Beatrice Ioan

Ethical issues in communication of diagnosis and end-of-life decision-making process in some of the Romanian Roma communities

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community.

Legal and Ethical Issues in Heroin Diagnosis, Treatment, and Research

This article explores the legal and ethical issues common to heroin-related research and clinical care, including issues of capacity and voluntariness and, in the context of research, the risks and benefits associated with participation. Attention to these issues is critical if we are to continue to search for mechanisms to ameliorate or eliminate the adverse effects of heroin dependence and withdrawal from its use. To lay a foundation for this discussion, we first present an overview of the mechanics and causes of heroin use and dependence and a synopsis of several major approaches to heroin treatment: methadone maintenance; harm reduction; and heroin prescription.

Dying and Death in Some Roma Communities: Ethical Challenges

The Roma people have specific values, therefore their views and beliefs about illness, dying and death are important to be known for health care providers caring for members of this community. The aim of this qualitative study based on 48 semi-structured interviews with Roma patients and caregivers in communities in two regions of Romania was to examine their selfdescribed behaviors and practices, their experiences and perceptions of illness, dying and death. Five more important themes about the Roma people facing dying and death have been identified: (1) The perception of illness in the community as reason for shame and the isolation that results from this, as well as the tendency for Roma people to take this on in their self image; (2) The importance of the family as the major support for the ill/dying individual, including the social requirement that family gather when someone is ill/dying; (3) The belief that the patient should not be told his/her diagnosis for fear it will harm him/her and that the family should be informed of the diagnosis as the main decision maker regarding medical treatment; (4) The reluctance of the Roma to decide on stopping life prolonging treatment; (5) The view of death as ‘impure’. These results can be useful for health care providers working with members of the Roma community. By paying attention to and respecting the Roma patients’ values, spirituality, and relationship dynamics, the medical staff can provide the most suitable healthcare by respecting the patients’ wishes and expectations.

Factors of the willingness to consent to the donation of a deceased family member's organs among the Romanian urban population.

OBJECTIVES Romania ranks near the bottom of the European hierarchy of posthumous organ donation rates. Objectives of this study were as follows: (1) to assess the willingness to donate (WTD) a family members organs in the inhabitants of a large Romanian city (Iasi) and to analyze its factors; and (2) to determine the most important behaviors of the medical staff for our respondents in a hypothetical donation decision scenario. METHODS The study included a representative sample of the Iasi population. The instrument addressed WTD a family members organs, both in general and in the particular situation of knowing that the deceased had a positive attitude toward organ donation, knowledge of transplantation-related issues, endorsement of beliefs concerning organ donation, and the importance of a set of medical staffs behaviors. RESULTS The questionnaire was completed by 1,034 participants, 48% (n = 496) of whom would most likely consent to donate a family members organs, 18% (n = 191) would most likely refuse and 34% (n = 347) were unsure. The following factors were found to influence this variable: believing in the possible reversibility of brain death (P = .004); believing that body integrity should be preserved after death (P < .001); believing that part of the deceased continues to live through the organ recipients (P = .001); and being concerned about mutilation after donation (P < .001). CONCLUSIONS The WTD the organs of a deceased next of kin in the Iasi population, even when the deceased had positive attitudes on the matter, is lower than that reported by other studies in other European countries. It is mainly influenced by knowledge and concerns regarding the posthumous manipulation of the body. Consent in a potential donation situation also depends on the way in which the medical staff interacts with the bereaved family.

The health mediators-qualified interpreters contributing to health care quality among Romanian Roma patients

In order to assure optimal care of patients with chronic illnesses, it is necessary to take into account the cultural factors that may influence health-related behaviors, health practices, and health-seeking behavior. Despite the increasing number of Romanian Roma, research regarding their beliefs and practices related to healthcare is rather poor. The aim of this paper is to present empirical evidence of specificities in the practice of healthcare among Romanian Roma patients and their caregivers. Using a qualitative exploratory descriptive design, this study is based on data gathered through three focus groups with 30 health mediators in the counties of Iasi and Cluj (Romania). We identified various barriers to access to healthcare for Roma patients: lack of financial resources and health insurance coverage, lack of cognitive resources or lack of personal hygiene, but also important cultural issues, such as the shame of being ill, family function, disclosure of disease-related information, patient’s autonomy, attitudes towards illness and health practices, that should be considered in order to create a culturally sensitive environment in Romanian medical facilities:… The role of the health mediators within the context of cultural diversity is also discussed, as cultural brokers contributing to health care quality among Romanian Roma patients Bridging cultural differences may improve patient–healthcare provider relationships, but may have limited impact in reducing ethnic disparities, unless coupled with efforts of Roma communities to get involved in creating and implementing health policies.

