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It is often said that it is important for patients to possess hope that their treatment will be successful. We agree, but a widely appealed to type of hope—hope based on conviction (religious or otherwise), renders this assertion problematic. If conviction‐based hope influences patient decisions to undergo medical procedures, then questions are raised about the scope of patient autonomy. Libertarians permit patients to make decisions to undergo medical procedures on the basis of any considerations, including conviction‐based hopes, on grounds of respect for freedom of choice. Rational interventionists want to restrict choices made on the basis of conviction‐based hope on the grounds that choices based on hope incorporate irrationality of a sort incompatible with autonomous decision‐making. In this article, we navigate a middle path between these extremes, arguing that patient decision‐making based on conviction‐based hope ought to be acceptable and permitted in health care when it conforms to norms of practical rationality. These norms allow patients some room to make decisions to consent to undergo medical procedures informed by conviction‐based hope. [ABSTRACT FROM AUTHOR]

Background and aim: This study investigated whether providers respected patient's autonomy, investigating providers' pattern of decisions and their associated characteristics. Methods: Cross-sectional study, conducted through anonymous questionnaire with hypothetical clinical cases, presented to providers at one oncology center. Decision-making patterns were pre-stablished accordingly to the response´s pattern. Findings: Of 151 responses, decisions patterns were paternalistic in 38%, shared in 38%, obstinate in 10.6% and consumerist in 13.2%. The consumerist providers reported never having participated in an EOL class in 35% and 30% had never trained in palliative care. Among providers with paternalistic pattern, 35.1% had never attended ethic lectures. In the obstinate group, 31.2% had no training in palliative care. When asked how subjects saw themselves about their pattern of decision, 100% of obstinate, 95% of consumerist and 89% of paternalistic patterns exhibited cognitive dissonance. Conclusion: Significative differences between decisions and how the providers judge themselves were observed. [ABSTRACT FROM AUTHOR]

The article "Can AI replace psychotherapists? Exploring the future of mental health care" published in Frontiers in Psychiatry discusses the role of Artificial Intelligence (AI) in transforming mental health care. AI is being integrated into mental health services to predict treatment outcomes, provide therapeutic interventions, and support patient monitoring. While AI shows promise in alleviating symptoms of anxiety and depression, further research is needed to establish its efficacy and sustainability. The article emphasizes the importance of balancing AI benefits with human oversight to ensure quality and accessibility in mental health care. [Extracted from the article]

Background: Uncertainty in medical decision-making is a significant challenge influenced by various patient- and physician-related factors. They include physicians' clinical reasoning skills and their tolerance for uncertainty. Medical students are trained in clinical reasoning and have to learn to manage uncertainty. This study investigates the influence of personality traits on the need for cognitive closure (NCC) among final-year undergraduate medical students participating in a simulation of a first day of residency. Methods: The study included 373 students who participated in a simulation of a first day of residency between March 2022 and November 2023. The simulation included a consultation, a management, and a patient handoff phase, followed by self-assessments of confidence in clinical reasoning. We used the 16-Need for Cognitive Closure Scale (16-NCCS) and the HEXACO Personality Inventory - Revised (HEXACO-PI-R) to assess NCC and personality traits. Multiple linear regression analysis was performed to explore the impact of personality traits and gender differences on the NCC. Results: Openness, Extraversion, and Honesty-Humility negatively predicted NCC, suggesting these dimensions favor a more explorative and less hurried approach to medical decision-making. Conscientiousness and Emotionality positively predicted NCC, indicating a preference for structured and decisive processes among medical students with high scores on these dimensions. Notably, gender emerged as a significant moderator, particularly influencing the relationship between Emotionality and NCC, with female students showing a higher tendency towards seeking closure when Emotionality was high. Conclusion: The personality dimensions Openness, Extraversion, and Honesty-Humility are negatively predictive of medical students' tendency towards cognitive closure. Learning to reflect on these interrelations is critical for medical students, as inappropriate responses to uncertainty can lead to poor medical decisions. Integrating self-reflective exercises into the curriculum could support students to recognize how their personality influences their response to uncertainty in medical practice. [ABSTRACT FROM AUTHOR]

The current legal test for capacity under the common law is a functional test. It determines whether a person can make a particular decision at a particular time; it focuses on retained abilities rather than on presumed deficits – in order to promote patient autonomy in decision-making. International evidence suggests however that the test is not well understood and consequently not being correctly applied in practice by a range of medical professionals. Donnelly has argued that gaining a better understanding of how capacity assessments are actually employed is essential to improving the quality of assessments. To date, there is little data on how doctors in particular make their assessments in practice. Using a socio-legal methodology, this quantitative study aims to assess understanding of capacity among a group of general practitioners/family medicine doctors in Ireland, and to determine how they assess capacity in clinical practice. Our study found that notwithstanding a lack of confidence in their ability to assess decision-making capacity, that respondents in fact demonstrated a high level of understanding and of ability to correctly apply the functional test in practice. [ABSTRACT FROM AUTHOR]

Introduction: According to the Institute of Medicine patient-centered medicine is one of the six crucial dimensions of health care quality. Although the patient-centered care model is widely recognized for its ethical underpinnings and effectiveness, its practical implementation still raises challenges, especially in end-of-treatment situations. This discussion paper offers an overview of the challenges facing the physician-patient relationship in end-of-treatment situations. Methods: We developed three clinical vignettes and made some theoretical considerations about ethical issues related to the decision-making process leading to the end of treatment. Results: We identified two main challenges that end-of-treatment situations pose to patient-centered care: (1) when the patient's autonomy challenges the best clinical treatment; and (2) when the proposed treatment (discontinuation of treatment) challenges the patient's preferences. Discussions: Patient-centered care supports personalized decision-making, in which the physician's approach varies according to the patient's situation and individuality. The idea of beneficence may change during care, because of acceptance of the patient's principles or a change in the primary goal of care. [ABSTRACT FROM AUTHOR]

