This document discusses the role of next-of-kin (NOK) in health decision making in Nigeria. It notes that NOK is commonly misunderstood to have decision-making authority, when in reality their role is merely as a point of contact. For incapacitated patients, authorized surrogates like those with power of attorney can make decisions following the patient's wishes. If no authorized surrogate exists, doctors typically rely on NOK, though they have no legal standing. The document emphasizes upholding patient autonomy based on the Nigerian constitution and calls for clearer legal frameworks on consent.
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In the presentation efforts have been made to guide the medical professionals how to deal with a MLC case in a step by step manner and certain issues relating to medical case records.
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Sometimes an individual will want to empower someone else to be able to act on his or her behalf in a legally binding manner. If you are in this situation, you would execute a legal device called a power of attorney. Learn more about power of attorney in Connecticut in this presentation.
Sometimes an individual will want to empower someone else to be able to act on his or her behalf in a legally binding manner. If you are in this situation, you would execute a legal device called a power of attorney. Learn more about power of attorney in Connecticut in this presentation.
Explains role of Next of kin in healthcare decision making in nigeria. Perspective of law and medical ethics.
This is what Nigerians must know to make choice of who to make their next of kin (NOK).
Autonomy, sanctity of life and relationship to end of life decisions are discussed
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
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disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
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pharmacotherapies for AUD.
Role of Next of kin in health decision making.pptx
1. Role of NOK on Health decision
making in Nigeria.
Muhammed Amin Badamosi
2. Outline
What is Nok?
The misconception
Role of Nok?
Inform Consent and Autonomy
Capacity to consent
Surrogate decision
Conclusion
3. What is NOK?
Next of kin
A person's closest living blood
relative
Despite the fact that people use ‘next
of kin’ a lot, the term ‘next of
kin’ is used in different context for
different purpose.
5. What then does nok connotes?
Next of Kin’ simply means someone who you would like
contacted in an emergency.
Being a ‘Next of Kin’ provides no legal standing whatsoever
despite widespread belief to the contrary;
6. What then is the role of NOK
Next-of-kin is merely the first contact point if anything
happens to you..
He is someone empowered to provide necessary information about
you where needed such as confirming your identity.
But
is he someone positioned to make medical decisions such as
providing consent for complex medical procedure, surgeries etc?
10. What is informed consent?
Its a 'voluntary, uncoerced decision made by a sufficiently
competent, autonomous person on the basis of adequate
information and deliberation to accept rather than to reject
some proposed course of action that will affect him or her.
11. Why is informed consent necessary?
It ensures the patient's autonomy and independence
Section 33 (1) of the Nigerian Constitution ("the
Constitution") provides that persons living in Nigeria, shall
have a right to life and no one shall be deprived
intentionally of his life unless in execution of the sentence
of a court of a criminal office of which he has been found
guilty.
12. Criteria to meet?
Consent is said to be informed when it proceeds voluntarily,
without fraud, duress, or misrepresentation, from a person
who has the capacity to understand and appreciate the nature
and consequences of the decision to be made as well as the
implications of making no decision.
13. Real life scenario
It is difficult to satisfy all the demands of an informed
consent in practice.
And it is a must according to the constitution
In Nigeria, the doctrine of informed consent has become
entrenched as a fundamental right under Section 37 and 38 of
the 1999 Constitution
14. Incapacitated conditions
mental health conditions –
dementia
severe learning disabilities
brain damage – for example, from
a stroke or other brain injuryphysical
or mental conditions that cause
confusion, drowsiness or a loss of
consciousness
intoxication
16. How will authorized surrogate decide?
have an obligation to follow the expressed wishes of the
patient and to act in the patient’s best interests, taking
into account the patient’s personal values, goals of care,
and wishes, to the extent known.
For power of attorney. You follow the patient written
instruction.(will)
17. What if No authorized surrogate or power of attorney?
18. What would be done…
health care practitioners usually rely on the next of kin or
even a close friend. Based on MDCN regulations.
have an obligation to follow the expressed wishes of the patient and to act in the patient’s best
interests, taking into account the patient’s personal values, goals of care, and wishes, to the
extent known. Without compromising his autonomy and right based on the constitution
If agreement on an ethically and legally sound resolution
cannot be reached, health care practitioners or their
institution may need to request court review.
19. What if No NOK?
The physicians, advisory
Council or the court of law
decides!
20. Conclusion
No specific Legal framework on consent by health act.
The legal backing are from the federal constitution and MDCN
regulations
Your autonomy is protected
You can control it if u choose an autorized surrogate or have
power of an attorney
If not you are in the hands of the court!
Well it doesn't work like this in nigeria unless Dr. Goes
extra miles for u.