A responsabilidade civil médica nos casos de recusa de tratamento pelo paciente

Trabalho de conclusão de curso (graduação)—Universidade de Brasília, Faculdade de Direito, 2015.A responsabilidade civil do médico é um tema que tem tido crescente importância no mundo jurídico, em especial com o aumento da judicialização da medicina. No entanto, ainda é pouco abordada a temática da recusa de tratamento médico por parte do paciente. Nesses casos, o embate do direito à vida e à saúde, frente à autonomia do paciente e a formação médica geram uma situação de grande dificuldade para o profissional. O presente trabalho objetiva a análise dos posicionamentos bioéticos, doutrinários, jurisprudenciais e legais para que o profissional de saúde tenha uma postura adequada, do ponto de vista legal, diante da recusa de tratamento do paciente. Dessa sorte, buscou-se realizar uma ampla revisão jurisprudencial acerca do tema, buscando os julgados presentes nos Tribunais Federais, Tribunais de Justiça, STJ, STF. Ao final desse trabalho, espera-se que possa definir, sob a perspectiva do direito, qual a conduta juridicamente adequada à ser tomada pelo profissional médico diante dos casos de recusa de tratamento por parte do paciente.The issue involving Civil Responsibility arising from Medical Care has a growing relevance, especially with the increasing number of judicial cases about the matter. However, the refusal of treatment by the patient is still largely undebated. These cases, in which there is a conflict between the right to health and life with the patient’s autonomy, give way to a difficult situation to the medical team. This paper aims the analysis of the bioethical, doctrinaires, legal and jurisprudential understandings about the issue. For this purpose, a broad review of judicial cases about the theme was made, including federal boards and our constitutional court. By the end of this work, the intent is that the medical professional can be guided through these difficult cases, acting within the legality

Characteristics of the ice pellets observed in mid-winter in the Arctic region

In mid-winter ice pellets were observed at Inuvik, Canada and Kiruna, Sweden in the Arctic region. The size distribution, morphology and crystalline nature were examined from the photomicrographs. Moreover, meteorological conditions in which the ice pellets could form were examined from the sounding data at Inuvik. The following results were obtained. (1) The sizes of ice pellets in the Arctic regions were considerably smaller than those in temperate regions. (2) The ice pellets simultaneously fell with the snow crystals with frozen small raindrops. (3) The morphology of ice pellets with a bulge or a spike was qualitatively similar to the results of laboratory experiments. (4) The rate of shattering was smaller than the results of laboratory experiments. (5) Single crystalline ice pellets were abundant in the size < 200μm. (6) Ice pellets in the Arctic are formed through the freezing of supercooled drizzle drops, which are formed by condensation-coalescence process below the freezing temperature

How Does Culture Appear in Interviews?: Focus on "Treating" in Korea and "Going Dutch" in Japan

研究ノー

ヨボウ ト リハビリテーション : ギョウセイ ノ タチバ カラ

Stroke is the third leading cause of death and a leading cause of adult disability in theJapan and the Tokushima Prefecture. Preventing stroke is the most important strategy forreducing the mortality from this disease, the suffering number of disability and also thedisability-related cost.Major modifiable causal risk factors for stroke include hypertension, diabetes, cigarettesmoking, alcohol consumption, atrial fibrillation and obesity.Current policies and practices for stroke prevention include both high-risk andpopulation-wide components. The high-risk approach requires detection and managementof these risk factors, once established in the affected individuals. The population-wide approachuses interventions intended to shift the distribution of risk favorably in those populationsin which a given risk factor has become prevent. The approach of the Health andMedical Service Law for Elderly (Rou-jin Hoken Hou) is the former. The approach of thenew policy of health promotion (Kenkou Nippon 21) is the latter. “Kenkou Nippon 21” is theprevention agenda for the nation. It is designed to achieve the goal, increase quality andyears of healthy life.Rehabilitation is the essential medical service for after stroke patient. The goal of a rehabilitationprogram for the patient is to provide for optimal physical, psychologic, physiologic,and social adaptation. It is important in this regard that the physical restoration activitynot be terminated abruptly at discharge, but that maintenance program be developedwhich can be continued by the patient on his return home. Namely, it is important toestablish the care system for stroke patient in the community following hospital discharge.The ten-year strategy to make up the framework of Tokushima prefecture in 21 century“Shin Chouki Keikaku” was established in 1997. It was designed to improve the health,welfare and medical service systems include the rehabilitation system in community

Biomechanical effects of offset placement of dental implants in the edentulous posterior mandible

