Ethical issues are often not addressed in national clinical practice guidelines for dementia

Main Category: Alzheimer's / Dementia
Article Date: 13 Aug 2013 - 14:00 PDT Current ratings for:
Ethical issues are often not addressed in national clinical practice guidelines for dementia

Twelve national dementia clinical practice guidelines included only half of 31 ethical issues the authors had identified as important in patient care, finds a study by Daniel Strech, of Hannover Medical School, Hannover, Germany, and colleagues, published in this week's issue of PLOS Medicine.

The authors identified current national clinical practice guidelines for dementia care published in English or German. They had previously systematically reviewed ethical issues in dementia care and they used thematic text analysis to assess whether and how the ethical issues were addressed in the guidelines. In the 12 national practice guidelines identified, an average of 49.5% of the 31 ethical issues were addressed (range, 22% to 77%). National guidelines differed substantially with respect to which ethical issues were represented, whether ethical recommendations were included, whether justifications or citations were provided to support recommendations, and to what extent the ethical issues were explained.

The clinical practice guidelines were published by a central governmental institution in 6 countries (Australia, France, Malaysia, New Zealand, Singapore, United Kingdom), by a medical association in 4 countries (Canada, Germany, Scotland, United States of America), one by a statutory health insurance body (Austria), and by an expert panel in one country (Switzerland). The authors state, "All guidelines explicitly acknowledged the involvement of experts from different specialties (most often from psychiatry, neurology, gerontology, and family medicine)."

Four (13%) ethical issues were not addressed in at least 11 out of 12 CPGs: "Adequate consideration of existing advance directives in medical decision making.", "Usage of GPS and other monitoring techniques ", "Covert medication" and "Dealing with suicidality."

The authors conclude, "Ethical issues and how to deal with them are important for guidelines to address, for the medical profession to understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines."

Furthermore, although clinical practice guidelines are "meant to improve standards of clinical competence and professionalism by referring explicitly to evidence-based information on benefits and harms", the authors state that clinical practice guideline development manuals worldwide fail to address how to include disease-specific ethical issues.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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This work has been funded by the German Research Foundation (DFG) through the research project Ethics Guide (STR 1070/2-1). The article processing charge was funded by means of the DFG-Project ‘‘Open Access Publishing’’ by the German Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

PLoS Med 10(8): e1001498. doi:10.1371/journal.pmed.1001498

Knüppel H, Mertz M, Schmidhuber M, Neitzke G, Strech D (2013)

PLOS Medicine

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Binge eating with bipolar disorder likely increases psychiatric issues including suicidal thoughts, anxiety

Main Category: Bipolar
Also Included In: Eating Disorders;  Obesity / Weight Loss / Fitness
Article Date: 29 Jul 2013 - 1:00 PDT Current ratings for:
Binge eating with bipolar disorder likely increases psychiatric issues including suicidal thoughts, anxiety

Bipolar disorder evolves differently in patients who also binge eat, a study by Mayo Clinic, the Lindner Center of HOPE and the University of Minnesota found. Binge eating and obesity often are present among bipolar patients, but the mood disorder appears to take a different path in those who binge eat than it does in obese bipolar patients who do not, the researchers discovered. The findings are published online in the Journal of Affective Disorders.

Up to 4 percent of Americans have some form of bipolar illness, and of those, just under 10 percent also have binge eating disorder - a higher rate of binge eating than seen in the general population, says co-author Mark Frye, M.D., a psychiatrist and chair of the Department of Psychiatry/Psychology at Mayo Clinic in Rochester. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) update released this spring recognizes binge eating disorder as a distinct condition, he noted.

Bipolar patients who binge eat are more likely to have other mental health issues such as suicidal thoughts, psychosis, anxiety disorders and substance abuse, the study found. People with bipolar disorder who are obese but do not binge eat are more likely to have serious physical problems such as arthritis, diabetes, high blood pressure and heart disease.

It was more common for women than men with bipolar disorder to binge eat or to be obese, the study showed.

"The illness is more complicated, and then by definition how you would conceptualize how best to individualize treatment is more complicated," Dr. Frye says. "It really underscores the importance of trying to stabilize mood, because we know when people are symptomatic of their bipolar illness their binge frequency is likely to increase. We want to work with treatments that can be helpful but not have weight gain as a significant side effect."

The researchers used the Mayo Clinic Bipolar Biobank, a collaborative effort by Mayo Clinic, the Lindner Center of HOPE, University of Minnesota and Mayo Clinic Health System. More research is planned to see whether there is a genetic link to binge eating disorder in bipolar disease.

