Violation Of Patients Research Articles

Nurses' perception of threats to human dignity in caring for patients with COVID-19: A qualitative study

PurposeIdentifying threats to patients' dignity is crucial for maintaining and promoting their dignity. Preserving patient dignity should be regarded as both a patient’s right and a moral obligation. This study was conducted to evaluate nurses' understanding of threats to human dignity in the care of patients with COVID-19. MethodsThis qualitative study was conducted using conventional content analysis in various clinical departments in Iran. Clinical nurses from different departments were selected through purposeful sampling. Data were collected via in-depth semi-structured interviews with 15 clinical nurses over two months in 2021 and analyzed using qualitative content analysis. ResultsDuring data analysis, two main categories and ten subcategories were identified: 1) Unethical behaviors (lack of respect for patient privacy, lack of patient involvement in decision-making procedures, ignoring the patient as an individual, aggressive behaviors, stigmatization, and failure to provide palliative and end-of-life care to patients and their families); 2) Organizational factors (inadequate financial support, lack of patient-care facilities, strict restrictions, and employing less experienced nurses in COVID wards). ConclusionThe present study showed that most participants expressed concerns about violations of patients' dignity and identified many threats to it. Based on the findings, it is suggested that other factors threatening patients' dignity be identified, the threats eliminated, and healthy treatment environments created to promote patients' dignity.

Mental health patients' preferences regarding restrictive interventions: An integrative review.

INTRODUCTION: The use of restrictive interventions is a violation of patients' rights that causes physical and psychological harm and which is a well-known challenge globally. Mental health law and legislative principles and experts agree that when restrictive interventions are applied, the least restrictive alternative should be used. However, there is no consensus on what is the least restrictive alternative, especially from the patient perspective. To investigate the literature on mental health patients' preferences regarding restrictive interventions applied during admission to a psychiatric hospital. An integrative review informed by the PRISMA statement and thematic analysis were undertaken. There were tendencies towards patients preferring observation and, for the majority, mechanical restraint was the least preferred restrictive intervention. Factors such as environment, communication and duration were found to influence patients' preferences. There is a lack of agreement on how best to measure patients' preferences and this complicates the choice of the least restrictive alternative. Nonetheless, our findings show that staff should consider environment, communication and duration when applying restrictive interventions. More research on restrictive interventions and the least restrictive alternative is warranted, but agreement is needed on standard measures, and a standard global definition of restrictive interventions.

"Open-window" craniectomy for the removal of frontal sinus mucosa to prevent a delayed mucocele: illustrative case.

Frontal craniotomies for a medial subfrontal approach necessitate crossing the frontal sinus. Large superior extensions of the frontal sinus into frontal bone can result in mucosal retention in a free craniotomy bone flap, leading to a delayed mucocele with significant associated morbidity. The authors describe an "open-window" craniectomy technique that permits mucosal removal under direct vision and maintains the inner table on the bone flap's inferior side, helping to seal off the sinus opening with a pericranial flap. An illustrative case involving a medial right frontal craniotomy for a third ventricle mass in a patient with a large superior extension of the frontal sinus into frontal bone is presented. After creating a free frontal bone flap, the inner table was drilled out to the margins of the frontal sinus cavity and any remaining mucosa was cleared. A portion of the inner table above the bone flap's inferior margin was left in place, resembling an open window when viewed from the inner table side. The remaining anterior and posterior wall of the flap inferiorly provided a matched surface for the opening into the remaining frontal sinus, which was covered by pericranium. Long-term follow-up indicated no major complications or delayed mucocele. The open-window craniectomy technique can be considered for frontal sinus violations in patients with large superior frontal bone extension.