When making decisions on behalf of someone, is asking what they would have wanted a good way to respect their autonomy? Against prevalent assumptions, I argue that in decisions about the care and treatment of those with advanced dementia, the notion of 'what one would have wanted' is conceptually, epistemically, and practically problematic. The problem stems from the disparity between the first‐person subjectivity of the past person and that of the present person. The transformative nature of dementia renders the very meaning of 'what the patient would have wanted' problematic. When applied to those with advanced dementia, the subjunctive notion is either (i) incoherent, (ii) fundamentally indeterminate, or (iii) normatively irrelevant. [ABSTRACT FROM AUTHOR]

'Reflexivity', as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in health care has been well‐documented but inadequately theorised. In this article, we use Archer's theory of fractured reflexivity to understand digital disparities in data from a 28‐month longitudinal ethnographic study of 12 UK general practices and a sample of in‐depth clinical cases from 'Deep End' practices serving highly deprived populations. Through four composite patient cases crafted to illustrate different dimensions of disadvantage, we show how adverse past experiences and structural inequities intersect with patients' reflexive capacity to self‐advocate and act strategically. In some cases, staff were able to use creative workarounds to compensate for patients' fractured reflexivity, but such actions were limited by workforce capacity and staff awareness. Unless a more systematic safety net is introduced and resourced, people with complex needs are likely to remain multiply disadvantaged by remote and digital health care. [ABSTRACT FROM AUTHOR]

Background: Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well‐being and independence. Objective: To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD). Design: Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement. Setting: Ambulatory, virtual. Participants: Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders. Results: NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) "Barriers to care", (2) "Family caregiver needs", (3) "Functional status and mobility issues", (4) "Illness understanding", and (5) "COPD care complexities". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized "Functional status and mobility issues", family caregivers prioritized "Family caregiver needs", and clinicians and health system leaders prioritized "COPD care complexities". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities. Conclusions: Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges. Implications: Patient‐centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsMain resultsAuthors’ conclusionsThe informed consent process in neurosurgery aims to support patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist, that need to be addressed. This systematic review examined the interventions and strategies which to enhance the process of consent in neurosurgery.A comprehensive search of databases and relevant sources to identify relevant studies for inclusion. Systematic review of prospective and retrospective studies that assess the effect of interventions which improve the consent process. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.The reviewed identified seven studies notably revealed an educational and interactive consent process involving strategies like booklets, videos, multiple interviews, and interactive websites showed improvements in patient knowledge. Recall of risks decreased over time, and factors like age, education, and timing of consent influenced recall.To maximise informed consent, neurosurgeons should consider various strategies. Tailoring communication-based on patient’s health literacy and treatment knowledge, involving their support system, and using a bullet-point consent form is essential. Utilising multiple modalities like verbal, static, and dynamic visuals improve information retention. Creative and memorable visual aids enhance comprehension. Allowing time for questions and team approach is superior. [ABSTRACT FROM AUTHOR]

Background: Ethical case discussions in psychiatric hospitals are particularly useful when a moral conflict between respect for the patient's autonomy and well-being becomes apparent when considering the legitimacy of coercive treatment. To date, there is hardly any data on the procedure and the results of such case discussions. We therefore present data from a large psychiatric clinic. Aim of the study: We retrospectively analyzed ethical case discussions prior to compulsory medication in a quantitative and qualitative manner. Methods: The study analyzed the protocols of all ethical case discussions over a 2-year period. They used the method of principle-based ethical case discussion. The qualitative analysis of selected cases was supplemented by reference to case records. Results: An advance care directive was not available in any of the cases, so that the presumed will was used generally to assess the autonomy perspective. It proved quite complex to address danger to third parties when assessing the beneficence and nonmaleficence perspective. In 5 out of 35 consultations, the compulsory medication was not recommended from an ethical perspective. Discussion: Ethical case discussions enable a holistic individual examination of moral obligations. They contribute to well-founded decisions and can help to reduce the frequency of coercive medications, suggesting routine use of ethics counselling. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most common cancer in Arabic women and is often diagnosed in advanced stages, resulting in an increased likelihood of requiring a mastectomy. Despite this, there is a lack of contemporary literature exploring Arabic women's experiences of breast cancer and its sequelae. Method: Semi-structured interviews were conducted between 2019 and 2022 of Arabic women diagnosed with breast cancer. Data were analyzed using thematic analysis as described by Braun and Clark. Results: Two main themes were identified: (a) Broken yet brave describes participants' experiences when diagnosed and (b) Making decisions about treatment and experiences of support detailing their lack of decision-making autonomy and perceptions of support. Discussion: Arabic women believe in the concept of fate and faith, and their cultural conditioning is to prioritize family over themselves, often with limited support. They lack autonomy in decision-making due to the patriarchal society they live in. [ABSTRACT FROM AUTHOR]

