Medical Explanation Research Articles

A Call for Compassionate Empathy: Analysis of Verbal Empathic Communication between Veterinary Students and Veterinary Clients and their Dogs.

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The "Model of Empathic Communication in the Medical Interview" by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including "fear" and "panic." Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients' perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

An approach to exploring associations between hospital structural measures and patient satisfaction by distance\u2010based analysis

BackgroundPatient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital structural measures but reports on the structure of patient satisfaction with respect to similarities among domains are scarce. This study is to explore by distance-based analysis whether similarities among patient-satisfaction domains are influenced by hospital structural measures, and to design a model evaluating relationships between the structure of patient satisfaction and hospital structural measures.MethodsThe Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital structural measures, followed by three different distance-based analyses - clustering, correspondence analysis, and ordinal multidimensional scaling – for robustness to identify homogenous groups with respect to similarities.ResultsOf 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital structural measures. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital structural measures, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital structural measures.ConclusionsDistance-based analysis can reveal the hidden structure of patient satisfaction. This study suggests that hospital structural measures including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.

Fishing nets and video creation: diabetic nephropathy education on screen

Abstract: Introduction: Noncommunicable Chronic Diseases (NCDs), such as Diabetes and Hypertension are responsible for 2/3 of deaths in the world, with Diabetic Nephropathy (DN) representing the most important cause of chronic kidney disease. Health Literacy (HL) is one of the social determinants of health. To guide and expand the knowledge of patients and teams involved in the care of people with NCDs, and for a better approach to chronic complications of Diabetes and Hypertension, the development of learning objects (LO) was proposed. Experience Report: this study involved the construction of an educational video by a group of five students during the academic program of undergraduate Medical School in 2019. They proposed a guiding question in relation to DN from a theoretical material. The chosen question was: “What is the level of understanding of patients with diabetic nephropathy in relation to their own disease?”. They developed a questionnaire on diabetes and hypertension and their complications, which was answered by patients with diabetes who were treated at the specialized outpatient clinic, aiming to answer the proposed problem. They drew a synthesis from the analysis of the responses, of the possible gaps in relation to the understanding of the diseases. Then, a script was created with the description of these gaps with the medical explanation and an analogy was made with fishing nets for the video production, containing narratives, texts, audios and images. Finally, the video was presented to teachers and students in the classroom. Discussion: The characterization of the video as an LO implies constructing it as an educational component, self-sufficient, reusable and with the possibility of combining it with other LOs as new educational tools. Conclusion: The educational material was characterized as an LO. It allows pointing out aspects of the progression of DN and recommended medical orientations for the disease. It establishes a tool for group discussions and isolated actions based on succinct and evidence-based medical information. The video validation is undergoing validation for use in health services.

Fishing nets and video creation: diabetic nephropathy education on screen

Abstract: Introduction: Noncommunicable Chronic Diseases (NCDs), such as Diabetes and Hypertension are responsible for 2/3 of deaths in the world, with Diabetic Nephropathy (DN) representing the most important cause of chronic kidney disease. Health Literacy (HL) is one of the social determinants of health. To guide and expand the knowledge of patients and teams involved in the care of people with NCDs, and for a better approach to chronic complications of Diabetes and Hypertension, the development of learning objects (LO) was proposed. Experience Report: this study involved the construction of an educational video by a group of five students during the academic program of undergraduate Medical School in 2019. They proposed a guiding question in relation to DN from a theoretical material. The chosen question was: “What is the level of understanding of patients with diabetic nephropathy in relation to their own disease?”. They developed a questionnaire on diabetes and hypertension and their complications, which was answered by patients with diabetes who were treated at the specialized outpatient clinic, aiming to answer the proposed problem. They drew a synthesis from the analysis of the responses, of the possible gaps in relation to the understanding of the diseases. Then, a script was created with the description of these gaps with the medical explanation and an analogy was made with fishing nets for the video production, containing narratives, texts, audios and images. Finally, the video was presented to teachers and students in the classroom. Discussion: The characterization of the video as an LO implies constructing it as an educational component, self-sufficient, reusable and with the possibility of combining it with other LOs as new educational tools. Conclusion: The educational material was characterized as an LO. It allows pointing out aspects of the progression of DN and recommended medical orientations for the disease. It establishes a tool for group discussions and isolated actions based on succinct and evidence-based medical information. The video validation is undergoing validation for use in health services.

The Rise of ST-Elevation Myocardial Infarction in Women of Northeast China.

