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Biomedical subjects

M Kelner

Publications and source records attributed to M Kelner.

At least 19 recordsLinked to original sources
PubMed2000

[Use of a self-administered quality of life questionnaire in a university preventive service].

In France, the student population represents close to two million people covered by the medical and social plan of the Services de Sante Inter-Universitaires (Inter-University Health Services), of which one of the objectives is to improve students' quality of life. This is why it seemed interesting to measure this quality of life in order to identify problems and to propose possible improvements. For this, we used a generic self-administered questionnaire, the SF 36, which allowed for detecting the variations of quality of life in relation to health status. Throughout the 1995-1996 school year, 1301 questionnaires were completed by first year students seen in routine visits or scheduled appointments. The questionnaire was well received. The self-administered questionnaire is a sensitive tool that revealed, among healthy students, statistically significant differences in scores between girls and boys (with girls showing lower scores). This difference is not found in the group of students who came for an appointment for a benign pathology. The causes of these variations remain to be explored.

Adult↗
PubMed1999

Quality end-of-life care: patients' perspectives.

CONTEXT: Quality end-of-life care is increasingly recognized as an ethical obligation of health care providers, both clinicians and organizations. However, this concept has not been examined from the perspective of patients. OBJECTIVE: To identify and describe elements of quality end-of-life care from the patient's perspective. DESIGN: Qualitative study using in-depth, open-ended, face-to-face interviews and content analysis. SETTING: Toronto, Ontario. PARTICIPANTS: A total of 126 participants from 3 patient groups: dialysis patients (n = 48), people with human immunodeficiency virus infection (n = 40), and residents of a long-term care facility (n = 38). OUTCOME MEASURES: Participants' views on end-of-life issues. RESULTS: Participants identified 5 domains of quality end-of-life care: receiving adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones. CONCLUSION: These domains, which characterize patients' perspectives on end-of-life care, can serve as focal points for improving the quality of end-of-life care.

Adult↗
PubMed1998

Mice with a homozygous null mutation for the most abundant glutathione peroxidase, Gpx1, show increased susceptibility to the oxidative stress-inducing agents paraquat and hydrogen peroxide.

Glutathione peroxidases have been thought to function in cellular antioxidant defense. However, some recent studies on Gpx1 knockout (-/-) mice have failed to show a role for Gpx1 under conditions of oxidative stress such as hyperbaric oxygen and the exposure of eye lenses to high levels of H2O2. These findings have, unexpectedly, raised the issue of the role of Gpx1, especially under conditions of oxidative stress. Here we demonstrate a role for Gpx1 in protection against oxidative stress by showing that Gpx1 (-/-) mice are highly sensitive to the oxidant paraquat. Lethality was already detected within 24 h in mice exposed to paraquat at 10 mg.kg-1 (approximately (1)/(7) the LD50 of wild-type controls). The effects of paraquat were dose-related. In the 30 mg.kg-1-treated group, 100% of mice died within 5 h, whereas the controls showed no evidence of toxicity. We further demonstrate that paraquat transcriptionally up-regulates Gpx1 in normal cells, reinforcing a role for Gpx1 in protection against paraquat toxicity. Finally, we show that cortical neurons from Gpx1 (-/-) mice are more susceptible to H2O2; 30% of neurons from Gpx1 (-/-) mice were killed when exposed to 65 microM H2O2, whereas the wild-type controls were unaffected. These data establish a function for Gpx1 in protection against some oxidative stressors and in protection of neurons against H2O2. Further, they emphasize the need to elucidate the role of Gpx1 in protection against different oxidative stressors and in different disease states and suggest that Gpx1 (-/-) mice may be valuable for studying the role of H2O2 in neurodegenerative disorders.

Animals↗
PubMed1998

Reconceptualizing advance care planning from the patient's perspective.