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>

Platelets characteristics in patients with coronary artery disease and atrial fibrillation

The aim. To estimate the connections between platelet morphological characteristics and amino acids (AA) profile in patients with coronary artery disease (CAD) and atrial fibrillation (AF).
 Materials and methods. 300 patients were included in the study. They were divided into 3 groups: first (CAD) – 149 patients with CAD but without arrhythmias, second (CAD+AF) – 124 patients with CAD and AF paroxysm and control group – 27 patients without CAD and arrhythmias. Platelets AA level was detected by method of ion exchange liquid column chromatography. Total platelet count (PC), mean platelet volume (MPV), platelets distribution width (PDW), platelet-to-leukocyte (PLR) were obtained from common blood count.
 Results. Significant decline of PC and rise of MPV and PLR ratio was found in CAD patients and AF paroxysm in comparison with group with CAD without arrhythmia, p < 0.05. Significant increase of isoleucine, leucine and decrease of threonine, serine, glycine, valine levels was found, changes in branched chain amino acids (rise of Isoleucine + Leucine / Valine ratio) and Glycine + Serine (decline Glycine + Serine sum) metabolism were revealed in CAD patients and AF paroxysm in comparison with group with CAD without arrhythmia, p < 0.05. Phenylalanine / Tyrosine ratio was significantly elevated in CAD patients with and without AF, p < 0.05.
 Taurine, serine, and glycine correlated with platelets morphological characteristics: PC (r = 0.714, r = 0.732 and r = 0.340 consequently), MPV (r = -0.724, r = -0.390 and r = -0.571 consequently), PDW (r = -0.666 and r = -0.364 consequently) and PLR (r = 0.586 and r = 0.648 consequently), p < 0.05. Platelets glycine (AUC = 0.8760), valine (AUC = 0.8707), leucine (AUC = 0.8267) and threonine (AUC = 0.8213) levels are closely connected with AF paroxysm in CAD patients by ROC-analysis results, p < 0.05.
 Platelets amino acids combinations: Glycine + 0.6 × Valine (AUC = 0.9987), Threonine – 3.6 × Leucine (AUC = 0.9040) were found in prediction AF paroxysm for CAD patients by ROC-analysis results, p < 0.05.
 Conclusions. Connections between platelets morphology and AA profile violations in patients with CAD and AF paroxysm were found in our study.

Exploring the challenges to using telecardiology as perceived by pre-hospital emergency care personnel: a qualitative study

BackgroundToday, using the medical technology of telecardiology, as part of advanced medical services, plays an essential role in providing care to cardiac patients in life-threatening conditions who need emergency care. However, pre-hospital emergency care personnel are faced with certain challenges in using telecardiology, with adverse effects on their performance. Therefore, the present study aimed to investigate the challenges to using telecardiology as viewed by pre-hospital emergency care personnel in Southern Iran.MethodsThe present study is a qualitative work of research with a content analysis approach. Selected using purposeful sampling, 19 pre-hospital emergency care personnel were interviewed on a semi-structured, personal, in-depth basis. The qualitative data obtained were analyzed using the Graneheim and Lundman’s conventional content analysis approach (2004).ResultsBased on the qualitative data analysis, 3 themes and 8 subthemes were obtained. The three main themes included professional barriers (lack of clinical knowledge of telecardiology, lack of clinical skill in telecardiology, violation of patients’ privacy, lack of clinical guidelines on telecardiology), medical equipment and telecommunication barriers (poor reception and ineffective means of communication, low charge on the battery of tele-electrocardiogram machines), and organizational management barriers (serious lack of cardiologists available for medical counseling and lack of continual personal development of the telecardiology personnel).ConclusionSenior managers in pre-hospital emergency care services are recommended to use the results of this study to identify the influential factors in using telecardiology and take the necessary measures to eliminate the existing barriers toward making optimal use of telemedicine, thereby improving the quality of care provided for cardiac patients.

Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border

BackgroundOver the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting.MethodsThis cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants’ experience caring for patients in ILE custody, including the perception of respect, violations of patients’ privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments.Results332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees’ medical care, detainees’ privacy rights, or ILE’s authority in patient care.ConclusionsThis study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.

Comparison of basic neurocognitive violations in patients with residual schizophrenia with and without history of ischemic stroke

