scholarly journals Same Coin-Different Sides? Futility and Patient Refusal of Treatment

2011 ◽  
Vol 8 (2) ◽  
pp. 141-143
Author(s):  
Eleanor Milligan
Keyword(s):  
Refusal Of Treatment ◽  
Patient Refusal

Long-term follow-up of clozapine prescribing

2018 ◽  
Vol 32 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Siobhan H Gee ◽  
Sukhwinder S Shergill ◽  
David M Taylor
Keyword(s):  
Demographic Variable ◽  
Binary Logistic Regression ◽  
Antipsychotic Treatment ◽  
Chi Square ◽  
Refusal Of Treatment ◽  
Treatment History ◽  
Treatment Information ◽  
Long Term Follow Up ◽  
Male Patients ◽  
Patient Refusal

Objective: Clozapine is uniquely effective for treatment-resistant schizophrenia, and so treatment continuation is essential. We aimed to identify factors associated with an increased likelihood of clozapine discontinuation in a cohort of patients in South East London. Methods: We gathered demographic and treatment information such as duration of illness and antipsychotic treatment history. t-tests, chi-square tests and binary logistic regression were used to compare patients who continued and discontinued clozapine during the study and to identify predictor variables for discontinuation. Results: Out of the study population of 133 patients, 48 discontinued clozapine at least once during the study period. The majority of these (75%) stopped treatment within the first 4 years of clozapine therapy. Age, ethnicity, diagnosis and antipsychotic treatment history were not predictive of the risk of clozapine discontinuation. However, male patients were more likely to stop taking clozapine (χ2 = 6.81, p = 0.009). The odds of discontinuing clozapine were 2.15 times higher for male patients. The most common reason for discontinuation was patient refusal of treatment. Conclusion: We found that patients who discontinue clozapine are more likely to be male, but no other demographic variable was found to predict treatment cessation. Discontinuation usually occurred due to patient refusal of treatment.

Patient refusal of treatment in obstetrics

2003 ◽  
Vol 27 (6) ◽  
pp. 435-445 ◽  
Author(s):  
James J Finnerty ◽  
Christian A Chisholm
Keyword(s):  
Refusal Of Treatment ◽  
Patient Refusal

Discontinuation and relapse with paliperidone palmitate three-monthly for maintenance of schizophrenia: Two year follow-up of use in clinical practice

2021 ◽  
pp. 026988112110097
Author(s):  
Phoebe Wallman ◽  
Ivana Clark ◽  
David Taylor
Keyword(s):  
Clinical Practice ◽  
Treatment Duration ◽  
Maintenance Treatment ◽  
Clinical Care ◽  
Paliperidone Palmitate ◽  
Reduce Risk ◽  
Patient Refusal ◽  
Long Acting ◽  
Post Hoc

Background: The use of antipsychotic long-acting injections (LAI) aims to reduce risk of relapse and hospitalisation in patients with schizophrenia compared with oral medication. Paliperidone palmitate is currently the only LAI that can be administered at three-monthly intervals for maintenance treatment of schizophrenia. Aim: This prospective study aimed to evaluate relapse and continuation in licensed use of paliperidone palmitate three-monthly (PP3M) over a 2-year follow-up in clinical practice. Method: Non-interventional, observational study of patients treated in the South London and The Maudsley NHS Foundation Trust. Results: A total of 166 patients initiated on PP3M, 55 were excluded from the study (non-F20 diagnosis ( n = 43); F20 >65 years old ( n = 12)). Of the 111 patients included, 67 (60%) continued PP3M for 2 years. Overall 102 patients received more than one dose of PP3M and 92 (90%) remained on the same dose of PP3M for the whole of their treatment duration. Relapse (defined as a step-up in clinical care) occurred in eight patients (7%) while on PP3M. The most common reason for discontinuation was patient refusal and the most frequent medication prescribed after discontinuation was paliperidone palmitate one-monthly (PP1M). Post hoc, we analysed outcome in those continuing any form of PPLAI (those continuing with PP3M and those switching back to PP1M). Continuation over 2 years with any PPLAI formulation was 73% (81/111) and relapse was recorded in 9% (10/111). Conclusion: Overall, PP3M was an effective maintenance treatment for schizophrenia after stabilisation on PP1M in a clinical setting.

