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"documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Impact of COVID-19 on the mental health of elderly population during the pandemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de la COVID-19 en la salud mental de ancianos durante la pandemia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gemma López-Molina, María Irigoyen-Otiñano, María Mur-Laín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Gemma" "apellidos" => "López-Molina" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Irigoyen-Otiñano" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Mur-Laín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775324004500" "doi" => "10.1016/j.medcli.2024.06.005" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775324004500?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624004911?idApp=UINPBA00004N" "url" => "/23870206/unassign/S2387020624004911/v1_202410310611/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020624004637" "issn" => "23870206" "doi" => "10.1016/j.medcle.2024.04.030" "estado" => "S200" "fechaPublicacion" => "2024-10-21" "aid" => "6709" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Perineal leiomyoma: an infrecuent clinical entity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leiomioma perianal: una entidad poco frecuente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1236 "Ancho" => 2050 "Tamanyo" => 374050 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anal lesion: (A) Tumour measuring 4<span class="elsevierStyleHsp" style=""></span>cm in greatest diameter, pedunculated and located in the right posterolateral quadrant of the anus. (B) Image of the surgical specimen showing an oval lesion with well-defined margins. (C) Appearance of the anal region after surgical resection.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pathological study: (D) Cross-linked fascicles of spindle cells with eosinophilic cytoplasm, nuclei with conical ends and small nucleoli, consistent with smooth muscle cells (H&E stain, 200×) are visible.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry study (E and F) showing strongly positive staining for actin (E) and negative for CD117, with positive mast cells as internal control, confirming the diagnosis of leiomyoma (F) (400×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Ruiz-Fernández, Daniel Fernández-Martínez, Iván Fernández-Vega" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Raquel" "apellidos" => "Ruiz-Fernández" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Fernández-Martínez" ] 2 => array:2 [ "nombre" => "Iván" "apellidos" => "Fernández-Vega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775324003671" "doi" => "10.1016/j.medcli.2024.04.034" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775324003671?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624004637?idApp=UINPBA00004N" "url" => "/23870206/unassign/S2387020624004637/v1_202410210424/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Medical-legal aspects in infectious diseases" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Robert Güerri-Fernández, Josep Benet, César Vargas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Robert" "apellidos" => "Güerri-Fernández" "email" => array:1 [ 0 => "Robert.guerri@comb.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Josep" "apellidos" => "Benet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "César" "apellidos" => "Vargas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Medicina Legal, Colegio Oficial de Médicos de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aspectos medicolegales en las enfermedades infecciosas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infectious diseases are a major public health problem, causing millions of deaths and illnesses each year.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In addition to the undoubted clinical impact, they can also raise complex legal issues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">When considering the medico-legal aspects of infectious diseases, the spectrum is broad and does not only include the actions of the health care professional. Indeed, one of the most important aspects is that of public health and the difficult balance with individual autonomy.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Measures to preserve public health may collide with the individual's right to make their own decisions about their health care. This has been highlighted during the SARS-CoV-2 pandemic, which has shown the importance of the legal-health aspects of infectious diseases, especially when it comes to global health.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> In recent years, we have seen authorities take exceptional measures in the context of public health emergencies. In some countries, movement rights have been restricted, and obligations have been imposed, such as, for example, vaccination.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Indeed, in many countries, the law itself can give authorities the power to act over individual rights with the ultimate aim of protecting the general population from the spread of an infectious disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At the other end of the spectrum is medical malpractice in everyday clinical practice and how this can be the subject of claims. Medical malpractice claims in the context of infectious diseases are an important area of clinical practice, as they can be made against healthcare professionals, but also against institutions that fail to respond adequately to the challenge of a potentially preventable adverse event, such as a nosocomial infection.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In infectious diseases, medical actions can have serious consequences for patients. Thus, delays in diagnosis leading to serious sequelae or death, the use of inappropriate treatment or the use of excessive or inadequate tests may be grounds for a claim.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Some of these situations are preventable and therefore the professional himself may be liable. On other occasions, however, the infectious causes of morbidity and mortality in patients are not easily controllable and do not depend directly on the healthcare professional but may be the responsibility of healthcare institutions. A healthcare-associated infection associated with surgery, such as orthopaedic surgery or other procedures, may not be as easily preventable and therefore the legal implications may be more difficult to define.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The medico-legal aspects of infectious diseases are therefore complex and increasingly challenging. They range from balancing individual rights, public health and resource allocation to direct action by physicians.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this review is to analyse what is the reality in the field of infectious diseases, which gives rise to claims and therefore has legal implications.