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Kaplan A, Kaçmaz HY, Öztürk S. An Evaluation on the Attitude Toward Using Patient Rights and Satisfaction Levels in Emergency Department Patients. J Emerg Nurs 2024; 50:243-253. [PMID: 38127045 DOI: 10.1016/j.jen.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In emergency health care services, patient satisfaction is one of the fundamental indicators of quality emergency care, making it essential to identify factors that can impact this component of care. This study aimed to determine emergency service patients' attitudes toward using patient rights, their satisfaction levels with emergency service, and related factors. METHODS The cross-sectional study was conducted with 382 patients who presented to the emergency department between November 2022 and March 2023. Data were collected using the Patient Description Form, the Emergency Department Patient Satisfaction Scale, and the Scale of Patient Rights Using Attitude. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting. RESULTS The mean score of the Emergency Department Patient Satisfaction Scale was 53.88 ± 6.88 (minimum score, 30; maximum score, 68), and the mean score of the Scale of Patient Rights Using Attitude was 108.89 ± 11.90 (minimum score, 73; maximum score, 135). As a result of the regression analysis, it was found that the Scale of Patient Rights Using Attitude scores and frequency of ED visits significantly contributed to the Emergency Department Patient Satisfaction Scale scores. Younger patients who had higher educational status presented to the emergency department more frequently and had chronic diseases were associated with positive attitudes about using patient rights and had higher levels of ED patient satisfaction (P < .001). DISCUSSION The study has provided valuable information for assessing the attitudes of ED patients toward exercising their patient rights and their satisfaction levels. Respect for patient rights and their effective utilization by patients can enhance the quality of ED services and increase patient satisfaction.
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Zirnsak TM, Ng AH, Brasier C, Gray R. Public involvement in Australian clinical trials: A systematic review. Clin Trials 2024:17407745231224533. [PMID: 38408931 DOI: 10.1177/17407745231224533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Public involvement enhances the relevance, quality, and impact of research. There is some evidence that public involvement in Australian research lags other countries, such as the United Kingdom. The purpose of the systematic review was to establish the rates and describe the characteristics of public involvement in Australian clinical trials. METHODS We reviewed evidence of public involvement in all Australian randomised controlled trials published in the first 6 months of 2021. To determine the quality of public involvement, we used the five-item short-form version of the Guidance of Reporting Involvement Patients and the Public, version 2. RESULTS In total, 325 randomised controlled trials were included, of which 17 (5%) reported any public involvement. Six trials reported public involvement in setting the research aim and seven in developing study methods. The authors of one study reflected on the overall role and influence of public involvement in the research. CONCLUSION Rate of public involvement in Australian clinical trials is seemingly substantially lower than those reported in countries with similar advanced public health care systems, notably the United Kingdom. Our observations may be explained by a lack of researcher skills in how to involve the public and the failure by major funding agencies in Australia to mandate public involvement when deciding on how to award grant funding.
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Affiliation(s)
- Tessa-May Zirnsak
- Social Work and Social Policy, La Trobe University, Melbourne, VIC, Australia
| | - Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
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Melville C, Corbin B. Sexual and reproductive health rights in Australia: we have much to celebrate but must not be complacent. Med J Aust 2024; 220:112-114. [PMID: 38130239 DOI: 10.5694/mja2.52194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
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Graziane JA, Ghahramani A, Bowen JL, Horton S, Swigart A, Kunkel E, Dalke KB. Psychiatry's Obligation to Promote Voting Among Patients With Mental Illness. Psychiatr Serv 2023; 74:1291-1293. [PMID: 37287229 DOI: 10.1176/appi.ps.20230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The American Medical Association adopted a resolution in June 2022 recognizing voting as a social determinant of health. As psychiatric professionals and trainees with experience in civic health, the authors argue that psychiatrists must consider the relationship between voting and mental health as part of care delivery. People with psychiatric illness can experience unique barriers to voting and garner mental health benefits from civic engagement. Provider-led activities to promote voting are accessible and simple. Given the benefits of voting, and the availability of interventions to foster voter engagement, psychiatrists have an obligation to promote voting access among their patients.
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Affiliation(s)
- Julie A Graziane
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Aria Ghahramani
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Joy Luther Bowen
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Sarah Horton
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Alison Swigart
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Elisabeth Kunkel
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Katharine B Dalke
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
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Teymori E, Tabatabaee SS, Akhlaghi S, Delavarinejad A, Kokabisaghi F. The assessment of health system responsiveness from the viewpoints of COVID-19 patients. BMC Health Serv Res 2023; 23:909. [PMID: 37620841 PMCID: PMC10463996 DOI: 10.1186/s12913-023-09806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients. METHODS This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used. RESULTS In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information. CONCLUSION The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.
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Affiliation(s)
- Ehsan Teymori
- Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Saeed Tabatabaee
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Akhlaghi
- Biostatistics Department, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azam Delavarinejad
- Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Kokabisaghi
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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Silvestri S, Carnevale F, Cavariani F, Deidda B. [The assessment of asbestos exposure of mesothelioma cases registered in Italy: which problems more than thirty years after the birth of the first regional archives]. Epidemiol Prev 2023; 47:298-305. [PMID: 37846453 DOI: 10.19191/ep23.4-5.a617.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
More than 30 years have passed since the beginning of the epidemiological surveillance of mesothelioma (MM). The Italian National Mesothelioma Register (ReNaM), part of the research department of the National Institute for insurance against industrial injuries (INAIL), has published 7 reports with the description of the cas-es concerning the assessment of diagnoses and exposures to asbestos suffered mainly during working activities but also environmental, in the family premises and during personal activities.Today we are witnessing a reduction in the commitment by some regions which negatively affects those who develop the pathology. Reading the ReNaM reports it emerges, among others, the problem of the delay in reporting new cases which limits the collection of information directly from patients. This contribution, discussing various topics, invites to develop a debate that should allow to update and resolve the critical aspects that arise after decades of activity regarding, in particular, the asbestos exposure assessment. It is the primary interest of the authors to give continuity and improve the ReNaM which remains the most prestigious MM register among those active in other countries.
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Affiliation(s)
- Stefano Silvestri
- Igienista del lavoro, già ISPO Toscana, collaboratore dell'Università del Piemonte Orientale, Novara;
| | | | - Fulvio Cavariani
- Igienista del lavoro, già Centro di riferimento regionale amianto della Regione Lazio
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Williams MJ. Ethical Issues of Psychiatric Consumer Advisory Boards. Psychiatr Serv 2023; 74:671. [PMID: 37259584 DOI: 10.1176/appi.ps.20220504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Putturaj M, Van Belle S, Krumeich A, Ns P, Engel N. "It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India. Int J Equity Health 2023; 22:47. [PMID: 36922856 PMCID: PMC10015129 DOI: 10.1186/s12939-023-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice. METHODS We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes. RESULTS Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India. CONCLUSIONS The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.
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Affiliation(s)
- Meena Putturaj
- Institute of Tropical Medicine, Antwerpen, Belgium. .,Maastricht University, Maastricht, Netherlands. .,Institute of Public Health, Bengaluru, India. .,The University of Transdisciplinary Health Sciences and Technology, Bengaluru, India.
| | | | | | | | - Nora Engel
- Maastricht University, Maastricht, Netherlands
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Toombs MR, Curtis C, Brolan CE. Supporting Indigenous health equity strategic planning: a Queensland perspective. Med J Aust 2023; 218:5-8. [PMID: 36450340 PMCID: PMC10098513 DOI: 10.5694/mja2.51794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Maree R Toombs
- Faculty of Medicine, University of Queensland, Brisbane, QLD
| | - Caitlin Curtis
- Centre for Policy Futures, University of Queensland, Brisbane, QLD.,School of Business, University of Queensland, Brisbane, QLD
| | - Claire E Brolan
- Centre for Policy Futures, University of Queensland, Brisbane, QLD.,School of Public Health, University of Queensland, Brisbane, QLD
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Bialke M, Geidel L, Hampf C, Blumentritt A, Penndorf P, Schuldt R, Moser FM, Lang S, Werner P, Stäubert S, Hund H, Albashiti F, Gührer J, Prokosch HU, Bahls T, Hoffmann W. A FHIR has been lit on gICS: facilitating the standardised exchange of informed consent in a large network of university medicine. BMC Med Inform Decis Mak 2022; 22:335. [PMID: 36536405 PMCID: PMC9762638 DOI: 10.1186/s12911-022-02081-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Federal Ministry of Education and Research of Germany (BMBF) funds a network of university medicines (NUM) to support COVID-19 and pandemic research at national level. The "COVID-19 Data Exchange Platform" (CODEX) as part of NUM establishes a harmonised infrastructure that supports research use of COVID-19 datasets. The broad consent (BC) of the Medical Informatics Initiative (MII) is agreed by all German federal states and forms the legal base for data processing. All 34 participating university hospitals (NUM sites) work upon a harmonised infrastructural as well as legal basis for their data protection-compliant collection and transfer of their research dataset to the central CODEX platform. Each NUM site ensures that the exchanged consent information conforms to the already-balloted HL7 FHIR consent profiles and the interoperability concept of the MII Task Force "Consent Implementation" (TFCI). The Independent Trusted Third-Party (TTP) of the University Medicine Greifswald supports data protection-compliant data processing and provides the consent management solutions gICS. METHODS Based on a stakeholder dialogue a required set of FHIR-functionalities was identified and technically specified supported by official FHIR experts. Next, a "TTP-FHIR Gateway" for the HL7 FHIR-compliant exchange of consent information using gICS was implemented. A last step included external integration tests and the development of a pre-configured consent template for the BC for the NUM sites. RESULTS A FHIR-compliant gICS-release and a corresponding consent template for the BC were provided to all NUM sites in June 2021. All FHIR functionalities comply with the already-balloted FHIR consent profiles of the HL7 Working Group Consent Management. The consent template simplifies the technical BC rollout and the corresponding implementation of the TFCI interoperability concept at the NUM sites. CONCLUSIONS This article shows that a HL7 FHIR-compliant and interoperable nationwide exchange of consent information could be built using of the consent management software gICS and the provided TTP-FHIR Gateway. The initial functional scope of the solution covers the requirements identified in the NUM-CODEX setting. The semantic correctness of these functionalities was validated by project-partners from the Ludwig-Maximilian University in Munich. The production rollout of the solution package to all NUM sites has started successfully.
