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  1 / 1973 MEDLINE  
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[PMID]:28658403
[Au] Autor:Delineau VMEB; Schultz RR
[Ad] Endereço:Universidade Federal de São Paulo, Escola Paulista de Medicina, Setor de Neurologia do Comportamento, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
[Ti] Título:Dementia and legal determination of capacity.
[So] Source:Arq Neuropsiquiatr;75(6):349-353, 2017 Jun.
[Is] ISSN:1678-4227
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Objective: To assess the legal capacity and guardianship proceedings in patients diagnosed with dementia. Methods: Ninety-seven patients diagnosed with dementia and seen at a tertiary hospital were evaluated. Results: Of these 97 patients, 60 (62%) were female. The mean age of the patients was 77.9 years; average schooling was 5.5 years. The main diagnosis was Alzheimer's disease (73%): 16 patients were at a mild stage, eight at a moderate stage and 73 at an advanced stage of dementia. Only 28 patients had been legally declared incapable. Conclusion: The large numbers of patients at an advanced stage of dementia, and the relatively few patients legally declared incapable show that legal issues in dementia are problematic.
[Mh] Termos MeSH primário: Demência
Tutores Legais/legislação & jurisprudência
Competência Mental/legislação & jurisprudência
Defesa do Paciente/legislação & jurisprudência
Autonomia Pessoal
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Escolaridade
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170726
[Lr] Data última revisão:
170726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE


  2 / 1973 MEDLINE  
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[PMID]:28366903
[Au] Autor:Wright MS; Ulrich MR; Fins JJ
[Ti] Título:Guardianship and Clinical Research Participation: The Case of Wards with Disorders of Consciousness.
[So] Source:Kennedy Inst Ethics J;27(1):43-70, 2017.
[Is] ISSN:1054-6863
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We review relevant federal law about research on human subjects and state laws on guardian authority to determine whether guardians can consent on behalf of their wards to participation in research. The Common Rule is silent on the issue as are most state guardianship laws. Our analysis shows significant variation in guardians' decision-making authority in the states that do regulate wards' participation in research.We consider how the appointment of guardians for patients with disorders of consciousness (DOC) impacts such patients' access to research. We assert that it is important that such persons be permitted to participate in research, so that their conditions and potential medical interventions can be studied, and that those with similar conditions can benefit from the knowledge gained from these studies. We argue that state guardianship laws should be adapted to specifically give guardians the authority to consent to research on behalf of wards who may be able to regain decisional capacity.
[Mh] Termos MeSH primário: Pesquisa Biomédica/ética
Pesquisa Biomédica/legislação & jurisprudência
Transtornos da Consciência
Tutores Legais
Experimentação Humana Terapêutica/ética
Experimentação Humana Terapêutica/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1353/ken.2017.0003


  3 / 1973 MEDLINE  
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[PMID]:28120031
[Au] Autor:Hack J; Buecking B; Lopez CL; Ruchholtz S; Kühne CA
[Ad] Endereço:Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043, Marburg, Deutschland.
[Ti] Título:[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].
[Ti] Título:Vorausverfügungen im klinischen Alltag : Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung..
[So] Source:Unfallchirurg;120(2):153-161, 2017 Feb.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
[Mh] Termos MeSH primário: Diretivas Antecipadas/legislação & jurisprudência
Tomada de Decisão Clínica
Tutores Legais/legislação & jurisprudência
Direito a Morrer/legislação & jurisprudência
Assistência Terminal/legislação & jurisprudência
Suspensão de Tratamento/legislação & jurisprudência
[Mh] Termos MeSH secundário: Regulamentação Governamental
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170126
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-016-0308-8


