مجله پزشکی قانونی
سال شانزدهم شماره 3 (پیاپی 59، پاییز 1389)

Ethical competency is one of the most important aspects of qualification in the nursing profession. In spite of the consensus over its importance, findings of the relevant studies show that there are many problems in the way of defining this concept. The aim of this study is description and expression of perception of nursing teachers about nursing students’ professional ethical competency. For this qualitative study, twenty teachers from Tehran nursing faculties were selected purposively. The data were gathered by employing semistructured interviews. The interviews were verbatim transcribed and analyzed according to the qualitative content analysis based on Graneheim and Lundman method. The analysis of data demonstrated five main categories about structure of nursing students’ professional ethical competency include: Individual characteristics and believes, theoretical knowledge and practical skills, holistic view on patient, ability to critical thinking and decision making, employing proper humanitarian relations. The results of this research could be useful in development of nursing educational programs. Paying attention to these dimensions of professional ethical competency can enhance the quality of nursing care. Also can prevent medical care errors and guarantee patients’ rights.

This study aimed at comparing patients with and without compensation claim with respect to the presence of mental disorders as a result of a follow-up study four months post traumatic brain injury (TBI). Overall, 238 TBI patients (43 females and 195 males), were chosen by nonprobability and consecutive sampling in the form of a descriptive-longitudinal study; each of whom, underwent neurosurgical examinations. Then, their demographic data were collected after obtaining written consent form. After 4 months follow-up, 65. 1٪ (155 cases) of patients referred to a psychiatrist to determine mental disorders due to TBI using a structured clinical interview based on DSM-IV diagnostic criteria. Out of 155 followed-up patients, 92 cases were still claiming compensation due to TBI incident and 47 cases were not interested in litigation and information of other 16 patients were unspecified. Also, 66 complained and 37 noncomplained patients (71. 7٪ and 78. 7 ٪, respectively) demonstrated post-TBI mental disorders 4 months post injury. The results of Chi-square test showed no significant difference between the two groups (with and without compensation claim), considering presence of mental disorders resulting from TBI, even after controlling for TBI severity and the level of overall disability due to TBI. The high frequency of mental disorders in the acute phase following TBI, along with many novel cases of personality changes, mood and anxiety disorders are evident; though meanwhile, no significant differences are observed in complained and noncomplained patients in terms of mental disorders 4 months after TBI.

Based on World Health Organization (WHO) report, 1. 3 million deaths per year in the world are due to traffic accidents. Without a care, it is expected that any number of injuries and deaths resulted from traffic accidents would rise by 65٪ and 80٪ respectively till year 2020. Data from WHO reveals that Iran has one of the highest mortality rates from traffic accidents in the world. The aim of this study is assessment of traffic accident rates and related factors in professional drivers of heavy Vehicles. This study is a cross sectional descriptive- analytic survey. 1136 professional heavy vehicle drivers had come to one of driver’s periodic examination centers in city of Yazd included in the study. Required data such as history of traffic accident, age, driving experience, weekly work hours and etc was collected through a questionnaire. The rate of reported accidents in one year was 7. 7٪. The findings showed that there is a significant relationship between factors such as age, body mass index, work hours, shiftworks and traffic accidents (P < 0. 05٪). Second job, chronic illnesses, and driving experience had no significant relationship with traffic accidents (P > 0. 05٪). Even after adjustment of study variables by regression analysis, again significant relationship between weekly work hours, body mass index, and age over 60 and under 29 and traffic accidents was found (P < 0. 05٪). Because of increased risk of traffic accidents, related to the age over 60, it seems that decreasing professional drivers work hours after this age may reduce traffic accidents. Also, advice and supervision on reduction of drivers’ weekly work hours could lead to traffic accidents decrement.

