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Biomedical subjects

R D Orr

Publications and source records attributed to R D Orr.

59 records · Page 4Linked to original sources
PubMed1979

Nutritional care in pregnancy: the patient's view. III. Perceived need for advice and effectiveness of advice received.

Interviews were conducted with ninety-two pregnant women who attended the out-patient clinic of a major obstetrical teaching hospital. Information was obtained on the patients' perception of their need for dietary advice during pregnancy and selected demographic, nutritional, and medical care characteristics, as well as their response to, and satisfaction with, the dietary advice and treatment they received. The patients' perceived need for dietary advice appears to be an important factor in the apparent effectiveness of prenatal dietary counseling. Patients who expressed a need for dietary advice were more likely to consider diet important during pregnancy, to have positive feelings toward nutrition services, to have visited the dietitian, and to report making changes in their diet because of the advice received. Little association was observed between demographic and medical care characteristics of patients or more objective measures of need for dietary advice and the patients' own perception of need. It is suggested that patients whose expressed need for counseling is at variance with objective measures are a group requiring special attention.

Adolescent↗
PubMedDate not supplied

End of life care in Duchenne muscular dystrophy.

End of life care for patients with Duchenne muscular dystrophy (DMD) has become increasingly complex because of new technologies, changes in medical personnel over periods of time, emergence of home health care systems, and increasing patient and family autonomy in decision-making. In this review, we discuss the medical problems, particularly respiratory and cardiac failure, faced by DMD patients. Current concepts concerning the evaluation and options for treatment of these problems are presented as well as the ethical issues involved in the care of the DMD patient. These issues include the medical indications for treatment, patient preferences, quality-of-life issues, and contextual features related to legal, institutional, religious, geographic, cultural, social, and financial factors. We also present our experience at Loma Linda University Medical Center over the past 10 years in the development of a home mechanical ventilation program for DMD patients and an algorithm for the evaluation of these patients. Many patients with DMD do well on long-term ventilation, but some find that their quality of life is less than desirable and choose to discontinue this method of life-prolongation. Many of these new options are very expensive, making the decision to use them a difficult one. Ultimately, these are societal issues that require clear reflection on matters of resource allocation that should be performed by health care professionals, citizens, and health planners.

Adolescent↗
PubMedDate not supplied

Religious variables are infrequently reported in clinical research.

BACKGROUND: More than 200 published studies have found some relationship between an individual's religion and health, yet reference to religious variables rarely appears in published empirical studies. METHODS: We performed a manual search of all articles reporting on human subjects in the 1989 issues of seven major medical journals to record and analyze religious and other demographic variables. RESULTS: Only 12 of the 1,066 articles (1.1%) mentioned religion, and eight of these mentioned only denominational affiliation. CONCLUSION: Most clinical investigators do not report on the religious variables of their subjects and thus may be missing important correlations.

Demography↗
PubMedDate not supplied

The family physician and ethics at the bedside.

BACKGROUND: Clinical ethics and ethics committees are a real phenomenon in medicine and play an important role in improving patient care by enhancing the decision-making process between patients and their physicians and thus strengthening this special bond. This article reviews the evolving qualifications of the clinical ethics consultant and compares them with the traditional knowledge, skills, attitudes, and values of the family physician. METHODS: Maternal for this comparison was gathered from a review of the pertinent literature of the past 10 years on the development of clinical ethics and the addition of ethics to the medical curriculum and from personal observations and literature commentary on family practice as a distinct entity. RESULTS AND CONCLUSIONS: Family physicians are uniquely qualified to serve as ethics consultants, particularly with additional training in moral philosophy and health care law. It is hoped that family physicians will become increasingly involved in this growing field to serve as future teachers, researchers, institutional leaders, and policy makers in clinical ethics. More importantly, faculty role models are needed to train family practice residents in ethical decision making at the bedsides of their patients.

Clinical Competence↗