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Zaglia Elisabetta - One of the best experts on this subject based on the ideXlab platform.

  • Valutazione ed inquadramento diagnostico-terapeutico delle violenze sessuali su adulto e minore. Validazione di linee guida e protocolli d'intesa interdisciplinari
    2009
    Co-Authors: Zaglia Elisabetta
    Abstract:

    La violenza è uno dei fenomeni più nascosti e più difficilmente rilevabili, ciononostante, rappresenta una realtà ben presente sia nei Paesi in via di sviluppo che in quelli in pieno benessere; una recente indagine condotta dall’ISTAT e dal Ministero delle Pari Opportunità rende noto come siano più di mezzo milione le donne vittime di stupri o di tentativi di violenza sessuale in Italia. Nonostante l’apprezzabile rialzo delle statistiche in Italia negli ultimi anni, non può essere negata la disparità rispetto ad altri Stati. Operando un raffronto tra U.S.A. ed Italia, sulla base dello studio di Jones L.M. et al. pubblicato su Child Abuse and Neglect nel 2001, risulta infatti che nel nostro Paese c’è un tasso di vittimizzazione sessuale di 40 volte inferiore rispetto a quello statunitense, dato che depone per una preoccupante sottostima del fenomeno. Preme quindi affrontare in modo più capillare il problema delle violenze, soprattutto in termini di sensibilizzazione e formazione degli operatori sanitari che vengono a contatto con le vittime, siano esse minori o adulti. Punto nodale è infatti la scarsa dimestichezza e l’insufficiente capacità da parte degli operatori tecnico-sanitari di riconoscere la violenza nonché l’inconsapevolezza delle procedure operative da adottare per la corretta raccolta, analisi ed archiviazione degli elementi di prova di natura biologica da impiegarsi nell’eventuale successivo procedimento giudiziario. A fronte di un quadro clinico-diagnostico ed identificativo così complesso sembra quanto mai opportuno un approccio multidisciplinare, con la collaborazione del clinico e del medico-legale che rappresenta l’operatore sanitario di riferimento per il Magistrato, deputato all’inquadramento del singolo caso in adempimento agli obblighi di legge ed all’effettuazione di tutte le indagini (tossicologiche e genetiche) utili per l’ottenimento e la preservazione degli elementi probatori. Paradossalmente, intervengono al riguardo alcune limitazioni procedurali le quali costituiscono un serio ostacolo all’attività clinico-forense di raccolta delle prove ma che, soprattutto, possono divenire strumento per l’invalidazione e l’inutilizzabilità degli elementi probatori acquisiti. Quanto mai necessaria ed opportuna, quindi, la creazione di un protocollo d’intesa con l’Autorità Giudiziaria che riguardi l’acquisizione ed il trattamento delle tracce biologiche e che preveda una precisa modalità procedurale rispettosa sia delle regole processuali sia di quelle dettate dal c.p.p. nonché dei diritti della vittima, ivi inclusa la creazione di un data base per l’archiviazione dei risultati. La strategia ideale consiste certamente, nella creazione di sistemi operativi, quali protocolli d’intervento e linee guida standardizzate, che permettano di indirizzare efficacemente l’opera di riconoscimento prima e di accertamento poi dei segni di violenza, ovviando ad inutili dispersioni di risorse e ad approcci polispecialistici scorretti, ulteriormente lesivi dell’integrità psico-fisica del soggetto. Un simile approccio, inoltre, consente un orientamento metodologico obiettivo ed inequivocabile senza lasciare spazio ad impressioni estemporanee ed a decisioni del momento. Nei tre anni di attività si sono impostati protocolli d’intesa con l’A.G. e protocolli operativi clinico-laboratoristici, sviluppati sulla falsariga del “Paediatric/Adolescent Sexual Abuse Medical Protocol”1. Si è inoltre sperimentato l’utilizzo tanto di un kit clinico, “Sexual Assault Evidence Kit” (SAEK)2, quanto di un test immunocromatografico (RSID test) volto a determinare la reale natura delle tracce biologiche ottenute in fase di repertamento. I risultati ottenuti sono stati soddisfacenti, tanto in termini di aumento della casistica quanto in termini di efficacia operativa clinica, tecnica e laboratoristica. 