Search Results (143)

(1) Background: Regulations governing food supplements vary considerably across countries, allowing products that are prohibited in one jurisdiction to be legally sold in another. Furthermore, online sales enable and facilitate this practice. Regarding pharmaceutical malpractice, the absence of a standardized European framework complicates the evaluation of pharmacist liability. As a result, the specific elements of the liability framework are defined by the national legislation of each Member State. The aim of our review is to map the global regulatory landscape of food supplements and to examine the pharmacist’s professional responsibilities, including instances of malpractice related to this area. (2) Methods: A literature review covering publications from January 2020 to December 2024 was performed using four databases: Scopus, PubMed, Embase, and Web of Science. The search retrieved 8243 records, of which 77 studies fulfilled the eligibility criteria. The extracted data were organized into five main themes: pharmacist responsibility and malpractice, food supplement regulation, consumer safety, health claims, and pharmacist knowledge. (3) Results: The literature reviewed indicated a relatively low number of malpractice cases within the pharmacy profession compared to other professions. A higher incidence of cases is observed among male pharmacists and those practicing in the private sector. Notably, no cases have been identified addressing pharmacists’ responsibilities in the dispensing of food supplements. In the context of food supplement regulation, the reviewed literature highlights a lack of standardized terminology and harmonized legislation across different jurisdictions. Therefore, products may be classified differently across jurisdictions. Another observed barrier is the considerable variation in market access requirements across countries. Regarding consumer safety, several irregularities have been observed. Substantial non-compliance in both product composition and labeling has been observed, reflecting insufficient quality control measures. Concerning health claims, significant regulatory non-compliance with European Union regulations has been documented. In addition, widespread misleading advertising practices have been observed. With respect to pharmacists’ knowledge, the reviewed literature identifies several professional challenges within pharmacy practice, particularly those concerning the dispensing of food supplements. (4) Conclusions: This research offers a comprehensive analysis of the literature published over the past five years concerning pharmaceutical malpractice cases, as well as an examination of food supplement regulation and the professional responsibilities of pharmacists. A recurring barrier identified is the absence of unified regulatory frameworks worldwide. This results in uncertainty concerning the pharmacist’s professional role and responsibilities. Full article

Background and Objectives: The COVID-19 pandemic has led to an unprecedented mental health crisis among workers in the healthcare field, with average burnout rates increasing from about 32% before the pandemic to 46–52% during peak times and post-traumatic stress disorder (PTSD) affecting 24–34% of frontline staff. The primary objective of this article is to synthesize evidence on the prevalence of burnout and PTSD among healthcare workers before and during the COVID-19 pandemic. The secondary objectives are: (a) to examine the mechanisms and empirical evidence linking clinician mental health to medical errors and patient safety outcomes and (b) to analyze the medico-legal implications of this relationship, including malpractice liability, institutional responsibility, and opportunities for policy reform. Materials and Methods: We conducted a narrative review searching PubMed (November 2025–January 2026) using predefined keyword combinations. Inclusion criteria comprised original research, systematic reviews, and meta-analyses examining mental health outcomes or patient safety among clinical staff. Data were synthesized narratively across five thematic domains. Results: Burnout prevalence increased from approximately 32% pre-pandemic to 46–52% during peak periods, with emotional exhaustion reaching 67.5% in some settings. PTSD rates rose to 24–34% among frontline staff, exceeding pre-pandemic levels of 15–20%, with ICU staff particularly affected (27–40%). Substantial overlap exists between conditions (86–98% comorbidity). Physician burnout is associated with 2.72 times higher odds of self-reported errors (95% CI: 2.19–3.37), with each point increase in emotional exhaustion raising the error risk by 5–11%. Mechanisms include cognitive impairment (reduced executive function, g = −0.39; impaired working memory, g = −0.36) and sleep disturbance. Malpractice litigation compounds psychological harm, increasing depression and suicidal ideation. Conclusions: This review, synthesizing data from over 500,000 healthcare workers, demonstrates bidirectional relationships among burnout, PTSD, and medical errors with significant medico-legal ramifications. Addressing this crisis requires systemic interventions including workload management, psychological support, blame-free reporting cultures, and policy reforms balancing accountability with recognition of system-level contributors to error. Full article

