[Civil, administrative and criminal liability of medical workers].

From the point of view of legislation, medical care refers to the provision of services, however, the issues of legal responsibility of a medical worker, which is imposed in case of violation of the rights of a patient, are quite difficult and are characterized by controversial points for assessment. Today, a large number of complaints from patients are filed against doctors, requiring consideration by the competent authorities. The article considers the features of civil, administrative and criminal liability applied to medical workers.

Castilla del Pino: un faro indispensable para navegantes de lo mental / Castilla del Pino: An Essential Lighthouse for Navigators of the Mental

Castilla del Pino ejerció un indudable liderazgo intelectual sobre varias generacio-nes de españoles en el último tercio del siglo XX, y de forma particular ejerció su función de intelectual aplicado a la práctica clínica de lo mental. Esta tarea constituyó un verdadero ma-gisterio para los profesionales interesados en prácticas clínicas rigurosas, respetuosas con la dignidad y los derechos de los pacientes. En este trabajo se revisan algunas de sus principa-les aportaciones como intelectual a la práctica psiquiátrica y la psicoterapia. Específicamen-te, se abordan sus contribuciones al estudio de la influencia de la ideología en la psicoterapia y la ideología de la locura y su impacto en la práctica psiquiátrica en contexto hospitalario. Sus observaciones y recomendaciones significan una magnífica guía para el ejercicio de la observación rigurosa, la reflexión y el pensamiento crítico frente al dogmatismo. (AU)

Castilla del Pino was an undoubted intellectual leader over several generations of Spaniards in the last third of the 20th century. He specifically played this role as an intellectual in the field of the mental health practice. This task constituted a true teaching for professionals interested in rigorous clinical practices, respectful of the dignity and rights of patients. This paper reviews some of his main contributions as an intellectual to psychiatric practice and psychotherapy. It specifically addresses his contributions to the study of the influence of ideology in psychotherapy, as well as the ideology of madness and its impact on psychiatric practice in a hospital context. His observations and recom-mendations are an excellent guide to the exercise of rigorous observation, reflection and critical thinking facing any dogmatism. (AU)

LEGAL CONFLICTS IN MEDICAL PRACTICE AND METHODS OF THEIR RESOLUTION.

OBJECTIVE: The aim: A theoretical and applied study of the essence of legal conflicts in the field of medical activity in order to determine the proper system of ways to protect the interests of patients, doctors and other participants in medical legal relations. PATIENTS AND METHODS: Materials and methods: Various methods of scientific knowledge make up the methodological basis of research. Thus, the comparative legal method was used to compare the features of the legal regulation of the rights protection of medical legal relations subjects in different countries. The essence and classification criteria of both legal conflicts and methods of protection in the field of medical activity were investigated with the help of a system-complex method. The following other methods were used in the study, in particular: formal-logical, dialectical, analysis and synthesis. CONCLUSION: Conclusions: The classification of dispute resolution methods in the aspect of medical activity indicates the possibility of distinguishing non-jurisdictional (self-defense) and jurisdictional (special, administrative, judicial protection) forms of patients' rights protection, as well as distinguishing two levels of such protection (pre-trial and judicial), each of which has its distinctive features and the patient himself is able to determine in what way and by what level to protect his rights. An important role in the conflict resolution in the field of health care is primarily played by the pre-trial protection, the defining features of which are the voluntary nature of conflict resolution, the availability, convenience and speed of dispute resolution as well as the possibility of compensation for the damage caused.

Quality of life from the patient perspective at the end of the first rehabilitation after the onset of spinal cord injury/disorder - A qualitative interview-based study.

CONTEXT: At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D). OBJECTIVE: To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D. METHODS: Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set. RESULTS: The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL. CONCLUSION: Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.

[Some aspects of ensuring patients' rights and accessibility of medical care in Austria, Belgium, Germany and Estonia].

