When the Patient Says No

2011 ◽  
Vol 29 (5) ◽  
pp. 401-404 ◽  
Author(s):  
Maria Aileen Soriano ◽  
Ruth Lagman
Keyword(s):  
Social Issues ◽  
Symptom Burden ◽  
Self Determination ◽  
Metabolic Disturbances ◽  
Family Conflicts ◽  
Existential Suffering ◽  
Decision Making Capacity ◽  
History Of ◽  
Illness Denial ◽  
Significant Symptom

The need to ascertain appropriate decision-making capacity is greatest when dealing with refusals of lifesaving or life-prolonging treatment. This may be complicated by delirium, concurrent depression, metabolic disturbances or significant symptom burden, family conflicts, and social issues. This is a case of a 48-year-old patient with a long-standing history of a symptomatic pan-invasive pituitary adenoma who refused life-prolonging treatment. Ultimately, a patient must be able to understand the information given to him, evaluate the consequences of the options presented, deliberate on these options based on his values, communicate this choice, and maintain consistency overtime. These refusals of treatment may fluctuate with time and intensity of the illness. Denial of this right of autonomy and self-determination may worsen the individual’s physical and existential suffering.

“You Have Living Legends among You”

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Sara Awartani
Keyword(s):  
Social Movements ◽  
East Coast ◽  
Puerto Ricans ◽  
Black Panther Party ◽  
Self Determination ◽  
Community Members ◽  
Multiple Generations ◽  
Young Lords ◽  
History Of ◽  
Lincoln Park

In late September 2018, multiple generations of Chicago’s storied social movements marched through Chicago’s Lincoln Park neighborhood as part of the sold-out, three-day Young Lords Fiftieth Anniversary Symposium hosted by DePaul University—an institution that, alongside Mayor Richard J. Daley’s administration, had played a sizeable role in transforming Lincoln Park into a neighborhood “primed for development.” Students, activists, and community members—from throughout Chicago, the Midwest, the East Coast, and even as far as Texas—converged to celebrate the history of Puerto Ricans in Chicago, the legacies of the Young Lords, and the promises and possibilities of resistance. As Elaine Brown, former chairwoman and minister of information for the Black Panther Party, told participants in the second day’s opening plenary, the struggle against racism, poverty, and gentrification and for self-determination and the general empowerment of marginalized people is a protracted one. “You have living legends among you,” Brown insisted, inviting us to associate as equals with the Young Lords members in our midst. Her plea encapsulated the ethos of that weekend’s celebrations: “If we want to be free, let us live the light of the Lords.”

Married Life in the Middle Ages, 900-1300

2019 ◽  
Author(s):  
Elisabeth van Houts
Keyword(s):  
Middle Ages ◽  
Married Couple ◽  
Self Determination ◽  
Emotional Life ◽  
Social And Emotional ◽  
Individual Agency ◽  
Married Life ◽  
The Face ◽  
History Of ◽  
The Individual

This book contains an analysis of the experience of married life by men and women in Christian medieval Europe c. 900–1300. The focus will be on the social and emotional life of the married couple rather than on the institutional history of marriage. The book consists of three parts: the first part (Getting Married) is devoted to the process of getting married and wedding celebrations, the second part (Married Life) discusses the married life of lay couples and clergy, their sexuality, and any remarriage, while the third part (Alternative Living) explores concubinage and polygyny as well as the single life in contrast to monogamous sexual unions. Four main themes are central to the book. First, the tension between patriarchal family strategies and the individual family member’s freedom of choice to marry and, if so, to what partner; second, the role played by the married priesthood in their quest to have individual agency and self-determination accepted in their own lives in the face of the growing imposition of clerical celibacy; third, the role played by women in helping society accept some degree of gender equality and self-determination to marry and in shaping the norms for married life incorporating these principles; fourth, the role played by emotion in the establishment of marriage and in married life at a time when sexual and spiritual love feature prominently in medieval literature.

scholarly journals Outcomes of Multidisciplinary Care for Pediatric Post-Concussive Symptoms

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S18.1-S18
Author(s):  
Jillian O’Neil ◽  
Sean Rose ◽  
Ashley Davidson ◽  
Kathleen Shiplett ◽  
Anthony Castillo ◽  
...  
Keyword(s):  
Aerobic Exercise ◽  
Psychological Intervention ◽  
Multidisciplinary Treatment ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Exercise Session ◽  
Symptom Improvement ◽  
Final Visit ◽  
Post Injury ◽  
History Of

