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Román-Gálvez RM, Gámiz-González F, Matas-Matas FR, Rivas-Arquillo MM, Cobos-Vargas A, Bueno-Cavanillas A. [Ethics of care: Assessment of the ethical issues in the protocols or consensuses on mechanical restraint in force in Spain]. J Healthc Qual Res 2024; 39:188-194. [PMID: 38614936 DOI: 10.1016/j.jhqr.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Mechanical restraints are widely used in health care practice, despite the numerous ethical conflicts they raise. The aim of this study is to evaluate the ethical considerations contemplated in the current protocols on mechanical restraint in Spain. METHOD Systematic review in PubMed, WOS and Scopus, Google and Google Scholar. An ad hoc list of 30 items was used to evaluate the ethical content of the protocols. The quality of guidelines was assessed with AGREE II. RESULTS The need for informed consent (IC) is reflected in 72% of the documents, the IC model sheet is included in only 41% of them, the rest of the analyzed characteristics on IC are fulfilled in percentages between 6% (the document includes the need to reevaluate the indication for IC) and 31% (the document contemplates to whom it should be requested). More than 20 ethical contents are reflected in 31% of them and less than 10 in 19% of the guidelines. The quality of the guides, according to AGREE II, ranged from 27 to 116 points (maximum possible 161), with a mean score of 68.7. Only 9% of the documents were classified as high quality. Finally, the correlation between ethical content and quality measured with AGREE II was 0.75. CONCLUSIONS The variability of ethical contents in guidelines on mechanical restraints is very high. The ethical requirements to be included in protocols, consensus or Clinical Practice Guidelines should be defined.
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Affiliation(s)
- R M Román-Gálvez
- Unidad Asistencial de Alhama de Granada, Granada, España; Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España.
| | | | | | - M M Rivas-Arquillo
- Unidad de Protección de la Salud, Centro de Salud Albayda, Granada, España
| | - A Cobos-Vargas
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, España
| | - A Bueno-Cavanillas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Investigación Biosanitaria de Granada IBS, Granada, España; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Vargas Blasco C, Martin-Fumadó C, Arimany Manso J. Informed consent in urology. Actas Urol Esp 2024:S2173-5786(24)00005-2. [PMID: 38191026 DOI: 10.1016/j.acuroe.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 01/10/2024]
Abstract
Appropriate professional practice includes the diagnostic and treatment process of urologic pathology, as well as patient information and respect for patient autonomy in decision making. Informed consent is the gradual process of providing information to the patient and their subsequent decision making. The informed consent document (ICD), when required, demonstrates that information has been provided sufficiently in advance to allow for the patient's deliberation. The dual need for simple yet complete documents make the preparation of adequate ICDs extremely difficult. If the information process is not carried out properly, the professional may incur a medical malpractice liability that is treated as a loss of opportunity. To avoid such situations, the work of scientific societies in the preparation, accessibility, and dissemination of ICD models is fundamental.
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Affiliation(s)
- C Vargas Blasco
- Servicio de Responsabilidad Profesional, Col·legi Oficial de Metges de Barcelona, Barcelona, Spain; Cátedra de Medicina Legal, Responsabilidad Profesional Médica y Seguridad Clínica, Universitat de Barcelona, Barcelona, Spain.
| | - C Martin-Fumadó
- Servicio de Responsabilidad Profesional, Col·legi Oficial de Metges de Barcelona, Barcelona, Spain; Cátedra de Medicina Legal, Responsabilidad Profesional Médica y Seguridad Clínica, Universitat de Barcelona, Barcelona, Spain
| | - J Arimany Manso
- Servicio de Responsabilidad Profesional, Col·legi Oficial de Metges de Barcelona, Barcelona, Spain; Cátedra de Medicina Legal, Responsabilidad Profesional Médica y Seguridad Clínica, Universitat de Barcelona, Barcelona, Spain
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Jaramillo Vélez AG, Aguas Compaired M, Granados Plaza M, Mariño EL, Modamio P. [Translated article] Design and validation of two instruments to analyze and evaluate the formal quality in the informed consent process of clinical trials with medicinal products. Farm Hosp 2023; 47:T64-T68. [PMID: 36934015 DOI: 10.1016/j.farma.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/13/2022] [Indexed: 03/20/2023] Open
Abstract
OBJECTIVE The activity of sponsors and Ethics Committees for Research with medicines has increased in recent years. The objective was to design and validate 2 instruments to analyze and evaluate the formal quality of the patient information sheet and the informed consent form of clinical trials with drugs, in accordance with the legislation. METHODS Design (Guideline for good clinical practice and European and Spanish regulations); validation (Delphi method and expert consensus: concordance ≥ 80%); reliability (inter-observer method, Kappa index). 40 patient information sheets/informed consent forms were evaluated. RESULTS Very good concordance was obtained in both checklists (k ≥ 0.81, p b 0.001). The final versions consisted of checklist-patient information sheet: 5 sections, 16 items and 46 sub-items; and checklist-informed consent form: 11 items. CONCLUSION The instruments developed are valid, reliable and facilitate the analysis, evaluation, and decision-making on the patient information sheets/informed consent forms of clinical trials with drugs.
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Affiliation(s)
- Andrea G Jaramillo Vélez
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, Spain
| | - Margarita Aguas Compaired
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, Spain; Comité Ético de Investigación con medicamentos (CEIm) Idcsalud a Catalunya, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Montserrat Granados Plaza
- Comité Ético de Investigación con medicamentos (CEIm) Idcsalud a Catalunya, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Eduardo L Mariño
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, Spain
| | - Pilar Modamio
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, Spain.
