Moral structuring of children during the process of obtaining informed consent in clinical and research settings

Background

Informed consent is an important factor in a child’s moral structure from which different types of doctor–patient relationships arise. Children’s autonomy is currently under discussion in terms of their decent treatment, beyond what doctors and researchers perceive. To describe the influential practices that exist among clinicians and researchers toward children with chronic diseases during the process of obtaining informed consent.

Methods

This was a cross-sectional, qualitative study via a subjective and interpretivist approach. The study was performed by conducting semi-structured interviews of 21 clinicians and researchers. Data analysis was performed using the SPSS version 21® and Atlas Ti version 7.0® programs.

Results

The deliberative and paternalistic models were influential practices in the physician–patient relationship. In the deliberative model, the child is expected to have a moral awareness of their care. The paternalistic model determined that submission was a way of structuring the child because he or she is considered to be a subject of extreme care.

Conclusions

The differentiated objectification [educational] process recognizes the internal and external elements of the child. Informed consent proved to be an appropriate means for strengthening moral and structuring the child.

Factors attributable to the cancellation of programmed surgeries

Objective

To analyze the factors attributable to the cancellation of surgeries of a third level health institution in the city of Valledupar, Cesar / Colombia (2017-2018).

Material and methods

Descriptive, retrospective, cross-sectional study. Data from the hospital surgical unit adverse case file were collected for 6 surgical specialties.

Results

They showed that in 2017 there was a surgical suspension of 4% of the total of scheduled surgeries that were (3339), for 2018 the rate was 3% with a total of scheduled surgeries (1733). The reason for the suspension for both periods was the factor related to the patient's adverse conditions with 45.9 and 38.5% respectively. The specialty most affected for these cases was the specialty of general surgery with the same percentage value in both periods of 4%.

Conclusion

The results give us an idea of the factors present for the cancellation of scheduled surgeries and the need to apply measures to guarantee patient safety.

Legal Implications for Actions Considered Iatrogenic: Knowledge and Practices of the Surgical Team, Valledupar, Cesar/Colombia

Introduction: The errors considered iatrogenic are caused by different causes that are mostly considered foreseeable, including inaccuracy, recklessness and ignorance, all these actions with ethical-legal repercussions. In Colombia, despite not having studies that position iatrogeny as one of the main causes of death. It is estimated that in Colombia 180,000 people die each year for this reason. Iatrogeny is described in the USA as the third leading cause of death. Objective: To evaluate the knowledge and aspects related to negligence, inexperience, recklessness, that the surgical team has in regard to its ethical-legal responsibilities. Methodology: Descriptive cross-sectional study. A total of 93 professionals were surveyed who are part of the surgical team of two health-care institutions in the department of Cesar, Colombia during 2019. Results: Surveyed professionals showed a 100% ignorance about the process to follow during an adverse event. It was identified that 32 % of the professionals and technicians surveyed do not have insurance to back them up legally. In addition, 31% said that errors such as negligence, recklessness and inexperience can occur in parallel with criminal and civil repercussions. The surgical team considers that the most frequent error are elements and instruments left in the cavity (oblites) in 64%. Conclusions: For surgical personnel, negligence is the error with the greatest penal repercussion if it is related to the death of the patient, surgery on the wrong patient and wrong side of the body, in addition to oblites or foreign bodies left in the cavity.

Perception of the Moral Development of the Child With Autoimmune Disease by Clinicians and Researchers

This article presents an analysis about meanings that clinicians and researchers have regarding the autonomy of the mature minor with autoimmune disease, which could lead to different power practices during the moment of taking the informed consent, keeping in mind the doctrine of the minor mature. Consequently, the role of clinicians and researchers in contributing to the moral development or autonomy of the child. The objective was to describe the meanings or perceptions of doctors and researchers, at the time of informed consent, in relation to the autonomy or moral development of the child with autoimmune disease, arising from their experiences, knowledge and prior conceptions of the child. The methodology used was of a qualitative nature with a subjectivist and interpretative approach and a transversal scope. Semi-structured interviews were applied to 21 people, researchers and doctors, who attend children with autoimmune diseases, whose data were analyzed through the Atlas Ti program. 8.0. In conclusion, the informed consent is a process of assertive communication ethical model that seeks the moral structuring of the child beyond what is perceived by the clinician or researcher, in addition the clinicians and researchers consider that to structure the minor is to perceive him as an autonomous subject; which is possible when it shows adherence to treatment and responsible care independently of the tutor's support.

