This document provides an overview and recommendations for implementing NICE guidance on organ donation. It discusses identifying potential organ donors, obtaining consent, discussing donation with families, and the roles and skills of healthcare professionals. The guidance aims to improve identification of potential donors and fulfillment of donor wishes. It emphasizes patient-centered care, early identification of donors, and compassionate discussions with families to increase donation rates and access to transplants.
Advance care planning: "Let's get talking"MS Trust
This presentation by Dr Jo Poultney, Dr Sarah MacLaran, and Dr Julia Grant looks at advance care planning and how to support patients to express their preferences about care: what they do and don't want to happen and the people important to them.
It was presented at the MS Trust Annual Conference in November 2014.
The document discusses the services provided by Geriatric Care Manager Linda Recinos and her company Infinity Care Management, which offers in-home care, care coordination, medication management, and assistive technologies to help seniors live independently and safely in their own homes. Infinity Care Management utilizes assessments, care planning, care oversight, and communication with families to support the well-being, dignity, and independence of older adults. The company provides an array of services and products tailored to each client's individual needs and circumstances.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
This document outlines a presentation on state initiatives impacting physicians and patients related to controlled substances. It includes disclosures from presenters and planners, as well as learning objectives. The first presentation discusses Maryland's emergency preparedness plan for responding when a physician's license to prescribe controlled substances is suspended. The plan was developed after an incident where over 2,000 patients lost access to prescriptions. It involves coordinating state agencies, conducting surveys, developing response teams, and temporarily providing resources to mitigate public health impacts. Focus groups provided guidance on barriers, triaging patients, documenting for referrals, and estimating costs. The goal is to deploy temporary resources at the local level until normal care processes resume.
This document summarizes a presentation on health care consent and advance care planning given by Judith Wahl from the Advocacy Centre for the Elderly. The presentation is divided into two parts, with part one covering health care consent basics and part two focusing on advance care planning. It discusses key concepts like informed consent, substitute decision-makers, and the difference between advance care plans and health care consent. Questions from participants are addressed during the webinar.
Advance care planning: "Let's get talking"MS Trust
This presentation by Dr Jo Poultney, Dr Sarah MacLaran, and Dr Julia Grant looks at advance care planning and how to support patients to express their preferences about care: what they do and don't want to happen and the people important to them.
It was presented at the MS Trust Annual Conference in November 2014.
The document discusses the services provided by Geriatric Care Manager Linda Recinos and her company Infinity Care Management, which offers in-home care, care coordination, medication management, and assistive technologies to help seniors live independently and safely in their own homes. Infinity Care Management utilizes assessments, care planning, care oversight, and communication with families to support the well-being, dignity, and independence of older adults. The company provides an array of services and products tailored to each client's individual needs and circumstances.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
This document outlines a presentation on state initiatives impacting physicians and patients related to controlled substances. It includes disclosures from presenters and planners, as well as learning objectives. The first presentation discusses Maryland's emergency preparedness plan for responding when a physician's license to prescribe controlled substances is suspended. The plan was developed after an incident where over 2,000 patients lost access to prescriptions. It involves coordinating state agencies, conducting surveys, developing response teams, and temporarily providing resources to mitigate public health impacts. Focus groups provided guidance on barriers, triaging patients, documenting for referrals, and estimating costs. The goal is to deploy temporary resources at the local level until normal care processes resume.
This document summarizes a presentation on health care consent and advance care planning given by Judith Wahl from the Advocacy Centre for the Elderly. The presentation is divided into two parts, with part one covering health care consent basics and part two focusing on advance care planning. It discusses key concepts like informed consent, substitute decision-makers, and the difference between advance care plans and health care consent. Questions from participants are addressed during the webinar.
We provide ongoing care coordination, transitional care management and concierge placement services combined with specialized senior real estate services.
By helping families and maturing adults navigate the aging process our goal is to alleviate the anxiety associated with the aging process and our current fragmented healthcare system.
The document summarizes findings from regional consultations with seniors and caregivers about navigating Ontario's healthcare system. Key themes emerged around primary care being disorganized and unconnected; difficulty connecting services; variable communication; disregard for family members' roles; and lack of support for those without family. The document also describes a patient experience survey in Northumberland County that found transitions between care settings often lacked coordination, communication, and inclusion of patients and caregivers in decision-making. Overall, the information suggests opportunities to improve navigation, coordination, communication and inclusion across healthcare settings from the perspectives of patients and caregivers.
This document discusses surrogate decision making and advance directives. It defines key terms like guardians, agents, and surrogates. It outlines the history of advance directives and surrogate statutes. It also discusses Vermont's approach, which focuses on a patient's core values and involves physicians. Research has shown that surrogates often fail to accurately predict patient preferences, and prior discussions don't necessarily improve accuracy. Notable cases like Nancy Cruzan, Karen Ann Quinlan, and Terry Schiavo helped shape policies around patient autonomy and state statutes regarding surrogate decision making.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
"This is how i want to die" DPT Study Day 16th September 2011Hospiscare
The document discusses advance care planning (ACP) and its importance in end-of-life care. It defines ACP as a voluntary process where patients discuss future medical treatment preferences with healthcare providers. Key points include:
- ACP allows patients to communicate their values and wishes should they become unable to make decisions later.
- Triggers for initiating ACP include prognosis from chronic illness or a "gut feeling" from clinicians. Sensitive conversations are important.
- Documents like Preferred Priorities of Care and Advance Decisions to Refuse Treatment can record a patient's wishes if properly completed.
- Valid advance decisions must be specific, signed/witnessed, and state they apply even if life is at
PELATIHAN PERAWATAN PALIATIF PADA STROKE - 16 maret 2020papahku123
This document discusses palliative care and end-of-life care for stroke patients. It outlines the seven principles of palliative care programs which focus on informed patient and family involvement, support for caregivers, a palliative approach to care, access to specialist palliative care, coordinated and integrated treatment, quality care from skilled staff, and community support. It also discusses assessing patient needs, managing symptoms, communication with patients and families, and the goals of palliative care for stroke which are to manage symptoms, provide counseling and support, and improve quality of life.
Risk Management for Mental Health CliniciansJohn Gavazzi
1. The document outlines an agenda for a training on risk management for mental health clinicians, covering topics like managing risk, standards of practice, licensing boards, documentation, competence, and patient consent.
2. Key points that will be discussed include building risk management into paperwork, managing slippery slopes, responding to complaints, documentation rules of thumb, using proper diagnoses, self-monitoring competence, and obtaining informed consent.
3. The goal is to provide clinicians with the nuts and bolts of legal and ethical practice to help minimize risks through proper procedures, documentation, and patient education.
Patient- and Family Centered Care: "Resident Performance from the Patient's V...hanscomhh5
This document summarizes a presentation about patient and family centered care (PFCC) in graduate medical education. It discusses the history and core values of PFCC, provides examples of how PFCC has been successfully implemented at institutions like the Medical College of Georgia, and shares results from a study that assessed resident performance through patient feedback surveys. The study found patient feedback improved residents' communication, patient care, and systems-based practice skills compared to traditional attending evaluations alone. The presentation concludes PFCC can enhance graduate medical education by providing meaningful feedback to help residents improve.
