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Munawar T, Ismail F, Mehmood Qadri H, Haq AU, Munawar A, Zahid AS, Sheraz M, Babar MS. Practices of Informed Consent for Emergency Procedures at a Tertiary Care Hospital in Lahore, Pakistan. Cureus 2023; 15:e50322. [PMID: 38205463 PMCID: PMC10777781 DOI: 10.7759/cureus.50322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
Background The purpose of obtaining informed consent is to ensure that patients undergoing any medical or surgical intervention are neither deceived nor coerced. Accurately estimating surgical risks is critical for shared decision-making and informed consent. Probable complications and alternative procedures should be presented to the patient so that they can freely choose an operative option. However, this factor is difficult to carry on in emergencies where an urgent decision is required. Objective This study aimed to assess the ongoing clinical practices of informed consent in emergency surgeries at a tertiary care facility. Materials and methods A cross-sectional survey was carried out from March 2022 to June 2022 at the Department of General Surgery, Lahore General Hospital, Lahore, Pakistan, with patients who had undergone surgical procedures under local, spinal, or general anesthesia within 24 hours of presentation. A Google Form (Google Inc., Mountainview, CA) was designed, containing a predefined set of 32 standard questions, and patients were interviewed in their native language to assess their satisfaction regarding the pattern and components of emergency informed consent. Categorical data were assessed using measures of central tendency, frequencies, and percentages. Results A total of 169 patients were selected for the study. Only 1.6% of them signed the consent form themselves, while 93.5% of the forms were signed by their first-degree relatives. Verbal consent was taken in 4.8% of cases. In 88% of cases, informed consent was obtained by the house surgeons. The majority of patients, i.e., 78.2%, were not able to read the written consent form; however, 83.1% understood the verbal information. About 66.3% of patients agreed that they were informed about the nature of their disease, while 67.5%, 14.8%, and 13.7% affirmed that they were explained the nature of surgical intervention, associated risks, and type of anesthesia, respectively. Overall, 59.5% of patients felt satisfied with the process of informed consent. About 91.1% of the patients believed that their decisions were unaffected by the procurement of informed consent. Conclusion The existing practices of informed consent and comprehension by the population were found to be substandard. Physicians seem to ignore bioethics, and patients appear to be unaware of their basic rights. Although practiced at our center, not all components of informed consent were communicated to the patients. The risks of the procedures and the mode of anesthesia used were not well addressed by doctors. There is a grave need to educate the medical community about the legal and ethical aspects of informed consent, as well as the public masses regarding their rights.
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Affiliation(s)
| | - Fiza Ismail
- General Surgery, Lahore General Hospital, Lahore, PAK
| | | | - Amjid Ul Haq
- General Surgery, Lahore General Hospital, Lahore, PAK
| | - Ali Munawar
- General Surgery, Shaikh Zayed Hospital, Lahore, PAK
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Grezenko H, Alsadoun L, Farrukh A, Rehman A, Shehryar A, Nathaniel E, Affaf M, I Kh Almadhoun MK, Quinn M. From Nanobots to Neural Networks: Multifaceted Revolution of Artificial Intelligence in Surgical Medicine and Therapeutics. Cureus 2023; 15:e49082. [PMID: 38125253 PMCID: PMC10731389 DOI: 10.7759/cureus.49082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
This comprehensive exploration unveils the transformative potential of Artificial Intelligence (AI) within medicine and surgery. Through a meticulous journey, we examine AI's current applications in healthcare, including medical diagnostics, surgical procedures, and advanced therapeutics. Delving into the theoretical foundations of AI, encompassing machine learning, deep learning, and Natural Language Processing (NLP), we illuminate the critical underpinnings supporting AI's integration into healthcare. Highlighting the symbiotic relationship between humans and machines, we emphasize how AI augments clinical capabilities without supplanting the irreplaceable human touch in healthcare delivery. Also, we'd like to briefly mention critical findings and takeaways they can expect to encounter in the article. A thoughtful analysis of the economic, societal, and ethical implications of AI's integration into healthcare underscores our commitment to addressing critical issues, such as data privacy, algorithmic transparency, and equitable access to AI-driven healthcare services. As we contemplate the future landscape, we project an exciting vista where more sophisticated AI algorithms and real-time surgical visualizations redefine the boundaries of medical achievement. While acknowledging the limitations of the present research, we shed light on AI's pivotal role in enhancing patient engagement, education, and data security within the burgeoning realm of AI-driven healthcare.
