Assessing patient willingness to reveal health history information

A survey was designed to determine how willingly patients reveal personal health information on dental health history forms. After giving informed consent, 107 patients at a university dental hygiene program completed a 10-item survey privately and anonymously. The results suggest that a significant number of patients provide inaccurate or incomplete information to questions routinely asked on the dental health history form.     

Approaches to informed consent

Informed consent (IC) is an indicator, or a pivotal point, in broader and more fundamental questions dealing with the way clinical experimentation and, more specifically, randomized controlled trials (RCTs) relate to routine clinical practice; the rules that characterize the doctor-patient relationship; the self-perception of medicine with respect to its capacity, duty, and autonomy in the production of new knowledge; and the role of medicine in society. The asymmetry of knowledge and power that characterizes the usual relationship between care providers and patients does not resolve when something experimental enters the relationship. The real world of clinical investigation is not uniformly distinct from clinical practice. Experimentation is more appropriately considered a continuum with respect to appropriate or recommended care. Fundamental patient rights come first and are more binding than compliance with procedures and regulations. The view that IC is the most important component of the "ethical" aspects of experimentation is highly misleading. The responsibility to foster well-informed decisions shapes the contents, the timing, the validity, and the credibility of IC. Documented, evaluable decisions are the natural substitute for individual IC when the patient is not able to handle information autonomously. Positive examples of IC practices and approaches suggest that IC may be important in improving the way medicine responds to its responsibilities and communicates with society.     

Diagnosis from thyroid aspirates. Is the cytopathologist handicapped if not fully informed about the patient?

OBJECTIVE: When fine needle aspiration cytology (FNA) of the thyroid is performed as a first-line test, the cytopathologist cannot be fully informed about the patient's data. The authors investigated whether this decreases the accuracy of FNA and results in consequences for the patient. STUDY DESIGN: FNA smears of 202 patients, 190 with benign and 12 with malignant thyroid disease, were reevaluated, supplying the cytopathologist first with only information from the case history known already at the initial admission, and subsequently with full data. RESULTS: The FNA diagnoses were corrected in 13 cases; in 8/13 they showed a more serious finding. The therapeutic modality was changed in only one case. No corrections were made in the ultimately malignant cases. CONCLUSION: In several cases the cytopathologist may be handicapped by receiving only partial information about the patient, but in our patients this had no demonstrable adverse consequences. Thus, FNA can be performed upon patient's admission.     

The psychotherapist and informed consent

The authors points out that psychotherapists are being increasingly required by law to function as instruments of social control. He believes it is incumbent on therapists to employ full and informed consent procedures with their patients in regard to the effects of providing psychiatric information to potential employers, insurance carriers, and other third parties.     

A guide to understanding informed consent

Anesthesia providers are expected to provide information to the patient during the preanesthesia interview that enables the patient to make informed choices. Adequate disclosure during the informed consent process ensures the equalization of the practitioner/patient relationship and the decision-making rights of the patient. Both certified registered nurse anesthetists (CRNAs) and anesthesiologists are not only legally required to provide information that will allow a patient to make an informed judgment about how to proceed with various anesthetic modalities but are also obligated by their standards of practice. This article informs the CRNA about the principles of informed consent so that they can better understand their role in the informed consent process.     

Whither informed consent to psychotherapy?

Suggests that, although T. A. Widiger and L. G. Rorer (see record 1984-29794-001) presented an excellent discussion of the ethical dilemmas that arise for responsible psychotherapists, they may have been overly critical of the informed consent process. It is argued that if the ethical guidelines for obtaining informed consent are left to individual therapists, the perception of the profession by consumers and by members of the legal profession (who are already wary of the field's ethical fortitude) will be negatively affected. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informatics support to medical diagnosis. General information obtained from a first structured contact with the patient

BACKGROUND: The methods and characteristics of clinical data gathered at the initial steps of development of a computerized system to aid medical diagnosis are reported. The objectives of the study were as follows: to describe the overall method and to set a framework for developing an intellectual model of the medical diagnosis procedure. MATERIAL AND METHODS: A structured medical interview and physical examination using an informatic program on PC compatible portable computers were completed in a sample 1,238 patients attending the outpatient clinics of our institution. Data obtained were compared with information in the patient's medical record taking as reference pattern the record of physicians in charge of the patients. Diagnosis were codified according to WHO International Classification of Diseases (ICD-9-CM). RESULTS: The distribution of symptoms and signs corresponding to the different organs and systems was analyzed. Each subdivision afforded a range of 1.3 to 3.9 abnormal findings per patient. A total of 3,571 diagnoses were codified for the whole group 1,238 patients with a mean (standard deviation) of 3 (2) diagnoses per patient (range 0-12). The distribution of diagnostic groups varied depending on the consideration of the main diagnosis or the concomitant diagnoses that defined the patient's clinical context. The most frequent main diagnoses included tumors, cardiovascular diseases, gastrointestinal disorders, and genitourinary tract diseases. CONCLUSIONS: As shown by results obtained in a sample of 1,238 patients, there is a very complex situation in clinical practice due to the simultaneous occurrence of several clinical patterns. This finding should be taken into account when developing clinical decision making support systems. The use of a structured medical interview or a structured and standard medical visit may be an adequate tool to clarify this matter and to contribute to standardization of clinical concepts and situations.     