The women of China’s Liaoning province display some morbidities in ways that defy medical explanation. Women have higher rates of hypertension, hypercholesterolemia, and metabolic syndrome than men, an anomaly for all three conditions. Most of these patients also suffer from Type 2 Diabetes Mellitus (T2DM) while there was a negative association between being female and T2DM for the rest of China. Each of these conditions can exist independently, but the increase in both their rates and congruence is a recent phenomenon. Stranger still is that Liaoning women are now presenting in hospital emergency departments with ST-Elevation Myocardial Infarction (STEMI), while diabetics predominantly suffer more benign Non-STEMI (NSTEMI) events. Confounding factors in any attempt to study this phenomenon include trace metals like manganese that have been shown to reduce systolic blood pressure in Asian men and raise it in Asian women. Some of the phenomenon may also be associated with the gene for Apolipoprotein 5, but its recent nature suggests other factors besides lipid profiles. Trace metals in the air, water, and diet of Liaoning province, or any urban environment, could play a role.

The Brief Strategic Treatment of Cardiophobia: A Clinical Case Study

Many individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a case of cardiophobia treated in an outpatient cardiac rehabilitation unit and, for the first time, describes the application of brief strategic therapy for the treatment of this condition. In the case reported, the first therapeutic encounter and the key elements of the strategic approach are described in detail with the aim to explain how brief strategic therapy works and how it can be used to identify and address cardiophobia-related behaviors. A 64-year-old male presented to cardiac rehabilitation reporting intense anxiety-provoking heart palpitations, and believing he was at risk of dying from a heart attack. After 3 sessions, an overall improvement in heart-related bodily sensations followed a decrease in the patient’s continuous checking of his heartbeat and seeking reassurance—factors that were largely responsible for the persistence of the problem. Moreover, quantitative evaluation showed increased scores of mood state at the end of treatment. This improvement persisted at the 18-month follow-up. This case is an interesting example of how brief strategic therapy can contribute to the development of a new conceptual model for the diagnosis and treatment of cardiophobia. Still, more systematic research in the field is needed to prove the efficacy and effectiveness of this therapeutic approach on symptoms of heart-focused anxiety.

Between the Psychical and the Material: Body Language in Freud's Dora

ABSTRACT Feminist theories of embodiment, particularly those that have emerged from corporeal feminism, have been influenced by the psychoanalytic distinction between the hysterical body and the anatomical body [Wilson, Elizabeth. 2015. Gut Feminism. Durham: Duke University Press]. Following Freud and his concepts of the body ego and somatic compliance, psychoanalytic assertions that the way the body is lived is psychically informed have proven productive to feminist aims. Freud proposes the notion of somatic compliance as the explanatory rationale for hysterical symptomatology’s strange ability to express itself in a manner incommensurable with medical explanation. This article opens and extends those questions raised by the anatomical body that originally perplexed Freud in the case of Dora. In particular, it queries the notion of somatic compliance by asking: what is the character of anatomy such that it can defy and revise its own apparent limits? How can the hysterical body achieve feats that the non-hysterical body cannot? And lastly, what does it mean to comply somatically? In this way, the article responds to the anti-biologism that continues to feature in much feminist scholarship on corporeality.

Racial/ethnic differences in general physical symptoms and medically unexplained physical symptoms: Investigating the role of education.

Distressing physical symptoms (e.g., back pain, nausea), many of which lack medical explanation, are a common cause for medical help seeking. However, racial/ethnic and educational differences may complicate identification and explanation of such symptoms, potentially contributing to clinician misdiagnosis and patient dissatisfaction. To better understand this issue, we examined racial/ethnic differences in general physical symptoms (GPS) and, more specifically, medically unexplained physical symptoms (MUPS) and whether differences varied by race/ethnicity and educational attainment. A sample of 4,864 Latino, Asian, and non-Latino White community respondents (54% female; average age of 41 years) self-reported their GPS. Two experts then rated whether endorsed symptoms were likely to have a medical basis. We assessed the associations of GPS and MUPS with race/ethnicity, age, gender, educational attainment, chronic physical conditions, and past-year psychiatric diagnoses. Asian respondents reported significantly fewer GPS than non-Latino Whites, and both Asian and Latino respondents endorsed significantly fewer MUPS than non-Latino Whites. When nativity and language were each included as covariates, racial/ethnic differences in GPS count were no longer observed; however, observed differences in MUPS count remained. Educational attainment did not demonstrate a significant relationship with either GPS or MUPS. Although comorbid mental health diagnoses were significantly related to both GPS and MUPS, age, gender, and comorbid physical conditions were the only significant predictors of GPS. Results from this study question existing stereotypical views of racial/ethnic differences in somatization and suggest that educational attainment does not significantly contribute to reported physical symptoms-with or without medical explanation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Phantom Penis: Extrapolating Neuroscience and Employing Imagination for Trans Male Sexual Embodiment