1Victims of sexual violence require a high index of suspicion and familiarity with the historical, physical and behavioural indicators of abuse and specific skills and abilities to collect all possible information (physical lesions and biological samples) useful as proof of this crime. This is particularly crucial when the victims are children. Many studies emphasize the extreme importance of medical examination using standardized protocol and multidisciplinary guide-lines to obtain physical and genital exam in a very short time (24-72 hours) after the assault, because after this time any biological sampling is completely useless. We got extremely important methods to obtain valid biological-Forensic proves of a sexual assault and did many tests to validate this techniques. Furthermore, we tried to optimize the Forensic management of child abuse cases (acute, sub-acute and chronic) providing all necessary services in one place and in a sensitive, safe and Forensically secure environment. A colposcope equipped with a camera is always used since January 2007. When the physical-genital exam was suspect or when the information were dubious, we collect various samples from the body, from clothes or from other evidences (sheet, underpants). For all of them we investigate the origin and the real nature. Confirmatory test for human spermatozoa was the microscopic identification of spermatozoa. In cases where no spermatozoa are detected, other methods as seminal vesicle specific antigen, known as Semenogelin (Sg), was employed to detect the presence of semen using membrane strip device provided in RSID-Semen Test. Sg I/II are the major seminal vesicle secreted proteins in human semen. Identification of Sg for semen detection was done in ELISA for years while detection of Sg in dot-blot-immunoassay and one-step immunochromatographic assay was described relatively recently. The test could be performed without consuming the DNA present in the samples since aliquots can be taken during DNA extraction procedures. Results of the Sg detection were obtained in 10 min. The RSID-semen test give excellent results; so in this way, we demonstrated that detection of Sg in seminal stain is an effective approach and it allows an alternative approach to the Forensic identification of seminal plasma. A Forensic pathologist qualified by the state to perform Clinical Forensic Medicine and who generally has specialized in pathology and legal Medicine, has spent more years of training performing examinations of victims of violence, especially children suspected of sexual abuse. All cases, including the colposcopic findings, are reviewed by a qualified senior; the Forensic pathologist are then qualified to appear in Court. The medical examination takes about one hour. Only few findings can be considered as proof. Among these are the presence of spermatozoa or pregnancy, non-accidental genital injuries especially at the posterior part of the vagina, hymen and vestibulum, recent tears and/or scars of the hymen, non-accidental anal injuries, positive tests for venereal diseases (syphilis, gonorrhoea, HIV) if an infection during pregnancy or perinatally is excluded. The local findings, the overall findings and the search for and/or results from trace evidence are to be evaluated. It is obvious that such search and examination must be as soon as possible; in order to document all injuries before or during treatment it must include all relevant body parts and orifices, also hidden ones (intraoral). Swabbing of relevant body surfaces has to avoid contamination. Last, but not least, also clothes, especially underpants, have to be included in these accurate evaluation. The possibilities of physical examination in cases of suspected sexual abuse are often grossly ignored in Italy. This leads to either lacking physical evidence or a low level in this procedure with either none or very poor documentation. There is therefore an urgent need for a higher level of professionalism in the institutions involved, i.e. Medicine, law enforcement agencies etc. In these three years we set up a specialized Service that, in collaboration with Pediatric and Gynecologist Divisions of the local Hospitals, Social Services and Crown Attorneys, provide medical and legal assistance to victims of violence. We are still strengthen the cooperation between all these different services planning a medical and technical procedure in agreement with Italian Legal Syste

