scholarly journals Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110297
Author(s):  
Monica Verhofstadt ◽  
Kurt Audenaert ◽  
Kris Van den Broeck ◽  
Luc Deliens ◽  
Freddy Mortier ◽  
...  
Keyword(s):  
Medical Condition ◽  
Assessment Procedure ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Existential Suffering ◽  
Somatic Disorders ◽  
Psychiatric Conditions ◽  
Assessment Procedures ◽  
Current Guidelines ◽  
Entire Procedure

To investigate the experience of psychiatrists who completed assessment procedures of euthanasia requests from adults with psychiatric conditions (APC) over the last 12 months. Between November 2018 and April 2019 a cross-sectional survey was sent to a sample of 753 psychiatrists affiliated with Belgian organisations of psychiatrists to gather detailed information on their latest experience with a completed euthanasia assessment procedure, irrespective of its outcome (i.e. euthanasia being performed or not). Information on 46 unique cases revealed that most APC suffered from comorbid psychiatric and/or somatic disorders, and had received different kinds of treatment for many years prior to their euthanasia request. Existential suffering was the main reason for the request. The entire procedure spanned an average of 14 months, and an average of 13.5 months in the 23 cases that culminated in the performance of euthanasia. In all cases, the entire procedure entailed multidisciplinary consultations, including with family and friends. Psychiatrists reported fewer difficulties in assessing due care criteria related to the APC’s self-contemplation – for example, unbearable suffering on top of the due care criteria related to their medical condition; incurability due to lack of reasonable treatment perspectives. In a few cases in which euthanasia was the outcome, not all legal criteria were fulfilled in the reporting physicians’ opinions. Both positive and negative experiences of the assessment procedure were reported: for example, reduced suicide risk for the APC; an emotional burden and a feeling of being pressured for the psychiatrist. This study confirms that euthanasia assessment in APC entails a lengthy process with diverse complexities, and psychiatrists require support in more than one respect if the assessments are to be handled adequately. Thorough evaluation of current guidelines is recommended: that is, to what extent the guidelines sufficiently address the complexities around (e.g.) assessing legal criteria or involving relatives. We formulate various avenues for further research to build on this study’s insights and to fill remaining knowledge gaps.

scholarly journals Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark

2020 ◽  
Vol 8 ◽  
pp. 205031212094621
Author(s):  
Afsaneh Bjorvatn ◽  
Anne-Mette Magnussen ◽  
Lisa Wallander
Keyword(s):  
Medical Condition ◽  
Waiting Times ◽  
Legal Regulation ◽  
General Level ◽  
Legal Regulations ◽  
Cross Sectional Survey ◽  
Severe Condition ◽  
Minor Variation ◽  
Cross Sectional ◽  
Specialist Treatment

Objective: This article explores the implications of legal regulation for medical discretion and decision-making in Norway and Denmark. Methods: The article is based on a cross-national cross-sectional survey exploring cardiologists’ assessments of patient eligibility for specialist health care. Forty-two cardiologists in Norway and 48 in Denmark were presented with two standardized case vignettes in the form of patient referrals and were asked to assess whether the patient was eligible for treatment by a specialist, and if so, what waiting time would be assigned to the patient. Results: Primarily based on descriptive statistics, our findings indicate interesting similarities and variations. While there was only minor variation across the countries in cardiologists’ professional assessments about a patient with a more severe condition, judgements of eligibility for specialist treatment varied for a patient with a less severe medical condition. Moreover, Danish cardiologists distinguished between the more severe and less severe conditions to a much lesser extent when assessing eligibility for specialist treatment. For waiting times, there was considerable variation at the general level, from 1 week to 6 months. The assigned waiting times were on average double those for Norwegian cardiologists compared with their Danish counterparts. Denmark’s legal standardization of waiting times appears to lead to shorter waiting times than those prescribed by Norway’s legal regulations. Conclusion: For a single clear overall intention with a new policy, simpler legal regulations may be more effective than very detailed and specific requirements. If policymakers’ overall intention is for medical doctors to make complex decisions involving the prioritization of patients, then more individualized regulations seem to be a better tool.

