THERAPEUTISCHE UMSCHAU最新文献

Introduction: Legal aspects play an increasingly big role in everyday medical practice. This can lead to uncertainties when dealing with medicolegal issues, which could negatively impact the healthcare system and its involved parties. In this study, the medicolegal knowledge of medical students and physicians in Switzerland was examined to give recommendations for undergraduate, postgraduate and further education. A survey was conducted to assess how comfortable individuals feel when dealing with medicolegal issues, and their medicolegal knowledge was tested using case vignettes. Participants generally felt «rather uncomfortable» to be confronted with medicolegal issues. The results of the case vignettes suggest some medicolegal knowledge. However, there were indications of lack of knowledge or incorrect knowledge across almost the entire range of the topics surveyed. In undergraduate, postgraduate and further education, it seems appropriate to focus on the topics insurance and patient rights. Nevertheless, a generally more comprehensive medicolegal education can be considered important. In addition to medicolegal theory, its practical application should be taught as well. A more comprehensive medicolegal education should be seen as one of various approaches to address the uncertainty when facing medicolegal issues.

Introduction: The legal framework in Switzerland regarding medicine and health care is complex. Switzerland doesn't have a specific federal law on medicine or health care. Instead, numerous legal provisions apply to very different medical and health care situations. There are regulations located at different hierarchical legal levels with a variety of international, national and cantonal regulations, as well as the (soft) law of the medical profession. Under federalism and the principle of subsidiarity, the Swiss Federal Parliament is only responsible for the federal legal re-gulations where the Swiss Federal Constitution grants it the power to do so. The 26 cantons of Switzerland are responsible for all other matters. Therefore, the cantons have enacted specific health laws, patient laws and other regulations relevant to the medicine and health care sector. In addition, the Swiss Criminal Code is particularly relevant to medical treatments. The Swiss Criminal Code punishes, among others, assaults on life and physical integrity. Criminal liability is an individual responsibility and is determined by whether the requirements for criminal behavior are met in the individual case.

Introduction: Pharmaceutical products and medical devices can pose a potenzial risk to health. They may therefore only be placed on the market if their safety, efficacy and quality have been proven. The safety requirements are not to be understood as absolute. Rather, the safety assessment is based on a risk-benefit assessment. Pharmaceutical products and medical devices are subject to different requirements, whereby pharmaceutical products are subject to an authorization procedure, while medical devices have to undergo a conformity assessment procedure. This article first sets out the basic principles and the system of therapeutic products law and discusses the categorization of pharmaceutical products and medical devices as well as their differentiation from other products, in particular foodstuffs and cosmetics. The main features of placing pharmaceutical products on the market are then presented, with a focus on the authorization procedures for pharmaceutical products. This article also provides a brief overview of the protection rights for pharmaceutical products. In addition to the protection rights under the Therapeutic Products Act, the regulatory data protection, there are also protection rights under intellectual property law. In addition to the patent, intellectual property law grants another protection right for products that require an authorization in order to be placed on the market. The supplementary protection certificate, which is only granted to medicinal products and plant protection products as products that require an authorization, is intended to partially compensate for the lack of possibility of using the patented invention during the approval process. Due to the scope of the medicinal products and intellectual property law regulations mentioned, this article must limit itself to selected areas in an overview.

Introduction: Swiss medical law is based on a clear distinction between substantive and procedural law. Substantive law defines the material rights and duties of persons and institutions, while procedural law regulates the procedures for enforcing these rights. In addition, Swiss law distinguishes between objective law, which represents the totality of legal norms, and subjective law, which defines individual rights and powers. Private regulations such as the FMH Code of Professional Conduct or the SAMS guidelines supplement state medical law and set ethical standards. In social insurance law, the definition of illness (Art. 3 para. 1 ATSG) plays a central role, which is substantiated by case law. The interplay of legal requirements, private-law regulations and clear procedural standards ensures high-quality and legally sound medical practice in Switzerland.

