[Medical and legal aspects of the responsibility of medical workers in cases of improper provision of medical care].

The article considers the concept of medical incidents of «improper provision of medical care¼, implying the action or inaction of a medical worker who violates the procedure for providing medical care established by regulatory legal acts and standards. The relevance of the study of issues related to the medical and legal norms of holding medical workers accountable when medical care is of inadequate quality is due to the importance of understanding offenses in the medical field and assessing the responsibility of medical workers, who act as criteria for the presence of problems in the medical field and the impetus for reforming the health system.

[Changes in court practice in cases of poor quality of dental care]. / Izmeneniya sudebnoi praktiki po delam, kasayushchimsya nekachestvennogo okazaniya stomatologicheskoi pomoshchi.

The study objective is to analyze changes in court practice over a 10-year period (from 2013 to 2022) including the quantitative and qualitative composition of complaints for conducted dental treatment, considering legislative changes in the procedure for the provision of dental service and formalization of the relationship between patient and medical organization. An investigation of 1800 legal cases containing complaints, forensic reports and court decisions allowed to identify tendencies in increasing the number of cases in which patients' demands were fully or partially satisfied, from 54% in 2013-2017 up to 61% in 2018-2022. At the same time, the amounts of payments determined by the courts increased by 14 times. In addition, the percentage of claims against medical organizations providing care under the CHI program increased significantly (from 5% in 2013-2017 to 15% in 2018-2022). A significant impact of changes in normative legal documents regulating the provision of dental care on the qualitative composition of complaints and the issues formed for medical experts by court has been noted.

Joint response from Latin American, European Obstetric Violence Observatories and others organizations all over Europe to the Joint Position Statement on Substandard and Disrespectful Care in Labour - Because Words Matter.

The issue of obstetric violence is internationally acknowledged as a serious violation of human rights. First identified by the Committee of Experts of the Inter-American Belém do Pará Convention in 2012, it is recognized as a form of gender-based violence that infringes upon women's rights during childbirth. Nations such as Argentina, Mexico, Venezuela, and certain regions in Spain have implemented laws against it, highlighting its severity and the need for protective legislation. Major international organizations, including WHO and the Council of Europe, advocate for the elimination of disrespectful and abusive treatment in maternity care. In 2019, the UN Special Rapporteur on violence against women called on states to protect women's human rights in reproductive services by enforcing laws, prosecuting perpetrators, and providing compensation to victims. However, despite advances, there remains institutional and systemic resistance to recognizing obstetric violence, which undermines trust in healthcare and impacts women's quality of life. Addressing this violence is imperative, requiring education and training in women's human rights for all healthcare professionals. As part of the coalition of experts from various organizations (InterOVO), we respond to the publication by EAPM, EBCOG, and EMA: "Joint Position Statement: Substandard and Disrespectful Care in Labor - Because Words Matter." We are committed to preventing and mitigating obstetric violence and improving care for women and newborns.

The Texas Medical Board and the Futility of Medical Exceptions to Abortion Bans.

This Viewpoint describes the failure of yet another state institution to generate meaningful guidance about medical exceptions to abortion bans.

State Regulation of Ensuring the Quality Medical Care During Martial Law in Ukraine: Lessons for the International Community.

Background: Nowadays, the quality of medical care and health care measures is considered the main target function of the health care system and at the same time the determining criterion for its activities. Objective: The article examines state regulation of medical care quality post- COVID and during martial law, identifying improvement areas. It emphasizes state roles in healthcare standardization, continuous feedback monitoring, and studying patient satisfaction. Interrelationships among Ukraine's state regulation mechanisms are determined, highlighting the need to enhance tools such as criteria and quality indicators for medical care assurance. Methods: The authors of this article utilize various scientific methods, including analysis, synthesis, induction, and deduction, as well as historical and legal, formal legal, and comparative legal methods to examine the state regulation of ensuring the quality of medical care during martial law in Ukraine. Results: The article considered the interrelationships of mechanisms and instruments of state regulation of quality assurance of medical care in Ukraine. Conclusions: The state should enhance medical care quality regulation, drawing on international experiences from the EU and the USA and adapting best practices to national circumstances. The resilience of the healthcare system depends on effective quality assurance, ensuring preparedness, stability, and ongoing improvement prospects.

Radiation therapy: Regulatory framework and constraints.

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France.

Claims in orthopedic foot/ankle surgery, how can they help to improve quality of care? A retrospective claim analysis.

BACKGROUND: Orthopedic foot/ankle surgery is a high risk specialty when it comes to malpractice claims. This study aims to evaluate the incidence, characteristics and outcome of claims in this area. METHODS: This was a retrospective, 10-year claim analysis, with data from an anonymous database. Baseline claim/claimant characteristics were collected from all orthopedic foot/ankle-related cases. RESULTS: Of 460 claims in total, most were related to delay in/wrong diagnosis or to (complications of) elective surgical procedures. Whether a claim was settled was related to type of injury (fracture) and type of claim (diagnostic mistake). Median amount disbursed in settled claims was €12,549. Claim incidence did not increase over the years. CONCLUSION: Missed fracture diagnosis and "failed"/disappointing results of elective surgical procedures were the most common causes for claims. Sufficient knowledge of missed (foot) fractures and clear communication/expectation management before elective procedures could help to improve quality of healthcare and patient satisfaction.

Nursing's Response to the Executive Order to Advance American Kidney Health.