Perceptions of people who inject drugs towards HIV pre-exposure prophylaxis in Australia

Sexual Health ◽  
2019 ◽  
Vol 16 (4) ◽  
pp. 383
Author(s):  
Phillip Read ◽  
Karen J. Chronister ◽  
Catherine Kostovski ◽  
Mary Ellen Harrod ◽  
Allison Salmon ◽  
...  
Keyword(s):  
Perceived Risk ◽  
Policy Development ◽  
People Who Inject Drugs ◽  
Hiv Status ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Willingness To Use ◽  
Exposure Prophylaxis ◽  
Current Guidelines ◽  
Hiv Negative

Background People who inject drugs (PWID) are a priority for HIV prevention. This study aimed to determine perceptions, potential eligibility and willingness to use PrEP among PWID in Sydney. Methods: Clients completed a cross-sectional survey to collect data on demographics, perceived risk of HIV and willingness to use PrEP, which were then analysed. Results: Twelve (7%) of 172 HIV-negative participants were eligible for PrEP under current guidelines for injecting reasons, of whom three would also be eligible for sexual risk, leaving nine (5%) eligible for injecting reasons alone. Half had heard of PrEP and, of these, 65% would consider taking it. Most (88%) thought they would continue using needle syringe program services. A minority (8%) indicated they may be likely to share needles and syringes or be less concerned about injecting partners’ HIV status (26%). Conclusions: Although PrEP will benefit a small proportion of PWID, this may equate to a significant number nationally. Policy development around PrEP incorporating affected populations will best support the community of people currently injecting to keep rates of HIV low.

Venous thromboembolism in medical outpatients – a cross-sectional survey of risk assessment and prophylaxis

2011 ◽  
Vol 105 (01) ◽  
pp. 190-196 ◽  
Author(s):  
Holger Lawall ◽  
Andreas Matthiessen ◽  
Volker Hohmann ◽  
Peter Bramlage ◽  
Sylvia Haas ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Medical Condition ◽  
Assessment Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Limited Mobility ◽  
Substantial Risk ◽  
Medical Outpatients

SummaryThe degree of thromboprophylaxis in medical outpatients is low despite a substantial risk for venous thromboembolism (VTE). This may be attributable to difficulties in assessing risk. Assessment tools like the Haas’ scorecard aid in determining the need for thromboprophylaxis. We aimed at evaluating how the use of this tool may aid physicians in appropriately using anticoagulants. This was an epidemiological, cross-sectional survey of acute medically ill patients with limited mobility treated by general practitioners and internists. Risk assessment for VTE by the treating physician was compared to calculated risk. Of 8,123 patients evaluated between August 2006 and April 2008, 7,271 fulfilled the in- and exclusion criteria. Mean age was 69.4 ± 13.6 years, and 45.2% were male. Of these 82.8% were high risk based on their acute medical condition, 37.9% based on their underlying chronic condition. Immobilisation, heart failure, pneumonia, age, obesity, and major varicosis were the most frequently encountered risk factors. The agreement between the Haas’ scorecard and physician indicated risk was high. At least 94.1% of patients with high risk received adequate anticoagulation mostly as low molecular weight heparins for a mean duration of 15.1 ± 30.5 days. There is a substantial risk for VTE in medical out-patients. Using a simple structured scorecard resulted in an overall appropriate risk assessment and high degree of anticoagulation. The scorecard may provide a tool to improve the overall awareness for VTE risk in medical outpatients, substantially improving the degree of prophylaxis in a patient population with largely underestimated risk.

scholarly journals Association between Disease-Specific Quality of Life and Complementary Medicine Use in Patients with Rhinitis in Taiwan: A Cross-Sectional Survey Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Malcolm Koo ◽  
Kai-Li Liang ◽  
Rong-San Jiang ◽  
Hsin Tsao ◽  
Yueh-Chiao Yeh
Keyword(s):  
Quality Of Life ◽  
Linear Regression ◽  
Medical Condition ◽  
Survey Study ◽  
Regression Analyses ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Female Sex ◽  
Disease Specific