Background: Experiences of discrimination in healthcare lead to poorer mental and physical health for transgender individuals. There is evidence that trans-specialists, i.e. health professionals specializing in transgender care, are an important source of discrimination experienced by transgender individuals in healthcare. In this qualitative interview study, we explored the reasons for this possibly surprising finding by analyzing subjective views of trans-specialists on various issues related to discrimination of transgender individuals. Methods: We conducted 20 semi-structured, qualitative, exploratory interviews with healthcare professionals specializing in transgender care. Interview questions were developed based on an extensive literature analysis and results of previous research on the topic. The interviews were conducted online, were digitally recorded and transcribed. Data analysis was conducted using the methods of content analysis and thematic analysis. Results: The interviewees had great difficulty giving a consistent definition of the concept of gender identity. Most of them saw it as a self-determination of a transgender individual. Although herewith emphasizing the autonomy of transgender individuals, most trans-specialists felt that they had to be convinced of their patient's transsexuality to carry out treatment. Most trans-specialists reported having had doubts about whether some transgender individuals were suffering from gender incongruence or not. There was also ambiguity among interviewees about whether transsexuality is a mental illness. Conclusions: We were able to identify specific topics that can cause discrimination experiences on the part of transgender individuals in their contact with trans-specialists. These include the vagueness of the construct of gender identity and the ambivalence between respect for the autonomy of transgender individuals and the validation of the diagnosis "transsexuality". Also, uncertainties regarding the classification of transsexuality as a mental illness can lead to experiences of discrimination. Furthermore, our results imply that trans-specialists might remember own discriminatory behavior less than it actually took place. Our results can contribute to the development of specific measures to avoid discrimination experiences of transgender individuals in contact with trans-specialists. These should include a reflection on one's own gender identity and training on mechanisms of discrimination. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aim Methods Findings Discussion In this text, the author’s lived experiences as a youth with anorexia nervosa, anxiety, and depression are explored. Experiences with accessing North American health services, both in specialized eating disorder (ED) and disordered eating (DE) settings, as well as in healthcare more broadly are shared.This work seeks to shed light on a patient perspective in mental health and to draw attention to some of the ways that the current framings of EDs and DE within the biomedical system might perpetuate harm.In this piece, a collection of the author’s lived‐experiences and interactions with the healthcare system are explored.The medical framing of EDs as a defect of both mind and body can jeopardize one’s autonomy and contribute to a sense of hopelessness. As mental health treatment increasingly prioritizes evidence‐based approaches and standardized practices, there is a growing concern that this shift risks undermining the autonomy of those it aims to support. The dualistic conceptualizations of mental and physical health in ED/DE treatment, at times, can cause harm, particularly for those who do not present with the physical manifestations of an ED/DE but remain largely affected in day‐to‐day life.The imposition of rigid treatment regimens can inadvertently diminish personal agency, overshadowing the nuanced, individualized needs and preferences of patients. Lived experience narratives encompass the personal, subjective insights of individuals navigating mental health challenges, in turn, providing invaluable insight that conventional methods may overlook. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore how incorporating shared decision‐making (SDM) can address recruitment challenges in clinical trials. Specifically, it examines how SDM can align the trial process with patient preferences, enhance patient autonomy and increase active patient participation. Additionally, it identifies potential conflicts between SDM and certain clinical trial aspects, such as randomization or blinding, and proposes solutions to mitigate these issues. Materials and Methods: We conducted a comprehensive review of existing literature on patient recruitment challenges in clinical trials and the role of SDM in addressing these challenges. We analysed case studies and trial reports to identify common obstacles and assess the effectiveness of SDM in improving patient accrual. Additionally, we evaluated three proposed solutions: adequate trial design, communication skill training and patient decision aids. Results: Our review indicates that incorporating SDM can significantly enhance patient recruitment by promoting patient autonomy and engagement. SDM encourages physicians to adopt a more open and informative approach, which aligns the trial process with patient preferences and reduces psychological barriers such as fear and mental stress. However, implementing SDM can conflict with elements such as randomization and blinding, potentially complicating trial design and execution. Discussion: The desire for patient autonomy and active engagement through SDM may clash with traditional clinical trial methodologies. To address these conflicts, we propose three solutions: redesigning trials to better accommodate SDM principles, providing communication skill training for physicians and developing patient decision aids. By focussing on patient wishes and emotions, these solutions can integrate SDM into clinical trials effectively. Conclusion: Shared decision‐making provides a framework that can promote patient recruitment and trial participation by enhancing patient autonomy and engagement. With proper implementation of trial design modifications, communication skill training and patient decision aids, SDM can support rather than hinder clinical trial execution, ultimately contributing to the advancement of evidence‐based medicine. [ABSTRACT FROM AUTHOR]

In recent years, stories of individuals travelling to Switzerland for an assisted death have been the subject of a notable number of news reports, particularly in the UK, giving the impression that this is largely a British practice. Coverage of individuals undertaking this journey, colloquially known as 'suicide tourists', frequently features in newspaper media in other European countries however, presented as a rousing reminder of the incongruity between the modern desire for greater choice over one's death, and the law on assisted suicide making this practice a crime in all but a few European nations. In this mixed-methods study I explore the framing of suicide tourism in the newspaper media of four Western European countries between 2002 and 2021. A quantitative analysis of trends in reporting was carried out initially, complemented by a qualitative thematic analysis of news stories using a critical discourse framework. Four themes indicative of a wider 'European' discourse employing common frames, language, and meaning were identified: 1/suicide tourism as an individual choice grounded on a desire for autonomy and self-determination 2/Dignitas as an 'emergency exit' 3/the law on assisted suicide as outdated and coercive, and 4/dying in Switzerland as a 'good death'. [ABSTRACT FROM AUTHOR]

