Medical Action Research Articles

Current Status of Informed Consent Form for Acupotomy in Korean Medicine Hospitals and Development of a Standard Informed Consent Form Using Delphi Method

Objectives: This study was conducted to develop a standard acupotomy consent form that takes into account the unique characteristics of Korean Medicine. The study was motivated by the increasing importance of patient autonomy and the growing number of legal disputes related to medical malpractice in the clinical field of Korean Medicine.Methods: The analysis phase of the study involved a survey of the current status of acupotomy consent forms in Korean Medicine hospitals nationwide. The items of each form were analyzed based on the contents of the Medical law and the standard contract for medical procedures of the Fair Trade Commission (FTC). In the development and evaluation phase, the items and contents of the acupotomy consent form were evaluated using a 5-point Likert scale and content validity was assessed through two rounds of Delphi surveys. In the improvement phase, the contents of the consent form were revised based on the results of a survey of inpatient and outpatient patients in the Department of Acupuncture and Moxibustion at Pusan National University Korean Medicine Hospital, and real-time online meeting. The final version of the standard acupotomy consent form was completed after undergoing proofreading and corrections by a linguistics expert.Results: Only 30% of Korean Medicine hospitals have implemented acupotomy consent forms. The items of the consent forms did not fully include the items presented in the Medical act and the standard contract for medical procedures of the FTC. To address this issue, two rounds of Delphi surveys and a real-time discussion were conducted with a panel of 12 experts on 27 preliminary items of consent forms. The items and contents that met the criteria for content validity ratio, convergence, and consensus were derived. Based on the derived items and content, a standard acupotomy consent form was developed.Conclusions: The standard consent form for acupotomy is anticipated to ensure patient autonomy and enhance transparency and liability in acupotomy. Furthermore, it is expected to serve as evidence in case of medical disputes related to acupotomy and contribute as a reference document for the development of standard consents forms for various procedures of Korean Medicine. However, the limitations of the study include that the survey of consent forms was limited to only training hospitals of Korean Medicine, and the standard consent form is only applicable to adults in Korea. Future studies are needed to address these limitations.

Hubungan Faktor Pekerjaan dengan Stres Kerja pada Perawat di Rumah Sakit Daerah Jakarta Timur

Nurses have an essential task and important role in hospital services. The increase in hospital services will affect the performance of nurses. Nurses are required to do quality work and provide professional services to patients. Nurses have more medical actions than other medical workers. This condition gives nurses more significant work pressure and increases stress levels. This study aims to determine the relationship between work factors and work stress experienced by nurses. The type of research is a quantitative research using a cross-sectional approach. The population in this study were nurses who worked in Pondok Kopi Islamic Hospital, East Jakarta. The total population in this research is 191, and the samples taken were 125 people. This study used a cross-sectional approach. The results showed that 53 nurses (42.4%) experienced work stress, and 72 (57.6%) did not experience work stress. The bivariate analysis results show a significant association between job demands, social support, interpersonal relationships, roles and organisational changes with job stress. There is also an insignificant association between control over work and job stress.

ASUHAN KEPERAWATAN IBU NIFAS PADA NY F POST SECTIO CAESAREA DI RUANG TERATAI RSUD BATARA SIANG PANGKEP

Sectio Caesarea is a medical action that is needed to help deliveries that cannot be carried out normally due to problems with the mother's health or the condition of the fetus, this problem can be overcome by the role of nurses in providing comprehensive nursing care. The purpose of this study is to be able to carry out nursing care for postpartum mothers with post-sectio caesarean section at Batara Siang Pangkep Hospital.The research method is a qualitative method with a case study approach.The results of the study were obtained in patients with post section caesarea pathological indications that need to be considered is the assessment on physical examination, namely breast enlargement, uterine contractions are good/hard, there is lochia rubra. some changes in physical, psychological and social problems. The nursing problems found in the case review were acute pain, knowledge deficit, risk of infection.the intervention still refers to the target, outcome criteria and time criteria. At the end of the evaluation all objectives can be achieved due to good cooperation between the patient, family and health team, suggestions the involvement of the patient, family and health team that is well established needs to be improved so that mutual trust arises

Persetujuan Tindakan Kedokteran Sebagai Bagian Perjanjian Terapeutik di Puskesmas Desa Sungai Jambat