  • Valutazione ed inquadramento diagnostico-terapeutico delle violenze sessuali su adulto e minore. Validazione di linee guida e protocolli d'intesa interdisciplinari
    2009
    Co-Authors: Zaglia Elisabetta
    Abstract:

    La violenza \ue8 uno dei fenomeni pi\uf9 nascosti e pi\uf9 difficilmente rilevabili, ciononostante, rappresenta una realt\ue0 ben presente sia nei Paesi in via di sviluppo che in quelli in pieno benessere; una recente indagine condotta dall\u2019ISTAT e dal Ministero delle Pari Opportunit\ue0 rende noto come siano pi\uf9 di mezzo milione le donne vittime di stupri o di tentativi di violenza sessuale in Italia. Nonostante l\u2019apprezzabile rialzo delle statistiche in Italia negli ultimi anni, non pu\uf2 essere negata la disparit\ue0 rispetto ad altri Stati. Operando un raffronto tra U.S.A. ed Italia, sulla base dello studio di Jones L.M. et al. pubblicato su Child Abuse and Neglect nel 2001, risulta infatti che nel nostro Paese c\u2019\ue8 un tasso di vittimizzazione sessuale di 40 volte inferiore rispetto a quello statunitense, dato che depone per una preoccupante sottostima del fenomeno. Preme quindi affrontare in modo pi\uf9 capillare il problema delle violenze, soprattutto in termini di sensibilizzazione e formazione degli operatori sanitari che vengono a contatto con le vittime, siano esse minori o adulti. Punto nodale \ue8 infatti la scarsa dimestichezza e l\u2019insufficiente capacit\ue0 da parte degli operatori tecnico-sanitari di riconoscere la violenza nonch\ue9 l\u2019inconsapevolezza delle procedure operative da adottare per la corretta raccolta, analisi ed archiviazione degli elementi di prova di natura biologica da impiegarsi nell\u2019eventuale successivo procedimento giudiziario. A fronte di un quadro clinico-diagnostico ed identificativo cos\uec complesso sembra quanto mai opportuno un approccio multidisciplinare, con la collaborazione del clinico e del medico-legale che rappresenta l\u2019operatore sanitario di riferimento per il Magistrato, deputato all\u2019inquadramento del singolo caso in adempimento agli obblighi di legge ed all\u2019effettuazione di tutte le indagini (tossicologiche e genetiche) utili per l\u2019ottenimento e la preservazione degli elementi probatori. Paradossalmente, intervengono al riguardo alcune limitazioni procedurali le quali costituiscono un serio ostacolo all\u2019attivit\ue0 clinico-forense di raccolta delle prove ma che, soprattutto, possono divenire strumento per l\u2019invalidazione e l\u2019inutilizzabilit\ue0 degli elementi probatori acquisiti. Quanto mai necessaria ed opportuna, quindi, la creazione di un protocollo d\u2019intesa con l\u2019Autorit\ue0 Giudiziaria che riguardi l\u2019acquisizione ed il trattamento delle tracce biologiche e che preveda una precisa modalit\ue0 procedurale rispettosa sia delle regole processuali sia di quelle dettate dal c.p.p. nonch\ue9 dei diritti della vittima, ivi inclusa la creazione di un data base per l\u2019archiviazione dei risultati. La strategia ideale consiste certamente, nella creazione di sistemi operativi, quali protocolli d\u2019intervento e linee guida standardizzate, che permettano di indirizzare efficacemente l\u2019opera di riconoscimento prima e di accertamento poi dei segni di violenza, ovviando ad inutili dispersioni di risorse e ad approcci polispecialistici scorretti, ulteriormente lesivi dell\u2019integrit\ue0 psico-fisica del soggetto. Un simile approccio, inoltre, consente un orientamento metodologico obiettivo ed inequivocabile senza lasciare spazio ad impressioni estemporanee ed a decisioni del momento. Nei tre anni di attivit\ue0 si sono impostati protocolli d\u2019intesa con l\u2019A.G. e protocolli operativi clinico-laboratoristici, sviluppati sulla falsariga del \u201cPaediatric/Adolescent Sexual Abuse Medical Protocol\u201d1. Si \ue8 inoltre sperimentato l\u2019utilizzo tanto di un kit clinico, \u201cSexual Assault Evidence Kit\u201d (SAEK)2, quanto di un test immunocromatografico (RSID test) volto a determinare la reale natura delle tracce biologiche ottenute in fase di repertamento. I risultati ottenuti sono stati soddisfacenti, tanto in termini di aumento della casistica quanto in termini di efficacia operativa clinica, tecnica e laboratoristica. 