scholarly journals Integration Of Anesthesia Into ECT: A Hospital- Based Study On MECT From Anesthesiologist Point Of View

2020 ◽  
Vol 9 (2) ◽  
pp. 59-63
Author(s):  
S Neupane ◽  
T Pahari ◽  
N Lamichhane ◽  
DK Thapa
Keyword(s):  
Informed Consent ◽  
Clinical Improvement ◽  
Point Of View ◽  
Long Bone ◽  
Research Centre ◽  
Consultant Psychiatrist ◽  
Accepted Standard ◽  
Standard Mode ◽  
Number Of Cycles ◽  
Written Informed Consent

Introduction: MECT is a unique procedure where psychiatrist and anesthesiologist work together as a team. It is estimated that annually, approximately 1 million patients receive ECT worldwide. Due to association of physical complications like long bone and vertebrae fractures with direct ECT, anesthesia has been integrated into ECT. MECT is now the globally accepted standard mode of ECT. This study was done to see the Socio-demographic and clinical profile of patients receiving MECT. Material And Method: This is a hospital-based study done in BG hospital and Research Centre, Pokhara, Nepal for the duration of 12 months; from Baisakh, 2074 to Chaitra, 2074. A total of 50 consecutives cases that received MECT were enrolled after written informed consent for the ECT from the patients’ caretaker. The patient’s details, diagnosis and the numbers of cycles of MECT thus applied till clinical improvement were noted during the study period. MECT was administered on alternate days. The assessment of clinical improvement was done by the consultant psychiatrist. Following the protocol, each cycle of MECT was applied by consultant psychiatrist in the presence of the consultant anesthesiologist. Results: The total number of cases enrolled were 50. Out of 50 cases, 41 (82%) were male and mean age was 30.60 ± 10.13 years. The most common indications for MECT were BPAD (74%). The number of cycles of modified MECT applied on the individuals ranged from 6 to 18 cycles. Majority of the cases (78%) seem to have a clinical improvement after 6 cycles of modified ECT. There was no complication that warranted the termination of MECT. Conclusion: MECT when used judiciously is safe and leads to better clinical improvement.

scholarly journals Medical terminology circulation and interactional organisation in interpreter-mediated medical encounters

2021 ◽  
Vol 11 ◽  
Author(s):  
Sara Pittarello
Keyword(s):  
Informed Consent ◽  
Active Participation ◽  
Point Of View ◽  
Personal Interest ◽  
Medical Terminology ◽  
Institutional Talk ◽  
Italian Hospital ◽  
Ethical Approval ◽  
Medical Interpreters ◽  
Written Informed Consent

Two medical encounters taking place in a Northern Italian hospital are analysed in this paper from a qualitative point of view, based on the author’s previous research. The aim is to reveal the strategies adopted by medical interpreters, in these two specific cases, to translate medical terminology and promote/exclude interlocutors’ active participation. This latter aspect is influenced by the way the interaction is socially and linguistically organised and, in particular, by how interlocutors’ utterances are translated. The prevalence of dyadic or triadic sequences and especially the shifts between such communication exchanges are pivotal in fostering or hindering interlocutors’ participation. Furthermore, medical interactions, as a form of institutional talk, enshrine specific expectations, which are mainly of a cognitive nature but may also be affective, as in the two encounters observed. By conveying such expectations and expressions of personal interest, interpreters have proved to contribute to the fair distribution of active participation among primary interlocutors. Hospital ethical approval and subjects’ written informed consent have been obtained.

Risk Minimization Measures in Off-Label Drug Use: A Survey of Community Pharmacists in Malaysia

2020 ◽  
Vol 15 (3) ◽  
pp. 181-189
Author(s):  
Omotayo Fatokun
Keyword(s):  
Informed Consent ◽  
Drug Use ◽  
Perceived Risk ◽  
Adverse Drug Events ◽  
Community Pharmacists ◽  
Risk Minimization ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Off Label ◽  
Written Informed Consent

Background: While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists’ beliefs regarding these measures in Malaysia. Objectives: This study examined community pharmacists’ beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures. Methods: A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia. Results: The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002). Conclusion: The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

274 Tumoral and peripheral immunophenotype of refractory vs relapse to PD-(L)1 blockade in patients with advanced non-small cell lung cancer

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A299-A299
Author(s):  
Maria Ascierto ◽  
Matthew Hellmann ◽  
Nathan Standifer ◽  
Song Wu ◽  
Han Si ◽  
...  
Keyword(s):  
Gene Expression ◽  
Informed Consent ◽  
Checkpoint Inhibitors ◽  
Patient Response ◽  
Calcium Dependent ◽  
Immune Exhaustion ◽  
Previously Treated ◽  
Expression Pathways ◽  
Relapsed Disease ◽  
Written Informed Consent