The document discusses guidelines for patients leaving the hospital against medical advice (AMA). It defines key terms like leave against medical advice (LAMA) and against medical advice (AMA). It outlines steps providers should take to determine a patient's capacity to leave AMA and ensure they understand the risks. Providers are advised to document the discussion of treatment options, risks of leaving AMA, and patient's informed refusal. Special circumstances like suspicious situations or those lacking capacity require additional measures.
This document summarizes a transitional care workgroup meeting held on July 12, 2013. The meeting included introductions and presentations on transitional care evidence and measuring patient-centered outcomes. Participants discussed a vignette about a patient being discharged from the hospital to identify questions patients would have about participating in a new transitional care program. The group's objectives were to understand transitional care broadly and narrow the topic by prioritizing important questions from multiple stakeholder perspectives. Breakout sessions allowed for submitted questions and discussion of proposed research topics. The meeting concluded with recapping next steps and welcoming further input.
•Don’t make firm predictions
•Do what predictions you do for yourself
•Don’t communicate unless asked
•Don’t be specific
•Don’t be extreme
•Be compassionate and optimistic
Legal, Clinical, Risk Management and Ethical Issues in Mental HealthJohn Gavazzi
This document provides an agenda and materials for an ethics training presentation. The presentation aims to help participants differentiate between clinical, legal, and risk management issues, define common risk management strategies, and explain how competing ethical principles can create dilemmas. It includes slides on key ethical principles, codes, risk management strategies, documentation, informed consent, and working with clinical dilemmas. Case examples will also be discussed and analyzed from an ethical perspective. The goal is for participants to learn how to make ethical clinical decisions that balance patient welfare, competence, and legal/risk management concerns.
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
This document provides guidance on ethics related to assessing and managing suicide risk in mental health patients. It outlines the professional responsibility to properly evaluate suicide risk through comprehensive assessment of current and historical factors. Relying solely on patient reports is insufficient. Admission is generally or may be needed depending on risk level and other criteria. The document also reviews specific information needed when reporting child abuse or neglect to authorities, such as description of injuries or neglectful supervision circumstances. Priorities for child protective investigations are also outlined.
How to Avoid Being a Target in the Mental Health Outpatient WorldPYA, P.C.
PYA Consulting Manager Lori Baker recently presented "How to Avoid Being a Target in the Mental Health Outpatient World" at the Florida Council for Community Mental Health 2017 Behavioral Health Conference. The presentation covered: -General discussion related to Intensive Outpatient Programs (IOPs)
-Documentation requirements and admission criteria for accurate orders to IOPs
-How to appropriately document the need for ongoing IOP services
-Defining the appropriate language to support that a group environment benefits the patient
-Additional best practices for IOP services
-How to evaluate when payers may consider services a “social” service/environment as opposed to a therapeutic environment
-Telehealth in the IOP world and the compliance implications associated with this service
Supporting Medical Necessity in the Inpatient SettingPYA, P.C.
PYA Consulting Manager Lori Baker facilitated a workshop, “Supporting Medical Necessity in the Inpatient Setting,” at the Florida Council for Community Mental Health 2017 Behavioral Health Conference.
The workshop explored:
Common problems with behavioral health regulatory compliance, including documentation, billing and coding, treatment plans, and medical necessity.
Questions providers should ask to determine appropriate patient settings, as well as third-party payer reimbursement.
The importance of physicians incorporating ancillary staff notes and findings within their records.
Key words that third-party payers look for to support patient stability and need for discharge.
Recommendations for ongoing utilization review plans and payer communication.
Ways to define and document what is potentially harmful to an individual or others.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Polestar Oncology is the all-in-one product to assess and connect cancer patients to the psychosocial support they need, while exceeding new accreditation requirements set forth by the Commission on Cancer. With Polestar Oncology, the multidisciplinary cancer care team can efficiently navigate patients’ psychosocial needs in the context of their medical progress.
We provide ongoing care coordination, transitional care management and concierge placement services combined with specialized senior real estate services.
By helping families and maturing adults navigate the aging process our goal is to alleviate the anxiety associated with the aging process and our current fragmented healthcare system.
The document summarizes findings from regional consultations with seniors and caregivers about navigating Ontario's healthcare system. Key themes emerged around primary care being disorganized and unconnected; difficulty connecting services; variable communication; disregard for family members' roles; and lack of support for those without family. The document also describes a patient experience survey in Northumberland County that found transitions between care settings often lacked coordination, communication, and inclusion of patients and caregivers in decision-making. Overall, the information suggests opportunities to improve navigation, coordination, communication and inclusion across healthcare settings from the perspectives of patients and caregivers.
This document discusses surrogate decision making and advance directives. It defines key terms like guardians, agents, and surrogates. It outlines the history of advance directives and surrogate statutes. It also discusses Vermont's approach, which focuses on a patient's core values and involves physicians. Research has shown that surrogates often fail to accurately predict patient preferences, and prior discussions don't necessarily improve accuracy. Notable cases like Nancy Cruzan, Karen Ann Quinlan, and Terry Schiavo helped shape policies around patient autonomy and state statutes regarding surrogate decision making.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
"This is how i want to die" DPT Study Day 16th September 2011Hospiscare
The document discusses advance care planning (ACP) and its importance in end-of-life care. It defines ACP as a voluntary process where patients discuss future medical treatment preferences with healthcare providers. Key points include:
- ACP allows patients to communicate their values and wishes should they become unable to make decisions later.
- Triggers for initiating ACP include prognosis from chronic illness or a "gut feeling" from clinicians. Sensitive conversations are important.
- Documents like Preferred Priorities of Care and Advance Decisions to Refuse Treatment can record a patient's wishes if properly completed.
- Valid advance decisions must be specific, signed/witnessed, and state they apply even if life is at
PELATIHAN PERAWATAN PALIATIF PADA STROKE - 16 maret 2020papahku123
This document discusses palliative care and end-of-life care for stroke patients. It outlines the seven principles of palliative care programs which focus on informed patient and family involvement, support for caregivers, a palliative approach to care, access to specialist palliative care, coordinated and integrated treatment, quality care from skilled staff, and community support. It also discusses assessing patient needs, managing symptoms, communication with patients and families, and the goals of palliative care for stroke which are to manage symptoms, provide counseling and support, and improve quality of life.
Risk Management for Mental Health CliniciansJohn Gavazzi
1. The document outlines an agenda for a training on risk management for mental health clinicians, covering topics like managing risk, standards of practice, licensing boards, documentation, competence, and patient consent.
2. Key points that will be discussed include building risk management into paperwork, managing slippery slopes, responding to complaints, documentation rules of thumb, using proper diagnoses, self-monitoring competence, and obtaining informed consent.
3. The goal is to provide clinicians with the nuts and bolts of legal and ethical practice to help minimize risks through proper procedures, documentation, and patient education.