The article devoted to ensuring the rights of patients and the availability of medical care in Austria, Belgium, Germany and Estonia notes the experience of creating an institute of independent ombudsmen who plays an important role in this issue. Basically, in these countries, the choice of a medical organization and a doctor is possible, and in Belgium the right to choose an insurance organization is granted. Patients in these countries are given the right to control the process of providing them with medical care, including its payment and joint decision-making with the doctor on treatment tactics. The State also ensures the patient's right to receive preventive and restorative services provided to children free of charge, and compensated for adults in 80% of cases. It is impossible not to recognize the high percentage of citizens of these countries, reaching 98%, satisfied with the medical services provided to them. However, in some countries there is an imbalance in the availability of medical care, which is expressed by high availability of family doctor services and low availability of specialist services, as in Estonia. Nevertheless, this does not cause an increase in the level of corruption in the medical spheres of these countries, which is below the European average. According to the totality of indicators of the availability of medical care, Germany is the leader among the analyzed countries.

Respecting the Patient's Right to Information in Hospital Wards in Poland - Socio-Economic Determinants of Patients' Opinions.

Background: Implementation of the patient's statutory right to information is one of determinants the quality and safety of medical services. The patients' opinions survey is an element of patient-centric care, which is now one of the most important things in modern healthcare. The main aim of the work is to examine patients' opinions on the observance of patients' right to information in the hospital and quality of healthcare in the hospital. A secondary objective was to examine the impact of socioeconomic variables on patients' opinions. Materials and Methods: The study was based on the Computer-Assisted Web Interview (CAWI) questionnaire, carried out in March 2022. The sample included 801 persons. Respondents were patients hospitalized within a maximum of 12 months. The questionnaire contained closed questions about the quality of medical care, observance of the patient's right to information. Results: Probability of referral was measured using the Net Promoter Score (NPS). Respondents answered the question about the recommendation on a scale from 0 to 10. People who rated the hospital ward at 10 and 9 are promoters, people who rated the hospital ward at 8 and 7 are neutral people. In turn, people who rated the hospital ward at 6, 5, 4, 3, 2, 1 or 0 are critics, ie people who will not recommend the hospital to their relatives. Most patients in hospital wards were the detractors (37%). The percentage of promoters was only 1% lower (36%) than that of the detractors. Patients was rated medical and nursing staff at a similar level with regard to the observance of the patient's right to information. Conclusion: Most statistically significant differences in the assessment of medical care in the hospital ward were associated with such sociodemographic variables as age and income. People aged 55-64 and 65+ rated most of the analyzed aspects better.

Ethical issues in the operating room: A scoping review.

BACKGROUND: For the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients' basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard. AIM: This study determines the direction of future research by identifying ethical issues experienced in the operating room. METHOD: This scoping review is based on the methodological framework suggested by Arksey and O'Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected. FINDINGS: Five categories were identified: Professional ethics, Organizational ethics, Patients' rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses' (ICN) code of ethics, with the exception of one element, that is, global health. CONCLUSIONS: This study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field.

Patients' rights in physicians' practice during Covid-19 pandemic: a cross-sectional study in Romania.

BACKGROUND: Although the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians' practices regarding patients' rights during the Covid-19 pandemic and the effects of age, experience, and specialty on physicians' behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance. METHODS: A cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients' rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022. RESULTS: 396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients' rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians' age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients' claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes. CONCLUSION: Adherence to patients' rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context.

Derechos y deberes de información: el rol de la atención primaria de salud en la implementación de la ley que despenaliza la interrupción voluntaria del embarazo en tres causales en Chile / Drets i deures d'informació: el rol de l'atenció primària de salut en la implementació de la llei que despenalitza la interrupció voluntària de l'embaràs en tres causals a Xile / The right to information: The role of Primary Health Care in theimplementation of the Abortion Law in Chile

