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PubMedDate not supplied

Discussing cardiopulmonary resuscitation: a study of elderly outpatients.

Decisions about when to perform cardiopulmonary resuscitation (CPR) are frequently made without knowing the wishes of the patient. To evaluate the feasibility of outpatient discussions about CPR, the authors surveyed 22 male and 53 female, mentally competent, ambulatory patients 65 years of age and older. Only 7% of those interviewed had an accurate understanding of what CPR meant before hearing a standardized description. Eighty-seven per cent thought discussions about CPR should take place routinely, but only 3% had previously discussed this issue with their physicians. Seventy per cent felt such discussions should take place during periods of health, and 84% felt their views should be part of the medical record. When asked about three terminal illnesses, a minority of patients wanted CPR: 25% felt CPR was indicated in the presence of irreversible coma, 28% for terminal cancer, and 41% for irreversible heart failure. More patients felt they would request CPR if they had irreversible heart failure than if in a coma (p less than 0.002) or for terminal cancer (p = 0.002). The majority of elderly outpatients have clearly defined opinions about the application of CPR and wish to discuss them with their physicians.

Aged↗
PubMed1993

Patient acceptance of an information sheet about cardiopulmonary resuscitation options.

OBJECTIVE: To determine initial patient acceptance of a cardiopulmonary resuscitation/do-not-resuscitate orders (CPR/DNR) information sheet intended to facilitate early discussion of CPR preferences. DESIGN: Attitudinal survey of adults after reading a CPR/DNR information sheet. SETTING: Inpatient wards and outpatient clinics of a tertiary care military teaching hospital. PATIENTS: 230 English-reading, mentally competent, volunteer patients (95%) of 243 eligible patients completed questionnaires. Mean age was 51.5 +/- 17 years; 122 (53%) patients were men; 103 (45%) were inpatients. Self-reported diagnoses were: cancer, 42 (18%); HIV disease, 22 (10%); other medical conditions, 87 (38%); pre- and postoperative cases, 35 (15%); and unknown, 44 (19%). RESULTS: 56% of the patients had previously thought about CPR options. 10% of the patients had actually discussed preferences with their physicians. 90% of the patients desired discussion with their physicians and other health care providers. 91% of the patients reported feeling better or no change after reading the information. 78% of the patients agreed that the information sheet would be helpful in discussing their preferences and most thought the information should be routinely given to all patients. CONCLUSIONS: Written information about CPR options was perceived as helpful and acceptable to most patients surveyed. Since a few patients initially reported feeling worse after reading the CPR/DNR information sheet, written information should not be used alone but may facilitate initial communication and discussion.

Adolescent↗
PubMed2006

[On informed patient consent].

One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.

Adolescent↗
PubMed2002

[Continuous mental disorder as a prerequisite for the loss of legal capacity].

German civil law differentiates between continuous and temporary mental disorder. Loss of legal capacity can only be ascertained if a continuous mental disorder is evident. Considering the far-reaching consequences of the loss of legal capacity, careful distinction between these two groups of disorders is necessary, but clear legal guidelines and unequivocal psychiatric statements are still lacking. The solution given here can assure the quality of expert testimony by taking into account the current diagnostic conventions of ICD-10 research criteria as well as relevant knowledge about clinical course and therapy of psychiatric disorders.

Disability Evaluation↗
PubMed2006

[Patient knowledge regarding tardive dyskinesia].

BACKGROUND: Patients can provide appropriate and legally valid consent to treatment with antipsychotics only if they received adequate information on the risk of tardive dyskinesia (TD) and have the capacity to give informed consent. METHODS: Eighty-seven patients in a psychiatric practice undergoing treatment with antipsychotics were interviewed for their level of information regarding TD and were subsequently provided with additional information on TD as needed. Three months after provision of this information, the interview was repeated. RESULTS: Though 82% of the patients had read the patient information leaflet and 44% had already received previous information, only 17% were found to be informed. The proportion of informed patients increased to 72% at the second interview. Among patients remaining uninformed despite previous information, a statistically significant higher proportion of elderly patients and patients with marked psychopathological impairments was found. CONCLUSIONS: Schizophrenic patients' knowledge on TD is low. With appropriate oral information being provided patients' knowledge can be considerably improved in the short run.

Adult↗
PubMed2000

[Psychiatric consultation services for the elderly. Changes in utilization due to the new German legislation concerning guardianship and restructuring of health care providers].

In the discussion of increasing costs of health care in Germany, the frequent and long hospital stays of elderly patients are often pointed out. Since these patients very frequently suffer from psychiatric disorders, psychiatric consultation is often required. This study was aimed at investigating whether new German laws concerning guardianship and the structure of health care providers change conditions for psychiatric consultation services. For this purpose, the documentation of all consultations in the years 1991 to 1995 was retrospectively evaluated. In about 3% of all patients aged over 65 referred to the General University Hospital of Lübeck, psychiatric consultation was ordered. The most frequent diagnosis was senile dementia. Comparison of the requests and psychiatric recommendations show a significant increase in wishes and recommendations for guardianship. Moreover, there is evidence of the increasing need of consultation in elderly patients. Possibly due to the new law concerning the structure of health care providers and the number of requests and recommendations to transfer patients to psychiatric wards, these results show that the new laws do affect psychiatric consultation.

