Satisfaction and discontent of Polish patients with biological therapy of rheumatic diseases : results of a multi-center questionnaire study

Objectives: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. Material and methods: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. Results: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients. In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. Conclusions: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers)

Wokół rekodyfikacji prawa cywilnego. Prace jubileuszowe

Praca recenzowana / Peer-reviewed paperPrezentowana książka to głos w debacie nad stanem naszej kodyfikacji cywilnej. Jubileusz 50-lecia uchwalenia Kodeksu cywilnego, Kodeksu rodzinnego i opiekuńczego oraz Kodeksu postępowania cywilnego zbiega się z jubileuszem Profesora Janusza Szwai1. Profesor, wybitny cywilista, obchodzi swoje 80. urodziny, mija także 50 lat od obrony przez Niego doktoratu. Jest to doskonała okazja by przyjrzeć się propozycjom zmian prawa cywilnego płynących z różnych środowisk akademickich. Wszak dużą część swojego życia Profesor Szwaja poświęcił pracom legislacyjnym, ich komentowaniu czy krytykowaniu. Sam aktywnie w zmianach różnych kodyfikacji uczestniczył. Jego poglądy zawsze były wyważone. Dziś właśnie taki wyważony głos w dyskusji nad kształtem polskiego prawa cywilnego stał się niezbędny

Prawne i medyczne aspekty modyfikacji aktywności wszczepialnych urządzeń do elektroterapii serca u pacjentów u kresu życia

At the beginning of our considerations, it should be pointed out that cardiovascular diseases are the reason for almost half of deaths in Poland. Some disorders of the cardiovascular system are treated with cardiac implantable electronic devices. The aim of this paper is a comprehensive analysis of the issue regarding management of cardiac implantable electronic devices (peacemaker and cardioverter-defibrillator). In this respect it is significant to explain the legal status of these devices and the basic medical issues in the above scope (the type of devices, their similarities and differences). It is necessary for further consideration. In the scientific paper the management of cardiac implantable electronic devices both in legal and medical aspects is studied. In this context such problems as the patient’s consent and the obligation to be provided with medical information are analysed. In addition it should indicate how, why, when and in which scope the devices could be managed. What is more, the subject matter is taken into consideration concerning medical futility.Finally, the conclusions of the analysis are presented.Choroby układu krążenia przyczyniają się do prawie połowy zgonów w Polsce. Określone zaburzenia czynności serca leczone są przy pomocy wszczepialnych urządzeń do elektroterapii serca. Celem pracy jest kompleksowa analiza problematyki modyfikacji funkcji implantowanych urządzeń do elektroterapii na przykładzie dwóch z nich: stymulatora serca (PM) i kardiowertera-defibrylatora (ICD). W powyższym kontekście znaczenie ma zaakcentowanie statusu prawnego tych urządzeń oraz wyjaśnienie podstawowych kwestii medycznych (rodzaje urządzeń, występujące różnice i podobieństwa), których przedstawienie jest konieczne do prowadzenia dalszych rozważań. W tym zakresie omówiono zagadnienie modyfikacji funkcji urządzeń do elektroterapii zarówno w ujęciu prawnym, jak i medycznym. Poruszono zatem problematykę zgody uprawnionego podmiotu oraz zakresu obowiązku informacyjnego. Wskazano też, na czym może polegać modyfikacja aktywności urządzeń, z jakich przyczyn, kiedy oraz w jakim zakresie się jej dokonuje. Dodatkowo w świetle tytułowego zagadnienia rozważono, czy, a jeśli tak, to w jakich przypadkach przedmiotowa terapia może być traktowana jako uporczywa. Rozważania zostały zakończone wnioskami z przeprowadzonej analizy

Granice dopuszczalności przeprowadzania testów genetycznych w celach medycznych u osób małoletnich. Rozważania na tle Europejskiej Konwencji Bioetycznej