Relevance. The cognitive symptoms associated with schizophrenia have been a subject of controversy and are often viewed through a dualistic lens. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), these cognitive symptoms can be further elucidated within specific neurocognitive domains.
 Many of the symptoms of schizophrenia manifest behaviorally and can be challenging to differentiate from the consequences of organic brain impairment, especially when these symptoms involve the frontal and temporal cortex or have a diffuse presentation.
 Aim – to evaluate neurocognitive deficit in patients with residual schizophrenia with history of ischemic stroke.
 Materials and methods. A comprehensive study was conducted involving 100 patients diagnosed with recurrent schizophrenia (ICD-10: F20.5) at the Communal Non-Profit Enterprise "Regional Clinical Institution for the Provision of Psychiatric Care". We selected 59 patients: 32 patients with residual schizophrenia without history of stroke (Group 1, G1) and 27 patients with residual schizophrenia with history of stroke (Group 2, G2). Neuropsychological testing was used to evaluate neurocognitive violations. Due to massive distortions that brought to testing results by schizophrenia negative symptoms, only general evaluation was made to reflect critical or non-critical to no violations in separate functions. Statistical method of chi-square test was used to compare results in groups. 
 Study results. To compare neurocognitive violations in G1 and G2 we performed neuropsychological testing in basic neurocognitive domains. G2 patients, diagnosed with both schizophrenia and a stroke, generally exhibit heightened cognitive impairments compared to G1 patients with only schizophrenia. Notably, deficits in Sustained Attention, Divided Attention, Processing Speed, Working Memory, Mental Flexibility, immediate memory, implicit learning, and both expressive and receptive language are more pronounced in G2 patients. However, for functions like Selective Attention, Planning, Decision-Making, recent and very-long-term memory, and interpersonal understanding, the added influence of a stroke in G2 doesn't drastically differentiate them from G1. In essence, while schizophrenia inherently poses cognitive challenges, the co-occurrence of a stroke amplifies certain deficits but not others. This data suggests a complex interplay between schizophrenia and stroke in influencing cognitive function.
 Conclusions. The coexistence of schizophrenia and a history of stroke in G2 patients frequently exacerbates certain cognitive impairments when compared to those diagnosed solely with schizophrenia. This underlines the compounded cognitive challenges faced by patients with comorbid conditions. However, for some cognitive domains, the severity of impairments is primarily governed by schizophrenia, irrespective of the presence of an additional stroke history. This comprehensive analysis underscores the complex interplay of multiple conditions on cognitive function and emphasizes the importance of individualized care and intervention strategies tailored to the specific cognitive challenges faced by each patient group.

Empathic care as a command of a new clinical bioethics

The current context of healthcare, which perpetuates the subordinate position of the patient and the violation of patients’ rights, demands the construction of a bioethical theory based on the ethical commitment to change this reality. Consequently, Principialism, the hegemonic line of Clinical Bioethics, needs to be overcome, and another framework needs to be formulated, such as what is now proposed based on clinical empathy and empathic care. This new framework for Clinical Bioethics conforms to an innovative aspect called “Healthcare Bioethics,” which has been the subject of a series of studies. These studies aimed at the theoretical structure of Healthcare Bioethics but did not focus on empathic care as an ethical structuring of this new theoretical-normative proposition. This article proposes theoretical contributions to Healthcare Bioethics based on clinical empathy and, specifically, by formulating the empathic care concept as a constituent and structuring command of this new aspect of Clinical Bioethics. Empathic care is a central ethical command of the further reference of clinical practice, Healthcare Bioethics. However, as seen, empathy is a motivational phenomenon conditioned to subjective factors that concern the individuals themselves and the context in which they find themselves. Although empathy is essential to our well-being, self-esteem, sense of belonging, and positive emotions, often, the choice is not to be empathic, given the costs of being so. This is also true in healthcare. Thus, health institutions and systems must adopt training, continuing education of health professionals, and other motivational interventions to drive empathic choice. It is an illusion to expect this choice to be made predominantly without creating factors that motivate empathic care, which must be an ethical substrate for constructing these motivational interventions. Therefore, empathic care should be incorporated into the health area as a new paradigm that founds institutions and health systems centered on the patient and the quality of care.

A comparative qualitative assessment of the severity of diabetic retinopathy in patients with stages III, IV and V, requiring hemodialysis, of chronic renal insufficiency

Purpose. Comparative qualitative assessment of the severity of proliferative diabetic vitreoretinopathy (PDR) in patients with stages III, IV and V of chronic renal failure (CRF). Material and methods. 150 patients (64 % women; 36 % men, aged 38 to 79, mean age 61.3 ± 2.3 years) were examined. The patients were divided into three groups, each consisting of 50 subjects (100 eyes), according to the stages of CRF diagnosed in terms of glomerular filtration rate — CRF-3; CRF-4; and CRF-5, the latter requiring hemodialysis (НD). All groups were approximately equally distributed as to age and gender. A total of 11 qualitative indicators were assessed, including the condition of the fundus, the severity of diabetic macular edema, the degree of fibrovascular tissue neovascularization, the spread of traction retinal detachment to the periphery. All examinations were performed by one ophthalmic surgeon (A.S. Golovin) in order to increase the reliability of the qualitative assessment. The following scoring system was used: 1 point— no changes; 2 points — insignificant (weak) changes; 3 points — moderate severity of changes; 4 points — pronounced changes. Results. For all qualitative indicators, the severity of PDR in patients with HD was significantly higher than in patients with CRF-3 or CRF-4. The average severity of clinical manifestations of PDR for all criteria was 2.10 ± 0.27; 2.35 ± 0.30 and 3.21 ± 0.10 points (p < 0.05) for CRF-3; CRF-4 and CRF-5 (HD), respectively. Conclusion. The severity of retinal violations in patients with HD is 36.5–52.9 % higher compared with patients with CRF-4 and CRF-3. Considering the more severe nature of PDR and somatic status of HD patients, it seems expedient to develop an advanced vitrectomy technology for HD patients, its medical maintenance and anesthetic means.

The status of ethical behaviour in clinical nursing in three Chinese hospitals: A qualitative interview study.

We aim to explore the status of nurses' ethical behaviours in clinical practice and what contributes tonurses' unethical behaviours. Nurses' ethical behaviours strongly impact the nurse-patient relationship and the quality of nursing services. Therefore, we must understand the status of clinical nurses' ethical behaviours and the causes of nurses' unethical behaviours. Focus group and in-depth semistructured interviews were conducted with 21 head nurses and nine nurses, respectively. The data were analysed by content analysis. The analysis revealed seven themes: lack of awareness of the protection of patients' privacy; violation of patients' autonomy; improper communication; failure to protect the patient's best interests; lack of moral emotion; lack of psychological care for special patients; and causes of unethical behaviour. The present situation of ethical nursing behaviour is not optimistic, and there are still many unethical nursing behaviours in clinical work. There are many reasons for unethical behaviours. Efforts should be made related to nurses, patients, workload, the ethical climate and rules and regulations to improve the situation. Nursing managers can improve ethical behaviour by strengthening nurses' ethics studies, enhancing nurses' professional identity and social status, optimizing the allocation of nursing human resources, creating a good ethical climate and improving relevant rules and regulations.

Respect for patients’ rights in health facilities: experiences of patients during the early period of the COVID-19 pandemic in Ghana

PurposeThis paper aims to identify human rights violations of patients during the early periods of the COVID-19 pandemic in Ghana by investigating the experiences of people on how health-care professionals discharged their responsibilities during the time in question.Design/methodology/approachExplanatory design of the mixed methods approach was adopted, with the intention of collecting both quantitative and qualitative data sequentially, and then integrating the results at the interpretation stage. The approach enriched the quality of data collected as it offered the advantage of shedding light on the primary motivations and reasons for attitudes and behaviours and helped to provide an in-depth understanding of how individuals interpret the happenings around them and their experiences. Thus, although some amount of quantitative method was used in the data collection, the core of this paper is based on the qualitative interpretations.FindingsThe study reveals that health-care professionals, especially those in the Tema Metropolis, undermined certain fundamental human rights of patients during the early period of the COVID-19 pandemic. This includes failure to provide information to patients about treatment options and potential risks of medications; failure to seek the informed consent of patients before performing medical procedures; denial of access to medical files of patients for transfer; and inability or failure to provide medical ambulances services to patients on time.Originality/valueAlthough many publications on human rights dimensions and health protective issues on COVID-19 pandemic are available on a global scale, still little information pertaining to experiences of individuals with health-care professionals during the early days of the COVID-19 pandemic, especially in Ghana through the lens of patient’s rights exists. This paper, therefore, fills an important gap in health-care management information, critical for policy decision-making processes regarding patient’s rights in times of pandemic control.

The evolving role of digital media in medical education.