Aims: To analyse the concept of eating experiences in people living with dementia. Design: Rodgers' evolutionary method of concept analysis was used as a framework for the paper. Data Sources: The literature was searched using electronic databases PubMed, Google Scholar, CINHAL, PsycInfo, Web of Science, Embase and Elsevier databases. These databases cover a variety of disciplines, including but not limited to nursing, medicine and occupational therapy. The relevant literature published from 1989 to April 2023 was thoroughly examined. Any quantitative or qualitative studies published in English focused on eating or dining experiences in people with dementia were included. Review Methods: Rodgers' evolutionary method for concept analysis was used. The attributes, antecedents, consequences and case examples of the concept were identified. Results: Twenty‐two articles met the inclusion criteria, identifying key attributes of self‐connection, the special journey of life and self‐interpretation. Antecedents, as framed by the socio‐ecological model, were categorized to represent intrapersonal (personal preferences, individual culture, mealtime routines), interpersonal (social interaction) and environmental (dining room environment, policies) factors. Consequences were divided into external (nutritional health, physical health and quality of life) and internal (personhood, autonomy and independence, dignity and feeling valued and mental well‐being) domains. Conclusion: A theoretical definition and conceptual model of eating experiences in people living with dementia was developed. The identified attributes, antecedents and consequences can be utilized in nursing education, research and intervention approaches. Impact: This article allows nurses and other healthcare professionals to better understand people living with dementia through the relationship between eating and interpersonal, intrapersonal and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life. Patient or Public Contribution: Not applicable. [ABSTRACT FROM AUTHOR]

Currently, in the United States, there is no legal obligation for medical professionals or civil courts to uphold patients' Advance Directives (ADs) regarding end-of-life care. The applicability and standing of ADs prepared by Alzheimer's patients is a persistent issue in bioethics. Those who argue against giving ADs full status take two main approaches: (1) appealing to beneficence on behalf of the Alzheimer's patient and (2) claiming that there is no longer any personal equivalence between the AD's creator and the subject of the AD. In this paper, I present profound arguments against both approaches. Firstly, I argue that the principle of beneficence cannot apply in the case of Alzheimer's patients, and, secondly, that the moral and legal authority of the AD need not depend on strict equivalence of personal identity. I conclude by arguing that valid ADs protect the dignity and autonomy of Alzheimer's patients and that, therefore, there are moral obligations to uphold ADs which should be reflected in public policy and legislation. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a major criminal, social and public health problem. As one effort to prevent IPV and intimate partner homicide, several countries have adopted legislation requiring professionals to disclose IPV to the authorities (commonly referred to as mandatory reporting). The child welfare service (CWS) is centrally positioned for detecting, reporting and preventing IPV, but there is limited empirical knowledge concerning how the service handles IPV cases or of social workers' awareness of mandatory reporting of IPV. Using qualitative interviews, we explore how CWS workers in Norway describe their discretionary space and mandatory obligations towards adults subjected to IPV. Our findings indicate an inexpedient interplay between understandings of professional mandate and individual responsibility and local routines and organisation and insufficient knowledge about IPV and mandatory reporting. We suggest that a reframing of CWS workers' understanding of their discretionary space is needed to ensure that their individual responsibility towards adults subjected to IPV is understood as part of their mandate. This reframing presupposes structural efforts, such as formal training. We propose further investigations concerning how local organisation and routines either facilitate or interfere with systematic and thorough handling of IPV in families with which the municipal CWS meets. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical, clinical, and regulatory challenges of using molecular diagnostic tests, such as circulating tumor DNA (ctDNA), in cancer care. Topics include the evolving role of ctDNA testing in detecting minimal residual disease, the ethical considerations surrounding early adoption of tests with uncertain clinical benefits, and the responsibility of oncologists in guiding patients through emerging technologies.

This case study reflects on the use of improvisation and songwriting to support a patient with significantly impaired short-term memory and long-term memory interference as a result of acquired brain injury. Memory has long been associated with personal identity, linking the past with the present, and enabling us to project into the future. This continuity of consciousness helps us to learn from, and make sense of our experiences, strengthening our internal representation of self. Disruption to short-term memory can significantly impact decision making, planning and initiation, all of which are key components of personal identity and self-expression. Supporting patient autonomy and self-expression through improvisation, and crafting lyrical content around personal preferences and events, sessions were designed to bolster his internalised sense of self through both revisiting old memories and facilitating new memory formation within the present. While short-term memory has been considered a conduit to long-term memory consolidation, and integral to the individual's self-expression, this case study implies short-term memory was neither the gatekeeper to formation of long-term memories, nor critical to maintaining a sense of self, and reflects on how music helped the client create and access new learning beyond procedural memories, anchoring the self in newly internalised self-expression. [ABSTRACT FROM AUTHOR]

Background: The differences in clinical bioethics between the Mediterranean and Latin American cultures have not been analyzed. The objective of the study is to compare the ethical conflicts that internists in Spain, Mexico and Argentina have. Methods: Cross-sectional observational study through a survey directed at internists from Spain, Argentina and Mexico. The survey was administered to affiliated members of the National Societies of Internal Medicine across three countries via an online platform. Results: 762 internists participated, 261 from Spain, 154 from Argentina and 347 from Mexico. The main ethical conflicts that internists in Spain, Argentina and Mexico have are related (in order) to the end of life, to the clinical relationship and to the patient's autonomy. Withholding and withdrawing life-sustaining treatment is the most frequent conflict in Spain and Argentina and the second in Mexico. Conclusions: Internists from Spain and Argentina identify very similar ethical conflicts. Furthermore, they consider them more frequent and difficult than in Mexico. In Argentina they are less satisfied with the way they are resolved. To explain these differences, socio-cultural factors are postulated, among others: paternalism, individualism, masculinity, organization of the health system, formal training in bioethics and assessment of death. [ABSTRACT FROM AUTHOR]

