The patient's order as a separate manifestation of his will

The article analyzes the issues of the patient's will in medical relations, it is proved that it is due to the expression of will to the proposed treatment (consent or refusal) that the patient is a full active participant in this relationship. However, his inability to express his will, temporary or irreversible, caused by the development of the disease, the peculiarity of its course may be an obstacle to determining his real desire for future treatment, medical intervention and jeopardize the violation or inability to exercise the patient's right to consent or refuse medical intervention. To avoid this, there is a certain legal institution in the legislation of a number of countries around the world, through which it is possible to plan your treatment in advance, to refuse it, in case of inability to do so in the future. In some legal systems, this institution has different names - "wishes made earlier", "medical will", "patient's will", "power of attorney to make decisions on health care", "patient orders" and so on. The paper analyzes the content of this institute, considers the views of scholars on it, made a comparative analysis with the legal construction of the "testament" and concluded that there are significant differences between these constructions, which makes it impossible, from the author's point of view, to call this will "testament". . It is proposed to consider such a will as one of the patient's rights - "patient order", which is made in writing by an adult - the patient, regardless of the type and stage of the disease in case of possible future inability to consent to medical examination, intervention or treatment. The patient has at his disposal not only his will for the future (list of medical procedures that are allowed to be performed in relation to his health, which are not), but also the case when it can be used (for example, coma, autonomic state). It is impossible to conclude it through a representative, because in this case the will of the patient is unknown. This order is executed by proxies (relatives, close persons, representatives, doctors, etc.). Despite the fact that in Ukraine today this legal institution is absent, the main directions of recoding of civil legislation indicate the possibility of its appearance in the updated legislation

A rare cutis verticis gyrata secondary to cerebriform intradermal nevus: case report and literature review

Background Cutis verticis gyrate (CVG) is a rare morphologic syndrome that presents with hypertrophy and folding of the scalp. CVG can be classified into three forms: primary essential, primary non-essential, and secondary. Cerebriform intradermal nevus (CIN) is a rare cause of secondary CVG. We are here to report a rare case of CVG with an underlying CIN and discuss the clinical course, treatment options, and critical screening guidelines for these patients. Case presentation A 25 year-old male patient presented with a chief complaint of generalized hair loss in the scalp parietaloccipital region for a duration of 1 year and the hair loss area was occasionally accompanied by mild itching. The hair loss started gradually and worsened over time. In addition, he had scalp skin folds resembling the ridge and furrow of the cerebral cortex in the parietaloccipital region since birth. Physical examination revealed hypertrophy and formation of folds in the parietal-occipital area, forming 5 to 6 furrows and ridges. The size of the cerebriform mass was about 12.0 cm × 8.5 cm, without other skin lesions. Diffuse non-scarring hair loss was distributed on the posterior-parietal scalp, mid-parietal scalp and superior-occipital scalp. The diseased tissue of the patient's parietaloccipital area was excised under general anesthesia. The postoperative pathological examination of the tissue excised showed that there were dense intradermal melanocytic nevus, so the patient was diagnosed with secondary CVG caused by CIN. At the 2 year follow-up, there were no obvious changes in the lesions. Conclusions CIN must be differentiated from other conditions that manifest as CVG, including primary essential or non-essential CVG and secondary CVG caused by other reasons. Each CIN patient requires a specific decision of whether to excise the lesion surgically or follow a wait-and-see policy, depending on the patient's will and specific condition. Surgical treatment may be performed when there is an aesthetic demand. However, clinical observation and close follow-up is also a good treatment choice for patients with stable disease or mild symptoms.