Background: Proper implant placement is very important for long-term implant stability. Recently, numerous biomechanical studies have been conducted to clarify the relationship between implant placement and peri-implant stress. The placement of multiple implants in the edentulous posterior mandible has been studied by geometric analysis, three-dimensional finite element analysis (FEA), model experimentation, etc. Offset placement is a technique that reduces peri-implant load. However, few studies have used multiple analyses to clarify the value of the offset placement under identical conditions.The present study aimed to clarify the biomechanical effects of offset placement on the peri-implant bone in edentulous posterior mandibles by comparative investigation using FEA and model experimentation with strain gauges.Methods: Three implants were embedded in an artificial mandible in the parts corresponding to the first premolar, the second premolar, and the first molar. A titanium superstructure was mounted to prepare models (experimental models). Three load points (buccal, central, and lingual) were established on the part of the superstructure corresponding to the first molar. Three types of experimental models, each with a different implant placement, were prepared. In one model, the implants were placed in a straight line; in the other two, the implants in the parts corresponding to the second premolar and the first molar were offset each by a 1-mm increment to the buccal or lingual side. Four strain gauges were applied to the peri-implant bone corresponding to the first molar.The experimental models were imaged by micro-computed tomography (CT), and FEA models were constructed from the CT data. A vertical load of 100 N was applied on the three load points in the experimental models and in the FEA models. The extent of compressed displacement and the strain in the peri-implant bone were compared between the experimental models and the FEA models Results: Both experimental and FEA models suffered the least compressed displacement during central loading in all placements. The greatest stress and compressive strain was on the load side in all types of placements.Conclusions: Offset placement may not necessarily be more biomechanically effective than straight placement in edentulous posterior mandibles.Keywords: Offset placement, Three-dimensional finite element analysis, FEA, Amount of compressed displacement, Stress distribution, Strain gaug

レジン添加型グラスアイオノマーセメントの通電後の剪断強度減少に対するイオン液体含有の有無と水中浸漬の影響

The enhancement in the bonding strength of advanced dental cements has enabled long-lasting dental restorations. However, the high bonding strength can cause difficulty in removing these restorations. Therefore, “smart” dental cements with simultaneous strong bonding and easy on-demand debonding ability are required. A resin-modified glass-ionomer-cement (RMGIC) with an ionic liquid (IL) has demonstrated significant reduction in the bonding strength with current application (CA). This research investigates the effects of immersion in distilled water on the electric conductivity and bonding strength of RMGIC with and without an IL and CA. The RMGIC without the IL exhibited significant electric conductivity after immersion, and a significant decrease in bonding strength with CA. In comparison, the electric conductivity after immersion and the decrease in bonding strength with CA were greater for RMGIC with the IL. Thus, the feasibility of smart dental cements capable of electrically debonding-on-demand is indicated

Flow Cytometric Assessment of Neutrophil Oxidative Metabolism in Chronic Granulomatous Disease on Small Quantities of Whole Blood: Heterogeneity in Female Patients

A rapid and sensitive flow cytometric assay is presented for the quantitative estimation of the oxidative metabolic activity of individual polymorphonuclear leukocytes (PMN) on less than 100 td of whole blood. This procedure is a simplified version using whole blood of the method of Bass et al (J. Immunol. 130:1910, 1983) that estimated the metabolic burst activity of phorbol myristate acetate (PMA)-stimulated individual PMN as the intracellular generation of a fluorescence product by a flow cytometric assay. With this method, almost all the PMN from normal subjects responded to PMA as a single cell population generating bright intracellular fluorescence. PMN from a boy with chronic granulomatous disease (CGD), could not respond to PMA with any increase of their fluorescence intensity. His mother had two distinct PMN populations one functionally normal and the other defective, indicating a random lyonization in the carrier mother and the X-linked recessive mode of inheritance. In two female patients with CGD from unrelated families, their PMN responded to PMA, as a whole, with a minimal increase in the fluorescence intensity, but the metabolic defects in their PMN were not so complete as seen in a classical X-linked CGD boy. But, PMN from two female sibling patients from the other family responded to PMA as a single uniform cell population with a weak but definite fluorescence intensity. However, the genetic background of these female patients with CGD remains unclear, since PMN dysfunction could not be identified in their mothers with this method.This work was supported in part by a grant (No. 58440046) from the Ministry of Education of Japan

レジン添加型グラスアイオノマーセメントの電気伝導度と通電によるせん断試験強度低下に塩化ナトリウム溶液浸漬が与える影響

Advancements in dental cements have considerably improved their bond strengths. However, high bond strength often makes the removal of restorations difficult. Thus, smart dental cements that show controllable bond strength are required. A conventional resin-modified glass-ionomer-cement demonstrated a significant reduction in the bond strength after current application. However, for this system, the ions in the cement are released into the oral cavity, resulting in a reduction of the electrical conductivity and in losses of the expected on-demand debonding property. Herein, the effects of immersion in 0.9 and 15% NaCl solutions on the electrical conductivity and debonding properties were investigated. The cement immersed in 0.9% NaCl solution from 1 to 28 days maintained similar bond strength reductions after current application, whereas that in 15% NaCl solution initially showed no bond strength reduction after 1 day but exhibited an increase in the bond strength reduction after immersion for 28 days