Capacity In Patients Research Articles

Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study.

Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses. In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH2O with positive end-expiratory pressure (PEEP) level of 0-cmH2O (PSV7PEEP0), PSV 0-cmH2O with PEEP 0-cmH2O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure-time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous. Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH2O s/min, median and interquartile range, IQR) was 256 (208-321) after extubation, 192 (127-281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235-347) at the end of PSV0PEEP0 and 262 (198-338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe. Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

The Concept of Health, From Definition to Measurement and the Implications of the Reserves-Based Model for Nursing in France.

To discuss a reserves-based model of Health, recently developed in the literature, defining Health and moving from conceptual considerations to methods of measuring Health, applicable to nursing practice and research. Discursive paper. A discursive paper critically synthesising a reserves-based model of Health for conceptualising and operationalising Health, with reference to key Health theories from nursing science and social epidemiology. In the reserves-based model of Health, Health was defined as the ability to maintain/restore physical, socioemotional, cognitive and physiological health reserves in order to adapt and self-manage to life's challenges. Health was measured by the sum of indicators of deterioration of health reserves. The reserves-based model of Health defining Health through the prism of adaptation reinforces the holistic vision of Health, appropriate to nursing practice, based on the interconnectedness of the whole person and the whole system. This reserves-based model of Health is likely to modify nursing practices. Nursing diagnosis of patient adaptation could be implemented, in order to offer support care adapted to the patient's capacity to adapt, enabling health promotion strategies to be developed. Nursing research on health reserves is a future promising direction to act on individuals' capacity to adapt.

Comparative Analysis of Rehabilitation Strategies Following Ankle Fracture Surgery: A Systematic Review.

Considering various forms of immobilization that enable early weight-bearing or exercise initiation, rehabilitation following an ankle fracture can start shortly after the fracture has been repaired. Alternatively, after the period of immobility, physical or manual therapy may be used to begin rehabilitation. This systematic review aimed to compare different rehabilitation strategies after ankle fracture surgery. Four different databases (Scopus, Web of Science, PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online, and Google Scholar) were used to retrieve the relevant data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized and quasi-randomized controlled trials involving people undergoing every type of rehabilitation therapy following an ankle fracture surgerywere taken into consideration. The main result was a limitationin activities. Adverse events and impairments were instances of such secondary outcomes. A total of 31 studies were found to be eligible for inclusion in this systematic review. The use of exercise and a removable form of immobilization during the immobilization phase to enhance activity limitation is supported by very little evidence. The patient's capacity to adhere to this treatment plan is crucial due to the possible higher risk. To support the available data, more carefully planned and sufficiently powered clinical trials must be conducted.

의사의 미성년 환자에 대한 설명의무

Medical treatment is based on a contract between the doctor and the patient, and the doctor must obtain the patient's consent to the medical treatment. This is to protect the patient's right to self-determination, and as a prerequisite for consent, the doctor is obligated to explain the medical treatment. However, there is no explicit regulation and no case law has directly addressed the duty of explanation for minor patients, but the recent Target Judgment has for the first time suggested that doctors have a direct duty to explain to minor patients and the requirements for determining that the duty of explanation has been violated. As a prerequisite to discussing the validity of the target judgment, we examined the general theory of a physician's duty of explanation, the legal basis for a minor patient's capacity to consent, and the difference between a minor patient's capacity to consent to medical treatment and civil law capacity. We also confirmed that the term decision-making capacity, as used in the target judgment and the statute, has virtually the same meaning as consent. After concluding that the duty of explanation to a minor patient is generally fulfilled by indirect explanation, but only by direct explanation, the case law sets out two requirements for recognizing a breach of a doctor's duty of explanation to a minor patient. There are several problems with the logic of the target judgment, first of all, considering that the other party to the duty of explanation, the minor patient, has decision-making capacity, adopting the direct explanation method is consistent with the protection and welfare of the minor patient's right to self-determination; secondly, even according to the logic of the target judgment, the criteria for determining decision-making capacity is still ambiguous; and thirdly, the indirect explanation method may be preferable in some cases, such as when a minor patient refuses medical treatment, which is an example of a situation where the target judgment requires the direct explanation method. Considering the problems with the subject judgment, it is recommended that the direct explanation method, in which the physician directly explains the medical procedure to the minor patient, should be the principle for the physician's duty to explain the medical procedure to the minor patient, and that specific practice guidelines should be developed to allow indirect explanations to minimize the confusion that may arise in the medical field.

Savings in social expenditures for work incapacity in patients with inflammatory bowel disease depend on access to innovative therapies in Poland.

