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Biomedical subjects

J Vollmann

Publications and source records attributed to J Vollmann.

At least 19 recordsLinked to original sources
PubMed2006

Decisions at the end of life: an empirical study on the involvement, legal understanding and ethical views of preregistration house officers.

OBJECTIVES: To collect information on the involvement, legal understanding and ethical views of preregistration house officers (PRHO) regarding end-of-life decision making in clinical practice. DESIGN: Structured telephone interviews. PARTICIPANTS: 104 PRHO who responded. MAIN OUTCOME MEASURES: Information on the frequency and quality of involvement of PRHO in end-of-life decision making, their legal understanding and ethical views on do-not-resuscitate (DNR) order and withdrawal of treatment. RESULTS: Most PRHO participated in team discussions on the withdrawal of treatment (n = 95, 91.3%) or a DNR order (n = 99, 95.2%). Of them, 46 (44.2%) participants had themselves discussed the DNR order with patients. In all, it was agreed by 84 (80.8%) respondents that it would be unethical to make a DNR order on any patient who is competent without consulting her or him. With one exception, it was indicated by the participants that patients who are competent may refuse tube feeding (n = 103, 99.0%) and 101 (97.1%) participants thought that patients may refuse intravenous nutrition. The withdrawal of artificial ventilation in incompetent patients with serious and permanent brain damage was considered to be morally appropriate by 95 (91.3%) and 97 (93.3%) thought so about the withdrawal of antibiotics. The withdrawal of intravenous hydration was considered by 67 (64.4%) to be morally appropriate in this case. CONCLUSIONS: PRHO are often involved with end-of-life decision making. The results on ethical and legal understanding about the limitations of treatment may be interpreted as a positive outcome of the extensive undergraduate teaching on this subject. Future empirical studies, by a qualitative method, may provide valuable information about the arguments underlying the ethical views of doctors on the limitations of different types of medical treatment.

Adult↗
PubMed2004

[Ethical decision-making at the end of life--knowledge and attitudes of medical students].

BACKGROUND AND OBJECTIVE: Physicians are often confronted with ethical and legal questions at the end of life. In this study we asked medical students at the universities of Mainz and Berlin (Charité) about the "Guidelines on Physicians' Aid to the Dying" issued by the German Medical Association: their moral attitude and legal knowledge regarding the limitation of medical procedures at the end of life and their judgement about the quality of medical education on these topics. METHODS: 569 medical students in their 1. and 4. clinical semester as well as the final year of their studies in Mainz and students in their 5. year of studies in Berlin received a questionnaire containing 14 items relating to ethical and legal questions at the end of life. RESULTS: 308 (54.1%) completed the questionnaire. 7.8% knew the contents of the "Guidelines on Physicians' Aid to the Dying". Between 10% (use of catecholamines) and 62% (parenteral feeding) viewed withholding or withdrawing life-sustaining measures from dying patients as illegal. 39-72% held the view that measures of nutrition and hydration were part of the indispensable basic medical care for every patient. 12-26% were unsure with respect to their moral views about withholding and withdrawal of therapy. 82% felt insufficiently prepared for dealing with ethical questions at the end of life. CONCLUSION: Only a minority of medical students was informed about ethical principles and legal regulations regarding end-of-life decisions. Teaching of ethical and legal knowledge and integration of these issues into clinical problem solving should be mandatory.

Advance Directives↗
PubMed2004

[Health care ethics committees in German university clinics. A survey of all medical directors and directors of nursing].

OBJECTIVE: Health Care Ethics Committees (HEC) are new ways of implementing clinical ethics in hospitals and nursing homes. In the US all health care institutions must provide some structure to handle ethical conflicts in everyday patients' care. However, in Germany only a minority of hospitals, often members of the Protestant or Catholic Hospital Associations, have founded HEC. No studies exist in regard to the situation at German university hospitals. METHODS: In November 2002 we posted a questionnaire with 13 items to all medical directors (M) and directors of nursing (N) of the 36 German university hospitals. RESULTS: The response rate was 82 %. Limitation of treatment, informed consent and the conflict between beneficience and autonomy are the most relevant ethical issues in everyday practice. N estimated the need for additional support of their staff in ethical issues higher than M. Improvement of interdisciplinary teamwork, further education in ethics and ethical guidelines have been identified in order to improve ethical professional performance. However, N mentioned the lack of time and the low priority of ethics more often than M as problems in implementing theses measures. Five German university hospitals are planning to establish a HEC and two hospitals want to employ a clinical ethicist. CONCLUSION: Our data show a high need for information about HEC in German university hospitals. The tasks, working methods and chances for further development of HEC are neither known nor used in the majority of German university hospitals.

Codes of Ethics↗
PubMed2004

Determination of the material properties of microstructures by laser based ultrasound.

