Admission of a minor to a psychiatric hospital under Polish law. Part I. / Przyjecie maloletniego do szpitala psychiatrycznego w mysl polskiego prawa. Czesc I.

Within the scope of mental health protection, numerous practical problems arise concerning the issue of providing health services to a minor. Admission of a minor to a psychiatric hospital is associated in practice with numerous doubts. This part of the article describes the conditions of admission to hospital with the consent of the patient. It distinguishes and accurately describes situations where a minor is under or over 16 years of age. In addition, it explains situations where there is a contradiction of declarations of will by legal guardians in relation to admission, their inability to perform legal acts, or a contradiction of the statements of the minor and guardian. It also addresses the aspect of receiving written consent during the COVID-19 epidemic.

Admission of a minor to a psychiatric hospital under Polish law. Part II. / Przyjecie maloletniego do szpitala psychiatrycznego w mysl polskiego prawa. Czesc II.

The prevalence of mental disorders among minors is steadily increasing in our country as well as in Europe. Contact of a minor with a psychiatric health service, and especially the admission of such a person to a psychiatric hospital as a matter of urgency, however, raises a lot of legal and medical controversy. Urgent admission allows the consent of both the minor and his legal guardian to be bypassed. The article deals with legal issues related to the direct threat to life of minors for psychiatric reasons, and also presents the conditions that must occur for admission without consent not to be subject to legal tort.

Procedural and material aspects of the protection of the rights of a person subject to proceedings for legal incapacitation - Part I. / Procesowe i materialne aspekty ochrony praw osoby, wobec której toczy sie postepowanie o ubezwlasnowolnienie ­ czesc I.

The aim and effect of the procedure for legal incapacitation is to ensure the widest possible social integration and the widest possible autonomy of the incapacitated person; the procedure should provide the disabled person with full procedural guarantees enabling him or her to have a fair hearing and to make an equitable decision, not only regarding the issue of incapacitation, but also on the revocation of the incapacitation or on a change in the type of incapacitation. In the first part of the paper, we presented the problem of legal incapacitation, answered questions about who could initiate the proceedings for legal incapacitation, who could be a participant of such proceedings, whether issuing a certificate of health condition is a necessity, and we presented the procedural aspect of protecting the rights of a person against whom proceedings for incapacitation are pending.

Procedural and material aspects of the protection of the rights of a person subject to proceedings for legal incapacitation - Part II. / Procesowe i materialne aspekty ochrony praw osoby, wobec której toczy sie postepowanie o ubezwlasnowolnienie ­ czesc II.

The aim and effect of the procedure for legal incapacitation is to ensure the widest possible social integration and the widest possible autonomy of the incapacitated person; the procedure should provide the disabled person with full procedural guarantees enabling him or her to have a fair hearing and to make an equitable decision, not only regarding the issue of incapacitation, but also on the revocation of the incapacitation or on a change in the type of incapacitation. In the first part of the paper, we presented the problem of legal incapacitation, answered questions about who could initiate the proceedings for legal incapacitation, who could be a participant of such proceedings, whether issuing a certificate of health condition is a necessity, and we presented the procedural aspect of protecting the rights of a person against whom proceedings for incapacitation are pending. In the second part of the manuscript, we described the characteristics of the institution of temporary advisor and guardian ad litem as well as the material aspect of protecting the rights of a person against whom proceedings for incapacitation are pending.

Pulmonary artery growth in univentricular physiology patients.

BACKGROUND: A Fontan-type operation, i.e. a connection of the systemic veins and pulmonary arteries without subpulmonary ventricle, with different surgical techniques, is nowadays the only treatment option for patients with a functionally univentricular heart (UVH). Understanding the development of pulmonary arteries in patients who are considered for the Fontan procedure is important clinically. AIM: To evaluate the development of pulmonary arteries in patients with univentricular circulation. METHODS: Between 1995 and 2007, 111 patients underwent a bidirectional Glenn procedure. In all patients, preoperative catheterisation was performed to assess the anatomy and haemodynamics of UVH, especially the size of the pulmonary arteries. Ninety nine patients were included in the bidirectional Glenn group; 62 of these underwent repeat catheterisation before Fontan completion. The late results, after one stage extracardiac total cavopulmonary anastomosis performed in 24 patients between 1992 and 2002, were reinvestigated (one-stage Fontan group). We assessed the changes in the McGoon ratio and Nakata index for the whole cohort of patients. McGoon ratio is the sum of the diameter of pulmonary arteries divided by the diameter of the aorta. Nakata index is the sum of the cross-sectional area of the pulmonary arteries divided by the body surface area. RESULTS: During cardiac catheterisation prior to Glenn procedure, the mean Nakata index was 351.9 (range 131.2-886) mm2/m2 and was higher in patients with increased pulmonary flow (p = 0.0135). Mean McGoon ratio was 2.5 (range 1.1-4.9). An average 40.3 months after Glenn procedure, the Nakata index and McGoon ratio decreased significantly to 226.4 ± 125 mm²/m² (p < 0.003), and to 2.14 ± 0.58 (p < 0.008) respectively. In the group of patients after one-stage Fontan in late follow-up, mean 7.4 years after procedure, the Nakata index decreased from 318.7 ± 159.1 mm²/m² to 120 ± 40 mm²/m² (p < 0.0001) and McGoon ratio from 2.4 ± 0.6 to 1.4 ± 0.27 (p < 0.0001). Only size of pulmonary arteries before Glenn procedure, in the bidirectional Glenn group, or before Fontan operation, in the one-stage Fontan group,were inversely correlated with the changes of size of pulmonary arteries (p = 0.0015 and p = 0.0012). CONCLUSIONS: The relative decrease of the size of pulmonary arteries in the inter-stage period (between bidirectional Glenn anastomosis and Fontan completion) and after Fontan completion may indicate that pulmonary artery sizes should probably not bean absolute limiting factor in the decision on treatment of functionally UVH patients, especially at the stage of Fontan approach.

