Issues in the development of advance directives in mental health care

<i>Background</i>: Interest in advance directives in mental health care is growing internationally. There is no clear universal agreement as to what such an advance directive is or how it should function. <i>Aim</i>: To describe the range of issues embodied in the development of advance directives in mental health care. <i>Method</i>: The literature on advance directives is examined to highlight the pros and cons of different versions of advance directive. <i>Results</i>: Themes emerged around issues of terminology, competency and consent, the legal status of advance directives independent or collaborative directives and their content. Opinions vary between a unilateral legally enforceable instrument to a care plan agreed between patient and clinician. <i>Conclusion</i>: There is immediate appeal in a liberal democracy that values individual freedom and autonomy in giving weight to advance directives in mental health care. They do not, however, solve all the problems of enforced treatment and early access to treatment. They also raise new issues and highlight persistent problems. <i>Declaration</i> <i>of</i> <i>interest</i>: The research was funded by the Nuffield Foundation grant number MNH/00015G

Compression Transmission Collar for Fastening

A compression transmission collar apparatus (20) for implantation into a bone (22) with a hole (28) having a hole wall (32) comprising an intramedullary nail (34) defining a bore (40) and a threaded fastener (42) and a compression transmission collar (58) including an exterior face (64) and a top edge (60) and a bottom edge (62) and a first end (70) intersecting the top edge (60) at an acute angle (α1) and the bottom edge (62) at an obtuse angle (α2) and a second end (72) intersecting the top edge (60) at an obtuse angle α2) and the bottom edge (62) at an acute angle α1) and the first end (70) partially overlapping and opposing the second end (72) to define a slit (74) such that applying a compressional load to the top edge (60) causes the first end (70) to slide relative to and along the second end (72) causing the compression transmission collar (58) to compress axially and expand radially pressing the exterior face (64) against the hole wall (32)

Adjustable Jig and Method for Targeting Interlocking Holes of an Intramedullary Nail

A targeting jig apparatus for targeting interlocking holes of an intramedullary nail. The targeting jig includes a support-arm extending substantially parallel to the intramedullary nail. A targeting mechanism including a pair of targeting mechanism drioll-guide orifices is adjustably disposed on the support arm for aligning the targeting mechanism drilol-guide orifice with the interlocking holes of the intramedullary nail. The targeting mechanism includes a saddle having a U-shape including a base and parallel legs that are slidable along the support-arm. A connection mechanism includes a horizontal slot on the support-arm aligned with a vertical slot on the targeting mechanism and a pivot screw extending through the slots for facilitating adjustment of the targeting mechanism relative to the support arm

Compression Transmission Collar for Fastening

A compression transmission collar apparatus for implantation into a bone with a hole having a hole wall comprising an intramedullary nail defining a bore and a threaded fastener and a compression transmission collar including an exterior face and a top edge and a bottom edge and a first end interstcting the top edge at an acute angle and the bottom edge at an obtuse angle and a second end intersecting the top edge at an obtuse angle and the bottom edge at an acute angle and the first end partially overlapping and opposing the second end to define a slit such that applying a compressional load to the top edge causes the first end to slide relative to and along the second end causing the compression transmission collar to compress axially and expand radially pressing the exterior face against the hole wall

Compression Transmission Collar for Fastening

A compression transmission collar apparatus (20) for implantation into a bone (22) with a hole (28) having a hole wall (32) comprising an intramedullary nail (34) defining a bore (40) and a threaded fastener (42) and a compression transmission collar (58) including an exterior face (64) and a top edge (60) and a bottom edge (62) and a first end (70) intersecting the top edge (60) at an acute angle and the bottom edge (62) at an obtuse angle and a second end (72) intersecting the top edge (60) at an obtuse angle and the bottom edge (62) at an acute angle and the first end (70) partially overlapping and opposing the second end (72) to define a slit (74) such that applying a compressional load to the top edge (60) causes the first end (70) to slide relative to and along the second end (72) causing the compression transmission collar (58) to compress axially and expand radially pressing the exterior face (64) against the hole wall (32)

