Medicolegal Aspects Research Articles

The Medico-Legal and Social Aspects of the Eligibility Examination for Enrolment in the Seafarers Registry: A Single-Center Retrospective Study

Background: Working on board presents unique healthcare challenges for maritime personnel. Italian Law mandates a medical fitness assessment for seafarers registry enrolment. The Port Health Officer assesses seaworthiness and, against this judgment, the applicants can appeal to the First-degree Medical Commission. Studies on maritime personnel’s medical fitness are limited and primarily focus on the health conditions of individuals already employed in the maritime sector. Methods: A retrospective study reviewed 459 medical reports of 361 seafarers from Naples’ Port Authority First-degree Medical Commission (2013–2022). Characteristics such as sex, age, diseases, and suitability judgments were analyzed. Results: Out of the 361 candidates, most were male with an average age of 28.67 years. A total of 160 (44.32%) were deemed suitable for matriculation in both the first and second categories, 79 (21.88%) were approved for one category, 53 (14.68%) were found not suitable, and 69 (19.11%) are still under assessment. Eye diseases were most common (50.83%), followed by cardiovascular and orthopedic conditions. Applicants with poorly controlled diabetes mellitus, epilepsy, psychiatric disorders, and advanced tumors were declared unsuitable. Conclusion: Our study provides opportunities to improve applicants’ awareness of the physical requirements for pursuing a career in navigation and to update the list of illnesses and physical impairments used for this medico-legal evaluation.

Frequency, Causes and Medico-Legal Aspects of Grievous Injury to the Eye after Physical Assault

Aims: A medicolegal report is prepared by the medicolegal officer in conjunction with an ophthalmologist in cases of physical assault claiming vision loss. The objective was to report the frequency and cause of grievous injury to the eye after a physical assault. Methods: This was a descriptive cross-sectional study, conducted in the Department of Ophthalmology of a tertiary care hospital in Pakistan from October 2019 to August 2022. A total of 378 medicolegal cases were reported in the ophthalmology outpatient. Among them, 285 patients of physical assault were included with consecutive sampling technique. Results: The mean age of the patients was 33.93±12.96 years. The mean reporting time to an ophthalmologist was 4.1±8.2 days. Simple and grievous injuries were found in 278 (97.5%) and 7 (2.4%) cases, respectively. Among the grievous injuries, 4 (57.2%) were close globe injuries and 3 (42.8%) were open globe injuries. Thirteen (4.5%) were malingers. Domestic violence was observed in 82 (28.8%) study subjects. Conclusion: The frequency of grievous injury to the eye is very low (2.4%) in patients with physical assault. The patients of assault-related grievous injury were mostly males, young age, low level of education, and doing manual jobs. Vitrolage with corneal melting, and firearm injury caused the grievous injury in open globe patterns. Vitreous hemorrhage, retinal detachment, macular hole, and secondary glaucoma were seen among close globe patterns. J Bangladesh Coll Phys Surg 2024; 42: 336-341

Performance of OpenAI’s GPT-4 in a mock MRCS Part A Examination

Introduction: OpenAI’s latest iteration of a Large Language Model (LLM); GPT-4 (Generative Pre-trained Transformer 4) has demonstrated its proficiency against various professional examination standards like the USMLE (United States Medical Licensing Examination), FRCS (Fellowship of the Royal Colleges of Surgeons) and the United States Bar. However, GPT-4’s capability with the MRCS (Membership of the Royal College of Surgeons) Part A has not yet been investigated. Methodology: A representative MRCS Part A examination that was prepared and provided by “TeachMeSurgery” based on the MRCS Intercollegiate Curriculum was used to assess GPT-4's performance. Each question was processed via the web-based interface of ChatGPT (Chat Generative Pre-trained Transformer) Plus. Results: GPT-4 scored 87.2% on Applied Basic Sciences (157/180) and 86.7% on Principles of Surgery in General (104/120 questions), achieving an overall score of 261/300 (87%), which is above the typical passing threshold. GPT-4 scored 100% in four out of the eleven predefined curriculum areas, which included: Pharmacology, Microbiology, Data Interpretation and Audit, and The Surgical Care of Children. GPT-4’s weakest performance was in the Medico-Legal Aspects of Surgical Practice, in which it scored 33.3%. Conclusion: GPT-4 successfully passed the mock MRCS Part A without any specialised preparatory training, however further research could look at integrating the GPT-4 model to enhance a trainee surgeon’s learning and use it as an effective tool to deliver high quality & efficient patient care.

Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013–2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders.

Neurobiology and medico-legal aspects of suicides among older adults: a narrative review.

The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.

Histopathological and medico-legal aspects in a case of death related to an undiagnosed cerebral large B-cell lymphoma.

We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.

Complications associated with needle-based medical aesthetic procedures: clinical and medico-legal aspects from the Polish perspective

Complications associated with needle-based medical aesthetic procedures: clinical and medico-legal aspects from the Polish perspective

Artificial intelligence in colorectal multidisciplinary team meetings. What are the medicolegal implications?

To give an insight into areas for future development and suggestions in the complexities of incorporation of AI into human colorectal cancer (CRC) care while bringing into focus the importance of clinicians' roles in patient care. Existing literature around AI use in CRC care is reviewed and potential regulatory issues and medicolegal implications around its implementation in CRC multidisciplinary team meetings (MDTs) are identified. Challenges with patient privacy and confidentiality, patient consent, inequity and bias, patient autonomy, as well as AI system transparency and the liability and accountability issues arising from complications that arise from AI-aided clinical decisions are important focusses associated with the use of AI in CRC MDTs. Consideration of various medicolegal aspects of the use of AI in CRC MDTs is warranted to ensure its safe and smooth incorporation into CRC MDTs. AI function as a clinical decision support system and does not replace professional expertise.

Robotic surgery: Consent and medico-legal aspect

Robotic surgery has rapidly evolving as a ground-breaking field in medicine, revolutionizing surgical practices across various specialties like oncology, urology, gynaecology, bariatric surgery.Despite its benefits, the adoption of surgery faces significant medicolegal challenges. This article develops into the underexplored legal implications of robotic surgery and identifies distinct medicolegal problems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medico legal aspects of robotic surgery effectively, thereby unlocking its full potential for the future development.

Medicolegal Aspects of Traumatic Head Injuries (THI) Admitted to Neurosurgery department at Sohag University Hospitals

Medicolegal Aspects of Traumatic Head Injuries (THI) Admitted to Neurosurgery department at Sohag University Hospitals

Medicolegal Aspects of Examination of Accused of Sexual Offences

Medicolegal Aspects of Examination of Accused of Sexual Offences

Primary care physicians’ perceptions of artificial intelligence systems in the care of adolescents’ mental health

BackgroundGiven that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs’ challenges in addressing adolescents’ mental health, along with their attitudes towards using AI to assist them in their tasks.MethodsWe used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis.ResultsWe reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients’ data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm.ConclusionThis study provides the groundwork for assessing PCPs’ perceptions of AI systems’ features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents’ perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.

Artificial intelligence in forensic medicine and related sciences – selected issues = Sztuczna inteligencja w medycynie sądowej i naukach pokrewnych – wybrane zagadnienia

Aim. The aim of the work is to provide an overview of the potential application of artificial intelligence in forensic medicine and related sciences, and to identify concerns related to providing medico-legal opinions and legal liability in cases in which possible harm in terms of diagnosis and/or treatment is likely to occur when using an advanced system of computer-based information processing and analysis. Materials and methods. The material for the study comprised scientific literature related to the issue of artificial intelligence in forensic medicine and related sciences. For this purpose, Google Scholar, PubMed and ScienceDirect databases were searched. To identify useful articles, such terms as „artificial intelligence,” „deep learning,” „machine learning,” „forensic medicine,” „legal medicine,” „forensic pathology” and „medicine” were used. In some cases, articles were identified based on the semantic proximity of the introduced terms. Conclusions. Dynamic development of the computing power and the ability of artificial intelligence to analyze vast data volumes made it possible to transfer artificial intelligence methods to forensic medicine and related sciences. Artificial intelligence has numerous applications in forensic medicine and related sciences and can be helpful in thanatology, forensic traumatology, post-mortem identification examinations, as well as post-mortem microscopic and toxicological diagnostics. Analyzing the legal and medico-legal aspects, artificial intelligence in medicine should be treated as an auxiliary tool, whereas the final diagnostic and therapeutic decisions and the extent to which they are implemented should be the responsibility of humans.

