Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed. This article sets out best practices for performing the assessment and writing the medical report, common errors, and issues of concern.
Documentation ; Humans ; Mental Competency ; legislation & jurisprudence ; Patient Advocacy ; legislation & jurisprudence ; Physicians ; legislation & jurisprudence ; Proxy ; legislation & jurisprudence ; Singapore ; Third-Party Consent ; legislation & jurisprudence ; Vulnerable Populations ; legislation & jurisprudence ; Writing

The Mental Capacity Act (MCA) came into effect in March 2010 but the impact of this groundbreaking legislation on the doctor-patient relationship has not yet been studied in Singapore. It is evident that communication between healthcare professionals, patients and their loved ones has never been so critical. Translating this into practice, healthcare professionals must identify the decision-maker to obtain consent from the correct person. Consent for healthcare and treatment must be obtained from the patient with capacity or the patient's legally appointed proxy decision-maker under a Lasting Power of Attorney (LPA) where the patient lacks capacity. However, the doctor is the decision-maker for patients lacking capacity in matters of life-sustaining treatment or treatment to prevent a serious deterioration of the patient's health. All decisions made on behalf of persons lacking capacity must be made in their best interests. Capacity assessments must be properly conducted and if a patient has the capacity to make the decision then healthcare professionals must take practicable steps to help them make a decision.
Advance Directives ; legislation & jurisprudence ; Decision Making ; Delivery of Health Care ; legislation & jurisprudence ; Humans ; Informed Consent ; legislation & jurisprudence ; Mental Competency ; legislation & jurisprudence ; Physician-Patient Relations ; Physicians ; legislation & jurisprudence ; Singapore ; Third-Party Consent ; legislation & jurisprudence

Advance Care Planning ; ethics ; legislation & jurisprudence ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Decision Making ; ethics ; Female ; Humans ; Male ; Middle Aged ; Patient Preference ; statistics & numerical data ; Risk Assessment ; Singapore ; Terminal Care ; ethics ; methods ; Third-Party Consent ; ethics ; legislation & jurisprudence

OBJECTIVE: Although advances in neuroradiologic imagings have enabled us to diagnose intrauterine central nervous system(CNS) anomalies, it's management remains difficult because the natural history and postnatal outcome were not well understood. This study is undertaken to clarify the natural history and postnatal outcome of prenatally diagnosed CNS anomaly. METHODS: Between January 1999 and October 2002 there were 18 cases of a fetus with a CNS anomaly prenatally diagnosed by ultrasonography. In six cases, intrauterine magnetic resonance(MR) image was undertaken to confirm the findings when ultrasonography was inconclusive. In this prospective follow-up study the authors have applied the "perspective classification of congenital hydrocephalus(PCCH)" proposed by Oi et al. RESULTS: Hydrocephalus was diagnosed in three cases at PCCH stage I, in six cases at stage II, in 9 cases at stage III. In 8 cases, termination of pregnancy were performed due to severe CNS anomalies. Among these cases, hydrocep halus was diagnosed in 3 cases(100%) at stage I, in 3 cases(50%) at stage II, in 2 cases(22.2%) at stage III. Out of these 8 cases, 5 cases underwent autopsy following parental consent. Of the 10 cases who were delivered, 4(40%) patients were treated. In these 4 cases, hydrocephalus was diagnosed at PCCH stage III(3 fetuses survived, 1 fetus died at 6 months after birth). CONCLUSION: The postnatal outcome is significantly poor in the fetuses with CNS anomaly diagnosed in the early gestation. So it is important to diagnose the fetal CNS anomalies in the early stage of gestation and follow up periodically.
Autopsy ; Central Nervous System* ; Classification ; Fetus ; Follow-Up Studies* ; Humans ; Hydrocephalus ; Natural History ; Parental Consent ; Pregnancy ; Prospective Studies* ; Ultrasonography