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Affiliation(s)
- Han Grezenko
- Translational Neuroscience, Barrow Neurological Institute, Phoenix, USA
| | - Lara Alsadoun
- Plastic Surgery, Chelsea and Westminster Hospital, London, GBR
| | - Ayesha Farrukh
- Family Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | | | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbotabad, PAK
| | | | - Maria Quinn
- Internal Medicine, Jinnah Hospital, Lahore, PAK
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3
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Charman O, Forty E, Hassoulas A. Medical students observing a primary care consultation: does student gender affect patient consent? Educ Prim Care 2023; 34:40-43. [PMID: 36604830 DOI: 10.1080/14739879.2022.2161073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical placement is an important aspect of undergraduate education in the United Kingdom (UK) but with no national curriculum for primary care teaching, it is important to consider the learning opportunities afforded to students when on these rotations. In earlier years, observing consultations constitutes a large proportion of student experience, with patient consent an integral aspect of this teaching method. This study investigated whether patients consider the gender of a medical student when granting consent for their primary care appointment to be observed and whether this was conditional based on their presenting complaint. In total, 551 adult participants (420 females and 131 males) residing in the UK, aged 18-87 years, responded to an online questionnaire. In total, 229 (41.6%) participants stated that they would be influenced by the student's gender when consenting to observation, notably if the presenting complaint concerned an intimate area or their sexual health. A statistically significant correlation was revealed for consent, participant age and participant gender, with younger female respondents less likely to consent to observation by male students. The findings highlight a potential concern pertaining to equal opportunities between medical students based on gender, with inclusivity and diversity considerations for medical schools and clinicians.
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Terán AÁ, Palazuelos C, Dierssen-Sotos T, Alonso-Molero J, Llorca J, Gómez-Acebo I. Evolution of Medical Students' Perception of the Patient's Right to Privacy. Int J Environ Res Public Health 2022; 19:11067. [PMID: 36078783 PMCID: PMC9517786 DOI: 10.3390/ijerph191711067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
During clinical rotations, medical students experience situations in which the patients' right to privacy may be violated. The aim of this study is to analyze medical students' perception of clinical situations that affect patients' right to privacy, and to look for the influential factors that may contribute to the infringement on their rights, such as the students' age, sex, academic year or parents' educational level. A cross-sectional study was conducted with a survey via "Google Drive". It consisted of 16 questions about personal information, 24 questions about their experience when rotating and 21 questions about their opinion concerning several situations related to the right to privacy. A total of 129 medical students from various Spanish medical schools participated. Only 31% of 3rd-6th year students declared having signed a confidentiality agreement when starting their clinical practice, and most students (52%) reported that doctors "sometimes", "rarely" or "never" introduce themselves and the students when entering the patients' rooms. Additionally, about 50% of all students reported that they would take a picture of a patient's hospitalization report without his/her (consent), which would be useful for an assignment. Important mistakes during medical students' rotations have been observed, as well as a general lack of knowledge regarding patient's right to privacy among Spanish medical students. Men and older students showed better knowledge of current legislation, as well as those whose parents were both university-educated and those in higher academic years.