Background: Although medical aid in dying (MAID) legalization continues to expand across the United States, limited research has elucidated attitudes toward its clinical provision, especially in terms of clinician presence. Objective: The objective of the current study was to explore attitudes toward presence throughout a patient's death via MAID in hospice physicians, nurses, social workers, and chaplains. Aims included (1) characterizing willingness to be present throughout patient death via MAID and (2) describing rationales for willingness. Design: We employed a cross-sectional design. Methods: A national convenience sample of interdisciplinary hospice clinicians in the United States (N = 413) completed a self-administered, mixed-method survey via Qualtrics. A quantitative item assessing participants' willingness (no, unsure, yes) to be present throughout a patient's death via MAID preceded a qualitative probe inquiring about their rationales behind their previous response. Quantitative responses were characterized through frequencies and percentages. Qualitative responses within each resulting quantitative subsample were content analyzed for surface-level meaning using inductive coding. Results: Participants who were willing to be present (n = 305 [74%]) attributed their willingness to personal support, definitions of quality clinical care, and values from their professional training. Some engaged in boundary setting, describing particular conditions under which they would be willing to be present. Those who were unwilling (n = 63 [15%]) noted personal objections to the concept of MAID, personal objections to MAID participation, and perceptions of MAID's misalignment with healthcare. Those who were unsure (n = 45 [11%]) premised their responses on ambivalence and a lack of experience, both of which precluded formulating a definitive position. Conclusion: Although three-quarters of participants were willing to be present during MAID, qualitative responses revealed great nuance within and across quantitative subsamples. Hospice clinicians would benefit from greater professional guidance and support pertaining to MAID. [ABSTRACT FROM AUTHOR]

A diagnosis of behavioral variant frontotemporal dementia (bvFTD) often relies on informant reports of significant behavioral changes. “BvFTD-by-proxy” describes situations of neuropsychiatric changes reported solely by an informant under circumstances that may raise questions regarding their objectivity. We present three cases of bvFTD-like symptoms reported by spouses, where progression was unclear, testing showed mild but stable executive dysfunction, and neuroimaging was unremarkable. The subjective nature of bvFTD criteria leaves patients vulnerable to misleading informant reports, especially amid relational discord, and may threaten patient autonomy. Recognizing and managing this situation is critical but time-consuming, often requiring coordinated care across multiple providers. [ABSTRACT FROM AUTHOR]

ABSTRACT Patient‐initiated brief admission (PIBA) is an innovative psychiatric care intervention that gives patients the autonomy to initiate a short admission (approximately 1–3 days) to psychiatric inpatient care. This intervention is structured around a mutual agreement between the patient and their care provider that outlines the specific structure and content of their care. Unlike regular psychiatric admissions, healthcare professionals do not review the patient's decision for admission during PIBA. Similar interventions have been developed globally to reduce the need for long inpatient admissions and compulsory care by enhancing patient autonomy, promoting active participation in care, and empowering patients to recognise early signs of mental health deterioration. The objective of this systematic review was to explore the experiences of PIBA among individuals with mental health disorders. A systematic review was conducted using qualitative articles sourced from the PubMed, CINAHL, and PsycINFO databases. A total of thirteen original articles were included in the review, encompassing 186 patients. Research demonstrates that PIBA significantly impacts patients' care experiences in various ways. Access to PIBA gives patients the opportunity to take a break from daily stressors, which has proven significant in interrupting the cycle of worsening symptoms and negative thoughts. Furthermore, when the care environment is characterised by trust and respect, patients experience an increased sense of freedom, which contributes to a more effective recovery process. PIBA provides patients with a sense of safety and offers the possibility of a more functional daily life. Healthcare professionals'attitude and care provision also significantly influences patients' experiences. Central to a positive patient experience are a warm reception, attentiveness, and active listening. PIBA can not only change patients' perceptions of healthcare but, more importantly, fosters a transformative view of themselves as active participants in their own well‐being. Knowledgeable healthcare professionals are crucial for the successful implementation of this intervention. By offering dignity and warmth alongside safety, PIBA addresses a critical gap in patient mental health care. [ABSTRACT FROM AUTHOR]

Background: Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge. Methods: In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations. Results: More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5–2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1–1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3–1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2–1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy. Conclusions: This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia. Reporting method: The STROBE Statement was followed for reporting. [ABSTRACT FROM AUTHOR]

Increasing interest in applying large language models (LLMs) to medicine is due in part to their impressive performance on medical exam questions. However, these exams do not capture the complexity of real patient–doctor interactions because of factors like patient compliance, experience, and cognitive bias. We hypothesized that LLMs would produce less accurate responses when faced with clinically biased questions as compared to unbiased ones. To test this, we developed the BiasMedQA dataset, which consists of 1273 USMLE questions modified to replicate common clinically relevant cognitive biases. We assessed six LLMs on BiasMedQA and found that GPT-4 stood out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which showed large drops in performance. Additionally, we introduced three bias mitigation strategies, which improved but did not fully restore accuracy. Our findings highlight the need to improve LLMs' robustness to cognitive biases, in order to achieve more reliable applications of LLMs in healthcare. [ABSTRACT FROM AUTHOR]

