Comparative assessment of infection prevention and control practice among maternity unit health workers in public and private secondary health facilities in Kaduna state, Nigeria

OBJECTIVES: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. MATERIAL AND METHODS: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. RESULTS: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. CONCLUSION: IPC practice especially among public HF workers was poor.

Knowledge, attitude, and practices of dental patients presenting at a secondary health care facility in southern Nigeria towards covid-19

With the emergence of the COVID-19 disease, ascertaining the level of knowledge, attitudes and practices of patients will lead to effective patient education, creation of gaps in the life cycle of the SARS-CoV-2 virus and a decrease in the spread of the infection. Objective: To assess the knowledge, attitudes, and practices of dental patients presenting at a secondary healthcare facility in Southern Nigeria towards COVID-19.Materials and Methods: This was a cross-sectional descriptive study of dental patients presenting at the Dental department, Central Hospital Benin, Edo State, Nigeria between August 2020 and February 2021. Data on knowledge, attitude and practices were collected using a researcher-administered semi-structured questionnaire. Analysis of data was done using the IBM®SPSS® Statistics version 25 software. Data on categorical variables were expressed as frequencies and percentages. Mean percentage knowledge, attitude and practices was expressed as poor: < 50%, fair: 50% ­ 69.99%, good: ≥ 70%. Results: In this study, 244 questionnaires were analysed. The respondents' age ranged from 18 ­ 93, with a mean and median age of 34.93 ± 13.15 years and 32.00 years, respectively. The mean percentage knowledge (74.81%), attitudes (68.93%), and practices (63.99%) among patients concerning COVID-19 were good, fair, and fair, respectively. Conclusion: The respondents' knowledge concerning COVID-19 was good; meanwhile, attitudes and practices were fair. There is a need for a more robust health education and promotion programme on COVID-19, due to gaps in relevant sensitisation pathways

Responsabilidad Médica en Chile: Fallos de la Corte Suprema de Justicia 2017 / Medical Malpractice in Chile: Rulings of the Supreme Court of Justice 2017

RESUMEN: El objetivo de este trabajo fue analizar los datos epidemiológicos y jurídicos de los casos por responsabilidad médica fallados por la Corte Suprema de Justicia chilena (CSJ) el año 2017, para relevar los escenarios de alto riesgo, aportando a su prevención. Se realizó un estudio retrospectivo, revisando los fallos de la CSJ en la base de datos electrónica del Poder Judicial chileno. Se seleccionaron y analizaron los fallos por responsabilidad médica. Se detectó un total de 61 casos por responsabilidad médica que alcanzaron la CSJ en 2017. Todos correspondieron a causas civiles. La duración promedio de los juicios fue 41,9 meses. La especialidad más demandada y condenada fue ginecología. La mayoría de las demandas y condenas afectó al Sistema Público de salud. Los casos que dan origen a las demandas son, en su mayoría, de atención de urgencias por sobre las programadas, y de tratamiento por sobre procedimientos quirúrgicos. El 54,8 % de los casos resultaron en la muerte del paciente. La mitad de los fallos condenatorios involucraba el fallecimiento del usuario afectado. Se deben investigar los factores de riesgo no sólo de la ocurrencia de mal-praxis, si no de la judicialización de los conflictos médico-paciente, especialmente en el área gineco-obstétrica, incluyendo los casos de instancias anteriores a la CSJ. Se debe investigar así mismo los factores de riesgo para la mayor propensión de los profesionales de sexo masculino de ser demandados y condenados por malpraxis médica.

ABSTRACT: The objective of the present study is to characterize the epidemiologic and juridical data for medical malpractice cases ruled by the Chilean Supreme Court (CSC) in 2017, to highlight the high risk scenarios, as a contribution to their prevention. A search of the CSC electronic database was conducted to identify and analyze CSC rulings for medical malpractice cases. In this study 61 malpractice cases ruled by CSC were identified. The CSC received only civil cases of medical malpractices during the studied period. The average duration of the trial was 41.9 months. Gynecologists faced suits and received sentences more frequently than any other type of specialist. The majority of prosecuted cases and convictions were associated with the public health system. A greater number of claims were related to emergency care than with scheduled procedures. Likewise, more claims were associated with non-surgical treatment than with surgical procedures. 54.8 % of all cases resulted in the patient's death. Half of the cases that lead to conviction, were related to the death of a patient. Risk factors should be investigated, not only of the occurrence of malpractice, but also of the judicial process of doctor-patient conflicts, especially in the obstetrics and gynecology area, including the analysis of cases of prior judicial instances. The risk factors for the higher propensity of male professionals to be prosecuted and convicted for medical malpractice should also be investigated.

