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Com a maior possibilidade de conhecimento e acesso a informações, o paciente deixa de ser uma parte passiva no relacionamento médico-paciente, sendo a cada dia mais contestador e argumentativo a respeito de seus diagnósticos e terapêuticas instituídas. Parte destes questionamentos, principalmente no que diz respeito a intercorrências médicas, acaba por desgastar esta relação, fenômeno que tem sido descrito como um potencializador na judicialização dos conflitos médicos no mundo. Com esta trajetória, assistiu-se de perto a um afastamento nessa relação médico-paciente, não apenas com um público geral mais desconfiado das prestações de serviços, mas também um médico mais desgastado, com posturas defensivas, hiperespecializado e, consequentemente, mais técnico e formalista do que humano e empático. O reforço na informação médica e na comunicação entre as partes é um sinalizador forte no que se pensa de uma profilaxia jurídica nas prestações de serviços médicos. Ainda assim, intercorrências ocorrem, e posturas diversas existem frente ao ocorrido. Quando isso ocorre, temos hoje a possibilidade de contar com um grande sistema jurídico dito "multiportas", capacitado a abrigar a contingência necessária, a depender do diagnóstico nas relações entre as partes, para uma terapia jurídica adequada a cada situação em particular. Tal "terapêutica jurídica" pode dar-se por autocomposição, como os consagrados métodos de mediação ou conciliação, já não estranhos à área da saúde, ou por métodos heterocompositivos, e, entres estes, a já conhecida tutela Estatal e a Arbitragem, por autonomia da vontade das partes desde que o direito a ser discutido seja disponível.
Highly empowered by knowledge and available information, patients are no longer a passive part of the patient-physician relationship but become more challenging and argumentative about their diagnoses and prescribed therapies. Part of the issues, especially regarding medical complications, may weaken this relationship, a phenomenon that has been described to enhance judiciary litigation against physicians worldwide. With this trajectory, there was a distance in this medical relationship. In this perspective, a wedge has been placed within the patient-physician relationship, delineating on one side a general public more suspicious of the services provided, and on the other side, a more worn-out doctor, with a defensive stance, hyper-specialized and consequently more technical and formalistic than humane and empathic. The reinforcement of medical information and communication between the parts strongly signal what is considered legal prophylaxis in medical services. Even so, complications do occur, and different attitudes do exist in the face of what may have happened. When this happens, one can count on a large legal system called "multi-doors," able to accommodate the necessary contingency, depending on the diagnosis in the relations between the parts, for a legal therapy appropriate to each particular situation. Such "legal therapy" can occur by self-composition, as are the established methods of Mediation and Conciliation, no longer foreign to the health area, or by heterocompositive methods, among which are the already well-known methods of judicial adjudication and Arbitration.
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RESUMO Este estudo teve como objetivos analisar a trajetória de vida de árbitras de futsal da região Nordeste e refletir sobre como suas representações de "ser mulher árbitra" se articulam à sua identificação enquanto "mulher nordestina". Baseamo-nos nos campos da História Oral, História Cultural e nos Estudos de Gênero. Foram analisadas 13 entrevistas e documentos de acervos pessoais e institucionais. Nossas análises revelam que as interlocutoras se deparam com limitações às quais respondem recorrendo a variadas referências de gênero que, por sua vez, expõem as complexidades da categoria "mulher". Destacamos, aqui, o lugar de uma "identidade regional" ao qual elas frequentemente se referem ao tratarem das formas encontradas para questionarem e enfrentarem os preconceitos que atravessam suas trajetórias.
ABSTRACT This study aimed to analyze the life trajectory of referees from futsal in the northeastern region and reflect on how their representations of "being a referee woman" are linked to their identification as a "northeastern woman". We are based on Oral History, Cultural History and Gender Studies. Thirteen interviews and documents from personal and institutional collections were analyzed. Our analyzes reveal the interlocutors are faced with limitations and difficulties to which they respond by resorting to various references of gender and behavior that, in turn, expose the complexities of the "woman" category. We highlight the place of a "regional identity" that they often refer to when dealing with the ways found to question and face the prejudices that cross their trajectories.
