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Maclean, Alasdair Rhuairidh. "Consent to medical treatment and the competent adult." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/5448/.
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In this thesis I analyse the concept of consent to medical treatment. I explore its ethical basis in autonomy and examine how other principles and ethical approaches might interact with the rules derived from autonomy. I then situate the relevant ethical obligations within the context f the healthcare professional-patient relationship which subsequently allows me to develop a textured model of consent. The model is predicated on the theory that consent is a secondary right, derivative on the underlying right which it controls. By giving or withholding consent, the autonomous person determines who may justifiably infringe the primary right. Importantly, however, the context of the professional-patent relationship highlights the relevance of consent, not just as permission, but also as agreement. I subsequently utilise the model of consent to analyse the current law, which is found to be deficient. I explore the conceptual difficulties of the split regulation between the torts of battery and negligence. I examine the current standard of disclosure and conclude that while it seems to be moving towards more autonomy respecting prudent patient standard, the courts may still be affording expert witnesses too much say in determining which risks should be disclosed. Most importantly I expose the thin and unsatisfactory conception of autonomy that appears to ground the current legal approach. Some of the common law’s deficiencies lie in tort law’s focus on the outcome rather than the process of the interaction between healthcare professional and the patient. There are three responses to these deficiencies. The common law could be allowed to continue its piecemeal development. The deficiencies of the common law could be patched up by developing professional regulation, or new legislation could be drafted to deal specifically with consent to medical treatment. If there is a genuine commitment to patient autonomy and patient centred care then I submit that legislation is justified.
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McLean, Sheila Ann Manson. "Information disclosure, consent to medical treatment and the law." Thesis, University of Glasgow, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298800.
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Fennel, Phil. "Treatment without consent : law, psychiatry and the treatment of mentally disordered people since 1845." Thesis, Cardiff University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297519.
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Devereux, John Anthony. "Competence to consent to medical treatment in England and Australia." Thesis, University of Oxford, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.358468.
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Cai, Yinghong. "The legal rights in informed consent form for treatment in China." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478730.
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Cai, Yinghong, and 蔡映紅. "The legal rights in informed consent form for treatment in China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724347.
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Bourne, Katie. "Determining capacity to consent in people with learning disabilities." Thesis, n.p, 2000. http://ethos.bl.uk/.
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Wik, Michaela. "Children´s consent to medical treatment : with emphasis on essential treatments and the procedural protection of children´s rights." Thesis, Stockholms universitet, Juridiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-109664.
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Zale, Andrew. "PARENTAL UNDERSTANDING OF ANESTHESIA RISK FOR DENTAL TREATMENT." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2697.
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Purpose: To determine which method of anesthesia risk presentation parents understand and prefer across their demographic variables Methods: As a cross-sectional study, questionnaires were distributed to 50 parents of patients (<7 years of age) in the VCU Pediatric Dental Clinic. Parents were asked of their own and their children’s demographics, previous dental and anesthesia experiences, and anesthesia understanding. Parents were then asked to rate the level of risk of several risk presentations and finally asked which method of risk presentation they most understood or preferred. Data analysis was performed using descriptive statistics, correlation coefficients, likelihood chi square tests, and repeated measures logistic regression. Results: There was no evidence of a differential preference due to gender (P = 0.28), age (P > .9), education (P = 0.39) or whether they incorrectly answered any risk question (P > 0.7). There was some evidence that the three types were not equally preferred (likelihood ratio chi- square = 5.31, df =2, P-value = 0.0703). The best estimate is that 60% prefer charts, 34% prefer numbers, and 36% prefer activity comparisons. There was a relationship between the average relative risk of general anesthesia and age (r = –0.38, P = 0.0070). Younger individuals indicate High risk more often and older individuals indicate Low risk more often. Conclusion: There was no preference of risk presentation type due to gender, age, or education, but there was evidence that each was not equally preferred. Healthcare providers must be able to present the risk of anesthesia in multiple ways to allow for full patient understanding.
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Kane, Ingrid. "Thrombolysis for acute ischaemic stroke : can brain imaging and consent processes before treatment be improved?" Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/24750.
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The general aim of my research was to work on streamlining and improving a few key areas in the care for patients with stroke, particularly those likely to be candidates for thrombolysis. I focussed on: optimising the imaging method for patient selection; assessing the availability of different imaging methods; and evaluating a range of options for obtaining consent for treatment or research in this setting. In the imaging work I discuss some aspects of the two major imaging modalities available to stroke patients – computerised tomography (CT) and magnetic resonance imaging (MRI) and the evidence available for the treatment of acute stroke with thrombolysis. I then explore the evidence lying behind the use of some of the advanced MR imaging modalities and how they may assist in the selection of patients for thrombolysis. Using a systematic review, I play particular attention to the evidence behind the MR perfusion diffusion mismatch theory and the interaction with thrombolysis. Having analysed the evidence available on ‘mismatch’ and thrombolysis I go on to compare the many techniques available for measuring the perfusion lesion and the problems that arise as a result of this. I move from the more complex details of specific MR techniques to the practicalities of imaging acute stroke patients with MR, dealing with a UK survey on the actual availability of MR scanners. Finally, I deal with patients who meet clinical and imaging criteria for thrombolysis who require consent. This is a stage that can cause huge delays, particularly with an acutely ill patient. The process of consent needs to begin imaging. It is a vital first step in thrombolysis because, without it, patients can not undergo the complex MR imaging techniques that are discussed in earlier chapters of the thesis.
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Taylor, Darlene Lois. "A tool to assess capacity to consent for treatment among homeless populations with problematic substance use." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/50670.
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BACKGROUND: Individuals who misuse substances and who are homeless or unstably housed (IMSH) are at risk of acquiring communicable diseases such as HIV, sexually transmitted infections and blood-borne infections and have greater medical needs than the general population. However, obtaining informed consent for health care can be challenging as many IMSH have impaired cognition due to the effects of substances. This dissertation describes the development and validation process used to create a psychometric instrument that measures capacity to consent for health care (CTC-HC) among IMSH.
METHODS: Forty-six qualitative interviews were conducted with 19 nurses who deliver care to IMSH and 27 IMSH to identify concepts that should be included in a capacity assessment instrument. A panel of experts reviewed possible items to obtain content and face validity. The instrument was administered to 302 IMSH. Construct and criterion validity were assessed by comparing the results of the new instrument to 1) a psychiatric assessment and 2) scores obtained from the MacArthur Competency Assessment Tool for Treatment. Item analysis was conducted to determine the reliability of the instrument and a confirmatory factor analysis was conducted. The areas under the receiver operating characteristic curves (ROC) were calculated to assess criterion validity. A diagnostic cut-off value was created using the corresponding points on the ROC.
RESULTS: The final Capacity Assessment Instrument for People who misuse Substances (CAIPS) consists of items that address understanding, voluntariness, orientation, ability to communicate, sustained attention, distorted reality, appreciation, reasoning, expression of choice, decision making demands, and physical indication of
substance use. These concepts were incorporated into an 11-item instrument that scores items on a four-point Likert scale. The CAIPS instrument demonstrated good internal reliability (Cronbach’s alpha: 0.861 – 0.893) and inter-observer reliability (weighted kappa statistic of 0.657). The factor analysis confirmed the unidimensionality assumption and the ROC analysis revealed that the CAIPS has a sensitivity of .75 - .81 and a specificity of .63 - .51.
CONCLUSIONS: CAIPS is a reliable tool with moderate validity and is the first validated capacity assessment instrument available for clinicians to assess CTC-HC among IMSH.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Purvis, Charlotte Amanda. "Women's experience of the consent process in a randomised controlled trial of emergency treatment for postpartum haemorrhage." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/109637/.
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This thesis has been written in the format of three papers: a systematic review, empirical study and a critical reflection. Paper 1 presents a systematic review and thematic synthesis which explores patients lived experience of consenting to research during a life-threatening emergency. Four studies met the inclusion criteria. Themes highlighted the importance of communication, the patient-professional relationship and decision-making paradigms in increasing patient’s confidence in emergency medicine research and their role in the consent process. Further implications for clinical and research practice are discussed. Paper 2 presents a qualitative study that aimed to explore women’s experiences and views on the acceptability of consenting to a randomised controlled trial for the treatment of postpartum haemorrhage. 14 women and their partners were interviewed. Framework analysis was used to interpret the data and four central themes emerged highlighting the influence of individual and systemic factors on women’s comfort with the overall consent process. Women’s views of the acceptability of consenting to research during a postpartum haemorrhage are contingent on both individual and systemic factors. An understanding of these factors can inform future research protocols but also clinical practice. Improvements to future obstetric consent strategies are discussed. Paper 3 presents a critical reflection on the process of conducting the thesis and therefore it is not intended for publication. The implications of the research for clinical practice and the relevance to and role of clinical psychology in research, emergency medicine and obstetric care are discussed. Reflections on personal and professional development are also discussed.
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Langlois, Andre. "Working alliance and its effects on treatment outcome." CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1862.
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Belfrage, Sara. "In the name of research : Essays on the ethical treatment of human research subjects." Doctoral thesis, KTH, Filosofi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-144035.
