Comunicarea eficientă medic-pacient

Department of Philosophy and Bioethics, Nicolae Testemitanu SUMPhBackground. Effective communication between doctor and patient involves the beneficial process for both parties involved, based on the set of ethical and moral norms, which establish a favorable and harmonious relationship. Objective of the study. Highlighting the main ethical suppositions that ensure an effective doctor-patient communication. Material and Methods. When conducting the study, there were consulted national and international scientific publications, being used analytical, descriptive, bioethical and comparative research methods. Results: Active listening-the element that ensures the analysis and understanding of the information exposed in the doctor-patient communication. Detailed knowledge - the physician's ability to know both medical and psychosocial problems of the patient that may affect the effective development of the therapeutic process. At the moment, the patient is perceived as an Autonomous Agent, with the right to have points of view, to make choices and take actions based on personal values and beliefs regarding the prescribed treatmen. Conclusion. According to some research, it has been established that the beneficial result of treatment which consist 85 % is due to favorable relationships based on effective doctor-patient communication.Introducere. Comunicarea eficientă dintre medic și pacient presupune procesul benefic pentru ambele părți implicate, bazat pe ansamblul de norme etice și morale, care stabilesc o relație favorabilă și armonioasă. Scopul lucrării. Evidențierea principalelor particularități etice care asigură o comunicare eficientă medic-pacient. Material și Metode: În realizarea studiului au fost consultate publicații științifice naționale și intrenaționale, iar dintre metodele de cercetare aplicate s-au utilizat cea analitică, descriptivă, bioetică și comparativă. Rezultate. Ascultarea activă – elementul ce asigură analiza și înțelegerea informației expuse. Respectul, empatia și atitudinea calmă facilitează procesul de obținere a încrederii pacientului față de medic. Cunoașterea detaliată presupune cunoașterea problemelor de natură medicală și psihosocială a pacientului, probleme care pot afecta procesul terapeutic. Actualmente pacientul este perceput ca agent autonom, cu dreptul de a avea puncte de vedere, de a face alegeri și a întreprinde acțiuni bazate pe valorile și pe convingerile personale în ceea ce privește tratamentul prescris. Concluzii. Potrivit unor cercetări științifice s-a stabilit că rezultatul benefic al tratamentului în proporție de 85 % se datorează relațiilor favorabile bazate pe comunicarea eficientă medic-pacient

Flutter analysis of the IAR 99 SOIM aircraft

Flutter analysis is considered for the minimum altitude at which the minimum designed Mach number is achieved, for the maximum altitude at which the maximum designed dynamic pressure is obtained and for the minimum altitude at which transonic effects begin occurring. Moreover, analyzes is performed for any other altitudes considered necessary. Flutter analysis results is graphically presented in equivalent speed with the curves of structural damping coefficient g required for flutter according to the flutter speed. Flutter analysis aims to determine the speeds of IAR 99 SOIM

Dynamic study of the virtual prototype of the IAR-99 SOIM Aircraft

This paper contains a dynamic study of the IAR-99 SOIM aircraft using ADAMS, multibody dynamic solutions. First, the analysis of the whole airplane is envisaged and then the analysis of the flight control system and the landing gear are considered. The study is performed in the idea of upgrading the IAR-99 aircraft being a continuation of a previous study concerning a flutter analysis [9] of the same aircraft, and will be followed by a paper dedicated to modern tools in the stress analysis of the aeronautical structures. Using ADAMS one can build and test complex virtual prototypes, simulating mechanical systems in a realistic manner, both visually and mathematically which is very useful before developing a real prototype. Engineers can study the dynamics of moving parts and how loads and forces are distributed throughout a complex mechanical system as an airplane. In this way multiple design solutions can be analyzed and evaluated in order to shorten the time and to reduce the cost of a new project

Predictors of early death in female patients with breast cancer in the UK: a cohort study.

