Jak postępować z chorymi niewyrażającymi zgody na leczenie? Opis przypadku i przegląd aktów prawnych związanych z autonomią pacjenta w Polsce

Every patient, both in public and private healthcare institutions, has the right to maintain their own autonomy. This is one of the basic patient rights as well as one of the basic human rights, meaning that the patient cannot undergo treatment which is against his or her will. The patient has the full right to make independent decisions concerning his or her own life and health. Violation of the patient’s rights of autonomy by a doctor or another member of medical personnel may result in sanctions as described in article 448 of the Civil Code. The following publication describes the case of a female patient who refused consent to surgical intervention, and died shortly thereafter. The legal aspects concerning patient autonomy in Poland are also reviewed. Acta Angiol 2011; 17, 1: 109–116Każdy pacjent przebywający zarówno w publicznym, jak i niepublicznym zakładzie opieki zdrowotnej ma prawo do zachowania swojej autonomii. Prawo do autonomii jest jednym z podstawowych praw każdego chorego, jak również jednym z podstawowych praw człowieka. Dzięki niemu leczenie pacjentów nie może się odbywać wbrew ich woli. Chory ma pełne prawo samodecydowania o swoim życiu i zdrowiu. Za naruszenie prawa do autonomii lekarzowi lub innej osobie z personelu medycznego grożą sankcje zapisane w artykule 448 kodeksu cywilnego. W niniejszym artykule opisano przypadek chorej, która nie wyraziła zgody na leczenie operacyjne i zmarła. Przedstawiono również prawne aspekty związane z autonomią pacjenta w Polsce. Acta Angiol 2011; 17, 1: 109–11

Narracja jako temporalna podróż po świecie sensów i znaczeń

The subject of the article is the narrative accompanying man in the course of his biographical life. Narrative understood in this way occurs in ordinary human conversation, which allows both the narrator and the narrator to follow the temporal path of the individual history of life. The study distinguishes and discusses the understandings of the narrative as “a mark of a historical moment” (after Norman Denzin), a story on the way, a witness’s narrative. The whole thing ends with a description of the common understanding of narration as a story on the go.Przedmiotem artykułu jest narracja, towarzysząca człowiekowi w toku biograficznego życia. Tak pojmowana narracja występuje w zwyczajnej ludzkiej rozmowie, która pozwala zarówno narratorowi, jak i słuchającym narracji podążać temporalną drogą indywidualnej historii życia. W opracowaniu zostały wyróżnione i omówione rozumienia narracji jako: „znamię momentu historycznego” (za Normanem Denzinem), opowieść w drodze, narracja świadka. Całość kończy charakterystyka potocznego pojmowania narracji jako opowieści w drodze

Leczenie chorego z pękniętym tętniakiem aorty brzusznej i z nieoperacyjnym rakiem jelita grubego - opis przypadku i przegląd piśmiennictwa

Jednoczasowe występowanie u pacjenta choroby nowotworowej i pękniętego tętniaka aorty brzusznej w praktyce klinicznej występuje rzadko. Ze względu na coraz większą liczbę zachorowań na nowotwory, coraz lepsze i bardziej wyrafinowane badania diagnostyczne, a także wzrost w populacji liczby osób powyżej 65. roku życia, lekarze coraz częściej w swojej praktyce będą spotykać się z pacjentami, u których jednoczasowo występuje tętniak aorty brzusznej i choroba nowotworowa. Leczenie takich chorych wciąż budzi duże kontrowersje. W niniejszej pracy przedstawiono przypadek leczenia chorego z pękniętym tętniakiem aorty brzusznej i nieoperacyjnym rakiem jelita grubego. Poruszono także problematykę etyczną i prawną związaną z postępowaniem lekarza w takich przypadkach.It is very unusual to encounter in clinical practice a simultaneous neoplasm and a ruptured abdominal aortic aneurysm in one patient. Because of the growing number of patients suffering from neoplasms, better and more precise diagnostic procedures, and a growing population of people over 65 years old, doctors will, more often than not, meet patients with simultaneous abdominal aortic aneurysm and neoplasm disease. The treatment of such cases gives rise to a great deal of controversy. In this paper, the treatment of a patient with a ruptured abdominal aortic aneurysm and with unoperative colon carcinoma is presented together with the ethical and legal problems related to medical procedures in such cases