1Victims of sexual violence require a high index of suspicion and familiarity with the historical, physical and behavioural indicators of abuse and specific skills and abilities to collect all possible information (physical lesions and biological samples) useful as proof of this crime. This is particularly crucial when the victims are children. Many studies emphasize the extreme importance of medical examination using standardized protocol and multidisciplinary guide-lines to obtain physical and genital exam in a very short time (24-72 hours) after the assault, because after this time any biological sampling is completely useless. We got extremely important methods to obtain valid biological-Forensic proves of a sexual assault and did many tests to validate this techniques. Furthermore, we tried to optimize the Forensic management of child abuse cases (acute, sub-acute and chronic) providing all necessary services in one place and in a sensitive, safe and Forensically secure environment. A colposcope equipped with a camera is always used since January 2007. When the physical-genital exam was suspect or when the information were dubious, we collect various samples from the body, from clothes or from other evidences (sheet, underpants). For all of them we investigate the origin and the real nature. Confirmatory test for human spermatozoa was the microscopic identification of spermatozoa. In cases where no spermatozoa are detected, other methods as seminal vesicle specific antigen, known as Semenogelin (Sg), was employed to detect the presence of semen using membrane strip device provided in RSID-Semen Test. Sg I/II are the major seminal vesicle secreted proteins in human semen. Identification of Sg for semen detection was done in ELISA for years while detection of Sg in dot-blot-immunoassay and one-step immunochromatographic assay was described relatively recently. The test could be performed without consuming the DNA present in the samples since aliquots can be taken during DNA extraction procedures. Results of the Sg detection were obtained in 10 min. The RSID-semen test give excellent results; so in this way, we demonstrated that detection of Sg in seminal stain is an effective approach and it allows an alternative approach to the Forensic identification of seminal plasma. A Forensic pathologist qualified by the state to perform Clinical Forensic Medicine and who generally has specialized in pathology and legal Medicine, has spent more years of training performing examinations of victims of violence, especially children suspected of sexual abuse. All cases, including the colposcopic findings, are reviewed by a qualified senior; the Forensic pathologist are then qualified to appear in Court. The medical examination takes about one hour. Only few findings can be considered as proof. Among these are the presence of spermatozoa or pregnancy, non-accidental genital injuries especially at the posterior part of the vagina, hymen and vestibulum, recent tears and/or scars of the hymen, non-accidental anal injuries, positive tests for venereal diseases (syphilis, gonorrhoea, HIV) if an infection during pregnancy or perinatally is excluded. The local findings, the overall findings and the search for and/or results from trace evidence are to be evaluated. It is obvious that such search and examination must be as soon as possible; in order to document all injuries before or during treatment it must include all relevant body parts and orifices, also hidden ones (intraoral). Swabbing of relevant body surfaces has to avoid contamination. Last, but not least, also clothes, especially underpants, have to be included in these accurate evaluation. The possibilities of physical examination in cases of suspected sexual abuse are often grossly ignored in Italy. This leads to either lacking physical evidence or a low level in this procedure with either none or very poor documentation. There is therefore an urgent need for a higher level of professionalism in the institutions involved, i.e. Medicine, law enforcement agencies etc. In these three years we set up a specialized Service that, in collaboration with Pediatric and Gynecologist Divisions of the local Hospitals, Social Services and Crown Attorneys, provide medical and legal assistance to victims of violence. We are still strengthen the cooperation between all these different services planning a medical and technical procedure in agreement with Italian Legal Syste