ABSTRACT This article investigates transgender men’s phantom penis experience with respect to several contexts: historical reportage and medical explanations of phantom limbs and phantom penises following amputation; body dysphoria and “melancholic strength”; all renditions of trans penis including the testosterone-morphed clitoris; phenomenology and prosthetic incorporation; the neurobiology of metoidioplasty and phalloplasty; and neuroscience research on cortical mapping, hard-wired gender, proprioception, brain plasticity, epiphenomenal orgasm, the rubber hand illusion (RHI), virtual reality (VR) embodiment, and mirror neurons. Although a unique phantom instantiation, trans men’s phantom penises are instructively related to congenital aplasia, visual and motor neural simulation, and cis men’s phantom penises. I examine three aspects of trans men’s phantom penis: phantom presence of a penis, phantom penile erogenous sensation, and the volitional phantom penis. An emphasis on function over visibility, pleasure over presence, and synthesis over staidness enables an understanding of phantom penis sensation as the neurological underpinning of all erogenous penile perception and therefore a desirable asset for trans men’s sexuality. In that vein, cognitive imagination is deployed to postulate volitional phantom penises.

Evaluation of a Pharmacist-Dietician-Led Patient-Centered Approach to Managing CKD-MBD: A Mixed-Method Study.

Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication in end-stage renal disease (ESRD). To improve prescribing consistency and patient outcomes, a patient-centered, pharmacist–dietician-led approach to managing CKD-MBD was developed. The purpose of this study was to evaluate if the new approach impacted serum markers of CKD-MBD and medication burden, and to evaluate patient satisfaction. A single-arm, pre–post, mixed-methods study was conducted. Serum markers of CKD-MBD and medication data were collected pre- and post-intervention, and a patient survey administered post-intervention. Focus groups were conducted, transcribed, and analyzed thematically. No statistically significant differences in serum markers of CKD-MBD or medication burden were found. Eighty-seven percent of patients were satisfied with their care, however, 31% were very dissatisfied with medical explanations provided to them and 48% felt their allotted time with healthcare professionals was too short. Four major themes identified from focus groups included lack of privacy, knowledge and perceptions of blood work rounds, issues with taking phosphate binders, and areas for increased patient education. Patients would prefer more information regarding their blood work results and more time with the healthcare team. Areas for expanded education include renal diet, phosphate binders, and consequences of abnormal bloodwork.

Transtornos somatoformes durante a pandemia de COVID-19

Objetivo: apresentar os transtornos somatoformes mais comumente observados na clínica médica diária, relacionando-os com a atual situação de pandemia da COVID-19. Métodos: foi realizada uma revisão bibliográfica descritiva e exploratória, de abordagem qualitativa, utilizando os bancos de dados PubMed, LILACS, SciELO e ScienceDirect; com os seguintes descritores: Somatização, Transtornos Somatoformes, Psicossomática, Hipocondria, Transtorno neurovegetativo, Dor crônica, Pandemia, Epidemia, COVID-19, Coronavírus e o boleano AND. Foram incluídas 18 referências no total. Resultados: A situação de pandemia e as medidas mais efetivas de contenção da doença, que são o isolamento e o distanciamento social, geram novos fatores estressantes aos indivíduos e estimulam o aparecimento ou o agravamento de transtornos somatoformes. Tais transtornos são divididos pela CID-10 em sete subtipos, que têm em comum sinais e sintomas somáticos sem explicação médica e provocam prejuízo no funcionamento cotidiano do indivíduo. É esperado que a incidência e prevalência dos transtornos somatoformes aumentem com a pandemia, e perdurem mesmo após a resolução da crise. Conclusões: É de grande importância que, diante do quadro pandêmico da COVID-19, os pacientes com transtornos somatoformes recebam uma atenção integral e apropriada, que considere os fatores biopsicossociais e espirituais próprios de cada indivíduo. Para tanto, é fundamental que os profissionais da saúde saibam reconhecer tanto as características específicas da doença quanto sua associação ao atual cenário, para que seja feito o diagnóstico e o tratamento adequados.