Background: Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh. Methods: This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets. Results: This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family's wishes and preferences. Conclusions: While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient's active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Method Results Conclusion Implications for the Profession and Patient Care Impact Patient or Public Contribution Describe the stressors that long‐term care facility (LTCF) residents and their family members were exposed to during the COVID‐19 pandemic, the resources they mobilised to cope with them, and the strategies used by professionals to support them.A descriptive qualitative design study.Between March 2021 and February 2022, we carried out semi‐structured interviews with 8 LTCF residents, 11 family members, and 6 focus groups made up of healthcare and support staff from 8 LTCFs.Three themes emerged: (1) residents and family members: separated and suffering, (2) residents and family members: reinventing themselves, and (3) staff: attempts to maintain residents' well‐being.LTCF Residents' and their family members' exposure to the various stressors linked to the COVID‐19 pandemic generated suffering. Healthcare and support staff implemented strategies to support them, notably to maintain links between them. Some deep reflection must occur on the concepts of LTCF residents' autonomy and self‐determination when implementing protective measures in future pandemic situations.This study has provided new insights into the nature of the stressors faced by LTCF residents and their families, and the measures implemented by professionals to support them. The role of the families of LTCF residents needs to be better recognised. Our results indicate the importance of involving nurses in discussions on patient autonomy and self‐determination when implementing protective measures (in a pandemic situation).Exploring the nature of the stressors experienced by LTCF residents and their families enables professionals to tailor strategies to support them. Maintaining residents' self‐determination is essential when implementing protective measures. Families involved with residents must be recognised and included in the assessment of stressors and the personalisation and implementation of strategies to support LTCF residents.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: Informed consent (IC) is a fundamental principle in medical ethics that upholds respect for patient autonomy. Although widely applied in healthcare, its feasibility and implementation in herbal medicine have been underexplored. This study therefore aimed to explore the practices and attitudes of herbalists regarding informed consent. Methods: To achieve these objectives, a qualitative cross-sectional study was conducted from June to December 2020. Twenty-one in-depth interviews with herbalists and four key informant interviews with leaders of the different traditional medicine organizations were conducted. The data were analyzed thematically using NVivo version 12 software. Results: Sixteen of the twenty-one participants acquired oral herbal medicine knowledge from their relatives. Although a positive inclination toward obtaining IC was evident, the focus was on disclosing basic information. Discussions of alternative treatments and herbal specifics were less frequent. Disease management decisions often involve shared responsibility within families or societies. Documented IC procedures are rare among herbalists, who deem consent forms unnecessary, although they recognize the potential benefits of IC in fostering trust and professionalism. Challenges hindering IC implementation included regulatory gaps, inadequate skills, and the absence of mechanisms to protect the intellectual property rights of herbal medicine. Conclusion: This study illuminates how educational, cultural, familial, and regulatory factors influence herbalists' practices and attitudes toward informed consent. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya. Methods: This qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach. Results: Participants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making. Discussion: Understanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance. Significance: What is Already Known: Maternal immunization saves lives, but the presence of vaccines does not guarantee uptake. Decision-making for maternal vaccines does not occur in a vacuum and is influenced by multiple sources. What this Study Adds: Information on how peers influence future maternal vaccine acceptance is limited. Our findings show that pregnant and lactating people (PLP) believe the decision to vaccinate should be left to themselves due to autonomy and their caregiver role, even in rural Kenya. Additionally, our findings show that PLP are influenced not only by their partners and healthcare providers, but also female family members and peers. As RSV vaccine rollout begins, targeted demand generation strategies for PLP and their influences is paramount. [ABSTRACT FROM AUTHOR]

As the principle of respect for patient autonomy has gained salience over the past 75 years, surgeons now struggle to resolve conflicts between autonomy and beneficence in certain clinical scenarios. One such conflict occurs when a patient desires a surgical intervention, but the surgeon concludes that the patient is "too sick for surgery" and hence would not benefit from the operation. We provide historical context for the principle of respect for patient autonomy and review recent qualitative data that demonstrate surgeons experience significant moral distress when asked to perform nonbeneficial surgery. Therefore, we sought to empower surgeons with the appropriate ethical justifications to decline to perform surgery when they believe it would be nonbeneficial or harmful to patients. We outline 4 concepts that can help surgeons engage with patients, families, and colleagues in these scenarios. First, we describe the term "futility" and explain the difficulty in precisely defining and using the term in practice. Second, we contrast patients' positive and negative rights, drawing on historical context to argue that patients have robust negative rights but limited positive rights to request nonbeneficial interventions. Third, we use the centuries-old notion of medicine as a profession to show that surgeons have a fiduciary responsibility to act in the best interests of their patients, including and especially when patients request interventions that are not beneficial. Finally, we draw on virtue ethics to give surgeons character-based resources for fulfilling their professional obligations to patients. We contend that surgeons owe their patients the ability to trust that they will always use their knowledge and skills for patients' benefit, even if surgeons must limit patients' autonomy in certain ways to do so. [ABSTRACT FROM AUTHOR]

The article focuses on obtaining informed consent (IC), a critical and unavoidable step in the provision of care for any patient, from the newborn to the terminally ill. Topics include decisions that require IC in the reproductive ages, the application of IC to all aspects of medical care, and situations that seem to invite problems with IC.

Extracorporeal Carbon Dioxide Removal (ECCO2R) systems support patients with severe respiratory failure. Concurrent ambulation and physical therapy improve patient outcomes, but these procedures are limited by the complexity and size of the extracorporeal systems and rapid changes in patient metabolism and the acid–base balance. Here, we present the first prototype of a wearable ECCO2R system capable of adjusting to a patient's changing metabolic needs. Exhaust gas CO2 (EGCO2) partial pressure is used as an analog for blood CO2 partial pressure (pCO2). Twin blowers modulate sweep gas through the AL to achieve a desired target EGCO2. The integrated system was tested in vitro for 24 h with water, under varying simulated metabolic conditions and target EGCO2 values, and in a single test with whole blood. When challenged with changing inlet water pCO2 levels in in vitro tests, the system adjusted the sweep gas to achieve target EGCO2 within 1 min. Control runs with a fixed sweep gas (without negative feedback) demonstrated higher EGCO2 levels when challenged with higher water flow rates. A single in vitro test with whole ovine blood confirmed functionality in blood. This is the first step toward wearable ECCO2R systems that automatically respond to changing metabolism. Such devices would facilitate physical therapy and grant greater autonomy to patients. [ABSTRACT FROM AUTHOR]

Background: Past research has demonstrated that transgender and gender diverse (TGD) people often have negative experiences of healthcare. Exploratory research is needed to provide in-depth understanding of the healthcare experiences of TGD people. Primary care is a crucial element of healthcare, but past research has tended to overlook what contributes specifically to positive experiences of primary care for TGD adults. Aim: The aim of this study was to explore positive experiences of TGD adults when engaging with primary care in Aotearoa New Zealand. Methods: Semi-structured email interviews were conducted with 11 TGD adults aged 20- to 62-years-old, with a range of binary or non-binary genders living across Aotearoa New Zealand. The email interview method allowed nationwide recruitment and flexible interaction. All aspects of the study were led by a researcher who is part of the TGD community. Results: Three themes were formulated to explain TGD participants' positive experiences with primary care. In order to contextualize positive experiences, participants described past negative experiences of healthcare and low expectations (Theme 1: The Sad State of Care). Participants also described exerting autonomy, for example by carefully selecting a general practitioner (GP) or choosing when to disclose transgender status to their GP (Theme 2: The Sphere of Control). Three levels were evident in positive experiences (Theme 3: The Gradient of Positive Experiences): basic professionalism, more desirable experiences of trans-specific competencies, and GPs as advocates for systemic change. Discussion: TGD people experience positive interactions in primary care in a variety of ways, all of which are contextualized by the negative state of healthcare at present. TGD people create opportunity for autonomy while navigating healthcare, which requires a form of interacting that can be termed reactive self-determination. Training for health professionals could apply the gradient of positive experiences to scaffold appropriate primary care for TGD adults. [ABSTRACT FROM AUTHOR]

This case study focuses on the therapeutic change process, highlighting the crucial role of therapists in facilitating it. Rooted in constructivist epistemology, we employed an integrative systemic model. Our exploration centers on the presence or absence of system restructuring within the therapeutic process. We delve into the differing perceptions of change between the therapist and the client, particularly regarding the criteria for therapy discharge. A significant aspect of our analysis is the discussion on the authenticity of change. We examine the dual role of therapists as expert observers and participants in the therapy, navigating between "objective" and subjective perspectives in their interventions. This includes assessing various levels of change, first and second order. We highlight the client's autonomy in defining the reality and authenticity of change, advocating for a balance between the therapist's guidance and the client's agency. Additionally, we emphasize the therapist's need for self-reflection and adherence to ethical practices. Our study contributes to systemic therapy literature by demonstrating the effective application of an integrative approach. It reinforces the importance of collaboration in therapeutic change, offering insights into how therapists can navigate complex therapeutic dynamics. [ABSTRACT FROM AUTHOR]

Health care professionals can enhance conversations about serious illness and medical decision-making by adopting a transparent, standardized approach. This article critiques established communication strategies, which often emphasize patient values and goals without providing the necessary medical information to align these goals with a shared understanding of prognosis. We propose an alternate strategy that (1) provides detailed explanations of medical conditions at the beginning of the conversation, (2) includes support persons in discussions, (3) considers capacity, and (4) offers tailored advice by clinicians. The proposed framework aims to provide patients (or their delegates) with the information they need to integrate their values in pursuit of well-informed medical decisions. This strategy builds trust by providing honest information about medical conditions and their trajectories. It empowers decision makers to consider realistic outcomes, allowing them to accept or reject treatments in accordance with their preferences. This article presents a thorough step-by-step guide on how to conduct a serious illness conversation and facilitate medical decision-making, including a supplement that provides example phrases for use in clinical practice. [ABSTRACT FROM AUTHOR]

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high‐income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low‐ and middle‐income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low‐resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient‐physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future. [ABSTRACT FROM AUTHOR]

Background: Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. Methods: The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Results: Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. Conclusions: The paper debates the issues related to establishing a patient–physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non‐maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient–physician relationship evolves into a patient‐centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology‐specific decision aids are able to transform the informed consent tool, usually related to medical‐legal issues, into an aid for true partnership between the patient and the medical care team. [ABSTRACT FROM AUTHOR]

Background and Objectives Advance directives (ADs) are based on state-specific statutes that vary in structure, terminology, and options. This variability leads to inconsistent end-of-life (EOL) care for patients who have executed an AD in 1 state but fall ill in another state. This study revisits a 2002 article that identified considerable differences in ADs to determine whether ADs have become more uniform. Research Design and Methods ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were compared to the 2002 study using nonparametric approaches. Mean numbers of key issues were compared using t -tests and 1-way analysis of variance. Results Consistent with 2002, 3 states in 2023 provide statutes for a healthcare power of attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for healthcare (ADHC), increased from 13 to 30. Between both studies, Long-Term Care increased significantly in LW and ADHC, whereas Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer's in the United States, only 10% of states included this issue in 2023. Discussion and Implications Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding the proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals' preferences are understood and respected across different states. [ABSTRACT FROM AUTHOR]

The article discusses the ethical dilemmas associated with involuntary psychiatric holds as hospitals see an increasing number of psychiatric patients. Topics discussed include the conflict between patient autonomy and the need for involuntary treatment, the necessity of evaluating both decision-making capacity and voluntariness, and the importance of ethical training for healthcare providers to navigate these complex situations effectively.