Within the last decade, social media has progressed from a form of mere entertainment to a medium for solution of complex issues in our daily lives. During the last few years, social media has gained value in medical education and the diversity in the use of digital media has given new dimensions to medical education while facing the Covid pandemic. Digital media helps in creating virtual communities which not only bring more harmony between teachers and students but has also shown to have reduced anxiety and stress among students. Common social media platforms such as Facebook and WhatsApp have recently gained popularity as platforms which are being actively used in various ways to enhance learning. Social media in medical education is also utilised to enhance communication skills, professionalism and better patient care, but this should be addressed with caution as violation of patient's privacy and confidentiality remains a threat.

Public administration as a subject of protection of the rights of the medical sphere

In this scientific article, the author conducted a study of public administration as a subject of protection of the rights of patients in the medical field. With the implementation of the health care reform, a new vision of providing medical care and medical services to patients is provided, new approaches to the system of financing health care facilities and paying for medical care and medical services by patients are introduced, levels of medical care are determined depending on complexity. medicine and state guarantees of medical care, etc. However, the successful implementation of the goals and objectives of medical reform is not possible without a legal basis and systematic and coordinated activities of authorized public administration entities in the study area of administration.
 The main task of public administration of the medical sphere is to ensure a patient-oriented system, to ensure fair universal coverage of health services for the entire population of the country.
 The system of public administration bodies that protect patients' rights has a hierarchical structure. The availability of electronic databases of patients, medicines and drugs, electronic health care system facilitates the diverse interaction of competent entities to ensure the rights, freedoms and interests of patients in the exercise of their constitutional right to health care.
 It is important to bring the guilty officials, officials and employees of health care facilities to criminal, administrative, disciplinary and civil liability in case of violation of patients 'rights, ie that these rules are not declarative, but are an effective mechanism for protecting patients' rights.
 It is determined that public administration as a subject of protection of patients' rights in the medical sphere is a system of executive bodies and bodies exercising delegated powers in the field of health care, the purpose of which is to guarantee the constitutional right to health care, ensuring timely, continuous, highly professional provision of health care services to patients in case they apply to health care institutions, as well as bringing persons who violate the rights of patients to justice.

LEGAL CHARACTERISTICS OF PHARMACEUTICAL ACTIVITY UNDER THE EMERGENCY CONDITIONS: PANDEMIC AND WAR.

The aim: Study of the system of pharmaceutical activity legal support in emergency conditions, namely, the period of epidemics outbreak and during the war. Materials and methods: In the mentioned study, we analyze the state of the governmental pharmaceutical policy during the pandemic and the war in Ukraine. Legal norms and doctrinal positions of scientists regarding the above-mentioned issue are studied. The work analyzes the information presented by specialists in various scientific publications, and also uses scientific methods from a medical and legal point of view. This material is based on dialectical, comparative, analytical, synthetic, and complex research methods. This study analyzes the activities of pharmaceutical enterprises in the emergency state and the problem of ensuring patients' rights to medical care and epidemic safety. As part of the above-mentioned methods, we investigated the problems of pharmacies utilizing questionnaires. A survey of representatives of pharmacy chains, managers of purchasing pharmaceutical products and their pricing, in the cities of Kharkiv, Poltava, Kyiv, Mykolaiv and Lviv in the number of 460 specialists, shows negative trends in price gouging. This is a violation of patients' rights to affordable pharmaceutical products. Conclusions: The pharmaceutical industry of Ukraine was not prepared in advance for extraordinary events, such as a pandemic and martial law, as well as for other natural disasters and foreseeable emergencies. This negatively affected and continues to affect the health of patients.

Reporting violations of European Charter of Patients\u2019 Rights: analysis of patient complaints in Croatia

BackgroundThe European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the official complaints system and to a non-governmental organization in Croatia.MethodsThe official system for patients’complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients’ complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient’s Rights (CAPR) and mapped them to the ECPR.ResultsThe aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients’ rights in 2017–2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%).ConclusionsReporting and dealing with patients’ complaints about violations of their patients’ rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients’ rights and to plan actions to improve the complaints system for effective health care.

