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Laurentiu Lucaci

Latest posts by Laurentiu Lucaci (see all)

  • Models of decision making in pediatrics – part I - 23/07/2015
  • MODELE DE LUARE A DECIZIILOR IN PEDIATRIE – PARTEA I - 23/07/2015
  • Models of decision making in pediatrics – part II - 22/07/2015

Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Models of decision making in pediatrics – part I

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 1, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Models of decision making in pediatrics – part I

Stefana Maria Moisa, Rodica Gramma, Andrada Pârvu, Silvia Dumitraş, Mariana Enache, Gabriel Roman, Laurentiu Lucaci and Beatrice Ioan

ABSTRACT

Until recently, the parent was considered to be the legal guardian of the minor aged less than 18-21 years worldwide, thus being entitled and obligated to make medical decisions for the minor. But experience has showed that this model of decision making may not always work in the best interest of the child, especially when parents are part of extremist religious groups. The next step in pediatric decision making ethics was represented by the ability of the doctors to sue parents that refused treatment that was necessary to the child for religious reasons, which was followed by introducing the concept of “emancipated minor”, able to make his/her own healthcare decisions. Recently, British Columbia and New Brunswick regions of Canada have adopted a law that allows “capable” minors to make decisions concerning their own healthcare, the ability to make such decisions being evaluated by the doctor and not depending on the child’s age, but on the degree of his/her neurocognitive development. Paradoxically, this model increases the responsibility of the doctor, who has to evaluate if the minor is competent to make such decisions and if the decision that was made is in the patient’s best medical interest. In this context, the doctor might not be aware of certain social, cultural and religious aspects that might guide the minor’s decision, and this model does not eliminate medical paternalism, but it offers it new faces. The Dutch legislation permits euthanasia of competent persons aged more than 12, that request the active ending of their own life. Recently, this country has adopted the Groningen Protocol, a series of medical guidelines that allow the euthanasia on newborns with incurable diseases and a predicted deficient life quality. Those who oppose this protocol state that applying it opens the way to eugenics. World legislation is heterogeneous regarding pediatric decision making. Each of the presented models has apparently insurmountable deficiencies. This paper was written during the Project “Postdoctoral Studies in the Field of Health Policies Ethics” POSDRU/89/1.5/S/61879 cofinanced by the Social European Fund through the Sectorial Operational Program for Human Resources Development, 2007-2013.

Key words: decision making, pediatrics

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Stefana Maria Moisa

MODELE DE LUARE A DECIZIILOR IN PEDIATRIE – PARTEA I

SELECT ISSUE

Revista Romana de PEDIATRIE | Volumul LXII, Nr. 1, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ICMJE- Recommendations

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Promoting Global Health

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MODELE DE LUARE A DECIZIILOR IN PEDIATRIE – PARTEA I

Stefana Maria Moisa, Rodica Gramma, Andrada Pârvu, Silvia Dumitraş, Mariana Enache, Gabriel Roman, Laurentiu Lucaci and Beatrice Ioan

REZUMAT

Până recent, în întreaga lume se considera că părintele este tutorele legal al copilului cu vârsta mai mică de 18-21 ani, acest lucru atragând după sine dreptul şi obligaţia de a lua decizii medicale în numele minorului. Experienţa a arătat, însă, că acest model de luare a deciziilor poate să nu lucreze întotdeauna în interesul copilului, în special în situaţia în care părinţii fac parte din anumite grupuri religioase. Următorul pas în etica luării deciziilor în pediatrie a fost reprezentat de posibilitatea medicilor de a acţiona în instanţă părinţii care refuzau tratamentul necesar copiilor din motive religioase, etapă urmată de aceea a introducerii conceptului de „minor emancipat“, capabil de a lua decizii privind propria sănătate. Recent, în Canada, regiunile British Columbia şi New Brunswick au adoptat o lege care permite minorilor „capabili“ să ia decizii privind propria sănătate, capacitatea de luare a deciziilor fiind evaluată de medic şi nedepinzând de vârsta copilului, ci de gradul de dezvoltare neurocognitivă a acestuia. Acest model creşte, în mod paradoxal, responsabilitatea medicului, care trebuie să evalueze dacă minorul este competent decizional şi dacă decizia luată de acesta este în acord cu propriul interes al copilului din punct de vedere medical. În acest context, medicul poate fi depăşit de unele aspecte sociale, culturale şi religioase care ar ghida decizia minorului, iar acest model nu elimină paternalismul în medicină, ci doar îi oferă alte valenţe. Legislaţia olandeză permite euthanasia în cazul persoanelor competente, cu vârsta mai mare de 12 ani, care solicită întreruperea activă a propriei vieţi. Recent, această ţară a adoptat Protocolul Groningen, o serie de ghiduri medicale şi legale care permit euthanasia nou-născuţilor cu boli incurabile şi cu o calitate prezisă a vieţii deficitară. Opozanţii protocolului afirmă faptul că aplicarea acestuia deschide drumul spre eugenie. Legislaţia mondială este heterogenă în ceea ce priveşte luarea deciziilor medicale la copil. Fiecare dintre modelele prezentate are deficienţe aparent insurmontabile. Această lucrare a fost realizată în cadrul Proiectului „Studii postdoctorale în domeniul eticii politicilor de sănătate“ POSDRU/89/1.5/S/61879 cofinanţat din Fondul Social European prin Programul Operaţional Sectorial pentru Dezvoltarea Resurselor Umane 2007-2013.