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Essay 1: Traffic research shares a fundamental dilemma with other areas of empirical research in which humans are potentially put at risk. Research is justified because it can improve safety in the long run. Nevertheless, people can be harmed in the research situation. Hence, we need to balance short-term risks against long-term safety improvements, much as in other areas of research with human subjects. In this paper we focus on ethical issues that arise when human beings are directly affected in the performance of research by examining how the ethical requirements in biomedical research can inform traffic research. After introducing the basic ethical requirements on biomedical research, each of the major requirements is discussed in relation to traffic research. We identify the main areas where biomedical research and traffic research differ, and where the ethical requirements from the former cannot easily be transferred to the latter. We then point to some of the issues that need to be addressed for a systematic approach to the ethics of traffic research. Essay 2: The requirement of always obtaining participants’ informed consent in research with human subjects cannot always be met, for a variety of reasons. In this paper, research situations where informed consent is unobtainable are described and categorised. Some of these kinds of situations, common in biomedicine and psychology, have been previously much discussed, whereas others, more prevalent in for example infrastructure research, introduce new perspectives. The advancement of new technology may lead to an increase in research of these kinds. The paper also provides a review of methods intended to compensate for a lack of consent and their applicability and usefulness for the different categories of situations are discussed, thereby providing insights into one important aspect of relevance for the question of permitting research without informed consent: how well that which informed consent is meant to safeguard can be achieved by other means. Essay 3: This paper starts with the assumption that it is morally problematic when people in need are offered money in exchange for research participation if the amount offered is unfair. Such offers are called “coercive”, and the degree of coerciveness is said to be determined by the offer’s potential to cause exploitation and its irresistibility. Depending on what view we take on the possibility to compensate for the sacrifices made by research participants, a wish to avoid “coercive offers” leads to policy recommendations concerning payment for participation. For sacrifices considered compensable we ought to offer either no payment or payment at a level deemed fair, while for sacrifices deemed incompensable we always ought to offer no payment. Essay 4: It is commonly thought that transactions that are the result of voluntary gift-giving do not constitute exploitation. This paper argues that exploitation is indeed possible in such situations, by showing how gift-giving can fulfil the two commonly proposed criteria for exploitation, namely that in an interaction between two persons one receives disproportionally little and the other disproportionally much of the resulting benefits, and that this disproportion is caused by the latter making inappropriate use of a disadvantage of the former. A theoretical approach to what such inappropriate use would amount to in cases of gift-giving is lacking. The paper therefore aims at spelling out such an approach. The method of reflective equilibrium inspires this endeavour, which proceeds by testing intuitions about examples that embody a set of possible conditions. It is concluded that three of the conditions are necessary for exploitation of gift-giving, namely (1) the giver incurs a loss, (2) the recipient has aimed for the gift, and (3) the gift is undeserved.QC 20140407
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Tomita, Kiyomi. "Informed consent and the right to refuse medical treatment : a comparative study of common-law Canada and Japan." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61156.
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Common law in Canada recognizes the rights to self-determination and autonomy and the right of competent persons to decide for themselves on medical treatment which includes the right to refuse all treatment. The legal profession has caused Japanese law to begin to recognize these basic rights, however professional and societal factors combine to accord the Japanese physician a wide discretion to determine what information to disclose, especially in the case of cancer. This thesis examines the similarities and differences existing between Canada and Japan in the controversial area of informed consent and the patient's right to refuse treatment and as well as the current attitudes within the legal and medical professions in Japan toward recognition and enforcement of these rights.
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Kennedy, Judith Ronelle Graduate Program in Professional Ethics School of Philosophy UNSW. "The treatment engagement model as a tool for identifying problematic doctor behaviour. Three case studies." Awarded by:University of New South Wales. Graduate Program in Professional Ethics, School of Philosophy, 2006. http://handle.unsw.edu.au/1959.4/28220.
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This thesis is an exploration of professional behaviour in health care settings, using a Model of Treatment Engagement that is developed as a tool for ethics critique. The Model is tested and refined using data on: a psychiatric ???treatment??? carried out on over 1,127 occasions in a 15 - 40 bed non-acute hospital during the period 1961-1979; the problematic withdrawal of all life-support from a 37 year old man who had suffered acute brain trauma some five days previously, in a tertiary hospital in March 2000; and a clinical experiment recently proposed for the emergency setting and intended to encompass five hospitals and the NSW Ambulance Service. In each case, the Model proves useful in identifying the shift from the treatment paradigm and the ethical imperative of ensuring the patient (or his/her agent) appreciates the difference between what is proposed and what would normally be done. It reveals how doctors who dealt with the patient but did not decide on treatment contributed to ethically troublesome practice. It clarifies how having multiple doctor players in the treatment situation gave rise to the need to suppress dissenting views. Doctors who were close enough to the action to comprehend its nature, by not dissenting, reinforced the problematic choice for the actor and validated it in the eyes of observers. The lack of dissent at the level of doctors working under supervision, appeared to be a function of institutional arrangements. At the consultant level, there was evidence of pressure to concur from other consultants and indirect evidence of a fear of ostracism. The public responses in the two modern cases point to there being a strong idea in Sydney???s medical community that dissent should not be publicly displayed once a decision on how to treat has been made. I conclude there are two steps to reviewing ethically problematic treatment situations. The first consists of identifying the shift from the treatment paradigm. The second consists of establishing why the problematic choice is translated into action. The Treatment Engagement Model is put forward as a useful tool for both these analyses.
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Fick, Sarah Johanna. "Consenting to objectifying treatment? Human dignity and individual freedom." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20286.
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Thesis (LLM)-- Stellenbosch University, 2012.ENGLISH ABSTRACT: The purpose of this study was to determine whether an individual can and/or should be allowed to consent to objectifying treatment. This necessitated the determination of the meaning of dignity, the meaning of freedom and the relationship between dignity and freedom. It was found that both the right not to be objectified and the right to consent to objectification could be found within human dignity. This is due to the broad definition of dignity in terms of which dignity has two, sometimes contradicting, components. One component safeguards autonomy and the right to choose, which supports consent to objectification, whereas the other promotes individual self-worth by prohibiting objectifying treatment. By investigating the meaning of freedom it was found that freedom as a constitutional value, and possibly also a free-standing constitutional right, could incorporate the right to consent to objectifying treatment. Three possible solutions to this tension between human dignity and freedom were identified and critically analysed. The first was that an individual cannot and should not be allowed to consent to objectification. This solution is primarily based on the notion that dignity is supreme to freedom and that freedom should yield to communitarian dignity. Furthermore, it is contended that consent to objectification is often invalid due to economic coercion and undue influence. The second possible solution was that, although an individual might not be able to validly consent to objectifying treatment, such consent should still be allowed under certain circumstances. The example of invalid consent due to economic coercion introduced in the previous solution was examined in relation to prostitution. The contention regarding this approach is that, since our government is unable to fulfil the socio-economic needs of those who consent due to economic coercion, such consent should be allowed and strictly regulated. The third possible approach was that circumstances do exist in which individuals can give valid consent to objectification and that in these circumstances they should be allowed to do so. In this solution the grounds of the first approach is criticised by contending, for example, that dignity is not supreme to freedom, that a plural society should allow these type of choices and that consent to objectification is already allowed in some instances. The results of this study were that, although there are situations in which genuine consent is not possible, it can be given under certain circumstances. An individual who cannot give genuine consent to objectification should not be allowed to do so, unless transitional measures dictate otherwise. However, an individual who is capable of giving valid consent to objectification should be allowed to do so. Finally, regardless of whether such consent is genuine or not, strict regulation thereof is required.
AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om vas te stel of 'n individu kan toestem en/of toegelaat behoort te word om toe te stem tot objektiverende behandeling. Dit genoodsaak dat die betekenis van menswaardigheid en vryheid, asook verhouding tussen hierdie twee begrippe vasgestel word. Daar is bevind dat beide die reg om nie te geobjektifeer te word nie en die reg om toe te stem tot objektivering gevind kan word binne die begrip van menswaardigheid. Hierdie is te danke aan die breë definisie van menswaardigheid in terme waarvan menswaardigheid uit twee, soms weersprekende, komponente bestaan. Een komponent beskerm outonomie en die reg om te kies, wat toestemming tot objektivering ondersteun, terwyl die ander komponent individuele waarde bevorder deurdat dit objektiverende behandeling verbied. Tydens die ondersoek aangaande die betekenis van vryheid is bevind dat vryheid as 'n grondwetlike waarde, en moontlik ook 'n vrystaande grondwetlike reg, die reg om toe te stem tot objektiverende behandeling kan inkorporeer. Drie moontlike oplossings vir hierdie spanning tussen menswaardigheid en vryheid is geïdentifiseer en krities ontleed. Die eerste is dat 'n individu nie kan toestem en ook nie toegelaat behoort te word om toe te stem tot objektivering nie. Hierdie oplossing is hoofsaaklik gebaseer op die veronderstelling dat vryheid onderworpe is aan menswaardigheid en dat individuele vryheid moet toegee tot die menswaardigheid van die gemeenskap. Verder word dit beweer dat toestemming tot objektivering dikwels ongeldig is as gevolg van die ekonomiese dwang en onbehoorlike beïnvloeding. Die tweede moontlike oplossing was dat, alhoewel 'n individu nie noodwendig instaat is om geldige toestemming tot objektiverende behandeling te verskaf nie, sodanige toestemming onder sekere omstandighede steeds toegelaat behoort te word. Die voorbeeld van ongeldig toestemming as gevolg van ekonomiese dwang wat in die vorige oplossing bekendgestel is, is ondersoek aan die hand van prostitusie. Die bewering ingevolge hierdie benadering is dat, aangesien ons regering is nie in staat is om die sosio-ekonomiese behoeftes van diegene wat toestem tot objektivering as gevolg van ekonomiese dwang te vervul nie, sodanige toestemming toegelaat en streng gereguleer behoort te word. Die derde moontlike benadering is dat daar wel omstandighede bestaan waar individue geldige toestemming kan gee tot objektivering en dat hulle in hierdie omstandighede toegelaat behoort te word om dit te gee. In terme van hierdie oplossing word die gronde waarop die eerste benadering gebaseer is gekritiseer, deur byvoorbeeld te argumenteer dat menswaardigheid nie verhewe is bo vryheid nie, dat in ons huidige diverse samelewing sulke soort keuses aanvaar behoort te word en dat toestemming tot objektivering reeds in sommige geval toegelaat word. Die resultate van hierdie studie was dat, alhoewel daar omstandighede bestaan waaronder geldige toestemming nie moontlik is nie, dit wel onder sekere omstandighede gegee kan word. 'n Individu wat nie daartoe instaat is om geldige toestemming tot objektivering te gee nie, behoort nie toegelaat word om dit te doen nie, tensy oorgangsmaatreëls anders bepaal. Waar 'n individu egter in staat is om geldige toestemming tot die objektivering te gee, behoort dit toegelaat word. Ten slotte is streng regulering van toestemming tot objektiverende behandeling nodig ongeag of sodanige toestemming geldig is of nie.