Patient- and Family Centered Care: "Resident Performance from the Patient's V...hanscomhh5
This document summarizes a presentation about patient and family centered care (PFCC) in graduate medical education. It discusses the history and core values of PFCC, provides examples of how PFCC has been successfully implemented at institutions like the Medical College of Georgia, and shares results from a study that assessed resident performance through patient feedback surveys. The study found patient feedback improved residents' communication, patient care, and systems-based practice skills compared to traditional attending evaluations alone. The presentation concludes PFCC can enhance graduate medical education by providing meaningful feedback to help residents improve.
The document discusses guidelines for patients leaving the hospital against medical advice (AMA). It defines key terms like leave against medical advice (LAMA) and against medical advice (AMA). It outlines steps providers should take to determine a patient's capacity to leave AMA and ensure they understand the risks. Providers are advised to document the discussion of treatment options, risks of leaving AMA, and patient's informed refusal. Special circumstances like suspicious situations or those lacking capacity require additional measures.
This document summarizes a transitional care workgroup meeting held on July 12, 2013. The meeting included introductions and presentations on transitional care evidence and measuring patient-centered outcomes. Participants discussed a vignette about a patient being discharged from the hospital to identify questions patients would have about participating in a new transitional care program. The group's objectives were to understand transitional care broadly and narrow the topic by prioritizing important questions from multiple stakeholder perspectives. Breakout sessions allowed for submitted questions and discussion of proposed research topics. The meeting concluded with recapping next steps and welcoming further input.
•Don’t make firm predictions
•Do what predictions you do for yourself
•Don’t communicate unless asked
•Don’t be specific
•Don’t be extreme
•Be compassionate and optimistic
Legal, Clinical, Risk Management and Ethical Issues in Mental HealthJohn Gavazzi
This document provides an agenda and materials for an ethics training presentation. The presentation aims to help participants differentiate between clinical, legal, and risk management issues, define common risk management strategies, and explain how competing ethical principles can create dilemmas. It includes slides on key ethical principles, codes, risk management strategies, documentation, informed consent, and working with clinical dilemmas. Case examples will also be discussed and analyzed from an ethical perspective. The goal is for participants to learn how to make ethical clinical decisions that balance patient welfare, competence, and legal/risk management concerns.
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
This document provides guidance on ethics related to assessing and managing suicide risk in mental health patients. It outlines the professional responsibility to properly evaluate suicide risk through comprehensive assessment of current and historical factors. Relying solely on patient reports is insufficient. Admission is generally or may be needed depending on risk level and other criteria. The document also reviews specific information needed when reporting child abuse or neglect to authorities, such as description of injuries or neglectful supervision circumstances. Priorities for child protective investigations are also outlined.
How to Avoid Being a Target in the Mental Health Outpatient WorldPYA, P.C.
PYA Consulting Manager Lori Baker recently presented "How to Avoid Being a Target in the Mental Health Outpatient World" at the Florida Council for Community Mental Health 2017 Behavioral Health Conference. The presentation covered: -General discussion related to Intensive Outpatient Programs (IOPs)
-Documentation requirements and admission criteria for accurate orders to IOPs
-How to appropriately document the need for ongoing IOP services
-Defining the appropriate language to support that a group environment benefits the patient
-Additional best practices for IOP services
-How to evaluate when payers may consider services a “social” service/environment as opposed to a therapeutic environment
-Telehealth in the IOP world and the compliance implications associated with this service
Supporting Medical Necessity in the Inpatient SettingPYA, P.C.
PYA Consulting Manager Lori Baker facilitated a workshop, “Supporting Medical Necessity in the Inpatient Setting,” at the Florida Council for Community Mental Health 2017 Behavioral Health Conference.
The workshop explored:
Common problems with behavioral health regulatory compliance, including documentation, billing and coding, treatment plans, and medical necessity.
Questions providers should ask to determine appropriate patient settings, as well as third-party payer reimbursement.
The importance of physicians incorporating ancillary staff notes and findings within their records.
Key words that third-party payers look for to support patient stability and need for discharge.
Recommendations for ongoing utilization review plans and payer communication.
Ways to define and document what is potentially harmful to an individual or others.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Polestar Oncology is the all-in-one product to assess and connect cancer patients to the psychosocial support they need, while exceeding new accreditation requirements set forth by the Commission on Cancer. With Polestar Oncology, the multidisciplinary cancer care team can efficiently navigate patients’ psychosocial needs in the context of their medical progress.
The document discusses advance care planning (ACP), which involves discussing future medical care preferences with health providers. Key points include:
- ACP is a voluntary process that considers a person's values and wishes for end-of-life care if they become unable to communicate themselves.
- Discussing future care preferences can align treatment with a person's goals and values and may reduce family stress after death.
- Valid advance decisions to refuse treatment must be in writing, signed, and witnessed to be legally binding if a person loses capacity.
The document discusses informed consent and its importance. It defines informed consent as communication between a patient and physician that results in the patient authorizing agreement to a medical intervention. Informed consent is required by law, ethics, and regulations. It helps ensure patient safety, satisfaction, and reduces litigation risks. The clinician is responsible for obtaining informed consent, but a team approach is needed. Informed consent is required for invasive or complex procedures and includes discussing diagnosis, treatment options, risks and benefits, and alternatives. Consent can be provided by a competent patient or their healthcare representative. Improving informed consent involves simplifying language, allowing questions, and ensuring understanding.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Palliative Care Advance Care Planning A Collaborative ApproachSheldon Lewin
The document discusses the roles of various healthcare professionals in palliative care and advance care planning. It outlines 5 components of advance care planning including patient options, prognosis, pain management, patient/family treatment decisions, and spiritual needs assessment. It then describes the specific roles of social workers, nurses, chaplains, and case managers which include assessing psychosocial needs, providing education and support, facilitating advance care planning discussions, and coordinating referrals to home health or hospice.
The patient-provider relationship has changed. Welcome to the new era.Aida Sarkissian
The doctor is no longer the "captain of the ship" rather he/she plays the role of the "expert advisor" and "navigator?". The traditional role of a doctor dominating the relationship with the patient is outdated. In this presentation we will explore the provider-patient relationship that has shifted from medical paternalism to the empowered patient. We will discover the dynamics and the challenging nature of an engaged, empowered, more health literate yet impatient patient that demands an equal partner role in the decision-making process. How can a health practitioner meet the rising expectations of a patient that seeks immediate gratification, transparency and a hustle-free, personalised experience? How can a provider successfully meet the patient’s will to get added value, as he/she is used to receive by other sectors such as technology, retail and banking?
Clinical Ethics Committees - Some Local Health Districts and Specialty Networks within NSW Health have established local clinical ethics committees. These committees variously provide education, local policy advice regarding ethical issues arising in their facilities and ethics case consultation.
This document discusses several core ethics principles: autonomy, beneficence, nonmaleficence, justice, informed consent, confidentiality, and others. It provides definitions and examples for each principle. Several case studies involving ethical dilemmas in healthcare are also presented, including conflicts between patient/family wishes and physician recommendations for treatment. The document advocates using an ethical decision-making process and calling an ethics consultation to help resolve complex cases.
