Mijnegenský protokol: https://doi.org/10.1136/jme-2024-109927
Budovat vztah. Použít názvosloví pacienta. Rozšiřovat hypotetickými otázkami.
| - lék - | - SPC - | - poznamka - | - reference - |
| Morfin | ✅ | ||
| Midazolam | https://doi.org/10.1177/2632352419895527 | ||
| Levetiracetam | ❌ | https://doi.org/10.1159/000529461 https://doi.org/10.1089/jpm.2020.0414 | |
| Valproát | ❌ | https://doi.org/10.1177/02692163241234597 | |
| Ketamin | https://doi.org/10.1212/WNL.0000000000010611 | ||
| Fenobarbital | kontinuálně, ne bolus | https://doi.org/10.1136/spcare-2024-005361 https://doi.org/10.1016/j.yebeh.2023.109104 | |
| Ondansetron | ❌ | kontinuálně lepší | https://www.jpsmjournal.com/article/S0885-3924(22)00824-7/fulltext https://doi.org/10.5694/j.1326-5377.1993.tb137805.x |
| - lék - | - podání - | - indikace - | - reference - |
| Midazolam | Bukálně, rektálně, s.c., i.v. | Lék 1. volby při záchvatu, status/analgosedace | https://doi.org/10.1177/2632352419895527 |
| Levetiracetam | Tbl., sirup, i.v., s.c. | lék 2. linie, s.c. lze (off-label) | https://doi.org/10.1159/000529461 https://doi.org/10.1089/jpm.2020.0414 |
| Valproát | Tbl., sirup, i.v., s.c. | lék 2. linie, s.c. lze (off-label) | https://doi.org/10.1177/02692163241234597 |
| Brivaracetam | Tbl., sirup, i.v. | lék 2. linie, [s.c. nelze!!!] | |
| Phenytoin (fosphenytoin) | Tbl., i.v. | Lék 2. linie, [nutné přísně i.v.!!!] | |
| Lacosamid | Tbl., (sirup), i.v. | Lek 2. linie, [s.c. nelze!!!] | |
| Ketamin | i.v., i.m., s.c. | Off-label, lze zvážit jako přídatná léčba u statu | https://doi.org/10.1212/WNL.0000000000010611 |
| Propofol | i.v. | status/analgosedace | https://doi.org/10.1089/jpm.2023.0672 https://doi.org/10.1186/s12883-019-1281-y |
| Fenobarbital | i.v., s.c. | status/analgosedace [s.c. kontinuálně, ne bolus] | https://doi.org/10.1136/spcare-2024-005361 https://doi.org/10.1016/j.yebeh.2023.109104 |
CURVES 10.1378/chest.09-1133 Choose and communicate: Can the patient communicate a choice? Understand: Does the patient understand the risks, benefits, alternatives, and consequences of the decision? Reason: Is the patient able to reason and provide logical explanations for the decision? Value: Is the decision in accordance with the patients value system?
Emergency: Is there a serious and imminent risk to the patient's well-being? Surrogate: Is there a surrogate decision-maker available?
10.1056/NEJMcp074045
Table 1. Legally Relevant Criteria for Decision-Making Capacity and Approaches to Assessment of the Patient.
| - Criterion - | - Patient’s Task - | - Physician’s Assessment Approach - | - Questions for Clinical Assessment* - | - Comments - |
| Communicate a choice | Clearly indicate preferred treatment option | Ask patient to indicate a treatment choice | Have you decided whether to follow your doctor’s [or my] recommendation for treatment? Can you tell me what that decision is? [If no decision] What is making it hard for you to decide? | Frequent reversals of choice because of psychiatric or neurologic conditions may indicate lack of capacity |
| Understand the relevant information | Grasp the fundamental meaning of information communicated by physician | Encourage patient to paraphrase disclosed information regarding medical condition and treatment | Please tell me in your own words what your doctor [or I] told you about: The problem with your health now The recommended treatment The possible benefits and risks (or discomforts) of the treatment Any alternative treatments and their risks and benefits The risks and benefits of no treatment | Information to be understood includes nature of patient’s condition, nature and purpose of proposed treatment, possible benefits and risks of that treatment, and alternative approaches (including no treatment) and their benefits and risks |
| Appreciate the situation and its consequences | Acknowledge medical condition and likely consequences of treatment options | Ask patient to describe views of medical condition, proposed treatment, and likely outcomes | What do you believe is wrong with your health now? Do you believe that you need some kind of treatment? What is treatment likely to do for you? What makes you believe it will have that effect? What do you believe will happen if you are not treated? Why do you think your doctor has [or I have] recommended this treatment? | Courts have recognized that patients who do not acknowledge their illnesses (often referred to as “lack of insight”) cannot make valid decisions about treatment Delusions or pathologic levels of distortion or denial are the most common causes of impairment |
| Reason about treatment options | Engage in a rational process of manipulating the relevant information | Ask patient to compare treatment options and consequences and to offer reasons for selection of option | How did you decide to accept or reject the recommended treatment? What makes [chosen option] better than [alternative option]? | This criterion focuses on the process by which a decision is reached, not the outcome of the patient’s choice, since patients have the right to make “unreasonable” choices |