Limitations of carrying out genetic tests for health purposes on minors. Considerations on the basis of the Convention on Human Rights and BiomedicineThe present study concerns the problem which is related to the inherent conflict between the protection of human rights and the possibilities offered by modern medical technology. Moreover, such specific topic as genetic tests is analyzed in relation to the particular entity like minors.The attempt at solving the above issue is Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine and Additional Protocol concerning Genetic Testing for Health Purposes. In accordance with the above-mentioned provision, minors require more intensive protection because of their incapacity to form legal situation by themselves. The most essential is general principle established significantly restriction in the possibility of genetic tests. All strictly formulated terms required cumulative fulfilment. This special regulation ensure in appropriate way respect for the rights and interests of minorsTo sum up, carrying out genetic tests for health purposes on minors are permitted exceptionally. The above thesis finds support in rules of international law which set standards in this area.Limitations of carrying out genetic tests for health purposes on minors. Considerations on the basis of the Convention on Human Rights and BiomedicineThe present study concerns the problem which is related to the inherent conflict between the protection of human rights and the possibilities offered by modern medical technology. Moreover, such specific topic as genetic tests is analyzed in relation to the particular entity like minors.The attempt at solving the above issue is Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine and Additional Protocol concerning Genetic Testing for Health Purposes. In accordance with the above-mentioned provision, minors require more intensive protection because of their incapacity to form legal situation by themselves. The most essential is general principle established significantly restriction in the possibility of genetic tests. All strictly formulated terms required cumulative fulfilment. This special regulation ensure in appropriate way respect for the rights and interests of minorsTo sum up, carrying out genetic tests for health purposes on minors are permitted exceptionally. The above thesis finds support in rules of international law which set standards in this area

Sposób zachowania się pacjenta jako przyczyna uzasadniająca realizację prawa lekarza do odmowy leczenia

 Patient’s behavior as a legitimate reason to exercise a doctor’s right to refuse treatment A doctor has a fundamental duty to provide health services, which also includes treatment of a patient. This obligation is not absolute. First the statutory Art. 38 of the Act of 5 December 1996 on the medical and dental professions and deontology regulations Art. 7 of the Medical Code of Ethics related to this topic should be explained, because it is necessary for further consideration. According to the above-mentioned provision a doctor has a right to refuse treatment of a patient.The aim of this paper is to analyze the issue of a doctor’s right to refuse treatment for reasons attributable to the patient and related to the patient’s conduct. In this context it should be highlighted that a doctor can exercise the above right under certain circumstances. The most essential is the significant restriction to make use of a right to refuse treatment. All strictly formulated terms require cumulative fulfilment. This special regulation ensures in an appropriate way respect for the rights and interests of patients.To sum up, a legitimate reason to exercise a doctor’s right to refuse treatment is also the patient’s behavior, such as aggressive conduct, multiple non-compliance with the doctor’s order or negating the competence of the doctor. This thesis finds support both in statutory and deontology regulations. Patient’s behavior as a legitimate reason to exercise a doctor’s right to refuse treatment A doctor has a fundamental duty to provide health services, which also includes treatment of a patient. This obligation is not absolute. First the statutory Art. 38 of the Act of 5 December 1996 on the medical and dental professions and deontology regulations Art. 7 of the Medical Code of Ethics related to this topic should be explained, because it is necessary for further consideration. According to the above-mentioned provision a doctor has a right to refuse treatment of a patient.The aim of this paper is to analyze the issue of a doctor’s right to refuse treatment for reasons attributable to the patient and related to the patient’s conduct. In this context it should be highlighted that a doctor can exercise the above right under certain circumstances. The most essential is the significant restriction to make use of a right to refuse treatment. All strictly formulated terms require cumulative fulfilment. This special regulation ensures in an appropriate way respect for the rights and interests of patients.To sum up, a legitimate reason to exercise a doctor’s right to refuse treatment is also the patient’s behavior, such as aggressive conduct, multiple non-compliance with the doctor’s order or negating the competence of the doctor. This thesis finds support both in statutory and deontology regulations

Kilka uwag o obowiązku udzielania przez lekarza podstawowej opieki zdrowotnej świadczeń poza zakresem swojej specjalizacji