The aims of this research are to find out and analyze whether (1) What are the elements of informed consent that are implemented at the Sungai Jambat Village Health Center. (2) What are the exceptions to the absence of informed consent in a therapeutic agreement at the Sungai Jambat Village Health Center. The methodology had been used was an empirical juridical legal research regarding the application or implementation of legal provisions directly to every legal event that occurs in society. The results of this research indicate that the implementation of informed consent at the Sungai Jambat Village Health Center has been legally enforced as law because it implements and fulfills the four elements of the agreement in Article 1320 of the Civil Code, agreed after receiving the information, competent because they are 21 years old. and guardianship if under age, a certain thing related with the medical action/treatment, and the object of the agreement is fulfilled, and the last requirement related with the legally reason has been eligible because the object of the agreement were the medical treatment that accordance and do not deviate from the law. Regarding the exception to the absence of informed consent, the Sungai Jambat Village Health Center stipulates the rule that in an emergency situation, as an effort to save the patient and requires immediate action, informed consent is not required and can be requested after medical action has been given.

Foreign body within the upper esophagus of a patient not consenting to surgical treatment – case report and legal proceedings in light of current case law

<b><br>Introduction:</b> Patients intentionally inserting foreign bodies into the lumen of their gastrointestinal tract usually aim at achieving certain benefits, such as postponement or avoidance of punishment.</br> <b><br>Aim:</b> In view of the ever-increasing number of proceedings (including criminal proceedings) against health care professionals, the authors carried out a review of the available literature on: medical actions undertaken in cases of foreign bodies within the esophagus, current legislation and jurisprudence as practiced in the Republic of Poland within the context of model legal proceedings in cases involving patients raising doubts about being fully conscious and not consenting to necessary treatment.</br> <b><br>Case report:</b> The article presents a case of a patient with an esophageal foreign body who had not consented to the proposed surgical treatment. Doubts as raised within the otorhinolaryngological team with regard to the patient’s state of consciousness were not dispelled as the result of psychiatric consultation. Following a meticulous analysis of the current jurisprudence of the Polish judicial system and obtaining a court’s permission to intervene, the procedure (esophagoscopy with removal of esophageal foreign body) was performed. After exclusion of any life-threatening complications, the patient was transferred to the Psychiatric Department.</br> <b><br>Conclusions:</b> In the current state of the law, performing a procedure to remove a foreign body from the esophagus without prior court approval could qualify as a violation of patient’s rights. In such case, legal liability of the physician would arise regardless of the fact that the patient would have received care in accordance with the current medical knowledge and practice.</br>

“Cooperation between physicians and physios fosters trust you know”: a qualitative study exploring patients’ experience with first-contact physiotherapy for low back pain in French primary care

BackgroundPhysiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients’ experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP).MethodsA qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients’ experience and perceptions.ResultsTen patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients’ experience with the new FCP model were formalized: 1) “Going to see a physiotherapist who specializes in painful movements, well that makes sense to me”, 2) “Physiotherapist offered to give me exercises to do at home to relieve the back pain”, 3) “I went there feeling confident”, 4) “The physiotherapist can do more than just send you to see more appropriate people”. Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients’ experiences with FCP model of care were positive. Participants were highly confident in the FCP’s ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs’ scope of practice was needed to improve the model.ConclusionFindings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists’ scope of practice in French primary and secondary care settings.

Experience of the pandemic in the context of changing doctor-patient relationship

The article deals with the issue of transformation of doctor-patient relationship during the COVID-19 pandemic. The main aspects investigated by analyzing the results of the questionnaire survey were the attitude of Moscow residents to their health, their personal experience of overcoming the pandemic, and its impact on the perception of medical professionals. According to the results, the experience of overcoming the pandemic had a positive impact on changing the perception of the doctor's image and of the medical community in general. Survey participants noted the heroization of medical professionals' actions during the fight against the novel coronavirus infection, which resulted in a general rise in the level of trust in doctors and an increase in the status of the medical profession. Muscovites believe that part of the responsibility for their health lies with medical professionals. However, taking into account that behavioral strategies of a substantial number of the respondents are marked by low activity of observing the principles of healthy lifestyle, the presence of bad habits, low medical aid appealability at the occurrence of primary signs of disease, and non-compliance with doctor's prescriptions, it significantly complicates the possibility of providing medical care and preserving health.

A script-enabled interactive checklist document for efficient management of electronic devices in a busy multimodality radiotherapy clinic.