ObjectiveTo evaluate the effectiveness of a multidisciplinary treatment approach for adolescents experiencing prolonged recovery from concussion.BackgroundAlthough most youth recover from a concussion within 2–4 weeks, an estimated 14% of those injured remain symptomatic at 3 months post-injury. For those experiencing protracted recovery, the 2017 Berlin Concussion in Sport Group Consensus Statement recommends multidisciplinary collaborative care. While recent research utilizing progressive aerobic exercise among adolescents with concussion has shown promise for reduction in symptom burden, limited evidence exists for multidisciplinary care.Design/MethodsParticipants included 39 adolescents (77% female, 87% Caucasian) referred to the Nationwide Children’s Hospital Complex Concussion Clinic. All patients included had persistent (≥30 days post-injury) post-concussion symptoms (SCAT-5 symptom score ≥10). The sample ranged in age from 11-20 years (mean = 15.0, SD = 2.0) and median days since injury was 60 (range = 30–161). 31% of participants had a history of one or more previous concussions, 54% had a history of anxiety or depression, and 26% had a history of ADHD or a learning disorder. The multidisciplinary treatment included sessions with Neurology (mean number of sessions = 2.5), Neuropsychology (mean = 2.1), Physical Therapy (mean = 3.6), and Athletic Training sessions involving graded physical exercise (mean = 4.0), with an average treatment duration of 57.4 days. SCAT-5 symptom rating scales were completed at each visit.ResultsSymptom burden among participants significantly decreased between their initial visit (mean = 49.6, SD = 19.2) and final exercise session (mean = 12.8, SD = 14.1); p < 0.001. Gender did not predict symptom ratings at treatment onset, though males (mean = 5.6) had significantly lower symptom scores than females (mean = 15.0) at their final visit (p < 0.05). Demographic factors and premorbid psychological history did not predict rate of symptom improvement.ConclusionsHigh rates of premorbid psychological problems are evident in children referred for treatment of PCS. Multidisciplinary care involving graded aerobic exercise and psychological intervention shows promise, though specific factors associated with treatment response remain to be elucidated.

scholarly journals The hierarchical society: the politics of self-determination and the constitution of new states after 1919

2019 ◽  
Vol 26 (2) ◽  
pp. 372-396
Author(s):  
Maja Spanu
Keyword(s):  
World War I ◽  
International Relations ◽  
International Society ◽  
International System ◽  
World Politics ◽  
League Of Nations ◽  
Self Determination ◽  
World War ◽  
New States ◽  
History Of

International Relations scholarship disconnects the history of the so-called expansion of international society from the presence of hierarchies within it. In contrast, this article argues that these developments may in fact be premised on hierarchical arrangements whereby new states are subject to international tutelage as the price of acceptance to international society. It shows that hierarchies within international society are deeply entrenched with the politics of self-determination as international society expands. I substantiate this argument with primary and secondary material on the Minority Treaty provisions imposed on the new states in Central, Eastern and Southern Europe admitted to the League of Nations after World War I. The implications of this claim for International Relations scholarship are twofold. First, my argument contributes to debates on the making of the international system of states by showing that the process of expansion of international society is premised on hierarchy, among and within states. Second, it speaks to the growing body of scholarship on hierarchy in world politics by historicising where hierarchies come from, examining how diverse hierarchies are nested and intersect, and revealing how different actors navigate these hierarchies.

scholarly journals A Rival History of Self-Determination

2016 ◽  
Vol 27 (3) ◽  
pp. 719-743 ◽  
Author(s):  
Deborah Whitehall
Keyword(s):  
Self Determination ◽  
History Of

scholarly journals Treatment of what?

2005 ◽  
Vol 22 (1_suppl) ◽  
pp. 45-61 ◽  
Author(s):  
Johan Edman
Keyword(s):  
Family Policy ◽  
Social Issues ◽  
Institutional Care ◽  
Alcohol Abusers ◽  
Protest Movements ◽  
Care Services ◽  
The Family ◽  
History Of ◽  
Problem Formulations ◽  
And Gender

■ Aims The aim of this article is to investigate the problem formulations – the preconceptions about causes and effects and the possible solutions to the problems of alcohol abuse – that characterized the compulsory institutional care of alcohol abusers in Sweden in the 20th century. The article focuses on problem formulations that actually were practised in the institutions. ■ Methods & Data The main source material is to be found in the archives of four institutionalized care establishments and consists of official reports, correspondence, supply estimates, circulars for consideration and – above all – patient records. From this material you can learn about the institutions' struggle for autonomy, expansion and legitimacy, and also about the clients' characteristics and how the clients were viewed. The study of the archives allows you to form a picture of the problem formulations that affected the activities in the institutions directly, a picture that goes beyond the more abstract expectations preferred by official reports and legislation. ■ Results Within the compulsory institutional care actually carried out, the problem formulations that were stipulated in the gender-neutral legislation and vague regulations became gender-specific and precise. The treatment of alcohol abusers was a class and gender related project, aiming not only at encouraging male diligence and the fulfilling of a man's maintenance obligation but also at female virtuousness and concern for the family. ■ Conclusions The history of alcohol abusers' treatment shows that alcohol itself has been a secondary factor in problem definitions which have let themselves be attached – via perceived links with either cause or effect – to more overarching social issues in Sweden. The concerns of emergent family policy in the 1940s, the developmental optimism and scientistic passions of the 1950s, and the systemically critical protest movements of the 1970s are all clearly reflected in trends within social care services for alcohol abusers – albeit much more often at the level of discourse than of praxis.

