On 9th January 2008, new legislative changes concerning civil liability insurance (CLI) for physicians were implemented. There are three insurance options available, two of them compulsory. Compulsory CLI is advised to doctors in private practice who provide health services refunded by the National Health Fund. Additional agreement of insurance includes injury toa person, damage to property, as well as the legal responsibility of the physician. The voluntary insurance policy is an excellent complement of compulsory insurance policies when doctors work on the contract basis, fee-for-task agreement, in private medical practice as well as they are employed on the contract basis in independent healthcare centers.

The author of this article points out that ethical standards should be strongly introduced into medical practice. It has been of great importance since the involvement of the medical chambers in this field hasnot been satisfactory for the medical community. Medical staff cooperating with pharmaceutical or medical companies may be exposed to corruption. Unequalaccess to the same-standard medical care for patients is not rarely seen. The author attempts to show the background of corporate loyalty that often conflicts with ethical standards in medicine.

This article presents an enterprise establishing procedure for physicians in Poland. It describes step bystep enterprise registration stages. Different offices involved in registration procedures are described and documentation to be submitted is presented. Specific requirements for physicians are stressed.

This article presents the Polish regulations and corresponding provisions of the EC law concerning relationship between healthcare professionals and pharmaceutical companies. It deals in particular with the issue regarding promotional actions undertaken by pharmaceutical companies towards medical doctors and pharmacists, which include, among others: handingover of promotional gifts, sponsoring of scientific congresses (hold both domestically and abroad), providing samples of medicinal products and promotional meetings. Moreover, the article shows that the Polish and EC law in general do not preclude remunerated cooperation between pharmaceutical companies, MDs and pharmacists – e.g. during post-marketing, epidemiologicalor clinical surveys or providing expertise on requested subject. There are, however, certain limitations to the scope of allowed interactions – MDs cannot be paid for prescribing medicinal products and the range of promotional gifts which may be delivered to healthcare professionals is strictly limited.

The article defines the field of pediatric psychology as a science and aims to describe the role of the pediatric psychologist within the medical team. It also presents the ways of providing psychological help in the context of the individual situations of patients and their families (crisis intervention, counseling, various formsof psychotherapy, etc). The summary highlights the advantages of cooperation between the pediatric psychologist and the medical team.

We present the case of 12 years-old-boy with the onsetof acute pericardit is 10 days after the scarlet fever. A sharp, stabbing chest pain, radiating to the left shoulde rand dyspnea, worsening in supine position anddeep inspiration, were the leading symptoms. Despite the pharmacological treatment with nonsteroidal antiinflammatory drugs, diuretics, antibiotics the symptomsof cardiac tamponade occurred. Patient required pericardiocentesis with pericardial drainage. After 8 weeks he presented with pericarditis and pleuropneumonia. Pharmacological treatment was administered with good clinical effect. During the first hospitalization the streptococcal infection was considered asthe probable cause of pericarditis. Analyzing recurrent nature of pericarditis, positive antinuclear antibodies at low titers in the pericardial fluid and serum, the immune etiology of pericarditis, especially collagent issue diseases, should be considered in differential diagnosis.

Rheumatic fever is an autoimmunological complication of pharyngitis caused by beta-hemolytic StreptococcusA. We describe a case of a 10-year-old boy with acute rheumatic fever /RF/ with coexisting bilateralpneumonia and post-streptococcal glomerulonephritis. The diagnosis of RF was based on arthritis and carditis with mitral valve insufficiency. The boy was treated with antibiotics, prednisone and salicylate. Clinical symptoms resolved soon. At the follow upevaluations isolated erythrocyturia has been observed. Subsequent echocardiography did not revealmitral valve insufficiency. As a secondary RF prophylaxis and due to penicillin intolerance with recurrentarthralgia patient remains on a long-term salicylate therapy.

The authors review current opinions on the management with a child with arrhythmia. The role of pediatricians and family doctors in diagnosis and treatment of arrhythmia in these patients is discussed.

The number of children with congenital heart diseases, who require complex medical care to achieve normal physical development, has increased recently. Immunization of children with congenital heart diseases isa part of general medical care. The diagnosis of congenital heart disease it self is not a contraindication for vaccination. Clinical conditions that exclude fromvaccination schedule have to fulfill the criterion of the absolute contraindication. Prevention of infectious diseases is based on either passive or active immunization. Passive immunizationis rational when vaccine is not efficient or when the patient may be exposed to infection without having sufficient vaccinations given. The aim of an active immunizationis to initiate immunological response. Children with congenital heart diseases should, apart fromthe obligatory immunization schedule, undergo also pneumococcal and influenza vaccinations. Immunization schedule can be conducted by general practitioners if only the child remained in stable hemodynamic, neurological and immune condition and there were no contraindications for vaccinations or past adverse events. In case of any diagnostic difficulties that might cause vaccination delay the child should be referred to specialized out-patient clinic.

The article presents current possibilities of prenatal diagnosis in severe congenital heart malformations. Prenatal diagnosis seems to be crucial for neonates with congenital heart defects. There are studies suggesting that early prenatal diagnosis may improve results of treatment and further physical growth. Severecon genital heart defects like transposition of the great arteries or aortic coarctation are still rarely diagnosed in the prenatal period.

Incidence of influenza, unlike many other infectious diseases, is seasonal and comprises 5-25% of the total world population. Post-influenza complications and mortality may affect even one million patients annually. The most effective way to stop the epidemic ofinfluenza is prophylaxis, especially vaccinations. There have been various methods of quick viral diagnostics available for many years. They are claimed to be cost effectiveand beneficial for patients. New anti-influenza drugs as neuraminidase inhibitors give opportunity to treat persons with influenza virus infection andavoid life-threatening complications.

General recommendations on immunizations are one of the most important topics in the daily practice of afamily doctor. Decisions considering the vaccinations must be consistent with the national Program of Immunizations (NPI), which is created according to the current epidemiological situation. The only recommended minimal interval between two doses of vaccinesis 28 days in case of two live vaccines. The intervals between two doses of the same vaccine must followthe recommendations of the manufacturer. The next dose must not be given earlier than 4 days before the scheduled date. During the vaccination schedule the same vaccine should be used unless the vaccine is notavailable. the anaphylactic reaction to the previousdose or to the components of the vaccine is the most important contraindication to vaccination. The use oflive vaccines in persons with severe immunodeficiency is also contraindicated. Preterm infants should be vaccinated according to the chronologic age as full terminfants. In managing the injection pain breast feedingor sucrose solution may be used. Also some topical anesthetic may be helpful. Health professionals must be prepared to manage some allergic reactions including anaphylactic shock. All Adverse Events Following Immunizations (AEFI) must be reported to the properinstitutions.