Rhinitis is a common medical condition and can seriously impact patients’ quality of life. The objective of this study was to investigate the association between disease-specific quality of life and use of complementary and alternative medicine (CAM) modalities among Taiwanese rhinitis patients. A cross-sectional survey was undertaken at the outpatient department of otolaryngology in a medical center in Taiwan. Sociodemographic information, disease-specific quality of life (Chinese version of the 31-item Rhinosinusitis Outcome Measure, CRSOM-31), and previous use of CAM modalities for treatment of rhinitis of the patients were ascertained. Factor analysis was performed to reduce the number of CAM modalities. The resulting factors were analyzed for their association with CRSOM-31 score using linear regression analyses. Results from the multiple linear regression analyses indicated that Factor 1 (traditional Chinese medicine), Factor 2 (mind-body modalities), Factor 3 (manipulative-based modalities), female sex, and smoking were significantly associated with a worse disease-specific quality of life. In conclusion, various CAM modalities, female sex, and smoking were independent predictors of a worse disease-specific quality of life in Taiwanese patients with rhinitis.

scholarly journals Coping-strategieë, stres en selfmoord-denkbeeldvorming in die Suid-Afrikaanse polisiediens in die Vrystaat

2004 ◽  
Vol 30 (1) ◽  
Author(s):  
A. S. Van Der Merwe ◽  
S. Rothmann ◽  
J. Pienaar
Keyword(s):  
Suicide Ideation ◽  
Suicide Attempts ◽  
Medical Condition ◽  
Survey Design ◽  
Police Stress ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Passive Coping ◽  
South African Police Service ◽  
South African Police

The general objective of this study was to investigate the relationship between coping, stress and suicide ideation within the South African Police Service. A cross-sectional survey design was used. A random, stratified sample was taken of police officials in the Free State (N = 333). The Suicide Ideation Questionnaire, Police Stress Inventory and COPE Questionnaire were administered. The results of this study indicated that the following factors were related to suicide ideation: passive coping, problem-focused coping, former suicide attempts, medical condition, alcohol consumption and police stressors. The discriminant analysis furthermore indicated that these variables correctly classified 77,55% of the respondents with a high score in respect of suicide ideation. Opsomming Die algemene doelstelling van hierdie navorsing was om die verband tussen coping-strategieë, stres en selfmoord- denkbeeldvorming binne die Suid-Afrikaanse Polisiediens in die Vrystaat te ondersoek. ’n Dwarsdeursneeopnameontwerp is gebruik. ’n Ewekansige, gestratifiseerde steekproef (N = 333) is van polisiebeamptes in die Vrystaat geneem. Die Selfmoord denkbeeldvormingsvraelys, Polisiestres-inventaris en COPE-vraelys is aangewend. Die resultate van die studie het aangetoon dat die volgende faktore met selfmoord denkbeeldvorming verband hou: passiewe coping, probleemgerigte coping, vorige selfmoordpogings, mediese toestand, gebruik van alkohol en polisiespesifieke stressors. Die diskriminantontleding het verder aangedui dat bogenoemde veranderlikes 77,55% van die deelnemers met ’n hoë telling ten opsigte van selfmoord denkbeeldvorming korrek geklassifiseer het.

scholarly journals Attitudes to depression and its treatment in primary care

2007 ◽  
Vol 37 (9) ◽  
pp. 1239-1248 ◽  
Author(s):  
SCOTT WEICH ◽  
LOUISE MORGAN ◽  
MICHAEL KING ◽  
IRWIN NAZARETH
Keyword(s):  
Primary Care ◽  
Help Seeking ◽  
Medical Condition ◽  
Antidepressant Medication ◽  
Self Report ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Icd 10 ◽  
History Of ◽  
Depressive Episodes