Inflammatory bowel diseases (IBD) are an increasing burden for societies. We examined Polish Social Insurance Institution (ZUS) work incapacity expenditures for people with IBD compared with the general population. Aggregate data were obtained on ZUS expenditures between 2012 and 2021 in Polish zlotys (PLN). Annual work incapacity benefit expenditures were analyzed and IBD benefit expenditures were examined relative to innovative IBD drug utilization in individual provinces. Between 2012 and 2021, annual ZUS expenditures per person increased, while expenditures per IBD patient decreased. Proportionally, absenteeism was the largest ZUS expenditure in the general population, while disability pensions were the largest in the IBD population. ZUS expenditures due to absenteeism in the general population increased by PLN 282 per person; those due to disability pensions decreased by PLN 85. Disability pension spending due to Crohn's disease (CD) and ulcerative colitis (UC) decreased by PLN 371 and PLN 284, respectively, while absenteeism spending per person with CD and UC decreased (PLN 58 and PLN 35, respectively). Nationwide in 2021, 8.5% of people with CD and 1.9% of those with UC received innovative drugs. The percentage of people receiving innovative drugs and ZUS expenditure per person were inversely related in 9/16 provinces for CD and 5/16 for UC. Polish state spending on work incapacity benefits increased in the general population but decreased in people with IBD between 2012 and 2021. Use of innovative drugs was associated with reduced spending per person with IBD in some provinces.

The Role of Illness Perception and Self-Efficacy in Determining Quality of Life among Cancer Patients.

The quality of life for people with chronic illnesses like cancer has been shown to be significantly impacted by self-efficacy and perceptions of their illness. This study investigates the relationship between cancer patients' perceptions of their illness, their self-efficacy beliefs, and their quality of life. Conducted from December 2022 to February 2023, this research involved 120 adults undergoing cancer treatment. We utilized the Illness Perception Questionnaire (IPQ), the Arabic version of the Cancer Behavioral Inventory Brief (CBI-B), and the Arabic EORTC QLQ-C30, alongside clinical data collection. Statistical analyses included Pearson correlation and descriptive statistics. Breast cancer emerged as the most common type among participants. A positive correlation was found between self-efficacy and quality of life, as measured by the EORTC QLQ-C30, particularly in relation to symptom management. Interestingly, all dimensions of illness perception correlated with quality of life, except for control and concerns. The findings underscore the vital role of nurses and healthcare providers in aiding cancer patients to develop and utilize self-management strategies effectively. The study reveals that a patient's capacity to manage their illness is significantly influenced by their confidence, understanding of their condition, and overall quality of life. Addressing these aspects can greatly enhance healthcare professionals' contribution to improving the resilience and well-being of individuals battling cancer.

Awake magic: glioblastoma resection under 5-aminolevulinic acid guidance during awake craniotomy. A case report with video demonstration

An awake craniotomy's primary goal is to remove the tumor or damaged cells as much as possible without affecting the patient's capacity for clear thought or other crucial functions. This surgical procedure offers a better prognosis by balancing the maximum removal of lesions with the preservation of working zones. For patients with malignant gliomas, the current neurosurgical objective is for resection the large part of a tumor using contrast and not causing neurological deficits. Neurooncological patients are required to have further chemotherapy and radiotherapy, with a control MRI of the brain in 3 and 6 months. Real multidisciplinary work should be provided to improve each patient's quality of life and overall survival. This paper aims to report single case of successful awake craniotomy with fluorescence guidance and discuss the outcomes of the performed surgery.

Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services.

Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient's spouse, or other loved one or caregiver, revokes the patient's valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult's valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient's capacity to give or relinquish informed consent, the surrogate's intent and use of substituted judgment or best interest, and the clinician's duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.

The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care.

This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners.

S109 Savings in Social Expenditures for Work Incapacity in Patients With Inflammatory Bowel Disease Depend on Access to Innovative Therapies in Poland

S109 Savings in Social Expenditures for Work Incapacity in Patients With Inflammatory Bowel Disease Depend on Access to Innovative Therapies in Poland

High Rates of Treatment Failure and Amputation in Modular Endoprosthesis Prosthetic Joint Infections Caused by Fungal Infections With Candida.

