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Decisional capacity

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https://www.readbyqxmd.com/read/28935115/characteristics-of-patients-with-constant-observers
#1
Susan Solimine, Junji Takeshita, Deborah Goebert, June Lee, Brian Schultz, Maria Guerrero, Michael Tanael, Mark Pilar, Loraine Fleming, Stacy Kracher, Leah Lawyer
BACKGROUND: The use of constant observers ("sitters") has been common practice in many medical centers to maintain patient safety. RESULTS: A retrospective chart review of patients who required sitters from October 1, 2007 to September 31, 2013 at a large, private hospital serving a multiethnic community showed that the top reasons for sitters include suicide risk, agitation, fall risk, interfering with medical devices, and confusion/disorientation. Sitters were used for a mean of 3...
August 10, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28918381/assessing-decisional-capacity-for-research-participation-in-psychiatric-patients-and-their-relatives
#2
Donae Elizabeth George, Saumil Dholakia, Prathap Tharyan
A cross-sectional study among adult inpatients with non-organic psychiatric disorders, and among their key relatives, assessed their comprehension and recall of key information in consent forms. It also assessed their capacity to consent to participate in two hypothetical randomised controlled trials (RCTs) with different potential risks and burdens, using structured questionnaires and recorded interviews. Of the 24 participants (12 patient-key relative dyads), seven patients (58%) and three key relatives (25%) were clinically judged to lack the capacity to consent...
August 8, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28916521/behavioural-modeling-and-electrophysiological-evidence-for-supramodality-in-human-metacognition
#3
Nathan Faivre, Elisa Filevich, Guillermo Solovey, Simone Kühn, Olaf Blanke
Human metacognition, or the capacity to introspect on one's own mental states, has been mostly characterized through confidence reports in visual tasks. A pressing question is to what extent results from visual studies generalize to other domains. Answering this question allows determining whether metacognition operates through shared, supramodal mechanisms, or through idiosyncratic, modality-specific mechanisms. Here, we report three new lines of evidence for decisional and post-decisional mechanisms arguing for the supramodality of metacognition...
September 15, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28887888/neurocognitive-impairment-addressing-couple-and-family-challenges
#4
John S Rolland
Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development...
September 9, 2017: Family Process
https://www.readbyqxmd.com/read/28882828/systematic-review-and-meta-analysis-of-factors-that-help-or-hinder-treatment-decision-making-capacity-in-psychosis
#5
REVIEW
Amanda Larkin, Paul Hutton
BackgroundThe evidence on factors that may influence treatment decisional capacity ('capacity') in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it.AimsTo determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment-related factors, thus providing a thorough synthesis of current knowledge.MethodWe conducted a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis, assessing the direction, magnitude, significance and reliability of reported associations...
September 7, 2017: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/28840485/how-surrogates-decide-a-secondary-data-analysis-of-decision-making-principles-used-by-the-surrogates-of-hospitalized-older-adults
#6
Rohit Devnani, James E Slaven, Gabriel T Bosslet, Kianna Montz, Lev Inger, Emily S Burke, Alexia M Torke
BACKGROUND: Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions should focus on a patient's preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients. OBJECTIVES: We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so...
August 24, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28801195/avoidance-of-accelerated-aging-in-schizophrenia-clinical-and-biological-characterization-of-an-exceptionally-high-functioning-individual
#7
Barton W Palmer, Raeanne C Moore, Lisa T Eyler, Luz L Pinto, Elyn R Saks, Dilip V Jeste
OBJECTIVE: To determine the clinical and biological characteristics of an exceptionally high functioning index person (IP) with schizophrenia in her mid-50s, which may represent compensatory mechanisms, and potentially, avoidance of the accelerated aging typically associated with schizophrenia. METHOD: IP, 11 other women with schizophrenia, and 11 non-psychiatric comparison (NC) women were assessed with standard ratings of psychopathology, neurocognitive function, decisional capacity, and functional brain imaging...
August 8, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28734555/decisional-and-dispositional-capacity-determinations-neuropsychiatric-illness-and-an-integrated-clinical-paradigm
#8
REVIEW
James A Bourgeois, Mary Ann Cohen, Jennifer M Erickson, Rebecca Weintraub Brendel
BACKGROUND: Assessment of decisional capacity requires thorough clinical review of a patient's current psychiatric symptoms and cognitive processes. The assessment to determine the patient's capacity for self-management postdischarge is a different clinical concept from decisional capacity. OBJECTIVES: Standardized guidelines for capacity determinations (both for informed consent and for disposition) would be helpful to clinicians, patients, and their caregivers...
May 13, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28701031/patient-s-cognitive-function-and-attitudes-towards-family-involvement-in-cancer-treatment-decision-making-a-patient-family-caregiver-dyadic-analysis
#9
Dong Wook Shin, Juhee Cho, Debra L Roter, So Young Kim, Jong Hyock Park, Hyung Kook Yang, Hyun Woo Lee, Sun-Seog Kweon, Yune Sik Kang, Keeho Park
Purpose: Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. Materials and Methods: A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea, and were asked to express their preferences for family involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment)...
July 4, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28559033/refusal-of-emergency-medical-treatment-case-studies-and-ethical-foundations
#10
Catherine A Marco, Jay M Brenner, Chadd K Kraus, Norine A McGrath, Arthur R Derse
Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans...
May 27, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28553898/influence-of-psychiatric-symptoms-on-decisional-capacity-in-treatment-refusal
#11
Joshua M Baruth, Maria I Lapid
How psychiatric symptoms affect patients' decision making in practice can inform how we think-theoretically and conceptually-about what it means for those patients to have decision-making capacity. Assessment of a patient's decisional capacity allows those with adequate capacity to make choices regarding treatment and protects those who lack capacity from potential harm caused by impaired decision making. In analyzing a case in which a patient with stage II breast cancer refuses further treatment, we review the conceptual model of informed consent and approaches to assessing decision-making capacity that are in accordance with the American Medical Association Code of Medical Ethics as well as tools to assess decisional capacity...
May 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28544648/effects-of-a-web-based-patient-decision-aid-on-biologic-and-small-molecule-agents-for-rheumatoid-arthritis-answer-2-a-proof-of-concept-study
#12
Linda C Li, Chris Shaw, Diane Lacaille, Elaine Yacyshyn, C Allyson Jones, Cheryl Koehn, Alison M Hoens, Jasmina Geldman, Eric C Sayre, Graham Macdonald, Jenny Leese, Nick Bansback
OBJECTIVES: To assess the extent to which ANSWER-2, an interactive online patient decision aid, reduces patients' decisional conflict and improves their medication-related knowledge and self-management capacity. METHODS: We used a pre-post study design. Eligible participants had a diagnosis of rheumatoid arthritis (RA), had been recommended to start using a biologic or small molecule agent or to switch to a new one, and had Internet access. Access to ANSWER-2 was provided immediately after enrollment...
May 23, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28507770/the-recovery-of-factors-associated-with-decision-making-capacity-in-individuals-with-psychosis
#13
Colin Fernandez, Harry G Kennedy, Miriam Kennedy
BACKGROUND: There is limited data on the recovery of factors associated with decisional capacity in patients with psychosis. AIMS: To study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis. METHOD: Fifty-six patients with psychosis were assessed for capacity to consent to treatment on admission and at 6 and 12 weeks following treatment. The MacArthur Competence Assessment Tool - Treatment, the Positive and Negative Symptom Scale and the Global Assessment of Functioning Scale were used to measure mental capacities, symptom severity and global functioning respectively...