Introduction: Parkinson’s disease can influence oral health by impairing motor function and altering salivary composition, potentially affecting the oral microbiome. Materials and Methods: The objectives of this study are fourfold: (a) to compare the prevalence of bacterial species associated with periodontal disease in patients with and without Parkinson’s disease (PD), (b) to assess whether the coexistence of periodontal disease in PD patients contributes to an imbalance in the oral microbiome, (c) to evaluate the correlation between periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the concentrations of specific periodontopathogenic bacterial species, and (d) to explore the potential implications of these evidences for clinical management and preventive strategies in Parkinson’s patients. The main objective of this study is to compare periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the bacterial profile of patients with periodontal and Parknson’s disease. Two groups were included: 15 patients with periodontal disease (control group) and 16 patients with both periodontal and Parkinson’s disease (study group). Microbial samples were collected from the periodontal pockets at baseline and analyzed using the Polymerase Chain Reaction (PCR) Perio-Ident 12 kit to detect major periodontal pathogens. Results: Periodontal indices showed no statistically significant differences between groups, although the study group presented lower mean tartar index (49.31% vs. 67.4%, p = 0.069), bleeding on probing (44.31% vs. 56.67%, p = 0.137), and plaque index (66% vs. 68.93%, p = 0.754). Median bacterial loads were generally higher in control group, with Tannerella forsythia, but without statistically significant difference (p = 0.072). Significant correlations between plaque index and multiple pathogens occurred only in control gorup, suggesting disrupted plaque–pathogen dynamics (p < 0.05). Conclusions: The results highlight the potential value of integrating clinical and microbiological assessment when managing periodontal disease in patients with Parkinson’s disease. Full article

Background: Integrity, encompassing honesty, accountability, and ethical conduct, is a cornerstone of the dental profession, essential for patient trust and safety. Despite its importance, academic dishonesty remains a pervasive issue in dental education globally. This review examines the prevalence, causes, and long-term career implications of academic dishonesty in dental education and explores institutional strategies to cultivate a culture of integrity. Method: The study was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify studies published between 1970 and 2025 on academic dishonesty in dental education. Search terms included dental students, cheating, plagiarism, and clinical falsification. Eligible studies reported prevalence, drivers, or consequences of dishonest behaviors. Data were extracted and thematically synthesized to highlight common patterns and professional implications. Results: Self-reported data indicate alarmingly high rates of cheating among dental students, ranging from 43% to over 90%. Common forms include exam fraud, plagiarism, and the falsification of clinical records. Key drivers include intense academic pressure, competitive environments, and a perception of weak enforcement. Such behaviors are not merely academic violations—they have profound professional consequences. A history of academic dishonesty can damage a student’s reputation, hinder licensure and credentialing processes, and limit postgraduate opportunities. Crucially, studies indicate that unethical behavior in school can normalize dishonesty, predicting a higher likelihood of future professional misconduct, such as insurance fraud or malpractice, thereby jeopardizing patient care and public trust. Conclusions: Academic integrity is a critical predictor of professional ethical conduct. Dental schools must move beyond punitive policies to implement proactive, multi-faceted approaches. This includes integrating comprehensive ethics curricula, fostering reflective practice, promoting faculty role modeling, and empowering student-led initiatives to uphold honor codes. Cultivating an unwavering culture of integrity is essential not only for academic success but for developing trustworthy practitioners committed to lifelong ethical patient care. Full article

Background/Objectives: Orthopedic surgery is among the most frequently litigated medical specialties worldwide. However, high-court malpractice decisions involving orthopedic specialists in Türkiye remain underexplored. This study aims to identify the patterns, causes, and outcomes of malpractice cases involving orthopedists by analyzing Turkish Supreme Court decisions over the past 15 years. Methods: A retrospective review of orthopedic malpractice cases adjudicated by the Turkish Court of Cassation between January 2010 and November 2025 was conducted. Variables included type of alleged offense, clinical context, primary/secondary liability, initial court outcomes, high-court decisions, and fault attribution. Findings were compared with international literature to contextualize national patterns. Results: A total of 71 decisions were analyzed. Negligent injury was the most common allegation. Initial acquittal and conviction rates were 50.7% and 49.3%, respectively. The Supreme Court affirmed 53.5% of decisions and overturned 46.5%. Fault was attributed to orthopedic specialists in 29.6% of cases, while 40.8% were found faultless; the remaining cases required additional expert evaluation. Litigation themes included diagnostic delay, postoperative complications, inadequate monitoring, and documentation deficiencies. Comparative analysis revealed substantial alignment between Turkish and international malpractice patterns. Conclusions: Orthopedic malpractice litigation in Türkiye mirrors global trends, with most claims stemming from trauma-related care and diagnostic errors. Although many cases undergo prolonged appeals, ultimate conviction rates remain low. Strengthened documentation, improved communication, and enhanced clinical guideline adherence may reduce litigation risk and improve patient safety. Full article