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Morales-Valdivia E, Camacho-Bejarano R, Brady AM, Mariscal-Crespo MI. Evaluation of consent forms for clinical practice in Spanish Public Hospitals. J Healthc Qual Res 2023; 38:84-92. [PMID: 36175279 DOI: 10.1016/j.jhqr.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the access, development, and quality of consents forms for clinical practice within the Spanish Public Hospitals. METHOD A cross-sectional study was conducted in a two-stage process (January 2018-September 2021). In stage 1, A nationwide survey was undertaken across all public general hospitals (n=223) in the Spanish Healthcare System. In stage 2, Data was taken from the regional health services websites and Spanish regulations. Health Regional Departments were contacted to verify the accuracy of the findings. Data was analyzed using a descriptive and inferential statistics (frequencies, percentages, Chi-square & Fisher's exact tests). RESULTS The response rate was 123 (55.16%) of Spanish Public Hospitals. The results revealed a range of hospital departments involved in the development of consent documents and the absence of a standardized approach to consent forms nationally. Consent audits are undertaken in 43.09% hospitals and translation of written consents into other languages is limited to a minority of hospitals (35.77%). The validation process of consent documentation is not in evidence in 13% of Spanish Hospitals. Regional Informed Consent Committees are not place in the majority (70.7%) of hospitals. Citizens can freely access to consent documents through the regional websites of Andalusia and Valencia only. CONCLUSION Variability is found on access, development and quality of written consent across the Spanish Public Hospitals. This points to the need for a national informed consent strategy to establish policy, standards and an effective quality control system. National audits at regular intervals are necessary to improve the consistency and compliance of consent practice.
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Affiliation(s)
- E Morales-Valdivia
- PhD Candidate in Nursing, Orthopaedic Theatre Department, Croom Hospital, UHL Group, Limerick, Ireland
| | - R Camacho-Bejarano
- Nursing Department, Faculty of Nursing, University of Huelva, Campus El Carmen, Huelva, Spain; Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Madrid, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain.
| | - A M Brady
- Trinity Centre for Practice & Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - M I Mariscal-Crespo
- Nursing Department, Faculty of Nursing, University of Huelva, Campus El Carmen, Huelva, Spain
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Jaramillo Vélez AG, Aguas Compaired M, Granados Plaza M, Mariño EL, Modamio P. Design and validation of 2 instruments to analyze and evaluate the formal quality in the informed consent process of clinical trials with medicinal products. Farm Hosp 2023; 47:64-68. [PMID: 37000781 DOI: 10.1016/j.farma.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/13/2022] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE The activity of sponsors and Ethics Committees for Research with medicines has increased in recent years. The objective was to design and validate 2 instruments to analyze and evaluate the formal quality of the patient information sheet and the informed consent form of clinical trials with drugs, in accordance with the legislation. METHOD Design (Guideline for good clinical practice and European and Spanish regulations); validation (Delphi method and expert consensus: concordance ≥ 80%); reliability (inter-observer method, Kappa index). 40 patient information sheets/informed consent forms were evaluated. RESULTS Very good concordance was obtained in both checklists (k ≥ 0.81, p < 0.001). The final versions consisted of checklist-patient information sheet: 5 sections, 16 items and 46 sub-items; and checklist-informed consent form: 11 items. CONCLUSION The instruments developed are valid, reliable and facilitate the analysis, evaluation, and decision-making on the patient information sheets/informed consent forms of clinical trials with drugs.
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Affiliation(s)
- Andrea G Jaramillo Vélez
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, España
| | - Margarita Aguas Compaired
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, España; Comité Ético de Investigación con medicamentos (CEIm) Idcsalud a Catalunya, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Montserrat Granados Plaza
- Comité Ético de Investigación con medicamentos (CEIm) Idcsalud a Catalunya, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Eduardo L Mariño
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, España
| | - Pilar Modamio
- Unidad de Farmacia Clínica y Atención Farmacéutica, Departamento de Farmacia y Tecnología Farmacéutica, y Fisicoquímica, Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, España.
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Cabrera-Rodríguez A, Rico-Blázquez M, Sanz-Álvarez EJ, Schmidt-RioValle J. [Knowledge, use and opinion about written informed consent in primary healthcare nurses: CONOSER pilot project]. Aten Primaria 2023; 55:102525. [PMID: 36473409 PMCID: PMC9723936 DOI: 10.1016/j.aprim.2022.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To know the knowledge, implementation and opinion on informed consent of generalist nurses, specialists and primary care residents. DESIGN Descriptive cross-sectional study using an online self-administered 'ad hoc' questionnaire. SETTING Primary care nurses in Madrid, from November 2020 to March 2021. PARTICIPANTS Sample of 114 nurses: 91 generalist, 20 specialists and 3 residents. MAIN MEASUREMENTS Sociodemographics, knowledge, implementation and opinion. RESULTS The response rate was 27.7%. As a general rule, 48.2% indicated that informed consent was collected verbally, as established by law, with differences being found between categories, this percentage being higher in specialists and residents (P=0.004), and within specialists in those who had obtained their speciality by internal resident nurse (IRN) (P<0.0001). In addition, specialists and residents were those who most identified the legal norm regulating informed consent (P<0.0001). In terms of implementation and opinion, all groups obtained similar results. DISCUSSION There are no previous studies that have analysed these aspects of informed consent comparing the different categories. Studies from other healthcare and geographical areas show that nurses have greater knowledge, although the demand for specific training in bioethics and biolaw is greater in the nurses participating in this study. CONCLUSIONS Nurses have adequate knowledge about informed consent, use it in clinical practice and have an appropriate conception of it, being higher in some items in specialist nurses IRN and in residents.
