A study of women's views on carrying their medical records during their pregnancy was conducted in Cambridge in 1982.Eighty eight women who were given their fuli records were compared with a control group of 83 women who carried the traditional cooperation card, both groups answering postal questionnaires about the advantages and disadvantages of carrying the-ir respective records. Most women found advantages in carrying the complete record, although it was too large to carry for practical purposes. Both groups experienced difficulty in understanding what was written on their cards. IntroductionMost women in Britain carry the familiar cooperation card with them during pregnancy, on which medical staffrecord details of the pregnancy. This card has been criticised: the space on it is limited, and results of investigations may not be recorded. A few maternity units have given women the main hospital antenatal record to carry throughout pregnancy, and they reported it as successful, although no control group was incorporated in their studies."'3 We therefore studied women's views on carrying their complete record and compared them with views of a control group of women receiving traditional antenatal care.

Background The provision of supported decision-making for people living with disabilities is an emerging area of practice and rights-based law reform, and is required under international law. Objectives This qualitative study aimed to understand how Australian health and legal professionals conceptualised their professional roles in the practice of providing decision-making support for people living with dementia. Methods The methods were informed by grounded theory principles. In-depth, semi-structured interviews were conducted with 28 health and legal professionals involved in providing care or services for people with dementia. Interviews explored how professionals described their practice of providing support for decision-making and how they conceptualised their roles. The analysis was underpinned by the theoretical perspective of symbolic interactionism. Results Participants described providing support across a range of decision domains, some of which were specific to their professional role. Four key themes were identified: ‘establishing a basis for decision-making’, ‘the supportive toolbox’, ‘managing professional boundaries’ and ‘individualist advocacy versus relational practice’. Participants identified a range of generic and specialised techniques they used to provide support for people with dementia. These techniques were applied subject to resource limitations and perceived professional obligations and boundaries. A continuum of professional practice, ranging from ‘individualist advocacy’ to ‘relational practice’ describes the approaches adopted by different professionals. Discussion Professionals conceptualised their role in providing support for decision-making through the lens of their own profession. Differences in positioning on the continuum of ‘individualist advocacy’ through to ‘relational practice’ had practical implications for capacity assessment, engaging with persons with impaired decision-making capacity, and the inclusion of supporters and family members in decision-making processes. Further progress in implementing supported decision-making (including through law and policy reform) will require an understanding of these inter-professional differences in perceived roles relating to the practice of providing decision-making support.

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population.

In order to study the haemocompatibility of metal and carbon coatings, fibrinogen adsorption and platelet adhesion to various coatings have been investigated. Two metallic coatings--titanium and zirconium, and two carbon coatings - isotropic diamond-like and isotropic graphite-like coatings, were prepared by plasma vapour deposition onto stainless steel substrate. It has been shown that the adsorption of fibrinogen to metal and carbon coatings and its post-adsorptive transition are dependent on both the material properties and the fibrinogen environment. The adsorption of fibrinogen from human plasma on titanium and zirconium coatings is similar to that on uncoated stainless steel surface. Both carbon coatings adsorb much greater amount of fibrinogen from plasma, and fibrinogen retention by carbon surfaces is also greater than by metal surfaces. Increased numbers of adhered platelets have been found on both carbon coatings in comparison to the metal materials, although this does not correlate with the amount of adsorbed fibrinogen.

Objective Examine policies of aged care organisations relating to healthcare and lifestyle decision‐making. Methods Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) “Decision‐Making Principles” as a framework. Senior staff (N = 9) with policy development roles participated in follow‐up interviews. Results The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision‐making; however, the nature of this support was often unclear. Interview themes included factors relating to “organisational contexts” “policy development and implementation” and “ethical challenges.” An overarching theme among high‐performing organisations was “proactive response aimed at pre‐empting decision‐making dilemmas”. We provide recommendations for policy development, including a self‐assessment audit tool. Conclusion Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision‐making to meet current best practice principles.