BACKGROUND: Traditional academic assumptions about advance care planning (ACP) include the following: (1) the purpose of ACP is preparing for incapacity; (2) ACP is based on the ethical principle of autonomy and the exercise of control; (3) the focus of ACP is completing written advance directive forms; and (4) ACP occurs within the context of the physician-patient relationship. These assumptions about ACP have never been empirically validated. OBJECTIVE: To examine the traditional academic assumptions by exploring ACP from the perspective of patients actively participating in the planning process. METHODS: Forty-eight patients (30 men and 18 women with a mean age of 48.3 years) who were undergoing hemodialysis were interviewed 6 months after receiving an advance directive form. Their experience of ACP was noted in interviews that were audiotaped, transcribed, and analyzed. RESULTS: The participants said that their purpose in ACP was to prepare for death and dying, and their underlying goals included the exercise of control and an attempt to relieve burdens placed on loved ones. Advance care planning was viewed as a social process, and completing a written advance directive form was often regarded as unnecessary. Participants often involved close loved ones, but physicians infrequently. CONCLUSIONS: The traditional academic assumptions are not fully supported from the perspective of patients involved in ACP. The patients we interviewed stated that (1) the purpose of ACP is not only preparing for incapacity but also preparing for death; (2) ACP is not based solely on autonomy and the exercise of control, but also on personal relationships and relieving burdens placed on others; (3) the focus of ACP is not only on completing written advance directive forms but also on the social process; and (4) ACP does not occur solely within the context of the physician-patient relationship but also within relationships with close loved ones.

Adult↗
PubMed1997

Health care and consumer choice: medical and alternative therapies.

This paper reports on research conducted in a large Canadian city during 1994-1995. The study examines the motivations of patients who choose to seek care from one of five different types of practitioners: family physicians, chiropractors, acupuncturists/traditional Chinese doctors, naturopaths and Reiki practitioners. We use the Andersen socio-behavioural model to help explain why people choose orthodox medicine or a type of alternative care. The data are derived from face to face interviews with 300 patients: 60 from each of the five modes of treatment. The findings demonstrate that this model can explain the use of alternative as well as orthodox medical services. Patients choose specific kinds of practitioners for particular problems, and some use a mixture of practitioners to treat a specific complaint. The choice of type of practitioner(s) is multidimensional and cannot solely be explained either by disenchantment with medicine or by an "alternative ideology".

Adult↗
PubMed1997

Who seeks alternative health care? A profile of the users of five modes of treatment.

This article compares the social and health characteristics of patients of five kinds of practitioners: family physicians (used as a baseline group); chiropractors; acupuncturist/traditional Chinese medicine doctors; naturopaths; and Reiki practitioners. The data were gathered in a large Canadian city during the period 1994 to 1995. Face-to-face interviews were conducted with 300 patients (60 from each type of treatment group). While the most striking social and health differences occur between patients of family physicians and the patients of alternative practitioners, significant differences are also evident between the different groups of alternative patients. Reiki patients, for example, have a higher level of education and are more likely to be in managerial or professional positions than other alternative patients. The profiles presented here indicate that users of alternative care should not be regarded as a homogeneous population. The findings also show that almost all alternative patients also consult family physicians. The pattern revealed is one of multiple use: patients choose the kind of practitioner they believe can best help their particular problem.

Adult↗
PubMed1996

A sociobehavioural perspective on genetic testing and counselling for heritable breast, ovarian and colon cancer.

Testing for susceptibility to heritable breast, ovarian and colon cancer has unique psychosocial costs. Negative test results may not be sufficient to relieve anxiety, and positive results can cause sufficient distress to compromise patient compliance with surveillance and risk reduction measures. More needs to be learned about how sociocultural factors affect the understanding of risk, how decisions to undergo testing are made and how information about increased risk affects family dynamics. As the demand for testing and counselling grows, health care providers will be faced with new challenges and dilemmas. A better understanding of genetics by the public is needed to mitigate deterministic attitudes that can lead to the neglect of health promotion. Also of concern are the socioeconomic implications of being identified as having a high risk for heritable cancer and the dangers inherent in using genetics to explain sociological phenomena. Health care providers must take the lead in ensuring that developments in genetics are used to the benefit of all.