Fibromyalgia: from information to questions

A previous study has shown that sandblasting and silane priming a post-cured inlay resin gave a secure bond to dual-cure luting resin. To determine the influence of salivary contamination 4 additional groups of 15 post-cured resin discs were mounted in acrylic cylinders, their faces sandblasted with 50 microns alumina and silane primed. Surface treatments with saliva (sa), air/water spray (a/w), phosphoric acid gel (pa), and silane (si) followed in the order listed: A) control, no further treatment; B) sa, a/w; C) sa, a/w, si; D) sa, a/w, pa a/w; E) sa, a/w, pa, a/w, si. A 3.9 mm diameter column of dual-cure resin lute was then bonded to the dry stored in water surfaces. Specimens were stored in water for 2 weeks after which the dual-cure resin columns were sheared off the post-cured resin discs. Shear bond strengths were A) 19.2 +/- 3.7, B) 17.4 +/- 3.9, C) 16.7 +/- 3.1, D) 15.6 +/- 3.5, E) 15.4 +/- 2.3 MPa. One-way ANOVA and Duncan's Multiple Range Procedure showed groups D and E to be significantly lower than the uncontaminated control group A (p < 0.05). There were 2 adhesive failures in group B and all others were cohesive within the post-cured resin discs. This implies that air/water alone after salivary contamination is an unreliable cleansing method. The low shear bond values for Groups D and E may have been related to inadequate clearance of the phosphoric acid gel. It was concluded that salivary contamination adversely affected the quality of the bonds studied and decontamination using phosphoric acid gel resulted in significantly reduced shear bond strengths.     

The place of informed consent in ethical dilemmas

Considers ethical questions raised by the psychotherapeutic treatment of a highly religious person to be specific instances of general issues in the conduct of psychotherapy. It is stressed that the therapist has a responsibility to insure that the consent of the client is obtained under conditions of full information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Energy conservation behavior: The difficult path from information to action.

Presents a social-psychological model of energy-use behavior that draws on behavioral and social research to explain influence processes and behavioral change related to energy conservation behavior. The model consists of 2 interacting sets of factors: psychological factors that refer to how information is processed by individual decision makers and positional factors that relate to characteristics of the decision makers' situations that support or constrain action. Suggestions for maximizing the effectiveness of informational appeals to conserve energy by convincing the consumer that a pay-off will result from the use of energy conserving devices are discussed. It is suggested that the adoption of a conservatory attitude is influenced by the vividness of the argument to conserve energy, the credibility of the source, the understanding and retention of the message, and the degree to which an individual is able and willing to install conservation devices in his/her home. Alternatives to informational appeals through mass media to encourage energy conservation are proposed. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model

Binding of human polymeric IgA ligand to its epithelial cell polymeric Ig receptor, pIgR, has been shown to stimulate pIgR apical transcytosis in an in vitro system, based on polarized confluent MDCK cells expressing rabbit pIgR. The present study aimed at testing whether such a stimulation also occurs in vivo. Transcytosis of pIgR was monitored by rat liver output of total secretory component (SC) into bile, measured by radial immunodiffusion as the sum of free SC and pIgA-bound SC. Whereas in the perfused rat liver system addition of pIgA to the perfusate showed no effect, i.v. injection of human and rat pIgA, but not of monomeric IgA nor PBS, in living rats significantly increased total bile SC output for more than 1 h. Furthermore, depletion of the normal pIgA level circulating in the liver before injecting more pIgA was not required to show the stimulation. Our data thus strongly suggest that stimulation of liver pIgR transcytosis by pIgA ligand binding is physiologically relevant, helping to quickly adjust pIgA transport into bile to increase circulating pIgA levels, without need for increased SC/pIgR synthesis.     

Legal grounds for patient information in orthopedics

Neuroimaging is playing an increasing role in research of affective disorders, with investigators examining both volumetric changes of specific brain structures and vascular changes within white and gray matter. Recent studies have attempted to make clinical correlations between neuroimaging changes in unipolar and bipolar mood disorders. In this review, we focus particularly on those changes that are clinically meaningful. We conclude that there is enough evidence to begin to evaluate inclusion of neuroimaging findings in our mood disorder classification system. To this end, we propose two new mood disorder subtypes, vascular depression and vascular mania. Directions for future research in neuroimaging are then discussed.