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Healthcare-associated infections</span><p id="par0035" class="elsevierStylePara elsevierViewall">Healthcare-associated infections (HAIs) refer to nosocomial or hospital-acquired infections occurring within 48 h of first admission, 3 days after discharge and 30 days after invasive procedures such as surgery, but also institutionalised patients in nursing homes, patients receiving healthcare on an outpatient basis (e.g. haemodialysis, day hospital, chemotherapy…).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> As healthcare services become more accessible and the number of patients undergoing invasive procedures increases, so does the risk of HAIs. Moreover, this risk can lead to complications and, consequently, to claims for damages caused to the patient. These claims, which include damage claims and allegations of medical negligence, have been steadily increasing in recent years.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">However, there are doubts as to who is responsible for the acquisition of these infections. Healthcare facilities have infection control services and active epidemiological surveillance is carried out to prevent, detect and control outbreaks of complex microorganisms. These are more likely to occur in situations with a high aggregation of sick people and with regular use of broad-spectrum antibiotics that put pressure on the environmental flora, facilitating the creation of reservoirs of multidrug-resistant bacteria.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">When a patient contracts a HAI, it results in a longer hospital stay and a longer delay in recovery from the condition that caused the patient to be admitted, all of which can lead to a worse prognosis.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A clear risk situation is where the infection can be shown to be the result of poor hygiene or malpractice by healthcare staff. This case is mainly circumscribed in the area of patient safety and quality of care. In Spain, this is covered by patients' rights and most health centres have committees to monitor these aspects. In addition, hospitals in Spain are required to report cases of healthcare-associated infections and there are specific regulations for the prevention and control of these infections.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–19</span></a> If a hospital does not comply with these obligations, it could face legal consequences.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Another relevant area within HAIs is the rigorous implementation of antisepsis protocols in surgical contexts, as this is a critical element in the nosocomial infection control strategy, contributing significantly to the improvement of healthcare quality indicators and safeguarding patient safety.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,14</span></a> Non-compliance with these established guidelines can have serious legal consequences for the professionals and institutions involved. Strict adherence to antibiotic administration times prior to surgery and repeated doses if surgery is prolonged are important considerations and common sources of error. Non-compliance with this protocol has direct consequences for the physician and also for the hospital itself, which is ultimately responsible for the safety of the patient.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,14,17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In any case, it is important to note that each case is unique and the legal implications will vary depending on the specific circumstances.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Acute infections. Legal consequences of delayed diagnosis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Severe acute infections are challenging both in terms of diagnosis and clinical management. And because of the sometimes-unfavourable outcomes, they are a common cause of litigation.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,20</span></a> In fact, they are a frequent cause of legal action against health care professionals. In this area, misdiagnosis and delayed diagnosis are the two main causes of claims, which are sometimes not easily preventable. Among these serious acute infections, septic shock in any of its forms is the most serious because of its sudden onset and consequences. Septic shock is the organ dysfunction caused by infection, sometimes without symptoms.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The clinical manifestation is refractory hypotension leading to tissue hypoperfusion and, consequently, multi-organ failure and, in a significant number of cases, death.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Early diagnosis with subsequent control of the focus of infection and appropriate empirical antibiotic treatment is essential to improve the prognosis. However, delay in diagnosis often implies a poor prognosis.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Medical errors occur when the practitioner fails to follow an appropriate standard of care according to clinical guidelines and also underestimates the severity of the problem, resulting in harm to the patient.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a> In this context, both diagnostic error and delayed diagnosis can be a form of negligence, especially if it leads to inappropriate or delayed treatment that results in a worsening of the patient's condition or a worsening of the patient's prognosis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> A paradigmatic case, which in addition has an element of legal claims against professionals, is necrotising fasciitis.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a> It is an acute form of infection that rapidly progresses to septic shock and muscle destruction, which can cause death within hours or leave irreparable damage. Necrotising fasciitis is a case in point, as both late or misdiagnosis and lack of appropriate and comprehensive treatment (from antibiotics to urgent surgery) can lead to high morbidity and mortality, with severe sequelae or death.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,27</span></a> This infection, because of its similarity in its early stages to the symptoms of less serious infections, such as cellulitis, clearly increases the risk of misdiagnosis or late diagnosis, with the above consequences.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Legal consequences of inappropriate treatment</span><p id="par0075" class="elsevierStylePara elsevierViewall">Inadequate treatment of infectious diseases, whether through incorrect choice of antimicrobials, inappropriate dosing or inadequate clinical follow-up, can also have serious legal consequences.