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Affiliation(s)
| | - Camilo Palazuelos
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain
| | - Trinidad Dierssen-Sotos
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jessica Alonso-Molero
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
| | - Javier Llorca
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Inés Gómez-Acebo
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Koenigs KJ, Chou JH, Cohen S, Nolan M, Liu G, Terplan M, Cummings BM, Nielsen T, Smith NA, Distefano J, Bernstein SN, Schiff DM. Informed consent is poorly documented when obtaining toxicology testing at delivery in a Massachusetts cohort. Am J Obstet Gynecol MFM 2022; 4:100621. [PMID: 35354087 DOI: 10.1016/j.ajogmf.2022.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positive toxicology testing at delivery can have enormous consequences for birthing persons and their families, including charges of child abuse or neglect and potential loss of custody for the birthing parent. Therefore state and national guidelines stipulate that, clinicians must obtain consent before toxicology testing at delivery. OBJECTIVE This study aimed (1) to determine clinician documentation of patient consent for peripartum toxicology testing and (2) to characterize the extent to which patient and hospital characteristics were associated with documented consent. STUDY DESIGN This was a retrospective cohort of individuals who underwent toxicology testing within 96 hours of delivery between April 2016 and April 2020 at 5 affiliated hospitals across Massachusetts. Medical records were reviewed for documentation of clinician intent to obtain maternal toxicology, testing indication, verbal consent to testing, and child protective services involvement. Hierarchical multivariable logistic regression was used to examine the association between patient and hospital characteristics and documentation of verbal consent. RESULTS Among 60,718 deliveries, 1562 maternal toxicology tests were obtained. Verbal consent for testing was documented in 466 cases (29.8%). Documented consent was lacking across most demographic groups. Consent was no more likely to be documented when a report was filed with child protective services and less likely in cases where the birthing parent lost custody before discharge (P=.003). In our multivariable model, consent was least likely to be documented when a maternal complication (abruption, hypertension, preterm labor, preterm premature rupture of membranes, or intrauterine fetal demise) was the indication for testing (adjusted odds ratio, 0.46; 95% confidence interval, 0.28-0.76). Verbal consent was twice as likely to be documented in delivery hospitals with established consent policies (adjusted odds ratio, 2.10; 95% confidence interval, 1.01-4.37). CONCLUSION Consent for toxicology testing at delivery seemed to be infrequently obtained on the basis of clinician documentation. Provider education and hospital policies for obtaining informed consent are needed to protect the rights of birthing individuals.
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Affiliation(s)
- Kathleen J Koenigs
- Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA (Dr Koenigs)
| | - Joseph H Chou
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Drs Chou, Cohen, Cummings, and Schiff)
| | - Samuel Cohen
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Drs Chou, Cohen, Cummings, and Schiff)
| | - Moira Nolan
- Massachusetts General Hospital, Boston, MA (Ms Nolan)
| | - Gina Liu
- Harvard Medical School, Boston, MA (Ms Liu)
| | | | - Brian M Cummings
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Drs Chou, Cohen, Cummings, and Schiff)
| | - Timothy Nielsen
- Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, University of Sydney, Sydney, Australia (Mr Nielsen)
| | - Nicole A Smith
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA (Dr Smith)
| | - Joseph Distefano
- Boston University School of Public Health, Boston, MA (Mr Distefano)
| | - Sarah N Bernstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Bernstein)
| | - Davida M Schiff
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Drs Chou, Cohen, Cummings, and Schiff).
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Davey MS, Davey MG, Mohan K, O'Driscoll CS, Murphy CG. Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit. Cureus 2021; 13:e19460. [PMID: 34926032 PMCID: PMC8654130 DOI: 10.7759/cureus.19460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the ‘Orthopaedic Surgical Consent’ standards, as set by the American Association of Orthopaedic Surgeons (AAOS). If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma. Methods Following being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software. Results In the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient’s name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient’s name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015). Conclusion This closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.