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Affiliation(s)
- Martin Bialke
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Lars Geidel
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Christopher Hampf
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Arne Blumentritt
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Peter Penndorf
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Ronny Schuldt
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Frank-Michael Moser
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Stefan Lang
- Gefyra GmbH, Otto-Hahn-Str. 9, 48161 Münster, Germany
| | - Patrick Werner
- MOLIT Institute Heilbronn, Im Zukunftspark 10, 74076 Heilbronn, Germany
| | - Sebastian Stäubert
- grid.9647.c0000 0004 7669 9786Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Härtelstr. 16-18, 04107 Leipzig, Germany
- SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Hauke Hund
- grid.461673.10000 0001 0462 6615GECKO Institute, Heilbronn University of Applied Sciences, Max-Planck-Str. 39, 74081 Heilbronn, Germany
| | - Fady Albashiti
- grid.5252.00000 0004 1936 973XMedical Data Integration Center (MeDIC LMU), Hospital of the Ludwig-Maximilian-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Jürgen Gührer
- grid.5252.00000 0004 1936 973XTekaris GmbH (Partner of MeDIC LMU), Elsenheimerstraße 53, 80687 Munich, Germany
| | - Hans-Ulrich Prokosch
- grid.5330.50000 0001 2107 3311Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Wetterkreuz 15, 91058 Erlangen, Germany
| | - Thomas Bahls
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Wolfgang Hoffmann
- grid.5603.0Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
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Jones N, Gius B, Shields M, Florence A, Collings S, Green K, Watson A, Munson M. Youths' and Young Adults' Experiences of Police Involvement During Initiation of Involuntary Psychiatric Holds and Transport. Psychiatr Serv 2022; 73:910-917. [PMID: 34911351 DOI: 10.1176/appi.ps.202100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past decade, police involvement in behavioral health crisis response has generated concern and controversy. Despite the salience and timeliness of this topic, the literature on service user experiences of interactions with officers is small and studies of youths and young adults are nonexistent. The authors aimed to investigate youths' and young adults' experiences of police involvement in involuntary psychiatric hold initiation and transport. In-depth interviews were conducted with 40 participants (ages 16-27) who had experienced an involuntary hold; the 28 participants who reported police involvement are the focus of this analysis. Data were inductively coded, and codes were grouped into larger themes. A majority of participants reported negative experiences; major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication. The authors also characterized the positive experiences of officer involvement reported by a minority of participants and youths' perspectives on the degree of control officers could exert over initiation and transport decisions. Findings help center the voices of youths and young adults with mental health challenges and raise important questions about contemporary policies regarding police involvement in crisis response and, more broadly, about coercive responses to distress or emotional crisis.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Becky Gius
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Morgan Shields
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Ana Florence
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Shira Collings
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Kelly Green
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Amy Watson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Michelle Munson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
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Jackson DJ, Akuthota P, Andradas R, Bredenoord AJ, Cordell A, Gray S, Kullman J, Mathur SK, Pavord I, Roufosse F, Rubio C, Rusek IC, Simon D, Strobel MJ, Winders T. Improving Care in Eosinophil-Associated Diseases: A Charter. Adv Ther 2022; 39:2323-2341. [PMID: 35489014 PMCID: PMC9055373 DOI: 10.1007/s12325-022-02110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.
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Moumjid N, Durand MA, Carretier J, Charuel E, Daumer J, Haesebaert J, Hild S, Mancini J, Marsico G, Rat C, Zerbib Y, Vincent YM, Blot F. Implementation of shared decision-making and patient-centered care in France: Towards a wider uptake in 2022. Z Evid Fortbild Qual Gesundhwes 2022; 171:42-48. [PMID: 35606309 DOI: 10.1016/j.zefq.2022.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
We present the evolution of patient-centered care (PCC) and shared decision-making (SDM) in France since 2017, highlighting advantages and drawbacks of their implementation at the macro level. We then focus on several key policy and legislative milestones that are aimed to develop PCC and SDM. These milestones underline the importance of patient movements to support and fund the development of research and practice in the field. We shall conclude by presenting the growing research agenda and selected key topics. These key topics notably include the increase in both patient and healthcare professional trainings on PCC and SDM provided by healthcare users' and patients' representatives. PCC and SDM continue to be central preoccupations at the macro level, supported by public health policies and patients/healthcare users' actions. This overview, however, suggests that although implementation initiatives have increased since 2017, implementation remains scarce in routine clinical practice. Funding, not only for research projects, but for the implementation of PCC and SDM in real-life settings (e-decision aids, clinical guidelines integrating PCC/SDM, human resources dedicated to PCC/SDM, etc.) are needed to promote sustained adoption. More systematic training for both healthcare professionals and patients is also warranted for a true acculturation to occur.
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Affiliation(s)
- Nora Moumjid
- Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France.
| | - Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul-Sabatier, Toulouse, France; Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Medical Center Dr, Lebanon, NH, USA
| | | | - Elodie Charuel
- Clermont Auvergne University, Faculty of Medicine Department of General Practice, Clermont-Ferrand, France; Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Julie Haesebaert
- Univ Lyon, Claude Bernard Lyon 1 University, Lyon University Hospital HCL, RESHAPE, Inserm, Lyon, France
| | - Sandrine Hild
- University of Nantes, Faculty of Medicine, Department of General Practice, Nantes, France; French National College of Teachers in General Practice, Paris, France
| | - Julien Mancini
- Aix-Marseille University, Institut Paoli-Calmettes, SESSTIM, Marseille, France
| | - Giovanna Marsico
- National Center for Palliative Care end End of Life, Paris, France
| | - Cédric Rat
- University of Nantes, Faculty of Medicine, Department of General Practice, Nantes, France; French National College of Teachers in General Practice, Paris, France
| | - Yves Zerbib
- French National College of Teachers in General Practice, Paris, France; Univ Lyon 1, Claude Bernard Lyon 1 University, Faculty of Medicine, Department of General Practice, Lyon, France
| | - Yves-Marie Vincent
- French National College of Teachers in General Practice, Paris, France; University of Bordeaux, Faculty of Medicine, Department of General Practice, Bordeaux, France
| | - François Blot
- Gustave Roussy-Cancer Campus, Ethics committee and Interdisciplinary Cancer Course Department (DIOPP), Paris-Saclay University, Villejuif, France
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14
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Schumann C, Wiege S. [Medical liability and criminal law in emergency medicine]. Med Klin Intensivmed Notfmed 2022. [PMID: 35467112 DOI: 10.1007/s00063-022-00920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Medical liability is booming. Malpractice can entail both civil and criminal consequences. Besides financial and custodial penalties, at worst the license to practice medicine can be withdrawn. Physicians owe their patients a treatment according to current standards. Furthermore, physicians are obliged to fulfill their duty of care. Nevertheless, the patient's right of self-determination must not be violated. Especially in emergency situations, physicians have to focus on taking protective measures in order to avert further dangers to the health of patients. This article analyses common pitfalls in emergency medical treatment with respect to the legal aspects.
