<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902021000301501</article-id>
<article-id pub-id-type="doi">10.29193/rmu.37.3.9</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Homicidios intencionales en la salud. Un tema huérfano de la seguridad asistencial]]></article-title>
<article-title xml:lang="en"><![CDATA[Intentional homicides in health. An ignored topic in healthcare security]]></article-title>
<article-title xml:lang="pt"><![CDATA[Homicídios dolosos em saúde. Uma questão órfã de segurança de saúde]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vivas]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bagnulo]]></surname>
<given-names><![CDATA[Homero]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Servicio Médico Integral  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Maciel  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2021</year>
</pub-date>
<volume>37</volume>
<numero>3</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902021000301501&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902021000301501&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902021000301501&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Los homicidios intencionales cometidos por los trabajadores sanitarios durante el desempeño de sus tareas son eventos muy poco frecuentes. Su importancia reside en que a través de su análisis se exponen las debilidades estructurales y funcionales de los sistemas de salud. Sus efectos nocivos no se limitan a las víctimas y sus familias, sino que resulta dañada la confiabilidad del sistema sanitario en su conjunto. El presente artículo resume las características de estos ataques, haciendo énfasis en las estrategias de la seguridad asistencial que pueden interceptar a los ofensores.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Intentional homicides committed by health workers in the course of their duties are very rare events. Its importance resides in the fact that the structural and functional weaknesses of health systems are exposed through its analysis. Moreover, their harmful effects are not limited to the victims and their families, since the reliability of the health system as a whole is damaged. This article summarizes the characteristics of these attacks, emphasizing the strategies of healthcare security that can intercept offenders.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: Homicídios dolosos cometidos por profissionais de saúde no exercício de suas funções são eventos muito raros. A sua importância reside no fato de, através da sua análise, expor as fragilidades estruturais e funcionais dos sistemas de saúde. Seus efeitos nocivos não se limitam às vítimas e suas famílias, e faz com que a confiabilidade no sistema de saúde como um todo fique prejudicada. Este artigo resume as características desses ataques, enfatizando as estratégias de segurança da saúde que podem interceptar os infratores.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Asesinato en serie sanitario]]></kwd>
<kwd lng="es"><![CDATA[Homicidio]]></kwd>
<kwd lng="es"><![CDATA[Personal de salud]]></kwd>
<kwd lng="es"><![CDATA[Daño intencional]]></kwd>
<kwd lng="es"><![CDATA[Seguridad del paciente]]></kwd>
<kwd lng="es"><![CDATA[Medidas de seguridad]]></kwd>
<kwd lng="en"><![CDATA[Healthcare serial murder]]></kwd>
<kwd lng="en"><![CDATA[Homicide]]></kwd>
<kwd lng="en"><![CDATA[Health personnel]]></kwd>
<kwd lng="en"><![CDATA[Intentional damage]]></kwd>
<kwd lng="en"><![CDATA[Patient safety]]></kwd>
<kwd lng="en"><![CDATA[Security measures]]></kwd>
<kwd lng="pt"><![CDATA[Assassinato em série na área de saúde]]></kwd>
<kwd lng="pt"><![CDATA[Homicídio]]></kwd>
<kwd lng="pt"><![CDATA[Pessoal de saúde]]></kwd>
<kwd lng="pt"><![CDATA[Segurança do paciente]]></kwd>
<kwd lng="pt"><![CDATA[Medidas de segurança]]></kwd>
<kwd lng="pt"><![CDATA[Danos intencionais]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lubaszka]]></surname>
<given-names><![CDATA[CK]]></given-names>
</name>
<name>
<surname><![CDATA[Shon]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reconceptualizing the notion of victim selection, risk, and offender behavior in healthcare serial murders]]></article-title>
<source><![CDATA[J Crim Psychol]]></source>
<year>2013</year>
<volume>3</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>65-78</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lubaszka]]></surname>
<given-names><![CDATA[CK]]></given-names>
</name>
<name>
<surname><![CDATA[Shon]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Hinch]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Healthcare serial killers as confidence men]]></article-title>
<source><![CDATA[J Investig Psych Offender Profil]]></source>
<year>2014</year>
<volume>1</volume>
<page-range>1-28</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="">
<collab>The Long-Term Care Homes Public Inquiry</collab>
<article-title xml:lang=""><![CDATA[Expert report on safety and security of residents in the long-term care homes system]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yorker]]></surname>
<given-names><![CDATA[BC]]></given-names>
</name>
</person-group>
<source><![CDATA[]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ontario ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="">
<collab>The Joint Commission</collab>
<article-title xml:lang=""><![CDATA[Summary data of sentinel events reviewed]]></article-title>
<source><![CDATA[]]></source>
<year>2021</year>
<publisher-loc><![CDATA[Oakbrook Terrace (IL) ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sackman]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Vecchione]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Shmetterer]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Behind the murder curtain]]></source>
<year>2018</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Post Hill]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="">
<article-title xml:lang=""><![CDATA[Niels Högel: German ex-nurse convicted of killing 85 patients]]></article-title>
<source><![CDATA[BBC News]]></source>
<year>2019</year>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<collab>United Kingdom. Department of Health</collab>
<article-title xml:lang=""><![CDATA[The shipman inquiry: the final report]]></article-title>
<source><![CDATA[]]></source>
<year>2005</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wolf]]></surname>
<given-names><![CDATA[ZR]]></given-names>
</name>
<name>
<surname><![CDATA[Donohue-Smith]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Wolf]]></surname>
<given-names><![CDATA[KC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nurses who murder or who are accused of murder]]></article-title>
<source><![CDATA[Int J Hum Caring]]></source>
<year>2019</year>
<volume>23</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>51-70</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sackman]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Vecchione]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Shmetterer]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Behind the murder courtain]]></source>
<year>2018</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Post Hill]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sackman]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[When the ICU becomes a crime scene]]></article-title>