Sudden cardiac death (SCD) remains a major challenge in forensic medicine, representing a leading cause of natural mortality and frequently occurring in individuals without antecedent symptoms. Although conventional autopsy and histology remain the cornerstones of investigation, up to 10–15% of cases are classified as “autopsy-negative sudden unexplained death,” underscoring the need for complementary diagnostic tools. In recent years, post-mortem biochemistry and molecular approaches have become essential to narrowing this gap. Classical protein markers of myocardial necrosis (cardiac troponins, CK-MB, H-FABP, GPBB) continue to play a fundamental role, though their interpretation is influenced by post-mortem interval and sampling site. Peptide biomarkers reflecting hemodynamic stress (BNP, NT-proBNP, copeptin, sST2) offer additional insight into cardiac dysfunction and ischemic burden, while inflammatory and immunohistochemical markers (CRP, IL-6, fibronectin, desmin, C5b-9, S100A1) assist in detecting early ischemia and myocarditis when routine histology is inconclusive. Beyond these traditional markers, molecular signatures—including cardiac-specific microRNAs, exosomal RNA, proteomic alterations, and metabolomic fingerprints—provide innovative perspectives on metabolic collapse and arrhythmic mechanisms. Molecular autopsy through next-generation sequencing has further expanded diagnostic capability by identifying pathogenic variants associated with channelopathies and cardiomyopathies, enabling both cause-of-death clarification and cascade screening in families. Emerging multi-omics and artificial intelligence frameworks promise to integrate these heterogeneous data into standardized and robust interpretive models. Pre- and post-analytical considerations, together with medico-legal implications ranging from malpractice evaluation to the management of genetic information, remain essential components of this evolving field. Overall, the incorporation of validated biomarkers into harmonized international protocols, increasingly supported by AI, represents the next frontier in forensic cardiology. Full article

Italian Court of Cassation Ruling Decree 30032 of 30 October 2023 discusses a medical malpractice case concerning the diagnosis of dermatofibrosarcoma protuberans and the alleged diagnostic and therapeutic delay. By examining how the ruling frames the role of histopathology in proving pathology benignity, authors prompt to reflect on diagnostic path, the allocation of the burden of proof, and the role of dermatologist’s expertise in professional liability issues. Over a four-year period, five health professionals were involved in a claim concerning an initial diagnosis of an epidermoid cyst and a subsequent diagnosis of dermatofibrosarcoma protuberans. The plaintiff questioned the delay in diagnosis, and the Court of Cassation found two physicians liable because they could not prove that the treated pathology was initially benign. We argue that equating diagnostic correctness exclusively with histological confirmation is unnecessary, both clinically and legally, in typical cases, if the reasoning and findings are adequately documented. Additionally, we examine the value of dermatologists’ experience and the scope of professional competence as measures of liability. Finally, we outline the minimum standards of clinical documentation necessary to make the diagnostic pathway traceable and verifiable. The diagnostic process is a discretionary effort that integrates multiple sources of information, both instrumental and experiential, to reach the most reasonable hypothesis. While histopathology is a crucial tool, it is not the sole gateway to a correct diagnosis of every cutaneous alteration. Adequate disclosure and structured documentation of the diagnostic reasoning are fundamental to the care process and fair assessment of professional responsibility. Full article

