its legal issues; the knowledge they sought during informed consent discussions; and parents' opinions about their respective roles in the decision-making process for the treatment. Results: A total of 366 responses were included in this study. More than 95% of the participants agreed that informed consent was necessary; however, 94.7% felt that regardless of their beliefs, they had to sign the form. Surprisingly, the majority (61%) believed that any relative can sign the consent form on behalf of the parents/legal guardian. Most respondents believe that pre-operative procedures (80.8%), the cost (93.9%), and the reason for the procedure and its alternatives (87.2%) should be discussed when informed consent is being sought. About 76.5% of the participants wanted to know all the information regarding the procedure; of these, 48.3% responded that they would play a role in deciding the eventual treatment modality. Conclusion: The findings of this study indicate the need to increase knowledge regarding surgical informed consent among parents in the Jazan region of Saudi Arabia.

Pain relief in hip fracture patients may be sought by injecting local anesthetic such as ropivacaine, bupivacaine, and lidocaine to the femoral area. As femoral veins are a routine sampling site for postmortem blood, this short report aimed to describe the levels of local anesthetics in ipsilateral (i.e., side of surgery) and contralateral (i.e., opposite side) femoral blood in ten medico-legal autopsy cases that had undergone a hip fracture surgery within 7 days before death. Postmortem blood samples were systematically collected from the ipsilateral and contralateral femoral veins, and toxicological analysis was performed in an accredited laboratory. The sample comprised six female and four male decedents who died at the age of 71–96 years. Median postoperative survival was 0 days and median postmortem interval 11 days. Strikingly, ropivacaine concentration was a median of 24.0 (range 1.4–28.4) times higher on the ipsilateral than contralateral side. The median ipsilateral concentration of ropivacaine clearly exceeded the 97.5th reference percentile measured in this laboratory for ropivacaine in postmortem cases representing all causes of death. The remaining drugs did not show high concentrations or notable differences between the sides. Our data clearly advise against performing postmortem toxicology on femoral blood from the operated side; the contralateral side may constitute a better sampling site. Toxicology reports that are based on blood collected from the operated area should be interpreted with caution. Larger studies are needed to confirm the findings, with accurate records of the dosage and administration route of local anesthetics. [ABSTRACT FROM AUTHOR]

Background: Face is an entity that helps to distinguish one person from another. It also signifies distinction between races, ethnic groups, Sexes and even members of same family. Hence it has anthropological, anatomical and medico legal importance. Method: 60 adult males and 60 adults females aged between 18 to 35 were studied with spreading calliper, Facial Index was measured from Nasion to Gnathion, Zygion to zygion Results: The male facial Index was 90.5 (± 0.5) and female was 87.2 (± 0.3) (p<0.001) p value was highly significant. The present Facial Index was classified anthropologically under Lepto proscopic facial Index. Conclusion: Present Facial Index of Maharashtra Population is useful to anthropologist, anatomist and medico legal export to differentiate Maharashtra population from other racial or ethnic groups of India and abroad because morpho-metric values of mesodermalderivatives are un-certain. [ABSTRACT FROM AUTHOR]

Background: Age determination of individual is important in number of opportunities like education, sports, and medico-legal factors. Ossification centres of bones play vital role in age determination. It is accepted in court of law. Method: 45 Boys and 45 Girls (total 90) children aged between 11 to 18 years were studied radiologically and classified their numbers as per age and sex, Appearance and fusion of bones of elbow joints. Results: Equal number of boys and girls were selected from 11 years to 18 years of age. Appearance of trochlea at 11 years appeared only in girls. Fusion of trochlea was 14 to 15 years in boys, 12 to 14 years in girls. Appearance of lateral epicondyle was 11 to 12 year in boys and 11 year in girls. Fusion of lateral epicondyle was 13 to 16 years in boys and 13 to 14 years in Girls. Fusion of medial epicondyle 14 to 16 years in boys, 11 to 15 years in girls. Fusion of head of radius 11 to 16 years in boys and 11 to 13 in girls. Appearance of olecranon process- 11 to 13 years in boys and 11 years in girls. Fusionof olecranon process 17 to 18 years in boys and 15 to 16 years in girls. Conclusion: This pragmatic radiological study of elbow joint between 11 to 18 years has regional, environmental, anatomical, anthropological and medico-legal importance because morphometric values of mesodermal origin are uncertain. [ABSTRACT FROM AUTHOR]