RESUMEN Este estudio tuvo como objetivo analizar la trayectoria de vida de las árbitras de futsal de la región nordeste y reflexionar sobre cómo sus representaciones de "ser mujer árbitra" se articulan con su identificación como "mujer del nordeste". Nos basamos en la Historia Oral, la Historia Cultural y los Estudios de Género. Se analizaron 13 entrevistas y documentos de colecciones personales e institucionales. Nuestros análisis revelan que los interlocutores enfrentan limitaciones a las que responden recurriendo a diversas referencias de género que, a su vez, exponen las complejidades de la categoría "mujer". Aquí, destacamos el lugar de una "identidad regional" a la que suelen referirse cuando se trata de las formas que encuentran para cuestionar y enfrentar los prejuicios.
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Resumen El proceso editorial de una revista, específicamente la revisión por pares, valida la publicación científica con el respaldo de la experiencia y el conocimiento de los revisores. Sin embargo, a pesar de que existen programas que capacitan en la parte investigativa a los miembros de la comunidad científica, son escasas las herramientas de capacitación para participar en el arbitraje de un manuscrito. El propósito de este artículo es presentar una guía con una serie de recomendaciones sobre cómo un artículo científico debe ser revisado por pares. Se realiza una sumatoria de recomendaciones y criterios que servirán para que los revisores de Odovtos-International Journal of Dental Sciences puedan utilizar como referencia y respaldo para su labor.
Abstract The editorial process of a journal, specifically peer review, validates the scientific publication supported by the experience and knowledge of the reviewers. However, despite the fact that there are programs that instruct members of the scientific community in research, there are few training tools to participate in the arbitration of a manuscript. The purpose of this article was to present a guide with a series of recommendations on how a scientific article should be peer-reviewed. A synopsis of recommendations and criteria is presented and will be used by the reviewers of Odovtos-International Journal of Dental Sciences as a reference to support their work.
Subject(s)
Peer Review , Journal Article , DentistryABSTRACT
La revisión por pares representa uno de los pilares más importantes sobre los que se sustentan las revistas científicas. Es un proceso complejo y riguroso realizado por expertos nacionales y/o extranjeros que permite la evaluación crítica de los manuscritos. En el área salud, este proceso toma una dimensión relevante sobretodo en la valoración de la credibilidad de los resultados de investigaciones y en la descripción de procedimientos y resolución de casos.
De avaliação pelos pares representa um dos pilares mais importantes no qual estão baseados os periódicos científicos de avaliação pelos pares. É um processo complexo e rigoroso conduzido por peritos nacionais ou estrangeiros, que permite uma avaliação crítica dos manuscritos. Na área da saúde, este processo leva acima de tudo uma dimensão relevante na avaliação da credibilidade dos resultados da pesquisa e na descrição de procedimentos e resolução de casos.
The peer-review process is one of the main pillars of scientific journals. It is a complex and rigorous activity conducted by national or foreign experts, which allows for a critical assessment of manuscripts. In the health area, this process becomes highly relevant, especially regarding assessing the credibility of the research results and the description of procedures and resolution of cases.