BackgroundDespite the encouraging successes of immune checkpoint inhibitors, many patients do not benefit and are either refractory or relapse. The mechanisms of refractory or relapsed disease following PD-(L)1 blockade are largely unknown. To identify characteristics associated with refractory or relapsed disease we explored the immune and genomic landscape of samples derived from NSCLC patients who previously received PD-(L)1 blockade and had blood and fresh tumor biopsies collected at the time of progression.MethodsPatient response categories were defined prospectively; ‘refractory’ defined as progression within 16 weeks of initiating PD-(L)1 and ‘relapse’ defined as initial clinical benefit (CR, PR, SD) followed by progression. RNAseq (n=52) and PD-L1 IHC (n=22) were performed on tumor tissue. Immune profiling of whole blood was assessed using flow cytometry or Biomark HD (Fluidigm) gene expression panel (n=54 and n=62, respectively). Differential gene expression was defined as unadjusted p<0.05 and fold-difference >1.5. Pathways analysis was conducted by David tool. Patient samples were collected during screening for clinical trial of second line immunotherapy. Written informed consent was obtained from the patients for publication of this abstract.ResultsIn patients with NSCLC previously treated with PD-(L)1 blockade, tumors of relapsed patients were characterized by increased expression of genes associated with interferon signaling (e.g. CXCL9, SPIC, IFNg), immune suppression (e.g. ARG1, TGFB), immune exhaustion (e.g. ADORA2A), and increased PD-L1 expression (by gene expression and IHC). Refractory disease was associated with increased cadherin signaling and calcium-dependent-cell-adhesion gene expression pathways. In the periphery, reduced quantities of B cells and activated (HLA-DR+ or CD38+) or proliferating (Ki67+) CD8+ T cells were observed in refractory patients.ConclusionsThe tumor and peripheral compartments of patients with NSCLC previously treated with PD-(L)1 blockade differ based on prior response. Relapsed patients tend to have signals of sturdy immune activation and chronic inflammation thus ultimately leading to immune exhaustion. These results may help inform rational therapeutic strategies to overcome resistance to PD-(L)1 blockade in NSCLC.Trial RegistrationNCT02000947Ethics ApprovalResearch on human samples here analyzed have been performed in accordance with the Declaration of Helsinki.ConsentWritten informed consent was obtained from the patient for publication of this abstract.

scholarly journals Written Informed Consent—Translating into Plain Language. A Pilot Study

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 232
Author(s):  
Agnieszka Zimmermann ◽  
Anna Pilarska ◽  
Aleksandra Gaworska-Krzemińska ◽  
Jerzy Jankau ◽  
Marsha N. Cohen
Keyword(s):  
Informed Consent ◽  
Plain Language ◽  
Consent Forms ◽  
Software Analysis ◽  
Informed Consent Form ◽  
Education Levels ◽  
Polish Language ◽  
University Degree ◽  
Study Participants ◽  
Written Informed Consent

Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels; and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form’s degree of difficulty or readability. Results: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4–6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. Conclusions: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms.

scholarly journals Psychometric Properties of the Bern Illegitimate Tasks Scale – Spanish Version

2021 ◽  
Vol 12 ◽  
Author(s):  
Denisse Lizette Valdivieso Portilla ◽  
Angélica Gonzalez Rosero ◽  
Geovanny Alvarado-Villa ◽  
Jorge Moncayo-Rizzo
Keyword(s):  
Factor Analysis ◽  
Informed Consent ◽  
Confirmatory Factor Analysis ◽  
Psychometric Properties ◽  
Exploratory Factor Analysis ◽  
Work Stress ◽  
Factor Model ◽  
Spanish Version ◽  
Confirmatory Factor ◽  
Written Informed Consent

In recent years, a new factor for work stress has been studied along with stress as an offense to self-theory. Illegitimate tasks refer to assignments that are unnecessary or are not related to the employee’s role. Because of this, the Bern Illegitimate Tasks Scale was developed, which measures illegitimate tasks in terms of unreasonable tasks and unnecessary tasks. There are no studies in Latin America on illegitimate tasks, so the purpose of this research is to translate and validate the Bern Illegitimate Tasks Scale. The study was performed with a sample of nursing staff from a hospital in Guayaquil, Ecuador. Written informed consent was obtained from each of the participants. The reliability of the questionnaire was evaluated and its structural validity was verified by exploratory factor analysis and confirmatory factor analysis. The internal consistency of the whole scale, measured by Cronbach’s alpha, was 0.857. Moreover, the unnecessary and unreasonable subscales measure were 0.846 and 0.841, respectively. The exploratory factor analysis supported a two-factor model that explained 73.96% of the variance. Additionally, the confirmatory factor analysis showed good indexes of fit (GFI = 0.915, CFI = 0.955, TLI = 0.933, SRMR = 0.084, and RMSEA = 0.087). The Spanish version of the Bern Illegitimate Tasks Scale presents good psychometric properties and can be applied to nurses in the Ecuadorian population.