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Kelly, Katherine Patterson Ganong Lawrence H. "Stepping up, stepping back, being pushed, and stepping away the process of making treatment decisions for children with cancer by parents who no longer live together /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/6867.
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The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on April 1, 2010). Vita. Thesis advisor: Lawrence H. Ganong. "May 2008" Includes bibliographical references
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Lhermite, Astrid. "Éthique des soins aux personnes âgées : la capacité à consentir et traitement involontaire." Thesis, Toulouse 2, 2014. http://www.theses.fr/2014TOU20012/document.
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Notre recherche concerne l’éthique des soins prodigués aux personnes âgées institutionnalisées, spécialement les questions de la capacité à consentir et du traitement involontaire. Notre travail est basé sur la Théorie Fonctionnelle de l'Intégration de l'information de N.H. Anderson (1981). En ce qui concerne l'étude portant sur la capacité à consentir : 98 Hommes de la rue, 21 psychologues, 37 infirmières et 14 médecins ont jugé de la capacité de la personne âgée à faire des choix dans chacun des 50 scénarios proposés, résultants de la combinaison de trois facteurs: "type de Décision", "type de Trouble", et "Soutien social". Pour l'étude portant sur le traitement involontaire : 101 personnes du grand public, 20 psychologues, 20 infirmières et 10 médecins ont jugé de l'acceptabilité du traitement involontaire des 48 scénarios proposés, combinaison de quatre facteurs: "type de Trouble", "Décision du médecin", "Explications données au résident ", "état Cognitif". Les résultats montrent que pour les deux études, le grand public et les professionnels de santé ont intégré les facteurs de la même manière. Pour la première étude, le facteur « type de Trouble » a le plus de poids, suivi par le facteur « Soutien social ». Quatre groupes de répondants se distinguent par les poids qu'ils donnent aux différents facteurs. Concernant l'étude portant sur le traitement involontaire, le facteur le plus influent est « Explications», suivi par « Décision du médecin ». Trois groupes de répondants se distinguent en fonction des patterns de réponse. Les variables individuelles telles que l’âge, le sexe, le niveau d’éducation et l’expérience n’ont pas d’effet. L'évaluation de la capacité à consentir et l’acceptabilité du traitement involontaire sont influencées par les facteurs proposés et il apparaît qu’il existe des positions différentes face à ces questions éthiquesOur research deals with ethical questions in gerontology, especially the capacity to consent and involuntary treatment. Our research is based on the Integration Information Theory of N.H. Anderson (1981). 98 lay people, 21 psychologists, 37 nurses and 14 physicians judged a nursing home resident’s capacity to consent on 50 scenarios combining 3 factors : “type of Decision”, “type of Problem”, “social Support”. 101 lay people, 20 psychologists, 20 nurses and 10 physicians judged the acceptability of involuntary treatment on 48 scenarios combining 4 factors : “type of Disease”, “physician’s Decision”, “Explanations”, and “Cognitive status”. Results don’t show differences between lay people and health professionals in the way they integrate the factors presented. In the first study, the factor “type of Problem” is the most significant, followed by “social Support”. 4 groups of participants distinguish themselves by the way the weigh the factors. In the second study, the factor “Explanations” is the most significant, followed by “physician’s Decision”. 3 groups of participants distinguish themselves. Individual variables like age, gender, educational level or experience have no effect. Assessment of the capacity to consent and acceptability of involuntary are influenced by the factors presented and it appears that there are different positions among the participants
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Hatta, Taichi. "Crossover Mixed Analysis in a Convergent Mixed Methods Design Used to Investigate Clinical Dialogues About Cancer Treatment in the Japanese Context." Kyoto University, 2019. http://hdl.handle.net/2433/236596.
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Le, Du Nour. "Le consentement à l'acte médical des personnes vulnérables." Thesis, Paris Est, 2018. http://www.theses.fr/2018PESC0062.
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Le régime applicable au consentement à l’acte médical des personnes vulnérables que sont les mineurs et les majeurs sous protection juridique est un sujet délicat pour le législateur. Ce dernier doit instaurer une législation conciliant protection de l’intégrité physique du patient, et respect de son autonomie. Le droit positif échoue à trouver cet équilibre. Les mineurs sont privés de leur capacité d’exercice à toutes les étapes de leur vie, quel que soit leur âge ou leur degré de maturité. Elle réserve également un traitement disparate aux majeurs protégés. Leur autonomie variant selon la prise en compte ou non de leur régime de protection par le Code de la santé publique. À ces difficultés s’ajoute celle de l’existence de nombreux actes spécifiquement réglementés dont les règles ne sont pas toujours cohérentes ni compatibles avec les réalités de la pratique médicale. Une réflexion est menée sur les limites du régime actuel ainsi que sur l’élaboration d’une nouvelle législation plus respectueuse de l’autonomie des mineurs et des majeurs protégés. La possibilité de consentir à un acte médical dépendra non pas du statut juridique du patient, mais de son « aptitude à consentir », notion tirée des législations suisse et québécoise. Toutefois, la volonté de protéger l’autonomie du patient ne devant pas conduire à une mise en péril de son intégrité physique, un encadrement de sa capacité d’exercice sera instauré selon que le soin est ou non requis par son état de santéThe system of Consent to medical treatment for vulnerable persons – whether minors or adults without capacity – is a sensitive subject for legislator. The law has to combine protection of the patients’ physical integrity as well as the respect for their autonomy. The current state of law fails to achieve this purpose. Minors patients are deprived of their right to consent on their own, regardless of their age or level of maturity. Adults without capacity are treated in various ways depending on whether their legal protection is taken into account or not by the Public Health Code. An additional challenge is the existence of various medical acts that depend on specific regulations. Here we discuss the current limits of the law and propose a new system for the consent to medical treatment, which would be more respectful of the autonomy of minors patients or adults without capacity. Consent to medical treatment would depend on the ability to consent rather than on each patient’s legal status, such as stated in legislations from Switzerland or Quebec. However, the will to confer a larger autonomy should not put patient’s physical integrity at risk. Therefore, patients’ capacity for decision-making would depend whether the proposed care is required or not by their health state
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Teixeira, Ivan Lobato Prado. "Capacidade e consentimento na relação médico-paciente." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/2/2131/tde-07052010-085547/.
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Constitui objeto do presente trabalho o estudo da relação entre médico e paciente, com especial atenção ao problema da capacidade de que este último deve gozar quando instado a participar de atos e negócios que, referentes ao tratamento médico que lhe é proposto, possam repercutir sobre sua personalidade, especialmente considerada em seu aspectofísico. A fim de delimitar nossa pesquisa, consideraremos essa relação unicamente no âmbito dos tratamentos médicos que visem proporcionar ao paciente uma oportunidade de cura, isto é, de recondução ao estado anterior ao da doença, a qual constitui, por assim dizer, a causa final da relação entre médico e paciente. Portanto, não abordaremos, ao menos não profundamente, a relação havida entre o médico, enquanto pesquisador responsável por estudo ou ensaio clínico de novos medicamentos ou procedimentos, e o paciente, considerado sujeito de pesquisa. Tampouco trataremos da relação médico-paciente em sentido lato, assim consideradas as relações\' tipicamente de consumo, nas quais o paciente assume nitidamente a posição de contratante de serviços de saúde, geralmente prestados por hospitais ou clínicas das mais variadas especialidades médicas, entidades às quais perfeitamente se pode atribuir a definição de fornecedor de serviços, conforme o artigo 3° do Código de Defesa do Consumidor .Sem resumo.
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Cassidy, Aimee Kristine. "Resistance and perceptions of punitiveness as a function of voluntary and involuntary participation in domestic violence treatment programs." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1547.
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Mkosi, Barbara Nomsa. "Confidentiality as value in the management of HIV/AIDS in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51663.
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Thesis (M.Phil.)--Stellenbosch University, 2000.ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment.
AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.
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Le, Roux Rhonddie. ""Acts of disclosing" : an enthnographic investigation of HIV/AIDS disclosure grounded in the experiences of those living with HIV/AIDS accessing Paarl Hospice House seeking treatment." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16610.