<source><![CDATA[Crit Care Nurs Q]]></source>
<year>2015</year>
<volume>38</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>30-5</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yorker]]></surname>
<given-names><![CDATA[BC]]></given-names>
</name>
<name>
<surname><![CDATA[Kizer]]></surname>
<given-names><![CDATA[KW]]></given-names>
</name>
<name>
<surname><![CDATA[Lampe]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Forrest]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Lannan]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Russell]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Serial murder by healthcare professionals]]></article-title>
<source><![CDATA[J Forensic Sci]]></source>
<year>2006</year>
<volume>51</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>136-271</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<collab>Gillesse EE</collab>
<article-title xml:lang=""><![CDATA[Report of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System. A systemic inquiry into the offences]]></article-title>
<source><![CDATA[]]></source>
<year>2019</year>
<publisher-loc><![CDATA[Ontario ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yorker]]></surname>
<given-names><![CDATA[BC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The legal side: nurses accused of murder]]></article-title>
<source><![CDATA[Am J Nurs]]></source>
<year>1988</year>
<volume>88</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1327-32</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Johnstone]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Katz]]></surname>
<given-names><![CDATA[RL]]></given-names>
</name>
<name>
<surname><![CDATA[Stanley]]></surname>
<given-names><![CDATA[TH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Homicides using muscle relaxants, opioids, and anesthetic drugs: anesthesiologist assistance in their investigation and prosecution]]></article-title>
<source><![CDATA[Anesthesiology]]></source>
<year>2011</year>
<volume>114</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>713-6</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Farrell]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Health-care serial poisoning]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Farrell]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<source><![CDATA[Criminology of serial poisoners]]></source>
<year>2018</year>
<page-range>93-114</page-range><publisher-name><![CDATA[Palgrave Macmillan]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Graeber]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[The good nurse: a true story of medicine, madness, and murder]]></source>
<year>2013</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Hachette Book Group]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Field]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Pearson]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caring to death: the murder of patients by nurses]]></article-title>
<source><![CDATA[Int J Nurs Pract]]></source>
<year>2010</year>
<volume>16</volume>
<page-range>301-9</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Beine]]></surname>
<given-names><![CDATA[KH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Homicides of patients in hospitals and nursing homes: a comparative analysis of case series]]></article-title>
<source><![CDATA[Int J Law Psychiatry]]></source>
<year>2003</year>
<volume>26</volume>
<page-range>373-86</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yardley]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Wilson]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[In search of the 'Angels of Death': conceptualising the contemporary nurse healthcare serial killer]]></article-title>
<source><![CDATA[J Investig Psych Offender Profil]]></source>
<year>2016</year>
<volume>13</volume>
<page-range>39-55</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Henriksen]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Dayton]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Organizational silence and hidden threats to patient safety]]></article-title>
<source><![CDATA[Health Serv Res]]></source>
<year>2006</year>
<volume>41</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1539-54</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bagnulo]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Vivas]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[¿Cómo evitar que se repita?]]></article-title>
<source><![CDATA[Arch Med Interna]]></source>
<year>2012</year>
<volume>34</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>65-6</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martin]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ozieranski]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Willars]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Charles]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Minion]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[McKee]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Walkrounds in practice: corrupting or enhancing a quality improvement intervention?]]></article-title>
<source><![CDATA[Jt Comm J Qual Patient Saf]]></source>
<year>2014</year>
<volume>40</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>303-10</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bal]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[David]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Sellier]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[François]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intérêt des revues de mortalité et de morbidité pour la formation des médecins et l'amélioration de la qualité et de la sécurité des soins: revue de la littérature]]></article-title>
<source><![CDATA[Presse Med]]></source>
<year>2010</year>
<volume>39</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>161-8</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[de Wet]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bowie]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records]]></article-title>
<source><![CDATA[Postgrad Med J]]></source>
<year>2009</year>
<volume>85</volume>
<numero>1002</numero>
<issue>1002</issue>
<page-range>176-80</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wolf]]></surname>
<given-names><![CDATA[ZR]]></given-names>
</name>
<name>
<surname><![CDATA[Hughes]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Best practices to decrease infusion-associated medication errors]]></article-title>
<source><![CDATA[J Infus Nurs]]></source>
<year>2019</year>
<volume>42</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>183-92</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[Medication safety in high-risk situations. Technical Report]]></source>
<year>2019</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Greenall]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<collab>The Long-Term Care Homes Public Inquiry</collab>
<source><![CDATA[Expert report on safety and security of medication use process in residents in the long-term care homes system]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ontario ]]></publisher-loc>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