Сriminal Law Protection of the Autonomy of Patients in Ukraine. Part 1

<p>The article aims to analyze the phenomenon of “patient’s autonomy” as an object of criminal law protection. Patients’ autonomy is one of the most important rights. Respect for it is one of the factors ensuring the correct treatment process. The article is divided into two parts. In this part, the authors analyze the legal acts of Ukraine, which regulate the process of providing medical services and guarantee patients’ right to autonomy. The authors discuss, i.a., the issue of the patient’s consent to medical interventions or the right to information about his or her state of health. They also point to statistics on offences committed by medical staff members in connection with their professional activities. Furthermore, they point out that the problem of violation of patient’s autonomy should be looked at not only from the legal but also from the social point of view. This applies to the patient–medical relationship, in which the doctor plays a leading role. Moreover, the content of these relations lies not only on the professional but also on the bioethical level.</p>

PROTECTING PATIENT’S RIGHTS IN A POST-TRADITIONAL LEGAL SYSTEM: COMPARING LATVIAN AND JAPANESE MEDICAL JURISPRUDENCE

Litigation concerning the violation of patient’s rights, which are associated with informed consent, confidentiality, right to information and medical records, as well as occasionally with end-of-life decision- making are quite frequent in common law and civil law jurisdictions, and has lasted for over a century in issues concerning malpractice, or unauthorized medical interventions and breaches of medical confidentiality. However, what could we say about medical law-related litigation in Japan? Technically, the legal system of Japan is a civil law one, but is practically post-traditional, which is reflected in extreme paternalism in healthcare and patient-physician relationships, which could be observed before the recent decades and which still has some impact on the modern Japanese medical law, despite the number of medical law-related litigation is becoming more frequent nowadays. The Japanese legislation does not have a specific “patient’s rights law” in contrast to European states, and most of the principles relating to medical malpractice derive from case law – the practice of the Supreme Court and of the lower courts. Each of the decisions strongly depends upon the factual circumstances, and the post-traditional features of the legal system may have some impact on it.

Safe Zones for Spinopelvic Screws in Patients With Lumbosacral Transitional Vertebra.

Retrospective matched-pair analysis. Lumbosacral transitional vertebrae (LSTV) have a reported prevalence of 4-36% in the population. The safe zones for screw placement for spinopelvic fusion in adult spinal deformity surgery for patients with LSTV have not been described in the literature. Our study aimed to assess the safety of S1-pedicle screw (S1PS), S2-alar screw (S2AS), S2-alar-iliac screw (S2AIS), and iliac screw (IS) placement in patients with LSTV. Out of the 819 examined patients, 49 patients with LSTV were included in our retrospective analysis with a matched pair control group. We used the 3-dimensional planning tool mediCAD for screw placement of S1PS, S2AS, S2AIS, IS with different angles, length and diameters. We evaluated a total of 10 192 screw trajectories. No serious complications occurred due to the trajectories used for S1PS. LSTV increased the risk of vessel injury for S2AS trajectories (P = .001) but not for S2AIS (P = .526). Besides the presence of an LSTV, the screw trajectory had a major influence on the frequency of serious complications. Sacral anchoring of long spinal constructions using S1PS, S2AS, S2AIS and IS is also possible in the presence of LSTV. For S2AS the trajectory with 30° lateral and caudal angulation of 10° showed the least vascular injuries and the least sacro-iliac-joint violations in patients with LSTV. S2AIS trajectories with 40° lateral and 0° sagittal angulation reduced the risk of serious complications in our patients collective with LSTV.

\u201cI would do something if I could!\u201d: experiences and reflections from ethics teachers on how to respond when hearing alarming cases from medical students

BackgroundPrevious studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves.MethodsThis study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples.ResultsFour teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient’s rights and autonomy, and sexual harassment. Regarding teachers’ responses in general, we found three main themes: (1) being assertive, (2) being careful, (3) barriers and facilitators. Most teachers were convinced of the need to take action despite numerous barriers, which they identified, leading to doubts and concerns in taking action. Our study shows that formal education in ethics might not necessarily influence how teachers respond to alarming cases, and that their responses are mainly influenced by how they perceive their role and responsibility as teachers.ConclusionsOur study suggests that teachers should carefully consider the risks and consequences before taking action upon alarming cases to prevent further harm, and that support from higher authorities might be crucial, especially in the Indonesian context. Our study also shows that taking action as a group might be appropriate in certain cases, while personal approaches might be more appropriate in other cases. Most importantly, school leaders and administrators should develop effective organisational culture and support students and teachers for their ethical responsibility commitment.