Examinations are typically used by educational institutions to assess students’ strengths and weaknesses. Unfortunately, exam malpractices like cheating and other forms of academic integrity violations continue to present a serious challenge to the evaluation framework because it seeks to provide a trustworthy assessment. Existing methods involving human invigilators have limitations, as they must be physically present in examination settings and cannot monitor all students who take an exam while successfully ensuring integrity. With the developments in artificial intelligence (AI) and computer vision, we now have novel possibilities to develop methods for detecting students who engage in cheating. This paper presents a practical, real-time detection system based on computer vision techniques for detecting cheating in examination halls. The system utilizes two primary methods: The first method is YOLOv8, a top-of-the-line object detection model, where the model is used to detect students in video footage in real time. After detecting the students, the second aspect of the detection process is to apply pose estimation to extract key points of the detected students. For the first time, this paper proposes to measure angles from the geometry of the key points of detected students by constructing two triangles using the distance from the tip of the nose to both eyes, and the distance from the tip of the nose to both ears; one triangle is sized from the distance to the eyes, and the other triangle contains the measurements to their ears. By continually calculating these angles, it is possible to derive each student’s facial pose. A dynamic threshold is calculated and updated for each frame to better represent the body position in real time. When the left or right angle pass that threshold, it is flagged as suspicious behavior indicating cheating. All detected cheating instances, including duration, timestamps, and captured images, are logged automatically in an Excel file stored on Google Drive. The proposed study presents a computationally cheap approach that does not utilize a GPU or additional computational aspects in any capacity. This implementation is affordable and has higher accuracy than all of those mentioned in prior studies. Analyzing data from exam halls indicated that the proposed system reached 96.18% accuracy and 96.2% precision. Full article

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article

Introduction: This study investigates the severity of periodontal disease in patients with Parkinson’s disease by comparing clinical and salivary aspects. Materials and Methods: A total of 31 patients were included: 15 with periodontal disease (control group) and 16 with periodontal disease and Parkinson’s disease (study group). Demographic data, periodontal parameters (plaque index, tartar index, bleeding index, probing depth, periodontal pocket index) and salivary parameters included viscosity, pH, and buffering capacity were analyzed. Results: Patients with Parkinson’s disease exhibited slightly lower mean values for plaque accumulation, bleeding on probing, and tartar index compared with the control group, though these differences were not statistically significant. In contrast, salivary parameters, particularly buffering capacity, showed statistically significant differences (p < 0.05) between the groups. Conclusions: Parkinson’s disease impacts periodontal health. Early intervention and integrated care strategies may help mitigate oral health deterioration in Parkinson’s patients. Full article

Introduction: Orthodontic practice, though often considered low-risk compared with other dental specialties, is increasingly exposed to medico-legal challenges shaped by the volatile, uncertain, complex, and ambiguous (VUCA) environment of modern healthcare. The aim of this review was to identify the underlying causes and typologies of malpractice claims in orthodontics. Methods: This narrative review synthesizes evidence from 2010–2024 on malpractice allegations and risk management strategies in orthodontics, with attention to the clinical, ethical, and legal dimensions. Results: The analysis of the included articles identified the most common types of malpractice allegations and the share of malpractice allegations of orthodontists in relation to other specialties; the main risks of orthodontic practice were identified, as well as risk management strategies in orthodontics. The findings highlight that most malpractice allegations are not related to medical/clinical errors, but to ethical–legislative, behavioral/relational, and perceptual/aesthetic vulnerabilities. Conclusions: This review highlights the need for physicians to focus on the acquisition of transversal skills, to have the ability to understand, adapt and respond to the rational and emotional needs of patients. This is essential in an ever-changing world, supporting healthcare professionals in maintaining professional safety. This review opens a relevant research direction on the role and impact of digital technology in the orthodontist–patient relationship, having the ability to influence the dynamics of this therapeutic relationship and the perception of the treatment outcome. Full article

In recent years, scandals regarding the malpractices of many nonprofit organizations (NPOs) for selfish ends have eroded public trust in them. Therefore, it is necessary to consider whether the credibility of NPOs, as one of the three key implementers in cause-related marketing (CRM) campaigns, has a transfer effect on enterprise brand image. The aim of the current study is to examine the relationship between NPO credibility and enterprise brand image, along with its underlying mechanism and boundary conditions. Drawing on the affect-transfer model as well as attribution theory, we propose a theoretical model. This model highlights the mediating role of perceived corporate hypocrisy in the relationship between NPO credibility and enterprise brand image. Moreover, it incorporates public emergency, specifically in reference to the COVID-19 pandemic, as a moderator. Three experiments were conducted to test our model. Results reveal that consumers perceive a more negative enterprise brand image when the company partners with a low-credibility NPO compared to a high-credibility NPO. Additionally, the impact of NPO credibility on enterprise brand image is mediated by perceived corporate hypocrisy, which is weakened in the presence of a public emergency. Full article