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Affiliation(s)
- Martin S Davey
- Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL
| | - Matthew G Davey
- Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL
| | - Kunal Mohan
- Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL
| | | | - Colin G Murphy
- Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL
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7
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Zalmay P, Collis J, Wilson H. Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report. Cureus 2021; 13:e20322. [PMID: 35028219 PMCID: PMC8742997 DOI: 10.7759/cureus.20322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cognitively impaired patients with a hip fracture may be undergoing major operations without attempts being made to involve their next of kin (NoK) in best-interest decisions. Methods We used the Plan-Do-Study-Act (PDSA) methodology to guide our quality improvement (QI) project. Cognitively impaired hip fracture patients were identified retrospectively by searching the hip fracture database of a medium-sized district general hospital (DGH). Their medical notes were reviewed for documented attempts at contacting their NoK prior to surgery as well as on completion of the NoK section of the Consent Form Four. Intervention A simple feedback intervention was delivered in the form of a mixed verbal and visual presentation to the orthopaedic registrars responsible for obtaining consent from these patients. Results Post-intervention, there were documented attempts at contacting the NoK before surgery for all patients, a significant improvement from only 80%. There was also a significant increase in completion of the NoK section of the consent form, from 30% to 64.3%. Conclusions Simple audit and feedback interventions can produce significant positive changes in communication between clinicians and the NoK of cognitively impaired patients with hip fractures. Further interventions have been implemented to sustain these improvements.
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Affiliation(s)
- Pardis Zalmay
- Trauma and Orthopaedics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
| | - Justin Collis
- Trauma and Orthopaedics, Medway Maritime NHS Foundation Trust, Gillingham, GBR
| | - Helen Wilson
- Geriatrics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
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Spanakis EG, Sfakianakis S, Bonomi S, Ciccotelli C, Magalini S, Sakkalis V. Emerging and Established Trends to Support Secure Health Information Exchange. Front Digit Health 2021; 3:636082. [PMID: 34713107 PMCID: PMC8521812 DOI: 10.3389/fdgth.2021.636082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
This work aims to provide information, guidelines, established practices and standards, and an extensive evaluation on new and promising technologies for the implementation of a secure information sharing platform for health-related data. We focus strictly on the technical aspects and specifically on the sharing of health information, studying innovative techniques for secure information sharing within the health-care domain, and we describe our solution and evaluate the use of blockchain methodologically for integrating within our implementation. To do so, we analyze health information sharing within the concept of the PANACEA project that facilitates the design, implementation, and deployment of a relevant platform. The research presented in this paper provides evidence and argumentation toward advanced and novel implementation strategies for a state-of-the-art information sharing environment; a description of high-level requirements for the transfer of data between different health-care organizations or cross-border; technologies to support the secure interconnectivity and trust between information technology (IT) systems participating in a sharing-data "community"; standards, guidelines, and interoperability specifications for implementing a common understanding and integration in the sharing of clinical information; and the use of cloud computing and prospectively more advanced technologies such as blockchain. The technologies described and the possible implementation approaches are presented in the design of an innovative secure information sharing platform in the health-care domain.
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Affiliation(s)
- Emmanouil G Spanakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Stelios Sfakianakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Silvia Bonomi
- Department of Computer, Control, and Management Engineering Antonio Ruberti, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Claudio Ciccotelli
- Department of Computer, Control, and Management Engineering Antonio Ruberti, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Sabina Magalini
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Vangelis Sakkalis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
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Abstract
Incidental or secondary findings have been a major part of the discussion of genomic medicine research and clinical applications. For pharmacogenetic (PGx) testing, secondary findings arise due to the pleiotropic effects of pharmacogenes, often related to their endogenous functions. Unlike the guidelines that have been developed for whole exome or genome sequencing applications for management of secondary findings (though slightly different from PGx testing in that these refer to detection of variants in multiple genes, some with clinical significance and actionability), no corresponding guidelines have been developed for PGx clinical laboratories. Nonetheless, patient and provider education will remain key components of any PGx testing program to minimize adverse responses related to secondary findings.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomic and Precision Medicine, Duke University School of Medicine, Durham, NC, United States
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Strini V, Schiavolin R, Prendin A. The Role of the Nurse in Informed Consent to Treatments: An Observational-Descriptive Study in the Padua Hospital. Clin Pract 2021; 11:472-83. [PMID: 34449571 DOI: 10.3390/clinpract11030063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The process to obtain valid informed consent in healthcare reflects many aspects. Healthcare professionals that take care of the patient must provide him all the necessary information and verify his understanding, considering individual characteristics. Nurses are one of the main participants in this process. Objective: This study assesses nurses’ perceptions of their role in the informed consent process. Material and Methods: An observational study involving 300 nurses operating in 13 wards of the Padua Hospital, through the submitting of a questionnaire in the period November–December 2018. Results: The final sample is made up of 206 nurses—27 males (13.11%) and 179 females (86.89%). Work experience, on average 15 years, is significant in determining the answers to questions about opinions and experiences. Age is significant in determining how often nurses provide information to the patient’s family members about the actions to be taken after discharge. The ward was decisive in the responses related to information provided to patients on the nursing care level and the actions to be taken after discharge, and the definition of the nurse’s duties. Conclusions: The data collected show the need for interventions to reduce the causes of difficult that the nurse has in informing patients.
