Dentistry and psychology in the care and treatment of odontophobic patients: the concise systematic review

This study aimed to demonstrate the use of psychological methods in the routine care of a dental office. The research was carried out through a literature review in the PubMed, Scielo, Cochrane Library, Web of Science and Scopus, and Google Scholar databases, from 2002 to 2021. Throughout the work, the causes and symptoms of anxiety of these patients during the care process and the view of the dentist was also described in terms of crises of fear and often refusal of treatment by these patients. At the end of the study of the works described above, the great importance of the interdisciplinary work of Psychology and Dentistry as a method of optimizing the care of odontophobic patients was concluded.

Islam and urostoma: a modern view through the prism of a religiously traditional legal system

Patients who practice Islam often refuse the proposed type of treatment for malignant neoplasms, citing religious reasons. Most fear that complete or partial non-retention of urine, the presence of a urostoma (ileal conduit) will violate their ritual purity and, as a result, their religious duties. The consequence of such refusal of treatment may be a lower quality of life, compared with patients of other faiths. Unfortunately, a low awareness of religious responsibilities among surgeons performing pelvic exentesis, cystectomy, prostatectomy, may prevent a full-fledged discussion of these issues before surgery. The presented review of the literature examined studies, legal aspects, and religious arguments that assist doctors in choosing treatment tactics for patients.

The Right to Refuse Treatment for Infectious Disease

One of the central tenets of contemporary bioethics is that mentally competent persons have a right to refuse medical treatment, even if the refusal might lead to the individual’s death. Despite this principle, laws in some jurisdictions authorize the nonconsensual treatment of persons with tuberculosis (TB) or other serious infectious diseases, on the grounds that doing so is necessary to protect the safety of others. This chapter argues that, in the vast majority of situations, overriding a refusal of treatment for infectious disease is not justifiable, as the risk to third parties can be avoided by the less restrictive alternative of isolating the patient. At the same time, it rejects the extreme position that the nonconsensual treatment of infectious disease is never appropriate. Instead, it concludes that compelling an individual to undergo treatment for infectious diseases may be ethically justifiable in exceptional situations if a refusal of treatment poses a grave risk to third parties, the treatment is not overly burdensome and has been established to be safe and effective, and less restrictive alternatives, including humanely isolating the patient, are not feasible under the circumstances. The burden should be on those seeking to compel unwanted treatment to demonstrate that these requirements have been met.