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15
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Schumann C, Wiege S. [Medical liability and criminal law in emergency medicine]. Anaesthesist 2021; 71:243-252. [PMID: 34821956 DOI: 10.1007/s00101-021-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
Medical liability is booming. Malpractice can entail both civil and criminal consequences. Besides financial and custodial penalties, at worst the license to practice medicine can be withdrawn. Physicians owe their patients a treatment according to current standards. Furthermore, physicians are obliged to fulfill their duty of care. Nevertheless, the patient's right of self-determination must not be violated. Especially in emergency situations, physicians have to focus on taking protective measures in order to avert further dangers to the health of patients. This article analyses common pitfalls in emergency medical treatment with respect to the legal aspects.
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Affiliation(s)
- Christina Schumann
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Stephanie Wiege
- Medizinrecht und Strafrecht, Kanzlei Ulsenheimer Friederich, München, Deutschland
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16
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Ascencio-Carbajal T, Saruwatari-Zavala G, Navarro-Garcia F, Frixione E. Genetic/genomic testing: defining the parameters for ethical, legal and social implications (ELSI). BMC Med Ethics 2021; 22:156. [PMID: 34814901 PMCID: PMC8609860 DOI: 10.1186/s12910-021-00720-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Genetic/genomic testing (GGT) are useful tools for improving health and preventing diseases. Still, since GGT deals with sensitive personal information that could significantly impact a patient's life or that of their family, it becomes imperative to consider Ethical, Legal and Social Implications (ELSI). Thus, ELSI studies aim to identify and address concerns raised by genomic research that could affect individuals, their family, and society. However, there are quantitative and qualitative discrepancies in the literature to describe the elements that provide content to the ELSI studies and such problems may result in patient misinformation and harmful choices. METHODS We analyzed the major international documents published by international organizations to specify the parameters that define ELSI and the recognized criteria for GGT, which may prove useful for researchers, health professionals and policymakers. First, we defined the parameters of the ethical, legal and social fields in GGT to avoid ambiguities when using the acronym ELSI. Then, we selected nine documents from 44 relevant publications by international organizations related to genomic medicine. RESULTS We identified 29 ELSI sub-criteria concerning to GGT, which were organized and grouped within 10 minimum criteria: two from the ethical field, four from the legal field and four from the social field. An additional analysis of the number of appearances of these 29 sub-criteria in the analyzed documents allowed us to order them and to determine 7 priority criteria for starting to evaluate and propose national regulations for GGT. CONCLUSIONS We propose that the ELSI criteria identified herein could serve as a starting point to formulate national regulation on personalized genomic medicine, ensuring consistency with international bioethical requirements.
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Affiliation(s)
- Tania Ascencio-Carbajal
- Program of Science, Technology and Society, Center for Research and Advanced Studies IPN (Cinvestav), 07360, Mexico City, Mexico
| | - Garbiñe Saruwatari-Zavala
- Department of Legal, Ethical and Social Studies, National Institute of Genomic Medicine (Inmegen), 14610, Mexico City, Mexico
| | - Fernando Navarro-Garcia
- Program of Science, Technology and Society, Center for Research and Advanced Studies IPN (Cinvestav), 07360, Mexico City, Mexico.
- Department of Cell Biology, Center for Research and Advanced Studies IPN (Cinvestav), 07360, Mexico City, Mexico.
| | - Eugenio Frixione
- Program of Science, Technology and Society, Center for Research and Advanced Studies IPN (Cinvestav), 07360, Mexico City, Mexico.
- Department of Cell Biology, Center for Research and Advanced Studies IPN (Cinvestav), 07360, Mexico City, Mexico.
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17
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Teuschl Y, Bancher C, Brainin M, Dachenhausen A, Matz K, Pinter MM. COVID-19-related delays of botulinum toxin injections have a negative impact on the quality of life of patients with dystonia and spasticity: a single-center ambulatory care study. J Neural Transm (Vienna) 2021; 129:49-53. [PMID: 34689260 PMCID: PMC8541799 DOI: 10.1007/s00702-021-02430-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Botulinum toxin A (BoNT-A) is considered a safe and effective treatment for spasticity and dystonia. Individual interinjection intervals are critical for the maintenance of the effect. In Austria, BoNT outpatient clinics were shutdown from November to December 2020 during COVID-19 control measures, leading to rescheduling of BoNT-A injections. This survey aimed at investigating the influence of injection delays on symptoms, physical functioning, and quality of life (QoL) of the affected patients. METHODS Between April and July 2021, 32 outpatients (21 females, mean age: 63.4 ± 12.1 years) treated ≥ 12 months at the BoNT outpatient clinic Horn-Allentsteig (Austria) and experienced ≥ 2 week injection delays, completed a structured face-to-face questionnaire. RESULTS Indications were dystonia (34%), spasticity (63%), and hyperhidrosis (3%). Injections were delayed by 10 weeks (median, range: 2-15). Muscle cramps increased in 95% of patients with spasticity, muscle twitches in 91% of those with dystonia, and pain in 9% and 60% for dystonia and spasticity, respectively. Overall, 75% reported functional worsening, and deterioration in QoL by 62.6% ± 16.8 (mean ± SD). The impact on QoL correlated with the subjective global improvement induced by BoNT-A (Rs: 0.625; p < 0.001). For 75%, long-term assurance of BoNT-A therapy was very important, and 81% felt their patient rights not respected. CONCLUSIONS COVID-19-related delays in BoNT-A injections illustrate the importance of this therapy for symptom relief, functional outcome, and QoL in patients suffering from involuntary muscle hyperactivity. BoNT-A therapy is essential and has to be guaranteed even in circumstances such as the COVID-19 pandemic.
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Affiliation(s)
- Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems - University for Continuing Education, Dr. Karl-Dorrek Str. 30, 3500, Krems, Austria
| | - Christian Bancher
- Department of Neurology, Landesklinikum Horn-Allentsteig, Horn, Austria
| | - Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems - University for Continuing Education, Dr. Karl-Dorrek Str. 30, 3500, Krems, Austria
| | - Alexandra Dachenhausen
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems - University for Continuing Education, Dr. Karl-Dorrek Str. 30, 3500, Krems, Austria
| | - Karl Matz
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems - University for Continuing Education, Dr. Karl-Dorrek Str. 30, 3500, Krems, Austria.,Department of Neurology, Landesklinikum Baden-Mödling, Mödling, Austria
| | - Michaela M Pinter
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems - University for Continuing Education, Dr. Karl-Dorrek Str. 30, 3500, Krems, Austria. .,Department of Neurology, Landesklinikum Horn-Allentsteig, Horn, Austria.
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18
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Askew DA, Foley W, Kirk C, Williamson D. "I'm outta here!": a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res 2021; 21:907. [PMID: 34479571 PMCID: PMC8414851 DOI: 10.1186/s12913-021-06880-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Occasions of self-discharge from health services before being seen by a health profession or against medical advice are often used by health systems as an indicator of quality care. People self-discharge because of factors such as dissatisfaction with care, poor communication, long waiting times, and feeling better in addition to external factors such as family and employment responsibilities. These factors, plus a lack of cultural safety, and interpersonal and institutional racism contribute to the disproportionately higher rates of Indigenous people self-discharging from hospital. This qualitative study aimed to increase understanding about the causative and contextual factors that culminate in people self-discharging and identify opportunities to improve the hospital experience for all. Methods Semi-structured interviews with five Aboriginal and/or Torres Strait Islander (hereafter, respectfully, Indigenous) people and six non-Indigenous people who had self-discharged from a major tertiary hospital in Brisbane, Australia, were audio-recorded, transcribed and thematically analysed. Results Study participants all respected hospitals’ vital role of caring for the sick, but the cumulative impact of unmet needs created a tipping point whereby they concluded that remaining in hospital would compromise their health and wellbeing. Five key categories of unmet needs were identified – the need for information; confidence in the quality of care; respectful treatment; basic comforts; and peace of mind. Although Indigenous and non-Indigenous participants had similar unmet needs, for the former, the deleterious impact of unmet needs was compounded by racist and discriminatory behaviours they experienced while in hospital. Conclusions Respectful, empathetic, person-centred care is likely to result in patients’ needs being met, improve the hospital experience and reduce the risk of people self-discharging. For Indigenous people, the ongoing legacy of white colonisation is embodied in everyday lived experiences of interpersonal and institutional racism. Racist and discriminatory behaviours experienced whilst hospitalised are thus rendered both more visible and more traumatic, and exacerbate the deleterious effect of unmet needs. Decreasing self-discharge events requires a shift of thinking away from perceiving this as the behaviour of a deviant individual, but rather as a quality improvement opportunity to ensure that all patients are cared for in a respectful and person-centred manner. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06880-9.