Develop an efficient, interactive, and instructive checklist document for the management of implanted electronic medical devices in a multimodality radiotherapy clinic. The built-in scripting and interactivity of a popular commercial word processor was used to develop an interactive document that changes the information presented to the user based on drop-down selections. The interactivity and scripting were compatible with the radiation oncology information system (ROIS) which allows the document to be accessible by all team members and serve as a permanent record in a patient's electronic chart. The final interactive document, which was clinically deployed after beta testing with a group consisting of nurses and medical physicists, presents information and action plans to the user based on multiple departmental medical device decision trees that are specific to the combination of device, treatment modality, rhythm-pacing dependence for cardiac devices, and distance from the device to the treatment volume. A script-enabled interactive document was developed for a busy multimodality clinic, condensing multiple comprehensive departmental guidelines spanning multiple device types and treatment modalities into a single interactive checklist accessible within the ROIS. Given the wide accessibility of the commercial word processor, this approach could be adopted by other clinics to streamline their own respective workflows.

ALGORITHM OF SECONDARY PREVENTION OF KIDNEY DISEASES AND URINARY TRACT IN OUTPATIENT CLINICS

Aim effectiveness evaluation of the medical staff actions algorithm an outpatient polyclinic institution during the secondary prevention of kidney and urinary tract diseases.
 Material and methods. This article presents an assessment of the effectiveness of the algorithm developed on the basis of a previously conducted medical and social study, which consists in conducting secondary prevention of exacerbations of the urinary system by prescribing drinking mineral water, diet, physical activity and a protective regimen under the remote control of medical workers with the determination of indicators of the quality of life of patients (on the Wisconsin Questionnaire). The developed algorithm represents the sequence of actions of medical personnel during remote monitoring of patients with pyelonephritis, urolithiasis, urethritis and cystitis. To assess the effectiveness of the proposed algorithm, a survey was conducted among outpatient clinic doctors with more than 10 years of experience using a specially developed questionnaire (score from 1 to 10). To assess the consistency of doctors' opinions, the concordance coefficient was calculated; a high degree of agreement between doctors' opinions in assessing the main indicators was considered at the value of the Kendal W coefficient 0.7. To assess the significance of the obtained concordance coefficient, the 2 criterion was calculated at a significance level of 0.05.
 Results. An analysis of the answers of doctors showed that this algorithm can be used as an alternative to sanatorium treatment for the prevention of exacerbations of diseases of the urinary system.
 Conclusions. The study of the possibility of using medical and organizational measures for the secondary prevention of exacerbations of diseases of the kidneys and urinary tract, presented in the algorithm, makes it possible to achieve an improvement in general well-being in patients under dispensary observation. Algorithm received a positive assessment from doctors of outpatient clinics.

Quality of life of patients with rheumatic diseases

ObjectiveHealth-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. MethodsObservational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. Results1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group. ConclusionsPatients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

The weekend factor: the effect on healthcare quality. A medico-legal, retrospective study.

In the healthcare system, in the last 30 years, the prognostically negative value of the so-called Weekend Effect (WE) has been internationally recognized. The WE is regarded as the increased risk a patient might incur when hospitalized during non-working days, of enduring severe complications in comparison to the same hospitalization that occur on working days. The aim of this study was to retrospectively verify whether, once a mistake was made during weekends or on holidays, in comparison to a mistake occurred on workdays, it subsequently implied a higher risk of complications, death included, in a statistical and medico-legal way. Three different evaluators independently examined a total of 378 medico-legal cases over a more than 20-year period. Eventual medical actions and omissions were labelled as 'mistake' when the AJ claimed that at least one occurred; 'alleged mistake' included the cases where the EW's report disagreed with the AJ's one; finally, 'no mistake' when both the AJ and the EW agreed in their evaluations. During weekends there is a higher risk that a mistake occurs (OR=3.3, 95% CI=1.6;7.4; p-value<0.001) compared to weekdays. When death occurs, delayed diagnosis is the main cause (p=0.02), whereas a damaging action is more frequently claimed in general. We verified as actual the impact of the WE on patients' outcome from a medico-legal point of view. The implications for an improvement of the several settings of the Italian NHS are various, and many are the consequences in the healthcare management.

