Doctor protection vs. patient protection. This diploma thesis deals with the medical law, namely the protection of physicians and the protection of patients, and their mutual comparison as entities standing more or less against each other. The main objective of the thesis was to analyse the protection of both sides; the practical example provides describes a controversial situation which may happen in reality, also gives better understanding of the issue for readers. The aim was to capture the complex and also very extensive legal regulation of the topic, focusing on the touchpoints between the medical and civic laws. In view of the wide range of the topic in question, I consider specifically some sections of the thesis as the most important. At the beginning, the thesis provides a specification of the elementary legislation regulating the medical law. This is not a comprehensive list of resources, due to the enormous extent of the legislation regulating the medical law. Individual chapters describe the topics of informed consent and the protection of personal data, the provision of healthcare without the patient's consent and the special arrangement concerning the consent of underage patients, the relationship between the physician and the patient, the confidentiality duty, previously expressed...

The aim of this thesis called "Disciplinary liability of health care professionals, relationship to criminal liability" is to analyse and compare criminal and disciplinary liability in medicine and outline their relationship. Considering its topicality and interdisciplinary character, I found this matter to be very inspiring. Although the medical liability issue seems to be very popular and frequently discussed subject, there are some aspects and problems that need to be sorted out in order to provide the doctors with a minimal standard of legal certainity. The thesis is composed of five chapters, each of them dealing with different aspects of any kind of liability rising out of medical profession. First chapter is subdivided into four parts briefly describing civil, labour, administrative and contractual liability relating to medicine. Chapter two focuses on criminal liability of doctors and composes of eight parts. First two parts reffer to the risk of fault, that any doctor can cause, and the ultima ratio principle. Part three illustrates the conditions of criminal liability. Part four adressess the issue of circumstances excluding illegality in medicine. Part five and six present the nature of medical intervention and define the term of health care professionals. Part seven and eight deals...

Patient's damage The goal of this presented diploma thesis is to discuss the problem of patient harm due to health care. To achieve the stated goal, the thesis is divided into five main chapters, in which the first chapter discusses the relationship between the patient. The first chapter also introduces the rights and obligations of both the patient and the physician. This chapter also deals with the issue of informed consent. The second chapter focuses on the issue of legal liability, addressing both civil liability in general and its individual types, as well as criminal liability. The next chapter is about the procedure lege artis and the related health ethics concept. Part of this chapter is also the issue of expert opinions. The fourth chapter is crucial for the thesis, because it deals with the patient's own damage. This chapter deals not only with undesirable events that could result in patient harm, but also about the subsequent compensation of the patient in the form of painful and compensation for the burden of social application. Within the subchapter on patient harm in practice are mentioned the decisions of the Supreme Court of the Czech Republic issued in specific cases of patients' injuries. And for completeness, one European Court of Human Rights decision. The last chapter mentions...

Responsibility of the doctor in criminal law and the circumstances under which it is possible to carry out medical procedures without the threat of legal punishment is a topic that has been, is and will be always up to date. It is a complex set of problems, which includes aspects of moral, medical and legal. In my thesis I focused on relationship between doctor's proffession and legal aspects of his work according to criminal law. Its goal is to describe the issue of the practice of medicine and circumstances of justification in terms of legislation in the Czech Republic. The thesis consists of three chapters. The first chapter provides an introduction to the problem and the reasons that led me to choose this topic work. The second chapter is devoted to criminal liability and is divided into two parts. The first contains the general conditions that are necessary for criminal liability of doctors. The second part contains the typical and most common possible crimes that may physician in the exercise of their profession commit. The third and most extensive chapter has focused on description of the circumstances of justification. The chapter is divided into four parts. Firstly it deals with self-defense and legitimate use of weapons that are not too common in the medical environment. Then I focus on...

The issue of causality in the suits for damages The subject of this thesis is the issue of causality in disputes relating to compensation for damage to health. Causation is a considerably miscellaneous institute, therefore, this paper deals with various aspects of this topic and its context. The writing focuses on cases in which damage was caused to health through providing health services, as this legal field is characterized by many specifics from other areas of liability. Firstly, the thesis aims at explanation of the concept of causation, its importance and development not only in law but also in other areas of human activity. Subsequently, the attention is focused on the significance of causation in law; after theories of causation are compared, its substantial features are described in comparison to the other elements of liability. Consequently, the work concentrates on processes through which the causal link is determined, on the selection of relevant causes and consequences and the relationship between them in cases involving their plurality. It does not forget to mention the importance of causation in the context of strict liability, particularly in its specific cases relating to the provision of health services. The core of this work is the issue of causation in disputes in which the...

