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Biomedical subjects

B Lo

Publications and source records attributed to B Lo.

At least 127 records · Page 7Linked to original sources
PubMed1985

How do doctors discuss do-not-resuscitate orders?

Although patient preferences are important in decisions about "do not resuscitate" (DNR) orders, little is known about how physicians discuss these orders with patients. We asked 15 physicians to simulate discussing such orders with a patient. We found a striking variation in whether physicians explicitly asked for patient preferences, how they described cardiopulmonary resuscitation (CPR) and its possible outcomes and whether they made a recommendation to the patient about DNR orders. There was no pattern to the different amounts of information presented about CPR. Physicians gave conflicting reasons for how they individualized discussions with patients. Awareness of such different behaviors may stimulate physicians to examine what they say to patients about this sensitive and important topic and why they say it.

Disclosure↗
PubMed1984

Do patients want to participate in medical decision making?

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.

Adult↗
PubMed1984

The death of Clarence Herbert: withdrawing care is not murder.

Two physicians were charged with murder for discontinuing mechanical ventilation and intravenous fluids for a comatose patient. Although these unprecedented criminal charges were dismissed, the ruling may give physicians little legal reassurance. The case shows the problems in judging prognosis, resolving disagreements with staff, and communicating with families. Indirectly the case suggests how decision making and the care of dying patients may be improved. Physicians will continue to have responsibility for making difficult decisions according to their best medical and ethical judgment, despite legal uncertainty.

California↗
PubMed1984

How good is communication between primary care physicians and subspecialty consultants?

We prospectively studied the communication between 27 referring practitioners and their consultants for 464 consecutive patient referrals from a general internal medicine group practice at a university medical center. The rates of referral among practitioners varied from 0 to 28.1 per 100 patients visits. Though referring physicians provided patient background information in 98% of the cases, they made explicit the purpose of the referral in only 76% of the cases. They contacted consultants directly in only 9% of the cases. In return, consultants communicated their findings to referring practitioners in only 55% of the consultations. Referring physicians who personally contacted consultants or who supplied them with more clinical information were more likely to learn the results of the consultation. While communication between the referring physicians and consultants in this setting is limited, it may be improved if referring physicians supply more clinical information to consultants and contact them directly.

California↗
PubMed1983

Choice and use of blood lipid tests. An epidemiologic perspective.

Serum cholesterol is a useful test in asymptomatic adults who are interested in preventing coronary heart disease (CHD). It guides the decision to recommend a fat-controlled diet to reduce the serum cholesterol level; this intervention probably decreases the risk of CHD in patients with high levels (eg, greater than 240 mg/dL), but not in those with lower levels (the majority). The potential effect of such intervention on absolute (attributable) CHD risk is relatively large in males and in patients with other risk factors. Dietary intervention probably has less effect on CHD risk than eliminating smoking or controlling hypertension. Lipid and lipoprotein tests other than cholesterol are not generally needed, although high-density lipoprotein cholesterol may be useful in certain situations. These epidemiologic considerations, tempered by the preferences of the patient, are useful for individualizing preventive medicine decisions.

Adult↗
PubMed1982

The diagnosis of pulmonary embolus.

In this issue The Western Journal of Medicine begins a new series, "Topics in Primary Care Medicine," that will present articles on common diagnostic or therapeutic problems encountered in primary care practice. These articles will address such frequently occurring problems as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections. These problems usually do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies are often lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series will discuss new tests and therapies and suggest a reasonable approach even when definitive studies are not available. Each article will have several general references for suggested further reading. We hope this new series will be of interest and we welcome comments, criticisms and suggestions.

Humans↗
PubMed1981

Frequency of ethical dilemmas in a medical inpatient service.

We studied the frequency of ethical problems in a general medical ward at a university hospital, using a quasi-experimental prospective design. In the baseline period, ethical problems were determined by self-report of residents. In the intervention period, one of us (B.L.) was a participant-observer during attending rounds. Ethical problems were determined by consensus among the attending physician, resident, and participant observer. No significant differences between baseline and intervention periods were found in patient variations, admissions per resident, or rating of each resident's sensitivity to ethical issues. In the baseline period, seven (3.9%) of 179 cases involved ethical problems. In the intervention period, 16 (17%) of 92 cases involved ethical problems. This difference was significant. The data imply that residents underidentify ethical problems but that sensitization, sympathetic listening, information, and advice increase physician recognition of ethical problems.

California↗
PubMed1980

Clinical decisions to limit treatment.

A case of a patient with gastrointestinal hemorrhage raises the question of limiting medical treatment. We analyze four reasons to limit treatment: Treatment is futile, the patient refuses treatment, the costs of treatment seem excessive, and the quality of life is judged unacceptable. For cases in which treatment is to be limited, we offer practical suggestions for compassionate and appropriate terminal care.

Aged↗
PubMed1980

Ethical decisions in the care of a patient terminally ill with metastatic cancer.

A case of a patient with metastatic cancer raises the issues of patient refusal of treatment, euthanasia, and unintended side effects of therapy. For each management dilemma, there are relevant ethical and legal considerations, justifications, and conclusions. In addition, psychological and social influences on the decision process tend to limit deliberation.

Decision Making↗
PubMed1978

Antibody levels following WI38 rabies vaccine.

WI38 rabies vaccine lots with varying mouse potency ratios were compared in their ability to induce neutralizing antibody in human volunteers. Three vaccination schedules were used: 0, 7 and 14 days; o,7 and 21 days; and 0,28 and 56 days. Regardless of the mouse potency ratio, antibody was barely or not detectable on the 7th day after the first dose of vaccine. After the second dose, however, there was a very good correlation between mouse potency and antibody level attained. Vaccines with potency ratios above 2 gave comparable results, whether the 0, 7, 14 or 0, 28, 56 schedules were used. The lowest potency vaccine, however, have a much better response when given at 0, 7 and 14 days than at 0, 28, and 56 days. Although the vaccine with the greatest potency ratio produced the highest levels of antibody, very adequate responses were obtained in 100% of recipients after three doses of vaccines having a ratio greater than 2, given at 0, 7, 14 or 0, 7, 21 days.

Antibody Formation↗
PubMedDate not supplied

The Supreme Court addresses physician-assisted suicide. Can its rulings improve palliative care?

In June 1997, the US Supreme Court unanimously decided that competent, terminally ill patients have no general constitutional right to commit suicide or to obtain assistance in committing suicide. Thus, the broad prohibitions against any kind of suicide assistance that almost every state has enacted do not violate the constitution. While many of the rulings and the bulk of the reaction to them focused on the Supreme Court's resolution of important legal controversies regarding physician-assisted suicide, this article focuses on the resulting potential for change in physicians' opinions on palliative care. The Court's reasoning may help physicians resolve substantial ethical dilemmas regarding the provision of narcotics given in high dosages, the care of incompetent patients, and the suffering caused by symptoms other than pain. For example, the Court concluded that a physician's intent can distinguish permissible acts of aggressive pain relief from impermissible acts of hastening death. This distinction has clinical uses and can help physicians develop ethical guidelines and practice standards to improve palliative care near the end of life.

Coma↗