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Affiliation(s)
- Airam Cabrera-Rodríguez
- Programa de Doctorado Medicina Clínica y Salud Pública, Departamento de Enfermería, Universidad de Granada, Granada, España; Departamento de Enfermería y Nutrición, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, España; Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España.
| | - Milagros Rico-Blázquez
- Unidad de Investigación de la Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud RICAPPS (RICORS), España,Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, España,Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Emilio José Sanz-Álvarez
- Departamento de Medicina Física y Farmacología, Facultad de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, España,Hospital Universitario de Canarias, Servicio Canario de Salud, La Laguna (Santa Cruz de Tenerife), España
| | - Jacqueline Schmidt-RioValle
- Programa de Doctorado Medicina Clínica y Salud Pública, Departamento de Enfermería, Universidad de Granada, Granada, España,Grupo de Investigación CTS-436, Centro de Investigación Mente, Cerebro y Comportamiento CIMCYC, Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
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Verástegui E, Páez R, Arrieta O. Towards objectivity in ethical assessment: legibility as part of informed consent form comprehension. GAC MED MEX 2023; 159:426-431. [PMID: 38096850 DOI: 10.24875/gmm.m23000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The experience on informed consent form (ICF) readability at the Research Ethics Committee of the National Institute of Cancerology of Mexico (INCan) is described. OBJECTIVE To evaluate the readability of a randomly-selected sample of ICFs submitted for review between March 1, 2022 and March 31, 2023. The number of pages, the time the reader takes to read the text and the level of education necessary to understand it were determined. RESULTS More than half the ICFs from internal investigations were shown to be somewhat or very difficult to read; the level of education required to understand them was up to 9.9 years, and the reading time was short. The ICF texts from international multicenter investigations were aimed at an average education level of 5.5 years and had normal readability. Most ICFs from external trials require a reading time of more than 60 minutes per ICF. CONCLUSION It is necessary to have tools that provide objectivity to the evaluation of ICFs under investigation by ethics committees, which should be indicators of their comprehension, such as readability of the documents.
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Affiliation(s)
- Emma Verástegui
- Palliative Care Department, Instituto Nacional de Cancerología
| | - Ricardo Páez
- Bioethics Master's Degree and Doctorate Program, Universidad Nacional Autónoma de México
| | - Oscar Arrieta
- General Directorate, Instituto Nacional de Cancerología. Mexico City, Mexico
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Boceta R, Martínez-Casares O, Albert M. The informed consent in the mature minor: Understanding and decision-making capacity. An Pediatr (Barc) 2021; 95:413-422. [PMID: 34782293 DOI: 10.1016/j.anpede.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The informed consent of the minor is a fundamental requirement of paediatric research. There is a lack of harmonisation as regards the age of the mature minor to consent, and there are no systematic tools available to assess competence in decision-making capacity. The objective of this work is to analyse the ethical and legal situation of consent by minors, as well as studies that use an objective assessment tool in the mature minor. MATERIAL AND METHODS Systematic review of scientific articles in PubMed, Embase and the Grey Literature, published with keywords "informed consent minors", without date restriction until March 2019. Abstracts and a selection of complete articles were reviewed following a protocol including identification, screening, eligibility, and inclusion. RESULTS Of the 260 records identified, 139 were excluded. After categorising the resulting 121 publications, 13 were finally selected following the eligibility criteria, including 7 articles on international ethical and legal regulations and 6 on understanding and decision- making capacity assessment. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) semi-structured interview was used in 4 studies, including different age ranges (6-21 years) in healthy and sick children. CONCLUSIONS The semi-structured MacArthur interview adapted to adolescents could be an appropriate tool with robust psychometric measures for assessing competence for the informed consent of minors between 9 and 12 years of age. The regulation of informed consent in paediatric research should consider this evidence.
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Affiliation(s)
- Reyes Boceta
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Olga Martínez-Casares
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Marta Albert
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
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Valdez-Martínez E, Bedolla M. Informed consent: its importance for retrolective research and medical science progress. GAC MED MEX 2021; 157:90-93. [PMID: 34125817 DOI: 10.24875/gmm.20000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In retrolective research, the information necessary to answer the research question is directly generated from medical records and other clinical-documentary sources. This article analyzes the waiver of informed consent and privacy notice when research is retrolective, from which two lines of argument emerge: one is the physician's duty to protect patient dignity, integrity, right to self-determination and privacy, as well as the confidentiality of the information obtained from him; the other is retrolective research contribution to the control of diseases and society's health improvement. Waiver of informed consent or privacy notice documented in the medical record is important for retrolective research, but it has ethical implications for researchers who do not comply with the rationality and personal responsibility they have before society.
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Affiliation(s)
- Edith Valdez-Martínez
- Health Research National Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Bedolla
- Department of Education, Northwest Vista College of San Antonio, Texas, United States of America
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Fuente-Cortez BEDL, García-Vielma C. Readability analysis of informed consent forms for genetic tests in Mexico. GAC MED MEX 2021; 157:52-57. [PMID: 34125814 DOI: 10.24875/gmm.20000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knowing if the document that supports the informed consent (IC) granted by the patient who undergoes genetic laboratory tests is legible and understandable is important. OBJECTIVE To analyze the readability of IC documents for laboratory genetic tests (LGT) in Mexico. METHODS Readability of 10 free IC forms on the internet used for LGT was analyzed using the Legible.es program; the Flesh index, Fernández-Huerta version, and the INFLESZ scale were evaluated. The number of syllables, words, phrases, paragraphs and strange words, time to read the document and minimum years of education required to understand it were counted. RESULTS 60 % of the analyzed IC documents were found to have poor readability. On average, 3,290 syllables, 1,459 words, 124 sentences, 58 paragraphs and 52 strange words were counted. The time required for reading it was seven minutes and minimum level of education to understand it was six years. CONCLUSIONS The analyzed IC forms for LGT have low readability rates and exceed the recommended number of words. We propose an IC model for LGT in Mexico that complies with appropriate readability indexes for a correct understanding of the document.
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Affiliation(s)
| | - Catalina García-Vielma
- Department of Cytogenetics, Centro de Investigación Biomédica del Noreste, Instituto Mexicano del Seguro Social. Nuevo Léon, Mexico
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Arimany-Manso J, Pujol RM, García-Patos V, Saigí U, Martin-Fumadó C. Medicolegal Aspects of Teledermatology. Actas Dermosifiliogr (Engl Ed) 2020; 111:815-821. [PMID: 32910922 PMCID: PMC7476561 DOI: 10.1016/j.ad.2020.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/13/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022] Open
Abstract
Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice».