AUTHORITY OF NURSES TO INSTALL INFUSATIONS DURING THE PANDEMIC OUTSIDE OF HEALTH CARE FACILITIES

During the COVID-19 pandemic emergency, one of the medical measures that nurses can use in certain limited conditions is installing infusion outside of healthcare institutions. The author's study methodology, which employs three approaches—legislation (statement approach), comparative approach (comparative approach), and conceptual approach (conceptual approach)—uses a normative legal research type to address these issues. Furthermore, primary, secondary, and tertiary legal documents are the sources of the legal materials used. The study's findings clarify the role and authority of nurses for infusions outside of healthcare facilities during the pandemic. Specifically, a nurse who is ill or in a state of restricted mobility during the COVID-19 emergency period is authorised to administer first aid in the form of medical action, such as infusions, in accordance with the law and her expertise in assessing the patient's condition. Although the nurse is personally accountable for the infusion because it is an autonomous duty, meaning that the nurse in question will take full responsibility if a mistake is made.

Preventive Legal Protection in Increasing Effectiveness Medical Actions of Nurses at Wakatobi Regency General Hospital Southeast Sulawesi Province, Indonesia

Objective: This study aims to determine and examine the implementation of preventive legal protection in increasing the effectiveness of nurses' medical actions at the Regional General Hospital of Wakatobi Regency, Southeast Sulawesi Province, Indonesia. Method: This research uses normative juridical and empirical juridical approach methods. Data collection techniques are carried out by interviews and collecting other data relevant to the research then analyzed using qualitative methods using principles, theories laws, and regulations related to the research topic, then described descriptively analytically in the discussion. Respondents and research resource persons were determined by purposive sampling. The respondents amounted to 4 nurses and the resource persons amounted to 4 hospital leaders. Result: The results showed that in the Regional General Hospital of Wakatobi Regency, Southeast Sulawesi Province, Indonesia, Preventive Legal Protection in Increasing the Effectiveness of Nurses' Medical Actions related to the implementation of the delegation of doctors' authority to nurses to perform medical actions has not been maximized. This is because nurses who perform certain medical actions have not received delegation of authority, both delegative and mandated in writing from doctors following the provisions of Article 290 of Law Number 17 of 2023 concerning Health and Article 32 of Law Number 38 of 2014 concerning Nursing. Furthermore, preventive legal protection related to standard operational procedures has been running well. Where every medical action carried out by nurses already has standard operational procedures, the implementation of medical actions is following standard operational procedures, standard operational procedures for medical actions carried out by nurses have been socialized and have been monitored regularly following the provisions of Law of the Republic of Indonesia Number 17 of 2023 concerning Health, Conclusion: Based on the results of the study, it can be concluded that Preventive Legal Protection in Increasing the Effectiveness of Medical Actions of Nurses at the Regional General Hospital of Wakatobi Regency, Southeast Sulawesi Province, Indonesia is still inadequate.

Capacity Building for Maternal Emergency Services Using Low Tech High Fidelity (LTHF) Simulator Method and Interprofessional Collaboration for Health Workers on Bawean Island

Background - Maternal emergencies encompass a wide range of conditions that can endanger the lives of pregnant women or newborns, so the speed and availability of quality care is crucial in saving the lives of mothers and babies, especially in remote areas such as Bawean Island. Objective - Capacity building for maternal emergency services is a strategic step aimed at improving the ability and efficiency of the health care system to handle emergency situations related to pregnancy and childbirth. Design / methodology / approach - The method used in capacity building is training on the ability to conduct interprofessional collaboration among health workers with lecture, discussion and simulation methods with the use of LTHF simulators so that it is expected that during capacity building activities, participants can experience conditions that resemble real life. This capacity building activity consists of: Providing refreshing material related to maternal emergencies and simulating interprofessional collaboration using the LTHF simulator. Findings - Training participants stated that the above training method was very interesting and provided new experiences to prepare themselves in handling maternal neonatal emergencies that can occur at any time. The increased capacity to manage maternal neonatal emergencies can improve the effectiveness of medical actions and case management in emergency situations involving maternal health during pregnancy, childbirth, or the postpartum period after the training. Maternal neonatal emergencies that are often found are heavy bleeding, eclampsia, infection, asphyxia or other complications that can endanger the lives of pregnant women and their babies. Conclusion - Increasing the capacity of maternal emergency services through the Low Tech High Fidelity (LTHF) Simulator method and Interprofessional Collaboration is a significant step to improve the quality of services and safety of pregnant women and newborns on the island of Bawean.