Etiology of Ventricular Septal Defects: An Epidemiologic Approach

PEDIATRICS ◽  
1985 ◽  
Vol 76 (5) ◽  
pp. 741-749
Author(s):  
Thomas B. Newman
Keyword(s):  
The United States ◽  
Incidence Rates ◽  
Identical Twins ◽  
Random Errors ◽  
Ventricular Septal Defects ◽  
Metabolic Disturbances ◽  
Cardiac Morphogenesis ◽  
Septal Defects ◽  
Wide Range ◽  
History Of

To investigate the recent 150% increase in the reported incidence of ventricular septal defects (VSDs) in the United States, the epidemiology of ventricular septal defects was examined. The apparent incidence of VSDs is highly dependent on case finding methods, and more complete diagnosis and reporting probably account for the increase in reported incidence. Variations in case ascertainment also account for the small differences in incidence in studies from different places. The several known risk factors for VSD, including a family history of congenital heart disease and exposure to certain drugs, infectious agents, and maternal metabolic disturbances, explain few cases. Incidence rates are similar in different races and seasons and are unrelated to maternal age, birth order, sex, and socioeconomic status. VSDs occur naturally in a wide range of mammals and in birds, which also have four-chambered hearts. Despite identical genes and similar prenatal environments, the concordance rate in identical twins is only about 10%. The consistency of incidence among individuals with widely differing genes and environments and the frequency of discordance in identical twins suggest that VSDs often occur as random errors in development, at a frequency largely determined by the complexity of normal cardiac morphogenesis. This hypothesis has two major implications: many VSDs are not preventable and parents need not feel responsible for VSDs in their children.

scholarly journals Aproximando o cuidador do idoso: a história oral de vida e a humanização do cuidado / Getting Closer Caregivers from the Elderly: the Life Oral History and Care Humanization

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Carla Souza Mota ◽  
Valdir Reginato
Keyword(s):  
Oral History ◽  
Dynamic Process ◽  
Social Issues ◽  
Population Aging ◽  
The Elderly ◽  
History Of ◽  
Historia De Vida

ABSTRACTThe population aging has brought social issues of great repercussion, among them try to identify the role of caregiver, as humanizing agent, in this dynamic process of aging was the challenge that gave rise to this study. The attempt of our project is to give importance to the history of the Elderly Life, valuing it as a unique, experiencing your opportunity to speak and be heard, approaching caregiver and elderly and involving them in a therapeutic process.RESUMOO envelhecimento populacional têm trazido questões sociais de grande repercussão, dentre eles procurar identificar o papel do cuidador, como agente humanizador, neste processo dinâmico do envelhecimento foi o desafio que originou este estudo. A tentativa do nosso projeto é dar importância à História de Vida do Idoso, valorizando-o como ser único, experenciando sua oportunidade de falar e ser ouvido, aproximando cuidador e idoso e envolvendo-os num processo terapêutico.

scholarly journals Narrative Strategies of Decolonisation: Autoethnography in Mamang Dai’s The Legends of Pensam

2020 ◽  
Vol 12 (5) ◽  
Author(s):  
Samrita Sinha ◽  
Keyword(s):  
United Nations ◽  
Northeast India ◽  
Self Determination ◽  
Narrative Strategies ◽  
Human Right ◽  
Post Colonial ◽  
History Of ◽  
The United Nations ◽  
Culture Of Impunity ◽  
Right Of Self Determination

According to John Quintero, “The decolonisation agenda championed by the United Nations is not based exclusively on independence. It is the exercise of the human right of self-determination, rather than independence per se, that the United Nations has continued to push for.” Situated within ontologies of the human right of self-determination, this paper will focus on an analysis of The Legends of Pensam by Mamang Dai, a writer hailing from the Adi tribe of Arunachal Pradesh, to explore the strategies of decolonisation by which she revitalizes her tribe’s cultural enunciations. The project of decolonisation is predicated on the understanding that colonialism has not only displaced communities but also brought about an erasure of their epistemologies. Consequently, one of its major agenda is to recuperate displaced epistemic positions of such communities. In the context of Northeast India, the history of colonial rule and governance has had long lasting political repercussions which has resulted not only in a culture of impunity and secessionist violence but has also led to the reductive homogeneous construction of the Northeast as conflict ridden. In the contemporary context, the polyethnic, socio-cultural fabric of the Northeast borderlands foregrounds it as an evolving post-colonial geopolitical imaginary. In the light of this, the objective of this paper is to arrive at the ramifications of employing autoethnography as a narrative regime by which Mamang Dai reaffirms the Adi community’s epistemic agency and reclaims the human right towards a cultural self-determination.

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