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Khurshid A, Holan C, Cowley C, Alexander J, Harrell DT, Usman M, Desai I, Bautista JR, Meyer E. Designing and testing a blockchain application for patient identity management in healthcare. JAMIA Open 2021; 4:ooaa073. [PMID: 34505001 PMCID: PMC7928860 DOI: 10.1093/jamiaopen/ooaa073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Healthcare systems suffer from a lack of interoperability that creates "data silos," causing patient linkage and data sharing problems. Blockchain technology's unique architecture provides individuals greater control over their information and may help address some of the problems related to health data. A multidisciplinary team designed and tested a blockchain application, MediLinker, as a patient-centric identity management system. METHODS The study used simulated data of "avatars" representing different types of patients. Thirty study participants were enrolled to visit simulated clinics, and perform various activities using MediLinker. Evaluation was based on Bouras' criteria for patient-centric identity management and on the number of errors in entry and sharing of data by participants. RESULTS Twenty-nine of the 30 participants completed all study activities. MediLinker fulfilled all of Bouras' criteria except for one which was not testable. A majority of data errors were due to user error, such as wrong formatting and misspellings. Generally, the number of errors decreased with time. Due to COVID-19, sprint 2 was completed using "virtual" clinic visits. The number of user errors were less in virtual visits than in personal visits. DISCUSSION The evaluation of MediLinker provides some evidence of the potential of a patient-centric identity management system using blockchain technology. The results showed a working system where patients have greater control over their information and can also easily provide consent for use of their data. CONCLUSION Blockchain applications for identity management hold great promise for use in healthcare but further research is needed before real-world adoption.
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Affiliation(s)
- Anjum Khurshid
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Cole Holan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Cody Cowley
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Jeremiah Alexander
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Daniel Toshio Harrell
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Muhammad Usman
- Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ishav Desai
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | | | - Eric Meyer
- School of Information, The University of Texas at Austin, Austin, Texas, USA
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12
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Standage H, Kelley K, Buxton H, Wetzel C, Brasel KJ, Hoops H. Revitalizing the Patient-Surgeon Relationship: Surgical Curriculum Including the Patient Perspective. J Surg Educ 2020; 77:e146-e153. [PMID: 32868227 DOI: 10.1016/j.jsurg.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/23/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE General Surgery residents have increasing obligations that limit time with patients. This affects the patient-physician relationship, decreases meaning in work and increases burnout. Patient-Centric Resident Conferences (PCRC)1 incorporate patients in resident didactics to promote meaning in work and improve resident confidence in counseling and consenting patients for surgery. DESIGN Prospective cohort study of General Surgery residents who participated in standard didactic conferences (control) and modified conferences (PCRC) between 2017 and 2019. Control conferences covered a relevant surgical topic. PCRC had shortened didactics and discussions with patients who had undergone the relevant index operation. Pre- and postconference surveys measured teaching effectiveness, confidence in counseling and consenting, and resident perception of how well the conference supported their decision to pursue surgery. Survey data was compared using chi-squared tests. Qualitative data analysis used ground theory methodology. SETTING This study was performed by the Department of Surgery at Oregon Health and Science University in Portland, Oregon. PARTICIPANTS All active General Surgery residents were asked to participate in conferences. RESULTS Eighty-one residents completed 136 surveys over 5 control conferences and 207 surveys over 7 PCRC. Residents reported increased confidence in counseling and consenting for surgery following control conferences (p < 0.0001) and PCRC (p < 0.0001). Residents' perception of effectiveness of teaching pathophysiology (p = 0.008) and operative steps (p = 0.013) was greater in control conferences whereas effectiveness of teaching surgical complications was greater in PCRC (p = 0.006). Resident responses indicated greater support for a surgical career following PCRC compared to control conferences (p = 0.013). Themes like "patient perspective," "impact on surgeon," and "psychological effects of surgery" were common in PCRC and rare in control conferences. CONCLUSIONS PCRC were associated with stronger motivations for a surgical career and included patient-centered themes, which can enhance meaning in work. These conferences complement but do not replace standard didactics.
