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Biomedical subjects

J Coulehan

Publications and source records attributed to J Coulehan.

At least 19 recordsLinked to original sources
PubMed2001

Vanquishing virtue: the impact of medical education.

North American physicians emerge from their medical training with a wide array of professional beliefs and values. Many are thoughtful and introspective. Many are devoted to patients' welfare. Some bring to their work a broad view of social responsibility. Nonetheless, the authors contend that North American medical education favors an explicit commitment to traditional values of doctoring-empathy, compassion, and altruism among them-and a tacit commitment to behaviors grounded in an ethic of detachment, self-interest, and objectivity. They further note that medical students and young physicians respond to this conflict in various ways. Some re-conceptualize themselves primarily as technicians and narrow their professional identities to an ethic of competence, thus adopting the tacit values and discarding the explicit professionalism. Others develop non-reflective professionalism, an implicit avowal that they best care for their patients by treating them as objects of technical services (medical care). Another group appears to be "immunized" against the tacit values, and thus they internalize and develop professional virtue. Certain personal characteristics of the student, such as gender, belief system, and non-medical commitments, probably play roles in "immunization," as do medical school features such as family medicine, communication skills courses, medical ethics, humanities, and social issues in medicine. To be effective, though, these features must be prominent and tightly integrated into the medical school curriculum. The locus of change in the culture of medicine has now shifted to ambulatory settings and the marketplace. It remains to be seen whether this move will lessen the disjunction between the explicit curriculum and the manifestly contradictory values of detachment and entitlement, and the belief that the patient's interest always coincides with the physician's interest.

Curriculum↗
PubMed2000

Knees.

Explore the source record for details and available documents.

Journal Article↗
PubMed2000

The tragic events of April 1996.

In the early 19th century, Port Arthur, Tasmania, was the site of a notorious prison in a land at the end of the world. In 1996, Port Arthur was also the site of the worst mass murder in modern Australian history. A gunman with a semiautomatic weapon stepped into a tourist coffee shop and systematically shot dead 35 men, women, and children. Throughout Australia, an outpouring of grief, shame, and anger followed this tragic event and led quickly to more stringent gun control legislation. Several years later, Australians still remember the mass murder at Port Arthur with shame and horror as a personal affront, rather than simply a historical event. In the more violent society of the United States, many Americans perceive themselves as helpless victims or detached observers, rather than as persons who are responsible for promoting change.

Female↗
PubMed1997

The man with stars inside.

Public opinion polls show that a large percentage of persons in the United States currently favor the legalization of professionally assisted death. This support reflects widespread fear and confusion over the tortuously prolonged and painful process of dying countenanced by contemporary medicine. Physician-assisted suicide and euthanasia are complex moral issues. The current drive to translate them into debates about "rights" and public policy is curious: Does the energy directed toward "palliation-by-death" mean that our society is more compassionate now, or more just, than in the past? To the contrary, I believe that the movement toward assisted death reflects inadequate palliative care, poor patient-physician communication, great confusion about the right to refuse treatment, and profound inequity in U.S. health care. Legalization of assisted death diverts us from addressing these problems. Palliation-by-death will drive us farther apart, not closer together.

Double Effect Principle↗
PubMed1994

Retinal and pregnancy outcomes in the presence of diabetic proliferative retinopathy.

The objective of this study was to examine the retinal and pregnancy outcomes of pregnancies complicated by advanced diabetic retinopathy. Twenty pregnancies complicated by advanced diabetic retinopathy were included in this retrospective study. The data were analyzed to determine trends in perinatal outcome and to document the ophthalmologic performance. Ophthalmologic management included frequent funduscopic examinations by ophthalmologists of the Yale Retina Center. Among the 20 pregnancies, spontaneous abortion occurred in 2 (10%) and stillbirth in 1 (5%); the remaining 17 (85%) pregnancies culminated in live births at a mean gestational age of 36 weeks (+/- 2.3 SD), with a mean birth weight of 2,620 g (+/- 834 SD). The perinatal survival rate was 94%. Photocoagulation therapy was necessary prior to pregnancy in 45%, during pregnancy in 60% and postpartum in 65%. No pregnancies were terminated because of progressive visual changes that did not respond to photocoagulation therapy. Retinal status should not preclude pregnancy since contemporary methods of management can result in satisfactory retinal and pregnancy outcomes even in the presence of advanced diabetic microvascular disease.