INDEXES OF TOLERANCE OF TOMATO (Lycopersicon esculentum Mill.) SEEDS FOR GERMINATION AT LOW TEMPERATURES

Sixteen tomato (Lycopersicon esculentum Mill.) cultivars from Poland and China were tested on their seed tolerance to germinate at low temperatures: 15 degree and 10 degree. Their responses were evaluated based on 4 characters: germination energy, germination capacity, maximum germination and fresh weight of 100 normal seedlings, calculated then into 6 different indexes. All of proposed indexes include the optimal temperature of germination (20 degree). There is a possibility to use the suggested indexes to evaluate seed tolerance of various tomato cultivars to germinate at low temperatures. The tested low temperatures decreased the germination energy of the seeds of the tested tomato cultivars. Three cultivars were found with a satisfactory germination at 15 degree, but at 10 degree the germination of all tested cultivars was poor. The biggest tolerances of seeds to germinate at 15 degree was found for the cultivars: 'Kibic', 'Maliniak' and 'Etna F1', the smallest - for the cultivars: 'Bai Guo Qiang Feng' and 'Sheng Li 919'. The biggest tolerances of seeds to germinate at 10 degree was found for the cultivars: 'Batory F1' and 'Korsarz', whereas the smallest - for the cultivars: 'Etna F1', 'Poranek', 'Maliniak', 'Kora', 'Bursztyn', 'Sheng Li 919', 'Ju Huang 83-3' and 'Bai Guo Qiang Feng'

Ballistic Impact Resistance of Bulletproof Vest Inserts Containing Printed Titanium Structures

Finite element modeling of ballistic impact of inserts containing titanium structures were presented in the article. The inserts containing an additional layer made using additive manufacturing technology were analyzed. The layer was created from repetitive elements made without connections (adjacent cells were inseparable). Four variants of printed titanium structures were placed between layers of Twaron CT 750 aramid fabric to create ballistic inserts. In order to assess the ballistic resistance of the inserts, numerical simulations of ballistic impact phenomenon were carried out using LS-Dyna software. In the simulations the inserts were placed on a steel box filled with ballistic clay and were fired at with the 9 × 19 mm full metal jacket (FMJ) Parabellum projectile. The main aim of the work was to check the effectiveness of such solutions in soft ballistic protection applications and to select the most effective variant of 3D printed structure. Results of the numerical analysis showed a high potential for 3D printed structures made of titanium alloys to be used for bulletproof vest inserts. In all analyzed cases the projectile was stopped by the armor. In addition, thanks to the cooperation of adjacent cells, the projectile energy density was distributed over a large area, as evidenced by large volumes of hollows in the ballistic clay. The indentations in the ballistic clay obtained in the simulations were significantly lower than the acceptable value for the back face deformation (BFD) parameter required by international body armor standards

Ballistic Impact Resistance of Bulletproof Vest Inserts Containing Printed Titanium Structures

Finite element modeling of ballistic impact of inserts containing titanium structures were presented in the article. The inserts containing an additional layer made using additive manufacturing technology were analyzed. The layer was created from repetitive elements made without connections (adjacent cells were inseparable). Four variants of printed titanium structures were placed between layers of Twaron CT 750 aramid fabric to create ballistic inserts. In order to assess the ballistic resistance of the inserts, numerical simulations of ballistic impact phenomenon were carried out using LS-Dyna software. In the simulations the inserts were placed on a steel box filled with ballistic clay and were fired at with the 9 × 19 mm full metal jacket (FMJ) Parabellum projectile. The main aim of the work was to check the effectiveness of such solutions in soft ballistic protection applications and to select the most effective variant of 3D printed structure. Results of the numerical analysis showed a high potential for 3D printed structures made of titanium alloys to be used for bulletproof vest inserts. In all analyzed cases the projectile was stopped by the armor. In addition, thanks to the cooperation of adjacent cells, the projectile energy density was distributed over a large area, as evidenced by large volumes of hollows in the ballistic clay. The indentations in the ballistic clay obtained in the simulations were significantly lower than the acceptable value for the back face deformation (BFD) parameter required by international body armor standards