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Many centres have implemented antimicrobial use optimisation programmes. These are multidisciplinary teams that recommend and optimise the antimicrobial regimen taking into account clinical, microbiological and pharmacological data. These teams assist in the treatment of infections by helping to tailor antibiotic treatment. Although their recommendations are not binding and it is up to the treating physician to decide whether or not to adjust the antibiotic regimen, their recommendations are very useful both clinically and as legal support in the event of a claim.</p><p id="par0080" class="elsevierStylePara elsevierViewall">All this, moreover, must be put in the current context as increasing resistance to first-line antimicrobials makes it necessary to tailor empirical antibiotic treatment to the likely ecology of the environment. This can ultimately be a source of error. Clinical guidelines sometimes suggest strategies that may be outdated in settings where the local ecology is different. For example, there are areas with high rates of quinolone or beta-lactam resistance in urinary tract Enterobacteriaceae infection.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In this case, empirical treatment following clinical guidelines may be inadequate due to lack of microbiological coverage. This may worsen the prognosis. Thus, when choosing the most appropriate treatment, clinical guidelines and recommendations should be taken into account, but the local ecology should also be known. The choice of the right treatment will be a balance between considering the worst-case scenario and the most appropriate type of therapy.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28–30</span></a> Therefore, the clinician must not only be up to date on clinical guidelines, but his or her knowledge must be adapted to the local reality. This makes it all the more difficult to consider where the line of malpractice lies when it comes to empirical therapy. In any case, it is essential to establish local epidemiological surveillance systems and local recommendations to prevent these errors and avoid potential malpractice litigation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Liability for lack of follow-up and prevention</span><p id="par0085" class="elsevierStylePara elsevierViewall">Legal liability may also arise from the lack of adequate follow-up in patients with infectious diseases. Infectious diseases are dynamic conditions that sometimes require close monitoring and the ability to adjust initiated antimicrobial therapy based on microbiological findings.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28,30</span></a> This is of legal relevance, as the prognosis of an infection can be significantly worsened if the empirical treatment initiated is not adjusted, either because of the risk of treatment failure or because of the adverse effects of antibiotic treatment.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,29</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Another aspect that also deserves consideration is the possibility of preventing infections through actions such as vaccination or post-exposure prophylaxis. In the event of a biological exposure incident, appropriate means must be in place to prevent the transmission of preventable infections. Examples such as HIV infection, hepatitis B or even <span class="elsevierStyleItalic">Clostridium tetani</span> infection are entities where means of passive immunisation or post-exposure treatment are available. Early warning and treatment circuits should be in place for potential exposure to these or other potentially preventable agents.</p><p id="par0095" class="elsevierStylePara elsevierViewall">On the other hand, vaccination is a useful tool in preventing severe forms of a wide range of infections that can affect both healthcare workers who contract them from sick patients and vice versa. Institutions should provide adequate means to prevent this. Healthcare workers should be adequately vaccinated and surveillance for outbreaks of communicable infections should be vigilant. Lack of diligence in both scenarios may lead to an increased risk of developing disease or significantly worsen the prognosis due to, for example, concurrent immunosuppression.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Implications of clinical decisions in the legal context</span><p id="par0100" class="elsevierStylePara elsevierViewall">The current legal environment emphasises the importance of informed, evidence-based clinical decision-making. Health professionals should be familiar with clinical practice guidelines and recommendations based on the best available evidence to effectively manage infectious diseases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,20,26,31</span></a> The importance of tailoring clinical guidelines to the local ecology has already been mentioned, but it is also important to tailor diagnostic and therapeutic interventions to clinical guidelines. This will ultimately provide legal protection in the event of an untoward event. Detailed documentation of clinical decisions and patient interactions can be critical in defending against malpractice claims.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Infectious disease transmission among healthcare workers - Legal implications</span><p id="par0105" class="elsevierStylePara elsevierViewall">The transmission of infections between healthcare workers and patients poses a real clinical and legal challenge and risk in the hospital setting. On the one hand, health care workers are exposed to infectious agents in their daily practice, which can lead to infections that not only affect their health, but can also be transmitted to hospitalised patients, which can be particularly serious in the case of immunocompromised individuals. Nosocomial transmission of these infections can lead to serious complications in patients, prolong hospital stays and increase morbidity and mortality. All of this creates a clear legal risk, as both centres and professionals can be held liable if there is evidence of negligence in implementing appropriate preventive measures that may jeopardise patient safety.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Recent case-law has shown an increase in the number of cases in which patients sue healthcare institutions for infections acquired during their stay in hospital. This underlines the need for clear and strict policies to protect both healthcare workers and patients. Similarly, healthcare facilities have a duty not only to provide adequate personal protective equipment (PPE), but also to provide preventive measures such as vaccination. These strategies are essential to reduce the risk of two-way transmission of infections.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Mandatory use of PPE and vaccination of healthcare workers have been shown to be effective in reducing the transmission of infections. However, the implementation of these measures is not always consistent. Some argue that mandatory vaccination may violate individual rights, while others argue that it is a necessary measure for collective safety. In healthcare settings where staff deal with potentially immunocompromised people, it should be part of the professional code of ethics to use all possible means (and vaccination is one of them, and a very effective one) to protect the safety of patients.