Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Civil liability for bodily injury in the provision of health services. The purpose of the present thesis is to analyse the issue of civil liability for bodily injury in the provision of health services. This issue is very topical, especially due to the adoption of new private law, which is presented in this work. The new legislation is evaluated and the problems that have occurred or might occur are defined. In addition the legislation of important institutes is compared with previous regulation. The thesis is composed of eight chapters, each of them dealing with different aspects of civil liability. Chapter one defines basic terminology used in the thesis. The next chapter presents the sources of law. Attention is paid to complex relationship between the Civil Code and the Law on Health Services, and also to a new type of contracts established by the Civil Code - agreement on health care. Chapter three mentions the basic relationship of medical law - the relationship between a doctor and a patient, including the reasons for its creation. The transformation from a paternalistic model to a partnership model is also highlighted. Chapters four and five are concerned with civil liability. At first the liability is defined in general, and subsequently individual facts relating to the provision of health...

The concept of assisted reproduction is widely discussed by both professional and lay public. New scientific discoveries in the fields of biology and medicine as well as the use of methods and procedures that enable the emergence of new life raise number of issues, not only the legal ones. The purpose of this thesis is to provide the comprehensive survey of criminal law relationships which may arise in the context of providing the assisted reproduction. The thesis examines whether the current legislation guarantees sufficient protection of relations, interests and values covered by the Criminal Code. Within the analysis of crimes the thesis deals with the need for criminal repression and gives proposals de lege ferenda. The thesis is composed of five chapters. The first chapter is subdivided into two parts. Part One defines the concept of assisted reproduction, describes the historical overview of the events that preceded the current interpretation of the concept and explicates basic medical terminology related to the chosen topic. Part Two presents the basic principles on which the Czech regulation is established and contains specification of the relevant sources of law. The second chapter briefly characterizes the criminal and medical law and clarifies their relationship. The third chapter deals with the...

The aim of my thesis is to analyze and evaluate instruments and methods used by public relations in selected health facilities. Determine which instruments of public relations are used most often and whether the effects brought by the organization expects from them. Will be discussed and possible solutions the shortcomings and problems in this sphere.

The theme of this thesis was determine the current status of preparedness of selected health service providers for evacuation security. Two randomly selected hospitals were approached, Hospital Český Krumlov, a.s. and Hospital Jindřichův Hradec a.s. Since it is an evacuation issue, hospital staff should be adequately informed and prepared. The theoretical part is devoted to research of legal norms and documents with the given issue. This is especially the law No. 372/2011 Coll., on health services and the conditions for their provision which describes health service providers and Ministry of Interiors notice No. 380/2000 Coll., to prepare and implement of tasks of population protection which deals with evacuation and its description. This part dealt with the characteristics of health service providers in more detail, types of medical facilities, description of evacuation and evacuation events in the Czech Republic and abroad. To answer the research question "What is the current status of preparedness of selected health service providers for securing evacuation?" additionally it was determinated hypothesis no. 1 "Preparedness of health service providers of South Bohemian Region for evacuation security does not reach 75 %". The questionnaire contained 29 questions, it was divided into 4 parts, respondent information, aspects of awareness, readiness aspects and other aspects. For evaluation of awareness of medical staff for evacuation readiness was determinated limit 75% success of correct answer. The results showed insufficient preparedness - 55%. Additionally there were determinated hypothesis no.1 - no.6 which were focused on influence of respondent information on age, sex, highest education level, department and practice length. The method ANOVA was chosen for statistical evaluation. It showed that respondent information depend on sex, age and highest education level by both hospitals and each individually. Respondent awareness is also addicted to departments both hospitals and Hospital Jindřichův Hradec a.s. and on the contrary by Hospital Český Krumlov a.s is not addicted. Practice length is not addicted by both hospitals and Hospital Český Krumlov a.s. and on the contrary by Hospital Jindřichův Hradec a.s. is addicted. Results of the questionnaire survey showed that readiness and preparedness of medical staff in Hospital Český Krumlov a.s. and Hospital Jindřichův Hradec a.s. are insufficient and points that it is necessary to familiarize medical staff with this issue.