Este artículo presenta los resultados de una investigación cualitativa que indagasobre la implementación de la ley de interrupción del embarazo que despenalizó elaborto en tres causales específicas en Chile en 2017 (Ley 21.030) y el rol que laatención primaria de salud (APS) en la Región Metropolitana de Chile. Serealizaron 19 entrevistas a personal de la salud de la APS y del nivel secundariode atención en la Región Metropolitana además de dos personas del Ministerio deSalud.El cambio de régimen de penalización total a uno de despenalización por causalesexige capacitación a los equipos de salud e información a la población. Loshallazgos revelan que la falta de información y capacitación formal al personalsanitario constituye un obstáculo para el ejercicio de los derechos de las mujeresque otorga la ley, produciéndose un efecto cascada, en que las mujeres nocuentan con la información suficiente para ejercer sus derechos. A ello se suma,una disposición en la ley que produce confusión entre profesionales sobrepublicidad e información sobre los servicios. Se analizan los resultados a partir deestándares normativos nacionales e internacionales respecto a la obligación deinformar, y el derecho a ser informado en contexto de prestaciones sanitarias relativas al aborto.(AU)

Es va realitzar un estudi exploratori a través d'una enquesta a Comitès d'Ètica a països d'Amèrica Llatina i el Carib de parla hispana, per rellevar la seva situació davant d'emergències sanitàriesi consultar els dilemes ètics enfrontats a les investigacions per a COVID-19. S'obtingueren respostes de 106 comitès, pertanyents a 14 països. Només el 24% va respondre que existia una xarxa de comunicació eficient i efectiva entre comitès, prèvia a la pandèmia. El 45% va respondre que no existien a la seva regió comitès específics per avaluar projectes vinculats a emergències sanitàries amb anterioritat a la pandèmia. El percentatge de CEI que disposava de procediments previs per avaluar investigacions ensituacions d'emergències sanitàries va ser només de 7%, si bé el 52% estava en procés d'elaboració arran de la pandèmia. El percentatge de CEI que va considerar raonable un temps inferior a 5 dies per a l'avaluació de projectes de recerca va variar en virtut del disseny: 32% per als estudis observacionals i 12% per als assaigs clínics amb drogues o amb vacunes.Els tres problemes ètics principals identificats als estudis per a COVID van estar relacionats amb el consentiment informat, els aspectes metodològics i la poca informació prèvia o manca d'evidència per als productes de recerca. Considerem que cal reformular la manera de pensar els problemes ètics de les emergències cap a un abordatge global, amb un enfocament preventiu, on les xarxes de col·laboració entre els CEI haurien de convertir-se en regla.(AU)

This article presents the results of a qualitative research that inquiriesabout theimplementation of the law on termination of pregnancy that decriminalized abortionon three specific grounds in Chile in 2017 (Law 21.030) and the role of primaryhealth care (PHC) in the Metropolitan Region of Chile. Nineteen interviews wereconducted with PHC and secondary level of care health professionals in addition totwo officials from the Ministry of Health. The change from a regime of totalcriminalization to one of decriminalization by cause requires training for healthteams and information for the population.The findings reveal that the lack ofinformation and formal training for health personnel constitutes an obstacle to theexercise of women's rights under the law, producing a cascade effect in whichwomen do not have sufficient information to exercise their rights. In addition, thereis a provision in the law that causes confusion among professionals aboutadvertising and information on services.The results are analyzed on the basis ofnational and international normative standards regarding the obligation to informand the right to be informed in the context of health services related to abortion.(AU)

Cruzan after Dobbs: What Remains of the Constitutional Right to Refuse Treatment?

In 2022, the U.S. Supreme Court removed constitutional protection from the individual's right to end a pregnancy. In Dobbs v. Jackson Women's Health Organization, the Court invalidated previous rulings protecting that right as part of the individual liberty and privacy interests embedded in the U.S. Constitution. Now, many observers are speculating about the fate of other rights founded on those interests. The Dobbs ruling conflicts with the Court's 1990 Cruzan decision restricting the government's power to interfere with personal medical choices. The language and reasoning in Dobbs and Cruzan offer guidance on how the Court might address future cases involving the right to refuse life-sustaining treatment. The decisions also point to policy strategies for preserving that right.

Development of a patients' satisfaction analysis system using machine learning and lexicon-based methods.