Gaps in medical school in the approach to ethics, bioethics, and palliative care: a challenge for professional training

Medical education requires discipline, effort, and dedication for professional improvement, which complies with the requirement for vast, dynamic knowledge, including (bio)technologies in diagnostics and therapeutics. However, this process does not ensure the appropriate human training of health professionals to deal with an abrupt demographic transition of older people with several comorbidities as well as with an increase in life expectancy and in the risk of serious health-related suffering. There is a gap in bioethics education offered to undergraduate medical students, especially in bioethical principles (not only those related to biomedical and deontological ethics), which must be bridged before good communication, attitudes, behaviors, and, particularly, better decision-making can be demanded from medical actions. The advent of chronic and incurable diseases in recent decades has contributed to strengthening the hospice movement toward patient-centered care, highlighting an unmet demand for palliative care in the face of progressive, advanced, and critical conditions. Thus, personalism, a contemporary bioethical trend, in line with the principles of palliative care, calls for human training in bioethics by demonstrating the challenges of disease-focused care amidst the conflicts generated by biotechnoscience to provide comprehensive integrated patient-centered care.

Juridical Analysis Of Medical Malpractice Actions Carried Out By Ophthalmologist

ABSTRACT / ABSTRAK Purpose of the Study: This research aimed to analyze legal considerations in malpractice cases carried out by ophthalmologists and analyze the differences between medical risk and medical malpractice Methodology: This research is normative legal research using the statute approach and case approach of medical malpractice cases. The research object discussed is the Supreme Court Judgment Number 277/PDT/2020/PT SBY and Supreme Court Judgment Number 338 K/Pdt/2020. The analysis technique implemented descriptive qualitative analysis. Results: The results of the research discovered that the judge's consideration in issuing nt in malpractice case by an ophthalmologist was inconsistent and defied the applicable laws and regulations, in which Articles 359 and 360 of the Criminal Code the judge should have imprisoned to the perpetrator. Apart from that, the judgment 277/PDT /2020/PT SBY is included in the medical malpractice action which is shown by the damages given to the patient and an apology from the doctor. Applications of this study: Research suggests the conformity of judgment with laws and punishment that should be given to doctors who committed medical malpractice from the proof and applicable laws and regulations. Novelty/Originality of this study: The study analyzed the judgments of medical malpractice cases through 6 court processes. Keywords: Medical Malpractice, Liability, Criminal Law Abstrak / Abstrak Tujuan Penelitian: Penelitian ini bertujuan untuk menganalisis pertimbangan hukum dalam kasus penyalahgunaan yang dilakukan oleh dokter mata dan untuk menganalisa perbedaan antara risiko medis dan penyimpangan medis Metodologi: Penelitian ini adalah penelitian hukum normatif menggunakan pendekatan hukum dan pendekatan kasus kasus kasus penyalahgunaan medis. Objek penelitian yang dibahas adalah Keputusan Mahkamah Agung Nomor 277/PDT/2020/PT SBY dan Keputusan Pengadilan Tinggi Nomor 338 K/Pdt/2020. Teknik analisis yang digunakan adalah analisis deskriptif kualitatif. Hasil penelitian menemukan bahwa pertimbangan hakim dalam mengeluarkan nt dalam kasus penyalahgunaan oleh seorang dokter mata tidak konsisten dan menantang hukum dan peraturan yang berlaku, di mana Pasal 359 dan 360 dari Kode Kriminal hakim harus menahan pelaku. Selain itu, putusan 277/PDT/2020/PT SBY termasuk dalam tindakan penyalahgunaan medis yang ditunjukkan dengan kerusakan yang dialami pasien dan maaf dari dokter. Aplikasi dari penelitian ini: Penelitian menunjukkan kesesuaian penilaian dengan hukum dan hukuman yang harus diberikan kepada dokter yang melakukan penyalahgunaan medis dari bukti dan hukum dan peraturan yang berlaku Novelty/Originality of this study: Studi ini menganalisis penilaian kasus penyalahgunaan medis melalui 6 proses pengadilan. Kata Kunci: Penyalahgunaan Medis, Tanggung Jawab, Hukum pidana

THE CORRLATION BETWEEN THE ROLE OF NURSES AS EDUCATORS AND MEDICATION ADHERENCE IN DIABETES MELLITUS PATIENTS AT RAWALUMBU BEKASI HOSPITAL IN 2023