Cuvinte cheie: luarea deciziilor, pediatrie

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Stefana Maria Moisa

Models of decision making in pediatrics – part II

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 2, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

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Models of decision making in pediatrics – part II

Stefana Maria Moisa, Rodica Gramma, Andrada Pârvu, Silvia Dumitraş, Mariana Enache, Gabriel Roman, Laurentiu Lucaci and Beatrice Ioan

ABSTRACT

Until recently, the parent was considered to be the legal guardian of the minor aged less than 18-21 years worldwide, thus being entitled and obligated to make medical decisions for the minor. But experience has showed that this model of decision making may not always work in the best interest of the child, especially when parents are part of extremist religious groups. The next step in pediatric decision making ethics was represented by the ability of the doctors to sue parents that refused treatment that was necessary to the child for religious reasons, which was followed by introducing the concept of “emancipated minor”, able to make his/her own healthcare decisions. Recently, British Columbia and New Brunswick regions of Canada have adopted a law that allows “capable” minors to make decisions concerning their own healthcare, the ability to make such decisions being evaluated by the doctor and not depending on the child’s age, but on the degree of his/her neurocognitive development. Paradoxically, this model increases the responsibility of the doctor, who has to evaluate if the minor is competent to make such decisions and if the decision that was made is in the patient’s best medical interest. In this context, the doctor might not be aware of certain social, cultural and religious aspects that might guide the minor’s decision, and this model does not eliminate medical paternalism, but it offers it new faces. The Dutch legislation permits euthanasia of competent persons aged more than 12, that request the active ending of their own life. Recently, this country has adopted the Groningen Protocol, a series of medical guidelines that allow the euthanasia on newborns with incurable diseases and a predicted deficient life quality. Those who oppose this protocol state that applying it opens the way to eugenics. World legislation is heterogeneous regarding pediatric decision making. Each of the presented models has apparently insurmountable deficiencies. This paper was written during the Project “Postdoctoral Studies in the Field of Health Policies Ethics” POSDRU/89/1.5/ S/61879 cofinanced by the Social European Fund through the Sectorial Operational Program for Human Resources Development, 2007-2013.

Key words: decision making, pediatrics

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Stefana Maria Moisa

MODELE DE LUARE A DECIZIILOR IN PEDIATRIE – PARTEA A II-A

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 2, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

DOI - Crossref
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DOAJ
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HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

Partners

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MODELE DE LUARE A DECIZIILOR IN PEDIATRIE – PARTEA A II-A

Stefana Maria Moisa, Rodica Gramma, Andrada Pârvu, Silvia Dumitraş, Mariana Enache, Gabriel Roman, Laurentiu Lucaci and Beatrice Ioan

REZUMAT

Până recent, în întreaga lume se considera că părintele este tutorele legal al copilului cu vârsta mai mică de 18-21 ani, acest lucru atrăgând după sine dreptul şi obligaţia de a lua decizii medicale în numele minorului. Experienţa a arătat, însă, că acest model de luare a deciziilor poate să nu lucreze întotdeauna în interesul copilului, în special în situaţia în care părinţii fac parte din anumite grupuri religioase. Următorul pas în etica luării deciziilor în pediatrie a fost reprezentat de posibilitatea medicilor de a acţiona în instanţă părinţii care refuzau tratamentul necesar copiilor din motive religioase, etapă urmată de aceea a introducerii conceptului de „minor emancipat“, capabil de a lua decizii privind propria sănătate. Recent, în Canada, regiunile British Columbia şi New Brunswick au adoptat o lege care permite minorilor „capabili“ să ia decizii privind propria sănătate, capacitatea de luare a deciziilor fi ind evaluată de medic şi nedepinzând de vârsta copilului, ci de gradul de dezvoltare neurocognitivă a acestuia. Acest model creşte, în mod paradoxal, responsabilitatea medicului, care trebuie să evalueze dacă minorul este competent decizional şi dacă decizia luată de acesta este în acord cu propriul interes al copilului din punct de vedere medical. În acest context, medicul poate fi depăşit de unele aspecte sociale, culturale şi religioase care ar ghida decizia minorului, iar acest model nu elimină paternalismul în medicină, ci doar îi oferă alte valenţe. Legislaţia olandeză permite euthanasia în cazul persoanelor competente, cu vârsta mai mare de 12 ani, care solicită întreruperea activă a propriei vieţi. Recent, această ţară a adoptat Protocolul Groningen, o serie de ghiduri medicale şi legale care permit euthanasia nou-născuţilor cu boli incurabile şi cu o calitate prezisă a vieţii deficitară. Opozanţii protocolului afirmă faptul că aplicarea acestuia deschide drumul spre eugenie. Legislaţia mondială este heterogenă în ceea ce priveşte luarea deciziilor medicale la copil. Fiecare dintre modelele prezentate are deficienţe aparent insurmontabile. Această lucrare a fost realizată în cadrul Proiectului „Studii postdoctorale în domeniul eticii politicilor de sănătate“ POSDRU/89/1.5/S/61879 cofinanţat din Fondul Social European prin Programul Operaţional Sectorial pentru Dezvoltarea Resurselor Umane 2007-2013.