BACKGROUND: Patients' rights are integral to medical ethics. This study aimed to perform sentiment analysis and opinion mining on patients' messages by a combination of lexicon-based and machine learning methods to identify positive or negative comments and to determine the different ward and staff names mentioned in patients' messages. METHODS: The level of satisfaction and observance of the rights of 250 service recipients of the hospital was evaluated through the related checklists by the evaluator. In total, 822 Persian messages, composed of 540 negative and 282 positive comments, were collected and labeled by the evaluator. Pre-processing was performed on the messages and followed by 2 feature vectors which were extracted from the messages, including the term frequency-inverse document frequency (TFIDF) vector and a combination of the multifeature (MF) (a lexicon-based method) and TFIDF (MF + TFIDF) vectors. Six feature selectors and 5 classifiers were used in this study. For the evaluations, 5-fold cross-validation with different metrics including area under the receiver operating characteristic curve (AUC), accuracy (ACC), F1 score, sensitivity (SEN), specificity (SPE) and Precision-Recall Curves (PRC) were reported. Message tag detection, which featured different hospital wards and identified staff names mentioned in the study patients' messages, was implemented by the lexicon-based method. RESULTS: The best classifier was Multinomial Naïve Bayes in combination with MF + TFIDF feature vector and SelectFromModel (SFM) feature selection (ACC = 0.89 ± 0.03, AUC = 0.87 ± 0.03, F1 = 0.92 ± 0.03, SEN = 0.93 ± 0.04, and SPE = 0.82 ± 0.02, PRC-AUC = 0.97). Two methods of assessment by the evaluator and artificial intelligence as well as survey systems were compared. CONCLUSION: Our results demonstrated that the lexicon-based method, in combination with machine learning classifiers, could extract sentiments in patients' comments and classify them into positive and negative categories. We also developed an online survey system to analyze patients' satisfaction in different wards and to remove conventional assessments by the evaluator.

Bioética y Derechos Humanos en una mirada latinoamericana / Bioètica i Drets Humans en una mirada llatinoamericana / Bioethics and Human Rights in a LatinAmerican perspective

Si bien parten del mismo contexto histórico y comparten preocupaciones centrales de fondo relacionadas con la protección de la persona humana, la interfaz entre Bioética y Derechos Humanos aún está experimentando un lento proceso de consolidación. Este artículo presenta un análisis histórico y conceptual de esta interfaz desde una perspectiva latinoamericana de la Bioética. Presenta dos temas que ejemplifican la complejidad -y el potencial -de este enfoque: la educación en bioética y la promoción de los Derechos de Pacientes. Sin desconocer las divergencias éticas y políticas que impregnan la discusión, el trabajo concluye en la necesidad de profundizar en este enfoque como vía para hacer efectivas las principales tareas que dieron origen a los dos campos:Bioética y Derechos Humanos, teniendo en cuenta el contexto histórico de la región.(AU)

Tot i que parteixen del mateix context històric i comparteixen preocupacions centrals de fons relacionades amb la protecció de la persona humana, la interfície entre Bioètica i Drets Humans encara està experimentant un lent procés de consolidació. Aquest article presenta una anàlisi històrica i conceptuald'aquesta interfície des d'una perspectiva llatinoamericana de la bioètica. Presenta dos temes que exemplifiquen la complexitat –i el potencial –d'aquest enfocament: l'educació en bioètica i la promoció dels Drets de Pacients. Sense desconèixer les divergències ètiques i polítiques que impregnen la discussió, el treball conclou en la necessitat d'aprofundir en aquest enfocament com a via per fer efectives les tasques principals que van donar origen als dos camps: Bioètica i Drets Humans, tenint en compteel context històric de la regió.

Although they start from the same historical context and share central fundamental concerns related to the protection of the human person, the interface between bioethics and human rights is still undergoing a slow consolidation process. This article presents a historical and conceptual analysis of this interface from a Latin American perspective of bioethics. It presents two themes that exemplify the complexity –and potential –of this approach: education in bioethics and the promotion of patients' rights. Without ignoring the ethical and political divergences that permeate the discussion, the work concludes for the need to deepen this approach as a way to make effective the main tasks that gave rise to the two fields: Bioethics and Human Rights, taking into account the historical context of the region.(AU)

[Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years]. / Trends in der Zufriedenheit von Jugendlichen mit ihrer stationären psychiatrischen Behandlung: Eine Verlaufsanalyse über 7 Jahre.