'* Questions are adapted from Grisso and Appelbaum. 31 Patients’ responses to these questions need not be verbal
10.1016/j.ncl.2010.10.001
Table 1 Capacity instruments
| - Instrument - | - Elements - | - Measured Length of Administration - | - Patient Population - | - Reliability - |
| MacCAT-T | Expression of a choice, Understanding, Appreciation, Reasoning | 15–20 min | Medical inpatients; schizophrenia; dementia; depression; psychosis; anorexia nervosa; normal controls | High interrater reliability |
| CCTI | Expression of a choice, Understanding, Appreciation, Reasoning | 20–25 min | Alzheimer disease (mild and moderate); Parkinson’s disease; normal controls | High interrater reliability |
| HCAT | Understanding | 10 min | Medical inpatients; Alzheimer disease; nursing home residents; psychotic patients in outpatient setting; normal controls | High interrater reliability |
| ACE | Expression of a choice, Understanding, Appreciation | 15 min | Medical inpatients | High interrater reliability |
Abbreviations: ACE, Aid to Capacity Evaluation; CCTI, Capacity to Consent to Treatment Instru␂ment; HCAT, Hopkins Competency Assessment Test II; MacCAT-T, MacArthur Competence Assess␂ment Tool for Treatment
Table 2 Questions to assess the 4 components of capacity
| - Component of Capacity - | - Possible Questions - |
| Expressing a choice | Were you able to give some thought to what we had talked about (ie, proposed treatment, risks, benefits and alternatives)? Have you come to a decision? What is your decision? |
| Understanding of the information regarding treatment | Are you aware of your diagnosis? What have you been told about your diagnosis? Could you please tell me what treatment was recommended and what is your understanding as to how this treatment can improve the condition? What are the benefits of getting this treatment? What are the risks involved in getting this treatment? Are there alternatives to the treatment that were recommended and if so what are the alternatives? |
| Appreciation of the situation as it pertains to the patient | What are your thoughts about what is wrong with your health? Do you think that you require treatment for your current condition? How do you think the recommended treatment can help you? If you decide to not receive treatment, how will this decision affect you? |
| Rational manipulation of the information | What are your thoughts regarding your decision? How is it that you arrived at your decision? What helped you to come to your decision? Are there any beliefs that affected your decision to accept/reject your decision (to assess for delusions and hallucination)? |
Paliativní škála funkční zdatnosti (Palliative Performance Scale – PPS)
| - PPS - | - Pohyblivost - | - Aktivita - | - Symptomy nemoci - | - Soběstačnost - | - Příjem potravy - | - Stav vědomí - |
| 100 | neomezená | normální | žádné | plná | normální | normální |
| 90 | neomezená | normální | mírné | plná | normální | normální |
| 80 | neomezená | normální, vyžaduje úsilí | mírné | plná | normální nebo snížená | normální |
| 70 | omezená | neschopen zaměstnání/práce | významné | plná | normální nebo snížená | normální |
| 60 | omezená | neschopen práce / činností doma | významné | příležitostná pomoc nutná | normální nebo snížená | normální nebo zmatenost |
| 50 | převážně leží nebo sedí | neschopen žádné práce | plně rozvinutá choroba | častá pomoc nutná | normální nebo snížená | normální nebo zmatenost |
| 40 | převážně na lůžku | neschopen většiny činnosti | plně rozvinutá choroba | nutná pomoc s většinou činností | normální nebo snížená | normální nebo spavost +/- zmatenost |
| 30 | trvale na lůžku | neschopen žádné činnosti | plně rozvinutá choroba | úplná nesoběstačnost | snížená | normální nebo spavost +/- zmatenost |
| 20 | trvale na lůžku | neschopen žádné činnosti | plně rozvinutá choroba | úplná nesoběstačnost | srkání tekutin | normální nebo spavost +/- zmatenost |
| 10 | trvale na lůžku | neschopen žádné činnosti | plně rozvinutá choroba | úplná nesoběstačnost | jen zvlhčování úst | spavost nebo bezvědomí +/- zmatenost |
| 0 | smrt | - | - | - | - |
Zařazení do programu mobilní specializované paliativní péče (MSPP) je indikované u pacientů s PPS ≤ 50
Tracheoesophageal Anastomosis for Intractable Aspiration Pneumonia.
Development for Critical CareDevelopment for Critical Care, https://doi.org/10.46409/sr.HJXJ7723 https://soar.usa.edu/cgi/viewcontent.cgi?article=1182&context=scholprojects
Střídání masek: Proper fit, různé typy. Nízkokontaktní masky. Gelové masky Amara. Silikonové vycpávky. Nasal Mask Liners.
Pressure barrier:
Naděžda Špaténková: Poradenství pro pozůstalé. Grada. 2023.
(Kubíčková 2001)