REVISITING THE MAXIM IMPERITIA CULPAE ADNUMERATUR IN CONTEXT OF MEDICAL NEGLIGENCE – CAN THE MAXIM BE EXTENDED TO INCLUDE THE APPLICATION OF LUXURIA?

Pieter Carstens

doi:10.17159/obiter.v38i3.11432

REVISITING THE MAXIM IMPERITIA CULPAE ADNUMERATUR IN CONTEXT OF MEDICAL NEGLIGENCE – CAN THE MAXIM BE EXTENDED TO INCLUDE THE APPLICATION OF LUXURIA?

Obiter ◽

10.17159/obiter.v38i3.11432 ◽

2017 ◽

Vol 38 (3) ◽

Author(s):

Pieter Carstens

Keyword(s):

Health Care ◽

General Practitioner ◽

Rural Areas ◽

Burden Of Proof ◽

Medical Practitioner ◽

Reasonable Doubt ◽

Medical Services ◽

Medical Negligence ◽

General Medical Practitioner ◽

Health Care Practitioners

In any given context, negligence means that the defendant or the accused failed to foresee the possibility of harm (bodily/mental injury or death) occurring to another in circumstances where the reasonable person (diligens paterfamilias) in the defendant’s or accused position would have foreseen the possibility of harm occurring to another and would have taken steps to avoid or prevent it. The generic test for negligence is thus one of foreseeability and preventability. Although the test for negligence is fundamentally objective, it does contain subjective elements when the negligence of an expert is assessed. Where the defendant or accused is an expert, the standard of negligence is upgraded from the reasonable layperson to the reasonable expert. Where the expert is a medical practitioner, the standard is that of the reasonable medical practitioner in the same circumstances. It is to be noted that the standard of care and skill, in context of medical negligence, required of a general practitioner is to be distinguished from the standard and care and skill required of a medical specialist. Simply stated, if the physician is a general medical practitioner, the test is that of the reasonable general practitioner. If the physician is a specialist, the test is that of the reasonable specialist with reference to the specific field of medical specialisation. This principle is of particular significance as it has definite implications for the practice of medicine in a developing country as South Africa. Due to the shortages of medical services and qualified health care practitioners and/or compromised medical services, particularly in rural areas, health care practitioners (inclusive of doctors, nurses and paramedics) are often called upon to perform medical services for which they are, strictly speaking, not qualified to undertake – for example, a general practitioner in a small rural hospital may be required to administer anaesthesia to a patient despite not being a qualified anaesthetist; a nurse might be required to assist with the extraction of a tooth without being a dentist. The question arises, according to which yardstick they should be judged in instances of alleged negligence? The locality of practice and the imperitia culpae adnumeratur – rule are clearly also relevant factors in answering this question.In view of the aforesaid, it is the aim of this note to revisit the meaning and application of the maxim imperitia culpae adnumeratur and its possible link with conscious negligence (luxuria) in context of medical negligence. It is to be noted, for purposes of this discussion, that the test for medical negligence is exactly the same in civil law as it is in the criminal law – it makes no difference whether a medical practitioner is sued civilly for damages or by a patient who alleges that he has been negligently treated or is prosecuted by the state. The burden of proof in criminal cases though, is heavier than in civil cases since in the latter the plaintiff must only prove his case on a balance of probability, whereas in the former negligence must be proven beyond reasonable doubt.

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MAVSCOT: A fuzzy logic-based HIV diagnostic system with indigenous multi-lingual interfaces for rural Africa

PLoS ONE ◽

10.1371/journal.pone.0241864 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241864

Author(s):

Olugbenga Oluseun Oluwagbemi ◽

Folakemi Etseoghena Oluwagbemi ◽

Abdulwahab Jatto ◽

Cang Hui

Keyword(s):