  4 / 1973 MEDLINE  
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[PMID]:28115542
[Au] Autor:Fanaroff JM; COMMITTEE ON MEDICAL LIABILITY AND RISK MANAGEMENT
[Ti] Título:Consent by Proxy for Nonurgent Pediatric Care.
[So] Source:Pediatrics;139(2), 2017 Feb.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Minor-aged patients are often brought to the pediatrician for nonurgent acute medical care, physical examinations, or health supervision visits by someone other than their legally authorized representative, which, in most situations, is a parent. These surrogates or proxies can be members of the child's extended family, such as a grandparent, adult sibling, or aunt/uncle; a noncustodial parent or stepparent in cases of divorce and remarriage; an adult who lives in the home but is not biologically or legally related to the child; or even a child care provider (eg, au pair, nanny, private-duty nurse/nurse's aide, group home supervisor). This report identifies common situations in which pediatricians may encounter "consent by proxy" for nonurgent medical care for minors, including physical examinations, and explains the potential for liability exposure associated with these circumstances. The report suggests practical steps that balance the need to minimize the physician's liability exposure with the patient's access to health care. Key issues to be considered when creating or updating office policies for obtaining and documenting consent by proxy are offered.
[Mh] Termos MeSH primário: Responsabilidade Legal
Pediatria/legislação & jurisprudência
Procurador/legislação & jurisprudência
Consentimento do Representante Legal/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adolescente
Criança
Custódia da Criança/legislação & jurisprudência
Confidencialidade/legislação & jurisprudência
Documentação
Acesso aos Serviços de Saúde/legislação & jurisprudência
Seres Humanos
Consentimento Livre e Esclarecido/legislação & jurisprudência
Tutores Legais/legislação & jurisprudência
Visita a Consultório Médico
Fatores de Risco
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170627
[Lr] Data última revisão:
170627
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170125
[St] Status:MEDLINE


  5 / 1973 MEDLINE  
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[PMID]:28079414
[Au] Autor:Griffith R
[Ti] Título:Ineligibility criteria and deprivation of liberty in relation to guardianship.
[So] Source:Br J Nurs;26(1):60-61, 2017 Jan 12.
[Is] ISSN:0966-0461
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses how the law surrounding deprivation of liberty safeguards relates to a person who is the subject of a guardianship order.
[Mh] Termos MeSH primário: Liberdade
[Mh] Termos MeSH secundário: Serviço Hospitalar de Admissão de Pacientes
Seres Humanos
Tutores Legais
Transtornos Mentais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170526
[Lr] Data última revisão:
170526
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170113
[St] Status:MEDLINE
[do] DOI:10.12968/bjon.2017.26.1.60


  6 / 1973 MEDLINE  
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[PMID]:27744538
[Au] Autor:Warren MB; Schak KM
[Ad] Endereço:Department of Psychiatry and Behavioral Sciences, Boise Veterans Administration Medical Center, University of Washington, 500 W Fort St, Boise, ID, 83702, USA. mark.warren@va.gov.
[Ti] Título:Disclosing Huntington's Genetic Testing Results in the Context of Intellectual Disability and Guardianship: Using the Family Illness Narrative to Guide the Flow of Information.
[So] Source:J Genet Couns;26(2):272-275, 2017 Apr.
[Is] ISSN:1573-3599
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A diagnosis of Huntington's disease has broad social, vocational, reproductive and psychological implications. The ability to accurately diagnose the illness via genetic testing is not new. However, given a persistent lack of robustly effective interventions, it remains an area of ethical concern. The difficulty is compounded in cases of intellectual disability. This paper presents a case of genetic testing for Huntington's disease conducted on a patient with intellectual disability with guardian consent, but without the patient's direct knowledge and how the family illness narrative and psychiatric care were employed in the eventual disclosure of the patient's diagnosis and subsequent management.
[Mh] Termos MeSH primário: Revelação
Aconselhamento Genético
Doença de Huntington/psicologia
Deficiência Intelectual/psicologia
Pacientes/psicologia
[Mh] Termos MeSH secundário: Adulto
Testes Genéticos
Seres Humanos
Doença de Huntington/complicações
Doença de Huntington/genética
Deficiência Intelectual/complicações
Tutores Legais
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171027
[Lr] Data última revisão:
171027
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161017
[St] Status:MEDLINE
[do] DOI:10.1007/s10897-016-0007-1