The burden of proof on the unlawful conduct of the health service provider Abstract This thesis describes a burden of proof and the distribution of the burden of proof on the unlawful conduct of the health service provider between the parties to the dispute. Particular emphasis is put on cases in which patient as party burdened by the burden of proof is unable to prove unlawful conduct of the health service provider or other elements of the obligation to pay damages because the health service provider violated his obligation to properly maintain medical records. This thesis is composed of eight chapters. Chapter One is introductory and describes the civil liability which can arise out of the provision of health services. It presents cases of strict liability and also liability for fault. Chapter Two deals with the unlawful conduct of the health care service provider. Besides the general introduction, attention is paid to medical malpractice and other typical cases of unlawful conduct related to the provision of health services. Chapter Three examines other elements of the obligation to pay damages in cases of medical malpractice. Chapter Four deals with the procedural obligations of the parties to the dispute, especially with the duty of assertion and evidence and the burden of assertion. Chapter Five is...

El actual proyecto surge a través de una necesidad, la cual es realizar un modelo de Arquitectura Empresarial del proceso de Compra de Prestaciones de Salud para la empresa estatal ESSALUD, con la finalidad de poder cubrir las inconsistencias que existen entre los procesos, usuarios, stakeholders, etc., las mismas que ocasionan pérdida de recursos, tiempo, además de afectar directamente la reputación y seriedad de la compañía. Así mismo, existe la necesidad de expandir la cobertura de los servicios de salud ofrecidos en el plano de una serie de restricciones financieras y políticas aplicadas por el gobierno de turno. De esta manera, gracias al desarrollo de la arquitectura empresarial para el proceso de compra de prestaciones de salud se puede optimizar y reducir los costos, gastos y tiempos utilizados actualmente en la entidad de salud; lo cual genera no solo un cuello de botella en el procedimiento general no solo internamente afectando al personal, sino, también, a la sociedad, pues existe actualmente un porcentaje muy alto de personas disconformes con el servicio que se ofrece. Para ello, es necesario que los procesos a los que se recurren esten correctamente definidos, de igual manera sus entradas, flujo interno y salidas, de tal manera que, al auditar estos procedimientos los números y estadísticas cuadren con el balance anual que se realiza para las entidades reguladoras de los presupuestos. / The current project comes through a necessity, which is to make a design model of the Enterprise Architecture Process Purchase benefits for the state company ESSALUD, in order to be able to cover the inconsistencies between processes, users, stakeholders, etc., the same that cause loss of resources, time, as well as directly affect the reputation and reliability of the company. Also, there is a need to expand the coverage of health services offered in terms of a number of financial and political restrictions imposed by the government. In this way, thanks to the development of the enterprise architecture for the process of buying health services in EsSalud, costs, expenses and time of use can be optimized and reduced at the health entity. Don’t make a change in this procedure generates not only a trouble in the general procedure, so it is not only internally affecting the staff, also affects to society, since there is a very high percentage of people that doesn’t like the service offered. For this, it is necessary that the processes that are used should be correctly define, as well as their inputs, the internal flow and outputs, this can generate that the numbers and the statistics match the annual balance that is made for the budgets regulatory entities. / Tesis