Consent involves obtaining free and voluntary approval from a patient for medical treatment or procedures, with key requirements being that the patient understands what they are consenting to and the potential consequences. There are different types of consent including implied, expressed, and informed consent, with informed consent being the standard that requires fully explaining treatment options and risks to ensure the patient can make an informed decision. Determining a patient's decision-making capacity is also important for valid consent.
The document summarizes key ethical issues in geriatric care including principles of autonomy, beneficence, and nonmaleficence. It discusses approaches to analyzing ethical dilemmas, including the four-box method and CASES framework. It also covers topics like moral distress, assessing decision-making capacity, and confidentiality/mandatory reporting laws. Specifically, it provides a case example of an elderly patient refusing discharge to a nursing home and walks through applying the CASES approach to determine the ethically appropriate discharge plan.
This document discusses ethics and ethical principles in nursing. It begins by defining key concepts like morals, values, beliefs, ethics and ethical principles. It then outlines five learning objectives related to differentiating between these concepts, defining ethics, discussing ethical principles in clinical contexts, identifying nursing codes of ethics, and applying ethics concepts to clinical situations. The document proceeds to define values, beliefs, and how personal and professional values develop. It also outlines several professional nursing values and defines morals, ethics, and ethical principles like autonomy, nonmaleficence, beneficence, justice, fidelity, confidentiality, veracity and accountability. The document concludes by discussing ethical dilemmas, codes of nursing ethics, and approaches to resolving ethical issues
This document discusses the ethico-moral responsibilities of nurses regarding euthanasia. It outlines two end-of-life options: medical aid in dying, where a terminally ill patient self-administers medication to hasten death; and euthanasia, where someone else administers medication to hasten a patient's death. While euthanasia violates nursing ethics, nurses must have end-of-life conversations with patients and be aware of their own values regarding medical aid in dying. The document recommends nurses remain objective, be knowledgeable on the issue, and respect patients' choices and confidentiality.
This document provides an overview of medical ethics, informed consent, and advance directives. It discusses key principles of medical ethics including autonomy, beneficence, non-maleficence, and justice. It defines informed consent and its legal and ethical basis, noting it is based on a patient's right to receive information and choose treatment. Exceptions to informed consent requirements are also outlined. Advance directives allow for healthcare decision making according to a patient's wishes if they become incapacitated. Case examples demonstrate how these principles apply to clinical scenarios.
Putting Patient First Cynthia Kilroy PH Alliance Dec 11 2014OptumPresentations
The document discusses strategies for managing healthcare populations in a consumer-centric way. It identifies four key factors: 1) segmenting the population based on clinical risk and healthcare costs to determine care models, 2) understanding individual motivations and behaviors, 3) intersecting population segments with attitudinal segments to identify key patient profiles, and 4) aligning care delivery models like health coaches, physicians and managers to different profiles based on their needs. The goal is improving outcomes while lowering costs through a personalized approach.
Este documento describe varias causas comunes de dolor de rodilla en niños, incluyendo osteocondritis de Sinding-Larsen y Osgood-Schlatter, dolor patelofemoral, y otros problemas. Explica cómo realizar un examen físico completo de la rodilla y cadera para diagnosticar la causa. También cubre opciones de tratamiento como hielo, descanso, ejercicios y ortesis. Pruebas de imagen como radiografías y resonancias magnéticas pueden ser útiles para diagnosticar condiciones específicas.
Protocolo para el diagnóstico precoz de la enfermedad celíacaCristobal Buñuel
Grupo de trabajo del Protocolo para el diagnóstico precoz de la enfermedad celíaca. Protocolo para el
diagnóstico precoz de la enfermedad celíaca. Ministerio de Sanidad, Servicios Sociales e Igualdad.
Servicio de Evaluación del Servicio Canario de la Salud (SESCS); 2018.
La Revista Pediatría de Atención Primaria 20 años despuésCristobal Buñuel
Este documento resume los 20 años de la Revista Pediatría de Atención Primaria, desde su creación en 1999 hasta 2018. Durante este tiempo se han publicado 76 números ordinarios y 26 suplementos, con la contribución de casi 3,000 autores. Aunque la Atención Primaria atraviesa un momento crítico, la revista continuará difundiendo conocimiento científico para mejorar la salud infantil. Se agradece a todos los que han hecho posible este logro a lo largo de dos décadas.
Este documento proporciona una guía sobre el manejo de la halitosis. Explica que la halitosis puede ser verdadera o imaginaria, y fisiológica o patológica. Detalla los pasos para realizar una anamnesis, exploración física y determinar el origen de la halitosis, ya sea intraoral o extraoral. Proporciona tablas con causas fisiológicas, intraorales y sistémicas de la halitosis patológica, así como su tratamiento. Recomienda derivar a odontólogo
Este documento describe varias causas comunes de dolor de rodilla en niños, incluyendo osteocondritis de Sinding-Larsen y Osgood-Schlatter, dolor patelofemoral, y otros problemas. Explica cómo realizar un examen físico completo de la rodilla y cadera para diagnosticar la causa. También cubre opciones de tratamiento como hielo, descanso, ejercicios y ortesis. Pruebas de imagen como radiografías y resonancias magnéticas pueden ser útiles para diagnosticar problemas específicos.
This document provides recommendations for the acute and preventative treatment of migraine. It recommends aspirin, ibuprofen, or paracetamol for acute treatment, with triptans as first-line. It recommends several options for preventative treatment including propranolol, topiramate, amitriptyne, candesartan, and flunarizine. It also provides guidance on addressing medication overuse headache and warnings about using certain treatments like sodium valproate during pregnancy due to risk of fetal malformations.
Este documento discute el uso de amoxicilina-ácido clavulánico para el tratamiento de infecciones. Explica que el ácido clavulánico inhibe las betalactamasas producidas por bacterias, restaurando la actividad de la amoxicilina. También describe las propiedades farmacocinéticas y farmacodinámicas de ambos compuestos, señalando que la relación óptima de tiempo sobre la concentración mínima inhibitoria es al menos del 40%. El documento concluye analizando aspectos microbiológic
AEPap: Guión de contenidos de la rotación del residente de Pediatría por Aten...Cristobal Buñuel
Este documento propone una guía para la rotación pediátrica en atención primaria (AP) de los residentes. Describe los objetivos de la rotación, que se centran en ampliar la formación del residente en atención al niño sano y patología de AP. También presenta una metodología docente basada en la práctica supervisada y el aprendizaje autónomo del residente, así como contenidos clínicos y bloques temáticos a abordar durante la rotación.