PURPOSE: This research compared a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of traumatic lacerations. METHODS: A prospective, randomized, controlled clinical trial enrolled consecutive patients under 5 yearsof age with non-bite, non-crush-induced lacerations who presented less than 6 hours after injury. Data sheets were completed at the time of laceration repair and suture removal. Patients were randomly assigned to treatment with either 2-octhlcyanoacrylate or standard wound closure. Infection was determined at the time of suture removal. Cosmetic appearance for 4 weeks was assessed by physicians using a previously validated categorical cosmetic scale and by patients and parentsusing a 100-mm visual analog scale. RESULTS: There were 14 patients randomized to the octylcyanoacrylate group (group I) and 16 patients, with parental consent, were treated with the standard wound closure technique after being injected with the HCL ketamine (ketalar(R), 5mg/kg) (group II). The two treatment groups were similar with respect toage, gender, medical history, and wound characteristics. Immediately after treatment, tissue adhesive was judged to be more satisfactory than the standard wound closure (tissue adhesive 81 mm vs standard wound closure 76 mm; p=0.003) and the procedure was faster. (tissue adhesive 4.4min vs standard wound closure 6.8min; p=0.001). On the modified Hollander scale, the two groups were similar (tissue adhesive 78% vs standard wound closure 82%; p= 0.662 ). CONCLUSION: Tissur adhesive is a more effective, faster procedure than the standard wound closure, but its use produced no significant difference in the cosmetic appearance.
Adhesives ; Child* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Ketamine ; Lacerations ; Netherlands ; Parental Consent ; Prospective Studies ; Sutures* ; Tissue Adhesives ; Visual Analog Scale ; Wound Closure Techniques ; Wounds and Injuries*

OBJECTIVES: The purpose of this study was to investigate the relationship of cord blood levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in preterm infants with maternal preeclampsia. METHODS: Thirty six preterm infants born at Ewha Womans University Mokdong Hospital from January 2006 to August 2006 were studied after prior parental consent at mid-pregnancy. sFlt-1, PlGF, and VEGF levels in the cord blood of preterm neonate, with or without maternal preeclampsia, were measured using enzyme-linked immunosorbent assay. RESULTS: There was no difference in sFlt-1 between infants with and without maternal preeclampsia. Infants with maternal preeclampsia had significantly lower PlGF levels (P=0.035) and higher sFlt-1/PlGF ratio (P=0.080) with borderline significance. Cord blood VEGF levels were not related to maternal preeclampsia. Infants with maternal preeclampsia had lower birth weight (P=0.030), lower neonatal platelet count without statistical significance (P=0.064) and more likely to be small for gestational age (P=0.057). Neonatal platelet count was significantly correlated with cord blood PlGF levels (r=0.674, P=0.032). CONCLUSION: Increased sFlt-1/PlGF ratio and decreased PlGF may not only be related to the pathophysiology of maternal preeclampsia but also affect the neonatal platelet count and birth weight.
Birth Weight ; Female ; Fetal Blood* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Parental Consent ; Platelet Count ; Pre-Eclampsia* ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor Receptor-1*

Neonates undergoing surgery are at higher risk than older children for anesthesia-related adverse events. During the perioperative period, the maintenance of optimal hemodynamics in these patients is challenging and requires a thorough understanding of neonatal physiology and pharmacology. Data from animals and human cohort studies have shown relation of the currently used anesthetics may associate with neurotoxic brain injury that lead to later neurodevelopmental impairment in the developing brain. In this review, the unique neonatal physiologic and pharmacologic features and anesthesia-related neurotoxicity will be discussed.
Anesthesia* ; Anesthetics ; Animals ; Brain ; Brain Injuries ; Child ; Cohort Studies ; Hemodynamics ; Humans ; Infant, Newborn ; Neurotoxicity Syndromes ; Parental Consent ; Perioperative Period ; Pharmacology ; Physiology

A 15-year old boy visited Samsung Medical Center complaining that when he ate curry and rice two months ago, he developed immediate palatal itching, generalized urticaria, headache and dyspnea. His chest radiographs were normal. He had no history of allergy, but a methacholine provocation challenge test revealed positive findings (PC20 3.62 mg/mL). Skin prick tests revealed positive findings to asparagus, house dust mites (Dp, Df), flower pollens (aster, chrysanthemum, golden rod), weed pollens (mugwort, ragweed, dandelion, short ragweed) and crude extract of curry powder. Specific IgE to Dp, Df and soy bean were positive (6.52, 31.2 and 1.91 kU/L) and total IgE was 1, 207 kU/L by the Pharmacia UniCAP- FEIA. After receiving parental consent, we performed an oral provocation test to confirm the relationship between his symptoms and curry powder. He ingested a small amount of curry powder with pure water, which was increased every 1 hour. We then measured his PEFR every 10 minutes after each subsequent curry powder ingestion. After he ate 20 gm of curry powder in one time, he exhibited profuse sweating, skin rash and dyspnea. When we treated him with epinephrine and bronchodilator, his symptoms improved. He developed the same symptoms 2 hours later, but these symptoms were brought under control by the same medication.
Adolescent ; Ambrosia ; Anaphylaxis* ; Chrysanthemum ; Dyspnea ; Eating ; Epinephrine ; Exanthema ; Flowers ; Headache ; Humans ; Hypersensitivity ; Immunoglobulin E ; Male ; Methacholine Chloride ; Parental Consent ; Peak Expiratory Flow Rate ; Pollen ; Pruritus ; Pyroglyphidae ; Radiography, Thoracic ; Skin ; Soybeans ; Sweat ; Sweating ; Taraxacum ; Urticaria ; Water