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Affiliation(s)
- Deborah A Askew
- Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8, Health Sciences Building, Qld, 4029, Brisbane, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia.
| | - Wendy Foley
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Corey Kirk
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, 4077, Inala, Qld, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, 33 Charlotte Street, Qld, 4001, Brisbane, Australia
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19
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Mathews B, Sanci LA. Doctors' criminal law duty to report consensual sexual activity between adolescents: legal and clinical issues. Med J Aust 2021; 215:109-113.e1. [PMID: 34275139 DOI: 10.5694/mja2.51163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/25/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ben Mathews
- Queensland University of Technology, Brisbane, QLD.,Johns Hopkins University, Baltimore, MD, USA
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20
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Affiliation(s)
- Steve O'Neill
- Division of General Medicine, Beth Israel Deaconess Medical Center (all authors), and Harvard Medical School (O'Neill, Delbanco), Boston
| | - Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center (all authors), and Harvard Medical School (O'Neill, Delbanco), Boston
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center (all authors), and Harvard Medical School (O'Neill, Delbanco), Boston
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21
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McGowan CR, Hellman N, Baxter L, Chakma S, Nahar S, Daula AU, Rowe K, Gilday J, Kingori P, Pounds R, Cummings R. A graphic elicitation technique to represent patient rights. Confl Health 2020; 14:86. [PMID: 33317586 PMCID: PMC7734610 DOI: 10.1186/s13031-020-00331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy. METHODS To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein. RESULTS Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities. CONCLUSIONS Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.
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Affiliation(s)
- Catherine R McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK. .,Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Nora Hellman
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Sonali Chakma
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Samchun Nahar
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Ahasan Ud Daula
- Save the Children International, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Kelly Rowe
- Save the Children Australia, 33 Lincoln Square South, Carlton, VIC, 3053, Australia
| | - Josie Gilday
- Save the Children International, St Vincent House, 30 Orange Street, London, WC2H 7HH, UK
| | - Patricia Kingori
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Rachel Pounds
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
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Dressler D, Adib Saberi F. Botulinum toxin therapy in the SARS-CoV-2 pandemic: patient perceptions from a German cohort. J Neural Transm (Vienna) 2020; 127:1271-1274. [PMID: 32734554 PMCID: PMC7391233 DOI: 10.1007/s00702-020-02235-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 12/03/2022]
Abstract
The SARS-CoV-2 virus pandemic has provoked drastic countermeasures including shutdowns of public services. We wanted to describe the effects of a 6 week shutdown of a large German botulinum toxin (BT) outpatient clinics on patients and their well-being. 45 patients (age 61.9 ± 9.8 years, 29 females, 16 males) receiving BT therapy (319.3 ± 201.9MU-equivalent, treatment duration 8.3 ± 5.5 years) were surveyed with a standardised questionnaire. The shutdown delayed BT therapy by 6.6 ± 2.3 weeks. 93% of the patients noticed increased muscle cramps and 82% increased pain reducing their quality of life by 40.2 ± 19.5%. For 23 patients with cervical dystonia this reduction was 41.1 ± 18.3%, for 3 patients with blepharospasm 33.3 ± 15.3%, for 9 patients with spasticity 37.8 ± 15.6%, for 4 patients with pain conditions 37.4 ± 35.7% and for 3 patients with hemifacial spasm 27.5 ± 17.1%. After the shutdown 66% of patients perceived BT therapy as more important than before, 32% perceived it as unchanged. For all patients long-term availability of BT therapy was very important or important. 98% of the patients perceived the shutdown as inadequate and felt their patient rights not respected. The shutdown confirmed the considerable burden of disease caused by dystonia, spasticity, hemifacial spasm and various pain conditions and the importance of BT therapy to treat them. Any shutdown severely affects these patients and needs to be avoided.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Zolfi Kashani A, Ranjbar H, Rasoulian M, Shabani A, Ghadirivasfi M, Mohammadsadeghi H. The experience of patients with bipolar disorder from diagnosis disclosure: A qualitative study. Med J Islam Repub Iran 2020; 34:36. [PMID: 32617275 PMCID: PMC7320983 DOI: 10.34171/mjiri.34.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Disclosure of the diagnosis is an essential part of the treatment process and an important part of patient rights. However, it can be a very stressful experience, especially in mental health disorders. Patients with bipolar disorder have a unique experience of receiving and managing their diagnosis. The objective of the current study was to explore the experience of patients with bipolar disorder of diagnosis disclosure. Methods: This was a qualitative study. Participants were recruited from patients who knew their disorder's name using purposive sampling method. The inclusion criteria were being diagnosed by a psychiatrist as having bipolar disorder and the disclosure was conducted by a psychiatrist. Sixteen semi-structured, in-depth interviews were conducted with twelve patients. Data were analyzed using thematic content analysis. Results: Patients received their diagnosis name in three steps including Wandering in Unknowns, Limited Brightness and Reaching to a Relative Insight. Patients believed that disclosure of the diagnosis was not accompanied by enough information. Conclusion: The disclosure of diagnosis in patients with bipolar disorder without providing enough information is stressful and is not helpful in empowering these patients. Based on our results, disclosure of diagnosis to patients with bipolar disorder was not conducted with enough information and patients had problems for understanding their symptoms and treatments.
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Affiliation(s)
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Maryam Rasoulian
- Mental Health Research Center, Tehran Institute of Psychiatry- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Shabani
- Mental Health Research Center, Mood Disorders Research Group, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghadirivasfi
- Mental Health Research Center, Tehran Institute of Psychiatry- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Mohammadsadeghi
- Mental Health Research Center, Tehran Institute of Psychiatry- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Ghinea N, Lipworth W, Kerridge I. Does Consumer Engagement in Health Technology Assessment Enhance or Undermine Equity? J Bioeth Inq 2020; 17:87-94. [PMID: 32060818 DOI: 10.1007/s11673-020-09962-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
Consumer engagement in decisions about the funding of medicines is often framed as a good in and of itself and as an activity that should be universally encouraged. A common justification for calls for consumer engagement is that it enhances equity. In this paper we systematically critique this assumption. We show that consumer engagement may undermine equity as well as enhance it and show that a simple relationship cannot be assumed but must be justified and demonstrated. In concluding, we present a number of challenges that need to be overcome in order for consumer engagement to contribute to health technology assessment in a morally and politically sound manner.
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Affiliation(s)
- Narcyz Ghinea
- The University of Sydney, School of Public Health, Sydney Health Ethics, Level 1, Building 1, Medical Foundation Building, NSW, 2006, Australia.
- The University of Sydney Law School, Law School Building (F10) Eastern Avenue, Camperdown Campus, NSW, 2006, Australia.
| | - Wendy Lipworth
- The University of Sydney, School of Public Health, Sydney Health Ethics, Level 1, Building 1, Medical Foundation Building, NSW, 2006, Australia
| | - Ian Kerridge
- The University of Sydney, School of Public Health, Sydney Health Ethics, Level 1, Building 1, Medical Foundation Building, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
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Juliá-Sanchis R, Aguilera-Serrano C, Megías-Lizancos F, Martínez-Riera JR. [Evolution and status of the community model of mental health care. SESPAS Report 2020]. Gac Sanit 2020; 34 Suppl 1:81-86. [PMID: 32883518 PMCID: PMC7457906 DOI: 10.1016/j.gaceta.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/07/2022]
Abstract
The legislative and ideological transition produced in recent years in Spain has favoured the implementation of the community model of mental health care. However, there is still strong resistance to the inclusion of community approaches in the care of people with mental health problems and to the implementation of integrated care and attention with a salutogenic approach. The purpose of the following report is to describe the evolution of the community model of mental health care in the Spanish National Health System and to assess its current status. Initially, a review of the published national mental health plans and strategies was carried out. Subsequently, the evaluation was carried out taking as reference the Consensus Document on the Fundamental Principles and Key Elements of Community Mental Health, which establishes the criteria for evaluating the quality of community care. In the absence of updated plans or strategies, international reports and recommendations were included. The results were grouped into: 1) social perspective, where the controversy about the capacity of the users to make decisions despite the recognition of their rights as autonomous moral agents is evident; 2) perspective of the centrality of the users of mental health care services, where the resistance to the implementation of integrated community care and attention is expressed; and 3) professional perspective in relation to the effectiveness of the interventions and the community network of care principles, which highlights the need to transform the institutions to carry out community interventions in mental health based on evidence and in an intersectoral, comprehensive, integrated and integrating manner.