Este documento trata sobre el retraso psicomotor. Explica que es un retraso en el desarrollo donde las habilidades aparecen más lentamente de lo normal o de forma alterada. Detalla los signos de alerta como un retraso significativo en el desarrollo o la persistencia de patrones que deberían haber desaparecido. También cubre las pruebas de screening, la historia clínica, la exploración pediátrica y los exámenes complementarios necesarios para diagnosticar la causa del retraso y establecer un plan de
Decálogo de propuestas de mejora de la Pediatría de Atención PrimariaCristobal Buñuel
Este documento propone 10 medidas para mejorar la Pediatría de Atención Primaria. Estas incluyen: 1) aumentar el número de plazas MIR y mejorar las condiciones laborales de los pediatras, 2) asegurar que los estudiantes y residentes de medicina reciban formación en Pediatría de Atención Primaria, y 3) incrementar la visibilidad y representación de los pediatras de Atención Primaria en cargos organizativos y de enseñanza. El objetivo general es recuperar y hacer más atractiva la Pediatría
Este documento describe varias situaciones que pueden favorecer la aparición de la depresión en niños y adolescentes, como la depresión en los padres, conflictos familiares o escolares, enfermedades crónicas, estrés, pérdida de seres queridos y abuso. Explica los síntomas comunes de la depresión infantil y adolescente y recomienda que si un joven se identifica con los síntomas, hable con un adulto de confianza o un profesional de la salud. Finalmente, ofrece consejos para que los pad
Este documento presenta algoritmos para evaluar la cojera en pacientes pediátricos. Describe la anamnesis, exploración física y pruebas a considerar para realizar un diagnóstico diferencial que incluye infecciones, lesiones musculoesqueléticas, trastornos óseos y otras causas. Recomienda derivación al hospital en casos de sospecha de infección, fractura u otras patologías que requieran estudio y tratamiento especializado.
1. El documento presenta un algoritmo para evaluar niños con infecciones recurrentes. 2. Propone realizar una historia clínica y exploración física detalladas para clasificar al niño como normal, atópico, con enfermedad crónica subyacente o con sospecha de inmunodeficiencia. 3. Recomienda estudios complementarios de primer nivel como hemograma, bioquímica, serología y cultivos para orientar el diagnóstico.
La proteinuria se define como la presencia de proteínas en la orina. Puede ser fisiológica o no fisiológica. La cuantificación de la proteinuria se realiza mediante tiras reactivas de orina, recogida de orina de 24 horas o cálculo del cociente proteína/creatinina. La proteinuria puede ser glomerular, relacionada con enfermedades del glomerulo, o tubular, asociada a defectos de la reabsorción tubular. La proteinuria persistente requiere estudio completo para determinar su causa.
La tos es uno de los motivos de consulta más frecuentes para el pediatra de Atención Primaria. Se considera tos crónica cuando dura más de 4 semanas. Es fundamental realizar una buena anamnesis para identificar las características de la tos y factores desencadenantes. En la evaluación hay que considerar si el paciente pertenece a un grupo de riesgo de tuberculosis u otras enfermedades y explorar signos que orienten al diagnóstico. La mayoría de los casos son infecciones virales, pero también pueden deberse a causas espec
Este documento presenta un algoritmo para el tratamiento del sangrado menstrual abundante en la adolescencia. Define el sangrado menstrual excesivo y describe los pasos a seguir, que incluyen realizar una anamnesis, exploración física y pruebas complementarias para valorar la gravedad del caso y determinar el tratamiento apropiado, que puede ser no hormonal, hormonal no anticonceptivo o anticonceptivos combinados. El objetivo es regularizar los ciclos menstruales y reducir la cantidad de sangrado.
Algoritmo AEPap: evaluación posviaje del niño viajeroCristobal Buñuel
Este documento proporciona una guía para la evaluación posviaje de niños que han regresado de viajes internacionales. Detalla los pasos a seguir dependiendo de la duración del viaje, los síntomas presentados como diarrea, fiebre o problemas de piel, y las pruebas complementarias recomendadas. El objetivo es identificar enfermedades importadas que requieran atención urgente o que puedan suponer un riesgo para la salud pública.
La otitis media aguda es una infección común en niños menores de 2 años. Los síntomas incluyen dolor de oído, irritabilidad y fiebre. El diagnóstico se basa en la presencia de exudado en el oído medio y signos de inflamación. Generalmente se trata con analgésicos y el antibiótico amoxicilina. Solo se recomienda tratamiento antibiótico inmediato en niños menores de 6 meses, menores de 2 años con síntomas graves o recurrentes, o cuando no se pueda garantizar se
1) La neumonía adquirida en la comunidad es un diagnóstico clínico basado en la historia, exploración física y pruebas como la pulsioximetría; la radiografía de tórax solo se recomienda en algunos casos. 2) El tratamiento depende de la edad del paciente, la gravedad de los síntomas y la sospecha de agente causal, optándose por antibióticos empíricos vía oral o intravenosa. 3) Los criterios de ingreso hospitalario incluyen afectación grave, dific
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
16. Seeking consent: 2 If the patient's prior consent has not already been ascertained, and in the absence of a person or person having been appointed as nominated representative(s), consent for organ donation should be sought from those in a qualifying relationship with the patient Where a nominated representative has been appointed and the person had not already made a decision about donation prior to their death, then consent should be sought after death from the said nominated representative(s)
17. A ‘qualifying relationship’ A person in a qualifying relationship can give consent for organ donation on behalf of a patient Qualifying relationship (hierarchical order) spouse or partner (including civil or same sex partner) parent or child (in this context a child can be any age) brother or sister grandparent or grandchild niece or nephew stepfather or stepmother half-brother or half-sister friend of long standing
18.
19.
20. Discussions when death is anticipated How death is confirmed and what happens next Provide a clear explanation on : Circulatory death Neurological death What end-of-life care involves and where it will take place How death is diagnosed using neurological criteria What happens if death does not occur within a defined time period
26. What do you think? Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our tools. Please complete a short evaluation form by clicking here . If you are experiencing problems accessing or using this tool, please email [email_address] To open the links in this slide – right click over the link and choose ‘open hyperlink’. NB. Not part of presentation
Editor's Notes
ABOUT THIS PRESENTATION: This presentation has been written to help you raise awareness of the NICE clinical guideline on organ donation. This guideline has been written for healthcare professionals involved in the process of organ donation, including their interactions with potential donors and parents, family, carers or guardians. The guideline is available in a number of formats, including a NICE pathway (explained further in the next slide) and a quick reference guide. You may want to download a copy of the quick reference guide for your presentation so that you can refer to it. You can add your own organisation ’s logo alongside the NICE logo. We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as a rationale or an explanation of the evidence for a recommendation. Where necessary, the recommendation will be given in full. DISCLAIMER This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself. PROMOTING EQUALITY Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
NOTES FOR PRESENTERS: Key points to raise: In this presentation we will start by providing some background about the aims of the guideline and why it is important. We will then discuss patient-centred care and the evidence before presenting the recommendations. The NICE guideline contains 32 recommendations. The recommendations, including actions that need to be taken to implement the guideline in practice, cover 7 themes: being prepared - organisation of the identification, referral and consent processes the multidisciplinary team (MDT) identification capacity assessing the patient ’s best interests seeking consent discussions with those close to the patient. Next, we will summarise the costs and savings that are likely to be incurred in implementing the guideline. Then we will open the meeting up with a list of questions to help prompt a discussion on local issues for incorporating the guidance into practice. Finally, we will end the presentation with further information about the support provided by NICE. N.B The final slide is not part of the presentation, it asks for feedback on whether this implementation tool meets your needs and whether it helps you to put this NICE guidance into practice – your opinion is appreciated. Please complete a short evaluation form at www.surveymonkey.com/s/ TJZKV73 a link can be accessed from the final slide. Additional information: aspects of consent covered by this guideline are: Structures and processes for obtaining consent for deceased organ donation for transplantation, including the optimum timing for approaching families about consent. Coordination of the care pathway from identification of potential donors to consent (note that the consent process itself is not covered).
