Conflictos de intereses en medicina. Recomendaciones del CETREMI.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Los conflictos de interés son situaciones en las que el juicio y la integridad de las decisiones o acciones médicas son influidas por un interés secundario, frecuentemente de tipo económico. El Comité de Ética y Transparencia en la Relación Médico-­Industria de la Academia Nacional de Medicina de México reconoce que estos conflictos ocurren en la vida diaria de los profesionales de la salud, pero también en las instituciones de servicios de salud públicas y privadas, así como en la academia y en la investigación. Por ello, es necesario identificar situaciones de conflicto y actuar siempre de acuerdo con el interés del paciente.

Medical and Legal Aspects of the Practice of Teledermatology in Spain. / Aspectos medicolegales de la práctica de la teledermatología en España.

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.

Management of testicular torsion in the ER: lessons learned from medical professional liability claims.

OBJECTIVE: To evaluate emergency care for testicular torsion (TT) in medical professional liability (MPL) claims. METHODS: Claims related to TT from 2000 to 2018 were located. The assistance provided and the association with MPL were analyzed. RESULTS: Eighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5 h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When TT diagnosis was performed, 97.3% had undergone ancillary tests. The MPL was significantly associated with non-criminal proceedings and with less than 6 h of symptoms' evolution, and, within this subgroup, without undergoing an ultrasound scan. CONCLUSIONS: Late consultations, wrong diagnosis and late diagnosis are claimed. When MPL are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6 h of evolution with no ancillary tests having been performed.

Medical malpractice liability and its consequences. / Encuesta a los urólogos sobre responsabilidad profesional médica y sus consecuencias.

INTRODUCTION: Urology is a specialty of medium risk of claim. Receiving a claim for medical professional liability is a stressful experience with significant repercussions. The objective of this study was to assess the impact of these claims on Spanish urologists. METHODOLOGY: A survey on medical professional liability in urology was designed. The Spanish Association of Urology and the Urological Research Foundation approved the questionnaire, generated by the PIEM online tool. RESULTS: The total number of responses obtained was 202 (11.6% rate), of which 25.24% reported having been claimed, 88% reported mood changes after being claimed, 100% in criminal proceedings. The level of emotional involvement reported was the highest at the beginning of the process and progressively decreasing until its resolution. An affected doctor-patient relationship was considered in 67.9% of cases and 71.4% acknowledged increased defensive medicine in their professional practice. A percentage of 6.7% considered leaving the profession. DISCUSSION: The response rate obtained and the medical acts motivating the claims were comparable to those obtained in a similar survey conducted in the United States. The fact that claims are perceived as very stressful situations and may give rise to the phenomenon of the second victim or to the clinical judicial syndrome is clear, so efforts should be devoted to develop training in this matter and programs that address the consequences derived from these situations.

[The responsibilities arising from the use of information and communication technologies in health professional practice]. / Las responsabilidades derivadas del uso de las tecnologías de la información y comunicación en el ejercicio de las profesiones sanitarias.

The increasing use of Information and Communication Technologies (ICT) in the health setting has given rise to the current phenomenon of eHealth or eMedicine, terms equivalent to the cyberspace concept, but refer exclusively to health. Due to the appearance of Web 2.0 it can be stated that we are dealing with a phenomenon much greater than just using the technologies: we are facing a real social change, giving rise to that called Health 2.0. The legal regulation of this cyberspace requires two different types of rules. Some that regulate cyberspace itself, and others, the actions performed with its use and to those that appear applicable to conventional law. In this latter case, we are referring to the applying of already existing laws to actions performed using ICT, as is the case of medical actions. Within these latter situations, two clearly different ones have to be distinguished: the professional responsibilities arising from medical actions carried out within health organisation settings when the use of ICT is introduced, and those other actions carried out voluntarily, individually and privately, using personal media and devices. It is in these types of actions where the legality, as regards data protection and privacy of the patient, appears to be violated, and at the same time the professional may be held responsible.

Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist. / La dermatología y sus aspectos médico-legales: seguridad clínica y dermatología.

Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them.

Physicians as second victims after a malpractice claim: An important issue in need of attention.