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Affiliation(s)
- Rocío Juliá-Sanchis
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
| | - Carlos Aguilera-Serrano
- Unidad de Salud Mental Comunitaria de Motril, Área de Gestión Sanitaria Sur de Granada, Consejería de Salud y Familias, Junta de Andalucía, Motril, Granada, España.
| | | | - José Ramón Martínez-Riera
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
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Yang Y, Li W, An FR, Wang YY, Ungvari GS, Balbuena L, Xiang YT. Voluntary and Involuntary Admissions for Severe Mental Illness in China: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:83-86. [PMID: 31575350 DOI: 10.1176/appi.ps.201900106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to examine the prevalence of voluntary and involuntary psychiatric admissions for severe mental illness in China and explore their associated factors. METHODS The PubMed, Cochrane Library, PsycINFO, EMBASE, CNKI, CQVIP, and WanFang databases were systematically searched for the span since their inception to October 2018. Meta-analyses were conducted with the random-effects model. RESULTS Fourteen studies with 94,305 patients were included in the analyses. The voluntary and involuntary admission rates were 30.3% (95% confidence interval [CI]=18.06% to 46.23%) and 32.3% (95% CI=10.39% to 66.21%), respectively, for severe mental illness and 19.6% (95% CI=14.09% to 26.54%) and 44.3% (95% CI=5.98% to 90.88%), respectively, for schizophrenia. Meta-regression analyses found an increase in the voluntary admission rate between 1998 and 2018. CONCLUSIONS The voluntary admission rate for severe mental illness has increased in China, whereas the involuntary admission rate has remained high, particularly for schizophrenia. Concerted efforts should be made to further decrease the rate of involuntary admissions.
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Affiliation(s)
- Yuan Yang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Wen Li
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Feng-Rong An
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Yuan-Yuan Wang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Gabor S Ungvari
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Lloyd Balbuena
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
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Vázquez-Campo M, Tizón-Bouza E, Martínez-Santos AE, Vilanova-Trillo L. What do Galicia's nurses know about living wills? Enferm Clin (Engl Ed) 2019; 30:16-22. [PMID: 31735459 DOI: 10.1016/j.enfcli.2019.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the level of knowledge and attitudes concerning living wills of nurses working in 3 hospitals of Servizo Galego de Saúde (Spain). METHOD Descriptive, cross-sectional, multi-centre study. Stratified sampling was carried out with nurses from the University Hospital Complexes of Ourense, Ferrol and Vigo. A sample size of 239 individuals was calculated. The data was collected during the first semester of 2018 using a validated self-administered questionnaire («Cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales»). RESULTS A total of 262 nurses participated. Fifty percent believe that health professionals are obliged to inform about living wills. Two percent consider that they have enough information on the subject, and this is demonstrated in the knowledge questions, where between 61%-93% fail in the questions related to the documentation, use, and their legal aspects. Eighty-four percent consider that they have the obligation to uphold the values and beliefs of patients, and 89% that patients have the right to receive and decide on the right care. Thirteen percent consider that patients are not well informed about living wills, and 83% would recommend to chronic patients that they complete a living will. CONCLUSIONS Nurses have a great lack of knowledge about the legal aspects and the use of living wills, which makes them feel unable to inform their patients about them. Despite of the lack of knowledge, their attitude is positive and most of them state that they would recommend them to their patients.
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Affiliation(s)
- Miriam Vázquez-Campo
- Escuela Universitaria de Enfermería de Ourense, Universidad de Vigo, Complexo Hospitalario Universitario de Ourense (CHOU), Sergas, Ourense, España
| | - Eva Tizón-Bouza
- Complexo Hospitalario Universitario de Ferrol (CHUF), Sergas, Ferrol, A Coruña, España
| | - Alba-Elena Martínez-Santos
- Departamento de Pedagogía y Didáctica, Universidad de Santiago de Compostela, Santiago de Compostela, España.
| | - Lucía Vilanova-Trillo
- Fundación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Pontevedra (CHUP), Sergas, Pontevedra, España
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Abstract
Incarcerated individuals are a vulnerable population who face not only high rates of mental disorders, substance use disorders, and other chronic medical conditions but also widespread social stigmatization. These patients occasionally present for treatment in community health care settings, including mental health facilities, where staff that do not often provide care for incarcerated patients may be unprepared for their visits. This column examines whether treatment of incarcerated patients should be managed differently than treatment of other patients at community mental health facilities and provides suggestions for clinical management.
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Affiliation(s)
- Nathaniel P Morris
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Paul S. Appelbaum, M.D., is editor of this column
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Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study. BMC Womens Health 2019; 19:112. [PMID: 31477083 PMCID: PMC6720084 DOI: 10.1186/s12905-019-0811-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 12/01/2022]
Abstract
Background Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients’ experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women’s informational needs. Methods A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. Results Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants’ unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. Conclusions This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients’ healthcare experience.
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Affiliation(s)
- Carla Freijomil-Vázquez
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain. .,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain.
| | - Denise Gastaldo
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Critical Qualitative Health Research (CQ), University of Toronto, Toronto, Canada
| | - Carmen Coronado
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
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Dahlberg J, Dahl V, Forde R, Pedersen R. Lack of informed consent for surgical procedures by elderly patients with inability to consent: a retrospective chart review from an academic medical center in Norway. Patient Saf Surg 2019; 13:24. [PMID: 31285756 DOI: 10.1186/s13037-019-0205-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.
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Lindahl AK. The 2018 establishment of a national expert panel for patients with serious life-threatening disease in Norway. Health Policy 2019; 123:468-71. [PMID: 30904386 DOI: 10.1016/j.healthpol.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/14/2018] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
The discussion on priority setting in Norwegian healthcare has resulted in several white papers and the establishment of a Council for priority setting from 2007-2017. In 2009 the Council discussed and proposed a system for renewed evaluation by an expert panel for cancer patients, as was in place in Denmark. However, the Directorate of Health found that patients already had the right of second opinion, and thus did not need a new expert panel like the one proposed. The case was discussed several times in the Council, coupled with the discussion on the inequity for patients to take part in studies of emerging treatments. This resulted in 2015 in a public website for patients with information on ongoing clinical trials open for inclusion, but no solution regarding the expert panel. A journalist in a national newspaper published a series of articles in the summer of 2017 on the topic. This was close to the election for Parliament, and the politicians got interested; first the opposition, then the current Minister of Health and Care services. The decision was made in August 2017 to establish such an expert panel for renewed evaluation for patients with serious lifeshortening disease Also, the information for patients on ongoing trials should be more complete and accessible. The Regional health authorities implemented the policy decision, and the expert panel was in place November 1st 2018.
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Bialke M, Bahls T, Geidel L, Rau H, Blumentritt A, Pasewald S, Wolff R, Steinmann J, Bronsch T, Bergh B, Tremper G, Lablans M, Ückert F, Lang S, Idris T, Hoffmann W. MAGIC: once upon a time in consent management-a FHIR ® tale. J Transl Med 2018; 16:256. [PMID: 30217236 PMCID: PMC6137912 DOI: 10.1186/s12967-018-1631-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of medical data for research purposes requires an informed consent of the patient that is compliant with the EU General Data Protection Regulation. In the context of multi-centre research initiatives and a multitude of clinical and epidemiological studies scalable and automatable measures for digital consent management are required. Modular form, structure, and contents render a patient's consent reusable for varying project settings in order to effectively manage and minimise organisational and technical efforts. RESULTS Within the DFG-funded project "MAGIC" (Grant Number HO 1937/5-1) the digital consent management service tool gICS was enhanced to comply with the recommendations published in the TMF data protection guideline for medical research. In addition, a structured exchange format for modular consent templates considering established standards and formats in the area of digital informed consent management was designed. Using the new FHIR standard and the HAPI FHIR library, the first version for an exchange format and necessary import-/export-functionalities were successfully implemented. CONCLUSIONS The proposed exchange format is a "work in progress". It represents a starting point for current discussions concerning digital consent management. It also attempts to improve interoperability between different approaches within the wider IHE-/HL7-/FHIR community. Independent of the exchange format, providing the possibility to export, modify and import templates for consents and withdrawals to be reused in similar clinical and epidemiological studies is an essential precondition for the sustainable operation of digital consent management.
