Casuistry in dental ethics: a case for cases.
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Ethics, Dental↗
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Videolaparocholecystectomy: casuistry of 1000 cases.
Despite the ongoing evolution in the medical treatment of biliary pathology, the standard of treatment for gallstones remains cholecystectomy. There are no alternative treatments that have shown the same efficacy as surgery. Current alternative treatments have shown high recurrence and failure rates. Cholecystectomy remains the gold standard for management of gallstones. The surgical access of laparoscopic cholecystectomy accomplished by Mouret in 1987 allows for a reduction in operative trauma, hospital stay, postoperative pain and convalescence. These factors permit a faster return to normal activities. Today, laparoscopic cholecystectomy is performed in almost all medical centers around the world; however, the procedure is not free of complications. The objective of this study was to analyze our first 1000 cases of laparoscopic cholecystectomy, giving emphasis to the morbidity and mortality of the procedure.
Adolescent↗
Can phronesis save the life of medical ethics?
There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.
Casuistry↗
Ethics and imagination. Implications of cognitive semantics for medical ethics.
Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an "imaginative casuistry" is to be preferred compared to principlism and to other forms of casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases.
Beneficence↗
Moral reasoning in social context.
Scholarly thinking about morality has been deeply affected by the confrontation with practical moral problems epitomized by bioethics. Attention to social context is increasingly seen as vital to sound moral reasoning. The dominant model in bioethics assumes that moral reasoning proceeds downward, from fundamental principles to specific cases. This top-down model, deductivism, is flawed both as a description of moral reasoning, and as a prescription for how moral reasoning should be done. In recent years, another model known as casuistry and based on case-centered moral reasoning has emerged to challenge deductivism. Casuistry suggests new lines of empirical and conceptual research into the history of moral disputes and the practice of moral reasoning and debate.
Advisory Committees↗
[Comparative study of a neonatology unit by means of 2 patient grouping technics].
In this study we make a measurement of the case-mix of the neonatology section in Hospital Puerta del mar in Cadiz during the year 1990, through two methods: Diagnosis Related Groups (GRDs), and Patient Management Categories (PMCs). We compare this case-mix with other hospitals. We compare this case mix with other hospitals. We also compare both methods between themselves through a multiple lineal regression. The results point out that the complexity of casuistry attended in Cadiz was lower to those attended in other control hospitals, and that these ones worked more efficiently. As for comparison of both technics, the GRDs demonstrated to have a superior capacity than the PMCs to discriminate the casuistry.
Diagnosis-Related Groups↗
Rural woman abuse and sexually transmitted disease: an ethical analysis of clinical dilemmas.
Women who have experienced abuse are often offered individual and group psychotherapeutic interventions to help them overcome psychological aftereffects of abuse and avoid future abusive relationships. Clinical cases that are complicated by the existence of abuse and sexually transmitted diseases (STDs) often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality that can potentially harm the individual. There is little known about the experiences of abused rural women with STDs, underscoring the need for modification of existing interventions for this patient population. This paper presents the application of an ethical framework to an actual case involving an abused rural woman with an STD that utilizes the concepts of casuiStry, or case-based reasoning. A methodological tool for ethical analysis of the clinical dilemmas involving evidence-based psychotherapeutic interventions for abused rural women with STDs is used to apply the concepts of casuistry to the development of the taxonomy of cases for clinical practice.
Adult↗
[Controversies connected with the therapeutic approach in palpebral epitheliomas].
OBJECTIVE: We try to clarify some controversies related to the palpebral epitheliomas, controversies related to the therapeutical applied attitude (surgery, radiotherapy or the association of the two therapeutical methods), to the indications and contraindications of their application. MATERIAL AND METHOD: It is a review study of the Military Hospital and Oncologic Institute Cluj-Napoca casuistry between 1984-1994, which comprises 244 patients with palpebral epitheliomas, histologically confirmed. This casuistry was followed taking into consideration the age, sex, histological type, anatomo clinical presentation, TNM clinical stage, the localisation of the tumor, the type of the applied treatment, complications, healing and the therapeutical failures. RESULTS: The efficiency of the applied therapeutical methods was considered related to their obtained results to the therapeutical failures. The rate of healing at 5 years was 90.57% for the whole group. CONCLUSIONS: 1. The two methods of treatment seems to be equally sensible concerning the therapeutical efficiency in stages I and II. 2. In the advanced stages (III and IV) our option is for mixing the two methods. An optimum treatment for each patient is possible only if there is a close cooperation between the ophthalmologist-surgeon, plastic surgeon and the radiation oncologist.
Adult↗
[Orbito-ocular dermoid cysts--incidence and particular cases].
This paper is concerned about a retrospective study on the casuistry of the Ophthalmologic Clinic of Craiova concerning those cases hospitalized and operated for different dermoidal cystic localization. A period of 20 years is under observation. The group of patients is analyzed taking into account the apparent debut age of the tumors, sex and different localization incidence. Both those tumor particular forms are exemplified by the clinic own casuistry and the association to other lesion types and profound localization in the orbit with particular clinic symptomatology. All the cases have been checked up and anatomopathologically confirmed.