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Affiliation(s)
- Hayley Standage
- Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - Katherine Kelley
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Heather Buxton
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Cate Wetzel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Heather Hoops
- Department of Surgery, Oregon Health and Science University, Portland, Oregon; Department of Surgery, University of Pittsburgh, UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania
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O'Sullivan J, McCarrick C, Tierney P, O'Connor DB, Collins J, Franklin R. Identification of Informed Consent in Patient Videos on Social Media: Prospective Study. JMIR Med Educ 2020; 6:e14081. [PMID: 33048058 PMCID: PMC7592068 DOI: 10.2196/14081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The American Medical Association Code of Medical Ethics states that any clinical image taken for public education forms part of the patient's records. Hence, a patient's informed consent is required to collect, share, and distribute their image. Patients must be informed of the intended use of the clinical image and the intended audience as part of the informed consent. OBJECTIVE This paper aimed to determine whether a random selection of instructional videos containing footage of central venous catheter insertion on real patients on YouTube (Google LLC) would mention the presence of informed consent to post the video on social media. METHODS We performed a prospective evaluation by 2 separate researchers of the first 125 videos on YouTube with the search term "central line insertion." After duplicates were deleted and exclusion criteria applied, 41 videos of patients undergoing central line insertion were searched for reference to patient consent. In the case of videos of indeterminate consent status, the posters were contacted privately through YouTube to clarify the status of consent to both film and disseminate the video on social media. A period of 2 months was provided to respond to initial contact. Furthermore, YouTube was contacted to clarify company policy. The primary outcome was to determine if videos on YouTube were amended to include details of consent at 2 months postcontact. The secondary outcome was a response to the initial email at 2 months. RESULTS The researchers compiled 143 videos. Of 41 videos that contained footage of patient procedures, 41 were of indeterminate consent status and 23 contained identifiable patient footage. From the 41 posters that were contacted, 3 responded to initial contact and none amended the video to document consent status. Response from YouTube is pending. CONCLUSIONS There are instructional videos for clinicians on social media that contain footage of patients undergoing medical procedures and do not have any verification of informed consent. While this study investigated a small sample of available videos, the problem appears ubiquitous and should be studied more extensively.
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Affiliation(s)
- Jane O'Sullivan
- Department of Anaesthesia, Letterkenny University Hospital, Donegal, Ireland
| | | | - Paul Tierney
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Donal B O'Connor
- Professorial Surgical Unit, Tallaght University Hospital & Trinity College Dublin, Dublin, Ireland
| | - Jack Collins
- Department of Anaesthesia, Letterkenny University Hospital, Donegal, Ireland
| | - Robert Franklin
- Department of Anaesthesia, Letterkenny University Hospital, Donegal, Ireland
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Abstract
BACKGROUND 'Off-label use' is the term used for the prescription and dispensing of a medicinal product for any indication, patient group, route of administration, dosage or treatment regimen other than that listed in the Summary of Product Characteristics. OBJECTIVE In this article the authors present a brief overview of current practices of off-label use in Europe and the applicable European law and jurisprudence. They then go on to present a set of guidelines for best practice in off-label use which underlines the need for guidance on prescription to be firmly rooted in the need to ensure patient safety above all other concerns. METHODS The article was written from desk research and expert engagement, including a presentation and Q&A in the European Parliament. RESULTS This article intends to demonstrate that off-label use entails increased risks for patients, especially when it is not underpinned by rigorous clinical studies or the reporting routes for use are not well defined. CONCLUSIONS Europe is seeing a growing trend the promotion of off-label prescription of medicinal products for reasons other than pure medical need, including motives such as cost-containment. This poses a numer of questions for the ethical and legal framework for medicine prescription and dispensing in Europe.