Artificial intelligence in forensic medicine and related sciences - selected issues.

The aim of the work is to provide an overview of the potential application of artificial intelligence in forensic medicine and related sciences, and to identify concerns related to providing medico-legal opinions and legal liability in cases in which possible harm in terms of diagnosis and/or treatment is likely to occur when using an advanced system of computer-based information processing and analysis. The material for the study comprised scientific literature related to the issue of artificial intelligence in forensic medicine and related sciences. For this purpose, Google Scholar, PubMed and ScienceDirect databases were searched. To identify useful articles, such terms as "artificial intelligence," "deep learning," "machine learning," "forensic medicine," "legal medicine," "forensic pathology" and "medicine" were used. In some cases, articles were identified based on the semantic proximity of the introduced terms. Dynamic development of the computing power and the ability of artificial intelligence to analyze vast data volumes made it possible to transfer artificial intelligence methods to forensic medicine and related sciences. Artificial intelligence has numerous applications in forensic medicine and related sciences and can be helpful in thanatology, forensic traumatology, post-mortem identification examinations, as well as post-mortem microscopic and toxicological diagnostics. Analyzing the legal and medico-legal aspects, artificial intelligence in medicine should be treated as an auxiliary tool, whereas the final diagnostic and therapeutic decisions and the extent to which they are implemented should be the responsibility of humans.

Factors Affecting Knowledge, Attitude, and Practice of Physicians Toward Medico-legal Aspects in Clinical Practice

Factors Affecting Knowledge, Attitude, and Practice of Physicians Toward Medico-legal Aspects in Clinical Practice

Telehealth and Telemedicine: Regulatory and Medicolegal Landscape.

Telehealth and telemedicine experienced remarkable growth during and after the recent COVID-19 pandemic. Telehealth is generally defined as nonclinical services that employ telecommunication technology. Telemedicine refers more specifically to remote clinical services including diagnosis, monitoring, and treatment. Nuclear medicine is no exception in employing telemedicine increasingly in clinical practice for image interpretation and treatment consultation and care delivery supervision. There is no doubt that soon, the use of tele-nuclear medicine will increase, comparable to the employment of telecommunication in other fields of medicine. We review the medicolegal and regulatory aspects of the evolution in the clinical practice of medicine through telehealth and telemedicine.

Fatal road traffic accident and medico-legal aspects in Lomé (Togo)

Objectives: know the circumstances and causes of death related to traffic accidents which have been the subject of forensic expertise in Togo. Methods: It was a case series study on fatal road traffic accident victims who benefited from forensic expertise from 2017 to 2021 (5 years) in the pathological anatomy department of Lomé in Togo. Result: A total of 248 forensic expertise files were collected, representing an annual frequency of 49.6 cases. The sex ratio (M/F) was 3.1. The ages of the victims ranged from 1 to 84 years with an average age of 39.2±4.3 years. The circumstances were dominated by motorcycle collisions (101 cases; 40.7%) followed by motorcycle- vehicle (67 cases; 27.0%). Speeding was reported as the leading cause of accidents in 179 cases (72.2%). The victims were mainly passengers and motorcycle drivers in 115 cases (46.4%). The anatomical lesions were grouped into four groups: polytrauma (152 cases, 61.3%), severe head trauma isolated (55 cases, 22.2%), thoracic contusion (23 cases, 9.3%), and abdominopelvic contusion with perineal lesion (18 cases, 7.2%). Conclusion: Raising awareness and applying road safety principles among motorcycle and car drivers will help stop this threat. Government at all levels should implement strong policies to reduce the speed of vehicles on the roads. Objectifs : connaître les circonstances et les causes des décès liés aux accidents de la circulation qui ont fait l'objet d'une expertise médico-légale au Togo. Méthodes : Il s'agissait d'une étude de série de cas sur les victimes d'accidents mortels de la circulation ayant bénéficié d'une expertise médico-légale de 2017 à 2021 (5 ans) dans le service d'anatomie pathologique de Lomé au Togo. Résultats : deux cent quarante-huit (248) dossiers d'expertise médicolégale ont été recueillis, soit une fréquence annuelle de 49,6 cas. Le sex-ratio (H/F) était de 3,1. L'âge des victimes variait de 1 à 84 ans avec une moyenne de 39,2±4,3 ans. Les circonstances étaient dominés par les collisions entre motocyclettes (101 cas ; 40,7%) suivies par les collisions entre motocyclettes et véhicules (67 cas ; 27,0%). L'excès de vitesse était la cause principale des accidents dans 179 cas (72,2%). Les victimes étaient principalement des passagers et des conducteurs de moto dans 115 cas (46,4 %). Les lésions anatomiques ont été regroupées en quatre groupes : polytraumatisme (152 cas, 61,3%), traumatisme crânien sévère isolé (55 cas, 22,2%), contusion thoracique (23 cas, 9,3%) et contusion abdomino-pelvienne avec lésion périnéale (18 cas, 7,2%). Conclusion : La sensibilisation et l'application des principes de sécurité routière parmi les conducteurs de motocyclettes et de voitures contribueront à mettre un terme à cette menace. Le gouvernement à tous les niveaux devrait mettre en œuvre des politiques fortes pour réduire la vitesse des véhicules sur les routes.