The case for cautious paternalism in the emergency management of patients with borderline personality disorder

Summary Principlism is the dominant ethical theory in modern medicine. Autonomy is ‘king’ of the principles espoused and operationalised in consent. Consent is the mechanism by which all medical interactions occur. In borderline personality disorder (BPD) there is often a diffuse sense of self, emotional instability and impulsivity that can lead to medically dangerous non-suicidal self-injury, acute medical intervention and then a withdrawal of consent while the potential threat to the person's well-being remains high. Claims of lack of capacity lack veracity, and simply acting against the patient's will may be illegal. Understanding the will and preferences of patients is a step forward, but it is not always possible in time-sensitive situations. A cautious paternalism is therefore warranted both to ensure the patient's well-being while being honest as to the reasons for this, and to possibly build epistemic trust between the medical system and the patient with BPD.

The Correlations Between Epidemiological and Clinical Characteristics, laboratory tests and CT Scan reports in the diagnosis of cases 2019 novel coronavirus pneumonia. A Diagnostic Accuracy Study

Background: The role of laboratory parameters and the relationship of them with radiology reports, CT scan and clinical outcomes in screening of COVID-19 patients not been definitely established, but this disease presented a major challenge in the field of clinical tests, radiology reports, clinical outcomes that help to monitoring and treatment COVID-19 disease. Methods: This study was performed on 340 suspected COVID-19 patients, who presented to Chamran Hospital, Shiraz University of Medical Sciences Shiraz, Iran from 20 February to 31 August, 2020. Information each patient’s will be completed using a data collection forms based on records. The evaluation of lungs involvement in CT scan and their relationship with laboratory indicator including biochemical and hematological factors, is the best scale for the severity and prognosis of Covid 19 patients. Results and Conclusion: The findings of this study indicated ALT, AST, CRP, NEU, LDH, and Urea have very good accuracy in predicting cases with positive RT-PCR for COVID-19, respectively. In this study we shown the correlation of clinical and laboratory findings with CT-based quantitative score of pulmonary involvement in COVID-19 pneumonia and attempted that our findings could be usable to development future clinical research associated with COVID-19 infection and show the relationship of reports CT scan and clinical outcomes in the diagnosis and severity of patients with COVID-19.

May the Patient’s Will, Expressed by Means of Assistive Communication Technologies, be Admissible as Evidence in Court Proceedings?

The article is dedicated to hallmark the problem of accepting evidence of a patient’s will by a court in diverse proceedings, and it being communicated by non-classical means. Modern technologies allow patients to communicate utilizing various electrified appliances, in case the disabled person suffers from an ailment, or a health disorder affecting speech and mental abilities. Such appliances may truly enhance the patient’s quality of life; however, it is uncertain whether such patient may be found to be a competent witness, or the information reflecting their will obtained in a non-classical method may be found to be as convincing evidence by the court. Currently, there is very little judicial precedent dealing with obtaining evidence of the patient’s will by means of assistive communication technologies, though recent Italian legacy has shown such evidence may be accepted by the court, in case forensic-psychiatric examination approves adequacy of the cognitive abilities of the patient, rendering their will competent. Diverse legal systems render the question of patient’s competence differently, and the issue of accepting information as evidence obtained by means of assistive communication technologies will surely become more frequent in disputes relating to testament validity or determining the patient’s will to undergo or forego medical treatment. Such cases may be of high relevance in civil proceedings on withdrawal of life-supporting treatment, which will ultimately result in the patient’s demise. Keywords: patient’s autonomy, patient’s legal capacity, withdrawal of life-supporting treatment, assistive communication technologies, theory of evidence, critically-ill patients.

