Health professionals ethical and legal liability on patient’s inadequate clarification in order to obtain free and informed consent

It is required that patients are provided information about therapeutic possibilities, showing the risks, benefits, prognosis and costs of each possible and indicated alternative. This is an ethical and legal resolution. However, health professionals possess the clinical/technical/scientific knowledge and determine what information will be (or not) provided. The patient in question decides to undergo a treatment, providing his/her free and informed consent on the basis of the data presented. Unfortunately, some professionals may not provide all the information necessary for making an informed decision or, after obtaining the consent of the patient, may provide him information that causes the patient to give up on the treatment initially accepted. Such information, if relevant, and not a supervening fact, should have been provided initially. However, the information may not be entirely true, and bring the patient, for instance, to decide based on inadequately presented risks. The craniofacial rehabilitation of the temporomandibular joint (TMJ) by means of TMJ prosthesis, is indicated in many situations. Often, patients in need of such prostheses have aesthetic and functional problems and the rehabilitation expectations run high. This work presents a case and discusses ethical and legal issues, including the liability of partial and inadequate information to a patient.

NUMERICAL SIMULATION of THE BEHAVIOR of THE BEHAVIOR of REINFORCED CONCRETE BEAMS and COLUMNS BY FEM CAASTEM 2000 PROGRAM

The objective of this paper is the numerical study of the behavior of reinforced concrete beams and columns by non-linear numerical simulations. The numerical analysis is based on the finite element method implemented in CASTEM 2000. This program uses the constitutive elastoplastic perfect model for the steel, the Drucker-Prager model for the concrete and the Newton-Raphson for the solution of non-linear systems. This work concentrates on the determination of equilibrium curves to the beams and force-strain curves to the columns. The numeric responses are confronted with experimental results found in the literature in order to check there liability of the numerical analyses.

Identification of a Microdeletion at the 7q33-q35 Disrupting the CNTNAP2 Gene in a Brazilian Stuttering Case

Speech and language disorders are some of the most common referral reasons to child development centers accounting for approximately 40% of cases. Stuttering is a disorder in which involuntary repetition, prolongation, or cessation of the sound precludes the flow of speech. About 5% of individuals in the general population have a stuttering problem, and about 80% of the affected children recover naturally. The causal factors of stuttering remain uncertain in most cases; studies suggest that genetic factors are responsible for 70% of the variance in liability for stuttering, whereas the remaining 30% is due to environmental effects supporting a complex cause of the disorder. The use of high-resolution genome wide array comparative genomic hybridization has proven to be a powerful strategy to narrow down candidate regions for complex disorders. We report on a case with a complex set of speech and language difficulties including stuttering who presented with a 10Mb deletion of chromosome region 7q33-35 causing the deletion of several genes and the disruption of CNTNAP2 by deleting the first three exons of the gene. CNTNAP2 is known to be involved in the cause of language and speech disorders and autism spectrum disorder and is in the same pathway as FOXP2, another important language gene, which makes it a candidate gene for causal studies speech and language disorders such as stuttering. (C) 2010 Wiley-Liss, Inc.

Aspectos médico-legais da cirurgia para hérnia inguinal

Professional responsibility is an inherent factor to the medical activity. Therefore, the adoption of a healthy conduct based on good relationship between the physician and the patient, as well as the understanding of this professional of the several aspects involved in the inguinal hernia repairs, are considered the better means to protect himself against possible litigations with its patients. This issue provides a complete evaluation of medical and legal problems related to the inguinal hernia surgery, and discusses the care that surgeon must exercise during preoperative, intraoperative and postoperative periods. That authors also comment about medical error and its conception from the point of the new Civil Code.

Prevenção de conflitos médico-legais no exercício da medicina

Os conflitos médico-legais que ocorrem no exercício da Cirurgia e da Medicina são motivos de preocupação não só no meio médico, mas também na sociedade como um todo, pois se de um lado geram um maior desgaste emocional ao médico, por outro, os pacientes estão sendo rejeitados. As causas desses conflitos são muitas, envolvendo fatores não assistenciais, como o sistema de saúde distorcido e desorganizado, a falta de participação da sociedade e do médico na melhoria desse sistema, o aparelho formador que lança no mercado grande número de jovens médicos despreparados para o exercício dessa nobre profissão, além da falta do ensino continuado. A solução para esses conflitos não poderá ser por meio de simples criação de leis, e nem pela negativa da existência do erro médico, que ocorre numa freqüência até maior do que os próprios conflitos. Todavia, pode-se afirmar que é muito importante melhorar a relação médico-paciente. É necessário, ainda, que o médico conheça a fundo seus deveres de conduta e que, principalmente, se abstenha de praticar abusos do poder. A sociedade deve também entender que a saúde não é uma questão exclusiva dos médicos e que deve lutar pela melhoria das condições dos níveis de vida.

O consentimento informado: Qual o seu real valor na prática médica?

Trata-se de um artigo que comenta sobre a real importância do Termo de Consentimento Informado na prática médica. Este documento tem sido cada vez mais usado como uma prática defensiva, a fim de constituir provas para defesa de um eventual processo judicial de responsabilidade médica, desvirtuando assim a idéia original, que seria a de respeitar a autonomia do paciente e delimitar a responsabilidade médica. O documento tem como objetivo mostrar que o médico cumpriu com seu dever de informar. Seu grande valor reside nos casos onde existam riscos de danos irreversíveis ao paciente. Conclui-se, porém, que um prontuário bem elaborado onde se inclui o registro das informações que foram transmitidas, bem como o grau de participação dos pacientes e seus familiares nas decisões terapêuticas, também deve ter valor ético e jurídico semelhante do TCI.

