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Biomedical subjects

K Blank

Publications and source records attributed to K Blank.

At least 37 records · Page 2Linked to original sources
PubMed1991

Regulation of benzodiazepine prescribing practices: clinical implications.

In an effort to control prescription abuse of benzodiazepines, the New York State Department of Health (DOH) enacted a regulation requiring the use of triplicate prescriptions for these medications. DOH predicted that this regulation would reduce the overall abuse of benzodiazepines and eliminate widescale organized fraud and abuse without any negative impact or reduced availability to patients. Following implementation of the regulation, the authors reviewed all psychiatric emergency room cases and outpatient clinic walk-in evaluations over a 3-month period in an urban medical center and identified 59 cases in which the use of benzodiazepines was a significant presenting problem. Of these, 24 (41%) were judged to be directly related to the new triplicate regulation. In all but one of these cases the patient presented because of symptoms or concerns directly stemming from the refusal by a clinician to continue prescribing a benzodiazepine in a previously established pattern. Typically, abrupt discontinuation of benzodiazepine treatment led to a withdrawal syndrome and/or the unmasking of a previously treated anxiety disorder. In attempting to redress what are essentially criminal substance abuse problems through the regulation of legitimate clinical practice, regulatory agencies may ultimately deprive patients of appropriate, legitimate, and efficacious treatments.

Adult↗
PubMed1991

Informed consent in the electroconvulsive treatment of geriatric patients.

The past 15 years have been marked by an increasingly stringent regulatory atmosphere regarding the administration of ECT, leading to delays in treatment and declines in usage. Regulatory changes requiring judicial intervention in clinical decisions are driven by the notion that only the courts can provide adequate due process protections when legal rights and clinical need conflict. We retrospectively reviewed the documentation of the informed consent process for 62 geriatric patients receiving ECT to assess the degree to which clinicians conformed to the spirit of the informed consent doctrine in a state that allows significant clinical discretion in decisions to administer ECT to patients lacking decisional capacity. In the eight cases in which the patient's decisional capacity was questioned, we found appropriate documentation of the patient's failure to comprehend his condition or the proposed treatment, evidence of a high degree of family involvement in decision making, and extensive use of outside consultants to document decisional incapacity and the need for treatment. Evidence of family participation in decision making was present for a high percentage of cases in which decisional capacity was unquestioned. Our review demonstrated high compliance with the procedural safeguards contained in the state regulation and with the spirit of the informed consent doctrine.

Aged↗
PubMed1986

Shifting competency during hospitalization: a model for informed consent decisions.

The demonstration of factual understanding should be sought when determining a patient's ability to give informed consent, but a patient's failure to demonstrate understanding should not always be equated with an inability to competently consent to or refuse treatment. The authors demonstrate the clinical use of a number of standards other than factual understanding. Judgments about competency are derived both from the patient's clinical condition and the risks and benefits inherent in the decision the patient is asked to make. Since both of these conditions may shift during the course of treatment, clinical competency is subject to continual reassessment using a variety of competency standards. The authors demonstrate the use of their model of shifting competency at five junctures in the treatment of a delusional patient.

Chronic Disease↗
PubMed1984

Relationship of psychological processes during delirium to outcome.

To determine which psychological processes during delirium might correlate with and predict postdelirium psychological outcome, the authors prospectively studied 34 burn patients who became delirious during hospitalization. After the delirium resolved, seven of the 25 survivors had severe psychological symptoms--either depression or posttraumatic stress disorders. During delirium, this outcome group was clinically distinctive: They showed significantly more preoccupation with their trauma and injury, had greater anxiety and fear, and differed in their use of defensive operations. These findings suggest modifying the standard approach to the delirious patient.

Adaptation, Psychological↗
PubMed1983

Medical students' learning as primary therapists or as participant/observers in a psychiatric clerkship.

The authors assessed two different inpatient models of clinical clerkships in psychiatry on the basis of both an examination assessing amount of learning and a survey of student attitudes. One clerkship model placed the third-year medical student in the role of primary therapist; the other model assigned each student to join a psychiatrist as a participant/observer. No overall difference in objective assessment of learning was found between the two groups of students, and student attitudes generally favored the participant/observer model. These findings suggest that the widespread bias favoring the primary therapist model may not be justified.

Attitude↗
PubMed1973

Monocular spatial distortions induced by marked accommodation.

Contraction of the ciliary muscle during marked accommodation causes the leading edge of the retina to advance as much as 0.5 centimeter. Near the posterior pole of the eye, the upward and downward extensional strains on the retina should be reasonably balanced. In the horizontal meridian an asymmetry is introduced because of the nasal location of the optic nerve head. Observers were asked to bisect the space between two parallel lines while fixating a movable line lying near the midpoint of the two lines. The test was conducted with the target far from and near the subject, in the horizontal and vertical meridians, and was repeated with accommodation paralyzed by a cycloplegic agent. Marked accommodation induced significant spatial distortions in the horizontal meridian. The effect is largely retinal.

Accommodation, Ocular↗
PubMedDate not supplied

Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients.

The objective of this study was to examine the interest of non-terminally ill hospitalized elderly patients in euthanasia and physician assisted suicide (PAS) and to determine the stability of these interests over time. Patients age 60 or older (n=158), including both a depressed sample and non-depressed control sample, underwent a structured interview evaluating their interest in euthanasia and PAS in the event of a series of hypothetical outcome scenarios. Substantial proportions of subjects (varying from 13.3%-42% depending on the scenario) expressed hypothetical acceptance of euthanasia and PAS. After six months a subset of patients changed their minds about euthanasia and PAS (8% - 26% depending on the scenario), most often in the direction of initial acceptance to later rejection. Patients depressed in the hospital and interested in PAS for the outcome of their current (non-terminal) condition were significantly more likely express unstable opinions, with most rejecting it six months later. Other correlations of instability, in specific scenarios, included being male, experiencing higher baseline suffering, poorer subjective health and lower instrumental support. Because euthanasia and PAS actions are irreversible, findings of instability have important implications both clinically and for design of PAS legislation.

Aged↗