Adolescent↗
[An evaluation of right ventricular compliance (author's transl)].
Right ventricular "compliance" and "stiffness" in a casuistry of 51 patients were studied with varied pressure loads, using the "specific compliance" (SC) index proposed by Smith and coll. (1974) for the left ventricle and the "stiffness" constant proposed by Gaasch and coll. (1972, 1975). The pateints were subdivided according to a hemodynamic criterion, on the basis of telediastolic volume values (RVEDV) and telediastolic pressure (RVEDP) of the right ventricle. The average "specific compliance" was 0.1203 +/- 0.0283 in patients with RVEDP below or equal to 7 mmHg and 0.0517 +/- 0.0269 in those with RVEDP greater than 7 mmHg. In these two groups, the respective average values of the "stiffness" constant were 0.0136 +/- 0.0007 and 0.0210 +/- 0.0016. Comparison of the groups showed a significant statistical difference among the indices. In the subdivision into groups with telediastolic volume, the average SC values were respectively 0.0832 +/- 0.0083 in the patients with RVEDV below 150 ml/m2; 0.1131 +/- 0.0375 in the patients with RVEDV between 150 and 200 ml/m2; 0.0650 +/- 0.0132 in the patients with RVEDV above 200 ml/m2. None of the three groups demonstrated statistically significant differences. In the telediastolic volume groups, the average values of the "stiffness constant" were respectively: 0.0235 +/- 0.0020; 0.149 +/- 0.0007; 0.0117 +/- 0.0006. A comparison of the three groups showed statistically significant differences for this index. The authors consider that in pressure overloading of the right ventricle with different etiopathogenesis of "stiffness" and "compliance" indices, based on the measuring of volume and pressure, are unable to give absolute measuring of the physical characteristics of the ventricular walls. Thus, recourse to methods that can evaluate wall "stress" are necessary. However, the parametres considered are quite useful for indicating the variations of ventricular distensibility in homogenous casuistries and are therefore comparable.
Adult↗
[Deliveries out of medical facilities].
AIM OF STUDY: Analysis of reasons and risks of planned and unplanned deliveries out of medical facilities. TYPE OF STUDY: Review of literature and casuistry. NAME AND SITE OF DEPARTMENT: Department of Obstetrics and Gynaecology, Teaching Hospital Na Bulovce, 1st Faculty of Medicine, Charles University in Prague. MATERIAL AND METHOD: Authors of this paper are discussing published evidences concerning the reasons and the risks of planned and unplanned deliveries out of the medical facilities. They are pointing out at the activities of some independently practising midwives, who systematically encourage females against medically conducted deliveries during their prenatal courses, thus obtaining clients for home deliveries. At the end of the paper the authors present three casuistries from their own practice to document the outcomes of disinformation and prenatal courses guided in a wrong way. CONCLUSION: According to the results of foreign studies and own experience home deliveries are accompanied by senseless risks for mother and child. Dubitable benefits of the home surroundings cannot counterbalance these risks. Prenatally purposely misinformed woman and her partner often threaten themselves and their arriving child during labour with senseless risks.
Adult↗
[The prehypophyseal-gonadal system in the normal male and in some forms of testicular dyscrinism. Evaluation studies in basic conditions and after stimulation].
The secretion values of the two seric gonadotropins and of plasmatic testosterone have been estimated in a casuistry of normal males subdivided in groups of 8 to 95 years of age, and of primitive and secondary testicular dyschrinia. In one part of this casuistry, normal and primitive hypogonadics, we have estimated the response to the intravenous administration of Gn-RH. Among the results which have been obtained, it appears that physiologic hypogonadism of the elderly is a primary phenomenum, not hypophyso-dependent. In the hypophysiary stimulus test, the response of gonadotropins in those old men moves away from the response of hypogonadics considered, by a behaviour much more similar to that of normal adults, even if delayed and prolonged. In all the cases, normal and pathologic, the response of testosterone is variable, perhaps owing to the relation with the various factor which have been noted.
Adolescent↗
[EEG in brain tumors in childhood. Anatomo-clinical correlations].
The authors reviewed the electroencephalographic findings relevant to a casuistry of 136 cerebral tumours in paediatric age and correlated them with the anatomic site of the neoplasias, as checked on the operating table, and with clinical symptomatology. The casuistry, as concerns the site of the tumours, consists of 32 cases with a hemispheric localisation, 35 localized on the median line (suprasellar tumours, tumours of the 3rd ventricle, tumours of the basal nuclei and tumours of the pineal region) and 68 cases of tumours of the cerebellar fossa. E.E.G. proved normal in 9.3% of the patients with a hemispheric tumour, 17.1% of those with median tumours and in 23.1% of the tumours of the cerebellar fossa. 12.5% of the cases with a hemispheric tumour showed a general widespread alteration of the electroencephalogram, which was also traceable in 20% of the deep seated tumours and 13% of the subtentorial tumours. A focal E.E.G. finding with polymorphic delta waves was detected in 62.5% of the tumours with a hemispheric localisation, as compared to 14.2% of the deep seated and 28% of the subtentorial ones. Finally, in the three groups, intermittent slow waves were detected respectively in 46.8%, 51.4% and 72.4% of the cases. Related with clinical conditions, in the presence of endocranial hypertension, a clear prevalence of general widespread alteration and of intermittent activities were detected. The authors discuss the diagnostic value of each E.E.G. finding in cerebral tumours with particular attention to localizing value of focal polymorphic delta waves and to the meaning of intermittent slow waves which, in paediatric age, show a clear prevalence in the posterior cerebral areas.