  • Valutazione ed inquadramento diagnostico-terapeutico delle violenze sessuali su adulto e minore. Validazione di linee guida e protocolli d'intesa interdisciplinari
    2009
    Co-Authors: Zaglia Elisabetta
    Abstract:

    La violenza \ue8 uno dei fenomeni pi\uf9 nascosti e pi\uf9 difficilmente rilevabili, ciononostante, rappresenta una realt\ue0 ben presente sia nei Paesi in via di sviluppo che in quelli in pieno benessere; una recente indagine condotta dall\u2019ISTAT e dal Ministero delle Pari Opportunit\ue0 rende noto come siano pi\uf9 di mezzo milione le donne vittime di stupri o di tentativi di violenza sessuale in Italia. Nonostante l\u2019apprezzabile rialzo delle statistiche in Italia negli ultimi anni, non pu\uf2 essere negata la disparit\ue0 rispetto ad altri Stati. Operando un raffronto tra U.S.A. ed Italia, sulla base dello studio di Jones L.M. et al. pubblicato su Child Abuse and Neglect nel 2001, risulta infatti che nel nostro Paese c\u2019\ue8 un tasso di vittimizzazione sessuale di 40 volte inferiore rispetto a quello statunitense, dato che depone per una preoccupante sottostima del fenomeno. Preme quindi affrontare in modo pi\uf9 capillare il problema delle violenze, soprattutto in termini di sensibilizzazione e formazione degli operatori sanitari che vengono a contatto con le vittime, siano esse minori o adulti. Punto nodale \ue8 infatti la scarsa dimestichezza e l\u2019insufficiente capacit\ue0 da parte degli operatori tecnico-sanitari di riconoscere la violenza nonch\ue9 l\u2019inconsapevolezza delle procedure operative da adottare per la corretta raccolta, analisi ed archiviazione degli elementi di prova di natura biologica da impiegarsi nell\u2019eventuale successivo procedimento giudiziario. A fronte di un quadro clinico-diagnostico ed identificativo cos\uec complesso sembra quanto mai opportuno un approccio multidisciplinare, con la collaborazione del clinico e del medico-legale che rappresenta l\u2019operatore sanitario di riferimento per il Magistrato, deputato all\u2019inquadramento del singolo caso in adempimento agli obblighi di legge ed all\u2019effettuazione di tutte le indagini (tossicologiche e genetiche) utili per l\u2019ottenimento e la preservazione degli elementi probatori. Paradossalmente, intervengono al riguardo alcune limitazioni procedurali le quali costituiscono un serio ostacolo all\u2019attivit\ue0 clinico-forense di raccolta delle prove ma che, soprattutto, possono divenire strumento per l\u2019invalidazione e l\u2019inutilizzabilit\ue0 degli elementi probatori acquisiti. Quanto mai necessaria ed opportuna, quindi, la creazione di un protocollo d\u2019intesa con l\u2019Autorit\ue0 Giudiziaria che riguardi l\u2019acquisizione ed il trattamento delle tracce biologiche e che preveda una precisa modalit\ue0 procedurale rispettosa sia delle regole processuali sia di quelle dettate dal c.p.p. nonch\ue9 dei diritti della vittima, ivi inclusa la creazione di un data base per l\u2019archiviazione dei risultati. La strategia ideale consiste certamente, nella creazione di sistemi operativi, quali protocolli d\u2019intervento e linee guida standardizzate, che permettano di indirizzare efficacemente l\u2019opera di riconoscimento prima e di accertamento poi dei segni di violenza, ovviando ad inutili dispersioni di risorse e ad approcci polispecialistici scorretti, ulteriormente lesivi dell\u2019integrit\ue0 psico-fisica del soggetto. Un simile approccio, inoltre, consente un orientamento metodologico obiettivo ed inequivocabile senza lasciare spazio ad impressioni estemporanee ed a decisioni del momento. Nei tre anni di attivit\ue0 si sono impostati protocolli d\u2019intesa con l\u2019A.G. e protocolli operativi clinico-laboratoristici, sviluppati sulla falsariga del \u201cPaediatric/Adolescent Sexual Abuse Medical Protocol\u201d1. Si \ue8 inoltre sperimentato l\u2019utilizzo tanto di un kit clinico, \u201cSexual Assault Evidence Kit\u201d (SAEK)2, quanto di un test immunocromatografico (RSID test) volto a determinare la reale natura delle tracce biologiche ottenute in fase di repertamento. I risultati ottenuti sono stati soddisfacenti, tanto in termini di aumento della casistica quanto in termini di efficacia operativa clinica, tecnica e laboratoristica. 