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Affiliation(s)
- Marc Dooms
- Senior Orphan Drug Pharmacist, University Hospital, Leuven, Belgium
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Curtin BM, Armstrong LC, Bucker BT, Odum SM, Jiranek WA. Patient Radiation Exposure During Fluoro-Assisted Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty 2016; 31:1218-21. [PMID: 26781389 DOI: 10.1016/j.arth.2015.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study sought to quantify the total patient radiation exposure during fluoro-assisted direct anterior approach (DAA) total hip arthroplasty (THA). We hypothesized that the patient radiation exposure would fall within acceptable published limits for a 1-time patient exposure. METHODS After institutional review board approval, we performed a retrospective chart review of consecutive unilateral primary DAA THAs at 2 institutions (N = 157) between 2012 and 2014 by a single fellowship-trained arthroplasty surgeon assisted by residents and fellows. Incomplete dose reporting information was the sole exclusion criterion. Patient electronic medical records were queried regarding exposure time (seconds), radiation emittance (mGy), and peak kilovoltage (kVp). Descriptive statistics were calculated. Pearson correlation coefficients were used to determine the correlation between variables. RESULTS Mean radiation dose for patient exposure measured 2.97 ± 1.63 mGy (range: 0.29-9.83). Positive but weak linear relationship with radiation dose and body mass index (BMI; r = 0.34; P < .0002). Average exposure time per procedure was 23.74 s (range: 11.3-61.7). Average kVp per procedure was 75.38 (range: 65-86). Average BMI was 28.32 (range: 16.6-39.8). There was a significantly strong correlation between kVp and BMI (r = 0.75; P < .0001). CONCLUSIONS Total patient radiation exposure was nearly identical with previously published values for a screening mammogram (3 mGy) and 4 times less than that of a standard chest computed tomography (13 mGy). Although it is difficult to ascertain the exact patient-absorbed radiation, our data suggest that a 1-time exposure during DAA THA is likely negligible and provides the surgeon with additional data for counseling patients preoperatively.
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Liew Y, Beveridge E, Demetriades AK, Hughes MA. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees. Br J Neurosurg 2015; 29:712-4. [PMID: 25822093 DOI: 10.3109/02688697.2015.1026799] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees.
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Affiliation(s)
- Yaoren Liew
- a University of Edinburgh Medical School , Edinburgh , Midlothian , UK
| | - Erin Beveridge
- b School of Life Sciences, University of Glasgow , Glasgow , UK
| | | | - Mark A Hughes
- c Department of Clinical Neurosciences , Western General Hospital , Edinburgh , UK
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Limer JL, Parkes AT, Waterworth A, Murphy CE, Tait CR, Witton CJ. 8th Nottingham International Breast Cancer Conference, Nottingham, UK, 16-19 September 2003. Breast Cancer Res 2004; 6:E1. [PMID: 14680487 PMCID: PMC314451 DOI: 10.1186/bcr735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The four-day biennial 8th Nottingham Breast Cancer Conference held at the East Midlands Conference Centre, University of Nottingham, UK (16-19 September 2003) once again proved to be a successful event. Recent advances in clinical and scientific research were presented to an international audience, covering a broad spectrum of breast cancer issues including prediction, diagnosis and treatment. Delegates were encouraged to participate in workshop sessions, which allowed the comprehensive discussion of existing and promising future advances in breast cancer care.
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Affiliation(s)
- Jane L Limer
- Molecular Medicine Unit, St James's University Hospital, Leeds, UK.
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