Diabetes Mellitus (DM) known in Indonesia as "Diabetes" is a disease whose prevalence is now increasing. The role of the educator itself is to help patients to improve their health by providing health education and medical actions received so that clients or families can know knowledge that is important to patients or families. This study aims to analyze the relationship between the role of nurses as educators with adherence to Treatment P there is Pasien DM at Rawalumbu Bekasi Hospital in 2023. The research method used is quantitative analytical observational with Cross Sectional Study approach and total sampling technique, which is to select samples based on the frequency distribution of patient respondent characteristics. The samples used in this study were 60 diabetes mellitus patients who were treated in the inpatient room at Rawalumbu Bekasi Hospital. The results of the study identified the role of nurses as good educators with medication adherence in non-adherent diabetes mellitus patients totaling 25 respondents (41.7%). There are Chi-Square test results with a significant level of 95% or a value of α 5% (0.05) obtained p value (0.000) &lt; a value of α (0.05) so that it can be concluded from the results Ho rejected means that there is a relationship between the role of nurses as educators with treatment compliance in diabetes mellitus patients at Rawalumbu Bekasi Hospital in 2023.

Quality of life of patients with rheumatic diseases

ObjectiveHealth-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. MethodsObservational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. Results1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group. ConclusionsPatients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

The Implementation of Medical Informed Consent In Sleman Regency

Background: Yogyakarta has a high number of morbidity rate which equal high possibility of using medical services. In therapeutic transaction arise obligation between patient, health personnel and health institution. Those obligation become legal responsibilities that lies in informed consent. Those responsibilities are reflected in the implementation of the hospital's obligations to fulfil patient rights carried out by doctors, nurses, midwives, and other health workers based on their authority and competence in accordance with professional ethics, as well as standard operating procedures that apply in the hospital by Minister of Health Regulation number 290 of 2008.&#x0D; &#x0D; Purpose: This research to understand the legal analysis of informed consent in health services as well as to to evaluate and enhance the implementation of medical informed consent in Sleman Regency, especially in the Ananda Maternity Clinic.&#x0D; &#x0D; Methods: The type of this research is a normative-empirical legal research method which in this case combines elements of normative law.&#x0D; &#x0D; Results and conclusion: This normative-empirical research shows that the informed consent has to be imply.&#x0D; &#x0D; Implications of research: It is expressly regulated that the granting of approval for medical action does not eliminate legal liability in the event that it is proven that there is negligence in carrying out medical actions that resulting harm for the patient.&#x0D; &#x0D; Originality/value: the work produced by the person concerned. Self-made, distinctive and personal and the work created is self-produced without quoting, copying, or plagiarism of other people's work.

Causality-Enhanced Multiple Instance Learning with Graph Convolutional Networks for Parkinsonian Freezing-of-Gait Assessment.

Freezing of gait (FoG) is a common disabling symptom of Parkinson's disease (PD). It is clinically characterized by sudden and transient walking interruptions for specific human body parts, and it presents the localization in time and space. Due to the difficulty in extracting global fine-grained features from lengthy videos, developing an automated five-point FoG scoring system is quite challenging. Therefore, we propose a novel video-based automated five-classification FoG assessment method with a causality-enhanced multiple-instance-learning graph convolutional network (GCN). This method involves developing a temporal segmentation GCN to segment each video into three motion stages for stage-level feature modeling, followed by a multiple-instance-learning framework to divide each stage into short clips for instance-level feature extraction. Subsequently, an uncertainty-driven multiple-instance-learning GCN is developed to capture spatial and temporal fine-grained features through GCN scheme and uncertainty learning, respectively, for acquiring global representations. Finally, a causality-enhanced graph generation strategy is proposed to exploit causal inference for mining and enhancing human structures causally related to clinical assessment, thereby extracting spatial causal features. Extensive experimental results demonstrate the excellent performance of the proposed method on five-classification FoG assessment with an accuracy of 62.72% and an acceptable accuracy of 91.32%, which is confirmed by independent testing. Additionally, it enables temporal and spatial localization of FoG events to a certain extent, facilitating reasonable clinical interpretations. In conclusion, our method provides a valuable tool for automated FoG assessment in PD, and the proposed causality-related component exhibits promising potential for extension to other general and medical fine-grained action recognition tasks.