Introduction: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure for obtaining informed consent for total hip arthroplasty (THA). We aimed to develop a solution for this need for a pre-designed, evidence-based informed consent form for THA cases. Materials and Methods: We extensively reviewed the literature on the medico-legal aspects of THA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in THA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had previously undergone THA in the previous year. Based on all of the above, we developed an informed consent form that was evidence-based. We then had the form reviewed by a legal expert. The final form was utilised for THA cases at our institution for 1 year. Results: Legally sound, evidence-based Informed Consent Form for Total Hip Arthroplasty is given in Form A. Conclusion: The use of legally sound, evidence-based informed consent for total hip arthroplasty cases would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, and promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary. [ABSTRACT FROM AUTHOR]

In the article the questions of providing of efficiency of realization of rights and defence of legal interests of suffering and civil plaintiffs are examined during pre-trial investigation of criminal offences in relation to falsification of medicinal facilities and improper implementation of professional duties by medical workers, in particular, due to more wide bringing in of experts for realization of judicial-pharmaceutical, judicial-pharmacological, medico-legal, commodity judicial-expert examinations and others like that during pre-trial criminal realization. With the aim of implementation of process of adaptation of criminal judicial legislation of Ukraine Ukraine to the standards of European Union and practice of the European court on human rights expediency of exception of department belonging of expert services is grounded by creation of only National expert service of Ukraine that will eliminate the risks of prejudice of experts of department establishments. From data of Worldwide organization of health protection, the annual market of the falsifyed medical preparations makes 75 milliards of dollars of the USA, every tenth packing of medications is off-grade or counterfeited in countries with the low and middle level of profits to that it is fixed and Ukraine. Some experts name a number in 30аголошується on the necessity of implementation of Convention MEDICRIME in relation to providing of realization of rights suffering by a grant and promulgation of information about harmful medicinal preparations, including, publication on the official web-site of Department, that carries out control after quality of medications, all present data about the educed imitations, and also opening of information that gets other states to the corresponding department about the names of products of pirate goods of the medical setting. Realization and to drawing on the results of judicial-pharmaceutical, pharmacological, medico-legal, commodity judicial-expert examinations promotes efficiency of providing of realization of rights and defence of legal interests of suffering and civil plaintiffs during pre-trial investigation of falsification of medicinal facilities and improper implementation of professional duties medical by workers. [ABSTRACT FROM AUTHOR]

Introduction: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. Materials and methods: We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. Results: Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. Conclusion: The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary. [ABSTRACT FROM AUTHOR]

Record-keeping during the perioperative period by anaesthetists is a fundamental part of modern anaesthetic practice. This article explores the numerous functions of the anaesthetic record, and highlights the practice guidelines governing their suggested content. The advantages and disadvantages of an electronic record keeping system are also explored. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from 16 March 2020 to 14 March 2021 at the ophthalmological departments of University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG) was conducted. The data collected between 16 March 2020 and 14 June 2020 (lockdown), 15 June 2020 and 13 September 2020 (unlock), and 14 September 2020 and 14 March 2021 (second wave) were compared with those of the same period of the previous year. Weekly data on the administered drug and the number and type of treated disease were collected and analyzed. During the lockdown, a drop of 59% at SGD (p < 0.00001) and 77% at UMG (p < 0.00001) in intravitreal injections was found. In the first year of the pandemic, the reduction in injections was approximately of 27% (p < 0.0008) and 38% (p < 0.0001) at SGD and UMG, respectively. The COVID-19-related containment measures and the health resources redistribution have led to a delay in the treatment of chronic diseases of the retina, prioritizing the undeferrable ones. The lack of management guidelines has conceived relevant ethical and medico-legal issues that need to be considered in future measures planning. [ABSTRACT FROM AUTHOR]