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Affiliation(s)
- J Arimany-Manso
- Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Unidad de Medicina Legal y Forense, Departamento de Salud Pública, Facultad de Medicina, Universidad de Barcelona, Barcelona, España; Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - R M Pujol
- Servicio de Dermatología, Hospital del Mar. Parc de Salut Mar, Institut Mar d'Investigació Mèdica, Universitat Autònoma de Barcelona, Barcelona, España
| | - V García-Patos
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - U Saigí
- Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España
| | - C Martin-Fumadó
- Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona (UAB), Barcelona, España; Departamento de Medicina, Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, España.
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Boceta R, Martínez-Casares O, Albert M. [The informed consent in the mature minor: Understanding and decision-making capacity]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30453-7. [PMID: 33272846 DOI: 10.1016/j.anpedi.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The informed consent of the minor is a fundamental requirement of paediatric research. There is a lack of harmonisation as regards the age of the mature minor to consent, and there are no systematic tools available to assess competence in decision-making capacity. The objective of this work is to analyse the ethical and legal situation of consent by minors, as well as studies that use an objective assessment tool in the mature minor. MATERIAL AND METHODS Systematic review of scientific articles in PubMed, Embase and the Grey Literature, published with keywords "informed consent minors", without date restriction until March 2019. Abstracts and a selection of complete articles were reviewed following a protocol including identification, screening, eligibility, and inclusion. RESULTS Of the 260 records identified, 139 were excluded. After categorising the resulting 121 publications, 13 were finally selected following the eligibility criteria, including 7 articles on international ethical and legal regulations and 6 on understanding and decision- making capacity assessment. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) semi-structured interview was used in 4 studies, including different age ranges (6-21 years) in healthy and sick children. CONCLUSIONS The semi-structured MacArthur interview adapted to adolescents could be an appropriate tool with robust psychometric measures for assessing competence for the informed consent of minors between 9 and 12 years of age. The regulation of informed consent in paediatric research should consider this evidence.
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Affiliation(s)
- Reyes Boceta
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, España.
| | - Olga Martínez-Casares
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, España
| | - Marta Albert
- Departamento de Epidemiologia y Salud Publica, Universidad Rey Juan Carlos, Móstoles, Madrid, España
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García Rivera E, San Norberto EM, Fidalgo Domingos L, Cenizo Revuelta N, Estévez Fernández I, Vaquero Puerta C. [Informed consents readability in vascular surgery and its progress over time]. J Healthc Qual Res 2020; 35:355-363. [PMID: 33121917 DOI: 10.1016/j.jhqr.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/07/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Doctors provide patients the information in written form by informed consents (IC), being the readability essential in the quality of care. The primary endpoint was to analyze the readability of IC published by the Chapter of Endovascular Surgery (CCEV) of the Spanish Society of Angiology and Vascular Surgery (SEACV) in 2019, and its evolution to those published by the SEACV in 2007. MATERIALS AND METHODS The ICs were organized by sectors and we obtained the following parameters: syllables, words, phrases, average words/phrases and syllables/words, Flesch, Flesch-Szigriszt, Fernández-Huerta and Gunning-Fog indexes, as well as the grade on the Inflesz scale. RESULTS The Flesch index classified the CCEV consents as very difficult, and the Gunning-Fog index reflected a readability equivalent to university texts. The Flesch-Szigriszt, Fernández-Huerta indexes and Inflesz scale classified them as normal. The ICs with less readability were those referring to supra-aortic trunks (SAT) and miscellaneous in the Fernández-Huerta (P<.020 and P<.05, respectively) and Flesch-Szigriszt (P<.05) indexes. However, ICs regarding venous pathology showed a better readability in this indexes (P<.006). CCEV consents were significantly longer than SEACV consents (P=.021). In addition, there was a decrease over time in the mean value of the Fernandez-Huerta and Flesch-Szigriszt indexes (P=.002). CONCLUSIONS Although CCEV consents had a normal readability, it has been observed a decrease in the readability indexes compared to those published in 2007 by the SEACV. In addition the length and content of the ICs should be reviewed, especially those relating to SAT and miscellaneous.
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Affiliation(s)
- E García Rivera
- Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - E M San Norberto
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | | | | | - C Vaquero Puerta
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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14
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Rodríguez Núñez A, Pérez Blanco A. [National recommendations on pediatric donation]. An Pediatr (Barc) 2020; 93:134.e1-134.e9. [PMID: 32620317 PMCID: PMC7326462 DOI: 10.1016/j.anpedi.2020.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/07/2022] Open
Abstract
A pesar de ser una referencia internacional en donación y trasplante, España precisa mejorar los procesos de donación en niños, en particular la donación tras la determinación de la muerte por criterios circulatorios (donación en asistolia). El presente artículo, resumen del documento de consenso elaborado por la Organización Nacional de Trasplantes y la Asociación Española de Pediatría, pretende facilitar los procesos de donación en niños y neonatos y analizar los conflictos éticos que plantea. Se comentan los fundamentos éticos de la donación pediátrica, los principios de la evaluación clínica de los posibles donantes, los criterios diagnósticos de muerte encefálica en niños, los cuidados intensivos para el mantenimiento de los donantes, los conceptos básicos de la donación en asistolia y los procesos de donación en neonatos con malformaciones muy graves del sistema nervioso incompatibles con la vida y en niños en cuidados paliativos. Considerar sistemáticamente la donación de órganos y tejidos cuando un niño fallece en condiciones de ser donante es un imperativo ético y ha de constituir un estándar profesional, tanto por la necesidad de órganos para trasplante, como por asegurar un cuidado integral centrado en la familia.
