Group items tagged

"Central Manchester University Hospitals NHS Foundation Trust"

"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

"Despite differences in practice patterns of nurses and physicians in using whiteboards, our findings suggest that all providers value their potential as a tool to improve teamwork, communication, and patient care. Successful adoption of whiteboard use may be enhanced through strategies that emphasize a patient-centered focus while also addressing important barriers to use."

"The goal of ART is to bring faculty development to the teaching practice through the use of short, focused modules."

"Welcome to the Virtual Interactive Case (VIC) system for creating simulations of encounters with patients in clinics. VIC cases are clinical reasoning exercises with feedback. Their role is to provide a bridge between theory and seeing patients in clinic (or ER), providing students with what Ericsson has called "deliberate practice" as a way of gaining clinical expertise. The strength of VIC is that it is optimized for rapidly creating a large number of cases, by using a patient template, and creating variations of cases with different differential diagnoses for the same presenting complaint."

"We found incorporating OSTEs into a FCR faculty development program to be an effective strategy for improving faculty teaching behavior. Additional study is needed to determine if this strategy results in sustained improvements in conducting FCRs in real inpatient settings. "

These strange-but-true nursing stories were told by nurses and nurse assistants in various places around the Web. Read, shudder, and enjoy!

Medical news and updates about medical articles and discussion in Google knols and in many medical websites.

Medical error