Easily Implantable and Stable Nail-Fastener for Skeletal Fixation and Method

An intramedullary nail (20) for insertion into the medullary canal (26) in a bone (24) surrounded by the cortex (28) and defines a bore (34) extending transverse to the intramedullary nail (20). A threaded fastener (22) extends along a fastener axis (A) and has a compression portion (48) having a compression portion diameter (DCP), and a threaded portion (50) having a threaded portion diameter (DTP) extending through a near cortex hole (40) and a far cortex hole (42), both holes (40, 42) radially overlapping the bore (34) and the threaded portion diameter (DTP) threadedly engaging the bore (34). A compression transmission device (54) has an exterior (56) and an interior (58) and defines an interior space for transmitting the compressional load of the threaded fastener (22) to the intramedullary nail (20). The threaded fastener (22) extends through the compression transmission device (54) and the intramedullary nail (20) and the far cortex hole (42) for threadedly engaging the bore (34) and fixating the intramedullary nail (20) within the medullary canal (26). The interior space of the compression transmission device (54) is greater than the compression portion diameter (DCP) of the fastener (22) for providing space at least partially about the threaded fastener (22) for allowing the fastener axis (A) to be variously disposed relative to the interior space

Difference in Bioimpedance Across the Knee in Un-Injured Young Adults

Background Knee injuries induce swelling and resolution of swelling may be a useful factor in identifying states of healing and time to return to sports activities. Recent work has suggested that bioimpedance can provide an objective measure of swelling following total knee arthroplasty (TKA) and therefore may also provide guidance for clinical decision-making following knee injury. This study measures knee bioimpedance in young, active people to help define baseline variability and factors that influence limb to limb differences. Methods Bioimpedance was measured via sensors placed at the foot/ankle and thigh, in positions similar to those suggested for monitoring post-TKA swelling. Initial tests were performed to verify method repeatability, then bioimpedance was measured in a convenience sample of 78 subjects (median age 21yrs). The influence of age, BMI, thigh circumference, and knee function (KOOS-JR) on the impedance measures and difference in impedance between the subject’s knees were examined using a generalized multivariable linear regression. Results The repeatability study measurements were highly consistent with a COV of 1.5% for resistance and an ICC of 97.9%. Women exhibited significantly larger dominant limb impedance and larger limb to limb difference in impedance than men. Regression analysis indicated that subject sex and BMI significantly influenced bioimpedance but joint score and age did not. The limb to limb differences in impedance were small on average (\u3c5%), with larger magnitudes of difference associated with female sex, lower knee function scores, and larger limb to limb differences in thigh circumference. Conclusion Bioimpedance measurements across right and left knees of healthy young people were similar, supporting use of bioimpedance measures from a patient’s uninjured knee as a benchmark to monitor healing of a contralateral injured knee. Future work should focus on understanding how knee function scores and bioimpedance are related, and further explore how sex and side to side anatomic differences impact the measurement

Adjustable Jig and Method for Targeting Interlocking Holes of an Intramedullary Nail

A targeting jig apparatus for targeting interlocking holes of an intramedullary nail. The targeting jig includes a support-arm extending substantially parallel to the intramedullary nail. A targeting mechanism including a pair of targeting mechanism drill-guide orifices is adjustably disposed on the support arm for aligning the targeting mechanism drill-guide orifice with the interlocking holes of the intramedullary nail. The targeting mechanism includes a saddle having a U-shape including a base and parallel legs that are slidable along the support-arm. A connection mechanism includes a horizontal slot on the support-arm aligned with a vertical slot on the targeting mechanism and a pivot screw extending through the slots for facilitating adjustment of the targeting mechanism relative to the support arm

Balancing autonomy and risk: the Scottish approach

The impact of compulsory measures of medical treatment for mental disorders have for some time interested medical and legal commentators, possibly because of the complex ethical issues these raise. In a context where stigma and discrimination are realities for many of those who use mental health services some people argue that holistic legislation, which places treatment for mental disorder within amore general framework of incapacity law, could reduce the stigma of mental ill health. Szmukler, Daw and Dawson have made an interesting attempt to show how such a law might look inpractice. They have built on and reflected the work of the Bamford Committee in Northern Ireland, which, while recommending a single legislative basis for mental health and incapacity law, fell short ofproducing a draft bill.In looking at these proposals from a Scottish perspective, we have resisted the temptation to focus on points of detail and have attempted to discuss certain themes. In particular, we have looked at how Scotland has introduced a capacity-based threshold for mental health law and how this compares with Szmukler et al’s proposed approach