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Affiliation(s)
- Antonio Rodríguez Núñez
- Sección de Pediatría Crítica, Cuidados Intermedios y Paliativos Pediátricos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
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15
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Faura A, Izquierdo E, Escriche L, Nogué G, Videla S. [Informed consent for anaesthesia: Presential or non-presential information?]. J Healthc Qual Res 2019; 34:283-291. [PMID: 31761744 DOI: 10.1016/j.jhqr.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/29/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The anaesthesia informed consent (AIC) is a process of communication between a clinician and a patient that results in the patient agreeing to undergo a specific anaesthetic procedure after understanding all the information needed to make a free, voluntary and conscious decision. This information is traditionally given during a face-to-face pre-operative visit. OBJECTIVE To evaluate patient perceptions when they receive the information about AIC, face-to-face or by phone. PATIENTS AND METHODS A single centre, randomised, double-blind, parallel-group pilot clinical trial was conducted on patients > 18 years of age undergoing major ambulatory surgery procedures with a surgical complexity that did not require a face-to-face pre-operative visit. Patients were randomly assigned to be informed by telephone (experimental group) or in a face- to-face visit (control group). Fifteen days after the surgery a questionnaire was used to gather patient perceptions in understanding the anaesthetic procedure and risks, autonomy (to ask for explanations), as well as and satisfaction. RESULTS Of the 160 patients that gave their consent, 142 were interviewed: 70 from the experimental group and 72 from the control group. Both groups were comparable in age, gender, anaesthetic risk, and surgical complexity. The percentage of patients that understood the information provided on the anaesthetic technique was 71% and 81%, respectively (P=.429); on its risks: 67% and 69% (P=.951); autonomy: 56% and 74% (P=.036) and satisfaction rate: 46% and 46% (P=.835). CONCLUSION There is no difference between the groups in the level of understanding of the information that the patient perceives and the level of satisfaction. Nevertheless, almost half of them did not remember to have been given the possibility to clear-up doubts.
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Affiliation(s)
- A Faura
- Servicio de Anestesiología y Reanimación, Hospital de Viladecans, Viladecans, Barcelona, España.
| | - E Izquierdo
- Servicio de Anestesiología y Reanimación, Hospital de Viladecans, Viladecans, Barcelona, España
| | - L Escriche
- Departamento de Admisiones y Documentación Clínica. Hospital de Viladecans, Viladecans, Barcelona, España
| | - G Nogué
- Unidad de Gestión de Pacientes, Hospital de Viladecans, Universidad de Barcelona, Barcelona, España
| | - S Videla
- Unidad de Soporte a la Investigación Clínica, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL)/Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, España
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Del Río JC, Sastre Gervás I, Romero Yuste S. The Patient Information Sheet (PIS) and Informed Consent (IC) for case reports and case series: Proposal for a standard model for presentations in congresses and other scientific publications. ACTA ACUST UNITED AC 2018; 14:215-223. [PMID: 30075946 DOI: 10.1016/j.reuma.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
Abstract
A standard model of the Patient Information Sheet (PIS) and Informed Consent (IC) would facilitate compliance with the guaranteed rights of the patient when their health data is used in any form for purposes other than medical assistance, like the release of case reports and case series. This model would be suitable for the presentation of case reports in a congress in any form (verbal communication, poster or presentation), for its publication in a journal that does not require the completion of its own model, or even for teaching practice. A standard model of the PIS and IC would facilitate the application of the current regulations and good clinical practices in clinical research: it would guarantee the compliance of the professionals' duty of protection of the patient's privacy against the use of their health data for purposes other than medical assistance.
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Affiliation(s)
- Juana Cruz Del Río
- Comité Autonómico de Ética de la Investigación de Galicia, Santiago de Compostela, A Coruña, España; Comité Territorial de Ética de la Investigación de A Coruña-Ferrol, A Coruña, España; Secretaría Técnica Xeral da Consellería de Sanidade, Santiago de Compostela, A Coruña, España
| | - Isabel Sastre Gervás
- Comité Territorial de Ética de la Investigación de A Coruña-Ferrol, A Coruña, España; Unidad de Farmacia de Atención Primaria. Centro de Salud San José-A, A Coruña, España
| | - Susana Romero Yuste
- Comité Autonómico de Ética de la Investigación de Galicia, Santiago de Compostela, A Coruña, España; Servicio de Reumatología. Complexo Hospitalario Universitario de Pontevedra, Pontevedra, España.
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17
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Abstract
Research in critical care patients is an ethical obligation. The ethical conflicts of intensive care research arise from patient vulnerability, since during ICU admission these individuals sometimes lose all or part of their decision making capacity and autonomy. We therefore must dedicate effort to ensure that neither treatment (sedation or mechanical ventilation) nor the disease itself can affect the right to individual freedom of the participants in research, improving the conditions under which informed consent must be obtained. Fragility, understood as a decrease in the capacity to tolerate adverse effects derived from research must be taken into account in selecting the participants. Research should be relevant, not possible to carry out in non-critical patients, and a priori should offer potential benefits that outweigh the risks that must be known and assumable, based on principles of responsibility.
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Affiliation(s)
- A Estella
- Unidad de Gestión clínica de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, España.
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18
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Míguez Navarro C, Oikonomopoulou N, Lorente Romero J, Vázquez López P. [Preparation of sedation-analgesia procedures in spanish paediatric emergency departments: A descriptive study]. An Pediatr (Barc) 2017; 89:24-31. [PMID: 28750729 DOI: 10.1016/j.anpedi.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. MATERIAL AND METHODS A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. RESULTS A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P<.001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n=480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%). CONCLUSION The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines.
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Affiliation(s)
| | - Niki Oikonomopoulou
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Jorge Lorente Romero
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Paula Vázquez López
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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19
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Estévez-Guerra GJ, Fariña-López E, Penelo E. [Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)]. Gac Sanit 2016; 32:77-80. [PMID: 27914750 DOI: 10.1016/j.gaceta.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/18/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. METHODS A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. RESULTS 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). CONCLUSIONS Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results.