Media representations of camera sexual voyeurism in Singapore: a medicalised, externalised and community problem

ABSTRACT This article examines the Straits Times’ coverage of camera sexual voyeurism (CSV) incidents in Singapore from 2004–2017. Utilising critical discourse analysis, I argue that the threat CSV poses to Singaporean exceptionalism was cohered through three distinct media discourses. Internalisation, which focused attention on medical explanations that pathologised perpetrators. Externalisation, which attributed CSV to camera technology and pornography use. And community intervention, which focused on successful community policing responses to CSV. These discursive oscillations individualised, de-politicised and de-gendered CSV by constituting it as the reprehensible acts of a few behaviourally disordered individuals which could be addressed through medical treatment, lateral surveillance and responsibilisation. By examining media representations of CSV, this article explores whether extant myths and discourses surrounding sexual violence re-emerge in media coverage of technologically facilitated sexual violence (TFSV).

Fabricated or induced illness: From “Munchausen by proxy” to child and family-oriented action

BackgroundIn fabricated or induced illness (FII), a child is harmed due to caregiver(s) behaviour and actions, carried out to convince mainly doctors that the child’s physical and/or psychological health is more impaired than in reality. Harm is caused directly by the caregivers(s) and also often inadvertently by doctors’ responses. ObjectivesTo describe: dynamics underlying FII; wider definition of FII; alerting signs for early recognition of possible FII; respective responsibilities of health, social care, education. MethodsLiterature review, clinical experience, expert opinion. Results and conclusionsCaregivers are motivated by gain from having their child treated as ill, and/or by erroneous beliefs about their child's health, either way needing medical confirmation about their contentions. Their behaviour is therefore directed primarily towards doctors. Most cases of FII present unexplained discrepancies between caregiver reports/actions and independent observations of the child. More rarely, the child has actual signs of illness, induced by the caregiver, occasionally fatal.Children are harmed in all aspects of life: health, daily functioning including education, and psychologically. Harm emanates directly from the caregiver(s) but also unintentionally from medical responses.Illness induction and clear deception by the caregiver require immediate child protection. Otherwise, the initial focus is on assessing the child’s current health and functioning rather than caregiver's mental health. If, beyond verified illness, there is no medical explanation for the child’s reported ill-health, the family require help to function better. This requires co-ordinated, multidisciplinary rehabilitation and long-term monitoring. If caregivers refuse rehabilitation, child protection is required. Several unanswered questions remain.

In-Service Education and Changes to the Electronic Health Record System Improve Intravenous Fluid Hydration in the Emergency Department in Patients With a Diagnosis of Acute Pancreatitis

According to ACG guidelines, initial management of acute pancreatitis includes aggressive hydration defined as 250-500 mL/hr of isotonic crystalloid solution. Based on literature, morbidity and mortality can be further reduced with early resuscitation of a bolus of at least 1 L followed by a rate of infusion at 250 mL/hr. The purpose of our study is to evaluate if providing education and including an option for infusions in an existing order set available to Emergency Department (ED) providers improves the adequacy of early fluid hydration in patients diagnosed with acute pancreatitis. Initially, we generated a list of adult patients who presented to the ED with acute pancreatitis during a 12 month period. A chart review was performed to obtain the demographic data, cause of pancreatitis, type and amount of bolus infusate, type and rate of infusion received in the ED and if there was a reason provided in the ED provider’s note when patients received less than 1L bolus and 250 mL/hr infusion. The results were presented to the ED providers. Barriers to giving adequate IV fluid hydration in the ED were identified. Changes were made to the electronic health record (EHR) system in the quick order section to include fluid infusion and in-service education about adequate fluid resuscitation in acute pancreatitis was provided to the ED providers. The study was then repeated over 7 months to detect an improvement. A total of 100 patients were diagnosed with acute pancreatitis in the ED in 12 months. Twenty eight percent of patients did not receive adequate fluid resuscitation (without medical explanation). After the in-service education was provided and change was made in the EHR system, 52 patients were diagnosed with acute pancreatitis in the ED in 7 months. Twenty one percent of patients did not receive adequate fluid resuscitation but two patients had a medical explanation for it. The proportion of patients receiving an inadequate bolus and infusion declined from 28% to 21%. Statistically this difference is not significant (test statistic of 0.937 vs critical value of 1.645). The proportion of patients receiving an inadequate infusion showed a significant decline from 85% to 50% (test statistic of 4.613). The proportion of patients receiving inadequate bolus increased from 23% to 38.5% (test statistic of 2.013). Based on our analysis, an unacceptably high percentage of patients are receiving inadequate fluid hydration in our ED. After in-service education was provided and changes were implemented in the EHR system, there was statistically significant improvement in the number of patients receiving adequate infusions but a decline in boluses that were given. This may suggest increased efficiency in navigating the EHR potentially made a more significant impact on outcomes than in-service education.

Patients' communication preferences for receiving a cancer diagnosis: Differences depending on cancer stage.