The subject of this thesis is one very important relationship of health care - the doctor- patient-relationship. During a recent decades a big attention was paid to this theme both on international and czech field. In the Czech Republic the doctor-patient-relationship went through the essential change, when instantly changed from a paternalistic relationship to a partnership. Many legal changes followed this change finishing it by accepting the Act on Healthcare Services which for example describes rights and duties of subjects of this relationship. The first part is dedicated to a doctor-patient-relationship itself. Its history and evolution, placement in a legal system, legal form. One part is dedicated to an ethic aspect of doctor-patient-relationship. The second part discusses about rights and duties of both participants of this relationship. Specifically, rights determined by the Act on Healthcare Services. The third part is dedicated to detailed analysis of some basic patient's rigths and the doctor's duties characterizing doctor-patient-relationship in its current form. These are informed consent, where I describe, why it is needed. I was concerned about its requisites, possibility to abandon informed consent, to informed dissent including its form while a short look on an issue of...

The topic of this thesis is divided in two main parts. The first is about the “tool/workpiece pair” method and the second is related to wear monitoring. The entire project will be about drilling and tapping operations done in SNECMA Vernon. In fact, the part is very expensive so they have to be closely controlled to avoid a maximum scrap pieces. Two software will be used to control it. Firstly, the “tool/workpiece pair” will be done through AMC3 (software developed at the ENSAM). And secondly the wear monitoring will be ensured by the software CTM Visu (developed by ARTIS). My task will be to learn how to use those software and then to implement them in the company.

The topic of this work is the administration of medicine following a face-to-face and telephone madication-related orders at hospitals. The methods used in the theoretic part of this work included both discussions with representatives of health care providers and the analysis of documents. Based on the description and analysis of the set-up of verbal madication-related orders as featured in the accreditation standards of four healthcare accreditation organisations and internal rules of five hospitals, the author of this work seeks to identify any possible risk elements of verbal orders, and to propose ways how to modify such parts of standards and rules so as to make the verbal ordination less risky. Whether or not the verbal medication-related orders at hospitals is a lege artis procedur depends first of all on the situation in which the verbal order is issued, on the authorization or qualifications of health employees who are involved in the implementation of such verbal order, and on the strict observance of procedures concerning the communication (including its recording into the medical documentation). Although verbal madication-related order represents risk arising from the ordinance's communication, forensic, or specialist consequence, no greater attention has been paid to them so far. There...

Le genre Entérovirus (EV) (famille des picornaviridae) est composé de petits virus à ARN non enveloppées classés en 12 espèces dont 7 sont pathogènes pour l'homme : 4 espèces (A-D) d'enterovirus humains (HEV) et trois espèces (A-C) de rhinovirus humains (HRV). Dans le genre enterovirus, les HRV et HEV sont reconnus comme des pathogènes respiratoires fréquemment responsables d'infections des voies aériennes supérieures et inférieures chez l'enfant et l'adulte. Entre 2009 et 2012, de nouveaux génotypes d'HEV à tropisme respiratoire (HEV-68, 104, 109, et le CVA-21) ont été décrits dans des cas isolés ou épidémiques démontrant la capacité des espèces A à D à induire des infections respiratoires basses humaines.La première phase de ce travail de thèse a eu pour objectifs de préciser le rôle étiologique des infections à EVs; d'identifier les génotypes potentiellement responsables des pathologies respiratoires pédiatriques nécessitant une hospitalisation, mais aussi d'analyser et de comparer les caractéristiques cliniques et épidémiologiques entre les différents groupes de génotypes identifiés. Nous avons réalisé une étude rétrospective sur une cohorte de 309 enfants hospitalisés au CHU de Reims entre septembre 2009 et juin 2010 pour une infection respiratoire aiguë non documentée microbiologiquement par la réalisation des tests virologiques et bactériologiques conventionnels. Nos résultats montrent que le génome des EVs (HEV et HRV) est retrouvé dans 60,5% (187/309) des aspirations naso-pharyngées des enfants hospitalisés, distinguant 15 infections à HEV (dont 10 souches HEV-68) et 172 à HRV. Les cas de bronchiolite et d'exacerbation de l'asthme (133/187) positifs pour la détection des souches HEV (12/133) étaient plus âgés (P=0,003) et plus fréquemment associés avec une détresse respiratoire (P=0,01) et un besoin en oxygénothérapie au moment de leur hospitalisation (P=0,01) que les cas infectés par un HRV. De plus, nous avons mis en évidence pour la première fois en France la circulation épidémique de souches d'HEV-68 (10/15 des souches d'HEV détectées) isolées au cours de l'automne 2009 chez des enfants hospitalisés pour une infection respiratoire aiguë. Nos résultats fournissent de nouvelles informations sur ce génotype ré-émergent qui semble présenter un tropisme respiratoire spécifique des voies respiratoires inférieures.La seconde phase de ce travail de thèse s'est intéressée à étudier les mécanismes liés au développent des processus inflammatoires de la muqueuse au cours de l'infection des voies respiratoires basses par HEV. A l'aide d'un modèle in vitro de cellules respiratoires humaines (A549) infectées par HEV-B (CVB5, Mitchell), nous avons observé que l'infection réplicative des HEV dans les cellules A549 induisait une augmentation dose et temps-dépendante des ARNm, et des protéines IL-8, MCP-1 et RANTES.En conclusion, nos résultats obtenus à partir de prélèvements respiratoires dans le cadre de notre étude de cohorte suggèrent que les EVs représentent une cause étiologique fréquente d'infections respiratoires basses chez l'enfant avec une pathogénicité supérieure des HEVs (principalement dans notre étude HEV-68) par rapport aux souches HRVs. De plus, nos résultats obtenus à partir d'expérimentation in vitro démontrent que les HEVs du groupe B sont capables d'induire au cours de l'infection des cellules épithéliales alvéolaires humaines (A459) une sécrétion spécifique d'IL-8, MCP-1 et RANTES. La production de ces chimiokines correspond à une réponse innée de la cellule épithéliale humaine infectée par les HEVs: nous avons montré pour la première fois que ce mécanisme était en partie régulé par l'activation de la voie non canonique de NF-kB via la protéine NIK dans la cellule épithéliale respiratoire humaine. / The Enterovirus (EV) genus (picornaviridae family) consists of small non-enveloped positive RNA viruses classified in 12 species of which 7 are pathogenic for humans: four species (A-D) of human enterovirus (HEV) and three species (A-C) of human rhinovirus (HRV). Among the EV genus, HEV and HRV are recognized as leading causes of acute respiratory tract infections (ARTIs) in human. Between 2009 and 2012, new HEV respiratory genotypes (e. g. HEV-68, 104, 109, 117 and CVA-21) have been described in isolated cases or outbreaks supporting the ability HEV species A to D to induce lower respiratory tract infections. This supports the hypothesis of an underestimation of the prevalence and etiological role of EVs in pediatric acute respiratory tract infections (ARTIs) (more specifically bronchitis, bronchiolitis and asthma exacerbation).To assess the etiological role and the clinical characteristics of HRV and HEV infections in pediatric patients hospitalized for ARTIs, we conducted a retrospective study of 309 hospitalized pediatric patients in University Hospital Centre of Reims with microbiologically unexplained ARTIs from September 2009 to June 2010. Among the 309 ARTIs, 15 HEV and 172 HRV strains were identified. Among bronchiolitis and asthma exacerbation cases (n=133), HEV infected cases were older (P=0.003) and were more frequently associated with a respiratory distress (P=0.01) and a need for oxygen therapy at the time of admission (P=0.01) than cases infected by HRV strains. Interestingly, during this retrospective study, we provided evidence that during the fall 2009 in France, HEV-D68 strains were responsible for a low proportion of pediatric cases hospitalized for acute airway diseases including bronchiolitis and asthma exacerbation.To identify the mechanisms that can regulate the development of airway mucosa inflammation during HEV respiratory lower tract infections, we investigated the production of chemokines by HEV infected human alveolar epithelial cells (A549). Using in vitro model A549 cells infected by HEV-B (CVB5, Mitchell), we demonstrated that HEV-B strains isolated from upper respiratory tract of child with bronchiolitis could actively replicate in various human airway epithelial cells, and that this replicative infection induced specific dose and time-dependent increases in mRNA and protein secretion of IL-8, MCP-1 and RANTES, but not of all other CC and CXC human chemokines tested. The protein secretion of these chemokines appeared to be significantly increased at 48 and 72 hours post-infection in culture treated by low-doses of IFN-γ in comparison with mock-infected cells (P <0.001), and was correlated to the viral replication activity. In second time, we explore the pathogenic mechanisms that can regulate inflammatory responses to HEV in lower respiratory airways. We show that HEV infection induced a time-dependent increase of NIK protein accumulation that peaks at 16 hours post-infection (H P-I). NIK protein accumulation mediated the processing of p100 in p52, which association with Rel B was evidenced in nuclear compartment between 16 and 48 H P-I.In conclusion, our findings indicate that EVs are a common cause of lower respiratory tract infections in pediatric patients with a potential higher pathogenicity of HEV strains (mainly HEV-68) by comparison to HRV strains. Moreover, our in vitro results demonstrated that HEV are capable to induce the release of specific chemokines (IL -8, MCP-1 and RANTES) by alveolar epithelial cells during a replicative infection. Finally, we demonstrated for the first time that this innate airway epithelial cell response against HEV infection was partly regulated by the activation of the non-canonical NF-kB via NIK protein.

The subject of this thesis is "Protection of personality in health care" which is an important and especially current topic. After the recodifications of relevant legislation - particularly the recent Civil Code (which is built on the natural law concept) - is more focused on the protection of personality and it generally changed perception of harm to personal rights. It is newly called "compensation for personal harm to the natural rights of person" and claims for compensation for damages and recompense of non-pecuniary damages is tied to a single court proceedings. The thesis is divided into four parts. The first part introduces the basic concepts related to personal rights and to certain medical terminology including explanation of the term "lege artis". The second part presents the relevant legislation, both national and international. The third and largest section is devoted to the protection of patient's personality which is defined by the individual rights of patient in health care. It refers to the patient's right to be treated "lege artis" during receiving of health services, patients' right to be informed and provide related informed consent (on which the thesis is particularly focused), medical confidentiality of health workers and issues related to handling the patient's medical...