NOTES FOR PRESENTERS: Key points to raise: UK Transplant commissioned a survey in 2003 that showed a large majority of the public is supportive of organ donation in principle, with 90% of those who responded being in favour. Nearly 17 million people (28% of the population) are already on the NHS organ donor register. However, the actual donation rate in the UK remains poor. This may be partly because of bereaved relatives not consenting to organ donation. Donated organs are important for the management of organ failure, such as the single organ system of kidneys, small bowel, liver, pancreas, heart, or lung, and of combined organ failure of the heart and lung, the kidney and pancreas, the liver and kidney, or liver and small bowel. There is a shortage of organs for transplant. This results in long waits for transplantation and a significant number of deaths among those awaiting transplantation, and among those not considered for transplantation because of organ scarcity. Organ donation helps to address the burden of disease by improving the availability of organs for transplant. Additional information: Many reviews of organ donation have been done, but all failed to resolve the problems that result from the lack of a structured and systematic approach to donation. Transplants may be needed because of primary organ disease, such as chronic inflammatory disease of the kidneys or cardiomyopathy, or because of secondary effects of a disease – for example, people with diabetes needing kidney, islet cell and/or pancreas transplants, and people with cystic fibrosis needing lung transplants.
NOTES FOR PRESENTERS: Key points to raise: The aim of this guideline is to promote the identification and fulfilment of those who wish to donate organs by: effective and expedient identification and referral of potential organ donors an informed, considered and timely approach to consent for donation that is based primarily on identifying the wishes of the individual, whenever known and however recorded considering organ donation as a usual part of ‘end-of-life care’ planning. A significant proportion of people in England and Wales would wish to donate their organs after death for the purpose of transplantation. We will discuss identification later in this presentation. Effective structures and processes help to address current inequalities in approach, helping to make organ donation a usual part of NHS practice, meaning that families of all potential organ donors are approached and supported, irrespective of factors such as ethnicity and religion. Additional information: When identifying potential donors and obtaining consent for solid organ donation, this should be done in accordance with current legislation, professional body guidance and ethics. The General Medical Council guidance, ‘Treatment and care towards the end of life: good practice in decision making’ states that consultant staff who have clinical responsibility for patients who are potential donors have a duty to consider organ donation as part of end-of-life care. Recommendation in full: Organ donation should be considered as a usual part of ‘end of life care’ planning [1.1.1]
NOTES FOR PRESENTERS: Key points to raise: Treatment and care should take into account people ’s needs and preferences, wishes and beliefs. People at the end of life should have opportunity to make informed decisions about their care. Unless the person has expressed otherwise, parents, families and guardians should be involved in decisions about consent. Patients should make end-of-life care decisions in partnership with their healthcare professionals. If potential donors do not have the capacity to make decisions, healthcare professionals should follow the Department of Health ‘ s advice on consent (available from www.dh.gov.uk/en/DH_103643 ) and the code of practice that accompanies the Mental Capacity Act (available from www.dh.gov.uk/en/SocialCare/Deliveringsocialcare/MentalCapacity ). In Wales, healthcare professionals should follow advice on consent from the Welsh Assembly Government (available from www.wales.nhs.uk/consent). If the potential donor is under 16, healthcare professionals should follow the guidelines in, Seeking consent: working with children (available from www.dh.gov.uk/consent ). This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death. Additional information: Good communication between healthcare professionals and the people involved is essential. It should be supported by evidence-based written information tailored to the person ’s needs. The information people are given about their care should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Parents, families and guardians should also be given the information and support they need.
NOTES FOR PRESENTERS: Key points to raise: This NICE clinical guideline aims to improve consent rates by making recommendations, based on evidence where it is available, on the structures and processes of identifying potential donors and the approach for consent. Organ donation for transplantation is a complex area and one to which conventional clinical research methods cannot be easily applied. Consequently, much of the evidence included in this guideline is of a qualitative nature and does not lend itself to conventional use of GRADE assessment. A modified version of the GRADE assessment tool has been used to assess study limitations, indirectness and inconsistency. However, evidence that was graded low was still valuable in aiding the guideline development group discussions, decision making and shaping of the recommendations. Definition: GRADE (Grading of Recommendations, Assessment, Development and Evaluation) is a systematic and explicit approach to grading the quality of evidence and the strength of recommendations.
NOTES FOR PRESENTERS: Recommendations in full: Each hospital should have a policy and protocol that is consistent with these recommendations for identifying patients who are potential donors and managing the consent process. [1.1.27] Each hospital should identify a clinical team to ensure the development, implementation and regular review of their policies. [1.1.28] Adult and paediatric intensive care units should have a named lead consultant with responsibility for organ donation. [1.1.29] The multidisciplinary team involved in the identification, referral to specialist nurse for organ donation, and consent should have the specialist skills and competencies necessary to deliver the recommended process for organ donation outlined in this guideline. [1.1.30]
NOTES FOR PRESENTERS: Key points to raise: The skills and competencies required of the individual members of the team will depend on their role in the process. All healthcare professionals involved in identification, referral to specialist nurse for organ donation and consent process should: know about organ donation, including the basic principles and the relative benefits understand the use of neurological or cardiorespiratory criteria and how this relates to the organ donation process be able to explain neurological death clearly to families understand the use of clinical triggers to identify potential organ donors for referral understand the processes, polices and protocols relating to donor management adhere to relevant professional standards of practice relating to organ donation and end-of-life care. Recommendation 1.1.31 in full: The skills and competencies required of the individual members of the team will depend on their role in the process. However, all healthcare professionals involved in identification, referral to specialist nurse for organ donation, and consent processes should: have knowledge of the basic principles, and the relative benefits, of donation after circulatory death (DCD) versus donation after brainstem death (DBD) understand the principles of the diagnosis of death using neurological or cardiorespiratory criteria and how this relates to the organ donation process be able to explain neurological death clearly to families understand the use of clinical triggers to identify patients who may be potential organ donors understand the processes, policies and protocols relating to donor management adhere to relevant professional standards of practice regarding organ donation and end-of-life care. Related recommendation: The MDT involved in the initial approach should have the necessary skills and knowledge to provide to those close to the patient appropriate support and accurate information about organ donation. [1.1.14]
NOTES FOR PRESENTERS: Recommendation 1.1.32 in full: Consultant staff should have specific knowledge and skills in: the law surrounding organ donation and medical ethics as applied to organ donation the diagnosis and confirmation of death using neurological or cardiorespiratory criteria the greater potential for transplantation of organs retrieved from DBD donors compared with organs from DCD donors legally and ethically appropriate clinical techniques to secure physiological optimisation in patients who are potential organ donors communication skills and knowledge necessary to improve consent ratios for organ donation. Definition: The consent ratio is the ratio of the number of people for whom consent was sought to those who actually consented.