This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis. A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale. Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support. Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

Diagnosis and management of chronic cough: similarities and differences between children and adults.

Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.

Directness of advice giving in traditional Chinese medicine consultations

Many studies of doctor–patient interaction have identified ways healthcare practitioners use various discourse strategies to mitigate the directness of their advice in medical consultations; however, precisely how healthcare practitioners express directness has been overlooked. Traditional Chinese medicine (TCM), one of the most popular therapeutic approaches to medicine, is of increasing importance in medical discourse research despite a relative lack of studies. To contribute to an understanding of modern Chinese medicine practice and doctor–patient communication in the TCM context, this study identifies categories of direct advice occurring in TCM consultations and explores how the directness of Chinese medical practitioners' advice is discursively constructed, negotiated, and perceived by consultation participants. Findings show that Chinese medical practitioners frequently use direct advice to express directness. Direct advice is often phrased in the imperative without mitigations. Occasionally, patients participate in the construction of directness by specifying practitioners' direct advice. Directness is also sometimes mitigated in direct advice via practitioners' medical explanations. Drawing upon the framework of relational work (Watts, 2003), this study argues that participants view advice directness in TCM consultations as judicious and appropriate. Chinese medical practitioners’ directness when offering advice in consultations can be attributed to the medical theory of TCM.

Evaluation of blood donor deferral causes in a tertiary care center

Objective: Blood transfusions save many lives each year globally and henceforth blood is very important for the vitality of humans. In the blood donation, it is very important to maintain safety of the donor and recipient and therefore, donor selection is the most important assessment process of blood donation in addition to the screenings of blood bags for infectious diseases. However, deferrals of blood donors result in loss of precious blood/blood components available for transfusion. For preventing this, it is necessary to have knowledge of causes of deferral and their frequency. This study aims to analyze the blood donor deferral rates, find out various causes of blood donor deferrals and to facilitate proper referral and follow up measure to reduce the rate of temporary deferral. Materials and Methods: It was a cross sectional two years retrospective study including all the blood donors reporting for blood donation from 1st Jan 2015 to 31st Dec 2016 at Dhiraj Hospital, a constituent hospital of S.B.K.S. Medical Institute and Research Center, Vadodara. The study was conducted by obtaining data from records maintained by blood bank and analyzed. Results: Total 9180 people registered for blood donation during the defined time period and out of which 230 donors (2.50%) were deferred. Among the deferred blood donors, 153 (66.52%) were temporary and 77 (33.48%) were permanent. Among temporary deferrals, anemia was the most common cause whereas among permanent deferrals, hypertension was found to be the commonest cause. Conclusion: Analysis and evaluation of blood donor deferral patterns will help medical personnel to emphasize on donor screening. Proper medical examination and explanation to the donor will motivate both selected and deferred donors to self-evaluate their eligibility to donate and return for donation in future.

Mental Capacity of Brain Disease

The concept of mental capacity refers to the a bility to understand medical explanations and make decisions with reference to values. Evaluating mental capacity is associated with patient autonomy and mental capacity is clinically and ethically important. In competent patients, patient self-determination is respected. On the other hand, in incompetent patients, "best interest" is presumed in terms of medical fact and patient value.

Parent Perspectives on Participation in Family-Centered Rounds and Informational Resource Use.

Objectives: Family-centered rounds (FCR) can improve communication and patient/family engagement. While use of informational resources (e.g., tablets, computers on wheels, paper notes) can guide FCR, there are limited data concerning parental perspectives on how use of these resources during FCR, or other factors, affect their engagement. Our objectives were to examine parental perspectives on factors that affect their participation during FCR and preferences for informational resources used.Methods: We performed a cross-sectional study with English-speaking parents (n = 200), of pediatric inpatients at an academic medical center, present during FCR. We surveyed parents to ascertain factors they believed affect their engagement during FCR. We asked about their preferences regarding informational resources used by the medical team. Responses were analyzed using descriptive statistics. Parents described their reasoning behind resource preferences, and we categorized these responses.Results: Parents reported that participation was affected by: clarity of the medical team's explanations (78.5%), understanding the information (75.5%), the child's health (74.5%), and being asked for their input (71%). Few (25%) parents believed the informational resource affects participation. Tablets were the preferred resource (24%) due to portability and ease of use, although 56% of parents had no preference.Conclusions: Parents of hospitalized children placed importance on delivery of clear information and an “invitation” to participate during FCR. The resource used by the team was less important, although tablets were most preferred. Next steps are to examine factors associated with objective measures of participation and further study FCR in families with limited English proficiency.