On the Necessity of Ethical Guidelines for Novel Neurotechnologies.

Because novel neurotechnologies may alter human identity and society in profound ways, we advocate for the early integration of ethics into neurotechnology. We recommend developing and adopting a set of guidelines, like the Belmont Report on human subject research, as a framework for development and use of brain-related technologies.

[Assessment of ability to drive in patients with MCI and dementia]. / Beurteilung der Fahrtauglichkeit bei Patienten mit MCI und demenziellen Syndromen.

People with mild cognitive impairment and dementia are a frequent and continuously increasing patient group in practically all fields of medicine. The associated challenges involve nearly all areas of life in addition to the direct medical treatment. Assessment of the ability to drive in patients with cognitive deficits is becoming increasingly more important. What are the options available to physicians in order to make a valid assessment? Which legal aspects must be taken into consideration? Which rights and obligations arise from the framework conditions? These questions nowadays give rise to great uncertainty for many medical personnel; however, the increasing importance of these problems necessitates a clear procedure, which allows difficult decisions to be made with utmost sovereignty and legal certainty and to be able to give patients and relatives a plausible explanation. Because age is a substantial risk factor for the development of cognitive disorders, the question of the ability to drive is affected not only by neuropsychiatric diseases, such as mild cognitive disorders or dementia but also the frequently occurring somatic comorbidities. Estimation of the ability to drive is therefore a complex approach, which should be standardized in order to appreciate all relevant aspects. It would be desirable to have a practice-oriented algorithm, the formulation of which is the aim of this article. Additionally, we would like to make a contribution to road safety and make medical personnel fully aware of this topic.

Medical devices; neurological devices; classification of the neuropsychiatric interpretive electroencephalograph assessment aid. Final order.

The Food and Drug Administration (FDA) is classifying the neuropsychiatric interpretive electroencephalograph (EEG) assessment aid into class II (special controls). The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Public policy and headache: observations of health care policy in the US congress from a legislative fellow's perspective.

Many neurologists and headache specialists are befuddled by inside the Beltway wheelings and dealings as they follow health care politics. A few of us join lobbying efforts, and even fewer become strangers in a strange land.

Monitoring the implementation of the State-Regional Council agreement 03/02/2005 as to the management of acute stroke events: a comparison of the Italian regional legislations.

Access to effective acute stroke services is a crucial factor to reduce stroke-related death and disability, but is limited in different parts of Italy. Our study addresses this inequality across the Italian regions by examining the regional legislations issued to adopt and implement the State-Regional Council agreement 03/02/2005 as to the acute stroke management. All decrees and resolutions as to acute stroke were collected from each region and examined by the means of a check list including quantitative and qualitative characteristics, selected in accordance with the recommendations from the State-Regional Council document. Each completed check list was then sent to each regional reference person, who filled in the section on the implementation of the indications and compliance, with the collaboration of stroke specialists if necessary. The study was carried out from November 2009 to September 2010. The documents and information were collected from 19 regions. Our survey revealed disparities both in terms of number of decrees and resolutions and of topics covered by the regional legislations about stroke care. Most legislations lacked practical and economical details. This feedback from national and regional stroke regulations revealed a need of more concrete indications. Involvement of various stakeholders (legislators, consumers, providers) might possibly ensure that policies are actually adopted, implemented and maintained. Although considerable challenges are present to the development of standard and optimal stroke care more widely across Italian regions, the potential gains from such developments are substantial.

When worlds collide: the uncomfortable romance between law and neurology.

Medicolegal work is a mystery to most neurologists. What does it involve? What does the beginner medical expert need to know? Should barristers be feared? This article provides some of the answers.

Automatisms: bridging clinical neurology with criminal law.

