Bed rails in an internal medicine clinical setting: a medico-legal analysis based on a systemic review of available literature

2021 ◽  
Vol 70 (4) ◽  
pp. 417-432
Author(s):  
Pamela Tozzo ◽  
Clara Cestonaro ◽  
Lorenzo Menozzi ◽  
Luciana Caenazzo
Keyword(s):  
Internal Medicine ◽  
Informed Consent ◽  
Clinical Setting ◽  
Medical Records ◽  
Systemic Review ◽  
Protective Device ◽  
Legal Analysis ◽  
Physical Restraints ◽  
Severe Injuries ◽  
Controversial Topic

The use of restraints and, specifically, bed rails embody a controversial topic. Bedrails are commonly considered to be a protective device; however, they may be used as a form of restraint, and they may lead to severe injuries. Often restraints are used despite the lack of indication and prescription, without complete informed consent and without adequate reporting in medical records. Due to these reasons, restraints may lead to lawsuits. We present two cases where the use of physical restraints was complicated by health consequences, leading to litigation and medico-legal evaluation of medical and/or nurse liability.

Computerization of the Patient History -Patient Answers Compared with Medical Records

1986 ◽  
Vol 25 (04) ◽  
pp. 222-228 ◽  
Author(s):  
M. J. Quaak ◽  
R. F. Westerman ◽  
J. A. Schouten ◽  
A. Hasman ◽  
J. H. Bemmel
Keyword(s):  
Internal Medicine ◽  
Medical Records ◽  
Patient Record ◽  
Frequency Of Occurrence ◽  
History Taking ◽  
Patient History ◽  
Patient Complaints ◽  
Computerized Patient Record ◽  
Extensive Information ◽  
Experienced Physician

SummaryComputerized medical history taking, in which patients answer questions by using a terminal, is compared with the written medical record for a group of 99 patients in internal medicine. Patient complaints were analysed with respect to their frequency of occurrence for all important tracts, such as the respiratory, the gastro-intestinal and the uro-genital tracts. About 36% of over 3,200 patient answers were identical in the patient record and the written record, but a considerable percentage of complaints (56%), that were present in the patient record, were missing in the written record; the reverse was true for 4.5%. A computerized patient record appears to contain more extensive information about patient complaints, still to be interpreted by the experienced physician.

Crisis and Informed Consent: Analysis of a Law-Medicine Malocclusion

1987 ◽  
Vol 12 (1) ◽  
pp. 55-97 ◽  
Author(s):  
Fran Carnerie
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Clinical Setting ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Catastrophic Illness ◽  
Physician Patient ◽  
Emotional Impairment

AbstractMany individuals develop a temporary state of cognitive and emotional impairment after being diagnosed with catastrophic illness. Thus, when crucial decisions about medical treatment are required, they are unable to assimilate information; or worse, the legal need to be informed can rival a psychological desire to not be informed. The Canadian informed consent doctrine is unresponsive to crisis and clinically impracticable, and so paradoxically compromises the integrity and autonomy it was designed to protect. Many aspects of the physician-patient relationship and clinical setting also undermine the philosophical values enshrined in this doctrine. This further jeopardizes the individual's integrity. The Article explores proposals for change such as delaying the informing and consenting, improving the concept of consent, and improving the role of the physician.

scholarly journals Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards

2013 ◽  
Vol 88 (5) ◽  
pp. 739-747
Author(s):  
Luiz Mauricio Costa Almeida ◽  
Michelle dos Santos Diniz ◽  
Lorena dos Santos Diniz ◽  
Jackson Machado-Pinto ◽  
Francisco Chagas Lima Silva
Keyword(s):  
Internal Medicine ◽  
Comparative Study ◽  
Medical Records ◽  
Skin Barrier ◽  
Epidemiological Studies ◽  
Internal Medicine Ward ◽  
Cross Sectional ◽  
Systemic Corticosteroids ◽  
Internal Medicine Wards ◽  
Belo Horizonte

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

scholarly journals The Prevalence of Alprazolam Uses in Geriatric Patients at Dr. Mohammad Hoesin Hospital Palembang

2016 ◽  
Vol 5 (2) ◽  
pp. 193
Author(s):  
Yohanes Febrianto ◽  
Sutomo Tanzil ◽  
Theodorus Parulian
Keyword(s):  
Internal Medicine ◽  
Heart Disease ◽  
Medical Records ◽  
Geriatric Patients ◽  
Age Group ◽  
Internal Medicine Ward ◽  
Drug Utilization Study ◽  
Short Acting ◽  
Infectious Origin ◽  
Male Patients

