Journal of forensic and legal medicine
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We describe a case of unintentional intoxication due to tramadol and propofol self administration, occurred in a middle aged man, healthcare provider, deceased despite advanced medical assistance an hour later the onset of severe and increasing dyspnea. Toxicological analysis performed with gas chromatography-mass spectrometry in blood sample, evidenced a lethal tramadol concentration and therapeutic level of Propofol. Quantitative determination was also performed in other specimens such as bile, tissues (liver, spleen, kidney) and pubic hair, to assess chronic exposure. Toxicological results and autopsy findings, supported by clinical and hematochemical data, suggested a myocardial damage, associated with respiratory failure.
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Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. ⋯ A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.
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The following report describes an unusual case of smothering by a medical nebulizer of a psychiatric in-patient and discusses the manner of death. A 43-year-old man, with previous medical history of paranoia was hospitalized at a psychiatric department because of a suicide attempt. He was found dead by the medical staff in the seclusion room. ⋯ Smothering is an uncommon cause of suicide and is particularly observed in psychiatric patient. Suicidal death is established by the study of the circumstances and autopsy finding. This paper highlights the importance of a closer psychiatric in-patient residing in seclusion room.
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The aim of this study was to investigate all the lawsuits related to oral surgery practice over a period of three years, and to analyze the different causes of litigation. Inclusion criteria involved all the closed cases that proved malpractice against an oral and maxillofacial surgeon or involved a dentist who performed an oral and maxillofacial surgical procedure. The most common causes of litigation were oro-antral communication, neurological deficit, and bleeding. The study presented the lessons learned from 20 cases, and concluded that most of the lawsuits in oral surgery practice can be prevented either through preoperative measures or by dealing with the impact of the surgical error through good patient rapport and communication.