Group items tagged

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"To describe the essential components of the medical model of substance use disorders. To delineate the interviewing skills necessary to screen effectively for substance use and abuse. To understand the high rate of psychiatric and medical co-morbidity and more effectively screen patients for these disorders. To demonstrate skills for evaluating patients' stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change. To clearly and supportively recommend treatment to patients with substance use disorders. To describe the skills required for addiction prevention counseling. To define the skills that help set respectful limits on patient requests for prescription medication. To demonstrate awareness of how physician/clinician attitudes toward patients with substance use disorders impact recognition, diagnosis, and treatment of patients. To demonstrate knowledge of substance use disorder treatment standards and the ability to recommend appropriate referrals."

"Welcome the eViP website! This site is dedicated to bringing you information about the eViP programme, a collaboration between nine universities and MedBiquitous Europe. eViP aims to create a bank of 320 repurposed and enriched virtual patients. These virtual patients will be available under a Creative Commons Licence. All virtual patients are repurposed using MedBiquitous Virtual Patient Technical Standards."

"The results can be used to reframe understanding of the SP role and of the psychometric discourse of assessment. Ratings awarded by SPs are socially constructed and reveal the complexity of the OSCE process and the unfeasibility of absolute objectivity or standardisation. Standardised patients valued individuality, subjective experience and assessment for learning. The potential of SPs is under-used their greater involvement should be used to promote real partnership as educators move into a post-psychometric era. New-generation assessments should strive to value subjective experience as well as psychometric data in order to utilise the significant potential for learning within assessment."

"The renewed emphasis on clinical skills in medical education comes at a time when there is also increasing focus on the need to provide better care for populations that experience health disparities.2,3,10 SPs provide a unique opportunity to meet both the general goals of medical education in developing students' clinical skills and goals specific to enhancing and evaluating students' knowledge, attitudes, and skills with regard to patients with disabilities."

" The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized."