Items in AFP with MESH term: Informed Consent
ABSTRACT: Physicians assess the decision-making capacity of their patients at every clinical encounter. Patients with an abrupt change in mental status, who refuse recommended treatment, who consent too hastily to treatment or who have a known risk factor for impaired decision-making should be evaluated more carefully. In addition to performing a mental status examination (along with a physical examination and laboratory evaluation, if needed), four specific abilities should be assessed: the ability to understand information about treatment; the ability to appreciate how that information applies to their situation; the ability to reason with that information; and the ability to make a choice and express it. By using a directed clinical interview or a formal capacity assessment tool, primary care physicians are able to perform these evaluations in most cases.
ABSTRACT: Persons with mental retardation are living longer and integrating into their communities. Primary medical care of persons with mental retardation should involve continuity of care, maintenance of comprehensive treatment documentation, routine periodic health screening, and an understanding of the unique medical and behavioral disorders common to this population. Office visits can be successful if physicians familiarize patients with the office and staff, plan for difficult behaviors, and administer mild sedation when appropriate. Some syndromes that cause mental retardation have specific medical and behavioral features. Health issues in these patients include respiratory problems, gastrointestinal disorders, challenging behaviors, and neurologic conditions. Some commonly overlooked health concerns are sexuality, sexually transmitted diseases, and end-of-life decisions.
Estimating the Risks of Coronary Angioplasty - Improving Patient Care
Dermal Electrosurgical Shave Excision - Article
ABSTRACT: The dermal electrosurgical shave excision is a fast and inexpensive method of removing epidermal and dermal lesions. The procedure is ideally suited for pedunculated lesions raised above the level of the surrounding skin. It consists of repetitive, unidirectional, horizontal slicing of a cutaneous lesion with a no. 15 blade followed by electrosurgical feathering to smooth out the wound edges. A smoke evacuator is used during electrosurgery to prevent inhalation of heat-disseminated viral particles. The procedure is followed by histologic evaluation of the shaved specimen. Suspicious pigmented lesions should not be shaved because the long-term prognosis of a malignancy may depend on the thickness of the lesion on histologic analysis. Administration of adequate local anesthesia should make this a painless procedure. Basic general surgery skills are required, and formal training in electrosurgery is highly recommended.
Ingrown Toenail Removal - Article
ABSTRACT: Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, and poorly fitting shoes. Patients commonly present with pain in the affected nail but with progression, drainage, infection, and difficulty walking occur. Excision of the lateral nail plate combined with lateral matricectomy is thought to provide the best chance for eradication. The lateral aspect of the nail plate is removed with preservation of the remaining healthy nail plate. Electrocautery ablation is then used to destroy the exposed nail-forming matrix, creating a new lateral nail fold. Complications of the procedure include regrowth of a nail spicule secondary to incomplete matricectomy and postoperative nail bed infection. When performed correctly, the procedure produces the greatest success in the treatment of ingrown nails. Basic soft tissue surgery and electrosurgery experience are prerequisites for learning the technique.
What You Need to Know About HIPAA Now - Feature
Perinatal HIV Testing - Editorials
VBAC: Protecting Patients, Defending Doctors - Editorials
Confidential Reproductive Care for Adolescents - Editorials
Using Medical Interpreters - Curbside Consultation