Fungal prosthetic joint infections (PJIs) are rare yet severe events associated with high rates of recurrent infection. Although bacterial PJIs associated with megaprostheses are known to be associated with higher rates of recurrence and amputation, little is known about fungal PJIs near megaprostheses. In patients with fungal megaprosthesis PJIs from one institutional registry, we asked: (1) What were the most common microorganisms isolated? (2) What were the reoperation-, revision-, and amputation-free survival rates 1 and 2 years after surgery? We conducted a retrospective analysis of megaprostheses in our institutional database. Between 2000 and 2022, 86 patients with a diagnosis of PJI after megaprosthesis implantation were surgically treated at our institution. We considered patients with microbiological cultures that were positive for fungal organisms and who had a minimum follow-up of 2 years from the initial treatment for PJI. Ten patients with fungal megaprosthesis PJIs were included. Although four patients had a follow-up shorter than 2 years, all reached one of the study endpoints at that earlier interval, and therefore were included. All included patients were treated between 2016 and 2022, and the diagnosis of PJI was made in accordance with the 2011 Musculoskeletal Infection Society criteria. Patients were treated with either debridement, antibiotics, and implant retention (DAIR), DAIR-plus (debridement, antibiotics, modular implant component exchange, and stem retention), or one-stage or two-stage revision. In general, DAIR was used for acute PJIs, while DAIR-plus was performed in patients with chronic PJIs who were deemed medically unfit to endure the high morbidity associated with removal of the stems. In cases of prior unsuccessful DAIR-plus or patients with fewer comorbidities, one-stage or two-stage revision was the main treatment approach. The median age at diagnosis was 67 years (range 32 to 84 years), 5 of 10 patients were female, and the median BMI was 31 kg/m 2 (range 20 to 43 kg/m 2 ). The median follow-up was 26 months (range 1 to 54 months). A Kaplan-Meier survival analysis was performed to calculate reoperation-, revision-, and amputation-free survival at 1 and 2 years from the index surgery for PJI. The two most common organisms were Candida albicans (5 of 10 patients) and C.parapsilosis (3 of 10). Six of 10 patients had coinfection with a bacterial organism. One-year reoperation-free and revision-free survival were 35% (95% CI 9% to 64%) and 42% (95% CI 11% to 71%), respectively. Two-year reoperation-free and revision-free survival were 12% (95% CI 1% to 40%) and 14% (95% CI 1% to 46%), respectively. Amputation-free survival was 74% (95% CI 30% to 93%) at the 1-year interval and 40% at the 2-year interval (95% CI 7% to 73%). At the final follow-up interval, four patients had undergone amputations and four were being administered chronic antifungal suppression. Megaprosthesis fungal PJIs are rare but devastating. Arthroplasty surgeons should consider treatment efficacy, which appears to be low across surgical strategies, and the patient's capacity to withstand it. A lower decision threshold for performing amputation may be considered in patients who require rapid infection control to initiate immunosuppressive treatments. Future studies should aim to compare the surgical and clinical outcomes of fungal PJIs with those of other etiologies while controlling for potential variables. Efforts should be made to establish multi-institutional collaborations to achieve larger study samples. Level IV, therapeutic study.

Motor Imagery Assesment Methods: A Narrative Review

Motor imagery is the mental rehearsal of movements without revealing any movement. It is a complex phenomenon that is difficult to study, understand and explain since it requires mental planning and preparing. It is particularly challenging to evaluate to what extent movements are mentally represented. However, not everyone experiences the same level of vividness and intensity in their vision. The study procedure in this area is complicated by the fact that there are variations in people's imagery styles. Although exercises that involve motor imagery have been found to be successful in physiotherapy, there is a crucial link between imagery skill and the effectiveness of the practice. This review's objective is to provide information on the tests used in physiotherapy clinics to assess a patient's capacity to use motor imagery.

Aide active à mourir et maladie mentale : le concept d’incurabilité est-il scientifiquement acceptable et éthiquement recevable ?

