Ethico-legal issues by medical specialism A–M

2021 ◽  
pp. 229-260
Author(s):  
Anna Smajdor ◽  
Jonathan Herring ◽  
Robert Wheeler
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
General Practice ◽  
Interventional Radiology ◽  
Cardiac Surgery ◽  
Elderly Care ◽  
Legal Issues ◽  
Relative Risks ◽  
Clinical Records ◽  
Self Defence

This chapter covers Ethico-legal issues by medical specialism and includes topics on the following subjects (A-M): Anaesthetics: Child refusing treatment, Cardiac Surgery: Candour, Dentistry: Gillick Competence, Dermatology; a right to treatment?, Diabetology: Maintaining clinical records, Elderly Care: Refusal of Treatment, Emergency Department: Knife Crime, Emergency Department: Restraint/Self-Defence, Endocrinology: Wishes/Feelings, ENT: Consent/Necessity, Family Planning: Gillick Competence, Gastroenterology: Mental Health Act, General Practice: Cultural Circumcision, General Surgery: Need for clinicians to keep up to date, Genetics: Confidentiality, Gynaecology: abortion, HIV: Confidentiality, Intensive Care: DNACPR, Interventional Radiology: Relative Risks, and Maxillofacial: Candour.

scholarly journals Study Protocol: Prospective, observational, cohort study of COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study)

2020 ◽  
Vol 3 ◽  
pp. 67
Author(s):  
Walter Cullen ◽  
Gordana Avramovic ◽  
John Broughan ◽  
Mary-Carmel Burke ◽  
Aoife Cotter ◽  
...  
Keyword(s):  
Mental Health ◽  
General Practice ◽  
Health Service ◽  
Health Behaviours ◽  
University Hospital ◽  
Service Utilisation ◽  
Presumptive Diagnosis ◽  
Health And Wellbeing ◽  
Clinical Records

Background: It is accepted that COVID-19 will have considerable long-term consequences, especially on people’s mental and physical health and wellbeing. Although the impacts on local communities have been immense, there remains little data on long term outcomes among patients with COVID-19 who were managed in general practice and primary care. This study seeks to address this knowledge gap by examining how the COVID-19 pandemic has impacted the medium and long-term health and wellbeing of patients attending general practice, especially their mental health and wellbeing.  Methods: The study will be conducted at 12 general practices in the catchment area of the Mater Misericordiae University Hospital, i.e. the North Dublin area, an area which has experienced an especially high COVID-19 incidence. Practices will be recruited from the professional networks of the research team. A member of the general practice team will be asked to identify patients of the practice who attended the practice after 16/3/20 with a confirmed or presumptive diagnosis of COVID-19 infection. Potential participants will be provided with information on the study by the clinical team. Data will be collected on those patients who consent to participate by means of an interviewer-administered questionnaire and review of clinical records. Data will be collected on health (especially mental health) and wellbeing, quality of life, health behaviours, health service utilisation, and wider impacts of COVID-19 at recruitment and at two follow up time points (6, 12 months). Deliverables: The project involves collaboration with Ireland’s Health Service Executive, Ireland East Hospital Group, and the Mater Misericordiae University Hospital, Dublin. The study is funded by the Health Research Board. Findings will inform health policies that attenuate the adverse impacts of COVID-19 on population mental health and health generally.

Mental health presentations to a paediatric emergency department

2020 ◽  
Author(s):  
Angelo Tolentino ◽  
Linda Symington ◽  
Faye Jordan ◽  
Frances Kinnear ◽  
Mairi Jarvis
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

scholarly journals Reported and unreported potentially important incidental findings in urgent nonenhanced abdominal CT for renal colic

2021 ◽  
Author(s):  
Elena Belloni ◽  
Stefania Tentoni ◽  
Ilaria Fiorina ◽  
Chandra Bortolotto ◽  
Olivia Bottinelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Status ◽  
Pleural Effusion ◽  
Incidental Findings ◽  
Renal Colic ◽  
Legal Issues ◽  
Abdominal Ct ◽  
Significant Difference ◽  
Original Report ◽  
The Difference

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

scholarly journals Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabine Ruths ◽  
Inger Haukenes ◽  
Øystein Hetlevik ◽  
Tone Smith-Sivertsen ◽  
Stefan Hjørleifsson ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
General Practice ◽  
Cohort Study ◽  
Drug Treatment ◽  
Time Trends ◽  
Older Patients ◽  
Antidepressant Drug ◽  
Depression Care ◽  
Patient Gender

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

scholarly journals Improving the Quality of Children’s Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes

2021 ◽  
Author(s):  
Corinna C. Klein ◽  
B. Erika Luis Sanchez ◽  
Miya L. Barnett
Keyword(s):  
Mental Health ◽  
Health Care ◽  
General Practice ◽  
Qualitative Interviews ◽  
Behavioral Observation ◽  
Parent Report ◽  
Therapist Attitudes ◽  
Child Interaction ◽  
Report Measure

AbstractProgress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.

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