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / A split-mouth, double-blind trial evaluated the effects of a surface sealant on the clinical performance of Class I composite resin restorations. In 16 patients, 27 pairs of maxillary and mandibular molars or premolars with Class I carious lesions or unsatisfactory restorations were restored with composite resin. For each pair, 1 surface was sealed with surface sealant. Clinical evaluations of marginal integrity, marginal discoloration, anatomical form, and secondary caries were performed by 2 experienced operators using modified US Public Health Service criteria 1-2 weeks and 6 and 12 months after treatment. Data were analyzed with the McNemar test (P < 0.05). After 6 months, only 1 (4%) sealed restoration presented a Bravo rating for marginal integrity. After 12 months, the Bravo ratings for marginal integrity were 2 (7%) for sealed restorations and 1 (4%) for nonsealed restorations. Restorations received a score of Alfa for all other parameters at all time periods. There were no statistically significant differences within or between the sealed and nonsealed groups (P = 1.0). The use of a surface sealant did not improve the clinical performance of posterior composite resin Class I restorations. / Revisión por pares

O problema da violência contra a mulher é um fenômeno mundial. O movimento feminista, no final dos anos 60, se fortaleça e começa a denunciar alguns casos, dando corpo e visibilidade a esta questão, que até então permanecia no campo do privado. O objetivo dessa pesquisa foi identificar situações de violência doméstica entre as usuárias das várias clínicas do Centro de Referência da Saúde da Mulher e de Nutrição, Alimentação e Desenvolvimento Infantil (CRSMNADI) do Hospital Pérola Byington. Os dados coletados foram obtidos por meio da utilização de Metodologia Qualitativa, denominada grupo focal, onde 164 mulheres reunidas em 12 grupos falaram sobre as formas e conseqüências da violência doméstica em suas vidas. O estudo permitiu compreender os significados e o sentido que as mulheres em situação de violência atribuíram as suas experiências. As informações foram organizadas em categorias construídas durante o próprio processo de análise, procurando assim contextualizar as multifaces e multicausas da violência doméstica vivenciada pelas usuárias do serviço. Os resultados obtidos revelaram que a maioria das usuárias vivem em situação de violência doméstica, tendo como conseqüência agravos de saúde e, portanto necessitam de atendimento em serviços de saúde / Violence against women is a global phenomenon. The Feminist Movement has strengthened in the late sixties and since then it has began to report some facts that so far we did not know. The aim of this research was identify the violence at home. This research was made at Nutricional Health Women Reference Center and Food Children Development at Pérola Byington Hospital. Data was collected through qualitative methodology called focal group, where 164 women were gathered in twelve groups in order to talk about different form and consequences of domestic violence in their lives. This survey allowed us to understand the meanings that women suffering from domestic violence attributed to their experiences. The information was organized into categories constructed during the process of analysis, aiming to contextualize the multi faceted of domestic violence experienced by the women users of this service. This results revealed that most women live in a situation of domestic violence which compromise their health and, therefore, in need of attending specialized health services.