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Affiliation(s)
- Martin Bialke
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Thomas Bahls
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Lars Geidel
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Henriette Rau
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Arne Blumentritt
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Sandra Pasewald
- Independent Trusted Third Party, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Robert Wolff
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
| | - Jonas Steinmann
- Technology, Methods and Infrastructure for Networked Medical Research (TMF), Charlottenstrasse 42/Dorotheenstrasse, 10117 Berlin, Germany
| | - Tobias Bronsch
- Institute for Medical Informatics and Statistics, Kiel University and University Medical Center Schleswig–Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Björn Bergh
- Institute for Medical Informatics and Statistics, Kiel University and University Medical Center Schleswig–Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Galina Tremper
- Department Medical Informatics for Translational Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Martin Lablans
- Department Medical Informatics for Translational Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Frank Ückert
- Department Medical Informatics for Translational Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Stefan Lang
- Technical Committee FHIR, HL7 Deutschland e.V, Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
| | - Tarik Idris
- InterComponentWare AG (ICW), Altrottstr. 31, 69190 Walldorf, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17475 Greifswald, Germany
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Mouton Dorey C, Baumann H, Biller-Andorno N. Patient data and patient rights: Swiss healthcare stakeholders' ethical awareness regarding large patient data sets - a qualitative study. BMC Med Ethics 2018. [PMID: 29514635 PMCID: PMC5842517 DOI: 10.1186/s12910-018-0261-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient’s rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. Methods We used a qualitative design to examine Swiss healthcare stakeholders’ experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. Results All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries’ patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients’ rights and citizens’ involvement on the other. Conclusions The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both concurrently. On a normative level, this study thus provides material from which to develop further ethical reflection towards a more cooperative approach involving patients and citizens in the governance of their health-related big data. Electronic supplementary material The online version of this article (10.1186/s12910-018-0261-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Corine Mouton Dorey
- Institute of Biomedical Ethics and Medical History (IBME), University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland.
| | - Holger Baumann
- Institute of Biomedical Ethics and Medical History (IBME), University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland.,Philosophy Seminar, University of Zurich, Zollikerstrasse 117, Zürich, CH-8008, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and Medical History (IBME), University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland
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Montesinos-Segura R, Urrunaga-Pastor D, Mendoza-Chuctaya G, Taype-Rondan A, Helguero-Santin LM, Martinez-Ninanqui FW, Centeno DL, Jiménez-Meza Y, Taminche-Canayo RC, Paucar-Tito L, Villamonte-Calanche W. Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru. Int J Gynaecol Obstet 2017; 140:184-190. [PMID: 29044510 DOI: 10.1002/ijgo.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/17/2017] [Accepted: 10/17/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru. METHODS In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances. RESULTS Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred. CONCLUSION Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region.
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Affiliation(s)
- Reneé Montesinos-Segura
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Diego Urrunaga-Pastor
- Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
| | - Giuston Mendoza-Chuctaya
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Alvaro Taype-Rondan
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis M Helguero-Santin
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Piura, Facultad de Medicina Humana, Universidad Nacional de Piura, Piura, Peru
| | | | - Dercy L Centeno
- Sociedad Científica Medico Estudiantil San Cristobal, Escuela Profesional de Medicina Humana, Universidad Nacional de San Cristóbal de Huamanga, Ayacucho, Peru
| | - Yanina Jiménez-Meza
- Sociedad Científica Médico Estudiantil Continental, Facultad de Medicina Humana, Universidad Continental, Junín, Peru
| | - Ruth C Taminche-Canayo
- Sociedad Científica de estudiantes de Medicina de la Amazonía Peruana, Escuela Profesional de Medicina Humana, Universidad Nacional de la Amazonía Peruana, Iquitos, Peru
| | - Liz Paucar-Tito
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
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Murphy R, McGuinness D, Bainbridge E, Brosnan L, Felzmann H, Keys M, Murphy K, Hallahan B, McDonald C, Higgins A. Service Users' Experiences of Involuntary Hospital Admission Under the Mental Health Act 2001 in the Republic of Ireland. Psychiatr Serv 2017; 68:1127-1135. [PMID: 28669292 DOI: 10.1176/appi.ps.201700008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland. METHODS In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process. RESULTS Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters. CONCLUSIONS This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being.
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Affiliation(s)
- Rebecca Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - David McGuinness
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Emma Bainbridge
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Liz Brosnan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Heike Felzmann
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Mary Keys
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Kathy Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Brian Hallahan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Colm McDonald
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Agnes Higgins
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
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Ibañez XA, Dekanosidze T. The State's obligation to regulate and monitor private health care facilities: the Alyne da Silva Pimentel and the Dzebniauri cases. Public Health Rev 2017; 38:17. [PMID: 29450089 PMCID: PMC5809997 DOI: 10.1186/s40985-017-0063-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
The Human Rights in Patient Care framework embraces general human rights principles applicable to both patients and health care providers in the delivery of health care. Under this framework, states have a duty to ensure patient and provider rights in both public and private health care settings. The paper examines the recent decisions in Alyne Da Silva Pimentel v. Brazil of the Committee on the Elimination of Discrimination against Women and Dzebniauri v. Georgia of the European Court of Human Rights and places these decisions within the wider debate on the extent to which states have human rights obligations in private settings. Drawing on these decisions, the paper demonstrates that this duty can be complied with by establishing appropriate laws and regulations for private entities, monitoring and enforcement of the standards, and performance of these bodies and professionals through investigation and accountability procedures.
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Affiliation(s)
- Ximena Andión Ibañez
- 1LLM International Human Rights Law, University of Essex, Colchester, UK.,Instituto de Liderazgo Simone de Beauvoir, Malaga 17, Depto. 6, Col. Insurgentes Mixcoac, C.P, 03920 Ciudad de México, Mexico
| | - Tamar Dekanosidze
- 1LLM International Human Rights Law, University of Essex, Colchester, UK.,Georgian Young Lawyers' Association, 24 D. Kipiani Street, 0154 Tbilisi, Georgia
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Igl G, Sulmann D. [10-year anniversary of the Long-term Care Charter : Time to take stock]. Z Gerontol Geriatr 2017; 50:287-293. [PMID: 28516195 DOI: 10.1007/s00391-017-1246-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 11/30/2022]
Abstract
Ten years ago, the Charter for People in Need of Long-term Care was published in Germany. The Charter contains a series of basic rights for people in need of long-term care. At the initiative of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), this was developed in a complex consensus process together with the Federal Ministry of Health (BMG) and representatives from all areas of care. Since then, the Charter has gained practical relevance in various areas of care and has entered into legislation. The article looks at the dissemination and impact of the Charter following a review of the social and legal environment. Further implementation requirements and the revision of the charter are discussed.
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Affiliation(s)
- Gerhard Igl
- , Güntherstr. 51, 22087, Hamburg, Deutschland.
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Weiss M, Rossaint R, Iber T. Generalizable items of quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia. World J Crit Care Med 2017; 6:91-98. [PMID: 28529910 PMCID: PMC5415854 DOI: 10.5492/wjccm.v6.i2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/07/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refunding does not deliver such a basis. Thus, in 2006 a new calculation base for the personnel requirement that included an Excel calculation sheet was introduced by the German Board of Anesthesiologists (BDA) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI), and updated in 2009 and 2015. Oriented primarily to organizational needs, in 2015, BDA/DGAI defined quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia, especially reflecting recent laws governing physician’s working conditions and competence in the field of anesthesia, as well as demands of strengthened legal rights of patients, patient care and safety. We present a workload-oriented model, integrating core working hours, shift work or standby duty, quality of care, efficiency of processes, legal, educational, controlling, local, organizational and economic aspects for calculating personnel demands. Auxiliary tables enable physicians to calculate personnel demands due to differing employee workload, non-patient oriented tasks and reimbursement of full-equivalents due to parental leave, prohibition of employment, or long-term illness. After 10 years of experience with the first calculation tool, we report the generalizable key aspects and items of a necessary calculation tool which may help physicians to justify realistic workload-oriented personnel staffing demands in anesthesia. A modular, flexible nature of a calculation tool should allow adaption to the respective legal and organizational demands of different countries.
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Abedi G, Shojaee J, Moosazadeh M, Rostami F, Nadi A, Abedini E, Palenik CJ, Askarian M. Awareness and Observance of Patient Rights from the Perspective of Iranian Patients: A Systematic Review and Meta-Analysis. Iran J Med Sci 2017; 42:227-234. [PMID: 28533570 PMCID: PMC5429490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recipients of healthcare services have rights, which must be acknowledged and protected. Such rights include observance of acceptable patient physical, mental, spiritual, and social needs guided by commonly accepted rules and regulations. The objective of this study was to conduct a systematic review and meta-analysis of awareness rates and observance of patient rights in Iran from the perspective of the patient. METHODS In this study, various references such as Medline (PubMed), Scopus, Scientific Information Database (SID), Google scholar, Magiran, and IranMedex were searched (from August to December 2015). Heterogeneity was assessed using the Q statistic. English and Persian search keywords and combinations included terms such as "patient bill of rights, patient rights, Iranian patient bill of rights, and Persian patient rights." A meta-analysis of the primary search sources was accomplished using STATA (version 11.0). RESULTS Initial review included 20 articles of which 12 assessed observance rates of patient rights and three described service awareness rates of recipients concerning their personal rights. Five articles covered both topics and had an estimated 54.2% coverage based on the results of meta-analysis and the random-effects model with the heterogeneity. CONCLUSION An Observance rate of patient bills of rights was considered somewhat adequate. However, contradictions in findings noted in this study suggest deficiencies do exist and need to be resolved. There appears a need to better describe and increase awareness rates of healthcare services by patients concerning their own bill of rights.
