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Biomedical subjects

B Freedman

Publications and source records attributed to B Freedman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Case notes and charting of bioethical case consultations.

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas.

Canada↗
PubMed1993

Viability of the rectus abdominis muscle following internal mammary artery ligation.

The purpose of this study was to determine if the rectus abdominis muscle in the dog model could be used as a transposition flap based on its proximal blood supply following ligation of the internal mammary artery. In 11 dogs, the left internal mammary artery and vein were ligated at the fifth intercostal space. Both the left and right rectus abdominis muscles were elevated from their respective beds, dividing the inferior epigastric and intercostal vascular pedicles. Each muscle was then wrapped in a thin silicone sheet and replaced. One week later the dogs were returned to surgery and the muscles inspected. The right rectus abdominis muscle was completely viable in all the dogs. In 10 of the 11 dogs, the left rectus abdominis muscle was completely viable. We conclude that a superiorly based rectus abdominis muscle in the dog can maintain its viability following ligation of its proximal blood supply at the fifth intercostal space.

Abdominal Muscles↗
PubMed1992

Suspended judgment. AIDS and the ethics of clinical trials: learning the right lessons.

There is a tribe of thinkers who believe that new technological advances and scientific discoveries raise new ethical issues. And it is the case, of course, that scientific and technological change--change in knowledge and power--implies a new realm for choice and, therefore, moral reflection. In the case presently concerning us, they see the AIDS social and scientific crisis as requiring the adoption of new ethical principles. I believe to the contrary. AIDS--more broadly, the entire spectrum of HIV disease--does not in itself present radically new issues at the level of principle. For example, the questions associated with confidentiality and HIV disease that have to this point dominated public discourse about morality and AIDS simply resurrect old questions raised by potentially deadly infectious disease. Recent discussions of the ethical issues associated with HIV-infectious health care workers fail to recognize that HIV is simply a new garb for the old question of the impaired or unsafe practitioner. HIV disease does have this effect on ethical reflection, however: It rubs our noses in issues that may have received insufficient attention to date. The urgency and poignancy associated with moral conflict and HIV disease forces us to face up to questions hitherto ignored. But this may be a good or a bd thing. In the heat of crisis, being human, we are likely to call for change without adequate consideration of the need for and effects of that change.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

Violating confidentiality to warn of a risk of HIV infection: ethical work in progress.

The old literature on whether medical confidentiality may be breached to warn a spouse of a risk of contracting syphilis from his/her partner - a deep and rich literature - has become relevant once again in the context of HIV infection and AIDS. This paper examines the reasoning and method employed in: the Catholic approach centered around the patient's (property) right to the secret; a (generic) model of justice, utilizing minimal principles of non-aggression and restitution; and an approach involving the elimination of unstable alternatives: the view that public health officials, but not the spouse, may/must be notified; and, that maintaining that the physician is at liberty to disclose but is not obliged to do so. The theory and method behind confidentiality turns out to be deeper than you might have anticipated.

Casuistry↗
PubMed1991

Legal liability for injury to research subjects.

In Weiss vs Solomon, the heirs of a subject who died while a volunteer in a nontherapeutic study successfully sued the investigator and his university-affiliated hospital. Without referring to any 'standard of practice', including the MRC Guidelines, the judge found the principal investigator and the hospital (for its research ethics committee) equivalently responsible for not disclosing a rare but fatal complication caused by fluorescein dye and not adequately screening the subject, who suffered from undisclosed hypertropic cardiomyopathy. From the point of view of research institutions, members of research committees, and the investigators themselves, the judgement has left serious uncertainty and ambiguity concerning their responsibilities for subject selection and safety, and disclosure for the purposes of informed consent.

Clinical Trials as Topic↗
PubMed1990

Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement.

The effects of short- and long-term calcium replacement on myocardial function in six asymptomatic patients (age 48 +/- 3, mean +/- SEM) with hypocalcemia complicating surgical hypoparathyroidism were studied. Cardiac output was determined by ascending aortic continuous wave Doppler assessment and was measured as minute distance. During intravenous calcium replacement at rest, ascending aortic minute distance increased from 6.75 +/- 1.10 to 9.17 +/- 1.29 m as the calcium level rose from 1.76 +/- 0.08 to 2.06 +/- 0.19 mmol/L without changes in heart rate and blood pressure (p less than 0.01). The peak velocity and acceleration of blood flow derived from Doppler measurement showed a similar rise during calcium infusion. Symptom-limited cycle ergometry was performed before and 3 months after normalization of calcium by long-term oral therapy. Although the resting cardiac output was unchanged, the maximum cardiac output at peak exercise also increased from a minute distance of 11.58 +/- 1.84 to 15.37 +/- 2.28 m (p less than 0.05), together with an increase of maximum heart rate from 136 to 149 beats/min (p less than 0.05). Exercise duration was also prolonged from 11.9 +/- 2.9 to 13.0 +/- 2.8 minutes. Thus hypocalcemia impairs cardiac performance, but this impairment is reversible with calcium replacement.

Calcium↗
PubMed1989

Factors influencing the time from onset of chest pain to arrival at hospital.

One hundred patients who were admitted to a coronary-care unit were interviewed to determine the time interval from the onset of chest pain to their arrival at the Emergency Department of Royal Prince Alfred Hospital. Forty-nine per cent of patients took longer than two hours and 29% took longer than four hours to arrive at hospital; the patient who reported the longest time interval reached hospital 72 h after the onset of chest pain. Most of the delay between the onset of symptoms and arrival at hospital was a result of the time that the patients took to decide to seek medical attention. Once this decision was made, there was relatively-little delay before hospital presentation in patients who went directly to hospital. However, those patients who contacted a doctor rather than going directly to hospital took significantly longer to arrive at hospital, with a median total time to reach hospital of 212 min compared with 85 min for those who went directly to hospital (P = 0.002). Time delays of this magnitude compromise the efficacy of interventions such as thrombolytic therapy. There should be continuing public education to encourage patients with chest pain to seek early medical attention and, in metropolitan areas, patients with chest pain should be advised to proceed directly to hospital.

Decision Making↗
PubMed1989

Normalised radionuclide measures of left ventricular diastolic function.

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.

Adolescent↗
PubMed1989

The VY tensor fasciae latae musculocutaneous flap.

When first introduced in 1978, the tensor fasciae latae flap was used both as a free-tissue transfer and as a local rotational flap. Its use as a free flap has diminished as other more appropriate flaps for free-tissue transfer have been described. The tensor fasciae latae flap has remained, however, an instrumental flap in the coverage of anterior and posterior soft-tissue defects around the hip region. The purpose of this paper is to present a new design of the tensor fasciae latae flap in the coverage of trochanteric pressure sores. By essentially creating a VY advancement flap into the trochanteric defect with the tensor fasciae latae, one can cover the trochanteric defect with the best-vascularized portion of the flap and avoid the dog-ear deformity.

Adolescent↗