Entre lo formal y lo sustantivo: La calidad de la asistencia al parto en el Uruguay / Entre o formal e o substantivo: a qualidade da assistência ao parto no Uruguay / Between the formal and the substantive: quality of childbirth care in Uruguay

Resumen Este artículo aborda una de las formas de violencia de género, la violencia en el marco de la asistencia al parto, contrastando los derechos sociales contenidos en la Ley de Salud Reproductiva uruguaya con el escenario donde se desarrolla la asistencia al parto. Para la discusión se tomaron entrevistas a personal de salud obstétrico y mujeres que han transitado por una experiencia de parto, realizadas en el marco de una maestría en sociología concluida y de un doctorado en curso. Como principal resultado aparece una distancia importante entre lo formal y lo sustantivo, siendo la violencia simbólica, expresada fundamentalmente a través de la relación médico-paciente, uno de los obstáculos para que "los derechos sean hechos". En las conclusiones se exponen propuestas para mejorar el respeto de los derechos de las mujeres en la asistencia al parto, referidos a un cambio de enfoque que resulte en la transformación del modelo de asistencia y de los/as profesionales que asisten.

Resumo O artigo refere-se a uma das formas de violência baseada no gênero: violência no contexto da assistência ao parto, contrastando os direitos sociais contidos na Lei de Saúde Reprodutiva uruguaia com o espaço onde a assistência ao parto é desenvolvida. Foram realizadas entrevistas com o pessoal da saúde obstétrica e mulheres que passaram por uma experiência de parto, no âmbito do mestrado em sociologia concluído e um doutorado em curso. O resultado principal é uma distância profunda entre os aspectos formais e os substantivos, ocorrendo violência simbólica no relacionamento médico-paciente, um dos obstáculos para que "os direitos sejam fatos". As conclusões estabelecem propostas para melhorar o respeito pelos direitos das mulheres na assistência ao parto, referindo-se a uma mudança de foco que resulta na transformação do modelo de assistência e dos profissionais que participam.

Abstract The article addresses one form of gender violence: violence in the context of childbirth care, contrasting the social rights contained in the uruguayan Reproductive Health Law with the actual scenario where childbirth attendance takes place. For the discussion, interviews with obstetrical health personnel and women who have had an experience of childbirth are taken into account, which were carried out in the context of a master's degree in sociology and an on-going doctorate. As the main result, an important distance between the formal and the substantive is revealed, where symbolic violence, expressed primarily through the doctor-patient relationship, is one of the obstacles for the rights to be respected. The conclusions offers proposals to improve respect for women's rights in childbirth care, referring to a modification in approach that can result in the transformation of the model of care and of the professionals.

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea / 예방의학회지

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

Medicina defensiva: uma prática necessária? / Defensive medicine: a necessary practice?

O artigo em questão aborda os motivos pelos quais a Medicina Defensiva é largamente utilizada no Brasil e no Mundo. A Medicina Defensiva, na prática, se caracteriza pela utilização exagerada de exames complementares, pelo uso de procedimentos terapêuticos supostamente mais seguros, pelo encaminhamento frequente de pacientes a outros especialistas e pela recusa ao atendimento de pacientes graves e com maior potencial de complicações. Trata-se de uma prática que tem como objetivo principal defender o médico de eventuais processos, principalmente na área judicial. A maneira como são conduzidos os processos pelo poder judiciário certamente contribui para a consolidação desta prática insensata. A morosidade da justiça, em nosso meio, associado ao despreparo dos juízes e peritos judiciais na análise dos casos, leva a um desgaste emocional das partes. Alem disso, a formação precária do médico em nosso país faz com que se utilize de meios requintados de diagnóstico e tratamento em detrimento a um exame clínico pormenorizado e uma adequada comunicação com o paciente. Além de ineficiente em proteger o médico, a Medicina Defensiva traz consequências graves ao paciente e à sociedade, já que gera um custo adicional incalculável ao exercício da Medicina, determina um maior sofrimento ao doente e faz com que haja uma deteriorização na relação médico-paciente, que sempre foi pautada pela confiança, respeito e pessoalidade.