OBJECTIVE: Being sued for malpractice is extremely stressful and potentially traumatizing. We aim to identify claims' consequences on the physicians' well-being and medical practice. MATERIAL AND METHODS: We administered a confidential telephonic survey to those physicians with a claim closed during 2014, among those insured by the main professional liability insurance company in the region. The questionnaire addressed several topics: symptoms and well-being changes, needs, impairments and practice changes. We used descriptive statistics as well as Chi-square and T-Student tests. RESULTS: A total of 99 physicians responded to the questionnaire (response rate of 64.7%). Most of them (80.8%) acknowledged having suffered a significant emotional distress, no matter the claim's outcome (p=0.958) or the kind of procedure (p=0.928). Anger and mood cluster of symptoms were frequent, and the experience frequently affected their personal, family or social life and professional conduct. Practice changes correlated significantly and positively with the number of symptoms reported (p=0.010), but not with the outcome of the claim (p=0.338) or the kind of procedure (p=0.552). CONCLUSIONS: Most claimed physicians suffer a significant emotional distress after a malpractice claim, which affects their professional performance. According to our results, they should be assessed and assisted in order to minimize the negative consequences on their well-being and their praxis.

Clinical safety and professional liability claims in Ophthalmology. / Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología.

INTRODUCTION: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. MATERIAL AND METHODS: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. RESULTS: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. CONCLUSIONS: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

Las negligencias más comunes en la práctica odontológica / The most common negligence in dental practice

Para el adecuado ejercicio de la odontología, los procedimientos realizados deben ejecutarse apegándose en todo momento a las normas y principios éticos propios de la profesión. Cuando un odontólogo decide, por voluntad propia, ejercer la profesión sin apegarse a dichos principios, se considera que actúa con negligencia. La negligencia se caracteriza por ser un acto indebido, en el cual el profesional ejecuta por voluntad propia acciones injustificables capaces de producir daños en la salud de los pacientes o en el pronóstico de un tratamiento. Los actos negligentes, además de atentar contra la integridad del paciente, ponen en riesgo a los profesionales de la salud que los cometen de sufrir consecuencias legales derivadas de dichos actos. El objetivo del presente artículo consiste en definir el concepto de negligencia, describir las formas más comunes en las que ésta se comete durante la consulta odontológica así como sus posibles consecuencias legales, ilustrándolas a su vez con la breve presentación de algunos casos (AU)

For the proper practice of dentistry, the procedures performed must be carried out adhering at all times to the standards and ethical principles of the profession. When a dentist voluntarily decides to practice the profession without adhering to these principles, he is considered to be acting negligently. Negligence is characterized as an improper act, in which the professional voluntarily executes unjustifiable actions capable of causing damage to the health of patients or the prognosis of a treatment. Negligent acts, in addition to threatening the integrity of the patient, put health professionals at risk who commit legal consequences derived from these acts. The aim of this article is to define the concept of negligence, to describe the most common ways in which it is committed during the dental practice as well as its legal consequences, illustrating them in turn with a brief presentation of some cases (AU)

Denuncias por mala práctica odontológica en Costa Rica: Análisis de 124 casos en el período 2015 - 2020 / Dental malpractice lawsuits in Costa Rica: analysis of 124 cases in the period 2015-2020

Resumen Introducción: En Costa Rica las demandas por mala práctica, mala praxis o responsabilidad profesional se encuentran tipificadas bajo el delito de lesiones culposas según el Código Penal de Costa Rica. Este estudio tiene como propósito describir las características de todas las demandas analizadas por la Unidad de Odontología Forense del Departamento de Medicina Legal en un período de seis años (2015-2020). Materiales y métodos: Se realizó una revisión detallada en la base de datos del Sistema de Medicina Legal (SIMEL) del Departamento de Medicina Legal del Organismo de Investigación Judicial de la totalidad de denuncias de "mal praxis" odontológica presentadas desde el 01 de enero de 2015 hasta el 31 de diciembre de 2020. La información recopilada fue tabulada en Excel e incluyó la clasificación por año, especialidad odontológica relacionada, sexo del denunciante y resultado del análisis pericial. Resultados: El análisis de los datos permitió determinar que de las 124 denuncias las disciplinas con mayores porcentajes fueron la cirugía oral y maxilofacial (39,52%), implantes dentales (16,94%) y ortodoncia (12,9%). Más de dos terceras partes (66,12%) de las denuncias corresponden a mujeres y dentro de los resultados de las pericias un 10% de los casos resultaron positivos, un 32% son negativos y un 58 % resultan no concluyentes. Conclusiones: El expediente odontológico completo es indispensable para lograr determinar un nexo de causalidad entre los hechos investigados y los resultados de un tratamiento; en Costa Rica los procedimientos invasivos generan mayor posibilidad de demandas, las mismas pueden ser evitadas mediante un adecuado manejo de los riesgos y complicaciones, comunicación adecuada paciente-tratante y manejo de las expectativas del tratamiento.