Objective To identify factors predicting early death in women with breast cancer. Design Cohort study. Setting 29 trusts across seven cancer networks in the North Thames area. Participants 15 037 women with primary breast cancer diagnosed between January 1996 and December 2005. Methods Logistic regression analyses to determine predictors of early death and factors associated with lack of surgical treatment. Main exposures Age at diagnosis, mode of presentation, ethnicity, disease severity, comorbidities, treatment and period of diagnosis in relation to the Cancer Plan (the NHS's strategy in 2000 for investment in and reform of cancer services). Main outcome measures Death from any cause within 1 year of diagnosis, and receipt of surgical treatment. Results By 31 December 2006, 4765 women had died, 980 in the year after diagnosis. Older age and disease severity independently predicted early death. Women over 80 were more likely to die early than women under 50 (OR 8.05, 95% CI 5.96 to 10.88). Presence of distant metastases on diagnosis increased the odds of early death more than eightfold (OR 8.41, 95% CI 6.49 to 10.89). Two or more recorded comorbidities were associated with a nearly fourfold increase. There was a significant decrease in odds associated with surgery (OR 0.29, 95% CI 0.24 to 0.35). Independently of disease severity and comorbidities, women over 70 were less likely than those under 50 to be treated surgically and this was even more pronounced in those aged over 80 (OR 0.09, 95% CI 0.07 to 0.10). Other factors independently associated with a reduced likelihood of surgery included a non-screening presentation, non-white ethnicity and additional comorbidities. Conclusions These findings may partially explain the survival discrepancies between the UK and other European countries in female patients with breast cancer. The study identifies a group of women with a particularly poor prognosis for whom interventions aiming at early detection may be targeted

Preliminary Estimation Methods for the Definition of the Landing Gear

The landing gear of an aircraft is an important part of the aircraft structure. The landing and the taking off are most critical parts of a flight mission. The main goal of this paper is to provide a methodology for designing and sizing the landing gear taking into account its main three functions: to ensure the taxiing during the take-off and to ensure both the dynamic contact with the ground during landing and the taxiing required until the aircraft loses speed. This paper continues our concerns about different aspects of the complex landing phenomena. The landing gear is the component that will likely cause many problems in the aircraft design. Its design combines the best in mechanical, structural and hydraulic design. The designed landing gear should be able to meet the specifications and requirements imposed for example by CS23

Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer

Introduction: The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome. Methods: Linked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons. Results: It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable. Conclusion: The results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required

Trends in the treatment of breast cancer in Southeast England following the introduction of national guidelines.

There is little published evidence on trends in the treatment of breast cancer in England following the publication of the Calman-Hine report in 1995. Reliable national data are available for women with screen-detected breast cancer, but data on women presenting symptomatically have been difficult to collect. Using data from both a clinical audit database and a population-based cancer register, we show that between 1996 and 2003 the rates of mastectomy and chemotherapy treatment for women with breast cancer in Southeast England have increased marginally, whereas there has been a steady decline in the use of hormone therapy and radiotherapy recorded within 6 months of diagnosis

PREDICTIVE ASSESSMENT OF AN AIRCRAFT STRUCTURE BEHAVIOUR FOR PASSENGER AND CREW SECURITY

In the aerospace industry one of the most important requirements in the aircraft design andoperation is the high level of fiability under various atmosphere and environmental conditions. Thedesign and validation of such a system is a great challenge. It must meet several requirements suchas: high resistence, low weight and a small occupied volume. The stresses that occur during theaircraft operation are extremely complex, being the result of the interaction of differentsystems.Consequently, in order to obtain an optimal design of the whole system, the design, testingand operating processes require a combination of laborious analysis and experimental data. As upto 90% of the structure failures are du to the fatigue, high performance methods of fatigue analysisare needed to estimate the aircraft ressources. These methods must enable a precise determinationof the static and dynamic strains inder to correctly estimate the aircraft ressource. The projectproposes an approach of some aspects of the aircraft/ aircraft subassemblies simulation and testingand develop o calculation methodology of experimental data and high performance numericmethods integration in order to establish the ressource

Comprehensive study of endurance for IAR-99 Hawk

The paper presents some methods of on-ground and in-flight calibration for strain gauges, intended to the development of complex programs which analyze the endurance phenomena for aerospace structures, with direct application to the IAR-99 Hawk. The strain gauges have the advantage of being sensitive to load and therefore to aerodynamic phenomena, thereby providing indications of the loads supported by the structure. The effects size of loads type phenomena caused by wind gusts or buffet can be measured only by strain gauges or accelerometres70 and they cannot be recorded by flight or fatigue parameters counters. The installation of a strain gauge is made using a pattern (its position and orientation are crucial) and the strain gauge selected for installation should not be fragile or unstable. Routines should be established for periodic inspection of strain gauges and those which are defective should be replaced immediately