Laws granting the right to obtain active assistance in dying initially concern people suffering from incurable illnesses that cause unbearable suffering and are life-threatening in the short to medium term. But these laws are always followed by proposals and debates aimed at extending the indications for euthanasia or assisted suicide to incurable conditions, even if they are not life-threatening, as soon as they cause unbearable suffering. And so it is that some countries accept psychiatric illnesses that are declared incurable as indications for access to active assistance in dying. In Belgium and the Netherlands, for example, the press has reported on cases of people suffering from depression or post-traumatic stress disorder who have been euthanized at the end of an authorization process that involves two psychiatric opinions declaring their condition incurable, without any collegial reflection on the diagnosis or the therapeutic programs implemented. Depression and post-traumatic stress disorder, however, account for less than half of all indications for euthanasia for psychiatric illness in Belgium. That leaves us with patients labelled psychotic and with ill-defined personality and behaviour disorders. Psychiatric indications for euthanasia raise their own specific ethical issues. How can we fail to underline the uncertainty and complexity of the diagnosis, which cannot, as a rule, be supported by imaging or biology? How can we understand that indications for euthanasia are accepted for patients with several psychiatric diagnoses? From one end of the procedure to the other, the problem is to obtain the opinions of two psychiatrists declaring that the disorders are incurable, that the suffering is intolerable and that the patient's capacity for discernment is intact. The decision thus stems from a libertarian paternalism convinced of the humanist dimension of active aid in dying, and which results in an incentive (nudge) whose aim, set by the law, is only to know whether the suffering is incurable, without calling into question the diagnosis and therapeutic programs. How can we say that a mental illness is incurable? How can we distinguish between a depressed person's disgust with life and so-called existential suffering? How can we reconcile preventing suicide in cases of depression and social isolation, while at the same time encouraging assisted suicide or euthanasia for the same people? What are the criteria for verifying that the capacity for discernment has been preserved? Is there not a danger, in the name of autonomic relentlessness, of declaring that a person is autonomous when in fact he or she is subject to the heteronomy of depression, delirium or obsessive disorders? The world of psychiatry cannot avoid such questions. The American Psychiatric Association, for example, has adopted the position on medical euthanasia holding that “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death”. Other psychiatric associations have hesitant positions. The debate must be opened. It must involve all those who treat, care for and support people of all ages whose mental health is suffering. It must also concern every citizen.

Curcumin‐loaded nanomedicines as therapeutic strategy in malaria management

AbstractMalaria, a parasitic protozoan disease widespread in tropical climates, is transmitted by Plasmodium spp. Many people are affected by this significant public health disease, which has a high incidence of illness and mortality worldwide. Because drug‐resistant parasites are on the rise, there are not enough controls on mosquitoes, and there are not any malaria vaccinations. Malaria is particularly challenging in developing countries. Antimalarial drugs approved by Food and Drug Administration are the main options for combating and preventing malaria; also the control of transmission at the level of mosquitoes is important. Current antimalarial chemotherapeutic therapies have significant clinical flaws such as Plasmodium resistance, the drugs that call for the development of novel drug candidates. To combat malaria, nanotechnology may give a viable alternative that is both more effective and safer than current treatment options. Nanotechnology‐based curcumin formulations have proved to overcome the limitations of current therapies in terms of optimum therapeutic benefits, safety, and cost‐efficiency, which increases a patient's capacity to adhere to prescribed medicine. The limits of current malaria therapies and the need to employ nanotechnological curcumin to treat malaria were addressed and discussed in this paper.

Informed consent for endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists should involve the patient in the decision-making process about the most appropriate endoscopic procedure for that individual, in keeping with a patient's right to self-determination and autonomy. Recognition of this has led to detailed guidelines on informed consent for endoscopy in some countries, but in many no such guidance exists; this may lead to variations in care and exposure to risk of litigation. In this document, the European Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that cover best practice in informed consent for endoscopy. These statements should be seen as a minimum standard of practice, but practitioners must be aware of and adhere to the law in their own country. 1: Patients should give informed consent for all gastrointestinal endoscopic procedures for which they have capacity to do so. 2: The healthcare professional seeking consent for an endoscopic procedure should ensure that the patient has the capacity to consent to that procedure. 3: For patients who lack capacity, healthcare personnel should at all times try to engage with people close to the patient, such as family, friends, or caregivers, to achieve consensus on the appropriateness of performing the procedure. 4: Where a patient lacks capacity to provide informed consent, the best interest decision should be clearly documented in the medical record. This should include information about the capacity assessment, reason(s) that the decision cannot be delayed for capacity recovery (or if recovery is not expected), who has been consulted, and where relevant the form of authority for the decision. 5: There should be a systematic and transparent disclosure of the expected benefits and harms that may reasonably affect patient choice on whether or not to undergo any diagnostic or interventional endoscopic procedure. Information about possible alternatives, as well as the consequences of doing nothing, should also be provided when relevant. 6: The information provided on the benefit and harms of an endoscopic procedure should be adapted to the procedure and patient-specific risk factors, and the preferences of the patient should be central to the consent process. 7: The consent discussion should be undertaken by an individual who is familiar with the procedure and its risks, and is able to discuss these in the context of the individual patient. 8: Patients should confirm consent to an endoscopic procedure in a private, unrushed, and non-coercive environment. 9: If a patient requests that an endoscopic procedure be discontinued, the procedure should be paused and the patient's capacity for decision making assessed. If a competent patient continues to object to the procedure, or if a conclusive determination of capacity is not feasible, the examination should be terminated as soon as it is safe to do so. 10: Informed consent should be sufficiently detailed to cover all findings that can be reasonably anticipated during an endoscopic examination. The scope of this consent should not be expanded, nor a patient's implicit consent for additional interventions assumed, unless failure to proceed with such interventions would result in immediate and predictable harm to the patient.

