Cultura

The Philosophy of the Burden of Proof in Medical Liability for The Harm Caused to the Unborn: Conversation With Experts as an Epistemological Paradigm of Judicial Assessment

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

José López-Oliva
Profesor asociado Universidad Militar Nueva Granada, sede Bogotá, Colombia.
Fernando Luna-Salas
Profesor de Planta e investigador Universidad de Cartagena, Colombia.
Andrea Alarcón-Peña
Profesora asociada Universidad Militar Nueva Granada, sede Bogotá, Colombia.

Abstract

The traditional conception of evidence attributed paramount importance to expert opinions as the primary mechanism for incorporating specialized knowledge into the judicial process. However, the jurisprudential evolution of the Colombian high courts has fostered the recognition of expert consultation as a tool aimed at complementing and clarifying technical issues relevant to the judicial decision. Although this does not constitute an independent means of proof, its function is to provide specialized elements that allow the judge to better understand the scientific context of the litigation and to more rigorously assess other evidence. This transformation in evidentiary philosophy is especially relevant in medical liability cases, particularly those arising from obstetric care, where scientific literature has highlighted the complexity of determining the nature of perinatal neurological injuries and establishing the causal link between medical intervention and the alleged harm. In these types of disputes, the judicial decision requires a critical and integrated assessment of the available scientific evidence, through the adoption of the preponderance of the evidence, rather than relying exclusively on the opinion of a single expert.

Keywords : Evidence, expert consultation, expert testimony, damage, causal link..
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty