scholarly journals But when can I go home?

2015 ◽  
Vol 21 (5) ◽  
pp. 313-314
Author(s):  
David J. Findlay
Keyword(s):  
Clinical Practice ◽  
Perceived Risk ◽  
Case Law ◽  
Mental Capacity ◽  
Older Person ◽  
General Hospitals ◽  
Ethical Duty ◽  
Return Home ◽  
Person With Dementia ◽  
Professional Judgement

SummaryAssessment of mental capacity is, or should be, a regular part of daily clinical practice in general hospitals. It is both particularly important and potentially complex in relation to an older person with dementia wishing to return home despite concern over perceived risk. Case law provides some guidance, but an ethical duty remains for clinicians to develop and hone their professional judgement in this increasingly important area of practice.

Fluctuating capacity: the concept of micro- and macro-decisions

2020 ◽  
Vol 26 (4) ◽  
pp. 238-244
Author(s):  
Martin Curtice
Keyword(s):  
Clinical Practice ◽  
Personality Disorder ◽  
Clinical Problem ◽  
Case Law ◽  
Mental Capacity ◽  
Routine Clinical Practice ◽  
Unique Case ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act ◽  
First Time

SUMMARYThere is much Mental Capacity Act 2005 (MCA) case law emanating from the Court of Protection. This article reviews an important and unique case when the court specifically addressed for the first time the question of fluctuating capacity, a not uncommon clinical problem that can often be complex. It describes how the Court of Protection in Royal Borough of Greenwich v CDM [2019] legally approached an issue of fluctuating capacity in a 64-year-old woman with a personality disorder and chronic diabetes. In doing so it elucidates a new conceptual framework to apply when assessing fluctuating capacity in terms of considering micro- and macro-decisions which can be used in routine clinical practice.

Determinants of Physicians’ Intention to Use Clinical Practice Guidelines on Antimicrobial at Tertiary General Hospitals in China

2020 ◽  
Author(s):  
Qingwen Deng ◽  
Wenbin Liu
Keyword(s):  
Clinical Practice ◽  
Perceived Risk ◽  
Structural Equation ◽  
Relevant Literature ◽  
Ease Of Use ◽  
Relative Advantage ◽  
Equation Modeling ◽  
Intention To Use ◽  
Cross Sectional Survey ◽  
General Hospitals

Abstract Background: Inappropriate use of antimicrobial has resulted in some great public health concerns, such as antimicrobial resistance (AMR). Although the effects of clinical guidelines in standardizing clinical practice, controlling costs and reducing medical risks have been proved, the CPGs on antimicrobial hasn’t been widely applied in China yet. Furthermore, the influencing mechanism for the intention to the use of CPGs on antimicrobial remains largely unknown. Methods: By summarizing the relevant literature, the research model and self-administered questionnaire were developed. A national cross-sectional survey was conducted among physicians at tertiary general hospitals in the eastern, central, and western parts of China. Results: A total of 644 valid questionnaires were collected. The results of reliability and validity analysis showed the questionnaire was acceptable. The analyses of structural equation modeling (SEM) showed the proposed model fitted the data well with favorable values of fit indices. SEM results also revealed that seven determinants influence the intention to the use of CPGs on antimicrobial, including attitude (ATT), subjective norm (SN), perceived risk (PR), relative advantage (RA), ease of use (EOU), top management support (TMS) and organization & implementation (OI). Conclusions: The findings of this study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobial. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobial, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.

scholarly journals Predictors of physicians’ intentions to use clinical practice guidelines on antimicrobial in tertiary general hospitals of China: a structural equation modeling approach

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Qingwen Deng ◽  
Zhichao Zeng ◽  
Yuhang Zheng ◽  
Junhong Lu ◽  
Wenbin Liu
Keyword(s):  
Perceived Risk ◽  
Subjective Norms ◽  
Ease Of Use ◽  
Relative Advantage ◽  
Equation Modeling ◽  
Top Management ◽  
Intention To Use ◽  
Management Support ◽  
General Hospitals ◽  
Top Management Support

Abstract Background With inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. Taking tertiary general hospitals in China for example, this study aimed to identify factors to investigate the comprehensive influencing mechanism for physicians’ intention to use CPGs on antimicrobials. Methods Based on the integration of Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), and Technology-Organization-Environment framework (TOE), a questionnaire survey was conducted covering potential determinants of affecting physicians’ intentions to use CPGs on antimicrobials at the individual level (attitude, subjective norms and perceived risk), technical level (relative advantage and ease of use), and organizational level (top management support and organizational implementation). Data were collected from 644 physicians in tertiary general hospitals in eastern, central and western China, which were obtained by multi-stage random sampling. The structural equation modeling (SEM) was used to link three-level factors with physicians’ behavioral intentions. Results The majority of the participants (94.57%) showed a positive tendency toward intention to use CPGs on antimicrobials. The reliability and validity analysis showed the questionnaire developed from the theoretical model was acceptable. SEM results revealed physicians’ intentions to use CPGs on antimicrobials was associated with attitude (β = 0.166, p < 0.05), subjective norms (β = 0.244, p < 0.05), perceived risk (β = − 0.113, p < 0.05), relative advantage (β = 0.307, p < 0.01), top management support (β = 0.200, p < 0.05) and organizational implementation (β = 0.176, p < 0.05). Besides, subjective norms, perceived risk, relative advantage, ease of use, and top management support showed their mediating effects from large to small on the intentions, which were 0.215, 0.140, 0.103, 0.088, − 0.020, respectively. Conclusions This study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobials. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobials, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.

scholarly journals The Use of Neuroscience and Psychological Measurement in England's Court of Protection

