Search Results (8)

Background: Competence (within the legal and bioethical framework in Spain, the term ‘competence’ is used as equivalent to healthcare decision-making capacity) in the field of child and adolescent psychiatry is a complex and evolving issue. Legal frameworks vary by country and legal tradition. Most concerns relate to treatment decisions within mental health, but in fact there is a wide range of decisions with a relevant impact on patients’ lives and quality of life over the long term. Forensic science must adapt its current practice to the worldwide challenge presented by this evidence. Objectives: This article will present a current research project about competence (healthcare decision-making capacity) in a sample of adolescent and child population in Spain. The final objective will be to validate the Spanish version of the MacCAT semi-structured interview consenting to psychiatric admission in adolescents in a mixed sample. We also examine some of the influences that must be taken into account in this research. Methodology: This is an instrumental and methodological study utilizing a sequential mixed-methods design (qualitative content validation followed by a quantitative psychometric evaluation). A process of adaptation of the Spanish MacCAT to consent to psychiatric admission in the adolescent population. A pilot study will initially be conducted to evaluate question comprehension and duration. Subsequently, a cross-sectional study will be carried out to assess inter-rater reliability, internal consistency, and validity. Evaluation will include clinical and neuropsychological assessment in five departments at two University Hospitals. Expected results: We will establish new evidence about the evaluation of competence in adolescent psychiatry; to date, no studies have been identified assessing the capacity to consent to psychiatric admission among Spanish-speaking adolescents, nor the factors potentially related to such competence. To our knowledge, the relationship between competence and illness awareness in the adolescent population remains unexplored in the literature, and its analysis constitutes one of the novel contributions of the present study. In addition, we will adapt and validate a well-known evaluation scale to the specific environments of our medical and psychiatric health departments. Conclusions: Objective evaluation of competence for medical interventions and treatments is a challenge in clinical and forensic examination. New evidence is necessary to operationalize classical evaluations in standardized ways, adapted to different countries, legal systems and forensic traditions. Full article

Effective dentist-patient communication underpins care, empowering informed decisions, reducing anxiety, improving efficiency, and fostering trust through clear, accurate, cohesive exchanges. This narrative review used a structured Medline search of literature, employing key terms to select and synthesize relevant English-language publications on dentist-patient communication without strict inclusion criteria. Key strategies include active listening, empathetic dialogue, patient-centred approaches, and the use of plain language and visual aids to demystify complex information. Additionally, integrating technology for appointment reminders, virtual consultations, and feedback mechanisms can streamline interactions. Crucially, cultural competency and sensitivity to individual needs ensure inclusivity and personalized care. Building on these findings, the study outlines ten actionable pillars for effective communication: (1) Initial Consultation: Establish rapport and gather comprehensive medical/dental histories. (2) Treatment Explanation: Simplify diagnoses and options using layman’s terms. (3) Informed Consent: Transparently discuss risks/benefits and invite questions. (4) Patient Education: Clarify oral hygiene practices and post-treatment expectations. (5) Anxiety Management: Address fears through reassurance and tailored coping strategies. (6) Follow-Up Care: Maintain post-treatment engagement to resolve concerns. (7) Feedback Systems: Leverage patient insights for service improvement. (8) Cultural Sensitivity: Adapt communication to diverse backgrounds. (9) Non-Verbal Cues: Employ positive body language and active listening. (10) Technology Integration: Utilize digital tools for efficiency and accessibility. By prioritizing empathy, clarity, and adaptability, clinicians can transform dental visits from anxiety-inducing encounters into collaborative partnerships. This approach not only elevates patient satisfaction and adherence but also redefines the standard of care, aligning clinical practice with the evolving needs of modern dentistry. Full article

This article outlines and critiques the Australian jurisprudence that has addressed whether minors are able to lawfully consent to gender-affirming hormone treatment, with reference to the landmark decision of Gillick v West Norfolk and Wisbech Area Health Authority. Although the principle of Gillick competency is well recognised in law, the Australian legal developments that apply Gillick to decisions about the commencement of gender-affirming treatment, have taken the principle astray. The approach under Australian law has diverged down a path that does not align with the original reasoning in Gillick, nor its contemporary interpretation. I outline the reasoning in Gillick so that the foundational principles are considered before discussing how Gillick has been interpreted and applied in subsequent cases. I then provide an outline of the key legal developments in Australia relevant to minors and the commencement of hormone treatment for gender dysphoria. I undertake a critique of the Australian law in this field and conclude that there is a need for future judicial determination of how Gillick should be applied, not only in the cases relevant to gender dysphoria, but beyond, so that the position in respect of minors’ decision-making is clarified. This is vitally important because the current approach to this issue has potential implications beyond cases relevant to gender-affirming hormone treatment. Full article

Introduction: The COVID-19 pandemic as well as the rate of spread of this particular pathogen around the world have caused the number of patients requiring medical attention and intensive care to exceed the capacity of even the best organized health care systems. This resulted in the need to hire employees who had not previously worked in intensive care units. Experience and knowledge have become particularly important in the context of mutual trust in the ICU team. At the same time, it could affect the level of professional autonomy of nurses, understood as the freedom to perform work based on knowledge, skills and competence without the need to submit to other medical professions. The pandemic status has required that nurses are always involved in their work by participating in training. Faced with the dangers of COVID-19, there is no doubt that by the end of the pandemic, both nursing and healthcare will be better equipped to face future challenges. Methods: The study lasted from July to September 2021. The data collection procedure started with the consent of the heads of the institutions where the data was collected. The study was conducted using the Dempster Practice Behavior Scale (DPBS), which examines work autonomy. The survey using the proprietary questionnaire was conducted among 225 nurses working in eleven ICUs in five voivodeships in Poland. Results: The autonomy of nurses during the COVID-19 pandemic was assessed at a high level. Younger respondents rated autonomy as being higher. Almost half of the respondents assessed the level of professional independence as high, including 52% of nurses, and significantly less, including 34% of doctors. A group of 47% of respondents assessed that trust had decreased and 28% said that trust had improved slightly. Conclusions: Professional independence allows you to perform work independently on others, taking responsibility for decisions and actions. The COVID-19 pandemic, through the influx of new staff members into treatment teams, had an impact on both nursing autonomy and the level of trust in a team, as shown in this study. Full article

