scholarly journals Medical–legal partnerships: 11 years' experience of providing acute legal advice for critically ill patients and their families

2019 ◽  
Vol 21 (1) ◽  
pp. 40-47
Author(s):  
C. Andrew Eynon ◽  
Lucy J. Robinson ◽  
Kara M. Smith
Keyword(s):  
Critical Illness ◽  
Major Trauma ◽  
The Elderly ◽  
Third Party ◽  
University Hospital ◽  
Legal Service ◽  
Power Of Attorney ◽  
Welfare Benefits ◽  
Legal Advice ◽  
Compensation Claim

Background Medical–legal partnerships integrate lawyers into health care to identify and address legal problems that can create and perpetuate disparities in health for patients and their families. They have previously been utilised for patients who are at high-risk of being disadvantaged such as the elderly, the disabled and those affected by chronic diseases. We have used a partnership to address the legal needs of patients with acute, critical illness including major trauma. Method In 2007, a free, comprehensive legal advice service was established at University Hospital Southampton NHS Foundation Trust. The service is bound by strict guidelines which have been endorsed by NHS England. The legal service is specifically prevented from acting against the NHS. A retrospective analysis of the service over a period of 11 years was undertaken to look at the range of legal advice sought. Where a potential compensation claim against a third party was identified, the percentage of cases where the legal service was instructed was noted and the outcome for those cases was examined in further detail. Results Five hundred and fifty-one patients and or their families have been referred to the legal service. Of these, 343 had sustained major trauma. Over 2300 hours of free legal advice were provided on non-compensation issues, primarily related to welfare benefits, local authority assistance, obtaining power of attorney or seeking Deputyship from the Court of Protection and claims against existing insurance policies. Two hundred and seventy-five of the 551 patients (50%) were found to have a potential compensation claim against a third party. The legal service was instructed to pursue a claim in 82 cases. Interim payments of nearly £13 million were provided and £128 million of compensation has been awarded in 51 cases that have been settled. Discussion Medical–legal partnerships are well-established in the USA. We have demonstrated that in UK, there is a demand for early legal advice for patients who have sustained critical illness including major trauma. More data are required to identify the rehabilitation outcomes for patients who have received legal support. A similar medical–legal partnership should be considered at every acute NHS Trust.

Lawyers in Intensive Care: Introducing an Acute Legal Service for Patients with Critical Illness

2010 ◽  
Vol 11 (2) ◽  
pp. 109-111 ◽  
Author(s):  
C Andy Eynon ◽  
Andrew Dinsmore ◽  
Stuart Dench
Keyword(s):  
Intensive Care ◽  
Third Party ◽  
University Hospital ◽  
Legal Service ◽  
Next Of Kin ◽  
Icu Patients ◽  
Legal Advice ◽  
Emergency Situations ◽  
Acute Hospitalisation ◽  
The Impact

Following admission to the intensive care unit (ICU), patients or their relatives may need legal advice. This is a retrospective review of the impact of an in-house legal service able to provide legal advice acutely, in a specialised 13-bed neurosciences ICU in a University Hospital over a two and a half year period. All patients admitted to the ICU were considered. Consent for approach by the legal service was taken from the patient if possible. If not possible, assent was obtained from the next of kin. Solicitors were available for one afternoon per week on the ICU or within one day in emergency situations. The amount of time spent in discussion of non-compensation issues arising as a result of admission was measured as well as the time spent identifying potential claims for compensation against a third party and resulting in legal firms being instructed to pursue claims. One hundred and nine legal audits were undertaken. Non-compensation advice was provided in all cases. Possible compensation claims were identified in 63 cases. Of these, the advising firm of solicitors was instructed in 14 cases. Significant numbers of ICU patients and their families have legal issues arising as a result of acute hospitalisation. In many instances, these are not dealt with while the patient is seriously ill. Early identification and management of these issues helps to relieve the anxiety experienced by families.

scholarly journals Clinical diagnosis of 80 cases of dementia in a university hospital

2013 ◽  
Vol 62 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Renata Teles Vieira ◽  
Norami de Moura Barros ◽  
Leonardo Caixeta ◽  
Sergio Machado ◽  
Adriana Cardoso Silva ◽  
...  
Keyword(s):  
Demographic Data ◽  
Lewy Body Dementia ◽  
The Elderly ◽  
Healthcare Services ◽  
Epidemiological Studies ◽  
University Hospital ◽  
Functional Activities ◽  
Considerable Impact ◽  
The City ◽  
State Examination