Cuvinte cheie: luare a deciziilor, pediatrie

Full text | PDF

Stefana Maria Moisa

LIPOSARCOM OSOS PRIMAR LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

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HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

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LIPOSARCOM OSOS PRIMAR LA COPIL

Ingrid Miron, Gabriel Aprodu, Doina Mihaila, Petru Plamadeala, Oana Tatiana Miron, Anamaria Ciubara, Lucian Miron, Marin Burlea, Stefana Maria Moisa and Laurentiu Lucaci

REZUMAT

Introducere. Deşi liposarcomul de ţesuturi moi este o tumoră frecventă, liposarcomul primar osos este foarte rar, fi ind localizat în special în oasele lungi.

Material şi metodă. Prezentăm cazul unei paciente în vârstă de 14 ani, spitalizată în Spitalul Clinic de Urgenţă pentru Copii „Sfânta Maria“ din Iaşi pentru durere, impotenţă funcţională şi tumefacţia bratului drept, simptome ce au debutat cu 24 de ore anterior internării, ca urmare a unui traumatism prin cădere al braţului drept. Radiografi a osoasă a evidenţiat o masă tumorală în porţiunea proximală a humerusului, asociată cu o fractură patologică.

Rezultate. S-a realizat o biopsie la nivelul tumorii, iar analiza anatomopatologică (histologică şi imunochimică) a documentat proliferare liposarcomatoasă malignă.

Concluzie. Diagnosticul anatomopatologic fi nal, corelat cu examenul fi zic, care a exclus posibilitatea unei metastaze osoase liposarcomatoase, a fost aceea de liposarcom primar osos. Particularitatea cazului: tumoră foarte rară, cu prezentare iniţială de fractură osoasă patologică. În stabilirea diagnosticului de liposarcom osos primar, trebuie exclusă posibilitatea unei metastaze de la un liposarcom cu localizare iniţială extraosoasă, ca şi pe cea a unui alt tip de tumoră osoasă primară. Prognosticul pare a fi mai favorabil decât cel al osteosarcomului, dar liposarcomul prezintă o rată mai mare de recurenţe locale şi diseminări sistemice.

Cuvinte cheie: os, liposarcom, copil

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Ingrid Miron

PRIMARY BONE LIPOSARCOMA IN CHILDREN

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

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HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

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PRIMARY BONE LIPOSARCOMA IN CHILDREN

Ingrid Miron, Gabriel Aprodu, Doina Mihaila, Petru Plamadeala, Oana Tatiana Miron, Anamaria Ciubara, Lucian Miron, Marin Burlea, Stefana Maria Moisa and Laurentiu Lucaci

ABSTRACT

Introduction. Even though the soft tissue liposarcoma is a frequent tumor, the primary bone liposarcoma is very rare, being localized especially in the long bones.

Material and meyhod. We present the case of a 14 years old female child, hospitalized in the „Sf. Maria“ Emergency Clinic Hospital for Children Iasi accusing pain, functional impairment and tumefaction in the right arm, symptoms which suddenly occurred about 24 hours prior to presentation, following a falling trauma on the right arm. The bone x-ray emphasized a tumor in the proximal part of the humerus bone, associated with a pathological fracture.

Results. A biopsy form the tumor was performed and the pathology report (histology and immunohistochemistry) documented a malignant liposarcomatous proliferation.

Conclusion. The final pathology diagnosis, correlated with the clinical findings, which excluded the possibility of a bone metastasis, was that of a primary bone liposarcoma. Case particularity: very rare tumor, witch presented with a pathological bone fracture. In establishing the diagnosis of a bone liposarcoma it is very important to exclude a bone metastasis from a liposarcoma with a primary localization other than the bone, as well as other primary bone tumors. The prognosis seems to be better than in the osteosarcoma but liposarcoma presents a higher rate of local recurrence and systemic dissemination.

Keywords: bone, liposarcoma, child

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Ingrid Miron


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