 A FEW REMARKS ON A PRIMARY CARE DOCTOR DUTY TO PROVIDE HEALTH SERVICES OUTSIDE THE SCOPE OF SPECIALIZATIONFirst it should be pointed out that a doctor has a duty to provide health services within the scope of his/her specialization. This basic rule arises from both statutory and deontological regulations.The aim of this paper is to analyze the issue of a primary care doctor duty to provide health services outside the scope of his/her specialization as an exception to the above rule. In this respect it is very significant to explain the statutory and deontological regulations related to this topic, because it is necessary for further considerations. Then the exceptions to the rule are discussed. In this context the specific duty to provide health services outside the scope of specialization, concerning a primary care doctor should be highlighted.In the end the conclusions of the analysis are presented. A FEW REMARKS ON A PRIMARY CARE DOCTOR DUTY TO PROVIDE HEALTH SERVICES OUTSIDE THE SCOPE OF SPECIALIZATIONFirst it should be pointed out that a doctor has a duty to provide health services within the scope of his/her specialization. This basic rule arises from both statutory and deontological regulations.The aim of this paper is to analyze the issue of a primary care doctor duty to provide health services outside the scope of his/her specialization as an exception to the above rule. In this respect it is very significant to explain the statutory and deontological regulations related to this topic, because it is necessary for further considerations. Then the exceptions to the rule are discussed. In this context the specific duty to provide health services outside the scope of specialization, concerning a primary care doctor should be highlighted.In the end the conclusions of the analysis are presented

Przeszczepianie komórek krwiotwórczych krwi obwodowej — aspekty prawne

Peripheral blood stem cell transplantation in light of legal regulationsThe increasingly widespread use of stem cells within medicine for the treatment of many diseases required that the legal aspects of this issue should be analysed.The normative basis for considerations regarding the above topic is the Act of 1 July 2005 on the procurement, storage and transplant of cells, tissues and organs. In this context it is important to highlight the specific legal regime of stem cell transplantation, the most common source of which is peripheral blood. The above thesis is reflected inter alia in unrestricted living donor circle. Thus, there is no requirement to obtain consent of the regional court for transplantation, when the donor is not a relative consanguinity sibling, adoptee or spouse of the recipient. The donors could be also entities under special protection as minors or pregnant women after fulfiling the additional statutory requirement. The special legal regime is also reflected in one other aspect, i.e. in the procedure to express consent by donor and recipient. The above consent does not need to include determined recipient or an acceptance of the transplant from specified donor, respectively.In light of the foregoing, it should be stressed that the legal regime of an ex vivo transplantation involves fewer stringent and rigorous conditions for its admissibility when the subject of transplantation are peripheral blood stem cells. In this respect the medical determinants related to peripheral blood stem cells as ability to regeneration, a lower level of risk and smaller effects for the donor’s health and life are directly reflected in legal regulations. In the available literature, there is proposed a view that the right to periodic examination should be introduced also for peripheral blood stem cell donors.Peripheral blood stem cell transplantation in light of legal regulationsThe increasingly widespread use of stem cells within medicine for the treatment of many diseases required that the legal aspects of this issue should be analysed.The normative basis for considerations regarding the above topic is the Act of 1 July 2005 on the procurement, storage and transplant of cells, tissues and organs. In this context it is important to highlight the specific legal regime of stem cell transplantation, the most common source of which is peripheral blood. The above thesis is reflected inter alia in unrestricted living donor circle. Thus, there is no requirement to obtain consent of the regional court for transplantation, when the donor is not a relative consanguinity sibling, adoptee or spouse of the recipient. The donors could be also entities under special protection as minors or pregnant women after fulfiling the additional statutory requirement. The special legal regime is also reflected in one other aspect, i.e. in the procedure to express consent by donor and recipient. The above consent does not need to include determined recipient or an acceptance of the transplant from specified donor, respectively.In light of the foregoing, it should be stressed that the legal regime of an ex vivo transplantation involves fewer stringent and rigorous conditions for its admissibility when the subject of transplantation are peripheral blood stem cells. In this respect the medical determinants related to peripheral blood stem cells as ability to regeneration, a lower level of risk and smaller effects for the donor’s health and life are directly reflected in legal regulations. In the available literature, there is proposed a view that the right to periodic examination should be introduced also for peripheral blood stem cell donors

Legal Aspects of Consent for Blood Donation

Blood taking is a medical procedure which requires a valid consent from patients. This problem may be considered in terms of many different aspects. The statement that the circumstances and aims of this medical procedure exert an influence on law serves as a good starting point. Blood donation is regulated by different rules than blood sampling. Moreover, yet another principles are applied when HIV test is performed. Additionally, blood taking is regulated in civil proceedings. To sum up, in each case a consent of blood taking is a necessary, yet not an exclusive component. It, however, ascertains that medical procedures are followed according to the law. In that way, the legislator protects patients’ fundamental rights