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Affiliation(s)
- Ghassem Abedi
- Department of Health Care Management, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jalil Shojaee
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farideh Rostami
- Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Aliasghar Nadi
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Abedini
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mehrdad Askarian
- Department of Community Medicine, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mehrdad Askarian, MD, MPH; Department of Community Medicine, School of Medicine, Karimkhan-e-Zand Avenue, P. O. Box: 71345-1737, Shiraz, Iran Tel: +98 917 1125777 Fax: +98 713 2347977
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Abstract
The European Society of Radiology (ESR) informs its membership and its associated Institutional Members about the new General Data Protection Regulation (GDPR) of the European Union (EU,) which will apply from 25 May 2018. Radiologists and radiology departments should be prepared to comply with several new rules for the protection of imaging data. Although the new GDPR applies to all domains of the public and private sectors, some specific derogations are defined for data concerning health, aiming at protecting the rights of data subjects and confidentiality of their personal health data, whilst preserving the benefits of processing data, including digital images for research and public health purposes. Specific new obligations which healthcare providers (including radiologists/radiology departments) should prepare for include data access for patients, rules for data processing including explicit consent of the data subject in the absence of derogations, or technical and organisational safeguards. National health authorities can define exceptions and derogations from certain obligations by means of national law. They will also define sanctions in the form of penalties or fines that may be applicable for organisations of the public and private sector that fail to comply with the rules of the GDPR. MAIN MESSAGES • Explicit consent prior to data processing will be necessary. • Explicit consent prior to communication of imaging data will be necessary. • Providing patient access to their personal data, including portability, will be required. • Certain derogations and exceptions exist for healthcare and research. • Additional specific rules may be defined by national law.
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Zirak M, Ghafourifard M, Aliafsari Mamaghani E. Patients' Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study. J Caring Sci 2017; 6:49-51. [PMID: 28299297 PMCID: PMC5348662 DOI: 10.15171/jcs.2017.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/07/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction: Dignity is considered as fundamental human
needs and recognized as one of the central concepts in nursing science. The aim of this
study was to assess the extent to which patients’ dignity is respected and to evalutae its
relationship with contextual variables. Methods: This cross-sectional study was conducted on 256
hospitalized patients in the two teaching hospitals affiliated to Zanjan University of
medical sciences, Iran. Data were collected by a questionnaire consist of two sections:
(a) demographic characteristics, and (b) patient dignity including 32 questions. Data were
analyzed by SPSS (ver.13) software using independent t-test, ANOVA and Pearson
correlation. Results: The result showed that the mean (standard
deviation) of total score of patient’s dignity was 108.17 (25.28). According to the
result, the majority of the respondents (76.2%) were not aware of patient’s rights. There
was a significant difference in mean scores of total dignity between single and married
persons, living in city or village, and hospitalization in Moosavi and Valiasr hospital. Conclusion: Health care systems should take the provision
of the patients' dignity into account through using a comprehensive educational program
for informing of patient, family members, and health professionals about patients’
dignity.
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Affiliation(s)
- Mohammad Zirak
- Department of Medical Surgical Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical Surgical Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Harper A, Rowe M. Environment-Level Strategies to Support Independent Control of Finances: A Response to the SSA Review of Financial Capability Determination Review. Psychiatr Serv 2017; 68:6-8. [PMID: 27745540 DOI: 10.1176/appi.ps.201600428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Social Security Administration (SSA) recently completed an evaluation of the process by which representative payees are assigned. The SSA report is welcome, particularly for its focus on developing more accurate, real-world assessments of a person's financial capability and its recognition of the need for more flexible options for people with disabilities. Crucially, the report discusses the impact of the broader environment-specifically, conditions related to living in poverty. However, it provides no guidance about environmental interventions that could enable more beneficiaries to manage their funds without a payee. Innovative financial products could be offered to beneficiaries, and the retail industry could develop processes to support responsible financial management by people with mental illness. Changes to SSA benefits systems, including raising benefits levels and asset limits, could enable more beneficiaries to manage their funds independently.
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Affiliation(s)
- Annie Harper
- The authors are with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut (e-mail: ). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Michael Rowe
- The authors are with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut (e-mail: ). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
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Barnicot K, Insua-Summerhayes B, Plummer E, Hart A, Barker C, Priebe S. Staff and patient experiences of decision-making about continuous observation in psychiatric hospitals. Soc Psychiatry Psychiatr Epidemiol 2017; 52:473-483. [PMID: 28161766 PMCID: PMC5380690 DOI: 10.1007/s00127-017-1338-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE Continuous observation of psychiatric inpatients aims to protect those who pose an acute risk of harm to self or others, but involves intrusive privacy restrictions. Initiating, conducting and ending continuous observation requires complex decision-making about keeping patients safe whilst protecting their privacy. There is little published guidance about how to balance privacy and safety concerns, and how staff and patients negotiate this in practice is unknown. To inform best practice, the present study, therefore, aimed to understand how staff and patients experience negotiating the balance between privacy and safety during decision-making about continuous observation. METHODS Thematic analysis of qualitative interviews with thirty-one inpatient psychiatric staff and twenty-eight inpatients. RESULTS Most patients struggled with the lack of privacy but valued feeling safe during continuous observation. Staff and patients linked good decision-making to using continuous observation for short periods and taking positive risks, understanding and collaborating with the patient, and working together as a supportive staff team. Poor decision-making was linked to insufficient consideration of observation's iatrogenic potential, insufficient collaboration with patients, and the stressful impact on staff of conducting observations and managing risk. CONCLUSIONS Best practice in decision-making about continuous observation may be facilitated by making decisions in collaboration with patients, and by staff supporting each-other in positive risk-taking. To achieve truly patient-centred decision-making, decisions about observation should not be influenced by staff's own stress levels. To address the negative impact of staff stress on decision-making, it may be helpful to improve staff training, education and support structures.
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Affiliation(s)
- Kirsten Barnicot
- Department of Medicine, Centre for Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
| | - Bryony Insua-Summerhayes
- grid.83440.3bDepartment of Medicine, Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Emily Plummer
- grid.7445.2Department of Medicine, Centre for Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN UK
| | - Alice Hart
- grid.83440.3bDepartment of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT UK
| | - Chris Barker
- grid.83440.3bDepartment of Medicine, Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Stefan Priebe
- grid.4868.2Unit for Social and Community Psychiatry, Department of Medicine, Queen Mary University of London, Glen Road, London, E13 8SP UK
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Contreras-Fernández E, Barón-López FJ, Méndez-Martínez C, Canca-Sánchez JC, Cabezón Rodríguez I, Rivas-Ruiz F. [Validation of the knowledge and attitudes of health professionals in the Living Will Declaration process]. Aten Primaria 2016; 49:233-239. [PMID: 27914719 PMCID: PMC6875958 DOI: 10.1016/j.aprim.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/24/2016] [Accepted: 06/02/2016] [Indexed: 10/30/2022] Open
Abstract
OBJECTIVE Evaluate the validity and reliability of the knowledge and attitudes of health professionals questionnaire on the Living Will Declaration (LWD) process. DESIGN Cross-sectional study structured into 3 phases: (i)pilot questionnaire administered with paper to assess losses and adjustment problems; (ii)assessment of the validity and internal reliability, and (iii)assessment of the pre-filtering questionnaire stability (test-retest). LOCATION Costa del Sol (Malaga) Health Area. January 2014 to April 2015. PARTICIPANTS Healthcare professionals of the Costa del Sol Primary Care District and the Costa del Sol Health Agency. There were 391 (23.6%) responses, and 100 participated in the stability assessment (83 responses). MAIN MEASUREMENTS The questionnaire consisted of 2 parts: (i)Knowledge (5 dimensions and 41 items), and (ii)Attitudes (2 dimensions and 17 items). RESULTS In the pilot study, none of the items lost over 10%. In the evaluation phase of validity and reliability, the questionnaire was reduced to 41 items (29 of knowledge, and 12 of attitudes). In the stability evaluation phase, all items evaluated met the requirement of a kappa higher than 0.2, or had a percentage of absolute agreement exceeding 75%. CONCLUSIONS The questionnaire will identify the status and areas for improvement in the health care setting, and then will allow an improved culture of LWD process in general population.
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Affiliation(s)
| | | | - Camila Méndez-Martínez
- Registro de Voluntades Vitales Anticipadas de Andalucía, Consejería de Salud, Sevilla, España
| | | | | | - Francisco Rivas-Ruiz
- Unidad de Investigación, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), ISCIII, España.
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45
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Hume C, Malpas P. A case based reflection on communicating end of life information in non-English speaking patients. Patient Educ Couns 2016; 99:1911-1913. [PMID: 27370179 DOI: 10.1016/j.pec.2016.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/12/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
Mr X was a 56year old Chinese man (non-English speaking), who presented to the emergency department with a range of non-specific symptoms. On full workup, he was diagnosed with an advanced cancer of the pancreas. It was an aggressive, highly treatment resistant cancer, with an alarmingly poor prognosis. Before the diagnosis had been made, the family had informed our team that we were not to discuss medical issues with Mr X directly, and that upon arriving on a diagnosis we were to come to them first and they would subsequently inform him. They reported that Mr X was in support of this arrangement. Eventually we told the family about Mr X's diagnosis, and they asserted their collective will to keep this information from him, reaffirming that all medical discussion go through them. However, the doctor in charge explained the diagnosis to Mr X using an interpreter while his family were away from his bed. In this discussion, I consider this case from the perspective of respecting patients' and families' preferences around medical treatment and care.