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Thesis (MPhil)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Paarl, in the Western Cape, has been identified as one of the 15 national sites where antiretroviral treatment (ARVs) would be made available to people living with HIV/AIDS. Paarl Hospice initiated a support group for people to deal with this disease in 2003. Since February 2004 Paarl Hospice has been recruiting people from the surrounding informal settlements for ARVs. By means of participant observation I explored how HIV/AIDS-related disclosure experiences unfolded in places, spaces and events associated with the support group in the context of factors enabling and preventing people from accessing Hospice House. I did this by considering the insights drawn from an anthropological approach. I found the meanings of disclosure in the majority of studies to be limited and restricted. Available studies approached disclosure in a top-down fashion by regarding the definition of disclosure as the announcement of HIV-positivity at the time of diagnosis only. These studies have not considered social differences relating to disclosure neither did they focus on the actual process of disclosure. By means of a constructivist approach to grounded theory I seek to broaden the definition of disclosure to account for the range of ways in which disclosure practices take place. I found that disclosure could not be separated from the situational context in which it occurs and that it can only be understood in relation to the circumstances and relationships in which it takes place. In this study, disclosure was an ongoing process, situated somewhere between active, public announcement of an HIV-status and complete secrecy and somewhere between voluntary and involuntary revealing of the disease.
AFRIKAANSE OPSOMMING: Paarl in die Wes-Kaap is geïdentifiseer as een van die 15 nasionale areas waar antiretrovirale medikasie beskikbaar gestel sou word aan mense wat leef met MIV/VIGS. Paarl Hospice het gedurende 2003 ʼn ondersteuningsgroep geїnisieer om aan MIV/VIGS aandag te gee. Sedert Februarie 2004 is Paarl Hospice in die proses om mense te werf uit die omliggende informele behuisingsgebiede vir antiretrovirale behandeling. Met behulp van antropologiese insigte en deelnemende waarneming kon ek nagaan hoe verskillende maniere van MIV/VIGS-verwante bekendmaking ontvou in plekke, ruimtes en gebeurtenisse wat verband hou met die ondersteuningsgroep. MIV/VIGSverwante bekendmaking is ondersoek te midde van inhiberende en fasiliterende faktore wat mense verhoed of aanhelp om Paarl Hospice te besoek. Ek het bevind dat die definisie van bekendmaking in die meeste navorsing gebrekkig is. Beskikbare navorsing het bekendmaking volgens ‘n bo-na-onder-wyse benader as die openbare bekendmaking van ‘n MIV-status na afloop van diagnose alleenlik. Met behulp van ‘n konstruktiewe benadering van die begronde teorie het ek gepoog om die definisie van bekendmaking uit te bou om sodoende die verskeidenheid maniere waarop bekendmaking plaasvind te akkommodeer. Ek het vasgestel dat bekendmaking onlosmaakbaar deel is van die situasionele konteks waarin dit plaasvind en dat dit slegs begryp kan word in verband tot die verhoudings en omstandighede waarin dit plaasvind. In hierdie studie was bekendmaking ʼn voortdurende proses, gesitueer tussen aktiewe openbare bekendmaking en volledige geheimhouding van ʼn MIVstatus, asook tussen volkome vrywillige en onvrywillige bekendmaking van ʼn MIVstatus.
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Guénolé, Nicolas. "Conseil adaptatif et accompagnement des demandeurs d'emploi." Phd thesis, Conservatoire national des arts et metiers - CNAM, 2013. http://tel.archives-ouvertes.fr/tel-01062786.
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Nous orientons nos travaux vers l'analyse des effets d'une individualisation de l'accompagnement proposé auxdemandeurs d'emploi, en fonction de leurs problématiques vocationnelles. Il s'agit de considérerl'individualisation sous la forme d'un accompagnement adapté aux problématiques vocationnelles desindividus, en partant de l'idée que ceux-ci ne bénéficient pas tous au même niveau d'une prestation d'aide à larecherche d'emploi. Nous postulons ainsi qu'un accompagnement à la recherche d'emploi différenciépermettra de mieux prendre en considération les attentes et les besoins des bénéficiaires, et d'accroîtrel'efficacité de leurs démarches. Les actions proposées aux personnes seront en effet a priori plus pertinentes sielles sont mises en oeuvre en fonction de leurs problématiques personnelles et vocationnelles. Ainsi, nousavons travaillé dans une première partie de nos travaux de thèse à la présentation d'une typologie desproblématiques vocationnelles de demandeurs d'emploi. Un protocole évaluant le niveau de ressourcespsychologiques, de dépression, de soutien social, de sentiment d'efficacité personnelle, d'estime de soi,d'indécision et d'employabilité a été proposé à 323 participants. Les résultats obtenus mettent en évidence troiscatégories de problématiques vocationnelles, permettant d'engager une réflexion sur les modalités d'unaccompagnement différencié. Dans un second temps, nous avons étudié les attentes et les besoins desdemandeurs d'emploi en matière de dispositifs d'aide à l'insertion professionnelle. Adoptant un point de vuequalitatif, nous avons mis en évidence auprès d'un échantillon de 16 demandeurs d'emploi, leur répartition entrois axes distincts. Les dispositifs doivent ainsi permettre de retrouver rapidement un emploi, de maîtriser destechniques de recherche d'emploi, et de formaliser un projet professionnel pertinent vis-à-vis du marché del'emploi. Ces deux expérimentations nous ont permis, dans un dernier temps, d'étudier, à l'aide d'uneapproche "interaction caractéristique traitement", les effets d'un dispositif d'aide à la recherche d'emploidifférencié fondé sur la théorie du conseil adaptatif. Si cette étude montre les effets significatifs d'un dispositifd'insertion professionnelle vis-à-vis des problématiques vocationnelles des participants et de leur niveau dedynamisation, elle ne permet pas de mettre en évidence l'effet accru d'un conseil différencié. Les limites denos travaux, ainsi que leurs apports théoriques et pratiques sont discutés en conclusion, tout en ouvrant denouvelles perspectives de recherche.
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Ghevaert, Cedric. "Recombinant anti-bodies with a modified non-destructive constant region for the treatment of fetomaternal alloimmune thrombocytopenia." Thesis, Open University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489916.
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Alloimmunisation against paternal human platelet antigen (HPA) can result in fetomaternal alloimmune thrombocytopenia (FMAIT) and intracranial haemorrhage (ICH) in the fetus, both in the antenatal and perinatal period. Analysis of 200 confirmed cases of FMAIT, showed that HPA-1a antibodies accounted for 75% of all cases and ICHs, with long-term neurological disabilities in 72%. Clinical data showed that antenatal treatment of alloimmunised pregnancies with intrauterine transfusions (lUT) carried a 15% risk of intrauterine death (lUD) and that postnatal treatment with HPA-1a negative platelet was effective but not used consistently.
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Spino, Margie A. "The Effects of Two Schedules of Instruction with Constant Time Delay on the Receptive Word Learning Skills of Preschool Children with Developmental Delays." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1365122852.
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Zaidi, Syed Faraz Ali, and Juthatip Sudthanom. "To Analyze The Relationship between BOD, Nitrogen And Phosphorus Contents at Constant Dissolved Oxygen Concentration In Municipal Wastewater Treatment." Thesis, Mälardalens högskola, Akademin för hållbar samhälls- och teknikutveckling, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-12524.
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In this report, the application of Principle Component Analysis (PCA) and Partial Least Square (PLS) regression analyzing methods used to understand the relationship of interdependent loads in municipal wastewater treatment plant. Two different wastewater treatment plants were chosen for analysis of the relationship between interdependent loads. Firstly, the collected data of incoming wastewater and outgoing water from both Västerås and Eskilstuna wastewater treatment plants were analyzed to find some relationship or correlation between contents and compare the data of both the plants. Secondly, the correlated contents were used to generate the regression model for predicting the value in the future, in this report we have focussed only on ammonium nitrogen value for regression model. The PCA study shows the variation between incoming and outgoing wastewater’s characteristics given by Västerås and Eskilstuna plant.BOD, ammonium nitrogen, nitrogen, phosphorus
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Bulik, Karin Juliane Duvoisin. "As especificidades da cl?nica psicanal?tica com crian?as na neurose e na psicose: conseq??ncias para a dire??o do tratamento." Universidade Federal do Rio Grande do Norte, 2010. http://repositorio.ufrn.br:8080/jspui/handle/123456789/17453.