Health Care ◽

Fuzzy Logic ◽

Health Care Professionals ◽

Rural Areas ◽

Diagnostic System ◽

Public Health Problem ◽

Indigenous Communities ◽

Major Public Health Problem ◽

Hiv Diagnosis ◽

Health Care Practitioners

HIV still constitutes a major public health problem in Africa, where the highest incidence and prevalence of the disease can be found in many rural areas, with multiple indigenous languages being used for communication by locals. In many rural areas of the KwaZulu-Natal (KZN) in South Africa, for instance, the most widely used languages include Zulu and Xhosa, with only limited comprehension in English and Afrikaans. Health care practitioners for HIV diagnosis and treatment, often, cannot communicate efficiently with their indigenous ethnic patients. An informatics tool is urgently needed to facilitate these health care professionals for better communication with their patients during HIV diagnosis. Here, we apply fuzzy logic and speech technology and develop a fuzzy logic HIV diagnostic system with indigenous multi-lingual interfaces, named Multi-linguAl HIV indigenouS fuzzy logiC-based diagnOstic sysTem (MAVSCOT). This HIV multilingual informatics software can facilitate the diagnosis in underprivileged rural African communities. We provide examples on how MAVSCOT can be applied towards HIV diagnosis by using existing data from the literature. Compared to other similar tools, MAVSCOT can perform better due to its implementation of the fuzzy logic. We hope MAVSCOT would help health care practitioners working in indigenous communities of many African countries, to efficiently diagnose HIV and ultimately control its transmission.

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LEGAL PRINCIPLES OF RURAL MEDICINE DEVELOPMENT IN THE CONTEXT OF MEDICAL REFORM IN UKRAINE

10.32014/2020.2518-1467.14 ◽

2020 ◽

Vol 1 (383) ◽

pp. 113-120

Author(s):

V. M. Yermolenko ◽

O. V. Hafurova ◽

M. A. Deineha

Keyword(s):

Health Care ◽

Medical Care ◽

Rural Health ◽

Rural Areas ◽

Medical Equipment ◽

The State ◽

Health Facilities ◽

Medical Services ◽

Rural Medicine ◽

Medical Reform

Legal support for the constitutional right of citizens to health care and medical care is an important condition for the realization of the principle of recognition the individual on the highest social value. The state guarantees everyone the right to protection of health, medical care and medical insurance; creates the conditions for effective and affordable medical care for all citizens. At the same time, the low level of provision of modern medical equipment, machinery and medicines makes it virtually impossible to provide timely and high-quality medical services in rural areas. The quality of primary health care in rural areas is in terrible condition and the people who live there, and this is more than 30 % of the total population of Ukraine, were very looking forward to changes in this area. After all, most of the old buildings and medical equipment are in poor condition. Medical institutions do not have a complete set of equipment, medical supplies and equipment necessary for primary care. The state of the legal regulation of providing medical care to the rural population of Ukraine objectively needs to be improved. Despite the adoption of numerous normative legal acts, the issues of providing health facilities located in rural areas with the necessary modern equipment and technology remained unresolved until recently. The goal of the article is to investigate the current problems of the legal support for providing medical care in the rural settlements. Particular attention is paid to the reform of the network of the rural health facilities and the problems of staffing. According to the results of the study it is established that from January 1, 2018, the implementation of the rural health reform began in Ukraine. This was due to the need to improve the availability of medical services for the population living in rural areas, to increase the efficiency and effectiveness of the use of funds allocated for the development of health care in the village, to bring the network of healthcare institutions in rural areas and their material and technical support into line with the needs of the population. Rural medicine reform is the lengthy process that requires not only careful adherence to legislation, but also a preliminary assessment of the real state of medicine in the remotest corners of Ukraine in order to prepare a platform for change. It is determined that the implementation of medical reform in cities is perceived better, and therefore much faster is happening, what not to say about the countryside. The prompt and timely solution of the problems of reforming rural medicine is possible with the assistance of the state authorities and local self-government, domestic businesses, foreign investors and financial donors, without which it is extremely difficult to cope with decentralization.

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Making Emergency Care in Rural Areas Fit for Future: Protocol for multi-method and multi-perspective longitudinal analysis and control group study (Preprint)

10.2196/preprints.14358 ◽

2019 ◽

Author(s):

Camilla Metelmann ◽

Bibiana Metelmann ◽

Dorothea Kohnen ◽

Clara Prasser ◽

Rebekka Süss ◽

...

Keyword(s):