The law, like neurology, grapples with the relationship between disease states and behavior. Sometimes, the two disciplines share the same terminology, such as automatism. In law, the "automatism defense" is a claim that action was involuntary or performed while unconscious. Someone charged with a serious crime can acknowledge committing the act and yet may go free if, relying on the expert testimony of clinicians, the court determines that the act of crime was committed in a state of automatism. In this review, we explore the relationship between the use of automatism in the legal and clinical literature. We close by addressing several issues raised by the automatism defense: semantic ambiguity surrounding the term automatism, the presence or absence of consciousness during automatisms, and the methodological obstacles that have hindered the study of cognition during automatisms.

Advance planning in end-of-life care: legal and ethical considerations for neurologists.

Neurological illnesses can leave patients unable to make legally valid decisions about their medical treatment. However, this loss of decision making capacity can often be predicted in advance. The law in the UK now enables patients to make legally binding arrangements to either refuse specific treatments in advance or to appoint others to make decisions on their behalf. This article discusses the mechanics of advance planning under UK law and the role of the neurologist in helping patients to plan ahead.

[Medico-legal assessment in civil lawsuits in patients with neurological disorders in the case material of the Forensic Medicine Department, Medical University of Bialystok, in the years 2004-2008]. / Opiniowanie w postepowaniu cywilnym u osób ze schorzeniami neurologicznymi w materiale Zakladu Medycyny Sadowej UM w Bialymstoku w latach 2004-2008.

Opinionating in civil proceeding is difficult and carries much responsibility, especially in the period of increasing claiming for damages. The authors analyzed civil opinions issued by the Forensic Medicine Department, Medical University of Bialystok, in the years 2004-2008. The above-mentioned opinions addressed neurologic diseases and symptoms. The victims were invited to the Department for examinations which were performed by a forensic medicine expert and a neurologist, alternatively also by other specialists depending on the reported ailments. The paper presents an analysis of the victims' age and sex, type of the event, injuries and ailments, duration of physical and mental suffering, percentage of health impairment. The study comprised 126 civil opinions issued. Occupationally active persons were predominantly subject to injuries. The most common symptoms reported were headache, vertigo and pain in the C, L-S spine.

[Medical Malpractice in Neurological Diseases].

The results of medical lawsuits in Japan can affect actual clinical settings, and it might be useful to analyze medical lawsuits in order to understand medical issues. Some diseases such as subarachnoid hemorrhage, cerebral infarction treated with thrombolytic therapy and treatable encephalitis could cause problems, which in turn may lead to lawsuits, when the results of treatment for those situations are fatal. In addition, there are cases in which other neurological diseases are related to litigation. Therefore, I scrutinized such cases and suggested useful tips for establishing good relationships between doctors and patients and preventing troubles that could lead to medical lawsuits.

[Neurological expert opinion in occupational disability insurance]. / Nervenärztliche Begutachtung in der Berufsunfähigkeitsversicherung.

An expert opinion on occupational disability insurance is not a common occurrence and because of this represents a challenge for the appointed specialist. The peculiarities of the eligibility requirements for this type of insurance are described in detail in this article, including case examples. Besides the medical considerations, there are detailed, specific occupational aspects which must be considered in order to reach an expert judgment which is comprehensible for both, the contracting party and the claimant.

[Malpractice in neurology in the case material of the Forensic Medicine Department, Medical University of Bialystok]. / Bledy medyczne z zakresu neurologii w materiale Zakladu Medycyny Sadowej UM w Bialymstoku.

The paper presents an analysis of legal opinions compiled by the Forensic Medicine Department, Medical University of Bialystok in the years 2003-2008. The above-mentioned opinions addressed medical treatment in the area of neurology. During this period, opinions were given in 142 cases, the majority of them representing idiopathic diseases (such as strokes, cerebral aneurysms, cerebral infections), followed by falls from high altitudes and traffic road accidents, further followed by fights, medical treatment and work accidents. In sixteen (11.27%) of such cases, the employed medical procedures were found to be incorrect; what might be qualified as medical decisive errors, committed in emergency ambulances or in admission rooms. Incorrect medical treatment consisted in negligence to perform necessary diagnostic examinations. In ten of the analyzed cases, the patients ultimately died.