Major infection after pediatric cardiac surgery: external validation of risk estimation model.

BACKGROUND: A multivariable risk estimation model, in which the primary outcome was major infection, was recently developed and published using The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. We have applied this risk estimation model to our congenital heart surgery program over a 16-year time interval to validate this risk estimation model and verify its specific risk factors for major infection. METHODS: Using complete and verified data, we selected patients in whom major procedures had been classified using both Aristotle Basic Score and Risk Adjustment for Congenital Heart Surgery (RACHS-1) and created a multivariable model in which primary outcome was major infection (septicemia, mediastinitis, or endocarditis). We checked the STS risk estimation model for major infection. We also assessed the significance of the STS risk factors in our program. RESULTS: A total of 6,314 patients were analyzed. We identified 197 (3.1%) major infections (septicemia 3%, endocarditis 0.015%, mediastinitis 0.09%). Hospital mortality, ventilation time, and length of stay were greater in patients with major infections. The following preoperative risk factors identified by the STS risk estimation model were significant in multivariate analysis in our patients: young age, high complexity, medium complexity, previous operation, and preoperative ventilation (p<0.0001). Estimated infection risk ranged from 0.32% to 11.58%. The model discrimination was good (c index, 0.808). Risks of infections after most common congenital heart surgery procedures were similar in both studies (rs=0.952, p=0.0003). CONCLUSIONS: Our external validation study confirmed that the STS model can be used as a preoperative risk stratification tool for major infection risk at the single institutional level.

[Perioperative antibiotic therapy in newborns according to CDC criteria - preliminary report]. / Antybiotykoterapia okolooperacyjna u noworodków a uwzglednieniem klasyfikacji CDC - doniesienie wstepne.

The aim of the study was elaboration of optimal perioperative antibiotic therapy in neonates according to CDC criteria (Center for Disease Control and Prevention). Classification in 4 groups of infections was carried out in relation to contamination of the surgical wound: clean, clean-contamination, contaminated and dirty. Based on the authors' own experience, CDC criteria were adapted to the contamination of surgical wounds in neonatal surgery. Antibiotic therapy for each of the four groups was also proposed except for the newborns with birth weight below 1500 g. For the neonates with extreme low birth weight (<1500 g) individual treatment based on other risk factors of infection, abnormal bacterial colonization and antibiotics received up to now have to be taken into consideration. Criteria for local and general infection were also defined. We consider that our report concerning rules of antibiotic therapy in neonates requiring surgical treatment will contribute to rational antibiotic administration in this group of patients. Verification of this report should be performed, based on a multicentre study.

Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period.

OBJECTIVE: Early postoperative arrhythmias are a recognized complication of pediatric cardiac surgery. METHODS: Diagnosis and treatment of early postoperative arrhythmias were prospectively analyzed in 402 consecutive patients aged 1 day to 18 years (mean 29.5 months) who underwent operation between January and December 2005 at our institute. All children were admitted to the intensive care unit, and continuous electrocardiogram monitoring was performed. Risk factors, such as age, weight, Aristotle Basic Score, cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest, were compared. Statistical analysis using the Student t test, Mann-Whitney U test, or Fisher exact test was performed. Multivariate stepwise logistic regression was used to assess the risk factors of postoperative arrhythmias. RESULTS: Arrhythmias occurred in 57 of 402 patients (14.2%). The most common types of arrhythmia were junctional ectopic tachycardia (21), supraventricular tachycardia (15), and arteriovenous block (6). Risk factors for arrhythmias, such as lower age (P = .0041*), lower body weight (P = .000001*), higher Aristotle Basic Score (P = .000001*), longer cardiopulmonary bypass time (P = .000001*), aortic crossclamp time (P = .000001*), and use of deep hypothermia and circulatory arrest (P = .0188*), were identified in a univariate analysis. In the multivariate stepwise logistic regression, only higher Aristotle Basic Score was statistically significant (P = .000003*) compared with weight (P = .62) and age (P = .40); in the cardiopulmonary bypass group, only longer aortic crossclamp time was statistically significant (P = .007*). CONCLUSION: Lower age, lower body weight, higher Aristotle Basic Score, longer cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest are the risk factors for postoperative arrhythmias. Junctional ectopic tachycardia and supraventricular tachycardia were the most common postoperative arrhythmias.

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

OBJECTIVE: The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. DESIGN: Prospectively defined analysis. SETTING: Fifty-seven secondary and tertiary care neonatal centers in Poland. PATIENTS: Patients were 1,299 newborns. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). CONCLUSIONS: The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.