Some new risks may also be Some new risks may also be introduced with the increased use of alternatives to the ozone-depleting substances ODSs.
Whilst individual procedures each have unique aspects to them, a sound working understanding of the common foundation of the issues involved in pre-operative care is critical to good patient outcomes.
Informed consent Informed consent is far more than the act of placing a signature on a form; that signature in itself is only meaningful if the patient has been through a reasonable process that has left them in a position to make an informed decision.
There has been much written around issues of informed consent, and the medico-legal climate has changed substantially in the past decade. It is important for any doctor to have an understanding of what is currently understood by informed consent.
Although the legal systems in Australia and New Zealand are very different with respect to medical negligence, the standards around what constitutes informed consent are very similar. Until relatively recently, the standard applied to deciding whether the patient was given adequate and appropriate information with which to make a decision was the so-called Bolam test, that is practitioners are not negligent if they act in accordance with practice accepted by a reasonable body of medical opinion.
Recent case law from both England and Australia and the standards embedded in the New Zealand's Health and Disability Commissions code of patient rights have seen a move away from the existing position. Although this area is complex, the general opinion is that a doctor has a duty to disclose to patients material risks.
It is important that this standard relates to what a person in the patient's position would do and not just any reasonable person. Important factors in considering the kinds of information to disclose to patients are: The nature of the potential risks: The nature of the proposed procedure: The patient's desire for information: The temperament and health of the patient: The general surrounding circumstances: What does this mean for a medical practitioner?
Firstly, you must have an understanding of the legal framework and standards. Secondly, you must be able to document how appropriate information was given to patients - always write it down. On this point, whilst information booklets can be a very useful addition to the process of informed consent they do not remove the need to undertake open discussions with the patient.
Doctors often see the process of obtaining informed consent as difficult and complex, and this view is leant support by changing standards. However, the principles are relatively clear and not only benefit patients but their doctors as well.
A fully informed patient is much more likely to adapt to the demands of a surgical intervention, and should a complication occur, they almost invariably accept such misfortune far more readily. Pre-operative assessment The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance.
Modern trends towards the increasing use of day-of-surgery admission even for major procedures have increased the need for careful and systematic peri-operative assessment. The goals of peri-operative assessment are: To identify important medical issues in order to optimise their treatment.
To identify important social issues which may have a bearing on the planned procedure and the recovery period. To familiarise the patient with the planned procedure and the hospital processes. Clearly the peri-operative evaluation should include a careful history and physical examination, together with structured questions related to the planned procedure.
Simple questions related to exercise tolerance such as can you climb a flight of stairs without shortness of breath will often yield as much useful information as complex tests of cardiorespiratory reserve. The clinical evaluation will be coupled with a number of blood and radiological tests to complete the clinical evaluation.
There is considerable debate as to the value of many of the routine tests performed, and each hospital will have its own protocol for such evaluations. Whilst there are a number of ways of looking at the type of surgery proposed, a simple three-way classification has much to commend it: Examples of such procedures would be groin hernia repair, cataract surgery, arthroscopy.
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Keyur Shah joined VCU Health Pauley Heart Center in and is the Chief of the Section of Heart Failure. He specializes in Advanced Heart Failure and Heart Transplantation. Tackling unwarranted variation in healthcare across the NHS Infectious diseases are covered for the first time with 5 indicators, including those on antimicrobial resistance and TB.
Critical. Bronchiolitis is an acute infectious disease of the lower respiratory tract that occurs primarily in the very young.
Recurrent Abdominal Pain in Children Recurrent abdominal pain is common in children. It is associated with trauma, systemic disease such as diabetes, drugs such as steroids, ocular disease, or heredity. Ageing is by far the most common cause; 95 per cent of people over 65 years of age have some degree of lens opacity (Gregory and Talamo, ), and in one US study 15 per cent of people aged years had a cataract that significantly reduced their vision (Newell, ).
A needs assessment survey of infectious diseases (ID) training program directors identified gaps in educational resources for training and evaluating ID fellows in antimicrobial stewardship. Antimicrobial resistance is a growing threat to public health [1, 2].
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