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This dissertation aims to answer the question: What are the specifics of psychoanalytical clinic with children in neurosis and psychosis and its consequences for the treatment direction? It constitutes a theoretical study based on Freud, Lacan and the current productions of Lacanian psychoanalysts about the clinic with children. It presents some clinical vignettes. To answer this question, were constructed four chapters. The chapter The subject constitution treats the psychoanalysis subjectivity, based on a structure from the relationship with the Other. Key concepts of Lacanian psychoanalysis are shown, necessary to understand what becomes present in clinic with children. The second chapter, The clinic of neurosis, reveals the structure of the subject in its oedipal mooring held by the Name-of the-Father, that separates the mother-child dual relationship. The child neurosis is the effect of psyche constitution and the symptoms are an interpretation of what child picks up from parents and helps him/her on the passage through the Oedipus. The analyst is there to help him/her through this path. The next chapter is entitled The clinic of psychosis. In psychosis the non-occurrence of the Name-of-the-Father is concerned. The subject is stuck in duality with the mother, and becomes what fills the Other s gap. To protect themselves, they have to be in incessant work. The analyst will be a child s partner in daily work already carried out by him/her. The last chapter, The consequences for the treatment direction, shows that the standard analytic treatment works well to the clinic of neurosis. To psychosis it s not true. Psychoanalysts thought about a different way of psychotic children treatment: the practice held in a multiprofessional team work. The practice shared by many has been a team strategy applied to the institutional practice that aims to attenuate the invasive character of the Other, facilitating the partnership between the analyst and the child in treatment and the Other contention
Este trabalho visa responder ? quest?o: Quais as especificidades da cl?nica psicanal?tica com crian?as na neurose e na psicose e suas conseq??ncias para a dire??o do tratamento? Constitui-se num estudo te?rico baseado em Freud, Lacan e nas produ??es atuais de psicanalistas lacanianos acerca da cl?nica com crian?as. Apresentam-se algumas vinhetas cl?nicas. Para responder tal quest?o, constru?ram-se quatro cap?tulos. O cap?tulo A constitui??o do sujeito trata da subjetiva??o para a psican?lise, pautada numa estrutura??o a partir da rela??o com o Outro. S?o evocados conceitos-chave da psican?lise lacaniana, necess?rios para compreender o que se presentifica na cl?nica com crian?as. O segundo cap?tulo, A cl?nica da neurose, revela a estrutura do sujeito em sua amarra??o ed?pica a partir do Nome-do-Pai, inst?ncia que separa a rela??o dual m?e-crian?a. A neurose infantil ? o efeito da constitui??o do aparelho ps?quico, sendo os sintomas uma tentativa de interpreta??o daquilo que a crian?a capta dos pais e que propicia o atravessamento do ?dipo. Ao analista caber? ajud?-la nesta travessia. O cap?tulo seguinte intitula-se A cl?nica da psicose. Na psicose o que est? em jogo ? a n?o efetiva??o do Nome-do-Pai. O sujeito fica colado na dualidade com a m?e, tornando-se aquilo que falta ao Outro materno. Para proteger-se, empreende um trabalho constante. O lugar do analista ser? de parceiro da crian?a neste trabalho di?rio que j? realiza. No ?ltimo cap?tulo, Conseq??ncias para a dire??o do tratamento, aborda-se o bom funcionamento do tratamento anal?tico padr?o no que diz respeito ? neurose. Para a psicose o mesmo n?o se evidencia. Psicanalistas debru?aram-se sobre um dispositivo diferente para tratamento das crian?as psic?ticas: o trabalho em institui??o multiprofissional. A pr?tica feita por v?rios tem sido uma estrat?gia de equipe aplicada ? pr?tica institucional que visa diluir o car?ter invasivo do Outro. Facilita, assim, a parceria do analista com a crian?a no tratamento e circunscri??o desse Outro
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Monteiro, Rodrigo Cesar de Moraes. "Viabilidade técnica do emprego de sistemas tipo \"wetlands\" para tratamento de água cinza visando o reúso não potável." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/3/3147/tde-09032009-110147/.
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A disparidade entre o crescimento populacional e a oferta de água potável apresenta grandes riscos de abastecimento em grandes centros urbanos. A utilização desse recurso em residências é diferenciada em uso potável e não potável. A utilização de água potável para finalidades menos nobres leva à escassez hídrica local em menor prazo, necessitando de busca de água cada vez mais longe, encarecendo o valor desse bem aos usuários. O uso não potável deveria ser suprido por fontes alternativas, como águas pluviais ou água de reúso. Em residências, muitas vezes o volume de água não potável é suprido pela produção de água cinza, necessitando de tratamento para que seu uso não ofereça riscos aos usuários. Sistemas de tratamento tipo wetlands podem ser uma alternativa economicamente viável em locais com disponibilidade de área, tendo como atrativos a independência de energia elétrica para o processo, ausência da necessidade de produtos químicos e forte apelo estético e ambiental. O presente trabalho visou avaliar a viabilidade técnica de sistemas tipo wetlands no tratamento de água cinza, determinando a remoção de material orgânico, a constante de remoção desse substrato, determinar as taxas de remoções de nitrogênio e fósforo e avaliar a eficiência na remoção de indicadores de contaminação fecal em um sistema tipo wetlands de fluxo subsuperficial horizontal cultivado em policultura. O sistema tipo wetlands apresentou remoção média de matéria orgânica próxima a 60% nos para os parâmetros DBO, DQO e COT, possibilitando: K20 DBO = 0,40; K20 DQO = 0,34; e K20 COT 0,30. As taxas de remoção de nutriente foram: 0,07g/m².d de fósforo total e 0,22g/m².d de nitrogênio kjeldahl total. A remoção média de indicadores de contaminação fecal foi de 56% para coliformes totais e uma média de 2,7x104 UFC/100mL e 94% para Escherichia coli com média de 4,6x101 UFC/100mL no efluente final. O efluente final do sistema tipo wetlands apresenta melhora na sua qualidade.The disparity between population growth and supply of drinking water presents major risks to supply in large urban centers. The use of this feature in homes is different in non-potable and potable use. The use of drinking water for less noble purposes leads to local water shortages in less time, requiring the search of water each time further, the value of this expensive and users. The non-potable use should be supplied by alternative sources such as rainwater or water reuse. In homes, many times the volume of non-potable water is supplied by production of greywater, requiring treatment for their use does not offer risks to users. Systems of treatment like \"wetlands\" may be an economically viable alternative in locations where the availability of area, with attractions such as the independence of electric energy to the process, no need for chemicals and strong aesthetic appeal and environmental. This study aimed to evaluate the technical feasibility of such systems \"wetlands\" in the treatment of gray water, determining the removal of organic material, the constant removal of the substrate, determining the rates of removal of nitrogen and phosphorus and evaluate the efficiency in the removal of indicators of fecal contamination in a system like \"wetlands\" of horizontal subsurface flow grown in polyculture. The system type \"wetlands\" showed average removal of organic matter close to 60% in for the parameters BOD, COD and TOC, allowing: DBO K20 = 0.40; K20 DQO = 0.34 and K20 TOC 0.30. The rates of removal of nutrients were: 0.07 g / m².d of total phosphorus, and 0.22 g / m².d of total Kjeldahl nitrogen. The average removal of indicators of fecal contamination was 56% for total coliforms and an average of 2.7x104CFU/100mL and 94% for Escherichia coli with an average of 4.6x101CFU/100mL in the final effluent. The effluent end of the system as \"wetlands\" has improved its quality.
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Promeyrat, Aurélie. "Analyse et modélisation des mécanismes à l'origine des modifications des protéines lors du chauffage du tissu musculaire." Thesis, Clermont-Ferrand 2, 2013. http://www.theses.fr/2013CLF22333.
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L'amélioration de la qualité nutritionnelle des produits carnés cuits nécessite une meilleure compréhension des changements physicochimiques des protéines induits au chauffage. Ce travail porte sur l'analyse des mécanismes à l'origine des changements d'état des protéines afin de développer un modèle stoechio-cinétique de prédiction de l'effet de la composition et de la température sur ces changements. Un modèle expérimental, représentant l'environnement physicochimique du tissu musculaire (pH et force ionique), a permis de quantifier l'incidence spécifique de la chaleur, de la composition en fibres, en oxydants (fer, peroxyde d'hydrogène et vitamine C) et en antioxydants (enzymatiques, vitaminique et peptidique) sur l'oxydation, la dénaturation thermique et l'agrégation des protéines. Le modèle stoechio-cinétique est constitué de 43 réactions, représentant l'ensemble des phénomènes mis en jeu dans le modèle expérimental : chimie de Fenton, attaques radicalaires des acides aminés et dénaturation thermique. La résolution du système d'équations différentielles permet de calculer les concentrations des composés au cours du chauffage ; 3 constantes de vitesse inconnues ont été ajustées à partir des cinétiques expérimentales. Les résultats expérimentaux montrent : (1) un effet synergique des oxydants et du chauffage sur les oxydations, (2) une incidence négligeable des oxydants sur la dénaturation thermique et l'agrégation, (3) une sensibilité accrue des protéines de fibres α-white aux oxydations et à la dénaturation thermique par rapport à celles de fibres β-red et (4) un important effet de la nature des oxydants et des antioxydants sur les taux d'oxydation. Les prédictions du modèle stoechio-cinétique permettent de reproduire les tendances expérimentales. En partant de cette base, les modèles expérimentaux et mathématiques pourront être complexifiés progressivement pour avoir un outil prédictif de la qualité nutritionnelle des viandes cuitesImproving the nutritional quality of cooked meat products needs a better understanding of protein physicochemical changes induced by heating. This study aims to analyse the mechanisms responsible to protein state changes, in the goal to develop a predictive stoichio-kinetic model of effect of composition and temperature on these changes. An experimental model which represent the physicochemical environment of meat tissue (pH and ionic strength) allowed to quantify the specific effect of heating, composition in fibres, in oxidants (iron, hydrogen peroxide and vitamin C) and in antioxidants (enzymes, vitamins and peptides) on oxidations, thermal denaturation (hydrophobicity) and aggregation of proteins. The stoichio-kinetic model is composed of 43 reactions which represent all phenomenon involved in the experimental model : Fenton chemistry, radical attack on amino acids and thermal denaturation. A system of differential equation solver allows to determine the concentration of compounds during heating ; 3 unknown rate constants were adjusted with experimental kinetics. Experimental results show : (1) a synergistic effect of oxidants and heating on protein oxidation, (2) a negligible impact of oxidants on thermal denaturation and aggregation (3) a significant higher sensitivity to oxidation and thermal denaturation of protein from α-white than those from β-red, (4) an important effect of the composition in oxidants and antioxidants on the protein oxidation levels. Stoichio-kinetic model predictions reproduce experimental tendencies. From this base, experimental and stoichio-kinetic models could be progressively complexified to obtain a predictive tool of nutritional quality of meat
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Yogi, Leda Shizuka. "Estudo comparativo entre métodos de avaliação funcional do ombro nas cirurgias de descompressão subacromial e capsuloplastia: avaliação de 60 pacientes com os métodos ASES, CONSTANT, ROWE, SF-36, SST e UCLA shoulder rating." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-30052007-152653/.