Attitude↗
PubMed1995

Activists and delegators: elderly patients' preferences about control at the end of life.

The views of elderly patients concerning control over the dying process are explored in this paper. Thirty-eight hospitalized elderly patients were interviewed about their attitudes, both general and personal, toward exerting control over end-of-life decisions. A majority (27) of the participants could be categorized as 'activists', that is, they preferred to have a voice in decision-making at the end of life. There were also a number of 'delegators' (11) in the study. They preferred to delegate the decision-making to their physicians, to God, or to fate. Activists were better educated, had held more professional and managerial jobs and tended more often to be middle class rather than lower class. Their advanced sophistication about consumer rights and their general knowledge of health issues is reflected in their greater interest in patient control over dying. Most activists rejected the idea of euthanasia or assisted suicide for themselves, but favoured the withholding and withdrawing of treatment. It is possible that these ideal types of 'activists' and 'delegators' could anchor a continuum that is measurable. Such a scale could facilitate the differentiation of the elderly on this issue and thereby prove useful in the development of appropriate policy.

Aged↗
PubMed1993

Advance directives: the views of health care professionals.

OBJECTIVES: This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. DESIGN: The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques. MAIN RESULTS: Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and health care professionals. Concerns about the use of advance directives focused on the lack of clarity in some patients' instructions, the absence of legal status for directives, the possible interference with a practitioner's clinical judgement, the adequacy and appropriateness of patients' information about their circumstances, and the type of intervention (passive or active) requested by patients. CONCLUSIONS: New regulations and legislation are making the use of advance directives more widespread. Health care professionals should participate in the development and implementation of these directives. Continuing professional education is essential in this regard.

Adult↗
PubMed1990

Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.

Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Understanding physicians' response to AIDS.

Attempts to comprehend physicians' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians' attitudes and practices. We suggest a framework developed from the literature on physicians' and society's response to other disorders that would provide a basis for organizing the ever-increasing amount of information on physicians and AIDS and would guide systematic research aimed at understanding and predicting physicians' participation in the prevention and management of AIDS. Within this framework we consider how characteristics of the disease, elements of the health care system and physicians' attitudes interact to influence clinical and personal practices. AIDS had led to new delineations of physicians' responsibility, modification of prevailing beliefs about physician autonomy and thus a redefinition of the role of the physician in North America.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Informed consent: the physicians' perspective.

Using the current controversy in breast cancer treatment as a model, this paper reports on physicians' attitudes and behavior in the use of informed consent. Findings are based on a survey of 170 oncologists from eight countries and representing three medical specialties. Physician responses indicate that they regarded informed consent as an intrusion into the doctor-patient relationship. Problems identified by the physicians included: decreasingly effective doctor-patient communication; less personalized relationships with patients and curtailed freedom with regard to disclosure procedures. They also viewed the informed consent regulation as having a negative impact on their patient care. The constraints of obtaining informed consent reduced physicians' willingness to participate in scientific experiments. The consent form was seen to highlight their dual role as care-giver and scientific investigator, making them uncomfortable in dealing with patients. These findings demonstrate the ways in which legal restrictions associated with the introduction of new technologies critically affect the practice of medicine.

Breast Neoplasms↗
PubMed1986

Postgraduate medical training, stress, and marriage.

In a pilot study, 20 interviews were conducted with married female interns and residents and their spouses in order to explore both positive effects of spousal support and negative effects of additional role obligations during medical training. The marital state has been shown to be related to lowered levels of stress. Past studies of medical marriage have focused on male physicians and their wives. However, marriage and parenthood impact differently on women than men, and thus on women physicians. To explore these differences, our findings are contrasted with findings on male medical students and their wives by R. Coombs. Compared to our subjects, Coombs found spouses were either housewives or held lower level jobs rather than demanding careers, and consequently our subjects experienced greater difficulty meeting demands of everyday life (cooking, cleaning, child care). Coombs' wives showed greater vicarious identification with the goals and satisfactions of the physician in-training; greater feelings of obligation to nurture, support and make sacrifices on behalf of their spouses; and less resentment toward the current system of medical training. They stressed the nurturing aspect of marital support rather than instrumental aspects. Subjects in both studies feared growing apart but while Coombs' wives feared being outgrown intellectually, our husbands were critical of their wives' narrowness of interests. Subjects in both studies believed marriage provided benefits (intimacy, support, affection, sex) but also complained of the negative impact of exhausting and emotionally draining medical training. Implications of findings for reducing the stress of medical training are discussed.