NOTES FOR PRESENTERS: Key points to raise: The MDT should be led throughout the process by an identifiable consultant Continuity of care should be provided where possible by those that have been directly involved in caring for the patient. Definition: Those close to the patient are family, friends, partners and anyone who knows the patient who can be, but is not necessarily, in a qualifying relationship (note: ‘qualifying relationship’ is discussed on slide 17). A specialist nurse for organ donation is a healthcare professional with specific expertise in the promotion and facilitation of the entire donation process, who works with all staff in critical care areas to support and maximise organ/tissue donation and provides support and information to families of potential donors. Recommendations in full: A multidisciplinary team (MDT) should be responsible for planning the approach and discussing organ donation with those close to the patient [1.1.11] The MDT should include: the medical and nursing staff involved in the care of the patient, led throughout the process by an identifiable consultant the specialist nurse for organ donation local faith representative(s) where relevant [1.1.12] Whenever possible, continuity of care should be provided by team members who have been directly involved in caring for the patient [1.1.13] Related recommendations: Every approach to those close to the patient should be planned with the MDT and at a time that suits the family ’s circumstances [1.1.18]
NOTES FOR PRESENTERS: Key points to raise: Identify patients through a systematic approach, while recognising that clinical situations vary. A proportion of the patients who are identified by these clinical triggers will survive. Use the stated clinical triggers for referral u nless there is a clear reason why these have not been met (for example because of sedation) and/or a decision has been made to perform brainstem death tests, whichever is the earlier. The healthcare team should initiate discussions about potential donation with the specialist nurse for organ donation when the criteria in recommendation 1.1.2 are met. Definitions: Clinical triggers are a set of clinical criteria used to indicate a high probability of death. These are used to define a standard point in care when the hospital is expected to initiate referral. Circulatory death is death diagnosed and confirmed following cardiorespiratory arrest. Recommendations in full: Identify all patients who are potentially suitable donors as early as possible, through a systematic approach. While recognising that clinical situations vary, identification should be based on either of the following criteria: defined clinical trigger factors in patients 1 who have had a catastrophic brain injury, namely: the absence of one or more cranial nerve reflexes and a Glasgow Coma Scale (GCS) score of 4 or less that is not explained by sedation unless there is a clear reason why the above clinical triggers are not met (for example, because of sedation) and/or a decision has been made to perform brainstem death tests, whichever is the earlier the intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death. [1.1.2] . 1 It is recognised that a proportion of the patients who are identified by these clinical triggers will survive. The healthcare team caring for the patient should initiate discussions about potential organ donation with the specialist nurse for organ donation at the time the criteria in recommendation 1.1.2 are met [1.1.3] .
NOTES FOR PRESENTERS: Key points to raise: The next two slides discuss assessing the best interests of a patient who lacks the capacity to make decisions. N.B If the potential donor is under 16, healthcare professionals should follow the guidelines in ‘Seeking consent: working with children’ (available from www.dh.gov.uk ). Recommendation [1.1.4] in full: shown on slide
NOTES FOR PRESENTERS: Key points to raise: If the patient lacks capacity to make decisions, determine whether taking steps to facilitate organ donation is in the patient ’s best interests. Stabilise the patient (for example, in an adult critical care unit or in discussion with a regional pediatric intensive care unit) while the assessment performed. Life-sustaining treatments should not be withdrawn or limited until the patient ’s wishes about organ donation have been explored and the clinical potential for the patient to donate has been assessed in accordance with legal and professional guidance. Additional information: N.B. Legal guidance available from www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108825 N.B Professional guidance available from www.ics.ac.uk/intensive_care_professional/standards_and_guidelines/dcd and http://www.gmc-uk.org/guidance/ethical_guidance/end_of_life_care.asp Recommendations in full: If a patient lacks capacity to make decisions about their end-of-life care, seek to establish whether taking steps, before death, to facilitate organ donation would be in the best interests of the patient. [1.1.5] While assessing the patient ’s best interests clinically stabilise the patient in an appropriate intensive care setting while the assessment for donation is performed - for example, an adult intensive care unit or in discussion with a regional paediatric intensive care unit (see recommendation 1.1.8). [1.1.6] Provided that delay is in the patient's overall best interests, life-sustaining treatments should not be withdrawn or limited until the patient ’s wishes around organ donation have been explored and the clinical potential for the patient to donate has been assessed in accordance with legal and professional guidance. [1.1.7]
NOTES FOR PRESENTERS: Key points to raise: Known wishes: in particular any advance statement or registration on the NHS organ donor register, but also any views expressed by the patient to those close to them. Beliefs that would be likely to influence the patient's decision if they had the capacity to make it. Views of others about what would be in the patient's best interests: anyone involved in the patient ’s care, as appropriate, or anyone named by the patient to be consulted about such decisions . Recommendation in full: In assessing a patient's best interests, consider: the patient's known wishes and feelings, in particular any advance statement or registration on the NHS organ donor register 1 but also any views expressed by the patient to those close to the patient the beliefs or values that would be likely to influence the patient's decision if they had the capacity to make it any other factors they would be likely to consider if they were able to do so the views of the patient's family, friends and anyone involved in their care as appropriate as to what would be in the patient's best interests, and anyone named by the patient to be consulted about such decisions. [1.1.8] 1 Available from www.uktransplant.org.uk and www.organdonation.nhs.uk
NOTES FOR PRESENTERS: Key points to raise: The organ donation register is available from www.uktransplant.org.uk or www.organdonation.nhs.uk Recommendation in full: If a patient lacks the capacity to consent to organ donation seek to establish the patient’s prior consent by: referring to an advance statement if available establishing whether the patient has registered and recorded their consent to donate on the NHS organ donor register 1 and exploring with those close to the patient whether the patient had expressed any views about organ donation. [1.1.9] 1 Available from www.uktransplant.org.uk or www.organdonation.nhs.uk
NOTES FOR PRESENTERS: Key points to raise: What constitutes a ‘qualifying relationship’ is discussed on the next slide. Recommendation [1.1.10] in full: shown on slide Definition: A nominated representative is a person appointed by the patient to represent the patient after their death in relation to consent for organ donation. The appointment may have been made orally or in writing.
NOTES FOR PRESENTERS: Key points to raise: A person in a qualifying relationship can give consent for organ donation on behalf of a patient if: a patient has not indicated their consent or refusal to postmortem, removal or storage of their organs consent should be obtained from the person ranked highest in the Human Tissue Authority hierarchy (as indicated on the slide) – Human Tissue Act (2004).