Full textAbstract:
Realizamos estudo prospectivo randomizado para comparar cinco métodos específicos de avaliação funcional do ombro e uma avaliação genérica da saúde em pacientes operados de capsuloplastia e descompressão subacromial associado à reparação do manguito rotador. Foram estudados 30 pacientes de cada grupo, avaliados no período entre cinco a seis meses após o tratamento cirúrgico com os questionários dos Cirurgiões Americanos de Ombro e Cotovelo(ASES), Sistema de Pontuação do Ombro de Constant & Murley (CONSTANT), Folha de Classificação da Reparação de Bankart (ROWE), Teste Simples de Ombro (SST), Escala de Avaliação do Ombro da Universidade de Califórnia - Los Angeles (UCLA) e o Questionário Genérico de Avaliação de Qualidade de Vida (SF-36). A idade no grupo de \"Descompressão\" variou de 44 a 77 anos (média 59,2) e no grupo de \"Capsuloplastia\" foi de 17 a 65 anos (média de 31,4). Em relação ao sexo, o grupo da \"Descompressão\" foi predominantemente feminino e no grupo da \"Capsuloplastia\" foi predominante o sexo masculino. As médias da pontuação no grupo de \"Capsuloplastia\" são maiores que no \"Descompressão\" (93,6 e 71,7 respectivamente). A variabilidade dos escores observado no grupo \"Capsuloplastia\" (89,1 a 100) é inferior ao do grupo \"Descompressão\" (65,1 a 95,9). Não existe uma forte concordância entre os resultados obtidos pelos diferentes questionários (variação de zero a 0,51). A média nos oito domínios do SF-36 no grupo \"Descompressão\" foi de 70,8 variando de 60,4 (Vitalidade) a 89,2 (Aspectos Sociais). Para o grupo \"Capsuloplastia\" a média foi de 91,2 variando de 83,4 (Saúde Mental) a 96,6 (Aspectos Emocionais). Nos coeficientes de correlação linear de Pearson, não foi detectada associação linear entre a escala de CONSTANT e SF-36 no grupo \"Descompressão\" e entre ROWE e SF-36 no grupo \"Capsuloplastia\". Em ambos os grupos a maior correlação encontrada foi entre os questionários UCLA e ASES (0,900 na \"Descompressão\" e 0,893 na \"Capsuloplastia\"). Concluiu-se que nas cirurgias de descompressão subacromial o questionário UCLA foi o mais completo mostrando maior confiabilidade e reprodutibilidade e para as capsuloplastias o método ROWE apresentou maior confiabilidade, reprodutibilidade e praticidade.A prospective randomized study was realized to compare methods of both disease specific and generic health status of shoulder\'s functional assessment in patients after operative treatment of subacromial decompression associated a repair of a tear of the rotator cuff and capsuloplasty. The thirty patients in each group were studied and at follow-up five to six months later, with the following questionnaires: American Shoulder and Elbow Surgeons Shoulder Evaluation Form (ASES), Constant-Murley Shoulder Scoring System (CONSTANT), Rating Sheet for Bankart Repair (ROWE), Simple Shoulder Test (SST), University of California at Los Angeles Shoulder Rating Scale (UCLA) and the Short Form-36 (SF-36). The age in Decompression group was greater than Capsuloplasty group and the gender of first group was predominantly consisted of women and in the second group was men. The scores averages of Capsuloplasty group were higher than Decompression group (93,6 and 71,7 respectively). The variability of the scores observed in the Capsuloplasty group, 89,1 to 100,0 was less than in the Decompression group, 65,1 to 95,9. A strong interrater reliability between the questionnaires does not exist - variation 0 to 0,51. The average in the eight domains of SF-36 in Decompression group was 70,8 [range 60,4 (Vitality) to 89,2 (Social Aspect)]. In Capsuloplasty group the average was 91,2 [range 83,4 (Mental Health) to 96,6 (Emotional Aspect) ]. Pearson\'s coefficient analysis, shows that the correlation between CONSTANT and SF-36 was not detect, and in Capsuloplasty was not detect in ROWE and SF-36. In both groups Capsuloplasty (0,893) and Decompression (0,900), a strong correlation between UCLA and ASES were observed. It follows that to subacromial decompression surgery, UCLA shows more reliability and in Capsuloplasty, the Rowe method shows more applicability.
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Chapman, P. D. "Application of diffusion laws to composting : theory, implications, and experimental testing : a thesis submitted in partial fulfilment of the requirements for the degree of Ph.D. [i.e. Doctor of Philosophy] at Lincoln University /." Diss., Lincoln University, 2008. http://hdl.handle.net/10182/819.
Full textAbstract:
Understanding the fundamentals of composting science from a pragmatic perspective of necessity involves mixtures of different sizes and types of particles in constantly changing environmental conditions, in particular temperature. The complexity of composting is affected by this environmental variation. With so much "noise" in the system, a question arises as to the need to understand the detail of this complexity as understanding any part of composting with more precision than this level of noise is not likely to result in greater understanding of the system. Yet some compost piles generate offensive odours while others don‟t and science should be able to explain this difference. A driver for this research was greater understanding of potential odour, which is assumed to arise from the anaerobic core of a composting particle. It follows that the size of this anaerobic core could be used as an indicator of odour potential. A first step in this understanding is the need to determine which parts of a composting particle are aerobic, from which the anaerobic proportion can be determined by difference. To this end, this thesis uses a finite volume method of analysis to determine the distribution of oxygen at sub-particle scales. Diffusion laws were used to determine the thickness of each finite volume. The resulting model, called micro-environment analysis, was applied to a composting particle to enable determination of onion ring type volumes of compost (called micro-environments) containing substrates (further subdivided into substrate fractions) whose concentrations could be determined to high precision by the application of first-order degradation kinetics to each of these finite volumes. Determination of the oxygen concentration at a micro-environment's inner boundary was achieved by using the Stępniewski equation. The Stępniewski model was derived originally for application to soil aeration and enables each micro-environment to have its own oxygen uptake rate and diffusion coefficient. This first version of micro-environment analysis was derived from the simpler solution to diffusion laws, based on the assumption of non-diffusible substrate. It was tested against three sets of experimental data with two different substrates: Particle size trials using dog sausage as substrate – where the peak composting rate was successfully predicted, as a function of particle size. Temperature trials using pig faeces and a range of particle sizes – the results showed the potential of micro-environment analysis to identify intriguing temperature effects, in particular, a different temperature effect (Q10) and fraction proportion was indicated for each substrate fraction. Smaller particle sizes, and possibly outward diffusion of substrate confounded a clear experimental signal. Diffusion into a pile trials which showed that the time course of particles deeper in the pile could be predicted by the physics of oxygen distribution. A fully computed prediction would need an added level of computational complexity in micro-environment analysis, arising from there being two intertwined phases, gas phase and substrate (particle) phase. Each phase needs its own micro-environment calculations which can not be done in isolation from each other. Unexplainable parts of the composting time course are likely to be partly explained by the outward diffusion of substrate towards the inward-moving oxygen front. Although the possibility of alternative electron acceptors can not be discounted as a partial explanation. To test the theory, a new experimental reactor was developed using calorimetry. With an absolute sensitivity of 0.132 J hr-1 L-1 and a measurement frequency of 30 minutes, the reactor was able to detect the energy required to humidify the input air, and "see" when composting begins to decline as oxygen is consumed. Optimisation of the aeration pumping frequency using the evidence from the data was strikingly apparent immediately after setting the optimum frequency. Micro-environment analysis provides a framework by which several physical effects can be incorporated into compost science.
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Jaume, Bennasar Andrés. "Las nuevas tecnologías en la administración de justicia. La validez y eficacia del documento electrónico en sede procesal." Doctoral thesis, Universitat de les Illes Balears, 2009. http://hdl.handle.net/10803/9415.
Full textAbstract:
La tesis se encarga de analizar, por un lado, la integración y el desarrollo de las nuevas tecnologías en la Administración de Justicia; y, por otro, los parámetros que constituyen la validez y eficacia del documento electrónico. La primera cuestión se centra en la configuración de los Sistemas de Información de la Oficina Judicial y del Ministerio Fiscal, así como de la informatización de los Registros Civiles, donde el art. 230 LOPJ es la pieza clave. Se estudian sus programas, aplicaciones, la videoconferencia, los ficheros judiciales y las redes de telecomunicaciones que poseen la cobertura de la firma electrónica reconocida, donde cobran gran relevancia los convenios de colaboración tecnológica. La digitalización de las vistas quizá sea una de las cuestiones con más trascendencia, teniendo en cuenta que el juicio es el acto que culmina el proceso. Aunque no todos los proyectos adoptados en el ámbito de la e.justicia se han desarrollado de forma integral, ni han llegado a la totalidad de los órganos judiciales. El objetivo final es lograr una Justicia más ágil y de calidad, a lo cual aspira el Plan Estratégico de Modernización de la Justicia 2009-2012 aprobado recientemente.