  7 / 1973 MEDLINE  
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[PMID]:27346290
[Au] Autor:Chamberlain K; Reid N; Warner J; Shelton D; Dawe S
[Ad] Endereço:School of Applied Psychology, Griffith University, Mt Gravatt, Queensland 4121, Australia.
[Ti] Título:A qualitative evaluation of caregivers' experiences, understanding and outcomes following diagnosis of FASD.
[So] Source:Res Dev Disabil;63:99-106, 2017 Apr.
[Is] ISSN:1873-3379
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The effects of prenatal exposure to alcohol are wide-ranging and pervasive in nature. In response to growing concerns about the lifelong disabilities related to prenatal alcohol exposure, a fetal alcohol spectrum disorder (FASD) diagnostic clinic was established in 2012. This was the first multi-disciplinary service operating permanently within an Australian health service. The current study aimed to explore the lived experience of the diagnostic process for caregivers of children with FASD. METHODS: Twelve caregivers were approached and ten participated in audiotaped interviews about caring for a child with FASD. Qualitative analysis was undertaken on transcribed interviews using NVivo 10 for thematic analysis. RESULTS: The major themes that emerged were: a desire for future support for their child although uncertainty about how this support could be accessed; an understanding of FASD prior to assessment but a concerted concern that this condition was not recognised as a disability across educational and related settings; that a formal assessment process provided validation for caregiver concerns and that caregivers felt respected and understood by the clinical team during this process. DISCUSSION: These findings highlight the concerns of caregivers, emphasising both the importance of diagnostic services and the need for provision of further support beyond diagnosis for a child with FASD. WHAT DOES THIS PAPER ADD?: This study provides information on the lived experiences of caregivers who attended the first multi-disciplinary FASD assessment and diagnostic service in Australia. This study provides valuable insight into the ongoing difficulties that families are experiencing following diagnosis in the current Australian context.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Cuidadores
Transtornos do Espectro Alcoólico Fetal/diagnóstico
Pais
Participação do Paciente
Satisfação do Paciente
[Mh] Termos MeSH secundário: Adoção
Idoso
Austrália
Criança
Feminino
Cuidados no Lar de Adoção
Seres Humanos
Tutores Legais
Masculino
Meia-Idade
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160628
[St] Status:MEDLINE


  8 / 1973 MEDLINE  
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[PMID]:26781243
[Au] Autor:Besse M; Methfessel I; Wiltfang J; Zilles D
[Ad] Endereço:Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland.
[Ti] Título:[Electroconvulsive therapy in nonconsenting patients].
[Ti] Título:Elektrokonvulsionstherapie gegen den natürlichen Patientenwillen..
[So] Source:Nervenarzt;88(1):46-52, 2017 Jan.
[Is] ISSN:1433-0407
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:BACKGROUND: Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law. OBJECTIVE: This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients. MATERIAL AND METHODS: Case report and literature review. RESULTS: The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful. CONCLUSION: The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.
[Mh] Termos MeSH primário: Eletroconvulsoterapia/legislação & jurisprudência
Eletroconvulsoterapia/métodos
Consentimento Livre e Esclarecido/legislação & jurisprudência
Tutores Legais/legislação & jurisprudência
Transtornos Psicóticos/terapia
Consentimento do Representante Legal/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adulto
Eletroconvulsoterapia/ética
Medicina Baseada em Evidências
Feminino
Alemanha
Seres Humanos
Consentimento Livre e Esclarecido/ética
Competência Mental
Transtornos Psicóticos/diagnóstico
Fatores de Risco
Consentimento do Representante Legal/ética
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160120
[St] Status:MEDLINE
[do] DOI:10.1007/s00115-015-0043-3