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Humans , Peer Review, Research , Periodicals as TopicABSTRACT
Resumen: Introducción: Las quejas constituyen un indicador negativo en la calidad de la atención médica. El conocimiento de los problemas que las originan y sus consecuencias constituyen elementos fundamentales para las estrategias de mejora de la calidad. En este estudio se dan a conocer los resultados del análisis de laudos concluidos, emitidos por la Comisión Nacional de Arbitraje Médico durante el periodo 2011-2015, que corresponden a la población usuaria menor de 15 años. Métodos: Estudio transversal descriptivo. Se analizó información extraída de los laudos concluidos en los últimos 5 años en los que la población afectada tuviera menos de 15 años, independientemente del servicio involucrado. Resultados: Se detectaron 40 laudos, la mayoría involucrados con servicios de pediatría, encontrándose una distribución homogénea por edad y sexo. Los porcentajes más altos se encontraron en las edades extremas de la población estudiada: menores de 1 año (32%) y de 10 a 14 años (30%). La principal causa de la queja fueron los problemas con los auxiliares de diagnóstico (45%). Se detectó un promedio de 8.7 eventos adversos por caso, la mayoría relacionados con procedimientos. Entre los daños destacan 12 defunciones y 9 discapacidades permanentes. Se encontró evidencia de mala práctica en el 65% de los casos y hubo una sentencia condenatoria en el 60% de los laudos. Conclusiones: Se obtuvieron resultados en cuatro grandes apartados: características sociodemográficas, descripción de la atención médica, eventos adversos y sus repercusiones en los daños a la salud, y la evaluación del acto médico y conclusiones del laudo.
Abstract: Background: Claims by health services users are a negative indicator of the care quality. To know the situations that originate them, and their consequences are key issues to consider in order to design strategies to improve the quality of health services. This study analyses the cases submitted to the National Medical Arbitration Commission with a final arbitration decision during the period 2011-2015, related to health service users younger than 15 years old. Methods: Cross-sectional descriptive study. We analyzed information extracted from the reports with a final arbitration decision in the last 5 years, selecting those where the affected users were younger than 15 years old. Results: A total of 40 cases arbitral award were found, most of them involving pediatric services, with a similar number of male and female users and a similar proportion in the extreme age groups, <1 year (32%) and 10-14 years (30%). The main cause of the complaint was related to diagnostic procedures (45%). An average of 8.7 adverse events per case were identified, most of them associated with procedures. Among the damages, there were 12 deaths and 9 permanent disabilities. There was evidence of malpractice in 65% of the cases and in 60% of the cases, the sentence was condemnatory. Conclusions: This manuscript shows information in four main sections: sociodemographic characteristics, description of medical care, adverse events and their repercussions on health damages, evaluation of the medical act and conclusions of the arbitration process.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Quality of Health Care/legislation & jurisprudence , Negotiating , Malpractice/statistics & numerical data , Cross-Sectional Studies , Age Factors , Malpractice/legislation & jurisprudence , MexicoABSTRACT
ANTECEDENTES: Se realizó la revisión de 7 años del Sistema de Quejas Médicas en la Comisión Estatal de Arbitraje Médico del Estado de Oaxaca, México, entidad autónoma y calificada para dirimir el proceso de inconformidad durante el fenómeno de la atención médica. Se analizaron todas las quejas, formas de resolución y en especial se identifico la queja en gineco-obstetricia. OBJETIVO: Caracterizar la inconformidad en la queja del usuario en la especialidad de gineco-obstetricia. MÉTODO: Investigación documental, descriptiva, transversal, retrospectiva y sin implicaciones éticas, efectuada mediante el análisis de bases de datos del SAQMEDO de enero de 2008 a abril de 2015. Se seleccionaron todos los expedientes de quejas médicas de la especialidad, entre todas las presentadas. RESULTADOS: El Instituto Mexicano del Seguro Social fue la entidad más frecuente en quejas médicas seguida por la medicina privada. Por octavo año consecutivo la ginecología y obstetricia prevalece como líder en quejas de los usuarios, sumando en el actual análisis 100 de 438 quejas. El origen de las quejas resulta de la deficiencia en la otorgación del servicio institucional y privado que contabilizó el 69% de los casos. CONCLUSIONES: La falta en el proceso de la evaluación del desempeño ha sido fundamental en la repetición de la queja en gineco-obstetricia. A lo largo de 8 años se ha repetido el modelo vicioso, sin que las instituciones hagan algo a cambio. De continuar ignorando el problema de manera local conseguiremos que éste ciclo se perpetúe.