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years Abstract. Because the German legislature is increasingly enabling adolescents' participation in their psychiatric treatment, we traced changes in satisfaction of 6,893 patients at the end of their stay in 10 hospitals using BEST-J. The treatments resulted in a fair overall satisfaction without any improvement over the 7 years studied. In seven hospitals, we calculated deviation from the overall satisfaction based on annual surveys. Satisfaction with the psychotherapeutic relationship was good from the beginning, whereas the relationship with caregivers improved during the sample period. When new legal standards were introduced, we measured an improvement in some items concerning patient participation (coercive measures information, goals of treatment discussed). Patients were less satisfied with the information about their illness than with medication information. Initially poor satisfaction with leave regulations significantly improved over time. Respect for privacy also improved. Satisfaction with the environment and service organization scored substantially worse than the other items. Peer relations within the ward were rated close to overall satisfaction. The results point to benefits from training in psychotherapy and a growing awareness of closeness-distance issues and patients' rights. Nevertheless, psychoeducation and leave regulations require improvement. Furthermore, patients stated unmet needs for refurbishing and renovating buildings.

Respecting patients' rights in hospitals: patients' and health-care workers' perspectives.

Considering the importance of respecting and observing patients' rights, this study aimed to assess the level of observance of hospitalized patients' rights from both patients' and health-care workers' (HCWs) perspectives. This cross-sectional descriptive-analytic study reports the responses of 486 patients and 887 HCWs in a public referral university hospital. The study illustrates that patients and HCWs think patients' rights are respected at a medium level; however, HCWs reported lower levels of respect for patients' rights than patients, and senior HCWs reported even lower levels than their younger colleagues. Older patients and those hospitalized in internal medicine wards reported lower respect for autonomy and responsiveness, and patients' companions reported lower levels of respect for patients' rights than the patients themselves.

Assessing the willingness of patients' companions to disclose bad news to cancer patients.

Breaking bad news to patients is an essential aspect of the physician-patient relationship, but in Iran, this relationship is often disrupted by patients' families. This study investigates the views of patients' companions on breaking cancer news. In this descriptive-analytic cross-sectional study, we conducted research on 170 cancer patients' companions and 170 non-cancer patients' companions. We designed a questionnaire to investigate the subjects' opinions and used CVI, CVR, Cronbach's alpha and ICC for evaluation. In order to compare groups, we used Mann-Whitney, Kruskal-Wallis, Chi-square tests and Spearman's correlation. Most participants believed that patients should be informed of their diagnosis. Cancer patients' companions were more willing to learn the bad news in case they were diagnosed with cancer and were less likely to choose "despair" as the reason for non-disclosure (71% vs. 44%).There was no difference between the two groups in willingness to break the cancer news to patients, choosing who should be informed first, and the reasons for non-disclosure. Most participants believed the family should be the first to know the diagnosis. In this study, most participants believed that patients should be informed of their diagnosis. However, they preferred to learn about the diagnosis before the patient, which confirms the importance of educating the families about autonomy.

Law and psychiatry-current and future perspectives.

We describe relevant interfaces between law and psychiatry and current ethical and legal views and changes within the past decades. Ideas of patient autonomy and patients' rights have been major drivers of changes in legal frameworks. We describe developments in the areas of patient information and informed consent, involuntary placement and involuntary treatment, use of coercive measures, forensic psychiatry, digital mental health, data privacy, physician liability, suicide, assisted suicide, euthanasia, end of life decision-making, advance directives, legal and illegal drugs, and delegation and substitution of professional activities. There is no unidirectional pathway between law and ethics. Views, conflicts, and requirements differ between countries and within countries and will need to be balanced according to the societies' changing values also in the future.