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Affiliation(s)
- Carl Hume
- MBChB Year 6(,) School of Medicine, Faculty of Medical and Health Sciences, Private Bag, 92019, University of Auckland, Auckland, New Zealand, New Zealand.
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, Private Bag, 92019, University of Auckland, Auckland, New Zealand, New Zealand.
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Mehdipour-Rabori R, Abbaszadeh A, Borhani F. Human dignity of patients with cardiovascular disease admitted to hospitals of Kerman, Iran, in 2015. J Med Ethics Hist Med 2016; 9:8. [PMID: 27974966 PMCID: PMC5155306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 07/05/2016] [Indexed: 11/29/2022] Open
Abstract
The human dignity of patients with cardiovascular disease (CVD) is an important issue, because of patients' dependence upon caregivers, and because it impacts all aspects of their quality of life (QOL). Therefore, understanding and improving the status of dignity among these patients is of great importance. This study aimed to determine the status of dignity in patients with CVD admitted to cardiac intensive care units (CICUs) in Iran. This cross-sectional descriptive study was performed in 2015 on 200 patients admitted to the CICUs of hospitals affiliated to Kerman University of Medical Sciences, Iran. The participants were selected using random sampling method. Patients' understanding of dignity was assessed through the reliable and valid Persian version of the Patient Dignity Inventory (PDI). Patients who were able to read and write or speak Persian and were conscious were included in the study. Data were analyzed using descriptive statistics tests, independent t-test, and one-way ANOVA in SPSS software. The mean age of the study participants was 59.0 ± 17.0. The mean score of human dignity was 3.60 ± 1.39. The mean scores of the factors of loss of independence, emotional distress and uncertainty, changes in ability and mental image, and the loss of human dignity were 3.94 ± 1.06, 3.63 ± 1.37, 3.57 ± 1.20, and 3.30 ± 2.08, respectively. A significant statistical correlation was observed between human dignity and the demographic characteristics of gender and frequency of hospitalizations in a CICU and a significant difference between those who lived alone and those who lived with family was observed (P < 0.05). Patients hospitalized in CICUs experience numerous problems associated with human dignity in each of its four dimensions. It is recommended that a study be conducted to investigate the relationship between the human dignity of patients with CVD and their QOL, anxiety, and depression.
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Affiliation(s)
- Roghayeh Mehdipour-Rabori
- Assistant Professor, Department of Medical-Surgical Nursing, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran;
| | - Abbas Abbaszadeh
- Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences AND Academy of Medical Sciences, Tehran, Iran;
| | - Fariba Borhani
- Associate Professor, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Fariba Borhani. Address: Medical Ethics and Law Research Center, No 8, Shams Alley, Tavanir Cross, Valieasr St., Tehran, Iran. Tel: 98 21 88202511. Fax: 98 21 88202518
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Bhuyan SS, Bailey-DeLeeuw S, Wyant DK, Chang CF. Too Much or Too Little? How Much Control Should Patients Have Over EHR Data? J Med Syst 2016; 40:174. [PMID: 27272134 DOI: 10.1007/s10916-016-0533-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
Electronic health records (EHRs) have been promoted as a mechanism to overcome the fragmented healthcare system in the United States. The challenge that is being discussed is the rights of the patient to control the access to their EHRs' data and the needs of healthcare professionals to know health data to make the best treatment decisions for their patients. The Federal Trade Commission has asked those who store consumer information to comply with the Fair Information Practice Principles. In the EHR context, these principles give the rights to the patient to control who can see their health data and what components of the data are restricted from view. Control is not limited to patients, as it also includes parents of adolescent children. We suggest that the ongoing policy discussion include consideration of the precise questions patients will be asked when a need for data sharing arises. Further, patients should understand the relative risks that they face, and the degree to which their decisions will (or will not) significantly reduce the risk of a data breach. As various approaches are considered, it is important to address the relative resource requirements and the associated costs of each option.
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48
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Gleyze P, Coudane H. Patient information in orthopedic and trauma surgery. Fundamental knowledge, legal aspects and practical recommendations. Orthop Traumatol Surg Res 2016; 102:S105-11. [PMID: 26826803 DOI: 10.1016/j.otsr.2015.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/03/2015] [Accepted: 06/03/2015] [Indexed: 02/02/2023]
Abstract
Providing information to surgery patients is a form of health-care governed by clearly defined therapeutic and medicolegal rules, and in particular in France by the Act of March 4, 2002 and the Code of Good Practice. The patient's right to information is implemented in a face-to-face consultation, which should be fully codified, and in a specific clinical examination, followed by information regarding the affected organ, pathology, treatment options, possible surgery, and the preconditions, risks and results associated with the procedure. Information should be personalized and as complete as possible, communicating the state of knowledge as validated by scientific societies and medical institutions. State of the art technology (dedicated website, on-line information suites, etc.) is indispensable but needs to be mastered and to adhere to the guidelines of the Council of the National Order of Medicine. Information traceability, the retraction period and proof of content of the information are essential. A signed document delivered in an informative atmosphere optimizes the exercise. Patient information is an ethical and medicolegal obligation, but above all is the expression and demonstration of the health-care potential of the practitioner and our contribution to reducing the information gap, reinforcing the cement holding our society together.
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Affiliation(s)
- P Gleyze
- Unité de chirurgie orthopédique et arthroscopique, hôpital Albert-Schweitzer, 201, avenue d'Alsace, 68000 Comar, France; Institut Franco-Chinois des arts du soin, Chengdu, China.
| | - H Coudane
- Department of locomotor system arthroscopy, traumatology and orthopedics, Nancy university hospital, 54035 Nancy, France
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49
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Peters M, Kern BR, Buschmann C. [Medicolegal aspects in emergency medical care : Analysis of the frequency of advance health care directives and the influence on decision making in emergency medicine]. Med Klin Intensivmed Notfmed 2015; 112:136-144. [PMID: 26604092 DOI: 10.1007/s00063-015-0120-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/28/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medical decisions in an emergency medical services (EMS) situation are always extremely time- critical and sensitive, potentially leading to medicolegal consequences. Advance health care directives (AHCDs) are crucial components in the patients' participative decision making. When a patient refuses resuscitation, and/or other life-extending treatments, emergency physicians face possible ethical, medical, and medicolegal conflicts. METHODS As part of the RIMANO II Study [Risk Management Präklinische (prehospital) Notfallmedizin (emergency medicine)], all 18 "emergency physician bases" of the Berlin Fire Department were polled regarding the influence of AHCDs in regard to emergency medical decision making. The assessment was based on anonymous questionnaires. Furthermore, emergency medical suggestions for improvement of AHCDs were gathered. Descriptive statistics and qualitative methods were used for evaluation. RESULTS A total of 112 responses from emergency physicians could be incorporated into the study. Anesthesiologists represented the largest group (n = 55, 49 %), followed by internists (n = 40, 36 %). The median length of experience in EMS was 7 years [interquartile range (IQR) 4-14 years]. Patients' "do not resuscitate" orders were obeyed in 78/112 cases (70 %, 95 % CI 69-78 %). In 49/112 cases (44 %, 95 % CI 34-53 %), the request to not be hospitalized was granted. The length of EMS experience, type of medical specialty, the number of EMS cases and ways in which AHCDs were handled were all contributing factors to the various emergency medical interventions. CONCLUSION AHCDs appear to have an influence in the emergency medical decision process. However, it is presently unclear as to what a standardized and universally comprehensible AHCD should look like, in order to provide a framework that is both acceptable and necessary in a prehospital emergency medicine environment, ensuring medicolegal certainty for the parties involved.
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Affiliation(s)
- Mike Peters
- Institut für Rechtsmedizin, Charité-Universitätsmedizin Berlin, Turmstraße 21, 10559, Berlin, Deutschland.
| | - B R Kern
- Juristenfakultät Universität Leipzig, Leipzig, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité-Universitätsmedizin Berlin, Turmstraße 21, 10559, Berlin, Deutschland
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50
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Trappe HJ. [Ethics in intensive care and euthanasia : With respect to inactivating defibrillators at the end of life in terminally ill patients]. Med Klin Intensivmed Notfmed 2017; 112:214-21. [PMID: 26577148 DOI: 10.1007/s00063-015-0119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/05/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise. MATERIALS AND METHODS Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed. DISCUSSION AND CONCLUSION It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.
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