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Affiliation(s)
- Gabriel J Estévez-Guerra
- Departamento de Enfermería, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Emilio Fariña-López
- Departamento de Enfermería, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
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20
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Mellado JM. Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law. Radiologia 2016; 58:427-434. [PMID: 27554038 DOI: 10.1016/j.rx.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.
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Affiliation(s)
- J M Mellado
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España.
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21
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Mellado JM. Autonomy, consent and responsability. Part 1: limitations of the principle of autonomy as a foundation of informed consent. Radiologia 2016; 58:343-51. [PMID: 27523956 DOI: 10.1016/j.rx.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/04/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.
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Affiliation(s)
- J M Mellado
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España.
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22
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Giménez N, Pedrazas D, Redondo S, Quintana S. [Informed consent process in clinical trials: Insights of researchers, patients and general practitioners]. Aten Primaria 2016; 48:518-526. [PMID: 26777978 PMCID: PMC6877861 DOI: 10.1016/j.aprim.2015.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Adequate information for patients and respect for their autonomy are mandatory in research. This article examined insights of researchers, patients and general practitioners (GPs) on the informed consent process in clinical trials, and the role of the GP. DESIGN A cross-sectional study using three questionnaires, informed consent reviews, medical records, and hospital discharge reports. SETTING GPs, researchers and patients involved in clinical trials. PARTICIPANTS Included, 504 GPs, 108 researchers, and 71 patients. RESULTS Consulting the GP was recommended in 50% of the informed consents. Participation in clinical trials was shown in 33% of the medical records and 3% of the hospital discharge reports. GPs scored 3.54 points (on a 1-10 scale) on the assessment of the information received by the principal investigator. The readability of the informed consent sheet was rated 8.03 points by researchers, and the understanding was rated 7.68 points by patients. Patient satisfaction was positively associated with more time for reflection. CONCLUSIONS GPs were not satisfied with the information received on the participation of patients under their in clinical trials. Researchers were satisfied with the information they offered to patients, and were aware of the need to improve the information GPs received. Patients collaborated greatly towards biomedical research, expressed satisfaction with the overall process, and minimised the difficulties associated with participation.
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Affiliation(s)
- Nuria Giménez
- Unidad de Investigación, Fundación para la Investigación Mútua Terrassa, Universitat de Barcelona, Barcelona, España; Comité Ético de Investigación Clínica, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, España; Laboratorio de Toxicología, Universitat Autònoma de Barcelona, España.
| | - David Pedrazas
- Unidad de Investigación, Fundación para la Investigación Mútua Terrassa, Universitat de Barcelona, Barcelona, España; ABS Abrera, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Susana Redondo
- Comité Ético de Investigación Clínica, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, España; Servicio de Farmacia, Hospital Universitari Mútua Terrassa, Fundación para la Investigación Mútua Terrassa, Universitat de Barcelona, Barcelona, España
| | - Salvador Quintana
- Comité Ético de Investigación Clínica, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, España
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Cardoso-Cita Z, Perea-Pérez B, Albarrán-Juan ME, Labajo-González ME, López-Durán L, Marco-Martínez F, Santiago-Saéz A. [Analysis of judicial sentences issued against traumatologists between 1995 and 2011 as regards medical negligence]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:29-37. [PMID: 26345174 DOI: 10.1016/j.recot.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 07/10/2015] [Accepted: 07/18/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Traumatology and Orthopaedic Surgery is one of the specialities with most complaints due to its scope and complexity. The aim of this study is to determine the characteristics of the complaints made against medical specialists in Traumatology, taking into account those variables that might have an influence both on the presenting of the complaint as well as on the resolving of the process. MATERIAL AND METHODS An analysis was performed on 303 legal judgments (1995-2011) collected in the health legal judgements archive of the Madrid School of Medicine, which is linked to the Westlaw Aranzadi data base. RESULTS Civil jurisdiction was the most used. The specific processes with most complaints were bone-joint disorders followed by vascular-nerve problems and infections. The injury claimed against most was in the lower limb, particularly the knee. The most frequent general cause of complaint was surgical treatment error, followed by diagnostic error. There was lack of information in 14.9%. There was sentencing in 49.8% of the cases, with compensation mainly being less than 50,000 euros. CONCLUSIONS Traumatology and Orthopaedic Surgery is a speciality prone to complaints due to malpractice. The number of sentences against traumatologists is high, but compensations are usually less than 50,000 euros. The main reason for sentencing is surgical treatment error; thus being the basic surgical procedure and where precautions should be maximised. The judgements due to lack of information are high, with adequate doctor-patient communication being essential as well as the correct completion of the informed consent.
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Affiliation(s)
- Z Cardoso-Cita
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España.
| | - B Perea-Pérez
- Escuela de Medicina Legal, Universidad Complutense de Madrid, Madrid, España
| | - M E Albarrán-Juan
- Escuela de Medicina Legal, Universidad Complutense de Madrid, Madrid, España
| | - M E Labajo-González
- Escuela de Medicina Legal, Universidad Complutense de Madrid, Madrid, España
| | - L López-Durán
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - F Marco-Martínez
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - A Santiago-Saéz
- Escuela de Medicina Legal, Universidad Complutense de Madrid, Madrid, España; Servicio de Medicina Legal, Hospital Clínico San Carlos, Madrid, España
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Guadarrama-Orozco JH, Garduño Espinosa J, Vargas López G, Viesca Treviño C. [Informed consent and parental refusal for medical treatment in childhood. The threshold of medical and social tolerance. Part II]. Bol Med Hosp Infant Mex 2015; 72:284-289. [PMID: 29421149 DOI: 10.1016/j.bmhimx.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022] Open
Abstract
Medical care in pediatric patients is conditional to parental consent. Parents decide the time and type of treatment they want their children to receive when they are ill. The physician should request parental consent before carrying out the most appropriate therapy. When parents refuse the treatment offered, the physician should seek alternative therapies that may be better accepted by parents and find the most beneficial treatment for children and their families. If physicians and parents are unable to agree on the best therapeutic methods, then the physician becomes involved in an ethical conflict related to the best interests of the child and parental choices. From the above posture, the following questions arise: What should the physician do when faced with this situation? Should the physician use legal measures to force parents to accept treatment? Under what conditions is it justified to force parents and when should the decision be tolerated? What is the role of the Hospital Bioethics Committee concerning this issue? This second part focuses on proposing four practical criteria to be used by the physician and Hospital Bioethics Committee when all alternative therapies and conciliatory options have been exhausted with parents and they continue to refuse treatment. The physician then has to make a decision because the child is placed at risk of harm. This decision focuses on whether there is danger to the minor arising from the decisions of parents and if such harm is avoidable.