Council of International Organizations for Medical Sciences

The Council for International Organizations of Medical Sciences (CIOMS) is an international, nongovernmental and nonprofit organization that was created in 1949 by the World Health Organization (WHO) and The United Nations Scientific and Cultural Organization (UNESCO). In 2010, CIOMS brought together over 55 international and national organizations from biomedical disciplines, national academies of sciences and medical research councils. Through its activities, CIOMS seeks to facilitate and promote international activities in biomedical sciences, by maintaining relations with the United Nations and its specialized agencies, especially WHO and UNESCO.

Gas Gangrene: Case Presentation and Literature Data

Although a disease with a particularly historical, war-related implication, gas gangrene still retains its importance in pathology through its highly severe prognosis and rapid death in the absence of immediate treatment. The most common occurrences of the infection in times of peace are traffic accidents and natural disasters, but this can also occur in a non-traumatic context, in carcinomas and digestive tract ulcers or diabetes. The most commonly cited etiological agent is Clostridium perfringens, but other anaerobic germs as well as various aero-anaerobic associations may be responsible for the appearance of gangrene. The accumulation of gas bubbles through the action of etiological agents, highlighted by the presence of crevices or radiological examinations, is the hallmark of this condition. In this paper, the authors present the case of a 26-year-old man who died as a result of the gas gangrene with a rapid evolution (60 hours), which occurred in the progress of a soil telluric wound in the right thigh despite doctors’ efforts. The authors emphasize the importance of suspicion of the possibility of the occurrence of gangrene in wounds contaminated with vegetal remains or soil, on the one hand because the pathognomonic sign appears at an advanced stage of the infection and on the other hand because the prophylactic, surgical and medicinal treatment together with the resuscitation measures may be life-saving when applied in a timely manner.

Clinical diagnosis versus autopsy diagnosis in head trauma

Abstract The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis- missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis- missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures (17.9%). Conclusions: The clinical cause of death is not always concordant with the autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

Traumatic spinal cord injuries – epidemiologic and medico-legal issues

Abstract Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region), type of lesions (vertebral, spinal cord, association with other trauma), circumstances leading to trauma (cause of the injury, season), data regarding hospitalization (medical condition at the hospital admission, number of days of hospitalization, clinical diagnosis, imaging exploration level) and data resulting from autopsy (diagnosis, toxicological examination). Most of our results are consistent with literature data, except for some epidemiological items, which might be explained with cultural differences, life style and inhomogeneous population. Based on our results, the general conclusion is the need for prevention campaigns, focusing on road traffic accidents and falls (especially in elderly) as the main causes of spinal cord injuries.

Drug related deaths between 2008 and 2011. A retrospective study in 32 Romanian counties

The purpose of this study is to determine the pattern of drug related deaths in Romania between 2008 and 2011 by analyzing the medical-legal cases, from a significant proportion of Romanian Counties (out of 41 plus the capital), in which the direct causal link between drug overdose and death was drug related. Material and methods. 446 forensic toxicology cases were analyzed in a four year period, obtained from more than two thirds of the counties in Romania. Results. 54.26% yielded a positive toxicological analysis, most often with benzodiazepines, opiates, barbiturates and cannabinoids. Males around 31 years old represented the most affected group. Illegal drug related deaths were more frequent in males and non-illegal drug related deaths were proportionally more frequent in females. Discussions and conclusions. The pattern of consumption is similar to the one obtained by similar studies in neighboring countries. The city capital has a very distinct pattern of consumption compared to other cities/counties.