We discuss the reasons why Defensive Medicine is widely used in Brazil and worldwide. The Defensive Medicine is characterized by excessive use of complementary tests, the use of supposedly safer therapeutic procedures, the frequent referral of patients to other specialists and by the refusal to care for critically ill patients and with greater potential for complications. This is a practice that aims to defend the doctor from legal suits. The way the processes are conducted by the judiciary certainly contributes to the consolidation of this foolish practice. The slow pace of justice in our country, associated with the unpreparedness of judges and legal experts in the analysis of cases, leads to an emotional exhaustion of the parties involved. Furthermore, poor training of doctors in our country values the use of sophisticated diagnostic and treatment methods, rather than a thorough clinical examination and appropriate communication with the patient. Besides inefficient in protecting the doctor, Defensive Medicine has severe consequences to the patient and to society, since it generates an additional invaluable cost to medical practice, determines greater suffering to the patient and causes deterioration of the doctor-patient relationship, which has always been marked by trust, respect and personhood.

Error y medicina a la defensiva: ética médica y la seguridad del paciente / Erro e medicina defensiva: ética médica e a segurança do paciente / Error and defensive medicine: medical ethics in patient?s safety

Baseando-se no imperativo ético da medicina, primun non nocere, este artigo apresenta considerações sobre o erro médico e a prática da medicina defensiva, cujo propósito principal parece, nuitas vezes, estar vinculado à proteção do profissional, em detrimento dos interesses do paciente. A partir de estudos realizados nos Estados Unidos se desenvolve uma reflexão sobre tal vinculação eos chamados ?pactos de silêncio?, que acabam gerando na sociedade, em geral, incerteza e desconfiança no que se refere à relação médico-paciente. Conforme os resultados da citada pesquisa, este artigo conclui considerando que ocultar o erro não resolve esta complexa problemática e pode trazer consequências nefastas à prática da medicina, relacionadas ao crescimento dos pedidos de exames, que produzem aumento nos custos da saúde, assim como dificultam o acesso aos serviços. Considera, ademais, que o Estado não pode estar ausente nesta discussão fundamental.

Basándose en el imperativo ético de la medicina, primun non nocere, este artículo presenta consideraciones de ética médica, enfocando el error médico y la práctica de la medicina defensiva, cuyo propósito principal parece muchas veces estar vinculado a la protección del profesional, endetrimento de los intereses del paciente. A partir de estudios realizados en los Estados Unidos se desarrolla una reflexión sobre tal vinculación y los llamados ?pactos de silencio?, que acaban generando incerteza y desconfianza en lo referente a la relación médico-paciente, en la sociedaden general. Conforme a los resultados de la citada pesquisa, concluye considerando que ocultar el error no resuelve esta compleja problemática y puede traer consecuencias nefastas a la práctica de la medicina relacionadas al crecimiento de los pedidos de exámenes, que producen aumento en los costes de la salud así como dificultan el acceso a los servicios. Considera, además, que el Estado no puede estar ausente en esta discusión fundamental.

Based on the ethical imperative of Medicine?s, primun non nocere, this article presents consideration of medical ethics foucusing on error and the pratice of defensive medicine, whose main purpose seems often to be linked to the protection of professional to the detriment of the patient?s interest. It is developed, from studies undertaken in the United States, a reflection on such linkage and the so-called ?pacts of silence?, which end by generating uncertainties and mistrust regarding physician-patient relationship in society at large. In consonance to the above mention research, I concluded by considering that hiding a medical error does not solve this complex problematic, and it may have mean consequences to medical practices related to increasing exams requests that produce increase in health costs as well as hampers access to services. It considers, additionally, that the State cannot be absent in this crucial discussion.