Essential Information for Transition of Care for Frail Elderly Patients in Japan: A Qualitative Study

Background: Information exchange between hospitals and primary care physicians is suboptimal. Most physicians are dissatisfied with the current referral process, and poor communication leads to negative care transition outcomes.Methods: To identify the key information needed in referral letters for successful transition of care. We conducted a qualitative study using consecutive, semi-structured in-person interviews and focus group sessions. We recruited 5 participants for individual interviews and 16 participants for focus groups. All participants were engaged in clinical work. We analyzed all data using qualitative thematic analysis. Interview transcripts were analyzed inductively and reflectively. All results were returned to the participants and modified based on their feedback. Results: The five individual interviews provided a general picture of the current referral process and a useful interview guide for the following focus group sessions. The focus group discussions were used to identify the essential care transition information needed at admission and discharge from the hospital. Essential information on hospital admission were: 1) Basic medical and care information, 2) Care resources available at home, 3) The purpose of admission and the goals of care during hospitalization, and 4) Status of advance care planning (ACP) and patient’s will in an emergency. Essential information on hospital discharge were: 1) Clinical course, 2) Explanation of medical condition during hospitalization, 3) Status of ACP and patient’s will in an emergency, and 4) Medical procedures to be continued at home. Conclusion: We identified the essential information needed for successful transition of care in Japan, particularly on admission to and discharge from acute hospitals. The clinical effectiveness of a template that contains the information identified in our study warrants investigation.

DELUSIONAL MISIDENTIFICATION SYNDROME: DISSOCIATION BETWEEN RECOGNITION AND IDENTIFICATION PROCESSES

Delusional misidentification syndrome (DMS) is an umbrella term for syndromes of intermetamorphosis, Fregoli, and Capgras. DMS) is thought to be related to dissociation between recognition and identification processes. DMS was described for the first time in 1932 as a variant of the Capgras syndrome and is currently on the DSM-V list of diseases as an independent disease entity. Patients affected by DMS believed that people around them, most often family, have changed physically (appearance) and mentally (character). Other symptoms include confabulation, derealization or depersonalization. In patients, aggressive behavior is often observed, aimed at alleged doppelgangers resulting from the sense of being cheated and manipulated. With the intermetamorphosis syndrome, for example, schizophrenia, depression, bipolar disorder or other misidentification syndromes (Fregoli's, Capgras) may coexist. There is also a reverse intermetamorphosis, where the object of the changed appearance or character becomes the patient himself. One of its forms may be lycanthropy. The etiology of the intermetamorphosis has not been fully understood, one of the reasons may be brain damage and changes in the parietal and/or temporal lobes of the right hemisphere. It may then damage long neuronal connections to the frontal areas of the brain, disturbances of working memory (WM) accountable for the keep and online management of data, so that it is available for further processing, and the patient's will be uncritical. The basic method of diagnosis of this delusion is a medical interview with the patient. Other diagnostic methods include computed tomography, magnetic resonance imaging, EEG and ERPs. Experimental methods include searching for the neuromarker of DMS. Currently, there are no treatment guidelines of this delusional disorder, and pharmacotherapy experimental, but the drugs from the group of neuroleptics and lithium seem effective. Some hope for the treatment is created by neurotherapy, but it is also experimental.

Self-Regulation of Relations in Information-Sharing on the Progress and Results of Genetic Studies: Problems of Professional and Ethical Requirements Development

The paper deals with the problems of development of professional and ethical requirements in the field of information sharing about the progress and results of genetic research. The author substantiates the conclusion about the need to adopt such requirements at the level of self-regulatory organizations of geneticists These requirements should include the provisions on additional information, providing information about secondary and random test results in specific cases where the potential benefit for the patient is significant, but the additional load on the specialist is not too noticeable. The requirements should contain a list of specific genetic abnormalities and diseases related to random and secondary results of the study and reported regardless of the patient’s will, as well as the procedure and role of all involved parties (specialists and patients) in the process of disclosure of the results of the study.

UNDERAGE PATIENT’S RIGHTS

The legal framework for the treatment of an under-aged patient is topical throughout the world. In Latvia, the rights of an under-aged patient are defined in Article 13 of the Patients' Rights Act, however, there is a significant contradiction in the article. It is related to the age of a under-aged patient, when he or she is entitled to independently decide on his / her own treatment, including a refusal of medical services, but there are legal cases where a medical practitioner may disregard this patient's will.