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally, it is necessary to promote ongoing education and training in safe and up-to-date practices for all healthcare workers, ensuring that they are well informed about risks and preventive measures.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Challenges and strategies to minimise legal risk</span><p id="par0125" class="elsevierStylePara elsevierViewall">To minimise the legal risk associated with the misdiagnosis and treatment of infectious diseases, physicians should adopt several strategies. These include ongoing education to keep abreast of advances in the diagnosis and treatment of the most common entities. Use of advanced diagnostic technologies, where available, and effective communication with patients about the risks and benefits of treatment options. Interdisciplinary collaboration and consultation with infectious disease specialists can improve diagnostic accuracy and treatment efficacy.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In summary, infectious diseases pose a challenge to clinicians as it is essential to get the diagnosis and treatment right to ensure the patient's recovery and avoid potential legal issues. Entities such as necrotizing fasciitis or septic shock illustrate the difficulty of treating these conditions correctly and the legal issues that can arise if this is not done properly. It is key to follow clinical guidelines, but also to adapt them to specific circumstances such as local ecology or antibiotic resistance. In addition, effective communication with patients and staying abreast of the latest medical advances are essential steps to successfully managing these increasingly complex diseases and avoiding legal ramifications for misdiagnosis or delays in treatment.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ethical considerations</span><p id="par0135" class="elsevierStylePara elsevierViewall">This manuscript does not discuss patients or share patient data. Informed consent was not required.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">This manuscript has not received funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2283888" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1900083" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2283889" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1900082" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Healthcare-associated infections" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Acute infections. Legal consequences of delayed diagnosis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Legal consequences of inappropriate treatment" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Liability for lack of follow-up and prevention" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Implications of clinical decisions in the legal context" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Infectious disease transmission among healthcare workers - Legal implications" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Challenges and strategies to minimise legal risk" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Ethical considerations" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-03-28" "fechaAceptado" => "2024-06-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1900083" "palabras" => array:3 [ 0 => "Infectious diseases" 1 => "Legal aspects" 2 => "Clinical guidelines" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1900082" "palabras" => array:3 [ 0 => "Enfermedades infecciosas" 1 => "Aspectos legales" 2 => "Guías clínicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This article reviews the medico-legal aspects associated with infectious diseases, highlighting their complexity and the challenges they pose. Infectious diseases cause not only an increase in morbidity and mortality in the healthcare setting but also involve complex legal issues. Healthcare-Associated Infections (HAIs) represent a growing risk with the increase in invasive procedures and can lead to patient complications and legal claims against healthcare professionals and institutions. The consequences of medical malpractice in this context are discussed, such as diagnostic delays, inappropriate use of treatments, and lack of adequate testing, which can have serious sequelae or even result in the patient's death.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The review focuses on highlighting the importance of prevention, considering that healthcare-associated infections can be difficult to avoid, posing complex legal challenges.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">It concludes that managing infectious diseases and their legal consequences requires careful consideration of clinical practice guidelines, prevention and control strategies, and effective communication with patients. An integrated and evidence-based approach is advocated to address these challenges, emphasizing continuous education, the use of advanced diagnostic technologies, and interdisciplinary collaboration.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Este artículo revisa los aspectos médico-legales asociados a las enfermedades infecciosas, destacando la complejidad y los desafíos que plantean. Las enfermedades infecciosas causan no solo aumento de la morbilidad y mortalidad en el entorno sanitario sino también implican complejas cuestiones legales. Las Infecciones Relacionadas con la Atención Sanitaria (IRAS) representan un riesgo creciente con el aumento de procedimientos invasivos y pueden dar lugar a complicaciones para el paciente y reclamaciones legales contra profesionales e instituciones sanitarias. Se discuten las consecuencias de la mala praxis médica en este contexto, como el retraso diagnóstico, el uso inadecuado de tratamientos y la falta de pruebas adecuadas, que pueden tener graves secuelas o incluso resultar en la muerte del paciente.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La revisión se centra en señalar la importancia de la prevención teniendo en cuenta que las infecciones relacionadas con la atención sanitaria, pueden ser difíciles de evitar, planteando desafíos legales complejos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se concluye que el manejo de las enfermedades infecciosas y sus consecuencias legales requiere una consideración cuidadosa de las guías de práctica clínica, las estrategias de prevención y control, y una comunicación efectiva con los pacientes. Se aboga por un enfoque integrado y basado en la evidencia para enfrentar estos desafíos, enfatizando la educación continua, el uso de tecnologías diagnósticas avanzadas, y la colaboración interdisciplinaria.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Projections of global mortality and burden of disease from 2002 to 2030" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.D. Mathers" 1 => "D. 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