Introduction: Due to the development of digitalisation and information technology, medicine is subject to constant change. This development raises many new legal questions, most of which are still unanswered. This article first looks at the subarea of telemedicine and its regulation in federal and cantonal law and the question of the extent to which telemedicine is legally permissible. The particular focus here is on the doctor's perspective. Furthermore, this article deals with digital healthcare from the perspective of data protection law. Due to the central position of personal data in medicine, this area has become an integral part of everyday medical practice. This article provides a brief overview of this extensive field and highlights the most important key points of data protection law. Finally, this article uses a case study to address the question of the extent to which digital health applications should be considered medical devices. In practice, it is often very difficult to determine in advance whether such a digital health application is to be considered a medical device and is therefore subject to stricter regulations. The most important conditions in this regard are then presented and analysed.

Introduction: The basic principles of medical liability in Switzerland are the same regardless of whether a physician is self-employed or employed. The first part of this article provides an overview of the jurisdiction of the Federal Supreme Court on the requirements for medical liability under civil law and state liability law, which is aimed at financial compensation for damages suffered by patients. The second part describes the insurance cover and important obligations that the physician has in the event of a claim. The third part of the article contains recommendations developed from the practice of a hospital on what to do after a possible medical error.

Introduction: Medical confidentiality protects the patient's privacy and medical data with criminal consequences in the event of a breach. It continues to exist even after the end of professional practice. Exceptions apply with the patient's consent or official authorisation. This paper describes various reporting obligations, e.g. in the case of exceptional deaths, abortions, communicable diseases and significant injuries caused by dogs. There are also reporting rights, e.g. for children or adults who are at risk. Some reports must be made anonymously, others require full patient details to be provided. Violations of the reporting obligations are punishable by law.

Introduction: The development of Swiss medical law is closely linked to social and medical development. In the early days and in the Middle Ages, healers and monasteries shaped medical care, with canon law playing an important role. In the early modern period, the first regional regulations for the medical profession emerged. With the founding of the federal state in 1848, the modernisation of medical law began; important laws such as the Factory Act (1877) and the first Health Insurance Act (1911) were introduced. In the 20th century, the introduction of the AHV/IV (1948) and the Health Insurance Act (KVG, 1996) marked the beginning of further professionalisation. Medical law is currently being adapted to meet modern ethical and legal challenges through laws such as the Human Research Act (2014) and remains a dynamic field.

Introduction: Gout, the most common arthritis worldwide, is closely linked to cardiovascular disease and metabolic syndrome. The most impor-tant risk factor for developing gout is hyperuricemia. Serum uric acid is the end product of purine metabolism and can be partially influenced by dietary changes. Since a quarter of serum uric acid is excreted via the intestine, there is also a connection with diet here - keyword microbiome. Recently, genetic predispositions and drug therapy for gout have come to the fore. However, since cardiovascular comorbidities exist in high frequency, a dietary adjustment also makes sense to improve the comorbidities. Recently, the focus has shifted away from simply reducing purine intake in favor of introducing a largely plant-based diet. Reducing alcohol consumption makes sense for many reasons but does not lead to a significant reduction in serum uric acid. In addition to drug therapy, however, all possibilities should be exploited to enable a rapid reduction in serum uric acid to the target range; a change in diet can contribute to this. A change in diet can also have a positive effect on the frequency of gout flares. Targeted, structured information for patients promotes their knowledge of the disease and motivation to achieve their serum uric acid (SUA) goal. The right diet may be the personal contribution to quickly reaching the SUA target level and freedom from gout flares.

Introduction: The treatment of gout includes anti-inflammatory therapy and prophylaxis of flare-ups on the one hand and measures for long-term uric acid reduction on the other. Acute arthritis urica is best relieved by intra-articular steroids; systemic steroids, NSAIDs and, in exceptional cases, colchicine are also suitable. For the prophylaxis of relapses, long-term use of colchicine, NSAIDs or low-dose steroids is an option. However, the main pillar of gout therapy is pharmacological reduction of uric acid. The xanthine oxidase inhibitors allopurinol and febuxostat are best suited. The goal is a serum uric acid below 360 µmol/l ("treat to target"). The «start low, go slow» strategy reduces the risk of relapses and, in the case of allopurinol, the occurrence of hypersensitivity syndrome. Allopurinol is started at a maximum of 100 mg/d (less in renal insufficiency), followed by a slow upward titration to the required maintenance dose, which may largely exceed 300 mg/d (also in renal insufficiency). Febuxostat is started at a maximum of 40 mg/d and also titrated upwards. The most common cause of insufficient uric acid reduction is unreliable medication intake. In the management of gout, its comorbidities should also be sought and addressed.