Medical consent in the era of personalized medicine: Issues and recommendations

Free and informed consent as a manifestation of adherence to a therapeutic act in medicine is central to the patient-physician relationship. Despite the medical advances of personalized medicine, it weakens the patient-physician relationship and thus the patient's capacity to consent, due to the increasing complexity of the analysis of available data and the intervention of a large number of specialist physicians in the care trajectory. This article proposes to examine the consequences of personalized medicine on the transmission and nature of information, to rethink the patient-physician relationship and the conditions under which consent is possible. Beyond the impacts of personalized medicine, we believe that the role of the doctor is similar to that of a coordinator capable of ensuring the transmission and coherence of information communicated to patients according to their needs with a view to restoring their understanding of the disease and the therapeutic proposals made to them.

Sollerman Hand Function Sub-Test "Write with a Pen": A Computer-Vision-Based Approach in Rehabilitation Assessment.

Impaired hand function is one of the most frequently persistent consequences of stroke. Throughout the rehabilitation process, physicians consistently monitor patients and perform kinematic evaluations in order to assess their overall progress in motor recovery. The Sollerman Hand Function Test (SHT) is a valuable assessment tool used to evaluate a patient's capacity to engage in daily activities. It holds great importance in the field of medicine as it aids in the assessment of treatment effectiveness. Nevertheless, the requirement for a therapist's physical presence and the use of specialized materials make the test time-consuming and reliant on clinic availability. In this paper, we propose a computer-vision-based approach to the "Write with a pen" sub-test, originally included in the SHT. Our implementation does not require extra hardware equipment and is able to run on lower-end hardware specifications, using a single RGB camera. We have incorporated all the original test's guidelines and scoring methods into our application, additionally providing an accurate hand spasticity evaluator. After briefly presenting the current research approaches, we analyze and demonstrate our application, as well as discuss some issues and limitations. Lastly, we share some preliminary findings from real-world application usage conducted at the University campus and outline our future plans.

The assessment of the effectiveness and safety of teduglutide in the treatment of children with chronic intestinal insufficiency. A systematic review

Chronic intestinal failure is a pathogenetic component in children with short bowel syndrome. Short bowel syndrome limits the patient's capacity to socialize fully, the bad prognosis of the child's physical and spiritual development, and the patient's family's organizational and material issues. The severity of the problem is aggravated by the limited prospects for surgical treatment of patients, including transplantology, the imperfection of the legal framework for health care, particularly in terms of parenteral nutrition at home, and the supply of expensive drugs, consumables, and equipment to children with short bowel syndrome under state guarantees. Developing an equivalent of glucagon-like peptide-2 (GLP-2), a drug teduglutide representing the endogenous intestinal growth factor and intestinal adaptation, created an additional therapeutic possibility for individuals with short bowel syndrome. There are no data in Russian academic literature on the efficacy and safety of teduglutide in pediatric practice.&#x0D; This study aims to conduct a systematic search and critical analysis of publications on the effectiveness and safety of using teduglutide in children with short bowel syndrome.&#x0D; Publications from the PubMed, Scopus, and eLibrary databases, as well as scientific journals, were examined from 2012 to 2022. The articles were reviewed in English and Russian. Seven hundred seventy publications on using teduglutide in experimental and clinical practice were found; 94 sources matched the keywords; and eight articles were selected according to the PRISMA criteria. The risks of confounding bias were assessed using the ROBINS-I tool. Most patients received the therapeutic impact of teduglutide, and 8.4%64.7% of patients achieved enteral autonomy. The drug's dose was 0.05 mg/kg/day. Without a therapeutic effect, the time limits for the inappropriate use of teduglutide ranged from 6 months to 1 yr. There is no causal relationship between taking teduglutide and undesirable reactions to treatment. The review of publications revealed an insufficient evidence foundation for the efficacy of teduglutide due to a lack of control groups in most studies, a small sample size, and errors in data methodology. Despite the encouraging preliminary results of individual studies, the problem of a shortage of randomized controlled tests of teduglutide remains.

Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.

Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options. Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population. This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed. There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, -2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate. In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.

Towards a concept of embodied autonomy: In what ways can a patient's body contribute to the autonomy of medical decisions?

"Bodily autonomy" has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient's bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient's capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual's capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient's body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law.