En referencia a la segunda perspectiva, no cabe duda que el Ordenamiento jurídico y los tribunales, en el ámbito de la justicia material, otorgan plena validez y eficacia al documento electrónico. Nuestra línea de investigación se justifica porque cada vez son más los procesos que incorporan soportes electrónicos de todo tipo, ya sea al plantearse la acción o posteriormente como medio de prueba (art. 299.2 LEC). Entre otros temas examinamos el documento informático, la problemática que rodea al fax, los sistemas de videograbación y el contrato electrónico.
La tesi s'encarrega d'analitzar, per una part, la integració i el desenvolupament de les noves tecnologies dins l´Administració de Justícia; i, per l'altra, els paràmetres que constitueixen la validesa i l'eficàcia del document electrònic.
La primera qüestió es centra en la configuració dels Sistemes d´Informació de l´Oficina Judicial i del Ministeri Fiscal, així com de la informatització dels Registres Civils, on l'art. 230 LOPJ es la peça clau. S'estudien els seus programes, aplicacions, la videoconferència, el fitxers judicials i les xarxes de telecomunicacions que tenen la cobertura de la firma electrònica reconeguda, on cobren gran rellevància els convenis de col·laboració tecnològica. La digitalització de les vistes tal vegada sigui una de les qüestions amb més transcendència, tenint amb compte que el judici es l'acte que culmina el procés. Però no tots el projectes adoptats en l'àmbit de la e.justicia s'han desenvolupat d'una manera integral ni han arribat a la totalitat dels òrgans judicials. L'objectiu final es assolir una Justícia més àgil i de qualitat, al que aspira el Pla Estratègic de Modernització de la Justícia 2009-2012 aprovat recentment.
En referència a la segona perspectiva, no hi ha dubte que l´Ordenament jurídic i els tribunals, en l'àmbit de la justícia material, donen plena validesa i eficàcia al document electrònic. La nostra línia d'investigació es justifica perquè cada vegada son més el processos que incorporen suports electrònics de tot tipus, ja sigui quant es planteja l'acció o posteriorment como a medi de prova (art. 299.2 LEC). Entre altres temes examinem el document informàtic, la problemàtica que envolta al fax, els sistemes de videogravació i el contracte electrònic.
The thesis seeks to analyse, on the one hand, the integration and development of the new technologies in the Administration of Justice; and, on the other, the parameters which constitute the validity and efficiency of the electronic document.
The first question centres on the configuration of the Information Systems of the Judicial Office and the Public Prosecutor, as well as the computerisation of the Civil Registers, where the art. 230 LOPJ it's the part key. Their programmes, applications, the Video Conferencing, the judicial registers and the telecommunication networks which are covered by the recognised electronic signatures, are studied, where the agreements on technological collaboration gain great relevance. The digitalisation of evidence might perhaps be one of the questions with most consequence, bearing in mind that the judgment is the act by which the process is culminated. Although not all the projects adopted within the compass of e.justice have developed completely nor have reached all the judicial organs. The final objective is to achieve an agile, quality Justice, to which the recently approved Strategic Plan for the Modernisation of Justice aspires.
With reference to the second perspective, there is no doubt that the juridical Ordinance and the tribunals within the compass of material justice grant full validity and efficacy to the electronic document. Our line of investigation is justified because there are more and more processes which are sustained by electronic supports of all kinds, whether it be at the establishment of the action or later, as a proof of it (art. 299.2 LEC). Amongst other things, we examine the computerised document, the problems which surround the fax, the systems for video recording and the electronic contract.
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Turrell, Sheri Lynn. "Capacity to consent to treatment in adolescents with anorexia nervosa." 2004. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=94692&T=F.
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Chen, Chun-Hung, and 陳駿宏. "The Application of Informed Consent Doctrine in Emergency Clinical Treatment." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/10815352321871460232.
Full textAbstract:
碩士逢甲大學
財經法律研究所
99
The basic theory of Informed Consent Doctrine, is the most important concept that doctor must explain the important medical information, such as patient’s condition, all kinds of therapy, cure rate, the complication or side effect which may take place and the result that if the patient refuses to accept any treatments. And after the doctor has done these above, the patient can consider and decide by himself what kind of the therapy he want to accept, and take the all risks which may be expected to come up. According to the documents of Informed Consent Doctrine, it is rarely to discuss about the problems that clinic diagnosis will happen, not to mention the related problems and advises of the medical process. Based on these reasons above, this thesis will apply the theory of Informed Consent Doctrine to emergency treatment, discover the issue of medical disputes, review the insufficient part of medical law in Taiwan, and provide a thinking direction to amend the medical law.
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Malý, Lukáš. "Informovaný souhlas, zejména trestněprávní aspekty." Master's thesis, 2012. http://www.nusl.cz/ntk/nusl-307109.
Full textAbstract:
Univerzita Karlova v Praze Právnická Fakulta Katedra trestního práva Centrum zdravotnického práva Lukáš Malý The Informed Consent, particularly the criminal aspects Thessis Short summary This thesis deals with a current problem of informed consent of a patient to a medical treatment, with a special regard to aspects of such consent pertaining to criminal law. Current healthcare in a vast majority of modern countries is based on the principle of informed consent. Following an introductory review of the history of the physician-patient relationship, the current legislation surrounding the informed consent is analyzed. These laws are undergoing major changes as this thesis is being finished, giving me the chance to describe both past and future legal regulation. I proceed to describe in detail when the informed consent is required, in what form must it be granted and what sort of medical information is needed to be given to the patient prior to his decision. To adequately weigh the aspects of criminal responsibility in relation to informed consent, the analysis of all possible forms of legal responsibility is performed, with some comparisons to relevant criminal regulation in other countries being made.
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WANG, YI-CHEN, and 王怡臻. "The Informed Consent And Off-Label Use In Human Subject Research Of Clinical Treatment." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/692rz2.
Full textAbstract:
碩士國立雲林科技大學
科技法律研究所
105
Medical progress requires constant innovation and research, thus thus Human Subject Research Ethics becomes very important recently. Obtaining informed consent is a basic ethical obligation and a legal requirement for researchers. Potential participants must be provided with information about the research project that is understandable and that permits them to make an informed and voluntary decision about whether or not to participate. The amount of information and the manner of presentation will vary depending on the complexity and risk involved in the research study. Informed consent is an ongoing educational interaction between the investigator and the research participant that continues throughout the study. This requirement is founded on the principle of respect for persons, one of the three ethical principles governing human subjects research described in the Nuremberg Code, the Declaration of Helsinki, the Belmont report. The principle of respect for persons requires that individuals be treated as autonomous agents and that the rights and welfare of persons with diminished autonomy be appropriately protected. In our study, we discuss substantive decisions as the research object, and collect judgments which are related to clinical Human Subject Research disputes related to the new therapy or therapy without proven indication (Off-Label Use) . The aim of our review, while helpful to physician practice groups and hospitals, makes clear the responsibility of physicians to obtain informed consent and to ensure that this is a conscious part of practice routine.
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Ling, Yi-hsuan, and 凌誼軒. "Research in the informed consent process in Taiwan and Germany for medical treatment differences." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/23145906790887144404.
Full textAbstract:
碩士國立高雄第一科技大學
資訊管理系企業電子化碩士班
103
The Concept Of The Global Village Is Increasingly Common, People Around The World To Travel, Work, And Study Opportunities For The Growing Number Of People, Perhaps Because Of Lack Of Acclimatization, Accident, And Then Derive Troubled And Medical Cultural Differences Abroad For Medical Treatment. When People Go Abroad For Medical Treatment Out, The Problem Is Most Frequently Encountered Language Barriers, And The Different National Conditions, Medical Treatment Process Is Not Quite The Same, Together With The Subsequent Payment Methods Are Slightly Different, Above Factors, There Are Likely To Reduce People Willingness To Go Abroad For Medical Treatment Out Of. This Case Study Is Based On Interviews With Fashion, Through Interviews To Hochschule Für Angewandte Wissenschaften Würzburg-Schweinfurt In Germany Of Three Exchange Students, And According To Informed Consent To Medical Treatment Process Into Six Steps (Symptom Description, Symptoms Confirmed, Examination, Diagnosis, Treatment, And Health Education), Were Compared To See The Doctor The Difference Between Taiwan And Germany. Which Found That Even Very Good English Skills Of Students, When A Doctor Will Still Face The Problem Of Language Barriers, And Do Not Understand The Way The Process To See The Doctor In Germany. And There Is No Relevant Information For Taiwan, Germany, Compared The Medical Treatment Process, Resulting In The Exchange Of Medical Students Still Need To Rely On German Students Assist. If Sustained Future Data Collection, Comparison Between The Medical Procedures Detailed Analysis Of Taiwan And Germany, The Department Of The Whole Presentation Will Summarize The Arguments Are Included In The System Development Considerations. And Began To Teach The English People For The Health Education Of Medical Terminology, Then People Will Be Able To Effectively Reduce The Problem Of Medical Treatment In A Foreign Land When Encountered.
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Du, Plessis Jonelle. "Operationalising the notion of sufficient maturity to provide informed consent when minors present for treatment." Thesis, 2011. http://hdl.handle.net/10413/7917.