Background: Previous research showed that the majority of the variation in providers’ practice patterns is unexplained by patient, physician, and primary care practice characteristics. This study assessed physicians’ personal behavioral characteristics as explanatory components of medical practice variation (MPV). Methods: In this cross-sectional study, primary care physicians from Clalit Health Services in southern Israel were interviewed using validated surveys assessing risk-taking, tolerance for ambiguity, stress due to uncertainty, fear of malpractice, and empathy. We analyzed how much these traits explained MPV compared to patient, physician demographic, occupational, and practice characteristics using generalized linear mixed models and Nakagawa’s R². Results: Of the 160 physicians approached, 146 (91.3%) participated. The median practicing time was 22 years; 48% were male, with a median age of 49. The median number of patients per practice was 1135. Overall, 40.4% of MPV was explained, mostly by patient characteristics (18.9%), practice characteristics (10.2%), and physician demographics (8.3%). Physician behavioral traits explained only 2.3%. Conclusions: Personal behavior characteristics explain a minority of MPV, leaving 60% of the MPV unexplained. This suggests either limitations in survey assessments or that these traits are not key drivers of MPV. Full article

Cataract surgery is the most common eye operation worldwide and is regarded as one of the safest procedures in medicine. Yet, despite its low complication rates, it generates a disproportionate share of litigation. The gap between excellent safety profiles and rising medico-legal claims is driven less by surgical outcomes than by patient expectations, often shaped by healthcare marketing and the promise of risk-free recovery. This narrative review explores the clinical and legal dimensions of cataract surgery, focusing on complications, perioperative risk factors, and medico-legal concepts of predictability and preventability. Particular emphasis is given to European frameworks, with the Italian Gelli-Bianco Law (Law No. 24/2017) providing a model of accountability that balances innovation and patient safety. Analysis shows that liability exposure spans all phases of surgery: preoperative (inadequate consent, poor documentation), intraoperative (posterior capsule rupture, zonular instability), and postoperative (endophthalmitis, poor follow-up). Practical strategies for risk reduction include advanced imaging such as macular OCT, rigorous adherence to updated guidelines, systematic video recording, and transparent perioperative communication. Patient-reported outcomes further highlight that satisfaction depends more on visual quality and dialogue than on spectacle independence. By translating legal principles into clinical strategies, this review offers surgeons actionable “surgical–legal pearls” to improve outcomes, strengthen patient trust, and reduce medico-legal vulnerability in high-volume cataract surgery. Full article

Background/Objectives: Novice nurses often struggle to assertively voice patient safety concerns due to limited clinical experience and hierarchical healthcare environments. Immersive virtual reality simulation (IVRS) may provide opportunities to practice assertive communication skills essential for interprofessional collaboration in a psychologically safe environment. This study aimed to evaluate the short- and long-term effectiveness of an IVRS speak-up training program in enhancing communication clarity and collaborative attitudes, as well as reducing experiences of nursing malpractice among novice nurses. Methods: A quasi-experimental study was conducted with 36 novice nurses (18 participants each in control and experimental groups). The experimental group received a 200 min IVRS speak-up training program incorporating TeamSTEPPS communication strategies through four virtual reality scenarios. The control group received a 110 min conventional group lectures and discussions on communication training covering the same TeamSTEPPS strategies. Communication clarity and collaborative attitudes were measured at baseline, immediately post-intervention, and 6 weeks post-intervention. Nursing malpractice experiences were assessed at 6 weeks post-intervention. Results: Communication clarity showed no significant interaction effect between groups and time points (F = 0.84, p = 0.437), though both groups demonstrated immediate post-intervention improvements. Collaborative attitudes showed a significant interaction effect (F = 4.23, p = 0.020), with the experimental group exhibiting significantly greater and sustained improvements at immediate and 6-week follow-up compared with the control group. No significant difference in nursing malpractice experiences was observed between groups (Z = 0.16, p = 0.872). Conclusions: The IVRS speak-up training program effectively enhanced novice nurses’ assertive communication skills in immersive, interactive environments tailored for realistic practice compared to conventional group discussion-based training. This program improved communication clarity in the short term and enhanced collaborative attitudes up to 6 weeks. Integrating or boosting IVRS training into novice nurses’ communication education may foster interprofessional collaboration and advance patient safety in clinical practice. Full article