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Affiliation(s)
| | - Juan Garduño Espinosa
- Subdireccción de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Guillermo Vargas López
- Unidad de Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Carlos Viesca Treviño
- Departamento de Historia y Filosofía de la Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
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Sanguinetti JM, Lotero Polesel JC, Iriarte SM, Ledesma C, Canseco Fuentes SE, Caro LE. Informed consent in colonoscopy: A comparative analysis of 2 methods. Rev Gastroenterol Mex 2015; 80:144-9. [PMID: 26021940 DOI: 10.1016/j.rgmx.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The manner in which informed consent is obtained varies. The aim of this study is to evaluate the level of knowledge about colonoscopy and comparing 2 methods of obtaining informed consent. MATERIALS AND METHODS A comparative, cross-sectional, observational study was conducted on patients that underwent colonoscopy in a public hospital (Group A) and in a private hospital (Group B). Group A received information verbally from a physician, as well as in the form of printed material, and Group B only received printed material. A telephone survey was carried out one or 2 weeks later. RESULTS The study included a total of 176 subjects (group A [n=55] and group B [n=121]). As regards education level, 69.88% (n=123) of the patients had completed university education, 23.29% (n= 41) secondary level, 5.68% (n=10) primary level, and the remaining subjects (n=2) had not completed any level of education. All (100%) of the subjects knew the characteristics of the procedure, and 99.43% were aware of its benefits. A total of 97.7% received information about complications, 93.7% named some of them, and 25% (n=44) remembered major complications. All the subjects received, read, and signed the informed consent statement before the study. There were no differences between the groups with respect to knowledge of the characteristics and benefits of the procedure, or the receipt and reading of the consent form. Group B responded better in relation to complications (P=.0027) and group A had a better recollection of the major complications (P<.0001). Group A had a higher number of affirmative answers (P<.0001). CONCLUSIONS The combination of verbal and written information provides the patient with a more comprehensive level of knowledge about the procedure.
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Affiliation(s)
- J M Sanguinetti
- Instituto de Gastroenterología y Endoscopia Salta, Salta, Argentina; Universidad Nacional de Salta, Salta, Argentina.
| | - J C Lotero Polesel
- Instituto de Gastroenterología y Endoscopia Salta, Salta, Argentina; Hospital Militar Salta, Salta, Argentina
| | - S M Iriarte
- Hospital Militar Central, Buenos Aires, Argentina
| | - C Ledesma
- Hospital Militar Central, Buenos Aires, Argentina
| | | | - L E Caro
- GEDYT Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina
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Moraleda Barba S, Ballesta Rodríguez MI, Delgado Quero AL, Lietor Villajos N, Moreno Corredor A, Delgado Rodríguez M. [The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making]. Aten Primaria 2015; 47:149-57. [PMID: 25113922 PMCID: PMC6983826 DOI: 10.1016/j.aprim.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. DESIGN Observational study of prospective validation. SETTING Primary and hospital care of the basic health area of Jaen. PARTICIPANTS One hundred twenty-nine patients. MAIN MEASUREMENTS Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). RESULTS The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. CONCLUSIONS The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent.
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Affiliation(s)
- Sandra Moraleda Barba
- Medicina de Familia y Comunitaria, Centro de Salud Virgen de la Capilla, Jaén, España.
| | | | | | | | | | - Miguel Delgado Rodríguez
- Departamento de Epidemiología, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España
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Afolabi MO, Okebe JU, McGrath N, Larson HJ, Bojang K, Chandramohan D. Informed consent comprehension in African research settings. Trop Med Int Health 2014; 19:625-642. [PMID: 24636078 DOI: 10.1111/tmi.12288] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous reviews on participants' comprehension of informed consent information have focused on developed countries. Experience has shown that ethical standards developed on Western values may not be appropriate for African settings where research concepts are unfamiliar. We undertook this review to describe how informed consent comprehension is defined and measured in African research settings. METHODS We conducted a comprehensive search involving five electronic databases: Medline, Embase, Global Health, EthxWeb and Bioethics Literature Database (BELIT). We also examined African Index Medicus and Google Scholar for relevant publications on informed consent comprehension in clinical studies conducted in sub-Saharan Africa. 29 studies satisfied the inclusion criteria; meta-analysis was possible in 21 studies. We further conducted a direct comparison of participants' comprehension on domains of informed consent in all eligible studies. RESULTS Comprehension of key concepts of informed consent varies considerably from country to country and depends on the nature and complexity of the study. Meta-analysis showed that 47% of a total of 1633 participants across four studies demonstrated comprehension about randomisation (95% CI 13.9-80.9%). Similarly, 48% of 3946 participants in six studies had understanding about placebo (95% CI 19.0-77.5%), while only 30% of 753 participants in five studies understood the concept of therapeutic misconception (95% CI 4.6-66.7%). Measurement tools for informed consent comprehension were developed with little or no validation. Assessment of comprehension was carried out at variable times after disclosure of study information. No uniform definition of informed consent comprehension exists to form the basis for development of an appropriate tool to measure comprehension in African participants. CONCLUSIONS Comprehension of key concepts of informed consent is poor among study participants across Africa. There is a vital need to develop a uniform definition for informed consent comprehension in low literacy research settings in Africa. This will be an essential step towards developing appropriate tools that can adequately measure informed consent comprehension. This may consequently suggest adequate measures to improve the informed consent procedure.