PURPOSE: Aeroallergens are important causative factors of allergic diseases. Previous studies on aeroallergen sensitization rates investigated patients groups that had visited pediatric allergy clinics. In contrast, we investigated sensitization rates in a general population group of elementary school to teenage students in Incheon, Jeju, and Ulsan. METHODS: After obtaining parental consent, skin-prick tests were performed on 5,094 students between March and June 2010. Elementary school students were tested for 18 common aeroallergens, whereas middle and high school students were tested for 25 allergens. The 25 allergens included Dermatophagoides pteronyssinus, Dermatophagoides farinae, pollen (birch, alder, oak, Japanese cedar, pine, willow, elm, maple, Bermuda grass, timothy grass, rye grass, orchard grass, meadow grass, vernal grass, mugwort, Japanese hop, fat hen, ragweed, and plantain), and mold (Penicillatum, Aspergillus, Cladosporium, and Alternaria). RESULTS: The sensitization rates in descending order were 25.79% (D. pteronyssinus), 18.66% (D. farinae), 6.20% (mugwort), and 4.07% (willow) in Incheon; 33.35% (D. pteronyssinus), 24.78% (D. farinae), 15.36% (Japanese cedar), and 7.33% (Alternaria) in Jeju; and 32.79% (D. pteronyssinus), 30.27% (D. farinae), 10.13% (alder), and 8.68% (birch) in Ulsan. The dust mite allergen showed the highest sensitization rate among the 3 regions. The sensitization rate of tree pollen was the highest in Ulsan, whereas that of Alternaria was the highest in Jeju. The ragweed sensitization rates were 0.99% in Incheon, 1.07% in Jeju, and 0.81% in Ulsan. CONCLUSION: The differences in sensitization rates were because of different regional environmental conditions and distinct surrounding biological species. Hence, subsequent nationwide studies are required.
Acer ; Allergens ; Alnus ; Alternaria ; Ambrosia ; Artemisia ; Asian Continental Ancestry Group ; Aspergillus ; Child ; Cladosporium ; Cryptomeria ; Cynodon ; Dactylis ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dust ; Fungi ; Humans ; Humulus ; Hypersensitivity ; Lolium ; Mites ; Parental Consent ; Phleum ; Poaceae ; Pollen ; Population Groups ; Salix

Neonatal hypoxic-ischemic (HI) brain injury is a major cause of neonatal mortality and long-term neurodevelopmental disabilities. Although promising neuroprotective interventions have been studied, the current management of HI brain injury has been limited to supportive measures and induced hypothermia. In addition to engrafting, migrating toward the damage sites and differentiating into multiple lineages, multipotent neural stem/progenitor cells (NSPCs) also provide trophic/immunomodulatory factors and integrate into the host neurons upon implantation into an HI-injured brain. However, NSPC-based therapies have shown poor cell survival and integration, poor differentiation or restricted differentiation into the glial lineages. Furthermore, to achieve full functional recovery following brain injury, the optimization of cell therapy is needed to recapitulate the precise migration of stem cells to the region of interest and the neural rewiring present in the brain microenvironment. Therefore, the efficacy of NSPCs in the treatment of CNS injury is currently insufficient. Human NSPCs (hNSPCs) were isolated from the forebrain of an aborted fetus at 13 weeks of gestation with full parental consent and the approval of the Institutional Review Board of the Yonsei University College of Medicine. Here, to enhance the regenerative ability of hNSPCs in HI brain injury, cells were either pretreated with pharmacological agents or engineered to serve as vehicles for gene delivery. Furthermore, when combined with a poly (glycolic acid)-based synthetic scaffold, hNSPCs provide a more versatile treatment for neonatal HI brain injury. Finally, hNSPCs transfected with zinc-doped ferrite magnetic nanoparticles for controlling both cell migration and differentiation offer a simple and smart tool for cell-based therapies.
Aborted Fetus ; Brain Injuries ; Brain ; Cell Movement ; Cell Survival ; Cell- and Tissue-Based Therapy ; Ethics Committees, Research ; Genetic Therapy ; Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Infant ; Infant Mortality ; Nanoparticles ; Neural Stem Cells ; Neurons ; Parental Consent ; Pregnancy ; Prosencephalon ; Stem Cells ; Translational Medical Research