<p>One of the most frequently prescribed drugs in geriatric patients is a benzodiazepine, especially a short-acting such as alprazolam. Unfortunately, alprazolam is oftenly used inappropriately because this drug has a short acting effect. Geriatric patients are more sensitive to this drug that can lead to the dependence. However, there is still lack of data on the use of this drug in geriatric patients. The aim of this study was to determine the prevalence of the use of alprazolam. A drug utilization study has been done for 2 months through analysis of patient’s medical records in the internal medicine ward at RSMH Palembang from June 1<sup>st</sup>, 2012 to May 31<sup>st</sup>, 2013. There were 25 out of 1634 patients receiving alprazolam, but only 23 patients whose data were obtained from the available medical records. Prevalence of alprazolam use was 1.408%. Based on gender, the prevalence was 1.798% in female and 1.09% in male patients. Proportion by age group was 91.3%, 8.7% and 0% in age group 60-74 years, 75-90 years and over 90 years, respectively. Based on the job, the population study comprised of the housewive (52.1%), unemployment (39.1%), and entrepreneur and farmer (4.3% together). The indication of usage was atheroscerotic heart disease, diarrhoea and gastroenteritis of presumed infectious origin, unspecified gastritis, and thyrotoxic heart disease. In other words, it could be said that the usage of alprazolam was inappropriate.</p>

scholarly journals Prevalensi periodontitis pada pasien diabetes mellitus (Studi observasional di poliklinik penyakit dalam RSUP Dr. Sardjito)

2017 ◽  
Vol 3 (2) ◽  
pp. 98 ◽  
Author(s):  
Rezmelia Sari ◽  
Dahlia Herawati ◽  
Rizky Nurcahyanti ◽  
Pramudita Kusuma Wardani
Keyword(s):  
Internal Medicine ◽  
Diabetes Mellitus ◽  
Informed Consent ◽  
Observational Study ◽  
General Hospital ◽  
Oral Hygiene ◽  
Periodontal Diseases ◽  
Central Java ◽  
Patients With Diabetes ◽  
Tissue Attachment

Prevalence of periodontal diseases in patients with  diabetes mellitus (An observational study     at internal medicine polyclinic in  Dr.  Sardjito General Hospital). Diabetes Mellitus (DM) is a  chronic disease    with an increasing prevalence and causes complications. The most frequent complication found in the oral cavity of patients with diabetes mellitus is periodontal diseases is characterized by the loss of tissue attachment. There have been numerous studies on the association of DM with periodontal diseases but there has not been any data on the prevalence of periodontal diseases in diabetic group, especially in Yogyakarta and Central Java. Dr. Sardjito General Hospital is a referral hospital in DIY and Central Java, so this study is expected to provide a picture regarding the level of periodontal tissue health among people in Yogyakarta and Central Java. This research was an observational study, involving 36 patients with DM according to criteria of the subjects: suffering from type 2 diabetes, being cooperative  and willing to sign an informed consent. The controlled variables: being 40 – 60 years of age, having good oral hygiene (OHI) according to Green and Vermillion, taking neither antibiotics nor anti-inammatory drugs in the last 3 months, not having a history of other systemic diseases. Oral hygiene exams were carried out, followed by examination using probe WHO to determine if there is CAL. The data were presented descriptively. The results showed that the prevalence of periodontal diseases in patients with DM at Internal Medicine Polyclinic in Dr. Sardjito General Hospital is 88.24% with a mean of CAL distance of 4.6 mm. The conclusion of this study is that the prevalence of periodontal diseases in patients with DM is high although the oral hygiene status is good. ABSTRAKDiabetes Mellitus (DM) adalah penyakit kronis menahun dengan prevalensi yang semakin meningkat dan menimbulkan komplikasi. Komplikasi yang paling sering terjadi di rongga mulut pasien DM adalah periodontitis yang ditandai dengan kehilangan perlekatan jaringan. Penelitian tentang hubungan DM dengan periodontitis banyak dilakukan namun belum ditemukan data mengenai prevalensi periodontitis pada kelompok  DM  khususnya di DIY dan  Jawa Tengah.  RSUP Dr. Sardjito merupakan rumah sakit rujukan DIY dan Jawa Tengah sehingga penelitian ini diharapkan dapat memberi gambaran mengenai tingkat kesehatan jaringan periodontal di masyarakat DIY dan Jawa Tengah. Jenis penelitian ini adalah observasional dengan melibatkan 36 orang pasien DM sesuai kriteria subjek yaitu menderita DM tipe II, kooperatif dan bersedia menandatangani informed consent. Variabel terkendali yaitu usia 40 – 60 tahun, kebersihan mulut (OHI) menurut Green and Vermillion dalam kriteria baik, tidak menggunakan antibiotik dan antiinamasi dalam 3 bulan terakhir dan tidak memiliki riwayat penyakit sistemik lain. Dilakukan pemeriksaan kebersihan mulut dilanjutkan dengan pemeriksaan menggunakan probe WHO untuk menentukan ada tidaknya CAL. Data disajikan secara deskriptif. Hasil penelitian menunjukkan bahwa prevalensi periodontitis pada pasien DM di Poli Klinik Penyakit Dalam RSUP Dr. Sardjito adalah 88,24% dengan rata-rata jarak CAL adalah 4,6 mm. Kesimpulan penelitian ini adalah prevalensi periodontitis pada pasien DM tinggi walaupun status kebersihan mulut tergolong dalam kriteria baik.