BACKGROUND: It has been made a complete analysis of 7 years in the State Commission of Medical Arbitration in Oaxaca, one of the southern states in México. This Commission is the legal entity to judge the process of malpractice. The study was aim to identify the obstetrics and gynecology complains. OBJECTIVE: Characterize the medical complain in the obstetrics and gynecology specialty. METHOD: It was conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2008 -2015 activity report; we selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The Mexican Institute of Social Security Services became the most demanded medical provider closely followed by the private practice. Obstetrics and gynecology was the most demanded medical specialty for 8th uninterrupted years. From 438 claims 100 accounted to this specialty. The failure to give or perform the service was the origin of the complains. CONCLUSION: Absence of risk assessment and supervision of competence in the performance of the medical process were the most forthcoming issues when malpractice were continue to identified. Eight in a row years of failure to amended these vicious process speaks for itself. Lots of hard work are to be consider as a reliability strategy.
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Humans , Female , Negotiating , Medical Errors/statistics & numerical data , Gynecology , Malpractice/statistics & numerical data , Obstetrics , Quality of Health Care , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies , Medical Errors/legislation & jurisprudence , Medical Care , Malpractice/legislation & jurisprudence , MexicoABSTRACT
The authoritative tribunal for the settlement of banking and financial disputes in most jurisdictions is the civil law court. However, the practices of the civil law court are repugnant to Islamic Commercial law and its judges lack the appropriate knowledgeable. More so, the jurisdiction of the Shariah court in most countries is restricted to the cases of Islamic family law. It does not cover the cases of the Islamic commercial transaction which includes, the Islamic banking, Islamic insurance, Islamic financial market and etc. This problem leaves arbitration as the only process for the settlement of Islamic commercial dispute. Nevertheless, arbitration cannot be resorted to, except if an arbitration clause is inserted in the respective commercial agreement. This article expounds the importance of the arbitration clause to the Islamic commercial contracts. It proposes arbitration as the panacea for court jurisdictional logjam.
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En este artículo se concibió la oponencia como forma de crítica científica. Se realizó un análisis del ejercicio de oponencia por los problemas identificados en la Universidad de Ciencias Médicas de Camagüey, desde el pregrado hasta el postgrado en la realización de los informes finales de investigaciones, tesis y publicaciones. El objetivo fue valorar la oponencia como forma madura y ética de la crítica científica. Se propuso una metódica para el ejercicio de la oponencia contentiva de la selección del oponente, conocimiento del investigador, acercamiento al trabajo investigativo y el juicio crítico al evaluar y emitir veredicto. De igual forma se expusieron requisitos para realizar una buena oponencia, así como elementos en la estructura de un informe de oponencia que no deben faltar, con independencia del nivel en el cual se realice. Para finalizar se hizo un acercamiento a la posición del investigador ante la crítica.
Discussion is conceived as a form of scientific criticism, for this reason an analysis of the discussant performance considering difficulties identified at the Medical University in Camag-ey, at the undergraduate and the postgraduate levels regarding final reports of researches, theses and articles for publication. The objective was to assess the discussants performance in regard to ethical issues. A methodology is proposed for the selection and education to enhance the performance of discussants in the scientific.
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During the last decade Brazil has witnessed the expansion and differentiation of its financial field, with a major impact on society and the composition of its elites. I analyze this process based on data concerning the new players and the instruments they disseminate in companies and other organizations in Brazilian society. These include both financial instruments per se and organizational tools based on the same logic. I seek to demonstrate that the quest for legitimacy for new players and instruments has led to a new cultural judgment on what constitutes societys "general interest", which drastically constrains action by the different governments and partially explains the paradoxes faced by the Lula Administration in its first year.