ABSTRACTBackgroundUndertreatment of depression in primary care is common. Efforts to address this tend to overlook the role of patient attitudes. Our aim was to validate and describe responses to a questionnaire about attitudes to depression and its treatment in a sample with experience of moderate and severe depressive episodes.MethodCross-sectional survey of 866 individuals with a confirmed history of an ICD-10 depressive episode in the 12 months preceding interview, recruited from 7271 consecutive general practitioner (GP) attendees in 36 general practices in England and Wales. Attitudes to and beliefs about depression were assessed using a 19-item self-report questionnaire.ResultsFactor analysis resulted in a three-factor solution: factor 1, depression as a disabling, permanent state; factor 2, depression as a medical condition responsive to support; and factor 3, antidepressants are addictive and ineffective. Participants who received and adhered to antidepressant medication and disclosed their depression to family and friends had significantly lower scores on factors 1 and 3 but higher scores on factor 2.ConclusionsPeople with moderate or severe depressive episodes have subtle and divergent views about this condition, its outcome, and appropriate help. Such beliefs should be considered in primary care as they may significantly impact on help seeking and adherence to treatment.

scholarly journals Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups

2020 ◽  
Vol 8 ◽  
Author(s):  
Aaron T. E. Beczkiewicz ◽  
Robert L. Scharff ◽  
Barbara B. Kowalcyk
Keyword(s):  
Social Media ◽  
Health Outcomes ◽  
Hemolytic Uremic Syndrome ◽  
Posttraumatic Stress ◽  
Support Groups ◽  
Medical Condition ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Uremic Syndrome

Individual burden and cost of hemolytic uremic syndrome (HUS)—a medical condition characterized by acute kidney failure—can be substantial when accounting for long-term health outcomes (LTHOs). Because of the low incidence of HUS, evaluation of associated LTHOs is often restricted to physician and outbreak cohorts, both of which may not be representative of all HUS cases. This exploratory study recruited participants from private social media support groups for families of HUS cases to identify potential LTHOs and costs of HUS that are not currently measured. Additionally, this study sought to identify case characteristics that may confound or modify these LTHOs and costs of HUS. Respondents self-selected to complete an online cross-sectional survey on acute and chronic illness history, treatments, and public health follow-up for HUS cases. Posttraumatic stress among respondents (typically case parents) was also evaluated. Responses were received for 74 HUS cases from 71 families representing all geographic regions, and levels of urbanicity within the US self-reported symptoms were typical for HUS, while 35.1% of cases reported antibiotic treatment at any point during the acute illness. Hospital transfers were reported by 71.6% of cases introducing possible delays to care. More than 70% of cases reported experiencing at least one LTHO, with 45% of cases reporting renal sequelae. Posttraumatic stress symptoms were frequently reported by respondents indirectly affected by HUS. Potentially large economic costs that are not addressed in existing analyses were identified including both financial and more general welfare losses (lost utility). While biases in the study design limit the generalizability of results to all HUS cases, this study provides new insights into unmeasured LTHOs and costs associated with HUS. These results suggest that robustly designed cohort studies on HUS should include measures of psychosocial impacts on both the affected individual and their family members.

scholarly journals A goal-systems perspective on plant-based eating: keys to successful adherence in university students

2020 ◽  
Vol 24 (1) ◽  
pp. 75-83
Author(s):  
Maricarmen Vizcaino ◽  
Linda S Ruehlman ◽  
Paul Karoly ◽  
Katy Shilling ◽  
Andrew Berardy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
University Students ◽  
Discriminant Function ◽  
Self Efficacy ◽  
Online Survey ◽  
Medical Condition ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Ethical Beliefs ◽  
Goal Systems

AbstractObjective:To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems.Design:A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits.Setting:Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools.Participants:University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents).Results:Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report ‘To manage or treat a medical condition’ as motivation and almost seven times more likely to report ‘To align with my ethical beliefs’ as motivation compared with non-adherents. However, these participants were 94 % less likely to report ‘To maintain and/or improve my health’ as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet.Conclusions:Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.