Abstract Introduction: In Costa Rica, dental malpractice lawsuits (professional liability) are classified under the crime of culpable injuries according to the Criminal Code of Costa Rica. The purpose of this study is to describe the characteristics of all the claims analyzed by the Forensic Dentistry Unit of the Department of Legal Medicine in a period of six years (2015-2020). Materials and methods: A detailed review was carried out in the database of the Legal Medicine System (SIMEL) of the Legal Medicine Department of the Organismo de Investigación Judicial (Judicial Investigation Agency) of all the complaints of dental "malpractice" filed since January 1, 2015 to December 31, 2020. The information collected was tabulated in Excel and classified by year, related dental discipline, sex of the complainant and the result of the expert analysis. Results: The data analysis determined a total of 124 complaints, the disciplines with the highest percentages were oral and maxillofacial surgery (39.52%), dental implants (16.94%) and orthodontics (12.9%). More than two thirds (66.12%) of the complaints correspond to women and within the results of the forensic report 10% of the cases were positive, 32% negative and 58% inconclusive. Conclusions: The complete dental record is essential to be able to determine a causal link between the investigated facts and the results of a treatment; in this study more than 50% of the files where incomplete, invasive procedures such as oral surgery generate a greater possibility of lawsuits that could be avoided through proper management of risks and complications, adequate patient-caregiver communication, and management of treatment expectations.

[Clinical safety and professional liability claims in Orthopaedic Surgery and Traumatology]. / Seguridad clínica y reclamaciones por responsabilidad profesional en Cirugía Ortopédica y Traumatología.

The specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

Aspectos legales del consentimiento informado en odontología / Legal aspects of informed consent in dentistry

El consentimiento informado forma parte de los elementos que constituyen el expediente clínico. Por su importancia informativa sobre posibles riesgos y complicaciones inherentes al tratamiento a realizar, su elaboración resulta de vital importancia. Existen numerosas legislaciones y normatividades que regulan este notable documento; sin embargo, resulta alarmante que muchos profesionistas omiten su realización o lo elaboran erróneamente, poniéndolos en riesgo de sufrir problemas legales. Además, es una realidad que el consentimiento informado es un documento mal entendido por la mayoría de los profesionistas, pudiendo incurrir en numerosos errores por desconocimiento. El objetivo del presente artículo es informar al cirujano dentista sobre los verdaderos alcances del consentimiento informado con fundamento en la legislación vigente en México (AU)

Informed consent is part of the elements that make up the clinical record. Due to its informative importance on possible risks and complications inherent to the treatment to be carried out, its preparation is of vital importance. There are numerous laws and regulations that regulate this remarkable document, however, it is alarming that many professionals omit its elaboration or wrongly elaborate it, putting them at risk of suffering legal problems. In addition, it is a reality that informed consent is a document misunderstood by most professionals, and may incur numerous errors due to ignorance. The aim of this article is to inform the dental surgeon about the true scope of informed consent based on current legislation in Mexico (AU)

Medical professional responsibility for postvasectomy pregnancy. / Responsabilidad profesional médica en embarazo posvasectomía.

BACKGROUND: The follow-up of patients postvasectomy is frequently limited to a seminogram at 3months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. MATERIAL AND METHODS: We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. RESULTS: A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. DISCUSSION: It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3months after vasectomy is risky, as is basing the waiting time on the number of ejaculations.

Actualización sobre los contenidos de actuación y responsabilidad médico-legal en atención primaria de salud / Update about the contents regarding performance and medical-legal responsibility in primary health care

