Procedimentos cirúrgicos assistidos pelo robô Da Vinci: benefícios, riscos e responsabilidade civil / Surgeryprocedures assisted by the Da Vinci robot: benefits, risks and civil liability / Procedimientos quirúrgicos asistidos por el robot Da Vinci: beneficios, riesgos y responsabilidad civil

Objetivo: verificar benefícios, riscos e eventos adversos na utilização da cirurgia assistida pelo robô Da Vinci, a fim de estabelecer a forma de atribuição de responsabilidade entre os diversos agentes envolvidos, quais sejam,médico, hospital, equipe de enfermagem e fabricante. Metodologia:o presente estudo centra-se na coleta e interpretação de material doutrinário e jurisprudencial relacionado à temática,sendo,inicialmente, realizado por meio da investigação dos benefícios, riscos e litígios que discutem eventos adversos na cirurgia assistida pelo robô Da Vinci,à luz do ordenamento jurídico norte-americano. Num segundo momento, é traçado um estudo comparatístico dessas demandas, sob a ótica do sistema jurídico brasileiro. Resultados e discussão: agrande complexidade na análise da responsabilidade civil na cirurgia robótica dá-se, sobretudo, na determinação da causa eficiente do dano­e a quem se atribuir o dever de indenizar.Nos Estados Unidos,essas demandas indenizatórias são conhecidas como finger-pointing cases, pois há sempre o dilema de quem deve responder quando há um dano ao paciente submetido à cirurgia robótica: o médico (e/ou o hospital) ou o fabricante do equipamento. Conclusão:para determinar a responsabilidade civil por eventos adversos na cirurgia robótica, torna-se imprescindível determinar a gênese do dano, isto é, se o dano é decorrente de serviço essencialmente médico, para médico ou extramédico. Além disso, na eventualidade de defeito do próprio robô Da Vinci, responderá o fabricante, independentemente da existência de culpa, pela reparação dos danos causados ao paciente.

Objectives: to verify benefits, risks and adverse events in the use of Da Vinci robot in surgical procedures in order to establish a means to attribute the responsibility between the many agents involved, whomever they may be doctors, the hospital, nursing team and manufacturer. Methods: the present study is based on the collection and interpretation of legal doctrinal and case law material related to the topic. This is initially achieved through the investigation of the benefits, risks and litigations that revolve around adverse events in surgery assisted by the Da Vinci robot, in the context of the North American legal order. In a second instance, a comparative study of these demands is drawn from the perspective of the Brazilian law system. Results and discussion: the great complexity of the analysis of civil liability in robotic surgery is mainly to determine the efficient cause of damage-and to whom should the duty to indemnify be attributed. In the United States of America, these indemnifying claims are known asfinger-pointing cases, as there is always the dilemma of who should respond when there is a damage to the patient who is submitted to robotic surgery, the doctor (and/or the hospital) or the equipment's manufacturer. Conclusion: in order to establish the civil liability due to adverse events in robotic surgery it is imperative to determine the source of the damage, whether it was from an essentially medical, paramedical or extra medical service. Furthermore, in the eventuality of a malfunction of the Da Vinci robot itself, the manufacturer must answer regardless of the existence of guilt to repair the damages caused to the patient.

Objetivo: verificar beneficios, riesgos y eventos adversos en la utilización del robot Da Vinci en procedimientos quirúrgicos, con el objetivo de establecer la forma de atribución de responsabilidad entre los diversos agentes involucrados, ya sean médico, hospital, equipo de enfermería y fabricante. Metodología:el presente estudio se centra en la recolección e interpretación de material doctrinario y jurisprudencial relacionado a la temática, siendo, inicialmente, realizado por medio de la investigación de los beneficios, riesgos y litigios que discuten eventos adversos en la cirugía asistida por el robot Da Vinci, a la luz del ordenamiento jurídico norteamericano. En un segundo momento, se traza un estudio comparativo de esas demandas, bajo la óptica del sistema jurídico brasileño. Resultados y discusiones:la gran complejidad en el análisis de la responsabilidad civil en la cirugía robótica se da, sobretodo, en la determinación de la causa eficiente del daño ­y a quien se le atribuya el deber de indemnizar. En los Estados Unidos, esas demandas indemnizatorias son conocidas como finger-pointing cases, ya que siempre existe el dilema de quién debe responder cuando hay un daño al paciente sometido a la cirugía robótica: el médico (y/o el hospital) o el fabricante del equipamiento.Conclusión:para determinar la responsabilidad civil por eventos adversos en la cirugía robótica, se hace imprescindible determinar el origen del daño, esto quiere decir, si el daño es un resultado del servicio esencialmente médico, paramédico o extramédico. Además, en la eventualidad de defecto del propio robot Da Vinci, responderá el fabricante, independiente de la existencia de culpa, por la reparación de los daños causados al paciente.

Screening of multiple pesticide residues in Jinyinhua Formula Granules / 中国中药杂志

To evaluate the pesticide residue risk of Jinyinhua Formula Granules( made from Lonicerae Japonicae Flos) used in the market preliminarily,20 samples of Jinyinhua Formula Granules from 5 manufactures were collected randomly through the national evaluative sampling test program. Totally 262 pesticides( involving 270 chemical monomers) with monitoring significance to traditional Chinese medicinal materials were detected. Samples were extracted by high speed homogenate with acetonitrile as solvent. And their residues were analyzed by GC-MS/MS and LC-MS/MS in MRM mode. No less than 2 groups of characteristic ion pairs were adopted for qualitative detection,and the calibration curve method was used for quantitative detection. The results showed that 20 pesticides were detected in 20 batches of Jinyinhua Formula Granules,with an average of about 9 pesticides detected in every batch,but no restricted pesticide was detected. The detected pesticides were all at the trace level,which was far lower than the limit of the general food standard. Therefore,the safety risk was low in Jinyinhua Formula Granules. In this study,a screening method for pesticide residues in Jinyinhua Formula Granules was established for the first time. The method was accurate and rapid,and the detection indicators were highly targeted. The results could provide theoretical reference for the prevention and control of pesticide safety risks in Jinyinhua Formula Granules and even traditional Chinese medicine formula granules.

The qualitative research of experiences of the disabled ages occurring safety risks in the communities / 中国实用护理杂志

Objective To understand the experiences of the disabled ages occurring safety risks in the communities.Methods Phenomenology method was used.13 disabled ages who occurred safety risks in Chongqing participated in semi-structured and in-depth interview,regarding their experiences of occurring safety risks.The data were analyzed using Colaizzi method.Results Four themes were found,including enduring mental stress,lack of safety knowledge,expecting perfection of society support system,desiring to achieve self-worth.Conclusions The nurses in the communities should provide better guidance for the disabled ages as well as the caregivers,for improving their living quality.