In most applications of MEMS the mechanical properties of the used materials are key parameters for the perfect working of the microsystems. Measuring bulk acoustic waves excited in MEMS structures with ultra-short laser pulses is a powerful method for the accurate and non-destructive evaluation as well as for the characterization of material properties. The pump-probe laser-based acoustic method generates bulk acoustic waves in a thermo-elastic way by absorbing the pump laser pulses. The acoustic waves are partly reflected at any discontinuity of the acoustic impedance. At the surface of the specimen the reflected acoustic pulses cause changes of the optical reflection coefficient, which are measured with the probe laser pulses. Thin membranes are part of numerous microelectromechanical systems (MEMS) like sensors, activators and bulk acoustic wave (BAW) filters for example. The described non-destructive and non-contact method is the right approach for testing such thin and brittle structures like membranes. Results of measurements on freestanding aluminium-silicon nitride multi-layer membranes with total thicknesses in the order of several hundred nanometers are presented and compared with thermo-elastic models and with measurements of the supported case. The measured results are used for the determination of the moduli of the membranes.

Journal Article↗
PubMed2003

[Advance Directives: theoretical concept and practical significance in the USA].

The article examines on the basic of empirical data the discrepancy between the theoretical demand and the practical role of advance directives. Often advance directives have no influence on medical decision-making in clinical care of critically ill patients. The vague language of the widely used standard living wills and the lack of physician-patient communication in the process of delivering an advance directives are contributing factors. However, many physicians even disregard patients' preferences in concrete and meaningful living wills at the end of life. Besides the lack of information many even seriously ill patients do not deliver an advance because they misjudge their medical prognosis and life expectancy. Often the communication between patients and doctors are blocked because they expect from the each other the first step to talk about end of life decisions and advance directives. In this context physicians claim lack of time, training in communication skills and their discomfort in talking about death and dying with their patients.

Advance Directives↗
PubMed2003

[Mental competence and neuropsychologic impairments in demented patients].

The study aim was to examine if neuropsychological tests and clinical dementia scales identify incompetent patients with dementia. Eighteen demented outpatients (ICD-10: F00-F03) underwent psychiatric examination, neuropsychological testing, and formal (MacArthur Competence Assessment Tool Treatment, Hopkins Competency Assessment Test) and clinical assessment of competence. Clinical dementia scales but not neuropsychological testing correlate with formal and clinical assessment of competence in patients with dementia. Our results do not support a neuropsychological model of competence assessment. However, in cases with poor results in clinical dementia scales, clinicians should assess the patients' competence in more detail. It remains open which is the best and ethically grounded methodology for competence assessment.

Aged↗
PubMed2003

Competence of mentally ill patients: a comparative empirical study.

BACKGROUND: This study investigates the competence of patients with dementia, depression and schizophrenia to make treatment decisions. The outcome of an objective test instrument is presented and compared with clinical assessment of competence by the attending physician. METHOD: The MacArthur Competence Assessment Tool-Treatment (MacCAT-T), a test instrument to assess abilities in different standards of competence, was administered to patients with diagnoses of dementia (N = 31), depression (N = 35) and schizophrenia (N = 43). Statistical significance of group differences in the MacCAT-T results were tested with the chi-square test. The concordance of the test and clinical assessment of competence by the attending physician were evaluated by Cohen's kappa coefficient. RESULTS: Patients with dementia, as a group, showed significantly more often impaired performance than those with schizophrenia who were still more impaired than depressed patients. Patients were classified as impaired or not depending on the standards used. By combination of all standards substantially more patients were classified as impaired than by clinical assessment (67.7 v. 48.4% of patients with dementia, 20.0 v. 2.9% of patients with depression, 53.5 v. 18.4% of patients with schizophrenia). CONCLUSIONS: Using different standards of competence the study showed substantial differences among patients with dementia, depression and schizophrenia. The high proportion of patients identified as incompetent raises several ethical questions, in particular, those referring to the selection of standards or the definition of cut-offs for incompetence. The discrepancy between clinical and formal evaluations points out the influence of the used procedure on competence judgements.

Adult↗
PubMed2003

[Patients' perspective on the quality of informed consent into psychopharmacological treatment in schizophrenia and depression].

BACKGROUND: Respect for autonomy and the right to self-determination require informed consent of patients before any medical procedure. So far the majority of empirical studies on informed consent deal mainly with single aspects e. g. delivery and recall of information and legal questions from a physicians' perspective. In our study we examine the quality of informed consent to psychopharmacological treatment from the perspective of patients with schizophrenia and depression in a German university department of psychiatry. METHODS: Face to face interviews using a structured questionnaire by a research psychiatrist. The participants taking part in this study were inpatients diagnosed with schizophrenia and depression. All patients received medication for their condition. RESULTS: Half of the patients rated the information they received and the process of informed consent positive. Only a minority recalls information regarding the aim and the risks of the treatment. 20 % indicated that they have been informed about alternative treatment options. A quarter of the patients did not know that they had a right to refuse any treatment. CONCLUSION: Compared with studies including patients with somatic illnesses the participants in our study judge the process of informed consent rather critical. The results need to be discussed in the light of the special aspects of psychopharmacological treatment and different cultural and institutional settings.

Adolescent↗
PubMed2002

[Informed consent and patient competence in the psychically ill. A review of empirical studies].

In clinical practice, patients' self-determination has become more and more important. However, in psychiatry, the practice of informed consent encompasses several problems. In many cases the psychiatrist is faced with the issue of determining patients' competence. This paper gives an overview of empirical studies on competence assessment in psychiatry. In the course of some of these studies, test instruments were developed which allow objective and reliable assessment of different standards of competence. The applicability of these tests is discussed. We present empirical data on the relationship between competence and psychopathologic symptoms and cognitive factors. In recent empirical research, a shift from an initial skepticism of the applicability of informed consent in psychiatry towards a more differentiated approach and an interest in multidisciplinary research can be observed.

Empirical Research↗
PubMed2002

Ultrasonic wave propagation in focussing tips with arbitrary geometries.

Pulsed laser acoustic experiments have the advantage of very high temporal resolution. However, the lateral resolution amounts to several wavelengths of light. To improve the lateral resolution a focussing tip in which the mechanical waves are focussed is introduced. The combination of high resolution in time and space domain leads to a new potential time resolved scanning probe method. Therefore several axi-symmetric structures are investigated numerically using a finite difference method. The ultrasonic wave propagation in different tips is discussed. By varying the geometry of the tip, the displacement at the sharp end is maximized. The numerically calculated results are verified experimentally on structures having macroscopic dimensions. Scaling effects are considered in order to translate the results into the microscopic scale where arbitrary geometries are much more challenging to implement.

Journal Article↗
PubMed2002

[Attitudes of psychiatrists toward physician-assisted suicide].

BACKGROUND: Physician-assisted suicide (PAS) is an important subject of the public debate. So far, legal regulations exist in the Netherlands, Belgium and in Oregon (USA). This review reports results of nine empirical studies from Japan, the Netherlands, the United Kingdom and the U. S. which examine attitudes of psychiatrists toward PAS. RESULTS: The approval of PAS by psychiatrists varies between the four countries (40 - 69 %). Comparisons with the attitudes of other physicians show a greater agreement among the psychiatrists. A psychiatric examination in order to evaluate competence even in patients with severe somatic illness was advocated by the majority of psychiatrists. CONCLUSION: Psychiatrists' attitudes toward PAS vary and are compared with other medical specialties, as well as in different legal and cultural contexts. Therefore, and because of missing empirical studies, results can not be transferred into the context of German speaking countries easily. So far, no acknowledged criteria for the assessment of competence exist. Further empirical research is needed on German psychiatrists' attitudes towards PAS and on competence assessment at the end of life. It remains an open question how legal changes and future developments of palliative care will influence attitudes toward PAS.

Attitude of Health Personnel↗
PubMed2001

[Do ethics committees hinder progress in medicine?].

Research Ethics Committees are instruments which allow the medical profession to control the research with human subjects. In this context, some medical researchers criticize the increasing bureaucracy and the hindrance of research which interfere with the ability to compete in international research. On the other hand, the public criticizes the missing transparency, independence and democratic legitimization of Research Ethics Committees as well as the possible conflicts of interests of their members. The medical research with human subjects who are incompetent to give informed consent serves as an example to show the necessity of quality control and standardized criteria of assessment. By comparison with the development of Institutional Review Boards in the United States, ideas for the necessary changes of Research Ethics Committees in Germany regarding their work, assembly and transparency are developed.

Cross-Cultural Comparison↗
PubMed2001

Advance directives in patients with Alzheimer's disease. Ethical and clinical considerations.

Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients.

Advance Directives↗
PubMed2001

[HIV prevention in young homosexual men. A medical ethical challenge].

Although considerable progress in the treatment of patients with AIDS has been achieved over the recent years, AIDS remains a non-curative disease. Therefore the prevention of new infections with HIV is an important goal for medicine and public health. However, during recent years the number of new HIV-infections in young gay men increased. New empirical data from the U.S. and the U.K. suggest that the traditional prevention methods fail to reach young gay men in Western countries who become HIV-infected by unsafe sex within intimate relationships. The paper discusses these problems from the perspective of medical ethics. New approaches to sex education and prevention of HIV and other sexually transmitted diseases are developed and the importance of personal values, responsibility, intimacy and emotions are emphasized.

Acquired Immunodeficiency Syndrome↗