Motivos associados ao atraso para o início do tratamento de hiv/aids

RESUMOObjetivo: identificar os motivos associados ao atraso para o início do tratamento de pacientes vivendo com HIV/Aids. Método: trata-se de um estudo qualitativo, descritivo, transversal, realizado com 31 prontuários de pacientes na listagem de gap de tratamento, no sistema SIMC do Ministério da Saúde, com análises estatísticas realizadas pelo software SPSS. Resultados: infere-se que o gap de tratamento do município, entre agosto a dezembro de 2017, foi de 21,7%, e, em 2018, foi de 78,3%; destes, 21 pacientes se encontravam em situação de abandono do TARV e 22 pacientes na situação de gap por outros desfechos. Conclusão: conclui-se que houve aumento de 360,87% no gap de tratamento das pessoas vivendo com o HIV/Aids entre 2017 e 2018, e que os fatores e causas associados foram a recusa do tratamento, o abandono de TARV, óbito e desfechos diversos. Salienta-se que o estudo não mostrou significância quanto à condição clínica, situação conjugal, socioeconômica e abandono do tratamento, e que as lacunas enormes na cobertura do tratamento, estigma e discriminação continuam a prejudicar a efetividade das respostas. Descritores: Recusa ao Tratamento; HIV/Aids; Acompanhamento dos Cuidados de saúde; Serviços Ambulatoriais de Saúde; Pacientes que Abandonam o Tratamento; Monitoramento do Paciente. ABSTRACTObjective: to identify the reasons associated with the delay in starting treatment of patients living with HIV / AIDS. Method: this is a qualitative, descriptive, cross-sectional study of 31 patient charts in the treatment gap listing in the Ministry of Health's SIMC system, with statistical analyzes performed by SPSS software. Results: it is inferred that the treatment gap of the municipality between August and December 2017 was 21.7%, and in 2018 it was 78.3%; of these, 21 patients were in the situation of abandonment of ART and 22 patients in the gap situation due to other outcomes. Conclusion: it was concluded that there was a 360.87% increase in the treatment gap between people living with HIV / AIDS between 2017 and 2018, and that the associated factors and causes were refusal of treatment, abandonment of ART, death and miscellaneous outcomes. It should be noted that the study did not show any significance regarding the clinical condition, marital status, socioeconomic status and treatment abandonment, and that the huge gaps in treatment coverage, stigma and discrimination continue to impair the effectiveness of responses. Descriptors: Refusal of treatment; HIV / AIDS; Follow-up of Health Care; Outpatient Health Services; Patients who abandon treatment; Patient Monitoring.RESUMEN Objetivo: identificar los motivos asociados al retraso para el inicio del tratamiento de pacientes que viven con el VIH / SIDA. Método: se trata de un estudio cualitativo, descriptivo, transversal, realizado con 31 prontuarios de pacientes en la lista de gap de tratamiento, en el sistema SIMC del Ministerio de Salud, con análisis estadísticos realizados por el software SPSS. Resultados: se infiere que el gap de tratamiento del municipio, entre agosto a diciembre de 2017, fue del 21,7%, y, en 2018, fue del 78,3%; de estos, 21 pacientes se encontraban en situación de abandono del TARV y 22 pacientes en la situación de gap por otros resultados. Conclusión: se concluye que hubo un aumento del 360,87% en el gap de tratamiento de las personas que viven con el VIH / SIDA entre 2017 y 2018, y que los factores y causas asociados fueron el rechazo del tratamiento, el abandono de TARV, muerte y los distintos resultados. Se destaca que el estudio no mostró significancia en cuanto a la condición clínica, situación conyugal, socioeconómica y abandono del tratamiento, y que las lagunas enormes en la cobertura del tratamiento, estigma y discriminación continúan perjudicando la efectividad de las respuestas. Descriptores: Negativa del Paciente al Tratamiento; VIH/SIDA; Continuidad de la Atención al Paciente; Atención Ambulatoria; Pacientes Desistentes del Tratamiento; Monitorización del Paciente.

4. Consent to Treatment

This chapter discusses ethical and legal aspects of patient consent. It covers the limits to consent (including the context of the unconscious patient and adults lacking capacity); the refusal of treatment by capacitous adults and others; the consequences of proceeding without consent; and the negligence action and the vagaries of information disclosure.

Long-term follow-up of clozapine prescribing

Objective: Clozapine is uniquely effective for treatment-resistant schizophrenia, and so treatment continuation is essential. We aimed to identify factors associated with an increased likelihood of clozapine discontinuation in a cohort of patients in South East London. Methods: We gathered demographic and treatment information such as duration of illness and antipsychotic treatment history. t-tests, chi-square tests and binary logistic regression were used to compare patients who continued and discontinued clozapine during the study and to identify predictor variables for discontinuation. Results: Out of the study population of 133 patients, 48 discontinued clozapine at least once during the study period. The majority of these (75%) stopped treatment within the first 4 years of clozapine therapy. Age, ethnicity, diagnosis and antipsychotic treatment history were not predictive of the risk of clozapine discontinuation. However, male patients were more likely to stop taking clozapine (χ2 = 6.81, p = 0.009). The odds of discontinuing clozapine were 2.15 times higher for male patients. The most common reason for discontinuation was patient refusal of treatment. Conclusion: We found that patients who discontinue clozapine are more likely to be male, but no other demographic variable was found to predict treatment cessation. Discontinuation usually occurred due to patient refusal of treatment.