Health Care ◽

Emergency Care ◽

Rural Areas ◽

Statutory Health Insurance ◽

First Aid ◽

Medical Services ◽

Emergency Medical Care ◽

Free Interval ◽

Emergency Medical

BACKGROUND The German Emergency Medical Services is a two-tiered system with paramedic staffed ambulances as primary response supported by pre-hospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply whilst the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of essence [1], because with each minute passing, the chance of survival with good neurological outcome decreases. OBJECTIVE The project follows four main objectives: 1) Reducing the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (called bystander-CPR), (2) fast, professional first aid in addition to rescue services through alarming trained first aiders via smartphone, (3) faster and higher availability of emergency physicians through introducing the tele-emergency physician (TEP) system, and (4) enhanced emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS The implementation of the project is evaluated through a tripartite prospective and intervention study: (1) in medical evaluation, the influences of various project measures on quality of care are assessed using multiple methods. (2) The economic evaluation mainly focuses on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. (3) As part of the scientific work and organizational evaluation important work- and occupational-related parameters but also network and regional indexes are assessed. RESULTS The project was started in 2017 and enrollment will be completed in 2020. The pre-analysis phase recently finished. CONCLUSIONS Overall, the implementation of the project entails the realignment of emergency medicine in rural areas and the enhancement of quality of medical emergency care in the long-term. It is expected to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills as well as much more frequently provided first aid through medical laypersons. Furthermore, the project is intended to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via smartphones. As demonstrated by previous projects in urban regions, the TEP system has already proven a higher availability and quality of emergency call-outs in regular health care. A closer interrelation of emergency practices of statutory health insurance physicians with the rescue service is expected to lead to a better coordination of rescue and on-call services. CLINICALTRIAL Ethikkomission (ethics comission) an der Universität Greifswald BB 111/17 http://www2.medizin.uni-greifswald.de/ethik/

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Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis

JMIR Research Protocols ◽

10.2196/14358 ◽

2020 ◽

Vol 9 (2) ◽

pp. e14358 ◽

Cited By ~ 2

Author(s):

Camilla Metelmann ◽

Bibiana Metelmann ◽

Dorothea Kohnen ◽

Clara Prasser ◽

Rebekka Süss ◽

...

Keyword(s):

Health Care ◽

Cardiac Arrest ◽

Rural Areas ◽

Statutory Health Insurance ◽

First Aid ◽

Medical Services ◽

Emergency Medical Care ◽

Free Interval ◽

Emergency Medical

Background German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. Objective The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. Methods We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. Results We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. Conclusions Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. International Registered Report Identifier (IRRID) DERR1-10.2196/14358

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Air medical transport myths

CJEM ◽

10.1017/cem.2019.478 ◽

2020 ◽

Vol 22 (S2) ◽

pp. S55-S61

Author(s):

Russell D. MacDonald ◽

Michael Lewell ◽

Sean Moore ◽

Andy Pan ◽

Michael Peddle ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Medical Service ◽

Service Providers ◽

Medical Services ◽

Transport Services ◽

Health Care Practitioners ◽

Medical Transport ◽

Care System

ABSTRACTThe role of air medical and land-based critical care transport services is not always clear amongst traditional emergency medical service providers or hospital-based health care practitioners. Some of this is historical, when air medical services were in their infancy and their role within the broader health care system was limited. Despite their evolution within the regionalized health care system, some myths remain regarding air medical services in Canada. The goal is to clarify several commonly held but erroneous beliefs regarding the role, impact, and practices in air medical transport.

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Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study (Preprint)

10.2196/preprints.10073 ◽

2018 ◽

Author(s):

Marzena Ewa Nieroda ◽

Artitaya Lophatananon ◽

Brian McMillan ◽

Li-Chia Chen ◽

John Hughes ◽

...

Keyword(s):

Risk Assessment ◽

Health Care ◽

General Practitioner ◽

Data Collection ◽

General Practitioners ◽

Risk Estimation ◽

The Public ◽

Health Care Practitioners ◽

The Uk ◽

Personalized Cancer

BACKGROUND Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. OBJECTIVE The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. METHODS Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. RESULTS The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. CONCLUSIONS This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation.

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Zimbabwe's New Diploma in Psychiatric Health

Bulletin of the Royal College of Psychiatrists ◽

10.1192/s0140078900008221 ◽

1983 ◽

Vol 7 (4) ◽

pp. 69-71

Author(s):

W. Murdoch

Keyword(s):

Public Health ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Rural Communities ◽

Medical School ◽

Rural Areas ◽

Medical Services ◽

Specialist Care ◽

Primary Health

Psychiatry in a land of 7 1/2 million (National Census, August 1982) people with relatively advanced general medical services, but only eight psychiatrists, has great problems. The facilities have been described elsewhere (Murdoch, 1982). Historically poorly related to population needs, and with immense difficulties in serving the rural communities that still comprise over half the population (National Census), Zimbabwe has concentrated its post-independence effort on the development of primary health care in village, district and small town. With a medical school expanding (current intake 80 students per annum) and good central facilities for training and specialist care, primary care in public health and general medical services are developing on a sound basis. In psychiatry, a mere 1200 beds for the country (only 141 in the capital, Harare, which, with dormitory towns, has an ‘official’ population of 1.1 million and serves a further four million in remote rural areas) the training and specialist facilities are sketchy indeed.

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