Aged↗
PubMed2003

Cross-cultural differences in the conceptualisation of patients' satisfaction with psychiatric services--content validity of the English version of the Verona Service Satisfaction Scale.

BACKGROUND: The VSSS is a multi-dimensional questionnaire developed to address methodological concerns about measurement of satisfaction with services on the part of psychiatric patients. The acceptability, sensitivity, content validity and test-retest reliability of the original version of the VSSS, in Italian, have already been demonstrated [1, 2]. The internal consistency [3] and test-retest reliability [4] of the English translation have been shown to be within acceptable ranges. The content validity of the original 82-item and the 54-item English version has not yet been assessed. AIMS: The aims of this study were to assess the content validity of the English translation of the VSSS and to compare it with that of the original version in Italian. METHOD: We used data collected as part of the first wave (T1) of the PRiSM Psychosis Study [5] and repeated the methods used to assess the content validity of the original Italian version of the VSSS [1, 2]. Content elements derived from answers to four open questions were rated independently by CH and HH in terms of their equivalence to VSSS items or dimensions. RESULTS: were compared to those from the content validity study of the Italian version. Results Inter-rater agreement was very high. The largest proportion of the content elements of the answers were rated as equivalent or related to a questionnaire item or a dimension of the VSSS. The dimension 'Professionals' Skills and Behaviour' appears the most significant contributor to satisfaction, as it was most often related to content elements in answers to all four key questions (39.1 %). The second most frequently mentioned dimension was that of 'Types of Intervention' for three out of four open questions, while 'Access' was second most frequent for the fourth. Of the content elements, 17.2 % did not include items or dimensions covered by the VSSS; the three most frequently mentioned were other patients, food and security. CONCLUSIONS: The 82-item English version of the VSSS captures sharply most contents relevant to patients' satisfaction. Consideration of contributors to satisfaction so far neglected may refine the conceptualisation of satisfaction.

Catchment Area, Health↗
PubMed2005

Awareness of diagnosis, and information-seeking behavior of hospitalized cancer patients in Greece.

PURPOSE: The goal of our study was to evaluate the extent of disease-related knowledge and the need for further information of cancer patients in Greece. MATERIALS AND METHODS: We evaluated 203 mentally competent adult cancer patients hospitalized in general and oncological hospitals in the city of Athens and its suburbs. Data were collected by means of semistructured interviews. Patients were evaluated as to whether they had awareness of their diagnosis. Those who did so (n = 83) were further questioned about additional disease-related information. RESULTS: The majority of patients (59%) claimed to have no knowledge of their diagnosis. Women (p = 0.004) as well as high school and university graduates (p = 0.024) showed significantly superior levels of information when compared to men and graduates of elementary schools, respectively. Age was also a factor that influenced the level of the awareness of the diagnosis and the request for additional information: patients who were informed about the diagnosis and patients who asked for more information were significantly younger than their counterparts who ignored the diagnosis (p < 0.001) and those who didn't ask for further information, respectively (p = 0.03). Hospital specialization (oncological versus general, p < 0.001) and department specialization (medical versus surgical, p = 0.004) were associated with significantly increased levels of information. The patient's educational level was associated with increased request for additional information (p = 0.006). Most patients with knowledge of their diagnosis requested detailed information about severity of their disease and prognosis. Only 13% of those in the informed group claimed they would have benefited psychologically by having been unaware of their diagnosis. CONCLUSIONS: Although Greek patients with diagnoses of malignancies want and need to be adequately informed, the amount of information they receive is inadequate. Over half of those patients evaluated were not aware of their diagnosis. Attitudes of health care professionals, preestablished family beliefs, "mind-set" difficulties, and organizational issues should not become barriers to the patients' right to be fully informed of their diagnoses and choices of potential therapies.

Adult↗
PubMed2006

Anton's syndrome due to a giant anterior fossa meningioma. The problem of routine use of advanced diagnostic imaging in psychiatric care.

We present a case of blindness and Anton's syndrome in a psychiatric patient with late diagnosis of a giant frontal meningioma. The criteria for advanced diagnostic imaging in the psychiatric population are discussed. We conclude that MR or CT scan is indicated in psychiatric in-patients who fail to improve with standard psychiatric treatment. This strategy should be submitted to a cost-benefit analysis.

Adult↗
PubMed2005

Infanticide: contrasting views.

