Carles Martin-Fumadó

Trastornos psiquiátricos en los casos de suicidio consumado en un área hospitalaria entre 2007-2010

INTRODUCTION Suicide is an important Public Health problem. One of the most relevant known risk factors for suicide is suffering from a mental health disorder, identified in up to 90-95% of completed suicides, with this risk being increased if comorbidity is present. Findings from international research on the most common psychiatric disorders are dichotomous, divided into mood disorders and psychotic disorders. In Spain, data of this kind are scarce. METHODS This study describes the psychiatric and forensic characteristics of completed suicide cases (n=79) ocurred in a psychiatric hospital healthcare area (in Spain), between 2007 and 2010. The forensic data were obtained from the Institute of Legal Medicine of Catalonia and the clinical data by reviewing the clinical records. RESULTS Most of the subjects in this sample were males (78.5%, 95% CI; 68.4%-87.3%). Almost half of the sample (45.4%, 95% CI; 33.8%-57.1%, 35/77) had records in the Mental Health Services Network (including substance misuse services). Two of the 79 were under 18, so we were not able to access the records. More than half (54.3%, 95% CI; 37.1%-71.4%) of those with psychiatric history suffered from a mood disorder; 37.1% (95% CI; 22.9%-51.4% from a depressive disorder; 14.3% (95% CI; 2.9%-25.7%) from a bipolar disorder, and 17.1% (95% CI; 5.7%-31.4%) suffered from a psychotic disorder. With regard to substance misuse, 42.9% (95% CI; 25.7%-60.0%) presented substance misuse, and 48.6% did not. CONCLUSIONS Psychiatric and forensic characteristics of completed suicide in this Spanish sample confirm previous findings from international studies: there is a high rate of psychiatric disorders in those who complete suicide, and there is a specific pattern as regards the method used to complete it.

Professional Liability Claims in Vascular Surgery Practice

BACKGROUND Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Angiology and vascular surgery is of special interest due to the complexity of the pathologies involved and the esthetic component of some of its procedures. In this study we identified the most frequent factors that apply to vascular surgery claims to determine areas of special risk in vascular surgery, with an aim to improve patient safety. METHODS We performed a retrospective and descriptive study of the claims pertaining to vascular surgery from the database of the Service of Professional Liability (SRP) of the Official College of Physicians of Barcelona. The time frame of data collection was from 1986 to 2009. We analyzed both the clinical and legal characteristics of the cases. RESULTS Of the total of 6952 registered claims during the 23-year period, 91 (1.3%) were related to the practice of vascular surgery. Of these, 53.8% were related to venous pathology and 46.1% to arterial pathology. Neurologic damage was the main motive for claims (15.3%), followed by thromboembolic disease (14.2%), burns as a result of cosmetic treatment (12%), and amputation (10.9%). The neurologic damage in relation to vein pathology registered the greatest proportion of cases with professional liability (30.8%), followed by burns (19.2%), forgotten gauze (11.5%), and amputations (11.5%). CONCLUSIONS Angiology and vascular surgery does not seem to be a specialty with a high risk for claims, but complications, such as thromboembolic disease and neurologic damage after varicose vein intervention, do occur and deserve special attention so improvements can be made to patient safety.

Managing the identification of the mortal victims run over by a train in the Castelldefels railway accident (Barcelona)

The identification of disaster victims is the formal, organized process of identifying multiple bodies after an incident with multiple victims. The appropriate management of these incidents, particularly of the bodies, is one of the most crucial aspects of disaster response and its importance has led to the evolution of the concept of Disaster Victim Management. The aim of this study is to report how the process of identifying the 12 mortal victims of a railway accident in June 2010 in Castelldefels (Barcelona) was managed. The methodology used complied with the National Protocol for medical forensic and scientific police response to mass casualty incidents. The family assistance center also served as an ante mortem (AM) office. Despite the fragmentation of the bodies, all the victims were identified satisfactorily. The main problems observed during the management of the disaster were due to the state of the bodies, which raised many doubts as to the number of fatalities. The experience prompted a proposal to establish some recommendations on limiting the number of fragments to be analyzed genetically. We would like to stress the importance of setting up a Data Integration Center which brought together all the participating institutions, and collected and supervised all the different identification reports in a single comprehensive text addressed to the competent legal authority.

Actuación medicolegal en personas en custodia judicial o policial

The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities.The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities.