ABSTRACT
INTRODUCTION: The goal of the medical staff is to provide proper, effective and efficient treatment to the patient and to take care of his well-being. An error in medical care that causes a serious outcome or mortality, can be considered negligence when the caregiver did not meet the requirements of a reasonable physician for reasonable care and did not take the necessary precautions in providing the treatment, in light of the information available to him. The perception of punishment and compensation due to harm, caused to a patient as a result of a medical error, changed dramatically over the years. Starting with direct and severe punishment according to Hammurabi laws and ending with the "no fault" approach that is accepted widely in some countries. Following an adverse event that occurred in medical treatment, a process should be conducted in order to draw lessons to reduce the likelihood of recurrence of similar incidents in the future, by answering 4 questions: What happened? How did it happen? Why did it happen? and What should be done to prevent similar incidents in the future? The Patient Rights Act does not suggest conducting a safety investigation but recommends an examination board in cases of negligence or error in treatment. By law, the protocols of the examination board are confidential and can be removed by the court in case the protocol contains evidence of importance that is unlikely to be found in the medical record. Lack of confidentiality may cause medical staff to be reluctant of conducting a safety investigation due to fear of using its findings for a lawsuit or appointing an examination board whose conclusions will be reported to the victim and his family. The "no fault" method overcomes these barriers by enabling a thorough safety investigation and has important professional, economic and social aspects with a direct impact on the quality and safety of treatment. The method expands the accessibility of victims to compensation, reduces the number of claims and the burden on the courts. Among additional benefits are transparency and consistency in decisions, promoting patient safety due to physicians' willingness to report failures, reduction in "defensive medicine" and spending in the health care system.
Subject(s)
Malpractice , Physicians , Male , Humans , Patient Rights , Medical Errors/prevention & control , ConfidentialityABSTRACT
OBJECTIVES: Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. METHODS: All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. RESULTS: Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. CONCLUSION: These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access.
Subject(s)
Intestinal Obstruction/mortality , Malnutrition/mortality , Neoplasms/mortality , Palliative Care/statistics & numerical data , Parenteral Nutrition, Home/mortality , Aged , Aged, 80 and over , Female , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/therapy , Kaplan-Meier Estimate , Male , Malnutrition/etiology , Malnutrition/therapy , Middle Aged , Neoplasms/complications , Palliative Care/methods , Parenteral Nutrition, Home/methods , Patient Selection , Severity of Illness IndexABSTRACT
The Russian experience in clinical anatomy education is described in this article. Such training is provided by the Department of Operative Surgery and Topographical Anatomy both during the pregraduate (undergraduate) period for medical students and in the postgraduate period for interns, residents, physicians, and surgeons of different specialties. The teaching of clinical anatomy in the pregraduate period occurs in combination with the study of operative surgery and follows the study of gross anatomy in the Department of Human Anatomy and microscopic anatomy in the Department of Histology, Cytology and Embryology.