A comparative study on assessment procedures and metric properties of two scoring systems of the Coma Recovery Scale-Revised items: standard and modified scores

2017 ◽  
Vol 31 (9) ◽  
pp. 1226-1237 ◽  
Author(s):  
Davide Sattin ◽  
Piergiorgio Lovaglio ◽  
Greta Brenna ◽  
Venusia Covelli ◽  
Davide Rossi Sebastiano ◽  
...  
Keyword(s):  
Evaluation Method ◽  
Scoring Systems ◽  
Assessment Procedure ◽  
Standard Score ◽  
Disorder Of Consciousness ◽  
Cross Sectional ◽  
Metric Properties ◽  
Scale Scores ◽  
Cross Sectional Design ◽  
Assessment Procedures

Objective: The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. Design: Cross sectional design/methodological study. Setting: Inpatient, neurological unit. Participants: A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013. Intervention: All patients were assessed with the Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2) procedures. Main outcome measures: Coma Recovery Scale-Revised score, number of cognitive and reflex behaviours and diagnosis. Results: Regarding patient assessment, rater 1 using standard and rater 2 using inverted procedures obtained the same best scores for each subscale of the Coma Recovery Scale-Revised for all patients, so no clinical (and statistical) difference was found between the two procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery Scale-Revised codified behavioural responses were not found during assessment, although higher response categories were present. A total of 51 (36%) patients presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard score, whereas no overlap was found using the modified score. Unidimensionality was confirmed for both score systems. Conclusion: The Coma Recovery Scale Modified Score showed a higher discriminant capacity than the standard score and a monofactorial structure was also supported. The inverted assessment procedure could be a useful evaluation method for the assessment of patients with disorder of consciousness diagnosis.

scholarly journals Perceptions of the Diabetes Online Community’s Credibility, Social Capital, and Help and Harm: Cross-Sectional Comparison Between Baby Boomers and Younger Adults (Preprint)

2018 ◽  
Author(s):  
Michelle L Litchman ◽  
Linda S Edelman
Keyword(s):  
Health Care ◽  
Social Capital ◽  
Baby Boomers ◽  
Source Credibility ◽  
Medical Condition ◽  
Health Care Team ◽  
Care Team ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Younger Adults

BACKGROUND The use of online health communities such as the diabetes online community (DOC) is growing. Individuals who engage in the DOC are able to interact with peers who have the same medical condition. It is not known if older adults are perceiving the DOC differently compared with younger adults. OBJECTIVE The purpose of this study was to explore and understand how the DOC is perceived in terms of social capital, source credibility, and help and harm. The findings from this study will shed light on how users of different age groups (baby boomers and younger adult counterparts) perceive DOC use. METHODS This study represents a subset of participants from a larger study of DOC users. Baby boomers and younger adults with diabetes were recruited from the DOC to participate in a cross-sectional survey. Demographics, electronic health use (reasons to join the DOC, DOC intensity, DOC engagement, internet social capital, and help or harm from the DOC), source credibility, health-related quality of life, and diabetes self-care data were collected. We examined the differences between baby boomer and younger adult responses. RESULTS The participants included baby boomers (N=76) and younger adult counterparts (N=102). Participants scored their diabetes health care team (mean 33.5 [SD 8]) significantly higher than the DOC (mean 32 [SD 6.4]) with regard to competence (<italic>P</italic>&lt;.05) and trustworthiness (diabetes health care team mean 36.3 [SD 7.1]; DOC mean 33.6 [SD 6.2]; <italic>P</italic>&lt;.001). High bonding and bridging social capital correlated with high DOC intensity (<italic>r</italic>=.629; <italic>P</italic>&lt;.001 and <italic>r</italic>=.676; <italic>P</italic>&lt;.001, respectively) and high DOC engagement (<italic>r</italic>=.474; <italic>P</italic>&lt;.01 and <italic>r</italic>=.507; <italic>P≤</italic>.01, respectively). The greater majority (69.8%) reported the DOC as being helpful, and 1.8% reported that the DOC had caused minor harm. Baby boomers perceived DOC credibility, social capital, help, and harm similarly to their younger adult counterparts. CONCLUSIONS Baby boomers are using and perceiving the DOC similarly to younger adults. DOC users find the DOC to be credible; however, they scored their health care team higher with regard to competence and trustworthiness. The DOC is beneficial with low risk and may augment current diabetes care.

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