Disclosure de incidentes de segurança do paciente sob a ótica do Direito do Paciente / Disclosure of patient safety incidents from the Patients' Rights perspective / Disclosure de incidente de seguridad del paciente desde la perspectiva del Derecho del Paciente

Objetivo: demonstrar a incidência dos princípios e direitos dos pacientes no processo de disclosure, que comumente não está associado a esses direitos, mas sim a obrigações profissionais e institucionais. Metodologia: tratou-se de pesquisa teórica, cujo escopo consiste em desenvolver aportes teóricos concernentes ao campo do Direito do Paciente, de modo a participar da sua consolidação e da sua incidência prática. O marco teórico empregado se dividiu em dois eixos: i) disclosure e cultura do disclosure; ii) Direito do Paciente. Resultados: destacam-se os seguintes pontos positivos do disclosure quando integrado ao Direito do Paciente: i) o disclosure é um aspecto significante que impacta o engajamento e o envolvimento do paciente; ii) aumento da confiança do paciente/familiar em relação à instituição de saúde; iii) contribui para o incremento da qualidade no cuidado em saúde; iv) alívio da culpa do profissional de saúde envolvido no evento adverso; v) os pacientes são compensados financeiramente de forma mais rápida e adequada. Conclusão: o disclosure é a resposta adequada, transparente e empática a um incidente que causa danos ao paciente, bem como é uma ferramenta de efetivação dos seus direitos.

Objective: to show the influence of patients' principles and rights on the process of disclosure, which is commonly associated not with these rights but with professional and institutional obligations. Methods: this is a theoretical research that aims to contribute to the field of patients' rights and to participate in its consolidation and practical impact. The theoretical framework was divided into two axes: i) disclosure and disclosure culture; ii) patients' rights. Results: the positive aspects of disclosure when integrated into patients' rights are: i) disclosure is an important aspect that affects patient engagement and participation; ii) it increases patient/family trust in the health care institution; iii) it contributes to improving the quality of health care; iv) it relieves the health care professionals involved in the adverse event of their guilt; v) patients are financially compensated more quickly and appropriately. Conclusion: disclosure is the appropriate, transparent, and compassionate response to an incident that causes harm to the patient and a tool to enforce the patients' rights.

Objetivo: demostrar el impacto de los principios y derechos de los pacientes en el proceso de disclosure, que comúnmente no se asocia a estos derechos, pero sí a las obligaciones profesionales e institucionales. Metodología: se trata de una investigación teórica, cuyo objetivo es desarrollar aportes teóricos en el campo del Derecho del Paciente, para participar en su consolidación y su impacto práctico. El marco teórico utilizado se dividió en dos ejes: i) disclosure y cultura de disclosure; ii) Derecho del Paciente. Resultados: los siguientes aspectos positivos de disclosure se destacan cuando se integran en la Ley del Paciente: i) disclosure es un aspecto significativo que impacta el compromiso y la participación del paciente; ii) aumento de la confianza del paciente/familia en la institución de salud; iii) contribuye al aumento de la calidad de la atención en salud; iv) alivio de la culpa del profesional de la salud involucrado en el evento adverso; v) los pacientes son compensados económicamente de forma más rápida y adecuada. Conclusión: disclosure es la respuesta adecuada, transparente y empática a un incidente que causa daño al paciente, además de ser una herramienta para hacer valer sus derechos.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

Participant Selection for Inpatient Physical Rehabilitation.

Intensive, inpatient physical rehabilitation in a dedicated unit can have a hugely positive influence on a person's life after a major injury or illness. This resource, however, is scarce and not every participant will benefit. Appropriate and fair participant selection for inpatient rehabilitation is therefore vital. This article considers challenges in these selection decisions, including the potential for inconsistency, bias and controversy, and the limits of evidence-based selection criteria. To provide best care in this setting, this article suggests that a clear process of decision-making is also important, alongside the use of objective selection criteria. One possible framework for this selection process is New Zealand's Health and Disability Commissioner Code of Patients' Rights, which is informative for clinicians and health authorities in rehabilitation selection in all jurisdictions, and which supports appropriate and fair participant selection.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot - Early and Midterm Results from a Tertiary Care Centre.

INTRODUCTION: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. METHODS: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. RESULTS: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. CONCLUSION: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.