Introducción: Los médicos de familia deben dominar la metodología para desarrollar acciones de salud que permitan una adecuada actuación y responsabilidad médico-legal, para dar una respuesta efectiva ante estos problemas. Objetivo: Describir la actualización de los contenidos relacionados con la actuación y la responsabilidad médico-legal de los médicos de familia en la atención primaria de salud, a partir de la revisión del libro Medicina general integral, salud y medicina, en su edición de 2014. Métodos: Se realizó una investigación descriptiva, de corte educacional. Se emplearon métodos teóricos y empíricos (guía de revisión), en función de la revisión bibliográfica y documental, con el propósito de identificar la coherencia entre los contenidos sobre actuación y responsabilidad médico-legal en la atención primaria de salud, presentados en Medicina general integral, salud y medicina (2014) y los contenidos nuevos del curso "Gestión de la atención a nivel del consultorio del médico y enfermera de la familia", del especialista en formación. Resultados: Se actualizaron los contenidos el Decreto Ley No. 234, de la Maternidad de la Trabajadora, receta médica y certificados de medicamentos controlados, y se introdujeron nuevos sobre el CIE10, dietas médicas y del certificado de asistencia de primera intención de un lesionado en correspondencia con el programa de estudio de la especialidad en Medicina General Integral. Conclusiones: Se actualizaron los contenidos sobre actuación y responsabilidad médico-legal en la atención primaria de salud a partir del libro Medicina general integral, salud y medicina (2014), con lo que se logró una total correspondencia con los contenidos del programa de estudio de la especialidad. Se debe valorar la inclusión del CIE en este programa(AU)

Introduction: Family physicians must master the methodology to develop health actions that allow adequate performance and medical-legal responsibility, to give an effective response to these problems. Objective: To describe the update of the contents related to performance and medical-legal responsibility of family physicians in primary health care, based on the review of the book Medicina General Integral. Salud y Medicina [General Comprehensive (Family) Medicine. Health and Medicine] in its 2014 edition. Methods: A descriptive, educational research was carried out. Theoretical and empirical methods (revision guide) were used, based on the bibliographic and documentary review, with the purpose of identifying the coherence between the contents on performance and medical-legal responsibility in primary health care, presented in Medicina General Integral. Salud y Medicina [General Comprehensive (Family) Medicine. Health and Medicine] (2014) and the new contents of the course Care Management at level of the family doctor's and nurse's office, of the specialist under training. Results: The contents of Decree-Law No. 234, of the Maternity Leave of the Worker Woman, medical prescription and certification for controlled medicines were updated, new ones were introduced based on the CIE10, medical diets certificates and the certificate of first-aid assistance of an injured person in correspondence with the syllabus of the specialty General Comprehensive (Family) Medicine. Conclusions: The contents on performance and medical-legal responsibility in primary health care were updated from the book Medicina General Integral. Salud y Medicina [General Comprehensive (Family) Medicine. Health and Medicine] (2014), which permitted to achieve a total correspondence with the contents of the syllabus of the specialty. The inclusion of the CIE in the specialty syllabus should be assessed(AU)

Odontología legal / Legal odontology

El odontólogo tiene especiales obligaciones y responsabilidades que se encuentran claramente descritas en nuestra legislación. Por desgracia, es una realidad que la odontología legal es un área que comúnmente no se incluye en el plan de estudios de la licenciatura en odontología, lo que produce, como consecuencia, que los odontólogos desconozcan en gran parte sus derechos y obligaciones ante el Estado y frente a sus pacientes. El objetivo del presente artículo es indagar sobre los tópicos más relevantes de odontología legal mediante una revisión de la literatura y de conformidad con las legislaciones vigentes en la República Mexicana (AU)

The dentist has specific obligations and responsobilities that are clearly described in our legislation, and unfortunately it is a reality, that legal odontology is an area that is not commonly included in the curriculum of the dental degree, which results in dentists largely unaware of their rights and obligations against the State and against their patients. The aim of this article is to investigate the most relevant topics of legal odontology through a review of the literature and in accordance with the laws in force in the Mexican Republic (AU)

Caracterización de la responsabilidad profesional medica, Dirección de Medicina Forense de Tegucigalpa / Characterization of complaints of medical professional responsibility, issued by Dirección de Medicina Forense in Tegucigalpa