Full textAbstract:
Laws in South Africa, such as the Children’s Amendment Act 41 of 2007(Government
Gazette, Act 38 of 2005), is developed with good intentions of promoting prevention and
intervention on various health-related issues. Laws also dictate, based on developmental and
evolving capabilities, chronological ages at which children and adolescents may access
certain healthcare services without parental consent, whilst limiting them in other areas such
as decision-making for research participation. Of interest to this study is how specialists in
health care, conceptualise, understand and apply “sufficient maturity” in their encounters
with minors presenting for treatment, in order to identify key concepts of sufficient maturity.
From the interviews conducted, themes were identified that were relevant to the construct of
“sufficient maturity.”Results indicated that there were two primary perspectives participants
used to assess “sufficient maturity” when minors presented for treatment.Health care
practitioners, depending on the health care context, assess minors’ sufficient maturity in
relation to, either a competency based or a deficiency model.Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.
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Rigg, Jeremy. "Performance under pressure: the impact of coercive authority upon consent to treatment for sex offenders." Thesis, 1998. http://hdl.handle.net/2429/9026.
Full textAbstract:
This thesis is concerned with the correctional treatment process for sex offenders, and the
problems that criminal justice system authority poses for treatment settings. A particular
focus is whether inmate participation in treatment programs is voluntary or coerced, given
the link between programs and prospects of release.
In examining this question, the author considers the results of an empirical project in
which a group of inmates were interviewed about their perceptions of the correctional
treatment process. Background to this project includes discussion of the doctrine of
informed consent and respect for autonomy as its underlying rationale; discussion of the
concepts of coercion and voluntariness; and examination of the development of
rehabilitative ideals. A conclusion drawn from the discussion is that the presence of
coercive authority may impact adversely upon correctional treatment efforts. Coercive
authority creates difficulties in relation to the voluntariness of inmates' consent, the
confidentiality of the treatment relationship, and the professional autonomy of the
clinician. These problems in turn raise questions as to whether correctional programs
retain the character of treatment, or are more properly considered as part of punishment,
or as tools of social control. However, coercive authority is a necessary presence if
correctional services are to work towards the goal of protection of society.
The central question to be addressed therefore is whether the prospects of release can be
used to motivate inmates for treatment in a way that is consistent with the requirement of
voluntary consent to treatment. The results of the empirical project suggest that for the
majority of inmates, the link between treatment and release is not coercive. However, a
number of inmates did indicate they felt coerced into treatment programs. Reforms may
thus be necessary to avoid coercive authority resulting in coerced treatment. In discussing
these results, the author considers a number of directions for reform, including the
introduction of an operational presumption of coerced referrals to treatment, which would
place greater emphasis on clinicians' obligations to secure voluntary consent.
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Fabris, Erick. "Identity, inmates, insight, capacity, consent, coercion: Chemical incarceration in psychiatric survivor experiences of community treatment orders." 2006. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=442159&T=F.
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Prociuk, Joan Louise. "The process of decision making for competency determination of the critically ill individual for consent to treatment." Thesis, 1994. http://hdl.handle.net/2429/5497.
Full textAbstract:
The purpose of this study was to investigate the process of decision
making that nurses use when determining whether critically ill individuals are
competent to consent to treatment. Grounded theory was employed as the
research approach to this qualitative study. Through the use of theoretical
sampling, data was collected from thirteen informants through audiotaped
interviews. The findings of the study reveal that nurses use a subconscious
process of decision making. Through the normal course of patient care,
nurses acquire considerable knowledge and understanding of their patients.
As nurses come to know their patients they make decisions about patient
competency. The process of decision making consists of four stages. In the
first stage, the nurse assimilates knowledge about the patient’s illness and
initiates the nurse-patient relationship. During the second stage, the nurse
comes to know the patient’s responses to their illness and to the environment.
In stage three, the nurse learns about the personal aspects of the patient.
Finally, in the fourth stage, the nurse integrates the knowledge gained from
the first three stages of the process, and tests the patient’s decision making
abilities. The completion of all four stages of the process places the nurse in
a position to make a clinical judgment about the patient’s competency.
However, for these informants, a determination of patient competence does not always ensure the patient’s involvement in decision making.
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Iyer, Monisha Gupta. "The costs and benefits of orthodontic treatment patients' values compared to professional judgments : a thesis submitted in partial fulfillment ... for the degree of Master of Science in Orthodontics ... /." 2003. http://catalog.hathitrust.org/api/volumes/oclc/68962637.html.
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Havlenová, Kateřina. "Informovaný souhlas pacienta." Master's thesis, 2020. http://www.nusl.cz/ntk/nusl-435423.
Full textAbstract:
The aim of this thesis is to describe and evaluate legislation concerning the informed consent in the Czech legal system and propose its changes de lege ferenda. The thesis also comprises many comparisons between the Czech legislation and the foreign legislation. The first five chapters of this thesis deal with sources of legislation, informed consent as such along with information of patients as a necessary prerequisite for giving of the consent, other topics are refusal of medical care by patients and the so called advance decisions. Apart from this theoretical part the thesis also includes a practical part. The aim of this practical part is to explore implementation of legislation concerning informed consent in the everyday practice of hospitals and subsequently to compare this practice with the requirements of law. This survey was carried out by means of questionnaires, which were submitted to doctors relating theirs experience with using of informed consents in their medical practice. The purpose of this practical part is also to find out the experience and opinions of recipients of medical services, i. e. the patients, concerning different issues connected with the informed consent, also by means of the questionnaire method. Last but not least the thesis mentions many problems which are...
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Maimela, Charles. "Legal issues relating to the treatment of persons living with cancer." Thesis, 2017. http://hdl.handle.net/10500/24490.
Full textAbstract:
Cancer is regarded as a global disease and one of the leading killer diseases in the
world. The reason why cancer is so widespread and often misunderstood stems from
multiple factors, namely, the lack of knowledge about cancer, unfair discrimination of
persons living with cancer, inadequate or inappropriate treatment provided to patients,
the stigma attached to cancer, misdiagnosis and late diagnosis of persons living with
cancer, as well as the inadequate provision of screening programs to detect cancer at
an early stage.
The combination of these issues raises alarming medico-legal problems that merit
further attention. The thesis will explore the origin, nature, philosophical and clinical
aspects pertaining to cancer, as well as legal issues related to cancer and oncology.
The study will conclude with recommendations aimed at mitigating and addressing the
shortcomings that exist in the medico-legal framework. The study will also draw on a
legal comparison of relevant South African, English and American laws and
regulations. Since this thesis entails focussing on medico-legal principles, the study
will draw on aspects of medical law, labour law, law of contract, law of delict,
constitutional law and criminal law.Private Law
LL. D.
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Pham, Bich Ngoc. "Informovaný souhlas pacienta - srovnání české a anglické právní úpravy." Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-340569.
Full textAbstract:
Informed consent is a basic institution of health services. This work aims at comparison of the basic components of informed consent in the Czech and English law. The beginning is dedicated to the development and the current relationship between patient and doctor. The traditional paternalistic approach that was prevailing until recently in the health care will be examined more in detail. Furthermore, the work deals with the concept of informed consent as such. The components of the informed consent will be specified as well as the form of the informed consent. Disclosure of the risks and other information must precede for the informed consent to be valid and the consent also have to meet the requirements of legal actions. Text will also focus on informed consent of the minors. Finally, an advance decision will be examined including its conditions of validity. Powered by TCPDF (www.tcpdf.org)
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Maciver, Elizabeth J. "Deciding about Heart Transplantation or Mechanical Support: An Empirical Study and Ethical Analysis." Thesis, 2012. http://hdl.handle.net/1807/34793.
Full textAbstract:
Purpose: Patients living with advanced heart failure experience dyspnea, fatigue, poor quality of life, depression and cognitive impairment which may threaten their ability to provide informed consent to undergo heart transplant (HTx) or mechanical support (LVAD). Using qualitative and quantitative methods, we asked how patients with advanced heart failure make decisions regarding HTx and LVAD. The variables chosen to reflect the elements of consent included quality of life and symptom severity (voluntariness), depression and cognitive impairment (capacity) and treatment preferences (decision-making).
Methods: 76 patients enrolled in the quantitative arm completed the Minnesota Living with Heart Failure Questionnaire; Visual Analog scales for dyspnea, fatigue and overall health; Beck Depression Inventory; Montreal Cognitive Assessment; Standard Gamble and Time Tradeoff. Qualitative methods were used to discover concepts, relationships and decision-making processes described by 17 of the 76 patients considering HTx and LVAD.
Results: Patients reported poor quality of life and high symptom severity scores which compelled them to consider surgery as a way to relieve unpleasant symptoms and improve quality of life. Although 30% of patients had evidence of depression and/or cognitive impairment, no patient was deemed incapable of decision-making. Patients were willing to take considerable risk (35%) and trade considerable time (4months) to improve their health. While heart failure-related concepts were important to the decision, entrustment emerged as the meaningful process for decision-making.
Conclusions: Patients who participated in this study were capable of decision-making and understood the risks associated with the surgery. Voluntariness was diminished by disease but not absent, and decisions were free of coercion. These results suggest the entrustment model of decision-making is the dominant process for patients considering high-risk surgical procedures and meets criteria for informed consent. Understanding the process of decision-making will help clinicians support and enable treatment decisions made by patients living with advanced heart failure.
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Alves, Raquel Ferreira Pedrosa. "Has end-of-life decisions or advance directives become an economic strategy to contain health care cost as much as a way to respect patient´s informed consent and private autonomy rights? : what can we learn from the american advance care model?" Master's thesis, 2018. http://hdl.handle.net/10400.14/27119.
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