2020 ◽  
Vol 11 ◽  
Author(s):  
Andrew McWilliams ◽  
Stephen M. Fleming ◽  
Anthony S. David ◽  
Gareth Owen
Keyword(s):  
Brain Function ◽  
Mini Mental State Examination ◽  
Case Law ◽  
Mental Capacity ◽  
Best Interests ◽  
Quantitative Review ◽  
Mental Capacity Act ◽  
State Examination ◽  
Neuroscience Community

The 2005 Mental Capacity Act of England and Wales provides a description in statute law of a test determining if a person lacks “mental capacity” to take a particular decision and describes how the “best interests” of such a person should be determined. The Act established a new Court of Protection (CoP) to hear cases related to the Act and to rule on disputes over mental capacity. The court gathers a range of evidence, including reports from clinicians and experts. Human rights organisations and others have raised concerns about the nature of assessments for incapacity, including the role of brain investigations and psychometric tests.Aim: Describe use and interpretation of structured measures of psychological and brain function in CoP cases, to facilitate standardisation and improvement of practices, both in the courtroom and in non-legal settings.Method: Quantitative review of case law using all CoP judgments published until 2019. The judgments (n = 408) were read to generate a subset referring to structured testing (n = 50). These were then examined in detail to extract the nature of the measurements, circumstances of their use and features of interpretation by the court.Results: The 408 judgments contained 146 references to structured measurement of psychological or brain function, spread over 50 cases. 120/146 (82.2%) referred to “impairment of mind or brain,” with this being part of assessment for incapacity in 58/146 (39.7%). Measurement referred on 25/146 (17.1%) occasions to “functional decision-making abilities.” Structured measures were used most commonly by psychiatrists and psychologists. Psychological measurements comprised 66.4% of measures. Neuroimaging and electrophysiology were presented for diagnostic purposes only. A small number of behavioural measures were used for people with disorders of consciousness. When assessing incapacity, IQ and the Mini-Mental-State Examination were the commonest measures. A standardised measure of mental capacity itself was employed just once. Judges rarely integrated measurements in their capacity determinations.Conclusion: Structured testing of brain and psychological function is used in limited ways in the Court of Protection. Whilst there are challenges in creating measures of capacity, we highlight an opportunity for the neuroscience community to improve objectivity in assessment, inside and outside the courtroom.

Clinical Practice Guidelines

2021 ◽  
Vol 3 (1) ◽  
pp. 1-155
Author(s):  
Malaysian Society of Neurosciences
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Hospital Care ◽  
Elderly Population ◽  
Mechanical Thrombectomy ◽  
Rapid Development ◽  
Reperfusion Therapy ◽  
Current Evidence ◽  
Older Person ◽  
Stroke Patients

The 1st Clinical Practice Guideline (CPG) on the management of ischaemic stroke was published in 2006 and the second edition was published in 2012. Since then, there was a rapid development in the management of acute stroke, mainly with the improvement and advancement of reperfusion therapy, encompassing both medical thrombolysis and mechanical thrombectomy. Furthermore, the importance of timely intervention, especially in the emergency department, had significantly improved the outcome in stroke patients. Therefore, this current CPG emphasizes the hyperacute management and has introduced new chapters, for example, emergency medical services. With the growing numbers of elderly population in Malaysia, we have also included a new chapter on stroke in the older person. This 3rd edition was developed to provide a clear and concise approach based on current evidence with the focus being on the efforts to reduce time and improve pre-hospital care. We have summarised and adapted relevant clinical trials data and published literatures to our local practice.

3. Consent

2021 ◽  
pp. 37-58
Author(s):  
Jo Samanta ◽  
Ash Samanta
Keyword(s):  
Public Policy ◽  
Information Disclosure ◽  
Common Law ◽  
Case Law ◽  
Mental Capacity ◽  
Best Interests ◽  
Mental Capacity Act 2005 ◽  
Relevant Case ◽  
The Common ◽  
Mental Capacity Act

This chapter deals with consent as a necessary precondition for medical treatment of competent adults. It provides an overview of the common law basis of the Mental Capacity Act 2005, followed by discussion of issues relating to information disclosure, public policy, and the key case of Montgomery and how this applies to more recent cases. It considers the statutory provisions for adults who lack capacity, exceptions to the requirement to treat patients who lack capacity in their best interests, and consent involving children under the Children Act 1989. Gillick competence, a concept applied to determine whether a child may give consent, is also explained. Relevant case law, including Gillick, which gave rise to the concept, are cited where appropriate.

scholarly journals Embedding the Mental Capacity Act 2005 in clinical practice: an audit review

2014 ◽  
Vol 38 (6) ◽  
pp. 291-293 ◽  
Author(s):  
Claudia Dunlop ◽  
Oluwatoyin Sorinmade
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Public Awareness ◽  
Mental Capacity ◽  
The Public ◽  
Audit Review ◽  
Mental Capacity Act 2005 ◽  
Improve Compliance ◽  
Audit Cycle ◽  
Mental Capacity Act

Aims and methodAn audit cycle assessed compliance of healthcare professionals within Oxleas NHS Foundation Trust with the statutory requirements of the Mental Capacity Act 2005 in patient care. Each stage involved a retrospective review of relevant patient electronic records. The additional purpose of the audit was to make recommendations to improve compliance with the requirement of the Act by healthcare professionals and improve patient understanding of its provisions.ResultsThe audit cycle demonstrated some improvement in clinical practice as well as the need for further efforts at raising the understanding and compliance of clinicians and the public with provisions of the Act.Clinical ImplicationsHealthcare professionals need further understanding of the provisions of the Act and their responsibilities. There is also the need to enhance public awareness to provisions of the Act in relation to their decision-making autonomy. Stakeholders need to put strategies in place for these to be achieved.

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