Justificación:Las fallas relacionadas a la actuación profesional, impactan negativamente a los pacientes e incluso pueden conducirlos a la muerte. Las denuncias constituyen un mecanismo por el que los pacientes o sus familiares expresan insatisfacción, y cuando se analizan, sistemáticamente, no solo desde la perspectiva legal, constituyen una oportunidad de mejora continua. Objetivo:Caracterizar las denuncias por responsabilidad profesional médica dictaminadas en la Dirección de Medicina Forense de Tegucigalpa. Metodología:Se realizó un estudio descriptivo de 89 denuncias por responsabilidad profesional médica, entre el 2010 y el 2015 dictaminadas en la Dirección de Medicina Forense de Tegucigalpa, siendo las variables de estudio: De las víctimas: edad, sexo, escolaridad. De los denunciantes: edad, sexo, motivo de la denuncia, relación con la víctima, procedencia. Del denunciado: Edad, sexo, centro donde laboraba, tiempo de laborar y especialidad ejercida. Resultados:El 5,61% de las denuncias correspondieron a casos de responsabilidad profesional médica, 20% de las cuales fueron por desconocimiento inexcusable y 80% por omisión de cuidados. Ginecobstetricia fue la especialidad más denunciada con el 30%. Los médicos más denunciados (77,6%) trabajaban en una institución pública, y el conflicto en la relación médico-paciente fue la causa de denuncia más frecuente (40.4%). Conclusión:Los médicos del sexomasculino, cercanos a los 50 años de edad y con más de 15 años de experiencia, que laboraban encentros públicos y que ejercían las especialidadesde Ginecobstetricia, OrtopediayCirugía General, fueron los más denunciados; entre los motivos más frecuentes dedenuncia se citaron losconflictos en la relación médico-paciente-familiar, la inconformidad en el diagnóstico y falta de ética profesional de otros profesionales con comentarios adversos hacia sus colegas o las instituciones...(AU)

[Surgical procedures involved in claims for alleged defects in praxis]. / Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxis.

Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to "non-curative" medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called "non-curative" medicine.

[Urological diseases most frequently involved in medical professional liability claims]. / Patologías urológicas más frecuentemente implicadas en las reclamaciones por responsabilidad profesional médica.

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety.

Responsabilidade e sentimento de culpa: uma vivência paradoxal dos profissionais de terapia intensiva pediátrica / Responsibility and guilt: paradoxical feelings among professionals from a pediatric intensive care unit / Responsabilidad y sentimiento de culpa: una vivencia paradójica de los profesionales de terapia intensiva pediátrica

O objetivo deste estudo foi analisar a constituição da responsabilidade no trabalho de profissionais de saúde em uma unidade de terapia intensiva pediátrica. A pesquisa é de abordagem qualitativa, com coleta de dados mediante entrevistas com roteiro semiestruturado a um grupo heterogêneo de 14 profissionais. Foram realizadas observações sistemáticas em diversos horários de trabalho, em um total de oitenta horas, registradas em diário de bordo. A análise do discurso fundamentou-se na perspectiva foucaultiana. A partir deste estudo, aponta-se que o sentimento de responsabilidade é convertido em sentimento de culpa pelos profissionais, a partir de um entrelaçamento de regimes de verdades provenientes dos campos do poder judiciário, do Cristianismo e do saber médico, que incidem sobre as práticas. As dificuldades em lidar com limites na atuação profissional desencadeiam conflitos interprofissionais geradores de sofrimento no lidar com a morte de crianças.(AU)

The objective of this study was to analyze the nature of responsibility at work among health professionals in a pediatric intensive care unit. This qualitative research involved data gathering from semi-structured interviews with a heterogenous group of 14 professionals. Systematic observations were carried out at different working hours, across a total of eighty hours, and were registered in a logbook. Discourse analysis was based on Foucault. The study showed that the feeling of responsibility is converted into a feeling of guilt by health professionals, based on the intermeshing of truth systems that draw on the fields of legal power, Christianity and medical knowledge, all of which impact on the individual's practices. The difficulties in dealing with limits in the professional sphere lead to conflicts between professionals which cause suffering when it comes to dealing with the death of children.(AU)

El objetivo de este estudio fue analizar la constitución de la responsabilidad en el trabajo de profesionales de salud en una unidad de cuidados intensivos pediátrica. La encuesta es de abordaje cualitativo con colecta de datos por medio de entrevistas con guion semi-estructurado a un grupo heterogéneo de 14 profesionales. Se realizaron observaciones sistemáticas en diversos horarios de trabajo, en un total de ochenta horas, registradas en un diario de a bordo. El análisis del discurso se fundamentó en la perspectiva foucaultiana. A partir de este estudio, se señala que el sentimiento de responsabilidad es convertido en sentimiento de culpa por parte de los profesionales, a partir de un entrelazamiento de regímenes de verdades provenientes de los campos del poder judicial, del Cristianismo y el saber médico que inciden sobre las prácticas. Las dificultades para enfrentar límites en la actuación profesional desencadenan conflictos interprofesionales generadores de sufrimiento al enfrentar la muerte de niños.(AU)