Informed consent in psychiatric practice: where does the law now stand?

2011 ◽  
Vol 28 (2) ◽  
pp. 86-90
Author(s):  
Peter Leonard
Keyword(s):  
Informed Consent ◽  
Medical Profession ◽  
Case Law ◽  
Point Of View ◽  
Psychiatric Practice ◽  
Mental Health Legislation ◽  
Clinical Scenarios ◽  
Legal Duty ◽  
Legal Position ◽  
Health Legislation

AbstractThere is an established ethical and legal duty upon psychiatrists to obtain informed consent before treating a patient, although some exceptions do apply under Mental Health Legislation. The required standard for informed consent has been the subject of important case law in Ireland and other common law jurisdictions and this has caused some uncertainty for clinicians. The standard of informed consent can be viewed from the point of view of what the medical profession thinks is appropriate, or alternatively from the position of what a patient would reasonably expect to be told. These contrasting approaches are discussed in detail. A recent decision of the Irish Supreme Court establishes the ‘patient-centred’ standard for informed consent as the relevant standard in Irish law. The current legal position on informed consent is discussed in relation to common clinical scenarios in psychiatric practice.

scholarly journals The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper

2017 ◽  
Vol 107 (8) ◽  
pp. 1259-1265 ◽  
Author(s):  
Ronald Bayer ◽  
Morgan Philbin ◽  
Robert H. Remien
Keyword(s):  
Informed Consent ◽  
Hiv Testing ◽  
Written Informed Consent

Use, content, and readability of written informed consent forms for treatment.

1986 ◽  
Vol 17 (6) ◽  
pp. 514-518 ◽  
Author(s):  
Mitchell M. Handelsman ◽  
Melinda B. Kemper ◽  
Pamela Kesson-Craig ◽  
Joanne McLain ◽  
Cynthia Johnsrud
Keyword(s):  
Informed Consent ◽  
Consent Forms ◽  
Written Informed Consent

Five years of ECT: the relationship between consent status and treatment experiences

2010 ◽  
Vol 27 (3) ◽  
pp. 117-122 ◽  
Author(s):  
Susanna Enriquez ◽  
Sheila Tighe ◽  
Noreen Fitzgibbon ◽  
Seamus Ó Flaithbheartaigh ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Cognitive Impairment ◽  
Informed Consent ◽  
Mental Health Services ◽  
Health Services ◽  
Response Rate ◽  
Electrode Placement ◽  
Severe Illness ◽  
Patient Consent ◽  
Written Informed Consent

AbstractObjectives:ECT has received limited systematic study in the Irish setting. Amendments to the Mental Health Act (2001) propose limiting the use of ECT to patients who can provide written informed consent. We report on the use of ECT in Limerick specifically addressing the issue of patient consent and how it relates to response rate.Method:Since 2003, the use of ECT within Limerick Mental Health Services has been monitored by a data gathering process that includes the documentation of mood disturbance before and after the procedure.Results:In the five years between 2003 and 2007, 153 courses of ECT were given to 126 different patients (frequency 16.7/100,000; Female:Male = 2:1). The principal indication for ECT was depressive illness (95%). Bilateral electrode application was the preferred mode comprising 83% of use. A total of 60% experienced at least a 50% reduction in MADRS score over the course of ECT with 78% experiencing a reduction of 10 points or more on the MADRS. Higher response rate was linked to use of bilateral ECT (p = 0.007; 95% CI 1.3-13.6). A total of 14% of patients were unable to provide written informed consent and these patients had more severe depression at outset (p = 0.007; 95% CI 1.8-11.1) and a trend towards greater reduction in MADRS scores during ECT (p = 0.08). The commonest adverse incident associated with ECT was cognitive impairment (33 patients). The risk of cognitive problems was not related to age, ECT dose, number of treatments, severity of depressive symptoms, treatment response, or consent status.Conclusions:Frequency of use, response and adverse effect rates for ECT in Limerick Mental Health Services are similar to other centres. Cognitive impairment was the most frequent adverse event. The choice of electrode placement for ECT requires further consideration. Restricting ECT to patients that can provide written informed consent would prevent its use in many patients with severe illness who experience significant response to treatment.

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