May 2017: BJPsych Open
https://www.readbyqxmd.com/read/28407800/advance-directives-and-power-of-attorney-for-health-care-in-the-oldest-old-results-of-the-agequalide-study
#14
Tobias Luck, Francisca S Rodriguez, Birgitt Wiese, Carolin van der Leeden, Kathrin Heser, Horst Bickel, Jürgen In der Schmitten, Hans-Helmut Koenig, Siegfried Weyerer, Silke Mamone, Tina Mallon, Michael Wagner, Dagmar Weeg, Angela Fuchs, Christian Brettschneider, Jochen Werle, Martin Scherer, Wolfgang Maier, Steffi G Riedel-Heller
BACKGROUND: Completion of advance directives (ADs) and power of attorney (POA) documents may protect a person's autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA. METHODS: We analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study...
April 13, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28379834/ethical-considerations-in-electronic-monitoring-of-the-cognitively-impaired
#15
Y Tony Yang, Charles G Kels
Cognitive impairment afflicts an estimated 16 million people in the United States. Wandering is a concerning behavior associated with cognitive impairment, as it may threaten patient safety. The risks posed by wandering place severe burdens on both professional and informal caregivers, as well as law enforcement institutions throughout the United States. As such, location trackers that could reduce this burden have become increasingly prevalent. As with many assistive technologies, the substantial promise of location trackers is counterbalanced by potential pitfalls with respect to loss of privacy and autonomy...
March 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28366903/guardianship-and-clinical-research-participation-the-case-of-wards-with-disorders-of-consciousness
#16
Megan S Wright, Michael R Ulrich, Joseph J Fins
We review relevant federal law about research on human subjects and state laws on guardian authority to determine whether guardians can consent on behalf of their wards to participation in research. The Common Rule is silent on the issue as are most state guardianship laws. Our analysis shows significant variation in guardians' decision-making authority in the states that do regulate wards' participation in research.We consider how the appointment of guardians for patients with disorders of consciousness (DOC) impacts such patients' access to research...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28366202/human-predatory-behavior-and-the-social-implications-of-communal-hunting-based-on-evidence-from-the-td10-2-bison-bone-bed-at-gran-dolina-atapuerca-spain
#17
Antonio Rodríguez-Hidalgo, Palmira Saladié, Andreu Ollé, Juan Luis Arsuaga, José María Bermúdez de Castro, Eudald Carbonell
Zooarcheological research is an important tool in reconstructing subsistence, as well as for inferring relevant aspects regarding social behavior in the past. The organization of hunting parties, forms of predation (number and rate of animals slaughtered), and the technology used (tactics and tools) must be taken into account in the identification and classification of hunting methods in prehistory. The archeological recognition of communal hunting reflects an interest in evolutionary terms and their inherent implications for anticipatory capacities, social complexity, and the development of cognitive tools, such as articulated language...
April 2017: Journal of Human Evolution
https://www.readbyqxmd.com/read/28336349/decisional-capacity-for-advanced-care-directives-in-parkinson-s-disease-with-cognitive-concerns
#18
Muneer Abu Snineh, Richard Camicioli, Janis M Miyasaki
INTRODUCTION: Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia...
March 8, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28248746/a-context-oriented-communication-algorithm-for-advance-care-planning-a-model-to-assist-palliative-care-in-heart-failure
#19
JinShil Kim, Shinmi Kim, Mi-Seung Shin, Jae Ok Jin, Yunmi Kim, Mee-Ok Lee
BACKGROUND: Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF). OBJECTIVES: The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions. METHODS: Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model...
February 28, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28154452/determinants-of-capacity-to-consent-to-research-on-alzheimer-s-disease
#20
Barton W Palmer, Alexandrea L Harmell, Luz L Pinto, Laura B Dunn, Scott Y H Kim, Shahrokh Golshan, Dilip V Jeste
OBJECTIVE: Investigators conducting Alzheimer's disease (AD) research need to consider participants' capacity to consent. Cognitive functioning is a significant predictor of decisional capacity, but there is a dearth of information on the influence of neuropsychiatric symptoms in AD on decisional capacity. We examined the rates of decisional capacity associated with two types of research protocols, and the association of capacity with neuropsychiatric symptoms and other participant characteristics...
2017: Clinical Gerontologist
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