  9 / 1973 MEDLINE  
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[PMID]:27901201
[Au] Autor:Scarpelli BB; Berger SB; Punhagui MF; Oliveira CA; Ferelle A; Oltramari-Navarro PV
[Ad] Endereço:Universidade Estadual de Londrina, Department Oral Medicine and Children's Dentistry, Londrina, PR, Brazil.
[Ti] Título:Evaluation of a preventive educational program for malocclusions: 7-year study.
[So] Source:Braz Oral Res;30(1):e119, 2016 Nov 28.
[Is] ISSN:1807-3107
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Results: 506 of the 802 guardians/children referred to the PPM joined. As for the children, the most frequently assessed habits were: bottle (56.1%), bottle and pacifier (18.4%), finger (11.9%), bottle and finger (7.1%), pacifier (5.7%), pacifier and finger (0.6%), and bottle/pacifier/finger (0.2%). After parent participation in the meetings, 335 (66.2%) children abandoned their habits. There was a statistical difference between type of oral habit and time to abandonment (p = 0.0001). However, those with only one habit abandoned it more easily (72.6%) than those with two or more associated habits (48.1%) (p = 0.042). Presence or absence of breastfeeding and parents' level of education had no significant effect on habit abandonment. Conclusion: PPM was an important tool for spreading knowledge to guardians, greatly contributing to the abandonment of deleterious oral habits. Bottle sucking warrants special attention - mentioned by 81.8% of parents - either alone or associated with other habits. Thus, educational actions to implement the children's approach to oral health are fundamental to making behavioral changes and promoting education of healthy habits, thereby keeping malocclusions from developing.
[Mh] Termos MeSH primário: Assistência Odontológica para Crianças/métodos
Educação em Saúde Bucal/métodos
Má Oclusão/prevenção & controle
[Mh] Termos MeSH secundário: Pré-Escolar
Escolaridade
Feminino
Hábitos
Seres Humanos
Lactente
Tutores Legais
Masculino
Má Oclusão/etiologia
Chupetas/efeitos adversos
Pais
Avaliação de Programas e Projetos de Saúde
Reprodutibilidade dos Testes
Estudos Retrospectivos
Comportamento de Sucção
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170308
[Lr] Data última revisão:
170308
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:161201
[St] Status:MEDLINE


  10 / 1973 MEDLINE  
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[PMID]:27733009
[Au] Autor:Steinert T; Heinz A; Hohl-Radke F; Koller M; Müller J; Müller S; Zinkler M
[Ad] Endereço:Zentrum für Psychiatrie Südwürttemberg, Universität Ulm.
[Ti] Título:[What is a "Considerable Damage to One's Health" in the Sense of German Guardianship Law?]
[Ti] Título:Was ist ein "erheblicher gesundheitlicher Schaden" im Sinne des § 1906 BGB?.
[So] Source:Psychiatr Prax;43(7):395-399, 2016 Oct.
[Is] ISSN:1439-0876
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:The term of a "considerable damage to one's health" is central in German guardianship law with respect to judge's decisions on involuntary commitment and coercive treatment. A legal definition has not been provided, and up to now no explanations from the part of medicine have been available what a "considerable damage to one's health" is in the case of mental illness and how it can be determined. A consensus paper of the German Association of Psychiatry and Psychotherapy (DGPPN) explains four possible scenarios of manifestation of such kind of damage, corresponding to somatic illnesses: evidence of structural brain lesions (rare), subjective suffering (sufficient, but not necessary), impairment of functioning in important areas of life, and severe impairment of social participation (e. g. by dangerous behaviour against others). This view corresponds with the WHO's bio-psycho-social concept of health.
[Mh] Termos MeSH primário: Internação Compulsória de Doente Mental/legislação & jurisprudência
Tutores Legais/legislação & jurisprudência
Competência Mental/legislação & jurisprudência
Transtornos Mentais/diagnóstico
Transtornos Mentais/terapia
Programas Nacionais de Saúde/legislação & jurisprudência
Autonomia Pessoal
[Mh] Termos MeSH secundário: Atividades Cotidianas/classificação
Atividades Cotidianas/psicologia
Coerção
Comportamento Perigoso
Avaliação da Deficiência
Alemanha
Seres Humanos
Transtornos Mentais/psicologia
[Pt] Tipo de publicação:CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161013
[St] Status:MEDLINE



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