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Affiliation(s)
- Muhammed O Afolabi
- Medical Research Council Unit, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Heidi J Larson
- London School of Hygiene and Tropical Medicine, London, UK
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Martínez-Diz S, Martínez Romero M, Fernández-Prada M, Cruz Piqueras M, Molina Ruano R, Fernández Sierra MA. [Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate]. An Pediatr (Barc) 2014; 80:370-8. [PMID: 24139560 DOI: 10.1016/j.anpedi.2013.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/17/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To examine the opinions, beliefs and attitudes about vaccination, of parents who decide not to vaccinate their children. To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination. METHOD Qualitative research based on semi-structured interviews and focal groups in Granada, Spain, including parents who chose to not vaccinate their children, and healthcare professionals who can provide a technical point of view. An analysis was made of the semantic content, and answers were categorized in thematic units. RESULTS The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way, without non-natural, aggressive or toxic products. Vaccination was considered unnecessary, if given adequate hygienic-sanitary conditions, effectiveness unproven and more dangerous than the diseases they prevent, especially the polyvalent vaccines. They believed that vaccination programs are moved by biased studies and interests other than prevention. Health care professionals believe that they had fears without scientific basis, which requires improving information systems. CONCLUSIONS Non-vaccinators are unaware of the benefit/risk ratio between the vaccination and the individual risk for preventable diseases, and ask for informed consent. Health care professionals believe that non-vaccinators' arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems. It was suggested to centralize registers and compare them in schools, working with local leaders and reporting regularly on the status of vaccine-preventable diseases.
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Guillén-Perales J, Luna-Maldonado A, Fernández-Prada M, Guillén-Solvas JF, Bueno-Cavanillas A. [Quality of information in the process of informed consent for anesthesia]. Cir Esp 2013; 91:595-601. [PMID: 24120209 DOI: 10.1016/j.ciresp.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/05/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the quality of the information that patients receive in the informed consent document signed prior to surgery. MATERIAL AND METHODS Cross-sectional study of a sample of cancer patients admitted for surgery at the University Hospital San Cecilio of Granada in 2011. After checking the inclusion criteria and obtaining their consent, demographic data were collected and procedure data, and a questionnaire «ad hoc» to assess the quality and comprehensiveness of the information provided in the informed consent. RESULTS 150 patients were studied. The majority (109 over 150) said they had received sufficient information, in appropriate language, and had the opportunity to ask questions, but only 44.7% correctly answered three or more issues related to anesthesia. University education level, knowledge of the intervention, information about the anesthesia problems and appropriate language were associated. CONCLUSIONS Although systematic informed consent was performed, half of the patients did not comprehend the anesthesia risks. Variables primarily related to the information received were associated with the quality of the response, but not with patient characteristics.
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Galán Gutiérrez JC, Galán Cortés JC. [Liability in Anaesthesiology: theory of disproportionate damage]. Rev Esp Anestesiol Reanim 2013; 60:457-464. [PMID: 23528691 DOI: 10.1016/j.redar.2013.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/26/2013] [Accepted: 01/31/2013] [Indexed: 06/02/2023]
Abstract
An analysis is made of the controversial application of the theory of disproportionate damage in the anaesthetic act, due to the high inherent risk, and regardless of the seriousness and importance of the surgery being performed. The existence of a disproportionate damage, that is, damage not foreseen nor accountable within the framework of the professional performance of the anaesthetist, does not by itself determine the existence of liability on the part of the anaesthetist, but the demand from the professionals themselves for a coherent explanation of the serious disagreement between the initial risk implied by their actions and the final consequence produced.
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Affiliation(s)
- J C Galán Gutiérrez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Oviedo, España
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Galán Gutiérrez JC, Galán Cortés JC. [Informed consent in anaesthesiology: period of notice as a requisite of validity]. ACTA ACUST UNITED AC 2013; 61:94-100. [PMID: 23809780 DOI: 10.1016/j.redar.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/23/2013] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
The analysis of one of the requisites of the validity of the informed consent, the notice period, during which the patient should be provided with information, so that he/she can reflect and fully exercise his/her Kantian right of self-determination. National legislation appears to be insufficient when dealing with this issue, which is compensated for in some regional legislations. We conclude by pointing the need to provide the patient with information with sufficient notice prior to operations, so that he/she can ponder over his/her decision.
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Affiliation(s)
- J C Galán Gutiérrez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Central de Asturias, Oviedo, España
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Quintero E, Alarcón-Fernández O, Jover R. [Colonoscopy quality control as a requirement of colorectal cancer screening]. Gastroenterol Hepatol 2013; 36:597-605. [PMID: 23769425 DOI: 10.1016/j.gastrohep.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 12/11/2022]
Abstract
The strategies used in population-based colorectal screening strategies culminate in colonoscopy and consequently the success of these programs largely depends on the quality of this diagnostic test. The main factors to consider when evaluating quality are scientific-technical quality, safety, patient satisfaction, and accessibility. Quality indicators allow variability among hospitals, endoscopy units and endoscopists to be determined and can identify those not achieving recommended standards. In Spain, the working group for colonoscopy quality of the Spanish Society of Gastroenterology and the Spanish Society of Gastrointestinal Endoscopy have recently drawn up a Clinical Practice Guideline that contains the available evidence on the quality of screening colonoscopy, as well as the basic requirements that must be met by endoscopy units and endoscopists carrying out this procedure. The implementation of training programs and screening colonoscopy quality controls are strongly recommended to guarantee the success of population-based colorectal cancer screening.
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Affiliation(s)
- Enrique Quintero
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España; Servicio de Aparato Digestivo, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, España.
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