In recent decades, health care policy makers and even general population have seriously paid attention to disclosure of medical errors (DME). However, the authors of this study didn’t find any study of this field in Iran. The aim of this study was the assessment of physicians and residents attitude about DME. In this cross-sectional study, 107 physicians and residents of surgical and internal specialty of Imam Khomeini hospital in Tehran were randomly selected. Goals of study were explained to participants. Then, any participants filled a questionnaires containing of demographic data (age, sex and specialty) and medical errors (amount of any types of medical error per year that occurred by them) and questions about their attitude of medical errors disclosure. Median (quartile 25٪-75٪) of major, minor and near miss medical errors occurred per year were 0 (0-1), 2 (0-4) and 1. 5 (0-3), respectively. Disclosure of major, minor and near miss medical errors have been approved by (77٪), (53٪) and (44٪) of participants, respectively. 83٪ of participants displayed that disclosure of medical errors to patient, by her/his doctor, is very difficult. “Patients litigation due to DME by her/his doctor” (50٪) was The most common cause of difficulty of DME. Ninety percent of participants knew medical error disclosure as one of the main challenges of health care system and revealed that creation of a comprehensive system to promote DME is essential. Major medical errors have been occurred by females were significantly higher than males (0. 94 Vs. 0. 79, P=0. 043) and by residents were significantly higher than physicians (1. 06 Vs. 0. 63, P=0. 019). The findings of this study showed that although the majority of participants approved DME, ninety percent of them still knew DME as one of the main challenges of health care system and revealed that creation of a comprehensive system promote DME is essential. These results indicate that nowadays DME process requires serious attention of policymakers in health care system, in Iran.

The purpose of this study is to investigate the referral process of cases requesting Sex Reassignment Surgery in Tehran legal medicine center according to the international standards. This study has been performed as a research during one year. Within a descriptive cross sectional study, 129 files which all of them have been given surgery permission, have been studied in Tehran legal medicine center since 2004 until 2008. A checklist of criteria was made by researchers according to DSM-IV-TR criteria and Harry Benjamin international gender dysphoria association (HBIGDI) for evaluation of research variables. The ethical permission was given to the researchers by LMO. In this case 52. 7٪ of files have been female that this rate is not similar to other international research fingings. Regarding to the main research variables (diagnostic situation, psychological intervention, real life opposite sex role, hormonal tests), descriptive results show that only 27. 13 ٪ of cases are in agreement with the standards and hypothesis of this study. Therefore, the hypothesis of this study based on all cases of non-complinace with the international standards were confirmed (P<0. 01). Regarding to low level compliance of patients’ therapies process with international standards and lack of sufficient real life in opposite sex role, it is necessary to attend to all of therapeutically process. Most of these real life problems are related to cultural situations in social acceptance of GID cases and need more suitable ground for enhancing.

We reviewed the laws and regulations in Iran for the management of medical misconducts and complaints. We aimed to determine a comprehensive view of the laws, as well as their potential weaknesses and strengths relevant to health system stewardship. we reviewed five scientific databases and two related websites using keywords. As a result, ten Parliamentary Acts, two regulations adopted by the Cabinet, six related organization, and thirteen books and papers were identified and retrieved. Two reviewers used content analysis approaches to analyze and categorize the issues extracted from and the laws and documents. We benefited from the advice of nine experts in this process. Other sources of data were used for complementing discussion. Retrieved laws and regulations were classified into five groups based on five law violation behaviors: administrative,’taazirat’, insurance, professional and criminal. For each group, examples of violation, enforcing organizations and the groups covered by law were introduced. Various aspects of medical practice are covered by the law and related punishments are established in legal system of Iran. There are weaknesses and overlaps in definitions, classifications and legislations about violation of the law. Examples include ambiguity in defining medical crimes, ambiguity in insurance fraud, and limitation in deterrent power of these laws.

Coronary artery anomalies are rare congenital disorders. These anomalies sometimes Result in sudden death in the young, particularly, in athletic field. In this report a 17 years old male is presented with acute severe epigastric pain at rest. He died before he was taken to hospital. Postmortem examination and forensic autopsy revealed congenital anomaly of coronary artery as the main cause of death. evaluation of sudden death in young adult (at rest and / or particularly in physical effort), coronary artery anomalies must be evaluated in examination of the heart.