Organização do sistema de referência e contra-referência no contexto do Sistema Único de Saúde: a percepção de enfermeiro

Este estudo teve como objetivo compreender e desvelar a percepção de enfermeiros sobre o sistema de referência e contra-referência, no contexto do Sistema Único de Saúde do município de Botucatu ISP/BR, a partir da experiência vivenciada na prática. Para tanto, optamos pela pesquisa qualitativa, na modalidade do fenômeno situado, vertente metodológica da fenomenologia. Num primeiro momento, buscamos realizar uma revisão histórica sobre o processo de construção do Sistema Único de Saúde no Brasil e o significado do sistema de referência e contra-referência neste contexto. A construção dos resultados foi realizada a partir das análises ideográfica e nomotética dos depoimentos de treze enfermeiras, tendo emergido destes treze temas, posteriormente agrupados em três categorias principais: o funcionamento do sistema de referência e contra-referência, as possibilidades de encaminhamento da clientela e fatores estruturais do sistema local, desvelando que a referência e contra-referência ainda não passa de um horizonte e só funciona quando há empenho pessoal dos profissionais isoladamente.

Mercury in soils and sediments from gold mining liabilities in Southern Amazonia

The 1980-1990 Amazonian gold rush left an enormous liability that increasingly has been substituted by developing fish aquaculture. This work aimed at the identification of the mercury levels in the environment, associated with fish farms located in the North of Mato Grosso State, Southern Amazon. Sediment and soil samples were analyzed for total organic carbon and total mercury. Results indicate that the chemical characteristics of the sediment largely depend on the management procedures of the fish pond (liming, fish food used and fish population). The soils presented relatively low concentrations when compared with other data from the literature.

Análise da configuração de SAMU utilizando múltiplas alternativas de localização de ambulâncias

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Study of stayability in Nellore cows using a threshold model

The objectives of the current study were to assess the feasibility of using stayability traits to improve fertility of Nellore cows and to examine the genetic relationship among the stayabilities at different ages. Stayability was defined as whether a cow calved every year up to the age of 5 (Stay5), 6 (Stay6), or 7 (Stay7) yr of age or more, given that she was provided the opportunity to breed. Data were analyzed based on a maximum a posteriori probit threshold model to predict breeding values on the liability scale, whereas the Gibbs sampler was used to estimate variance components. The EBV were obtained using all animals included in the pedigree or bulls with at least 10 daughters with stayability observations, and average genetic trends were obtained in the liability and transformed to the probability scale. Additional analyses were performed to study the genetic relationship among stayability traits, which were compared by contrasting results in terms of EBV and the average genetic superiority as a function of the selected proportion of sires. Heritability estimates and SD were 0.25 +/- 0.02, 0.22 +/- 0.03, and 0.28 +/- 0.03 for Stay5, Stay6, and Stay7, respectively. Average genetic trends, by year, were 0.51 +/- 0.34, and 0.38% for Stay5, Stay6, and Stay7, respectively. Estimates of EBV SD, in the probability scale, for all animals included in the pedigree and for bulls with at least 10 daughters with stayability observations were 7.98 and 12.95, 6.93 and 11.38, and 8.24 and 14.30% for Stay5, Stay6, and Stay7, respectively. A reduction in the average genetic superiorities in Stay7 would be expected if the selection were based on Stay5 or Stay6. Nonetheless, the reduction in EPD, depending on selection intensity, is on average 0.74 and 1.55%, respectively. Regressions of the sires' EBV for Stay5 and Stay6 on the sires' EBV for Stay7 confirmed these results. The heritability and genetic trend estimates for all stayability traits indicate that it is possible to improve fertility with selection based on a threshold analysis of stayability. The SD of EBV for stayability traits show that there is adequate genetic variability among animals to justify inclusion of stayability as a selection criterion. The potential linear relationship among stayability traits indicates that selection for improved female traits would be more effective by having predictions on the Stay5 trait.

Profile evaluation of orthodontic professionals as for their legal actions

Objective: Evaluate the legal actions and behavior in the doctor/patient relationship, used by dental surgeons practicing orthodontics. Methods: The population sample of the present study consisted of dental surgeons, active in the field of orthodontics, and registered with Dental Press Publishing Company - Maringá/PR, Brazil, with a total sample size of 525 professionals. The research was conducted using a 17-question survey forwarded to these professionals. Results and Conclusions: The majority of participants in our study are specialized in orthodontics; 75% of professionals use some sort of contract at the office/clinic; 73.7% of professionals periodically request maintenance X-rays; a large percentage of professionals (58.9%) keep patient records on file for life. The interviewed professionals demonstrate good knowledge of the Brazilian Code of Ethics in Dentistry, especially of Chapter XIV - on Communication.

Utilização de redes neurais recorrentes na caracterização de cargas não lineares em sistemas elétricos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Responsabilidade do Estado e do magistrado frente à concessão ou denegação de tutelas de urgência

Pós-graduação em Direito - FCHS

Danos morais: compensabilidade e quantificação

Pós-graduação em Direito - FCHS

Os direitos e obrigações da terceirização na administração pública

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)