Dans la dernière décennie, le Brésil a connu un essor et des changements dans son espace financier qui ont provoqué un grand impact dans la société et la composition de ses élites. On examine ici ce processus à partir de données concernant les nouveaux acteurs et les instruments qu'ils diffusent dans les entreprises et autres organisations de la société brésilienne. Leurs instruments sont non seulement d'ordre directement financier mais aussi d'ordre organisationnel inspirés par la même logique. On cherche à montrer que la quête de légitimité des nouveaux agents et instruments finit par créer un nouvel arbitraire culturel à propos de ce qui est "l'intérêt général" de la société; ce facteur, qui gêne fortement l'action des différents gouvernements, saurait expliquer, en partie, les paradoxes auxquels le gouvernement Lula doit faire face dans sa première année d'exercice.
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La revolución que representa el proceso de publicación electrónica ha despertado una polémica en torno a las ventajas y desventajas de éstas con respecto a las publicaciones en papel. Aspectos tales como la posible ausencia de arbitraje de los trabajos científicos, la paternidad incierta de algunos de ellos, las tergiversaciones o malinterpretaciones posibles de la información electrónica, la comodidad y facilidad real de los lectores para consultar la información, entre muchos otros, se contraponen a ventajas que radican en las potencialidades de las publicaciones electrónicas para compartir y expandir rápidamente información actualizada a amplios mercados y las amplias posibilidades de hipermedia que muchas de ellas ofrecen. Estas cuestiones también se analizan brevemente desde la óptica de la Unidad de Análisis y Tendencias en Salud, entidad del Ministerio de Salud Pública de Cuba, que ha comenzado ha insertarse en el entorno de la publicación electrónica.
The revolution that represents the process of electronic publishing has arose a controversy regarding its advantages and disadvantages compared to printed publications. Issues such as the possible absence of scientific paper screening, the uncertain paternity of some of them, the likely misinterpretations or distortion of the electronic information, the actual convinience and easiness of readers to consult the information, among others, are opposed to the advantages that reside on the potentialities of electronic publishing to quickly share and spread updated information towards wide markets and the broad possiblities of hypermedia that offer a lot of them. These ideas are briefly analized from the point of view of the Analysis and Trends Unit in Health, entity belonging to the Ministry of Public Health which has begun to insert itself in the environment of electronic publishing.
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Objective To find out the tendency of medical accident arbitration in 5 hospitals of Shanghai and the causes. Methods Cases involving medical accident arbitration that occurred in the 15 years running from 1985 to 1999 in 5 third tier hospitals of Shanghai were collected and a retrospective correlation analysis was conducted. Then 45 of the cases were selected by random sampling and a detailed analysis was made. Results ①During the 15 years the number of cases involving medical accident arbitration by class 1 commissions was 295, with the average number per year in the latter five years rising 51% as compared with the first ten years. ②There was no significant correlation between the number of cases involving arbitration and the number of cases judged to be accidents. ③There was no correlation, either, between the total volume of emergency outpatient service, which amounted to 68, 6 million visits, and the number of cases involving medical accident arbitration. ④The sample survey showed that the operating room and the emergency room were sections where medical accidents occurred most frequently. Conclusion In the past 15 years, the number of cases involving medical accident arbitration has been on the rise, yet there is no correlation between the rise and the number of cases judged to be accidents or the volume of medical service. The causes for the rise include both iatrogenic and non iatrogenic ones. The paper puts forward 6 countermeasures.
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Results of medical malpractice arbitration are important evidence and proofs for public health departments and judicial institutions to handle properly disputes over medical accidents. Owing to the flaws that exist in the structure of medical malpractice arbitration, arbitration specialists sometimes find it difficult to accept the evidence and proofs. The author of the present paper suggests that judicial discretion be introduced in medical malpractice arbitration. When exercising judicial discretion, the specialists should comply with the following principles: (1)Review objectively the evidence and proofs provided by both the physicians and patients according to law. (2)Ensure neutral arbitration according to the ethics of arbitration. (3)Apply specialized knowledge, clinical experience and logical inference. (4)Make independent and lawful judgments and draw definite conclusions. Anyone who exercises judicial discretion should do so in the light of laws and regulations and bear corresponding legal responsibilities.