Adult↗
PubMed1990

Does pregnancy alter the rate of progression of diabetic nephropathy?

The effect of gestation on the rate of decline in renal function was studied in 11 pregnancies complicated by diabetic nephropathy. For each pregnancy, serum creatinine levels were available within 4 years before pregnancy, during pregnancy, and within 4 years after delivery. Although all of these patients were hypertensive and had increased proteinuria during pregnancy, the mean serum creatinine just prior to conception (1.3 +/- 0.5 mg/dl) and the last follow-up value (1.2 +/- 0.3 mg/dl) were not significantly different. When the inverse of serum creatinine (1/Scr) was used to estimate creatinine clearance, the renal function was either improved or remained stable in the majority of the pregnancies (7 of 11). The observed decline in renal function through the end of follow-up appeared to be consistent with the expected natural course of diabetic nephropathy in the absence of pregnancy. Furthermore, the slope for inverse serum creatinine before and after pregnancy was not significantly different. In conclusion, pregnancy in patients with mild to moderate diabetic nephropathy does not seem to accelerate the rate of decline in renal function.

Adult↗
PubMed1989

Evolution of clinical ethics teaching at the University of Pittsburgh.

The authors explain that several years of effort, by many faculty from a variety of disciplines, were required to expand medical ethics teaching at the University of Pittsburgh School of Medicine beyond the preclinical years. Since 1986, faculty associated with the school's Center for Medical Ethics have begun a comprehensive ethics teaching program for all four years and the residency period; they also are attempting to develop an ethics consultation service. The authors describe the program, its promise and plans, and the significant difficulties involved in establishing and maintaining it, not only problems of long-term funding but of the uninformed and negative attitudes of some students and faculty toward ethics teaching, especially in the clinical setting. Also discussed are the pros and cons of using cases in ethics teaching and the program's approaches to evaluation and to training clinical faculty in clinical ethics issues.

Education, Medical↗
PubMed1988

Diabetic nephropathy: pregnancy performance and fetomaternal outcome.

A study of 31 continuing pregnancies complicated by diabetic nephropathy was conducted to determine the effects of diabetes-associated renal disease on maternal health and fetal outcome. Throughout pregnancy there was a significant increase in maternal blood pressure (p less than 0.001) and proteinuria (p less than 0.0001), with nephrotic syndrome (greater than 3.0 gm protein/day) developing in 71% of pregnancies. After birth, however, proteinuria reverted to levels not significantly different from values in early pregnancy. There was no apparent adverse effect of pregnancy on the natural course of the underlying renal disease. Stillbirths occurred in two patients (6%), and the remaining 29 pregnancies resulted in live-births at a mean gestational age of 36 weeks. Seventy percent of these infants were appropriate for gestational age, whereas 16% were small and 13% were large for gestational age. Birth weight was best correlated with gestational age and creatinine clearance (p less than 0.0001). Neonatal complications included respiratory distress syndrome (19%), hyperbilirubinemia (26), and congenital malformations (10%). The uncorrected perinatal survival rate was 94%. These data suggest that with contemporary methods of maternal evaluation and treatment, fetal surveillance, and neonatal care, the risks to patients with diabetic nephropathy during pregnancy are not excessive. The likelihood of a successful fetal and neonatal outcome is comparable to that in other patients with insulin-dependent diabetes.

Adolescent↗
PubMed1986

Comparison of fetal weight estimation formulas with and without head measurements.

Most published sonographic techniques for estimating fetal weight use measurements of the biparietal diameter (BPD) and abdominal circumference. In many clinical situations, however, accurate head measurements cannot be obtained. One hundred one patients were scanned within 72 hours of delivery. Using multiple stepwise regression analysis, a best-fit formula was developed using abdominal circumference and femur length, or femur length alone. The mean error was 109 g/kg fetal weight for abdominal circumference and femur length that was comparable with BPD and abdominal circumference formulas for estimated fetal weight. The mean error when femur length was used alone was 129 g/kg fetal weight. When these models were tested prospectively on 67 patients and compared with published formulas, they yielded results that were similar in accuracy. Among these additional patients, the model using one parameter (femur length) had an average error of 114 g/kg, whereas the femur length and abdominal circumference showed a mean error of 125 g/kg.

Anthropometry↗