OBJECTIVE: This study aims to estimate the prevalence of dementia subtypes and to assess the socio-demographic data of patients attending the outpatient clinic of dementia at Hospital das Clínicas from January 2008 to December 2009, in the city of Goiânia-GO, Brazil. METHODS: Procedures provided for diagnosis included physical and neurological examination, laboratory tests, neuroimaging and DSM-IV. The functional capacity and level of cognitive deficit were assessed by Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Mini-Mental State Examination (MMSE), respectively. RESULTS: Eighty patients met the criteria for dementia. The mean age was 63.48 (± 16.85) years old, the schooling was 3.30 (± 3.59) years old, the MMSE was 13.89 (± 7.79) and Pfeffer 17.73 (± 9.76). The Vascular Dementia (VD; 17.5%) was the most frequent cause of dementia, followed by Lewy body dementia (LBD) and Alzheimer's disease (AD) (12.25%). CONCLUSION: Considering entire sample and only the elderly over 60 years, VD, AD and LBD are the most common subtypes observed at both groups. Further epidemiological studies are necessary to confirm such rates, which may have a considerable impact on the organization and planning of healthcare services in our country.

scholarly journals Frequency of dementia among elderly admitted to a Geriatrics Inpatients Sector of a Brazilian public hospital

2018 ◽  
Vol 12 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Rafael Thomazi ◽  
Liciana Vaz de Arruda Silveira ◽  
Paulo José Fortes Villas Boas ◽  
Alessandro Ferrari Jacinto
Keyword(s):  
Univariate Analysis ◽  
The Elderly ◽  
Sociodemographic Factors ◽  
University Hospital ◽  
Chi Square ◽  
Diagnosis Of Dementia ◽  
Elderly Inpatients ◽  
Chi Square Test ◽  
Student’S T ◽  
Clinical Conditions

ABSTRACT Patients with dementia are commonly admitted to inpatient sectors. The aim of this study was to describe the frequency of dementia among elderly inpatients admitted to the Geriatrics Sector of a Brazilian Tertiary University Hospital, and to identify associations between dementia and clinical and sociodemographic factors. Methods: All patients admitted to the Geriatrics Sector of a public Brazilian university-hospital from March 1st 2014 to January 31st 2015 were assessed by geriatricians. The patients were divided into groups "with or without diagnosis of dementia". Univariate analysis was performed between these two groups using the Chi-Square Test, Student's t-test or the Mann-Whitney Test. Results: One hundred and three elderly inpatients, with a mean age of 82 (±7.9) years, were assessed. Overall, 74.7% had low educational level (<4 years), 66% used polypharmacy, 57.2% developed delirium during hospitalization and 59% were totally dependent for basic activities of daily living. The diagnosis of dementia was observed in 59 (57%) subjects. Conclusion: The frequency of dementia was high among the elderly inpatients evaluated. The association between dementia and certain clinical conditions, such as incontinence, delirium and use of psychoactive drugs, was in line with the medical literature.

scholarly journals A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study

10.2196/17729 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e17729 ◽  
Author(s):  
Ido Zamberg ◽  
Olivier Windisch ◽  
Thomas Agoritsas ◽  
Mathieu Nendaz ◽  
Georges Savoldelli ◽  
...  
Keyword(s):  
Medical Students ◽  
User Experience ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Postgraduate Education ◽  
Third Party ◽  
University Hospital ◽  
Knowledge Dissemination ◽  
Easy Access ◽  
The University

Background Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content’s author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation.

scholarly journals Comfort needs as perceived by hospitalized elders: an analysis under the light of Kolcaba’s theory

2020 ◽  
Vol 73 (suppl 3) ◽  
Author(s):  
Sanni Moraes de Oliveira ◽  
Kátia Neyla de Freitas Macêdo Costa ◽  
Kamyla Félix Oliveira dos Santos ◽  
Jacira dos Santos Oliveira ◽  
Maria Auxiliadora Pereira ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Nursing Care ◽  
Daily Life ◽  
Symptom Relief ◽  
The Elderly ◽  
University Hospital ◽  
Daily Life Activities ◽  
Physical Context ◽  
Thematic Units

ABSTRACT Objective: To reveal the Comfort needs as perceived by hospitalized elders, using Kolcaba’s theory. Methods: Descriptive and qualitative study, with 11 elders hospitalized in a university hospital, aiming to identify their needs for Comfort. Results: Discourses were categorized in four thematic units: Physical, Environmental, Sociocultural, and Psychospiritual. In the Physical context, several subcategories were found, namely, Symptom Relief; Daily Life Activities; Hygiene and personal care; Diet; Sleep and rest. In the Environmental context, the Comfort was considered to be superior than in the elders’ home; in the Sociocultural one, family bonds were found to become more distant, triggering feelings of missing one’s family and isolation, in the Psychospiritual context, spirituality and religiosity stood out. Final considerations: The Comfort needs of the hospitalized elders enable one to reflect on nursing care, offering information to improve the quality of assistance and to attend to the real needs of the elderly.