The sudden, unexpected death of a child (SUDC) is a devastating experience. It is vital that supportive and investigative services are effective and promote the best outcomes for families. Analysis of 5 years of data from 309 SUDC cases in Greater Manchester, United Kingdom (UK) shows how a number of key service outcomes can be measured and achieved through a raft of actions which are commensurate with and exceed the service level recommended by the UK Government. Annual reports covering the work of the Greater Manchester SUDC team are compiled from audit forms completed by the attending SUDC pediatrician for each case. Data from these reports from April 1, 2015 to March 31, 2020 were analyzed. Most cases happened out of normal working hours, predominantly on Sundays. This supports the need for a 24-hour, 7 days per week SUDC service to enable early investigation and timely support for families. The review demonstrated that the Greater Manchester model is able to deliver this in a rapid response with early attendance in emergency departments and early home visits; effective joint agency working with police, children's social services, and other agencies; and provision of support to families. The proposed instigation of a key worker role in the SUDC team is a welcome development. This is central to ameliorating the experience for parents by providing bereavement support separate from the investigative role of the SUDC team. Research is needed into the role of the key worker, potentially as a dedicated bereavement nurse, and understanding of families' experiences to ensure that support is optimal. [ABSTRACT FROM AUTHOR]

We aim to characterize the legal landscape of incarcerated patients' pain management malpractice claims and to discuss the ethical and policy implications that result. The most common rationales for lawsuits were failure to completely treat (38 [46.3%]), failure to offer (34 [41.4%]), and delay of treatment (6 [7.3%]). In cases won by defendants, the most common rationale for verdicts was no deliberate indifference occurred (74 [86.6%]). We found that incarcerated individuals were often unsuccessful in litigating claims for inadequate pain management despite several cases pointing toward treatment strategies far below what would be ethically accepted as standard of care in the community setting. [ABSTRACT FROM AUTHOR]

Abstract Background Every year, millions of children face sexual exploitation worldwide. In India, 109 children (National Crime Records Bureau2018) were sexually abused everyday (22% jump from the previous year). Even with advanced DNA techniques, the conviction rate remains low. The methods used for forensic DNA evidence analysis vary around the world, but the primary step of biological evidence collection plays the most vital role. Proper and timely evidence collection from the victim by a trained medical professional is important. Main body Dynamics of child sexual assault being massively different from an adult rape demands altogether different approach of evidence collection. A standard sexual kit employed for evidence collection needs urgent modifications considering genital development of pre- and post-pubertal victims. In the present study, parameters including systemic collection and evaluation of forensic evidences, medico-legal examination, and developmental consequences of sexual assault on pre-pubertal victims were assessed. Further suggestions for separate evidence collection kit during medico-legal examination were given for pre-pubertal victims and alleged accused in sexual assault cases in order to streamline and for better evaluation of DNA analysis in forensic laboratories. Conclusion The importance of expert medical practitioners plays a significant role in collection of appropriate information and evidences from the victim of sexual assault. General guidelines for evidence collection in sexual assault cases are not well suited for pre-pubertal victims. Appropriate reforms pertaining to the age and genital development of victims are required. Securing clothing as forensic evidence is essential in most cases as it turned out to be the exclusive evidence bearing material. The purpose of this article is to bring awareness about the thorough medical examination and modified sexual assault kit for pre-pubertal victims and alleged accused for a better approach in evidence collection and conviction rate.

