scholarly journals Are predominantly western standards and expectations of informed consent in surgery applicable to all? A qualitative study in a tertiary care hospital in Sri Lanka

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025299
Author(s):  
Udagedara Mudiyanselage Jayami Esha Samaranayake ◽  
Yasith Mathangasinghe ◽  
Anura Sarath Kumara Banagala

ObjectiveTo identify the different perceptions on informed surgical consent in a group of Sri Lankan patients.MethodsA qualitative study was conducted in a single surgical unit at a tertiary care hospital from January to May 2018. The protocol conformed to the Declaration of Helsinki. Patients undergoing elective major surgeries were recruited using initial purposive and later theoretical sampling. In-depth interviews were conducted in their native language based on the grounded theory. Initial codes were generated after analysing the transcripts. Constant comparative method was employed during intermediate and advanced coding. Data collection and analyses were conducted simultaneously, until the saturation of the themes. Finally, advanced coding was used for theoretical integrations.ResultsThirty patients (male:female=12:18) were assessed. The mean age was 41±9 years. Sinhalese predominated (50.0%, n=15). Majority underwent thyroidectomy (36.7%, n=11). The generated theory categorises the process of obtaining informed consent in four phases: initial interaction phase, reasoning phase, convincing phase and decision-making phase. Giving consent for surgery was a dependent role between patient, family members and the surgeon, as opposed to an individual decision by the patient. Some patients abstained from asking questions from doctors since doctors were ‘busy’, ‘short-tempered’ or ‘stressed out’. Some found nurses to be more approachable than doctors. Patients admitted that having a bystander while obtaining consent would relieve their stress. They needed doctors to emphasise more on postoperative lifestyle changes and preprocedure counselling at the clinic level. To educate patients about their procedure, some suggested leaflets or booklets to be distributed at the clinic before ward admission. The majority disliked watching educational videos because they were ‘scared’ to look at surgical dissections and blood.ConclusionThe informed consent process should include key elements that are non-culture specific along with elements or practices that consider the cultural norms of the society.

2021 ◽  
pp. 103195
Author(s):  
Muhammad Asharib Arshad ◽  
Naureen Omar ◽  
Muhammad Zaid Amjad ◽  
Khalid Bashir ◽  
Muhammad Irfan ◽  
...  

Author(s):  
Pankaj Ashok Pande ◽  
Amit Jagdish Jogdande

Background: Globally the incidence of dengue has increased in the past three decades. It is predominantly found in the urban and semi-urban area however now it is spreading in rural areas also. In India the incidence of dengue has increased due to rapid urbanization, lifestyle changes and improper water storage practices. Hence this study was planned to study the clinical and laboratory profile of dengue patient as the number of dengue patients is on rise every year and there is varied presentation of clinical features in different parts of India.Methods: This observational study was carried out in tertiary care hospital. Confirmed cases of Dengue were included in the study. There cases were observed seven days. During this period their clinical and biochemical profile was recorded in pre structured and pre tested proforma. Data was compiled and analyzed by MS-Office (Excel) and SPSS-21.Results: In this study total 129 patients were enrolled. Out of total 91 were males and 38 were females. Laboratory profile of dengue patients suggested steep decline in total leucocytes count and platelet during first five days but started to increase by seventh day but platelets have not reached to its original normal value while TLC reverted to normal range. Fever and headache were most common symptom in our study.Conclusions: Clinical and laboratory profile of dengue patient changes with every new epidemic and different region in India. Clinical features like organomegaly are more common in paediatrics age group than adults. 


2015 ◽  
Vol 5 (3) ◽  
pp. 1-5
Author(s):  
Zoheb Rafique Rafique ◽  
Urooj Bhatti

Objective: The aim of this paper was to assess the practice of medical ethics by the physicians at a public sector hospital in Jamshoro Sindh. Material and methods: This survey was conducted at four medical units of tertiary care hospital at jamshoro in the month of august 2014. Participants were randomly selected from patients aged over 18 years. A structured questionnaire was designed and the participants were asked about their demographic profile and their physician’s practice regarding informed consent, maintaining confidentiality, privacy and other treatment formalities. Written consent was taken from all the participants before interview.Results: A total of 100 patients were randomly selected for this study. The majority of patients reported that informed consent was taken from them. The patients also responded that privacy and confidentiality is maintained during their treatment. However, many patients agreed that they were not properly informed about the laboratory findings, role of proposed drugs and also side effects of drugs. Conclusion: There is marked improvement in the practice of medical ethics by physicians of this tertiary care hospital. However, awareness workshops should be conducted to update and improve the knowledge of medical ethics among physicians. This will surely help them translate the knowledge into practice. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21531 Bangladesh Journal of Bioethics 2014 Vol.5 (3): 1-5.


2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Manish Nath Pant ◽  
Saswat Kumar Jha ◽  
Sauravi Shrestha

Introduction: Left against medical advice is a worldwide phenomenon. Patients leaving against Left against medical advice do not provide the health professionals with legal impunity. A well-informed consent should be present with surety that they are well understood by the patient before they leave. The study was undertaken to study the prevalence of patients that leave against medical advice. Methods: This is a descriptive cross-sectional study done in the emergency department of a tertiary care hospital from 1st February 2020 to 31 July 2020. Ethical approval was taken from the Institutional Review Committee (ref. no. 130120205). The sample size was calculated and the convenient sampling method was used. Data were analyzed in the Statistical Package of the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 5834 visits, 332 (5.96%) (4.70-7.22 at 95% Confidence Interval) patients left against medical advice. The mean age was 36.48 years (3 days-91 years) and males 173 (52.3%) were prone to leave than females. Only 50 (15.1%) cases had well-informed consent with complications documented. Hundred (30.5%) patients had wanted to come on follow up the next day in the out-patient department while 41 (12.4%) had to leave because of financial reasons. Only seven (2.9%) of well-oriented patients gave their consent and the remaining 233 (97.1%) were by the kin present. Only 76 (23%) patients were sent home with a well-documented medicine prescription. Conclusions: The proportion of patients who left against medical advice was more than the studies done in a similar setting.


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