Discharge against medical advice (DAMA) in patients with long bone fractures at YEC: Epidemiological, clinical, evolutionary and medico-legal aspects

Discharge against medical advice (DAMA) is a term used in healthcare establishments when a patient leaves a hospital against the advice of their doctor.The aim of this study was to describe the epidemiological, clinical, evolutionary and medico-legal aspects of patients with long bone fractures discharged against medical advice at the Yaoundé Emergency Centre (YEC). This was a retrospective descriptive and analytical study conducted between January 2016 and December 2022 at the YEC. All patients aged 18 years or older with at least one long bone fracture and discharged against medical advice from our study site during the study period were included. Patients were then contacted to collect the reasons for DAMA, the therapeutic itinerary, the type of treatment undertaken, direct costs, and evolutionary data. Statistical analyses were performed using SPSS version 26 software. Six hundred and forty-seven patients were enrolled during the study period, representing a prevalence of DAMA of 45.7%. The mean age of the patients was 35.47 (± 13.86) years, and 475 (73.4%) were men. Socioeconomic status was low in 72.4% of cases. All religions and ethnic groups were represented. Road traffic accidents (RTA) were the cause of trauma in 83% of cases. The main site of injury was the tibia, in 253 (39.1%) cases. Open fractures accounted for 38.8% of cases. The median time to discharge against medical advice was 16 [6-26], , , hours, with 73.4% of DAMA within 24 hours. Lack of financial resources, the choice of traditional treatment and the preference for another hospital were the three main reasons. In our setting, 45.7% of patients with long bone fractures initially admitted to hospital were discharged against medical advice. The type of injury was varied, with 38.8% open fractures, some of which were complex.

The eye in forensic practice: In the living.

Eye examination plays an important role when living individuals are forensically investigated. The iris colour, retinal scans and other biometric features may be used for identification purposes while visual impairments may have legal implications in employment, driving and accidents. Ocular manifestations provide clues regarding substance abuse, poisoning and toxicity, and evidence of trauma, abuse or disease can be revealed along with psychological traits and lifestyle. Thus, the eye is a valuable tool in forensic investigations of living subjects, providing identifying characteristics along with health information. This review focuses on the medico-legal aspects of the eye's contribution when the living are subjected to forensic examination.

Estrangulación/sofocación no fatal en el contexto de violencia de género: aspectos médico-legales e implicancias para la práctica clínica

Despite the numerous efforts of the international community to eradicate all forms of violence against women, this problem is far from being resolved. According to the UN, one in three women has suffered physical or sexual violence from an intimate partner, sexual violence outside the couple, or both at least once in their life. Addressing this problem as a social health need of population groups allows an approach to gender violence as a collective health problem. At the level of physical violence, strangulation/suffocation has been identified as one of the most lethal forms of domestic violence and sexual assault. Victims of domestic violence who have been choked or strangled are 7.5 times more likely to be killed by their partner. A victim of strangulation/suffocation can lose consciousness in seconds or die within minutes, days or weeks after the attack, as well as suffer permanent brain damage or disability or emotional trauma. Recently, legal changes have been generated in the configuration of this crime, the penalties have increased in United Kingdom, the United States, Australia and New Zealand. The current non-systematic narrative review of literature sought to explore updated medico-legal aspects of non-fatal strangulation/suffocation in the context of gender violence, and are highlightedrelevant implications for clinical practice.