O controle orçamentário é apontado como um mecanismo gerencial adequado para redução, controle de custos e avaliação do desempenho de uma instituição hospitalar. No ambiente da Saúde, onde se inserem os hospitais, o orçamento atua como um instrumento de alocação de recursos, coordenação, controle e comunicação das estratégias da instituição, já que há crescente busca pela redução de custos e eficiência devido à escassez de recursos presente nesse setor. O processo orçamentário nesse ambiente pode ser influenciado por características peculiares desta área, como complexidade, frequência e incerteza da tarefa, e também da tensão existente entre as áreas clínica e administrativa do hospital no estabelecimento de metas. A pesquisa observará o fenômeno do processo orçamentário sob a ótica da área clínica, dos profissionais do Serviço de Saúde, predominantemente do Serviço de Enfermagem, cujo objetivo é investigar a relação das características do processo orçamentário no Serviço de Saúde sobre a efetividade da Execução Orçamentária. O modelo teórico da pesquisa e a definição das cinco hipóteses analisadas são alicerçados na literatura e apresentam a relação de cada característica do processo orçamentário - Participação Orçamentária, Feedback Orçamentário, Avaliação Orçamentária, Clareza e Dificuldade da meta orçamentária - com o Indicador de Execução Orçamentária Meeting the budget. Para o desenvolvimento da pesquisa, o questionário desenvolvido foi aplicado aos gestores do Serviço de Saúde, selecionados pela técnica de amostragem não probabilística snowball. As técnicas utilizadas para tratamento e análise dos dados foram de estatística descritiva e Modelagem em Equações Estruturais. Após a coleta e organização das respostas dos 33 questionários respondidos, as hipóteses foram testadas utilizando o software SmartPls, cujos resultados dessa análise do modelo foram: somente a Hipótese 3 foi suportada estatisticamente, afirmando que há uma relação positiva e significante da característica Avaliação Orçamentária sobre a performance da Execução Orçamentária, cujo coeficiente de caminho dessa relação foi de 0,487, o qual explica aproximadamente 50% da variação do efeito da Avaliação Orçamento sobre a efetividade do orçamento; as hipóteses H1 e H5 foram rejeitadas, mas verificou-se uma relação positiva com o Indicador de Execução Orçamentária; as hipóteses H2 e H4 não foram testadas devido à retirada dos construtos Dificuldade da meta orçamentária e Feeback Orçamentário. O achado dessa pesquisa foi uma constatação relevante para esse ambiente do setor de Saúde, no que se refere à amostra estudada, pois se constatou que mesmo havendo Participação Orçamentária e Clareza das Metas, esses gestores se orientam pela questão da Avaliação Orçamentária, ou seja, o quanto as variações orçamentárias ocorridas são reportadas aos responsáveis e utilizadas na avaliação de desempenho desses gestores. Nesse ambiente, com características peculiares, as decisões desses gestores se orientam para a prestação do serviço de assistência ao paciente, mas se importam com a alocação dos recursos escassos, expressa nas metas orçamentárias traçadas, cuja Avaliação Orçamentária dessa alocação interfere diretamente na execução orçamentária do seu setor/unidade. / Budget control is indicated as a management tool suitable to reduce and control costs and valuate a hospital performance. In the health services field, where the hospitals fit in, the budget works as an instrument to allocate resources, coordinate, control and communicate the institution strategies, aiming costs reduction e efficiency, taking in consideration the scarce resources available in the area. The budget process in this area could be influenced by peculiar characteristics, such as complexity, frequency, the task uncertainty and also the tension between the clinical and management departments of a hospital concerning establishment of goals. The research will show the budgetary process from the clinical department, health providers and specially from the Nursing Service perspective. Its goal is to investigate the relation between characteristics of the budgetary process in the health service and the budgetary execution. The theoretical framework of the research and also the definition of the five hypotheses analyzed are based on the literature and present the relationship between each budgetary process characteristic - Budgetary Participation, Budgetary Feedback, Budgetary Evaluation, Budget Goal Difficulty and Budget Goal Clarity - and the Budgetary Execution Indicator Meeting the budget. For the research, the questionnaire was applied to the health service managers selected by the non-probability sampling snowball. For the treatment and analysis of data we used descriptive statistics and Structural Equation modeling. After the data collection and organization that came from 33 questionnaires, the hypothesis were tested using SmartPls that showed the following results: only hypothesis H3 was supported statistically, stating that there is a positive and significant relation between budgetary evaluation and the Budgetary Execution performance, whose coefficient was 0,487. This figure explains the approximately 50% variation in effect of budgetary evaluation over the efficacy of the budget. The hypotheses H1and H5 were rejected. It was, however, observed that they both presented a positive relation with the Budgetary Execution Indicator. The hypotheses H2 and H4 were not tested due the removal of the constructs budget goal difficulty and budgetary feedback. The research finding was a relevant realization for the health area, concerning the samples analyzed as we observed that even when the budgetary participation and the budget goal clarity happened, these managers were guided by the budgetary evaluation. In other words, the budgetary variations are reported depending on their use for the managers\' performance evaluation. In this field, which presents peculiar characteristics, these managers\' decisions are towards the patient and their needs, considering, however, how to allocate the scarce resources they have as determined in the budgetary goals. Also, the budgetary evaluation impacts directly the department/unity budget execution.