scholarly journals Access to Social Security for the Rural Elderly in Vietnam

2019 ◽  
pp. 51-71
Author(s):  
Tran Quy Long
Keyword(s):  
Social Welfare ◽  
Rural Areas ◽  
The Elderly ◽  
Economic Life ◽  
Social Characteristics ◽  
Living Standard ◽  
Welfare Benefits ◽  
The Social ◽  
Agricultural Societies ◽  
Market Relations

The current situation of the socio-economic life of the elderly now in part reflects Vietnam’s historical characteristics. The socio-economic structure in Vietnam has changed drastically due to the development of market relations, migration, the transformation of traditional society and modern agricultural societies that are creating forms and levels of socio-economic risk for the elderly. Based on the data from two communes, the article shows that, older men are more likely to receive monthly social transfers than women. Elder ly people with higher education receive higher monthly social benefits than lower education one. The elderly in rural areas surveyed hardly enjoy any social welfare programmes. The only beneficiaries are those who must be 80 years or older without a pension or other allowance. Some older people are entitled to benefits but only from programmes not reserved for the elderly. In order to live, the elderly still have to work, mainly in agriculture. This fact reflects the contrast and inadequacy of retirement and health regulations, which stipulate that workers must stop working at a certain age. The enjoyment of social welfare differs between elderly groups with different personal and social characteristics. It can be said that elderly people in rural areas who are not entitled to social welfare benefits are “double disadvantaged”. This mandates that the policy should be aimed at all the elderly in ensuring social welfare. Along with this, it is necessary to have a roadmap to increase the level of monthly social welfare benefits for the elderly to gradually achieve the minimum living standard because the current level of support for the elderly in Vietnam is still much lower than the comparable level for the poor. The process of population ageing in Vietnam is bringing great opportunities as well as great challenges, requiring new approaches to pensions, social pensions, health and the social environment for the elderly in rural areas.

scholarly journals Age-related mortality in 61,993 confirmed COVID-19 cases over three epidemic waves in Aragon, Spain. Implications for vaccination programmes

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261061
Author(s):  
Diego Casas-Deza ◽  
Vanesa Bernal-Monterde ◽  
Angel Nicolás Aranda-Alonso ◽  
Enrique Montil-Miguel ◽  
Ana Belen Julián-Gomara ◽  
...  
Keyword(s):  
Age Groups ◽  
Case Fatality ◽  
The Elderly ◽  
Progressive Increase ◽  
University Hospital ◽  
Rapid Progression ◽  
Targeted Prevention ◽  
Older Individuals ◽  
Prevention Measures ◽  
Age Related

Background Risk for severe COVID-19 increases with age. Different vaccination strategies are currently being considered, including those aimed at slowing down transmission and those aimed at providing direct protection to those most at risk. Methods The objectives of the current study were i) to assess age-related incidence and survival between PCR-diagnosed COVID-19 cases (n = 61,993) in the Autonomous Community of Aragon from March to November 2020, and ii) to characterize age differences regarding the course of the disease in hospitalized patients in a tertiary university hospital. Results We found a similar incidence of COVID-19 in individuals between 10 and 79 years. Incidence increased in those over 80 years possibly because of the elevated transmission within the nursing homes. We observed a profound disparity among age groups; case fatality rates (CFRs) were near 0 in cases younger than 39 years throughout different waves. In contrast, there was an age-dependent and progressive increase in the CFRs, especially during the first pandemic wave. SARS-CoV-2 infection caused a more severe and rapid progression in older patients. The elderly required faster hospitalization, presented more serious symptoms on admission, and had a worse clinical course. Hospitalized older individuals, even without comorbidities, had an increased mortality risk directly associated with their age. Lastly, the existence of comorbidities dramatically increased the CFRs in the elderly, especially in males. Conclusion The elevated incidence of COVID-19 and the vulnerability of the elderly call for their prioritization in vaccination and targeted prevention measures specifically focused on this aged population.

scholarly journals Do we care enough about the medication in the elderly? (Case of the geriatric care facility at Military University Hospital Prague)

2021 ◽  
Vol 67 (5) ◽  
pp. e17-e22
Author(s):  
Veronika Krejčí ◽  
Irena Murínová ◽  
Jana Mohoutová ◽  
Petra Staňková
Keyword(s):  
Care Facility ◽  
The Elderly ◽  
Geriatric Care ◽  
University Hospital
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