Archive for the ‘Forensic Investigation of Injury’ Category

Female Genital Mutilation

March 27, 2013

Female genital mutilation (FGM) is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death. Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, about three million girls are at risk for FGM annually. Between 100 to 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 92 million girls age 10 years and above are estimated to have undergone FGM. The practice is most common in the western, eastern and north-eastern regions of Africa, in some countries of Asia and the Middle East, and among certain immigrant communities in North America and Europe. Since 1997, great efforts on the part of the World Health Organization (WHO) have been made to counteract FGM, through research, work within communities, and changes in public policy. Progress at both international and local levels includes wider international involvement to stop FGM, development of international monitoring bodies and resolutions that condemn the practice, revised legal frameworks and growing political support to end FGM, and in some countries, decreasing practice of FGM, and an increasing number of women and men in practicing communities who declare their support to end it. Research shows that, if practicing communities themselves decide to abandon FGM, the practice can be eliminated very rapidly. WHO efforts to eliminate female genital mutilation focus on developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation; generating knowledge about the causes and consequences of the practice, how to eliminate it and how to care for those who have experienced FGM; and developing training materials and guidelines for health professionals to help them treat and counsel women who have undergone procedures. WHO is particularly concerned about the increasing trend for medically trained personnel to perform FGM. WHO strongly urges health professionals not to perform such procedures. (2008). Female genital mutilation. World Health Organization Fact Sheets, (no. 241).

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Musculoskeletal System

March 21, 2013

I have found that the most consistent complaint, and yet the most difficult to evaluate, is chronic low back pain. Although most complaints are valid, I have had experiences where they were not. In one situation, a 56-year-old man presented for evaluation for long term disability- I was seeing him as a follow up. All appropriate scans had been ordered and were negative. He had several office exams that were inconsistent. When I examined him, he complained loudly with LE range of motion, but had no complaints when I did a leg raise. After speaking with the physician, we went with our instincts and refused to fill out his disability paperwork. He was very angry and sought a second opinion. He never returned to our office. Imagine my surprise when I was playing in a local golf tournament for charity and there was our patient who had absolutely no difficulty swinging his golf clubs! He saw me at the dinner following and refused to make eye contact. I told the physician I was working with and we both felt good about following our instincts.

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Alzheimer’s disease

February 7, 2012

Patients diagnosed with Alzheimer’s disease usually experience symptoms in their mid to late 60s. These symptoms usually include memory loss and confusion, developing to severe dementia. Because of their confusion, Alzheimer’s patients in nursing homes sometimes wander from their rooms or beds and fall and injure themselves, accidents that can sometimes be fatal.
Forensic nursing may be required in such situations. Nursing homes are accountable for the accidents that occur in their facilities. The extent of the Alzheimer’s disease in the patient sometimes needs to be determined for legal reasons. This is accomplished by examining the brain and the presence of neuritic plaques and neurofibrillary tangles. (Lehne, Richard A. Pharmacology for Nursing Care, 6th ed.)

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Poor Care Delivery

November 2, 2011

Medicare is certainly sending healthcare providers a message. They will not pay for poor care delivery. An example of this is that they will no longer pay if a patient falls or develops a bed sore. I applaud this. We should not add to our patient’s demise by adding additional disease processes to the one the came in with. While it may be true that someone with low immunity could develop a nosocomial infection, it can not be tolerated that we leave them unsafe with the ability to fall and break a hip. My hospital has developed techs that sit “one on one” with demented or confused patients. This has drastically reduced the falls.

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Birth Injuries

March 29, 2010

A birth injury refers to any trauma an infant endures during the birthing process. Most birth injuries occur as a result of the infant’s size or position during labor and delivery. For example, the birth canal may be too small, the fetus may be too large, or the fetus may be lying in an abnormal position in the uterus prior to birth. Common injuries as to the infant may include: swelling and bruising of the scalp, cephalohematoma, bone injury (fracture of the clavicle is most common, humerus fracture, femur fracture), intracranial hemorrhage, nerve injury (injury to brachial plexus is most common), perinatal asphyxia, and injury to skin and soft tissues. Markings on the skin, such as bruising, pink marks, may occur as well as a result of forceps use. Long-term conditions, such as brain injury and cerebral palsy, may also arise as a result of birthing injuries. The December 2nd 1999 issue of the New England Journal of Medicine contained a study done by Towner on birth injury due to the various methods of delivery. The study was conducted on 600,000 average weight infants born from 1992-1994 in the state of California. In the study, 66.5% were delivered by spontaneous vaginal delivery, 20.1% by cesarean delivery, 10.2% by vacuum extraction, 2.7% by forceps and 0.5% delivered by both vacuum and forceps. Results from the study with regards to death at birth due to these procedures were as follows: vaginal delivery death rate was 1 per 5000, vacuum extraction delivery death rate was 1 per 3333 and the forceps delivery death rate was 1 per 2000. Intercranial hemorrhages caused by these same procedures were also studied. Statistics were found as follows: 1 per 1900 for vaginal births, 1 per 860 for vacuum delivery, and 1 per 664 forceps delivery. The rate of birth injuries overall is much lower than it has been in previous decades. Improved prenatal assessments that include ultrasonograpy have allowed physicians to determine the best method of delivery for the infant that will produce the least amount of harm. In many cases, cesarean deliveries are done to lessen the chances of trauma to the infant during the birthing process.

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