1Victims of sexual violence require a high index of suspicion and familiarity with the historical, physical and behavioural indicators of abuse and specific skills and abilities to collect all possible information (physical lesions and biological samples) useful as proof of this crime. This is particularly crucial when the victims are children. Many studies emphasize the extreme importance of medical examination using standardized protocol and multidisciplinary guide-lines to obtain physical and genital exam in a very short time (24-72 hours) after the assault, because after this time any biological sampling is completely useless. We got extremely important methods to obtain valid biological-Forensic proves of a sexual assault and did many tests to validate this techniques. Furthermore, we tried to optimize the Forensic management of child abuse cases (acute, sub-acute and chronic) providing all necessary services in one place and in a sensitive, safe and Forensically secure environment. A colposcope equipped with a camera is always used since January 2007. When the physical-genital exam was suspect or when the information were dubious, we collect various samples from the body, from clothes or from other evidences (sheet, underpants). For all of them we investigate the origin and the real nature. Confirmatory test for human spermatozoa was the microscopic identification of spermatozoa. In cases where no spermatozoa are detected, other methods as seminal vesicle specific antigen, known as Semenogelin (Sg), was employed to detect the presence of semen using membrane strip device provided in RSID-Semen Test. Sg I/II are the major seminal vesicle secreted proteins in human semen. Identification of Sg for semen detection was done in ELISA for years while detection of Sg in dot-blot-immunoassay and one-step immunochromatographic assay was described relatively recently. The test could be performed without consuming the DNA present in the samples since aliquots can be taken during DNA extraction procedures. Results of the Sg detection were obtained in 10 min. The RSID-semen test give excellent results; so in this way, we demonstrated that detection of Sg in seminal stain is an effective approach and it allows an alternative approach to the Forensic identification of seminal plasma. A Forensic pathologist qualified by the state to perform Clinical Forensic Medicine and who generally has specialized in pathology and legal Medicine, has spent more years of training performing examinations of victims of violence, especially children suspected of sexual abuse. All cases, including the colposcopic findings, are reviewed by a qualified senior; the Forensic pathologist are then qualified to appear in Court. The medical examination takes about one hour. Only few findings can be considered as proof. Among these are the presence of spermatozoa or pregnancy, non-accidental genital injuries especially at the posterior part of the vagina, hymen and vestibulum, recent tears and/or scars of the hymen, non-accidental anal injuries, positive tests for venereal diseases (syphilis, gonorrhoea, HIV) if an infection during pregnancy or perinatally is excluded. The local findings, the overall findings and the search for and/or results from trace evidence are to be evaluated. It is obvious that such search and examination must be as soon as possible; in order to document all injuries before or during treatment it must include all relevant body parts and orifices, also hidden ones (intraoral). Swabbing of relevant body surfaces has to avoid contamination. Last, but not least, also clothes, especially underpants, have to be included in these accurate evaluation. The possibilities of physical examination in cases of suspected sexual abuse are often grossly ignored in Italy. This leads to either lacking physical evidence or a low level in this procedure with either none or very poor documentation. There is therefore an urgent need for a higher level of professionalism in the institutions involved, i.e. Medicine, law enforcement agencies etc. In these three years we set up a specialized Service that, in collaboration with Pediatric and Gynecologist Divisions of the local Hospitals, Social Services and Crown Attorneys, provide medical and legal assistance to victims of violence. We are still strengthen the cooperation between all these different services planning a medical and technical procedure in agreement with Italian Legal Syste