Adult↗
PubMed1983

Isopropanol ingestion: interpretation of blood concentrations and clinical findings.

We evaluated blood concentrations and clinical findings in 17 cases of isopropanol (IPROH) ingestion seen over a 8.5 year period at our institution. Eight ingestions involved IPROH alone ("pure") while the remainder involved at least ethanol in addition to IPROH ("mixed"). Fourteen patients had a history of alcoholism. Admission blood IPROH concentrations ranged from 5 to 70 mg/dL while the concentration of the acetone metabolite ranged from nondetectable to 220 mg/dL. The mean acetone concentration was significantly higher for "pure" ingestions than for "mixed" ingestions (p less than 0.05); however, the mean IPROH concentrations showed no significant difference. The mean anion gap was significantly higher for "mixed" ingestions than for "pure" ones (p less than 0.01). Fifteen patients were either alert or lethargic while two, who had ingested no compounds other than IPROH, were comatose. The most common other physical findings were tachycardia (10 cases), decreased deep tendon reflexes (5), dysarthria (4), and ataxia, hypotension, fever, and mydriasis (3 cases each). None of the findings including level of consciousness showed statistically significant correlation with the IPROH concentrations. Twelve patients were hospitalized; eleven of these recovered with supportive care alone. One patient expired from trauma suffered in a motor vehicle accident.

1-Propanol↗
PubMed1983

Micro-analysis for quinidine in serum by thin-layer chromatography followed by fluorescence densitometry.

We report a thin-layer-chromatographic micro-analysis for quinidine in serum, with detection by fluorescence densitometry. Quinidine is extracted from 20 microL of serum at pH 13 into 3 mL of hexane/acetone solution (80/20 by vol) containing N-(1-naphthyl)ethylenediamine as internal standard. The extract is concentrated and applied to silica-gel-impregnated plates for conventional thin-layer chromatography. Quinidine is identified from its RF value and quantified from the peak-height ratio between quinidine and the internal standard, relative to that of simultaneously extracted serum standards. The proposed assay is sensitive (to 0.2 mg/L), specific for unmetabolized quinidine, precise (between-run coefficients of variation less than 6%), and readily adaptable to large-scale "batch" analysis. Peak-height ratio is linearly related to concentration to at least 20 mg/L. Quinidine concentrations in the serum of patients, as measured by the proposed method (x) and by a traditional double-extraction spectrofluorometric assay (y), were related as follows: y = 0.994x + 0.276 (r = 0.989, n = 20).

Chromatography, Thin Layer↗
PubMed1983

Reversed-phase liquid-chromatographic simultaneous analysis for thiopental and pentobarbital in serum.

We describe a reversed-phase liquid-chromatographic assay suitable for therapeutic monitoring of thiopental and pentobarbital simultaneously in human serum. The drugs are extracted from serum at pH 6.6 into n-butyl chloride containing thiamylal and barbital as the respective internal standards. The compounds are back-extracted into dilute sodium hydroxide, an aliquot of which is submitted to chromatography. The lowest measurable concentrations are 1.0 mg/L for thiopental and 2.0 mg/L for pentobarbital. The standard curve is linear from 0 to 100 mg/L for both. Between-run CVs are: at 25 mg/L, 4.1% (thiopental) and 3.2% (pentobarbital); at 50 mg/L, 2.8% (thiopental) and 3.4% (pentobarbital). Data on patients receiving thiopental and pentobarbital illustrate use of the method.

Chromatography, High Pressure Liquid↗