Aplicación de la teoría de la consecución de objetivos al cuidado del paciente con enfermedad pulmonar obstructiva crónica / Applying the theory of achieving patient care goals with chronic obstructive pulmonary disease / Aplicação da teoria da consecução de objetivos no atendimento do paciente com doença pulmonar obstrutiva crônica

La enfermedad pulmonar obstructiva crónica (EPOC) genera efectos en la salud del individuo que la padece, porque limita su participación en las actividades cotidianas y repercute negativamente en la calidad de vida física y social. En consecuencia, el rol del profesional de enfermería y la aplicación de teorías cobran gran importancia en el establecimiento de una interacción eficaz con el paciente que permita mejorar su salud. En la teoría de la consecución de objetivos de Imogene King, aplicada al individuo con EPOC, el paciente y la enfermera crean una interacción basada en percepciones, juicios y acciones; estas, a su vez, generan reacciones y producen transacciones que permiten al individuo alcanzar los objetivos propuestos. King contempla tres sistemas de interacción dinámica: el personal, el interpersonal y el social, los cuales se convierten en herramientas que le permiten al profesional de enfermería orientar una valoración y atención integral del paciente. De forma adicional, las propuestas de la teoría dirigen el cuidado del paciente con EPOC, donde la educación es fundamental en la consecución de objetivos, pues suple el déficit de conocimientos, consigue la aceptación del tratamiento, mejora la confianza del paciente frente a la toma de decisiones y desempeño frente a su enfermedad y facilita el establecimiento de objetivos e intervenciones de mutuo acuerdo, que se traducen en resultados positivos para el paciente en términos de reducción de los síntomas, tolerancia a la actividad, mejoría de la calidad de vida, disminución de las exacerbaciones e incremento del rendimiento físico y social.

Chronic obstructive pulmonary disease (COPD) generates effects on the health of the individual who suffers from it, because it limits their participation in daily activities and negatively affects the quality of physical and social life. Consequently, the role of the nurse and the application of theories loom large in the establishment of an effective interaction with the patient to improve their health. When Imogene King's theory of goal attainment is applied to the individual with COPD, the patient and the nurse create an interaction based on perceptions, judgments and actions, and these, in turn, generate reactions and produce transactions that allow the individual to achieve the objectives. King includes three dynamic interacting systems: personal, interpersonal and social, which become tools that allow the nursing professional guide an integral assessment and care of patients. Additionally, the proposals from the theory direct the care of patients with COPD, where education is fundamental to the achievement of objectives, since it compensates the knowledge deficit, gets treatment acceptance, improves the patient´s confidence in regards to decision making and management of their disease and facilitates the establishment of objectives and interventions by mutual agreement, that result in positive outcomes for the patient in terms of reduction of symptoms, activity tolerance, improved quality of life, decreased exacerbations and increased physical and social performance.

A doença pulmonar obstrutiva crônica (DPOC) gera efeitos na saúde do individuo padecente, porque limita sua participação nas atividades cotidianas e repercute negativamente na qualidade de vida física e social. Consequentemente, o papel do profissional de enfermagem e a aplicação de teoria adquire grande importância no estabelecimento de uma interação eficaz com o paciente que permita o melhoramento da saúde dele. Na teoria da consecução de objetivos de Imogene King, aplicada ao individuo com DPOC, o paciente e a enfermeira criam uma interação baseada em percepções, julgamentos e ações e estas, por sua vez, geram reações e produzem transações a permitir o indivíduo alcançar os objetivos propostos. King contempla três sistemas de interação dinâmica: o pessoal, o interpessoal e o social, que se tornam ferramentas a permitir o profissional de enfermagem orientar uma avaliação e atendimento integral do paciente. Adicionalmente, as propostas da teoria conduzem o atendimento do paciente com DPOC, onde a educação é fundamental na consecução dos objetivos, pois fornece o déficit de conhecimentos, consegue o aceite do tratamento, melhora a confiança do paciente frente à tomada de decisões e desenvolve na frente da sua doença e facilita o estabelecimento de objetivos e intervenções por mútuo acordo, com resultados positivos para o paciente em termos de diminuição dos sintomas, tolerância à atividade, melhoramento da qualidade de vida, diminuição das exacerbações e incremento do desempenho físico e social.