BACKGROUND: The subject of infanticide is met with complex reactions. Paradoxically, the very same society that practices gender selection may also prosecute a mother for killing an infant. The author reviews historical, cultural, and political views on infanticide. OBJECTIVE: Using the case of Andrea Yates, the author illustrates the outcome of an infanticide case in American Judicial System in which a floridly psychotic mother serves a life in prison. This work explores contemporary worldwide experiences of infanticide and investigates culture specific attitudes towards causes, facilitation, and punishment of this tragic cause of infant mortality. The work illustrates the intricate relationship between a society's construction of parenthood and mothering, and its experience of infanticide. RESULTS: Infanticide is deeply embedded in, and responsive to the societies in which it occurs. Causes vary from poverty to stigma, dowry and insanity. The worldwide experience of infant murder reaches from facilitation of gender determination in China and Asia to lethal execution of mothers as perpetrators in the United States. CONCLUSION: Infanticide must be viewed against the political, cultural, social and legal backgrounds of societies that treat women with disregard. It is a reflection of social and cultural norms governing motherhood, a constant that links these seemingly disparate acts. The overall association of infanticide with crime, postpartum illness, population and sex selection speaks to unjust discrimination against women and children. We as a world society can do a far better job of protecting motherhood.

Capital Punishment↗
PubMed2000

Electroconvulsive therapy in adolescence.

The aim of this work is to discuss the ethical issues regarding the use of electroconvulsive therapy (ECT) in adolescents. Ethical implications of ECT in adolescents are analyzed in the light of general medical ethics, which include five prominent principles with respect to autonomy, nonmaleficence, beneficence, justice, and cautiousness. As adults, adolescents with acute psychotic impairment raise an inherent conflict between the respect for the patient's autonomy, on the one side, and the principle of beneficence on the other. However, this age group presents particular dilemmas: (i) As any adolescent suffering from a psychiatric illness is a highly vulnerable subject, society asks for particular attention. The consequence of potential overprotection is that the adolescent may remain untreated because of unrealistic fears regarding ECT. (ii) Some of these fears are linked to the cognitive secondary effects of ECT. Although preliminary data are reassuring, more empirical research on this population should be encouraged. (iii) Cautiousness recommends the use of ECT in limited indications catatonia, mood disorders, and intractable acute psychotic disorders. We conclude that there is no ethical reason to ban the use of ECT in adolescents. Ethical options in clinical practice must be evaluated empirically with respect to the consequences for the patient. Dogmatic views should be set aside.

Adolescent↗
PubMed2001

Turn-of-the-century ethical issues in child psychiatric research.

National concern in 2000 about increased psychoactive drug prescription for preschoolers accentuated the 1990s thrust for more pharmacologic research in children. Preschoolers are prescribed potent drugs without adequate evidence for efficacy or safety at this plastic age of the rapidly developing brain. Implementation of needed preschool research poses special ethical complications. Children with mental disorder qualify for special protection under both rubrics. Parental informed consent is crucial for preschoolers, who appear incapable of assent because of their preoperational, magical, animistic, egocentric thinking, with inability to comprehend relative risks and benefits. Whether they can dissent is an open question. Possibly for research with direct benefit outweighing the risk, parental permission/consent could override attempted preschooler dissent. Subject recompense should be adjusted for age differences in perception of amount, although parent reimbursement needs to be realistic. Insurance for research risk is desirable. Placebo controls appear justified for preschoolers because there is little evidence base to say that a proven effective treatment already exists. Disruptive behavior disorders, including attention-deficit/hyperactivity, have enough evidence of preschool diagnostic validity to justify therapeutic trials. In preschool pharmacologic research, a brief trial of a nonpharmacologic treatment should precede the drug trial to ensure that placebo responders and responders to the alternative treatment are not exposed to drug risk.

Child↗
PubMed2000

Ethical issues for the consultant in the general hospital.

Medical practice has changed dramatically in the past 50 years since psychiatry first made inroads into the general hospital setting. The image of the wise, gentleman-psychiatrist in a tweed jacket, spreading pearls of wisdom to a train of eager students and house-officers has been gradually replaced by that of a harried consultant being summoned for triage and tranquilization. In her quest to be all things to all people, the consultation-liaison psychiatrist has to confront many an ethical dilemma. This article highlights some familiar conflicts and attempts to achieve resolution.

Ethicists↗
PubMed1993

Low risk to certain diseases in aging: role of the autonomic nervous system and calcium metabolism.

The low risk of aging Africans, as opposed to high risk of Caucasians, to certain major disorders, including Parkinson's disease, myocardial infarction, osteoporosis and fractures, some rheumatic diseases, and an overall reduced incidence of cancer, has not been explained. In this study it is proposed, firstly, that relative risk is determined by a common physiological mechanism in which ANS status and calcium metabolism play a central role; secondly, that distinctive features of this mechanism in Africans may be subtly increased vagal tone, relatively enhanced dopaminergic versus noradrenergic activity, and an efficient dopamine/vitamin D-parathormone, anabolic hormone regulation of bone metabolism, and cell calcium homeostasis; and thirdly, that the neuroendocrine-metabolic context determines the response to specific stimuli; consequently, 'risk' factors, as defined for particular disorders, are not universally applicable. Maintained dopaminergic activity, as proposed for Africans, coupled with low risk to certain disorders, confirms the experimentally demonstrated paramount importance of this neurotransmitter in retarding aging processes in animals. The neuroendocrine profile as defined for Africans is consistent with a potentially extended period of physical and mental competence and a conceivable shorter duration of involutionary decline.

Aging↗