"Patients with bipolar disorder and binge eating disorder appear to represent a more severely ill population of bipolar patients. Identification of this subgroup of patients will help determine the underlying causes of bipolar disorder and lead to more effective and personalized treatments," says co-author Susan McElroy, M.D., chief research officer at the Lindner Center of HOPE.

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The study was funded by the Marriott family. Co-authors also include Scott Crow, M.D., University of Minnesota Medical School; Nicole Mori of the Lindner Center of HOPE; and Joanna Biernacka, Ph.D., Stacey Winham, Ph.D., Jennifer Geske, Alfredo Cuellar Barboza, M.D., Mikel Prieto, M.D., Mohit Chauhan, M.D., and Lisa Seymour of Mayo Clinic.

Mayo Clinic

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Acupuncture Eliminates Health Issues

Acupuncture has existed for thus a long time now. It came from in traditional Chinese and Japanese era. Actually long ago when artificial medicine wasn't sought after our forefathers turn to natural and herbal medications for stopping health issues. It's with these means they have discovered processes not just to cure health issues but additionally to keep a proper condition. This really is really exactly why lots of people nowadays turn to it as being health remedy. Indeed, it's effective.

The potency of Acupuncture could be tracked from the 3 studies that demonstrate that lots of health issues happen to be healed for example joint disease, joint pain, body discomfort as well as heartburn. Ought to be fact, this natural health remedy will help you to refuse surgical options or choices for treating your wellbeing problems. Thus, you are able to say good-bye to needles and dangerous methods. For treating your wellbeing problems especially individuals which involve interiors, you only have to seek and apply natural procedure to have the ability to receive the best rejuvenation and treatment that your system needs. This will help you to are more effective and performance well.

One more reason for seeking Acupuncture like a natural remedy to improve your health problems happens because it possesses a path for the qi or chi to initiate the body. This process includes using specialized needles positioned on your meridian or acupuncture points. This really is to spread out the path. The issue is dangerous if you don't apply this method correctly. It'll lead to body pains and worse, illnesses or any other body conditions. That must definitely be exactly why, it's important for the body to feel the significance of positive flow and rejuvenation for cleansing and relaxation reasons.

What's qi or chi? Qi is recognized as existence pressure or energy within your body. Usually this controls the way you perform and performance inside your day-to-day activities. Its regards to the acupuncture needles is sensible since it is these needles that open a path underneath the skin. It reaches completely for your vital organs due to the tingling sensation and also the utmost utilization in your body. Preserving your qi or chi will certainly stop you from body conditions. Allow that natural, internal and spiritual exercise in your body that you should obtain health
advantages over time.

The results of Acupuncture following the treatment methods are applied within your body include overcoming of the system and getting rid of dangerous substances. That's exactly why after treatment you'll sweat, vomit or sometimes feel restored and reborn because the entire process of Acupuncture is extremely effective it enables you to feel better about yourself inside and outside.

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Acupuncture Fix For Health Issues

Acupuncture continues to be used because the Chinese and Japanese era. It's been introduced here in the current generation to permit others for doing things as treatment, rejuvenation and therapy to individuals especially individuals who're really looking for natural medicine to have the ability to treat their conditions and ailments. It's a method of returning the flow of positive energy as well as the circulation in your body. Actually, with this particular natural treatment, you've got nothing to get rid of because all it will is affect the body both mental and physical right into a more healthy condition.

What's much more beneficial about Acupuncture is it relieves discomfort and suffering of numerous people through its painless process. You may have heard using specialized needles that should be placed unto the body to do this procedure. You could also come with an impression that it's painful. The fact is that the operation is painless. The objective of placing these needles is to produce a path for the pores to produce a path for positive energy and also to prevent any blockage within your body. Thus, this enables your chi or qi to operate normally.

Chi or Qi also describes the body energy or perhaps your flow of one's, through which you need to improve it and keep it inside a healthy condition. Therefore, permitting Acupuncture to get it done for you personally is less of the trouble. Returning the positive energy to your system enables you to definitely work easily and easily since you are not even close to health issues or that you simply feel lighter than in the past. That's the reasons you should make certain that you can to maintain your balance of energy system to ensure that you'll have the ability to work well.

Acupuncture isn't whatsoever an alternate fix for surgical procedures or open injuries. Additionally you need the aid of surgery if required. What Acupuncture does would be to relieve your from discomfort and stress that you simply feel when you're tired, stressed and haggard from work or using their company things. Stop their unwanted effects before they dominate the body. Actually, you should recognize that getting an all natural remedy or medicine to heal the body and eliminate your discomfort, you'll be free of negative conditions.

Indeed, Acupuncture may be the remedy that you're seeking that you should be relieved from internal health issues.

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