scholarly journals Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

2021 ◽  
Vol 15 ◽  
Author(s):  
Valter Paz Nascimento-Júnior ◽  
Einstein Francisco Camargos
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Health Insurance ◽  
Medical Records ◽  
Private Health Insurance ◽  
Medical Specialty ◽  
Health Care Managers ◽  
Inappropriate Use ◽  
Care Managers ◽  
Previous Diagnosis

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate TM test orders. METHODS: This study analyzed data regarding TM requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 TM tested within the study period. Tests were considered inappropriate when TMs were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician’s medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1,112 TM tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD, 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with TM tests. Cardiology professionals were the medical specialty that requested the most TM tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of TM tests in clinical practice.

scholarly journals Gambaran Faktor Risiko Kejadian Penyakit Jantung Koroner di Poliklinik Jantung RSI Siti Rahmah Padang Tahun 2017-2018

2020 ◽  
Vol 3 (1) ◽  
pp. 20-28
Author(s):  
Yushera Atika Sari ◽  
Wisda Widiastuti ◽  
Betty Fitriyasti
Keyword(s):  
Internal Medicine ◽  
Medical Records ◽  
Univariate Analysis ◽  
Secondary Data ◽  
Sampling Technique ◽  
Cross Sectional ◽  
Long Period ◽  
Survey Results ◽  
Artery Disease ◽  
Descriptive Method

Introduction: CAD occurs indirectly, usually a person will experience a process of narrowing of the coronary arteries in quite a long period of time. Primary survey results that researchers have done at Siti Rahmah Padang Hospital, recorded from 2017-2018 the number of CAD events as many as 115 cases. Aims : To obtain information about an overview of risk factors for the occurrence of coronary artery disease in the heart policlinic of Siti Rahmah Hospital Padang in 2017-2018. Method: This research covers the field of internal medicine and cardiology, this study was conducted at the Islamic hospital Siti Rahmah Padang in May to November 2019. This research used a descriptive method with a cross sectional approach using secondary data from medical records. The affordable population of this study is CAD patients who seek treatment at Siti Rahmah Hospital in Padang in 2017-2018 with 51 samples using Total Sampling technique. Univariate analysis is presented in the form of a frequency distribution table. Results: Based on the results of the study the most age was at the age of 50-59 years, 21 people (41.2%), the most sex was female, 26 people (51%), hypertension, 27 people (52,9%), experienced DM 26 people (51%) were obese, 16 people (31,4%) and hyperlipidemia, 13 people (25,5%). Conclusion : Most age 50-59 years, most sexes of women, most have hypertension, less than half are obese, most have DM and less than half have hyperlipidemia. 

Informed Consent Revisited

1996 ◽  
Vol 5 (2) ◽  
pp. 214-220 ◽  
Author(s):  
Amnon Goldworth
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Clinical Setting ◽  
Relevant Information ◽  
Best Interests ◽  
Limited Capacity ◽  
Legal Requirement ◽  
Good Level ◽  
Level Of Understanding ◽  
The Way

More than three decades after its introduction as a legal requirement for medical treatment in the clinical setting, informed consent continues to be viewed with skepticism as to its need or effectiveness. Some maintain that it is not required because the ordinary individual believes that doctors can be trusted to behave In the best interests of their patients. This issue will be discussed in a later portion of this article. Others are persuaded that informed consent is an unattainable ideal given the limited capacity of the ordinary individual to understand the relevant information. This view is supported by studies intended to show that satisfactory understanding on the part of patients cannot be achieved. In rebuttal, Apple-baum, Lidz, and Meisel observed that:Such statements are easily refuted by reference to studies of situations in which reasonable comprehension actually has been achieved. A sounder interpretation of all these studies might be that patients and subjects can attain a good level of understanding in many cases, but that several factors — including the manner in which disclosure is made as well as patients' limitations — may get in the way.

Informed Consent and Biobanks

2005 ◽  
Vol 33 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Ellen Wright Clayton
Keyword(s):  
Information Technology ◽  
Informed Consent ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Information ◽  
Information Resources ◽  
Biomedical Science ◽  
Research Setting ◽  
The Past

Biomedical research has always relied on access to human biological materials and clinical information, resources that when combined form biobanks. In the past, it appears that investigators sometimes used these resources with relatively little oversight, and without the consent of the individuals from whom these materials and information were obtained. Several developments in the last ten to fifteen years have converged to place greater emphasis on the role of individual consent in the creation and use of biobanks. The most important by far is the power of information technology, which has transformed our lives in almost every domain. In the research setting, it is now easy to abstract information from electronic medical records. Computers make it possible to analyze enormous datasets and have contributed in essential ways to the dramatic increases in our understanding of genomics and other areas of biomedical science.

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