The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.

Promoting patients' rights through hospital accreditation.

BACKGROUND: Over the past decade, hospitals in many countries, including Israel, have undergone an accreditation process aimed at improving the quality of services provided. This process also refers to the protection and promotion of patients' rights. However, reviewing the criteria and content included in this category in the Israeli context reveals definitions and implications that differ from those presented by the law - specifically the Patient's Rights Act 1995. Moreover, the rights included in it are not necessarily equally represented in other legislation. METHODS: This study seeks to examine the question of whether and to what extent the scope, contents, and definitions of patients' rights in the JCI Standards are similar to or different from patients' rights as they are addressed and protected in national legislation. The article provides a comparison and examination of the different regulatory frameworks of patients' rights, especially those in the accreditation of healthcare institution and legislation, analyzes the gaps between such frameworks, and suggests possible implications on our understanding of the concept of patients' rights. RESULTS: The patients' right chapter in the accreditation process introduces and promotes the concepts of patient and family rights, increases the awareness and compliance of such concepts, and may create greater consistency in their introduction and application. CONCLUSIONS: Discussion of the Israeli case not only demonstrates how regulatory frameworks are instrumental - for broader policy purposes, especially in the area of patients' rights and the rights of patients' families - but also calls for a more general examination of the concept of patients' rights in health policies and its contribution to the quality of health services. Reference to patients' rights in accreditation of healthcare institutions may promote and enhance this concept and contribute to the delivery of care, thereby complementing a lacuna in the law.

Improving access to quality medicines in East Africa: An independent perspective on the East African Community Medicines Regulatory Harmonization initiative.

Alexander Giaquinto and co-authors discuss the East African Community's Medicines Regulatory Harmonization initiative.

[Ethics of clinical trials]. / L'éthique des essais thérapeutiques.

TITLE: L'éthique des essais thérapeutiques. ABSTRACT: La pandémie de COVID-19 a conduit certains acteurs reconnus de la médecine à renoncer aux méthodes codifiées de la recherche médicale au profit d'affirmations établies dans l'urgence et sans réelle évaluation scientifique. Autant l'on peut comprendre que certains praticiens recourent à ce qui leur est ainsi proposé, autant cette confusion entre action dans l'urgence et recherche scientifique serait lourde de conséquences si elle venait à se généraliser, et cela à de multiples points de vue : image et rôle de la science, qualité et éthique de la recherche médicale et en fin de compte sort des malades soumis à des traitements mal évalués. Ce sont ces questions qui motivent la mise au point qui suit sur les questions d'éthique associées de longue date aux « essais thérapeutiques ¼, cette procédure rationnelle d'acquisition dans les meilleurs délais d'informations fiables sur les avantages et les risques des traitements dont on envisage l'éventuelle utilisation.

The development of hospital accreditation in low- and middle-income countries: a literature review.

Hospital accreditation has been transferred from high-income countries (HICs) to many low- and middle-income countries (LMICs), supported by a variety of advocates and donor agencies. This review uses a policy transfer theoretical framework to present a structured analysis of the development of hospital accreditation in LMICs. The framework is used to identify how governments in LMICs adopted accreditation from other settings and what mechanisms facilitated and hindered the transfer of accreditation. The review examines the interaction between national and international actors, and how international organizations influenced accreditation policy transfer. Relevant literature was found by searching databases and selected websites; 78 articles were included in the analysis process. The review concludes that accreditation is increasingly used as a tool to improve the quality of healthcare in LMICs. Many countries have established national hospital accreditation programmes and adapted them to fit their national contexts. However, the implementation and sustainability of these programmes are major challenges if resources are scarce. International actors have a substantial influence on the development of accreditation in LMICs, as sources of expertise and pump-priming funding. There is a need to provide a roadmap for the successful development and implementation of accreditation programmes in low-resource settings. Analysing accreditation policy processes could provide contextually sensitive lessons for LMICs seeking to develop and sustain their national accreditation programmes and for international organizations to exploit their role in supporting the development of accreditation in LMICs.

Civil Money Penalty Enforcement Actions for Quality Deficiencies in Nursing Homes.

BACKGROUND AND OBJECTIVES: Civil money penalties (CMP) are fines collected by CMS and then redistributed to states for the sole purpose of improving resident care and quality of life through reinvestment in quality improvement projects. This study examined state variation in civil money penalty enforcement actions for quality of life (QOL) and quality of care (QOC) deficiencies in nursing homes. RESEARCH DESIGN AND METHODS: 2015-2016 cross-sectional CASPER nursing home survey data obtained from the CMS QCOR database were used to explore the pattern of enforcement actions for QOL and QOC deficiencies across states. Fixed effects regression models examined relationships between state-level characteristics, quality deficiencies, and enforcement actions imposed by states. RESULTS: State enforcement actions resulting in a CMP were more likely for QOC deficiencies (M = 0.143, SD = 0.097) than for QOL deficiencies (M = 0.070, SD = 0.056) and states exhibited variability in imposing enforcement actions. The presence of severe QOC deficiencies resulting in actual resident harm contributed to CMP enforcement actions for both QOL and QOC deficiencies. States with primarily for-profit status providers had more enforcement actions. DISCUSSION AND IMPLICATIONS: The variability noted in state enforcement for quality deficiencies actions parallels inconsistencies in state regulatory oversight of nursing homes.