Social recognition of medical accident

There has been a great deal of concern about medical malpractice in Korea. Exact figures are difficult to determine, but medical accidents or disputes have increased since the late 1980's. Since 1988, there have been various legislative attempts to pass the 'Medical Dispute Adjustment Act', a kind of alternative dispute resolution. Finally, in March 2011, the mediation law was enacted. The purpose of this law is to create a rapid, efficient recovery system for patients, and to provide a safe, stable environment for medical personnel. Even though medical accidents are inevitable, like other accidents, of course neither doctors nor patients wish for them to occur. However, the medical system lacks an alternative solution for promoting a rational process for communication about medical accidents. As a result, violence against doctors and occupation of medical institutions are more common than they could be. Meanwhile, the Supreme Court has alleviated the burden of proof in medical disputes by applying the theory of prima facie evidence to protect the rights of patients. Though the Supreme Court's position is reasonable in terms of patient care, these cases could lead to 'defensive medicine'. This phrase refers to treatments motivated more by the reduction of liability than by medical needs. This means an increase in health care costs. Above all, civil litigation requires a great deal of time for both parties. Consequently, if medical accidents are inevitable, medical personnel should respond proactively to accidents rather than concealing them. The social recognition of medical malpractice must change in order to create an effective adjustment system and prevent as many medical accidents as possible.

O uso do termo de consentimento livre e esclarecido na prática médica / The use of the free and clarified consent term in medical practice

Este artigo analisa a aplicação do termo de consentimento livre e esclarecido (TCLE) na prática dos médicos que trabalham no Hospital Universitário (HU) da Universidade Federal de Sergipe, localizado na cidade de Aracaju. A pesquisa que originou o trabalho verificou aatribuição de importância à aplicação do TCLE na prática médica. Foram entrevistados cinco médicos do HU, bem como analisados 72 prontuários de pacientes internos, de acordo com a bioética, a legislação e a doutrina brasileiras. Concluiu-se que apesar de visto como importante, o TCLE só é utilizado em dois serviços naquela unidade, apesar dos avanços da responsabilidade civil médica no Brasil.

O consentimento informado para além da medicina defensiva / The informed consent beyond the defensive medicine

O consentimento informado é uma exigência ética e legal na assistência médica. Na perspectiva da Medicina Defensiva, o consentimento informado é visto como documento que visa a proteger os interesses do médico. Na perspectiva da Bioética, é um processo que visa a proteger os interesses do paciente. Numa visão jurídica fundamentada na Bioética, conclui-se que o consentimento informado é processo, que pode ser expresso na forma escrita, que visa proteger interesses tanto de médicos quanto de pacientes.

The informed consent is a legal and ethical requirement in medical care. In the perspective of Defensive Medicine, informed consent is regarded as a document to protect the doctor. On the Bioethics standpoint, informed consent is a process which aims the protection of the patient. In a legal stance based on Bioethics informed consent is a process that can be expressed in written form, to protect both doctors and patients.

Conduta atual nas síndromes compressivas do membro superior / Current approach to upper extremities entrapment neuropathies

As síndromes compressivas estão entre as causas mais comuns de queixas nos ambulatórios dos cirurgiões plásticos e ortopedistas. Os sintomas podem ser evidentes, mas muitas vezes passam despercebidos ao médico generalista. Facilmente são confundidos com sintomas vasculares, da “idade” ou somatização. O entendimento da fisiopatogenia destas lesões auxiliará no diagnóstico precoce e no tratamento mais adequado de cada caso. Neste artigo abordaremos de forma simplificada o manejo clínico, diagnóstico e a conduta nas principais síndromes compressivas do membro superior.

Compressive syndromes are among the most commons causes of complaint in the offices of plastic surgeons and orthopedists. Although the symptoms may be evident, they often go unnoticed to the primary-care physician. They are easily mistaken for vascular symptoms, “aging”, or somatization. An understanding of the physiopathogeny of such lesions will be helpful in the early diagnosis and to select the most appropriate treatment for each case. In this article we briefly address the clinical management, diagnosis, and the approach to the main compressive syndromes of the upper limbs.

Mala praxis: la visión de un cirujano / Medical malpractise: a surgeon's vision

In this article the author presents a surgeon's vision of medical malpractice.

Le Direttive Anticipate: Il Parere Dell’intensivista. La directriz de avanzada: el papel del intensivista / The roll of the intensivist

La deontología médica italiana, presenta la abstención al empeño terapéutico como un deber del médico e introduce por lo tanto una adhesión incondicionada a la voluntad del paciente. Uno de los esfuerzos que la sociedad médica ha tenido en cuenta son las diversas situaciones y enfermedades en las cuales permiten al médico elecciones que no son discutibles.