Second Generation Antipsychotics (SGAs) in Schizophrenic Patients and Bipolar Disorder: Correlation With Metabolic Syndrome (NCEP ATP III(a))

INTRODUCTION: The Metabolic Syndrome is a set of diverse clinical situations such as diabetes mellitus, hypertension and dyslipidemia. Patients with mental illnesses such as schizophrenia or bipolar disorder have a higher mortality than the general population attributable in 60% to somatic diseases and metabolic syndrome, where second generation antipsychotics increase the risk of weight gain and insulin resistance. Objectives. Correlate the treatment with second generation antipsychotics (SGAs) as a possible predictor for Metabolic Syndrome according to the NCEP ATP III (a) classification. METHODS: Descriptive, cross-sectional correlational study. The sample was of 92 patients, applying an open and convenience sampling due to the mental state of the patients in order to determine their degree of acceptance to the study (Informed Assent) and consent to the legal guardian as the main inclusion criterion. For the analysis, the following variables were considered: blood pressure, weight, height, abdominal circumference, serum levels of triglycerides, glucose and high density lipoproteins. The SPSS 20.0 ® program was used logistic regression analysis with a p-value <0.05 and a confidence level of 95%. RESULTS: SGAs most used was clozapine (54.3%). The correlation analysis showed that sociodemographic aspects such as personal history, habits, physical activity and paraclinical and anthropometric records correlated with the possible diagnosis of metabolic syndrome (p <0.05), but not with SGAs (p> 0.05). ). CONCLUSION: No correlation was found between the presence of the metabolic syndrome and the type of antipsychotic treatment.

Family Characterization of a Population of the Municipality of Puerto Colombia, Atlántico/Colombia

INTRODUCTION: The family as a fundamental structure of society is exposed to different economic, social and health problems. Families in conditions of vulnerability become an element of protection but also of dominance and power; because they are born without being aware of their status or they even normalize their condition of extreme poverty, not to mention the exposure to natural hazards of their geographical area due to being in close proximity to the sea, which leads to people being grouped, creating problems of violence due to overcrowding, lack of formal employment, as well as lack of access to education or basic sanitation services. These groups are considered as social groups with limited resources. OBJECTIVE: To describe the family structure of the household head members and their main practices of managing with vulnerability states on topics as health, economic and educational in the inhabitants of the Vista Mar neighborhood in the Municipality of Puerto Colombia / Atlántico. METHODOLOGY: Descriptive cross-sectional study with a sample of 135 inhabitants grouped into 27 families. An observation form and a survey were applied to the person of family care or economic maintenance. RESULTS: The level of education of the head of household has very low academic training with ages ranging from 20 to 60 years with informal occupations in 39.37%. CONCLUSIONS: The woman is responsible for the care of the members of the family and the man financially supports the home. The families are formed by adults and young people with training at the primary, secondary and technical levels.

Prognostic Factors of Early Neonatal Sepsis in the City of Cartagena Colombia

INTRODUCTION: The obstetirc or noenatal risk factors, are in many cases the major evidence to define and forecast of an early neonatal sepsis, considering that a newborn that has lived less tan 72 hours presents unspecified clinical manifestations and the diagnostic exams utilize infectious and inflammatory markers, with there being very litttle scientific evidence to support and establish an early diagnosis. Objective: Associate the obstetric and neonatal risk factors with the presence of early sepsis in Cartagena. MATERIALS & METHODS: A retrospective study of cases and controls was conducted. The sample consisted of 183 cases and 366 controls, including pacients who met simultaneously inclusion and exclusion criteria. A bivariated analysis and a multivariated model of regression logistics were used. RESULTS: Among the associtated variables and early sepsis in which it was able to define the risk that is found when there is a premature membrane rupture > 18 hours (OR 9,57 IC 95% 4,12-22,26), premature newborn (OR 8,19 IC 95% 3,66-18,3), the presence of maternal fever (OR 6,49 IC 95% 3,43-12,3), marital status (OR 5,89 IC 95% 3,42-10,15) and level of education (OR 4,80 IC 95% 2,63-8,77). CONCLUSIONS: The mechanisms of fetal evaluation and maternal prophylaxis should be prioritized in the cases of pregnant women that present a premature membrane rupture >18 hours, and have kids who were born premature and living in couple with a low level of education.

Communication Process for the Strengthening of the Care of the Minor in a Pediatric Unit

INTRODUCTION: The reflection about the elements of communication that health professionals use strengthens the empathic relationship and therefore the actions that seek self-care in patients. Nursing schools must teach how to acquire competences from what should be (moral) to fully consider the emotions and needs of hospitalized children so that they can attend to the call of care. Nursing should tend to social and communication skills to offer a humanized care when children appeal to crying, to silence, to play, to attract attention. OBJECTIVE: Propose a framework of moral management of communication from the design of a functional communication structure model for the pediatric patient to come to the call of their care in a positive way. METHODOLOGY: Nature of qualitative study of descriptive type and symbolic interactionism (perceptual regression). The population was 44 nurses. The data was obtained by interviews analyzed by the STATGRAPHICS XVII Centurión Plus® and Atlas Ti 8.0 ® programs. CONCLUSION: The practices of nurses respond to the dynamics so that the child comes to the care when they are aware of the purpose of communication in strengthening the moral development of the child. A model of functional communication structure for pediatric patient care adjusted to the axioms of Paul Watzlawick is proposed.