Ulrike Schmidt - One of the best experts on this subject based on the ideXlab platform.

  • sharp force injuries in Clinical Forensic Medicine
    Forensic Science International, 2010
    Co-Authors: Ulrike Schmidt
    Abstract:

    In general, the Forensic evaluation of sharp force injuries in living and dead individuals follows the same morphologic principles. Still, there are some special features of sharp force injuries in the Clinical context, which have to be considered as examination findings on the living are interpreted to differentiate between accidental origin, self-infliction or homicidal assault. These include the frequency and localization of defence injuries, injuries of the perpetrator, and artificial injuries, especially those inflicted for the purpose of insurance fraud. Characteristics and differential diagnoses of "Clinical" sharp force injuries are surveyed in this article.

  • sharp force injuries in Clinical Forensic Medicine findings in victims and perpetrators
    Forensic Science International, 2006
    Co-Authors: Ulrike Schmidt, Stefan Pollak
    Abstract:

    The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented here. Defence injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defence injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal.

Margaret M Stark - One of the best experts on this subject based on the ideXlab platform.

  • medical malpractice Clinical Forensic Medicine
    Encyclopedia of Forensic and Legal Medicine (Second Edition), 2016
    Co-Authors: Margaret M Stark
    Abstract:

    Clinical Forensic Medicine is that branch of Medicine that deals with both the provision of Clinical services (i.e., diagnosis, treatment, and management) to patients and the medicolegal aspects of patient care. Training is essential to ensure that practitioners have the knowledge and skills to work in a potentially coercive environment. Clinical Forensic medical services should be of an appropriate standard with monitoring and governance arrangements. Such oversight is to the benefit of all parties with a stake in the provision of Clinical Forensic medical services.

  • training in Clinical Forensic Medicine in the uk perceptions of current regulatory standards
    Journal of Forensic and Legal Medicine, 2011
    Co-Authors: Margaret M Stark, Guy Norfolk
    Abstract:

    Abstract As Clinical Forensic Medicine (CFM) is not currently recognised as a speciality in the UK there are no nationally agreed mandatory standards for training Forensic physicians in either general Forensic (GFM) or sexual offence Medicine (SOM). The General Medical Council (GMC), the medical regulator in the UK, has issued clear standards for training in all specialities recommending that “trainees must be supported to acquire the necessary skills and experience through induction, effective educational supervision, an appropriate workload and time to learn”. In order to evaluate the current situation in the field of Clinical Forensic Medicine, doctors who have recently (within the last two years) started working in the field “trainees” ( n  = 38), and trainers ( n  = 61) with responsibility for Clinical and educational supervision of new trainees, were surveyed by questionnaire to gather their perceptions of how the relevant GMC standards are being met in initial on-the-job training. Telephone interviews were performed with eleven doctors working as Clinical or medical directors to determine their views. It is clear that currently the quality of training in CFM is sub-standard and inconsistent and that the published standards, as to the minimum requirement for training that must be met by post-graduate medical and training providers at all levels, are not being met. The Faculty of Forensic and Legal Medicine (FFLM) needs to set explicit minimum standards which will comply with the regulator and work to pilot credentialing for Forensic physicians. A number of recommendations are made for urgent FFLM development.

  • Clinical Forensic Medicine history and development
    2011
    Co-Authors: Jason Paynejames, Margaret M Stark
    Abstract:

    The term “Forensic Medicine” is now used to embrace all aspects of Forensic work of a medical nature. In the past, the term was often used interchangeably with “Forensic pathology” – the branch of Medicine which investigates death. Nowadays the phrase “Clinical Forensic Medicine” is properly applied to that part of medical practice whose scope involves interaction between the law, the judiciary, and the police involving (generally) living persons. Clinical Forensic Medicine is a term that has become widely used only in the last three decades or so, although the phrase has been used at least since 1951 in the UK, when the National Association of Police Surgeons (which became the Association of Forensic Physicians in 2003 till its demise in 2006) was first established. The absence of a clear medical specialty of Clinical Forensic Medicine has resulted in practitioners of Clinical Forensic Medicine being given many different descriptive names over the years. The term “Forensic physician” (FP) is now widely accepted. Police surgeon, divisional surgeon, Forensic medical officer (FMO) and Forensic medical examiner (FME) are examples of other names or titles that have been used to describe those who practice in the specialty of Clinical Forensic Medicine, but names such as these refer more to the appointed role than to the work done. Worldwide, there are many who are involved in both Clinical and pathological aspects of Forensic Medicine.