Australian trans youth seeking medical treatment for gender dysphoria can encounter significant legal barriers to healthcare. Legal requirements for obtaining valid consent to gender-affirming care, first established in 2004, mean that an application to the Family Court is required in many cases before treatment can be provided. The development of Australian law concerning consent for the medical treatment of trans youth has been slow, haphazard, and remains incomplete. The Family Court process has been found to be damaging to trans youth and their families. There is widespread agreement that the law needs reform, even more so since the 2020 decision in Re: Imogen. This article explores the implications of the decision in Re: Imogen for trans youth and their families and raises possible models for reform. It starts by providing the background to Re: Imogen and explaining the current legal position. It then explores why the law needs to be reformed, highlighting the inconsistent approach to competency in Australian law and the harm the current law does to trans youth. Building on critiques of the law in this area, it reviews various options for law reform and suggests an optimal model. Full article

This study was conducted to evaluate the competency to consent to the treatment of psychiatric outpatients and to confirm the role of empowerment and emotional variables in the relationship between competency to consent to treatment and psychological well-being. The study participants consisted of 191 psychiatric outpatients who voluntarily consented to the study among psychiatric outpatients. As a result of competency to consent to treatment evaluation, the score of the psychiatric outpatient’s consent to treatment was higher than the cut-off point for both the overall and sub-factors, confirming that they were overall good. In addition, the effect of the ability of application on psychological well-being among competency to consent to treatment was verified using PROCESS Macro, and the double mediation effect using empowerment and emotional variables was verified to provide an expanded understanding of this. As a result of the analysis, empowerment completely mediated the relation between the ability of application and psychological well-being, and the relation between the ability of application and psychological well-being was sequentially mediated by empowerment and emotion-related variables. Based on these findings, the implications and limitations of this study were discussed. Full article

Introduction: The emergence of drug resistance mutations (DRMs) has been a major threat for successful lifelong combination antiretroviral therapy (cART), especially for HIV-vertically infected children within the context of the prevention of mother-to-child transmission (PMTCT). This study aimed to evaluate DRMs amongst immune competent treatment-naïve children in Cameroon. Methods: A cross-sectional study was conducted between 2015 and 2016 amongst 55 proxy consented HIV-1 positive children, aged 9 months to 6 years. They were all immune competent, cART naïve and with unknown history of PMTCT. CD4 cell counts and genotypic drug resistance testing were performed using standard methods. Results: Levels of DRMs to protease (PR) inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs were 27.6%, 3.7% and 40.7%, respectively. Only minor DRMs were observed for PR. The observed mutations for NRTI were K65R, T215I and K219E (33.0% each) and for NNRTI: V106M, Y181C and Y188H (6.0% each). Only minor accessory mutations were found in the integrase (IN) region. Conclusion: Despite widely available cART we still observe naïve HIV children, especially from the rural communities. We observe that a proportion of study participants had HIV-1 drug resistance associated mutations (RAMs). Data generated could help strengthen the current PMTCT programmes within the country. There is a need to upscale approaches for drug resistance testing for children in Cameroon and many other resource-limited settings. Full article

Diarrhoea caused by Cryptosporidium is usually mild in immune competent individuals but severe in the young and those with underlying disease leading to compromised immunity. The conventional diagnosis of Cryptosporidium requires observation of the infective oocysts however, their tiny size yields indistinct results, thus limiting the effectiveness of the conventional diagnostic technique, modified Ziehl-Neelsen (ZN) differential staining. Consequent to the abovementioned limitation, ZN staining, sandwich antigen detection enzyme linked immunosorbent assay (sad-ELISA) and a direct polymerase chain reaction (PCR) assay techniques were evaluated for diagnostic efficacy. Stool samples were collected from 180 consenting adult patients attending outpatient and inpatient clinics at Victoria Hospital, Alice, Eastern Cape Province of South Africa. Subjects were stratified as; 35 HIV-positive and diarrhoeagenic, 125 HIV-negative diarrhoeagenic and 20 apparently healthy controls. Cryptosporidium incidence following diagnostic techniques were 13 (37.1%; ZN staining), 26 (74.3%; sad-ELISA) and 23 (65.7%; PCR), respectively, among HIV-positive diarrhoeagenic patients and 34 (27.2%; ZN staining), 96 (76.8%; sad-ELISA) and 89 (71.2%; PCR) among HIV-negative diarrhoeagenic patients. Sensitivity, specificity and predictive values of the diagnostic techniques’ efficiency were: sensitivity: 46.2% (HIV-positive) and 32.3% (HIV-negative) against the ZN technique and 96.9% against sad-ELISA and PCR, respectively, for both HIV-positive and -negative patients; specificity was 88.9% (HIV-positive) and 96.6% (HIV-negative) against the ZN technique. Lastly, the predictive values were 92.3% (HIV-positive) and 96.9% (HIV-negative), respectively, following ZN staining. The sad-ELISA technique proved more suitable for the determination of the presence of Cryptosporidium oocysts. The high incidence of Cryptosporidium in HIV-positive subjects as compared to the HIV-negative population accentuates the significance of cryptosporidiosis diagnosis in the treatment and management of HIV cases. Full article