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Biomedical subjects

H D McIntosh

Publications and source records attributed to H D McIntosh.

At least 19 recordsLinked to original sources
PubMed1990

Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations.

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Risk factors for cardiovascular disease and death: a clinical perspective.

Coronary artery disease has been demonstrated to conform to the principles of an epidemic disease. Therefore, the incidence of the occurrence of the disease is dependent in large part on "disturbances of human culture." These primarily include a cholesterol-rich diet, obesity, cigarette smoking, elevated blood pressure and sedentary life-style. It is gratifying that during the last quarter of a century, large segments of society in the United States have modified many of their adverse patterns of living. As a result, there has been a striking decline in both the incidence of the diagnosis of coronary artery disease and the frequency of premature death due to the disease process. Sudden cardiac death is frequently an unexpected first clinical manifestation of coronary artery disease and, despite heroic efforts, treatment of sudden death victims is frequently unsuccessful. Furthermore, progression of coronary artery disease, even in patients who present with angina pectoris or acute myocardial infarction, is unpredictable. Coronary arteriography, the "gold standard" used for evaluation, gives insight primarily into anatomy and ventricular function (under experimental conditions) existing at a given instant in time. Which lesions are serious and likely to progress are usually unknown, even to the most experienced angiographer. Therefore, surgical and catheter-directed therapeutic approaches are at best only "shotgun" or partial techniques. For these reasons, the principal and continuing therapeutic efforts to reduce the occurrence and control the ravages of coronary artery disease should be directed toward prevention. Such efforts should begin in early childhood and become a lifelong practice, one that all physicians, including the most procedure-dominated specialists, should personally adopt and teach.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1986

Education of the patient with cardiac disease in the twenty-first century: an overview.

The current status of education, behavioral change, and use of technology identifies a need for professionals who can develop interactive educational programs and apply existing techniques in a cost-effective manner. The general public, including patients with cardiac disease, are sophisticated consumers of information technology and demand quality production. The challenge is to train specialists to produce educational programs, to instruct health professionals in use of these programs, to deliver appropriate messages, to teach needed skills to patients with cardiac disease, and to evaluate the outcomes. Unless incentives to restore cardiac patients to an optimal functional status with few recurrences and complications are as tangible as are incentives for treating acute cardiac illnesses, the appropriate use of technology to educate patients with heart disease is unlikely to develop. However, the trend to increased ambulatory care under prospective payment systems makes it likely that technology will be applied to improve the efficiency in maintaining health and preventing acute illness. The potential benefits to the nation are substantial.

Attitude to Health↗
PubMed1985

The stabilizing and unstabilizing influences of neurogenic and vascular activities of the heart as related to sudden cardiac death.

Despite the frequency with which sudden cardiac death occurs in affluent societies, little is known about the precise mechanisms by which it is caused. Practically nothing is known about why sudden cardiac death occurs in one but not another person. It is difficult to escape the conclusion that in many instances, the final events occur almost by chance. Therefore, it would appear that every effort should be made by the physician to assist in preventing the changes, that is, cardiomegaly and myocardial ischemia, that appear to be potential markers of sudden cardiac death in many persons. Attention should be directed toward identifying and facilitating stabilizing neurogenic and vascular activities and identifying, controlling and reversing unstabilizing influences likely to foster sudden cardiac death. In the absence of a more complete knowledge of precise mechanisms, the efforts of the physician should be directed toward behavior modifications that appear to reduce the clinical manifestations of coronary heart disease which contribute to the development of cardiomegaly and myocardial ischemia.

Animals↗
PubMed1982

Aortocoronary bypass grafting: an internist's perspective.

Seven hundred fifty thousand to 1 million persons in this country have undergone aortocoronary bypass grafting since 1968, but many questions regarding the indications for the procedure and its advantages and disadvantages persist. Based on this surgical experience and on observations made during the last decade regarding nonoperative therapy and changes in the natural history of coronary heart disease, at least eight considerations should influence attitudes regarding the role of surgery: (1) The operation is a significant addition to the management of some patients with coronary heart disease. (2) The operative mortality in many centers is gratifyingly low. (3) Mortality from coronary heart disease in this country has declined strikingly during the past decade. (4) Because of the declining mortality from coronary heart disease, the prognosis of patients with the disease seen in 1980 is uncertain. (5) Coronary heart disease is a progressive disease and surgery does not prevent the progression of the disease in the native circulation. (6) Reports of therapeutic results, whether surgical or medical, are often biased toward the positive side. (7) Aortocoronary bypass does appear to postpone premature death in symptomatic patients with stenosis of the left main coronary artery, and possibly in symptomatic patients with three-vessel disease and modest impairment of left ventricular contractility. (8) Conclusions of meetings of "experts" regarding therapy may not by applicable to the country at large. The profession and the general public should be so informed.

Coronary Artery Bypass↗