  • comprar Clinical Forensic Medicine a physician s guide margaret m stark 9781617792571 humanitas
    2011
    Co-Authors: Margaret M Stark
    Abstract:

    Tienda online donde Comprar Clinical Forensic Medicine. A Physician's Guide al precio 149,57 € de Margaret M. Stark, tienda de Libros de Medicina, Libros de Medicina legal y forense - Medicina legal

  • Clinical Forensic Medicine a physician s guide
    2005
    Co-Authors: Margaret M Stark
    Abstract:

    Chapter 1 The History and Development of Clinical Forensic Medicine Worldwide Jason Payne-James Chapter 2 Fundamental Principles Roy N. Palmer Chapter 3 Sexual Assault Examination Deborah Rogers and Mary Newton Chapter 4 Injury Assessment, Documentation, and Interpretation Jason Payne-James, Jack Crane, and Judith A. Hinchliffe Chapter 5 Nonaccidental Injury in Children Amanda Thomas Chapter 6 Crowd-Control Agents Kari Blaho-Owens Chapter 7 Medical Issues Relevant to Restraint Nicholas Page Chapter 8 Care of Detainees Guy Norfolk and Margaret M. Stark Chapter 9 Infectious Diseases: The Role of the Forensic Physician Felicity Nicholson Chapter 10 Substance Misuse Margaret M. Stark and Guy Norfolk Chapter 11 Deaths in Custody Richard Shepherd Chapter 12 Traffic Medicine Ian F. Wall and Steven B. Karch Appendices Index

B R Sharma - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Forensic Medicine in the present day trauma care system an overview
    Injury-international Journal of The Care of The Injured, 2006
    Co-Authors: B R Sharma
    Abstract:

    Criminal violence and its associated trauma comprise a critical health problem throughout the world. Clinical Forensic Medicine represents a new discipline of medical practice that is evolving in direct response to the sequelae of criminal and interpersonal violence. The application of the principles and standards of the Forensic specialist has been increasingly recognized as playing a crucial role in trauma care; the results of the extremes of human behaviour-abused children, individuals suffering from blatant neglect and maltreatment, or self-inflicted injury, and victims of road-traffic accidents, firearm injuries and other assaults. These cases must be reported to a legal agency for investigation and follow-up. As trends in crime and violence change, new antiviolence legislation is likely to be implemented; consequently, new personnel resources are required to ensure that these legislative mandates effectively meet the needs of society.

  • Clinical Forensic Medicine management of crime victims from trauma to trial
    Journal of Clinical Forensic Medicine, 2003
    Co-Authors: B R Sharma
    Abstract:

    The loss of human life and function due to violence constitutes a phenomenon that affects millions of patients annually. Society demands an investigation of trauma associated with criminal activity. No longer is it acceptable for health care professionals to operate in isolation of Forensic philosophies and principles. It is assumed that the individuals responsible for the performance of the examination of Forensic victims have the necessary basic education, experience, and skills. Health care professionals involved in the initial response to these victims, in the emergency department, are faced with unique problems, as social changes require continual reevaluation of standards and professional responsibility. The role of Forensic Medicine has been expressly designed to provide solutions to some of the most urgent concerns in our society. Forensic Medicine focuses on the areas in which Medicine and human behavior interface with the law. Existing problems are great and multifaceted and call for new solutions. The application of Forensic science to contemporary medical practice reveals a wider role in the investigation of crime and the legal process that contributes to public health and safety. The responsibility of the Forensic Medicine is to provide continuity of care from the health care institution or the crime scene to courts of law...from trauma to trial.

Stefan Pollak - One of the best experts on this subject based on the ideXlab platform.

  • sharp force injuries in Clinical Forensic Medicine findings in victims and perpetrators
    Forensic Science International, 2006
    Co-Authors: Ulrike Schmidt, Stefan Pollak
    Abstract:

    The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented here. Defence injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defence injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal.