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...

Distribution and payment of profit in joint stock company and advance payment Abstract Although the theme of this diploma thesis may seem traditional, its topicality results from the ongoing expert debate of legal doctrine and the recent legislative activity, resulting into the adoption of Act No. 33/2020 Coll. that will change the legal environment in which the distribution, payment of profits and advances on it occur. This thesis aims to map selected problematic issues and to analyze them, considering expert opinions of legal doctrine, domestic jurisprudence and to some extent as well the foreign legal regulation. To achieve this goal, the legislation on which ground problematic questions arise is also considered. This thesis is divided into five chapters, the last three of which can be described as crucial. The first chapter lays out the conceptual definition of profit, dividends, and royalties, as well as the comparison between the right to profit and the right to a share in profit while not leaving aside equity and other own resources. The following chapter deals with the different types of profit-related shares in relation to their classification as preferred shares, shares with a different share of profit, a fixed share or shares with a subordinate share of profit. This chapter also comments on...

Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.

Background: Home health is the fastest-growing healthcare setting in the country. Through Home Health Value-Based Purchasing (HHVBP), the Center for Medicare and Medicaid Services (CMS) provides incentives or penalties to HHAs based on outcomes. Hospitalization and emergency department use are weighted heaviest as poor outcomes. HHVBP requires HHAs to report on whether they are engaging in advance care planning (ACP) conversations. For this study, ACP was defined as a conversation held in advance of a medical crisis with a loved one and/or a health care provider about goals; values; preferences for future medical treatments; and choice of a surrogate decision-maker. Purpose: to determine whether the proportion of Black patients was correlated with robustness of HHAs’ ACP protocols and levels of acute care services use. Methods: A cross-sectional, quasi-interventional design was used. The sample size was n = 89. Electronic surveys about ACP protocols were distributed to HHAs. Existing data about demographics and acute care services use were accessed via CMS websites. Spearman’s correlation coefficient was used. Results: No relationship was found between robustness of ACP protocols and the proportion of Black population per agency. No relationship was found between overall acute care services use rates proportion of Black patients. However, a trend was found: The greater proportion of Black patients, the greater the tendency for an agency to have a higher hospitalization rate. Discussion: Results are compared to current literature and to a CMS-commissioned study’s discussion about the potential for value-based purchasing programs to exacerbate health disparities in vulnerable populations.

Background: Advance directives allow patients to put in writing the type of health care they want if they are unable to make decisions due to their medical condition. Purpose: The purpose of this study was to determine if there were differences in senior nursing students’ knowledge, attitudes, and confidence based on when the information is positioned in the curriculum. Theoretical: Social cognitive learning theory and Zimmerman’s self-regulation model provided the theoretical framework. Methods: This study reflected a non-experimental, exploratory design, with a convenience sample of senior nursing students from 2 different nursing programs in central Illinois. One program offers advance directive education in the first year and the other program offers the information in the second year. A total of 131 students participated in the study that used subscales of the Knowledge, Attitudinal, Experiential Survey on Advance Directives. Results: The group that received the information the second year rated themselves as having more confidence with advance directives. However, both groups scored low in the area of knowledge of advance directives, the Patient Self-Determination Act, and Illinois law. Students who reported higher knowledge levels had higher attitudes about end-of-life care. There was no difference in attitudes between the two groups. Conclusion: The results of this study highlight the need to review nursing curricula specifically relating to end-of-life care content and its placement in the curriculum.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23385号 / 人健博第92号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 田村 恵子, 教授 稲富 宏之, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(人間･環境学) / 甲第20722号 / 人博第831号 / 新制||人||199(附属図書館) / 29||人博||831(吉田南総合図書館) / 京都大学大学院人間・環境学研究科共生人間学専攻 / (主査)教授 田地野 彰, 教授 桂山 康司, 准教授 金丸 敏幸, 教授 植松 茂男 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

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Bakgrund: Olika typer av krisplaner, psykiatriska förhandsdirektiv, har använts som ett verktyg för att hjälpa patienter att kommunicera sina behov och önskemål under psykisk kris när de inte förmår göra det själva. Sedan 1980-talet har de psykiatriska förhandsdirektiven använts för att öka patientsäkerheten, personcentrering, minska vårdkonsumtion inklusive ofrivillig behandling. Syfte: Syftet var att beskriva patientens erfarenheter av krisplanering i den psykiatriska vården. Metod: En kvalitativ litteraturöversikt med systematisk ansats. Femton artiklar med kvalitativ eller mixad metod valdes ut och analyserades utifrån Thomas och Hardens metod för tematisk syntes. Resultat: Patienters upplevelse av krisplanering redovisas i sex analytiska teman; stärkt vårdrelation, autonomi och empowerment, en väg till självinsikt, trygghet och säkerhet, involvering av närstående samt svårigheter i samband med krisplanering. Det framkom att patienternas upplevelser var starkt färgade av personalens bemötande. Tidigare erfarenheter var avgörande för patientens förmåga att ingå ett samarbete med personalen i syfte att arbeta proaktivt och förhindra negativa konsekvenser av återfall. Slutsats: Krisplanens skyddande och förebyggande funktion var till nytta för såväl patienter som närstående och personal. Patienter upplevde krisplaneringen som ett verktyg för att stärka vårdrelation samt att genom ökad delaktighet utöka autonomi och empowerment. Processen utvecklade patientens kunskap om sin sårbarhet, sina förmågor och självinsikt. Det är viktigt att vara medveten om att vårdpersonalen har en stor inverkan på patienters upplevelse av krisplaneringen. / Background: Various types of crisis plans, psychiatric advance directives, have been used as a tool to help patients communicate their needs and wishes during psychological crises when they are unable to do so themselves. Since the 1980s, psychiatric advance directives have been used to increase patient safety, person-centeredness, reduce care consumption including involuntary treatment. Aim: The purpose was to describe patients’ experiences of the crisis planning in psychiatric care. Method: A qualitative literature review with a systematic approach. Fifteen articles with a qualitative or mixed method were selected and analyzed based on Thomas and Harden's method for thematic synthesis. Results: Patients' experience of crisis planning is reported in six analytical themes; strengthened care relationship, autonomy and empowerment, a path to self-awareness, safety and security, involvement of relatives and difficulties in crisis planning. It emerged that the patients' experiences were strongly colored by the treatment of the staff. Previous experiences were decisive for the patient's ability to enter into a collaboration with the staff in order to work proactively and prevent negative consequences of relapse. Conclusion: The crisis plan's protective and preventive function was beneficial for patients as well as relatives and staff. Patients experienced the crisis planning as a tool to strengthen the care relationship and to increase autonomy and empowerment through increased participation. The process developed the patient's knowledge of their vulnerability, abilities and self-awareness. It is important to be aware that the staff had a large impact on the patients' experience of crisis planning.