Forensic Mental Health in Bangladesh is an unattended domain of mental health services. With about 17% of the population suffering from mental disorders per year and more than 80 thousand prisoners in the country, there have not been any studies to look into forensic mental health situations. This research has given an overview of the health and legal systems through qualitative research focusing on a desk review and key informant interviews. Findings show that though there are guidelines in the law and regulatory codes in the judicial systems, implementing those guidelines is not seen in many cases. There are several areas in the health system in terms of capacity, service and resources which needs to be addressed by the government for supporting the healthcare providers, lawyers, judges and mentally ill or disabled people. Our study also portrayed the current referral mechanisms connecting both legal and health systems while addressing different cases of forensic mental health. Finally, discussing the implications of the findings, we presented recommendations from our study and other literature.

Medico legal autopsy is one of the significant areas in criminal justice. This article highlights the practices of Medico legal autopsy and presents the challenges in province of Sind, Pakistan. The potential audience of this paper are the medico-legal practitioners. Qualitative methods were used to conduct this study. The study used both primary and secondary data for this research. However, a significant part of the study is based on secondary sources. The results suggest that the forensic labs in Sindh province lack equipment and funds to sufficiently analyze medico-legal autopsies. The study recommends more funding and equipment along with improvement in human resources. [ABSTRACT FROM AUTHOR]

Objectives: To present the number and outcomes of urological referrals to the General Medical Council (GMC) and provide a breakdown of the doctors' demographics. Methods: Data were requested and collected from the GMC under the Freedom of Information Act 2000 for all complaints about urologists between 2007 and 2021 (14‐year period). Results: Between 2007 and 2021 a total of 635 urologists were referred to the GMC, totalling 734 referrals (1.15 referrals/doctor). Of these, 50% (364) were closed following a provisional enquiry (PE; 1 month) and another 43% were investigated but no action was taken. Action was taken for only 7% of urologists (49); these urologists were given advice, required to do extra training, suspended from practice, or erased from the medical register. Compared to the current urology workforce, a marginally higher proportion of those referred were international medical graduates or from diverse backgrounds. Conclusion: For urologists unfairly referred to the GMC it is reassuring to know that half of cases are closed at a PE. Of those investigated, only 7% of urologists were given sactions, suspension or given extra training. Reassuringly, our data demonstrate a robust process of GMC investigation, with most doctors going back into work following suitable complaints and, over the last 14 years, only nine urologists received sanctions, two of whom were erased from the medical register. There were only marginal differences when comparing our data to the current urologist population with regard to race and location of primary medical qualification. Conversely, the male‐to‐female split was more heavily weighted towards males being referred to the GMC. [ABSTRACT FROM AUTHOR]

Fitness to stand trial (equivalent to competency to stand trial) requires that defendants have a basic understanding of the purpose of the trial and the trial procedures. Little is known, however, about what constitutes a basic factual understanding of the matters. This study developed a legal knowledge survey in which participants were asked to define legal concepts and respond to legal scenarios. They then rated the importance of each component of the fitness to stand trial test to achieving a fair trial. Participants (N = 393; females 69.7%) aged between 18 and 66-years (M = 31.26-years, SD = 11.48-years) from each Australian state and territory completed the online survey. Legal knowledge was high (86.5% correct) and there was no difference between participants on any clinical (e.g., current or past mental illness, neurological conditions), criminological (e.g., criminal history), or demographic variable (e.g., gender, employment, education), except age (curvilinear R2 =.12). Participants under 30-years old used significantly more Americanisms on difficult items compared with participants over 30-years old. On average, participants rated almost every component of the legal test as "extremely important" to a fair trial. The legal knowledge survey had good psychometric properties (Cronbach's α =.86, interrater reliability ĸ >.80 on most variables, single solution factor analysis). Overall, the results support the presumption underpinning the Australian test for fitness, which is that people possess a basic factual understanding of a trial and trial procedures. Further research should focus on testing knowledge in special populations (e.g., mental illness, dementia, intellectual disability). [ABSTRACT FROM AUTHOR]