NOTES FOR PRESENTERS: Key points to raise: Allow time to consider the information they have been given, time for those close to the patient to understand the inevitability of the death or that death has occurred and to spend time with the patient. Discuss donation separately from treatment and death, unless those close to the patient initiate these discussions in the same conversation. ( Implementation advice - decide who should be present and which member of the team will lead the approach). Recommendations in full: Approach those close to the patient in a setting suitable for private and compassionate discussion. [1.1.17] In all cases those close to the patient should be approached in a professional, compassionate and caring manner and given sufficient time to consider the information. [1.1.19 ] Discussions about organ donation with those close to the patient should only take place when it has been clearly established that they understand that death is inevitable or has occurred. [1.1.20] When approaching those close to the patient: Discuss with them that donation is a usual part of end-of-life care. Use open-ended questions – for example, ‘how do you think your relative would feel about organ donation?’ Use positive ways to describe organ donation, especially when patients are on the NHS organ donation register or they have expressed a wish to donate during their life time - for example, ‘by becoming a donor your relative has a chance to save and transform the lives of many others’. Avoid the use of apologetic or negative language (for example, ‘I am asking you because it is policy’ or ‘ I am sorry to have to ask you’). [1.1.21] Allow sufficient time for those close to the patient to understand the inevitability of the death or anticipated death and to spend time with the patient. [1.1.23] Discuss withdrawal of life-sustaining treatment or neurological death before, and at a different time from, discussing organ donation unless those close to the patient initiate these discussions in the same conversation. [1.1.24]
NOTES FOR PRESENTERS: Key points to raise: NHS organ donor register at www.uktransplant.org.uk or www.organdonation.nhs.uk Advance statement - A set of instructions given in advance by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. It does not always have to be written down, although most are. Lasting Power of Attorney (LPA) – A Lasting Power of Attorney (LPA) is a legal document that enables a person who has capacity and is over 18 to choose another person or people (attorneys) to make decisions on their behalf. A health and welfare LPA is for decisions about both health and personal welfare, such as where to live, day-to-day care or having medical treatment. Recommendations in full: Before approaching those close to the patient: identify a patient ’s potential for donation in consultation with the specialist nurse for organ donation check the NHS organ donor register and any advance statements or Lasting Power of Attorney for health and welfare clarify coronial, legal and safeguarding issues. [1.1.15] Before approaching those close to the patient, try to seek information on all of the following: knowledge of the clinical history of the patient who is a potential donor identification of key family members assessment of whether family support is required – for example faith representative, family liaison officer, bereavement service, trained interpreter, advocate identification of other key family issues identification of cultural and religious issues that may have an impact on consent. [1.1.16]
NOTES FOR PRESENTERS: Recommendations in full: For discussions where circulatory death is anticipated, provide a clear explanation on: what end-of-life care involves and where it will take place – for example, theatre, critical care department how death is confirmed and what happens next what happens if death does not occur within a defined time period. [1.1.25] For discussions where neurological death is anticipated, provide a clear explanation on: how death is diagnosed using neurological criteria how this is confirmed and what happens next. [1.1.26] Definitions: Circulatory death is death diagnosed and confirmed following cardiorespiratory arrest. Brainstem death is death diagnosed after irreversible cessation of brainstem function and confirmed using neurological criteria. The diagnosis of death is made while the body of the person is attached to an artificial ventilator and the heart is still beating.
NOTES FOR PRESENTERS: Recommendation in full: The healthcare team providing care for the patient should provide those close to the patient who is a potential donor with the following, as appropriate: assurance that the primary focus is on the care and dignity of the patient (whether the donation occurs or not) explicit confirmation and reassurance that the standard of care received will be the same whether they consider giving consent for organ donation or not the rationale behind the decision to withdraw or withhold life-sustaining treatment and how the timing will be coordinated to support organ donation a clear explanation of and information on: the process of organ donation and retrieval, including post-retrieval arrangements what interventions may be required between consent and organ retrieval where and when organ retrieval is likely to occur how current legislation applies to their situation*, including the status of being on the NHS organ donor register or any advance statement how the requirements for coronial referral apply to their situation consent documentation reasons why organ donation may not take place, even if consent is granted [1.1.22] * Mental Capacity Act (2005) and Human Tissue Act (2004).
NOTES FOR PRESENTERS: Organ transplantations are commissioned by NHS Specialised Services and the ten specialised commissioning groups. The costing template produced to support the guideline details the national cost impact of implementing the guideline for England. NICE does not consider that any of the individual recommendations in the guideline are likely to have a significant impact on NHS resources on their own. However, implementing the recommendations in the guideline is expected to lead to an increase in the number of organ donors and a corresponding increase in the number of transplantation procedures carried out. Increasing the number of donors over current numbers by 10% in year 1, 20% in year 2 and 25% from year 3 onwards results in a cost impact in year 1 of around £2.5 million for England, a cumulative cost impact of £3.0 million in year 2, a cumulative cost impact of £0.4 million in year 3, a cumulative cost saving of £4.5 million in year 4, followed by increasing cumulative savings up to steady-state cumulative savings of around £18.2 million. The costs of all additional donor reimbursement payments and transplant procedures are incurred by the NHS for each cohort of patients only in year 1. It is assumed that increased maintenance therapy costs and savings from reduced haemodialysis (for kidney patients) are made each year up to year 6. Initial increases in costs to the NHS due to increased reimbursement payments to trusts and increased numbers of all transplantation procedures carried out are therefore outweighed by the recurrent savings from reduced haemodialysis costs for kidney patients from year 4 onwards.
NOTES FOR PRESENTERS: These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt these to suit your local situation. Additional questions regarding current practice Do we currently use clinical triggers? If not, how would we implement clinical triggers? Do we know how to contact the specialist nurse for organ donation and lead clinician? Do we have a donation committee and donation lead? What are the possible benefits of early (triggered) referral? - possible answers N.B .This is not covered in the scope of this guideline This question highlights the possible benefits of implementing the guideline recommendations. Identification of all potential ‘donation after brainstem death’ donors. Reduction in subsequent delays should donation go ahead. Early access to advice and expertise from specialist centres. Expedient assessment of likely donation potential. Prompt arrival of the specialist nurse for organ donation at the referring centre. Greater involvement of the specialist nurse for organ donation in the family approach and other aspects of donor care. Earlier organ retrieval.
NOTES FOR PRESENTERS: NICE pathways: guidance at your fingertips Our new online tool provides quick and easy access, topic by topic, to the range of guidance from NICE, including quality standards, technology appraisals, clinical and public health guidance and NICE implementation tools. Simple to navigate, NICE pathways allows you to explore in increasing detail NICE recommendations and advice, giving you confidence that you are up to date with everything we have recommended. The NICE pathway can be found at: http://pathways.nice.org.uk/pathways/organ-donation
NOTES FOR PRESENTERS: You can download the guidance documents from the NICE website. The full guideline – all the recommendations, details of how they were developed, and reviews of the evidence they were based on. NICE pathway - visually representing everything NICE has to say on organ donation. A quick reference guide – a summary of the recommendations for healthcare professionals. ‘ Understanding NICE guidance’ – information for patients and carers. NICE has developed tools to help organisations implement this guideline, which can be found on the NICE website: National costing report – gives the background to the national savings and costs associated with implementation National costing template – an amendable tool that details the cost impact of implementing the guideline for England Baseline assessment tool – an Excel spread sheet that organisations can use to help review current practice and plan activity needed to meet recommendations . Clinical triggers poster – to highlight the signs for identifying possible organ donors in critical and emergency care settings, such as Intensive care unit (ITU) and emergency departments. Clinical case scenarios – case studies that can be used as a basis for discussions on how the recommendations should be applied in practice.
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