Revista clínica española
-
For patients to be able to make decisions autonomously (and to grant informed consent), they must have information, understanding, freedom and willingness, with competence a prerequisite for autonomy. Clinicians are often faced with patients lacking competence to make decisions but detect less than half of such cases and often inadequately assess the patients' competence. This article offers guidelines for assessing the competence of patients for whom there are doubts about their ability to make decisions concerning their health. The procedure is based on 5 steps: 1) recognising the conditions that require a competence assessment; 2) fully evaluating the competence; 3) correlating the degree of competence with the complexity of the decision; 4) improving the patient's competence when possible; and 5) establishing who will make the decision.
-
The present article reviews the usefulness of lung ultrasound in the diagnosis, prognostic stratification and treatment of patients with heart failure. The article addresses the technical aspects when performing lung ultrasonography, as well as the importance of the presence of B-lines in the diagnosis and the prognostic value of pulmonary congestion. Moreover, the article reviews the most recently published evidence on the use of lung ultrasound in heart failure. Lastly, the article references the new clinical trials currently underway, including the EPICC study conducted jointly by the Heart Failure and Clinical Ultrasonography Workgroups of the Spanish Society of Internal Medicine.
-
Revista clínica española · May 2020
Completion of the medical certificate of cause of death in Madrid: A descriptive cross-sectional study.
The medical certificate of cause of death is a dual-purpose document: an official registration of an individual's death and a statistical analysis of the populational causes of death. However, the completion of this document in clinical practice creates significant conflicts. ⋯ We propose possible improvements to the official document so that it meets the legal requirements, facilitates its completion and fulfils its function. We also offer recommendations for hospitals that have their own document and suggestions for improving its completion.