The objective of this study was to investigate the relationship between women's healthcare autonomy and the utilization of maternal healthcare services (MHS), including antenatal care services, the services of health professionals at the birth of a child, and facility-based delivery. This was a cross-sectional study. This study utilized data from the 2015 Afghanistan Demographic and Health Survey (AFDHS 2015), which included women aged 15–49 years who had given live birth within the five years before the survey. Multilevel logistic regression was used to estimate the adjusted odd ratios (AOR) for each outcome variable. Among respondents, 16.49% made at least four ANC visits, 52.57% of childbirth were assisted by a skilled birth attendant (SBA), and 45.60% of children were born in health facilities. Women with high healthcare autonomy, compared to medium and low, were more likely to use ANC (AOR 1.45; 95% CI = 1.26–1.67), SBA (AOR 1.15; 95% CI 1.02–1.29), and FBD (AOR 1.12; 95% CI 1.04–1.20). The association between women's healthcare autonomy and the use of maternal healthcare services (MHS) was positively and significantly moderated by household wealth and women's access to media. Women's higher healthcare autonomy was significantly and positively associated with MHS in Afghanistan. Policy and programs that encourage women's empowerment and awareness of the importance of MHS utilization should be initiated. [ABSTRACT FROM AUTHOR]

The evaluation of the effects of architecture and design in psychiatric hospitals primarily focuses on final outcomes, such as disease progression, and is made from the perspective of evidence-based medicine. Meanwhile, the evidence-informed, realist approach addresses how the intervention works. Understanding the underlying action mechanisms of the intervention is needed to facilitate its scaling-up and adaptation in new environments. This umbrella review reports in which ways architecture and design have an effect on patients' and staff experience in inpatient psychiatric hospital. The search was constructed around three key concepts (psychiatric hospital, design, and staff and patient outcomes) and was conducted across three reference databases (Embase, Medline, and PsychINFO). Academic and gray literature was analyzed. Information on design and architectural features in psychiatric hospitals, their effects on patients and staff experience, and the acting mechanisms enabling these effects were extracted. From 951 original references, 14 full texts were included in the analysis. Design and architectural features (e.g., aesthetic appeal of places, home-like environment) in psychiatric hospitals address patients' stress, boost social interaction, foster patients' autonomy and feelings of control, ensure respect for patient's privacy and dignity, and prevent under-and overstimulation. Using theory-driven evaluation may facilitate future hospital renovation and the evaluation of its effect. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Involuntary psychiatric holds, such as the 5150 hold in California, allow for an individual to be taken into custody for evaluation and treatment for up to 72 h when they present a risk of danger to themselves. 5150s and other coerced holds present a bioethical tension as patient autonomy is overridden to provide psychiatric care. I discuss two arguments that aim to provide ethical justifications for overriding patient autonomy during 5150 holds: the "clinical benefit" and "lack of capacity" arguments. By demonstrating that these arguments do not always hold, I argue that overriding patient autonomy during 5150 holds is not always ethical and can be harmful. Lastly, I make recommendations for the 5150 and similar involuntary psychiatric holds to minimize harmful breaches of patient dignity: creating consistent field guidelines for assessing prehospital capacity, educating prehospital providers about the potential harms of 5150s, and utilizing existing support structures within the social context of the patient when they have capacity to refuse further prehospital care. [ABSTRACT FROM AUTHOR]

Bouveret's syndrome, a rare complication of gallstone disease, poses a significant diagnostic and therapeutic challenge, particularly in elderly individuals with multiple comorbidities. The mortality rate ranges from 12-30%, emphasizing the importance of prompt and accurate diagnosis. Nonspecific symptoms, such as nausea, vomiting, and abdominal pain, contribute to delayed diagnosis. Healthcare professionals, especially those involved in gastroenterology and surgery, require comprehensive education on Bouveret's syndrome. Training should emphasize the diverse diagnostic modalities, including the use of imaging techniques such as X-rays, ultrasound, and MRI. Awareness of the syndrome's rarity and collaboration among specialists from various fields are crucial for effective management. Additionally, educational programs should underscore the need for individualized treatment plans, considering patient parameters such as age, comorbidities, and the inflammatory state of surrounding tissues. While endoscopic procedures exhibit lower success rates, they are often preferred due to the high risk associated with open surgical procedures in elderly patients. Continuous medical education should also highlight the potential link between diabetes and Bouveret's syndrome, emphasizing the importance of recognizing risk factors and ensuring timely medical intervention. In conclusion, enhancing the knowledge base of healthcare professionals through targeted education is essential for improving the diagnosis and management of Bouveret's syndrome, ultimately contributing to better patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Voice is a cultural construct directly linked to identity. Given the degree of cultural diversity that exists, clinicians cannot be expected to comprehend the intricacies of every culture in their patient population. This observation emphasizes the necessity of a universal approach. Research suggests that selfdetermination theory (SDT) can serve this purpose. SDT is a macrotheory of human motivation and personality supported by over 4 decades of empirical research that focuses on innate, universal psychological processes and needs. The primary aim of this clinical focus article is to propose the application of SDT as an evidence-based framework to guide clinicians in the provision of culturally responsive voice care. Conclusions: When SDT is used as a framework, it allows clinicians to foster an environment that supports the patient's basic psychological needs while being mindful of cultural diversity. This approach leads to more autonomous forms of motivation, which has been shown to result in better outcomes in the domain of health behavior change, contributing to a more satisfying and meaningful intercultural therapeutic experience. [ABSTRACT FROM AUTHOR]

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