No Deaths Associated with Patient Refusal of Transport After Naloxone-Reversed Opioid Overdose

2011 ◽  
Vol 15 (3) ◽  
pp. 320-324 ◽  
Author(s):  
David A. Wampler ◽  
D. Kimberley Molina ◽  
John McManus ◽  
Philip Laws ◽  
Craig A. Manifold
Keyword(s):  
Opioid Overdose ◽  
Patient Refusal

Disseminating a patient-centered education bundle to reduce missed doses of pharmacologic venous thromboembolism (VTE) prophylaxis to a community hospital

2020 ◽  
pp. 251604352096932
Author(s):  
Oluwafemi P Owodunni ◽  
Brandyn D Lau ◽  
Dauryne L Shaffer ◽  
Danielle McQuigg ◽  
Deborah Samuel ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Real Time ◽  
Community Hospital ◽  
Post Intervention ◽  
Patient Centered ◽  
Record System ◽  
Vte Prophylaxis ◽  
Patient Refusal ◽  
Preventable Harm ◽  
Frequent Reason

Background Venous thromboembolism (VTE) is a leading cause of preventable harm in hospitalized patients. However, many doses of prescribed pharmacologic VTE prophylaxis are frequently missed. We investigated the effect of a patient-centered education bundle on missed doses of VTE prophylaxis in a community hospital. Methods We performed a pre-post analysis examining missed doses of VTE prophylaxis in a community hospital. A real-time alert from the electronic health record system facilitated the delivery of a patient education bundle intervention. We included all patient visits on a single floor where at least 1 dose of VTE prophylaxis was prescribed during pre- (January 1, 2018, - November 31, 2018) and post- (January 1 - June 31, 2019) intervention periods. Outcomes included any missed dose (primary) and reasons for missed doses (refusal, other [secondary]) and were compared between both periods. Results 1,614 patient visits were included. The proportion of any missed dose significantly decreased (13.8% vs. 8.2% [OR, 0.56; 95% CI, 0.48, 0.64]) between the pre-post intervention periods. Patient refusal was the most frequent reason for missed doses. In the post-intervention period, patient refusal significantly decreased from 8.8% to 5.0% (OR, 0.54; 95% CI, 0.46, 0.64). Similarly, other reasons for missed doses significantly decreased from 5.0% to 3.2% (OR, 0.62; 95% CI, 0.51, 0.77). Conclusions A real-time alert-triggered patient-centered education bundle developed and tested in an academic hospital, significantly reduced missed doses of prescribed pharmacologic VTE prophylaxis when disseminated to a community hospital.

REFUSAL OF TREATMENT BY PROXY

The Lancet ◽  
1985 ◽  
Vol 325 (8430) ◽  
pp. 699 ◽  
Author(s):  
Michael Kaye
Keyword(s):  
Refusal Of Treatment

scholarly journals Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

2021 ◽  
Author(s):  
Rose-Marie W. Thörn ◽  
Jan Stepniewski ◽  
Hans Hjelmqvist ◽  
Anette Forsberg ◽  
Rebecca Ahlstrand ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Feasibility Study ◽  
Early Mobilization ◽  
University Hospital ◽  
Serious Adverse Events ◽  
Elective Colorectal Surgery ◽  
Post Surgery ◽  
Surgical Icu ◽  
Patient Refusal ◽  
Four Levels

Abstract Background Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach. Methods This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space. Results In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred. Conclusions Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

scholarly journals The Right to Refuse Treatment for Infectious Disease

2020 ◽  
pp. 171-182
Author(s):  
Carl H. Coleman
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Medical Treatment ◽  
Third Parties ◽  
Extreme Position ◽  
Refusal Of Treatment ◽  
Right To Refuse Treatment ◽  
The Right ◽  
Right To Refuse

Abstract One of the central tenets of contemporary bioethics is that mentally competent persons have a right to refuse medical treatment, even if the refusal might lead to the individual’s death. Despite this principle, laws in some jurisdictions authorize the nonconsensual treatment of persons with tuberculosis (TB) or other serious infectious diseases, on the grounds that doing so is necessary to protect the safety of others. This chapter argues that, in the vast majority of situations, overriding a refusal of treatment for infectious disease is not justifiable, as the risk to third parties can be avoided by the less restrictive alternative of isolating the patient. At the same time, it rejects the extreme position that the nonconsensual treatment of infectious disease is never appropriate. Instead, it concludes that compelling an individual to undergo treatment for infectious diseases may be ethically justifiable in exceptional situations if a refusal of treatment poses a grave risk to third parties, the treatment is not overly burdensome and has been established to be safe and effective, and less restrictive alternatives, including humanely isolating the patient, are not feasible under the circumstances. The burden should be on those seeking to compel unwanted treatment to demonstrate that these requirements have been met.

Sign in / Sign up

Export Citation Format

Share Document