Adolescent↗
[Behaviour of the LAP (leucine-amino-peptidase) in the serum of blood in subjects affected of cirrhosis of the liver in stage ascitical (author's transl)].
The AA. have studied behaviour of the LAP (leucine-amino-peptidase) in the serum of blood in subjects affected of cirrhosis of the liver in stage ascitical, of cause toxic-alcoholic excluding about of the casuistry the cirrhosis of the another cause and the cirrhosis that are compled white an obstruction in and extrahepatic standard biliary cirrhosis 1 degree e 2 degree. After the exposition of the casuistry in the registred normality of the test (seric-LAP) in some cases of hepatic-alcoholic cirrhosis, the AA. concluded considering the LAP an indicator only of the obstruction in and extra-hepatic, consistent with hepatic-organ well operating; do not be a secure test to follow development of a chronic hepatitis of any kind, even if in the hepatic disease is present an infiltration and an overturning of the hepatic-lobule, like it is normally in the hepatic alcoholic diseases.
Alkaline Phosphatase↗
[FSH, LH and testosterone evaluation in healthy males from pre-puberty to senile age. Study in basic conditions and after stimulation with Gn-RH].
The secretion values of the two seric gonadotropins and of plasmatic Testosterone have been estimated in a casuistry of normal males, 114 subjects, subdivided in groups of 8 to 95 years of age. Our investigation allowed to compare hormonal levels in the different ages; in particular, the pattern in senescence appeared greatly interesting. In one part of this casuistry, we have estimated the response to the intravenous administration of Gn-RH. The test showed a positive gonadotropic response in all ages, with some differences between FSH and LH, and induced no significant change in testosterone secretion. Among the results which have been obtained, it appears that physiologic hypogonadism of the elderly is a primary phenomenon, not hypophysodependent.
Adolescent↗
[Human heart transplantation in Brazil].
PURPOSE: To analyze patients operated on in Brazil from May 1968 until June 1993. METHODS: Three patients were transplanted in the historical period of 1968 and 1969. In the modern period from 1984-1993, 380 transplants were performed in 379 patients. These patients were transplanted in 23 services in 20 hospitals. These services are in 12 cities of 11 states. The state with the larger number of patients was São Paulo with 239 transplants followed by Minas Gerais with 58. RESULTS: In this casuistry, the patients were predominantly male (81%) with age between 31 and 40 years (30%). The most frequent indication was idiopathic dilated cardiomyopathy (53.4%) followed by ischemic (26.8%) and with a special reference for the Chagas' etiology (11%). The results in 297 patients showed 48 immediate and 49 late deaths. The actuarial survival curve showed 64.7% and 47.4% respectively after one and five years. CONCLUSION: Important differences were observed in relation to the international casuistry but even so benefits were present when compared with medical treatment.
Adult↗
[Complications of cryosurgery in the treatment of prostatic tumors].
Most of the complications in cryosurgery (pyelonephritis, peritonitis, perforations and haemorrhages) are caused by an indequate control of the freezing process or by the use of unsuitable cryosurgical techniques. To this effect, an important role is played by the unsuitable choice of the kind of freezing probe and the use of an unsuitable freezing time. Only endoscopic cryosurgery enables a precise and exact control by means of viewing through the endoscopic trocar along with simultaneous rectal feeling, both of which enable us to achieve an exact supervision of the size of the subvesically-formed freezing sphere adjacent to the rectum. Short, repeated freezings prevent the risk of necrosis (called "sloughts" by English authors). There is a 2% mortality, bearing in mind that the casuistry in cryosurgery is similar to the normal one in open prostate surgery with the difference in favour of the former that these patients generally belong to the so-called inoperable group or with a special surgical risk and aged between 70 and 80 years old. On the other hand, in both groups of our casuistry, the U.T.R. produced a mortality of only 0.3%.
Aged↗
[Ethics and nursing. A contribution to nursing education].
Given today's developments in public health, nursing will be forced to manage different care services in the future. Nurses' growing responsibilities and the complexity of decision-making increase the necessity of a discussion of ethics in nursing. Ethics should help nurses solve moral conflicts. This article (an excerpt from a thesis) describes one possible way to improve ethical decision-making: by using casuistry as an attempt to help nurses bridge the gulf between general moral rules and specific problems in specific cases, for example the conflict between respecting autonomy and the obligation to care, one of the main problems of decision-making. This problem is analyzed according to Thiroux's ethical principles. The limits of casuistry lie in the fact that each person is accountable for his own decision in a specific situation without having a relevant context to refer to.
Conflict, Psychological↗