The polygraph test--a flawed diagnostic method.
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Arousal↗
Biomedical subjects
R Steinbrook
Publications and source records attributed to R Steinbrook.
Health care workers infected with the human immunodeficiency virus. The next steps.
The tragedy of five patients who contracted human immunodeficiency virus (HIV) infection from a seropositive dentist has alarmed the public. The Centers for Disease Control (CDC) recently revised its recommendations for preventing the transmission of HIV infection to patients during invasive procedures. The CDC abandoned a previous plan to list exposure-prone invasive procedures that HIV-infected health care workers should not perform. The CDC said "expert review panels" should decide on a case-by-case basis whether seropositive health care workers may perform invasive procedures. As of February 1992, the revised recommendations were under review by the US Department of Health and Human Services. Many issues remain to be clarified, such as how these panels will operate and whether decisions will be consistent in similar cases. Disregarding the CDC guidelines or infection-control precautions may further erode public trust and lead to draconian restrictions on HIV-infected health care workers. Physicians and dentists should respond more effectively to public fears about HIV transmission. The challenge is to protect patients while respecting the privacy and livelihood of health care workers.
Centers for Disease Control and Prevention, U.S.↗
The Oregon Medicaid Demonstration Project--will it provide adequate medical care?
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Ethics, Medical↗
Beyond the Cruzan case: the U.S. Supreme Court and medical practice.
In a landmark decision, the U.S. Supreme Court affirmed a Missouri ruling that sharply limited family decisions about life-sustaining treatment for incompetent patients. The Court held that the Constitution protects the refusal of life-sustaining treatment by competent patients. For incompetent patients, states may require "clear and convincing" evidence of refusal, specifically for the withdrawal of tube feedings, if such a person were in a persistent vegetative state. The ruling left many clinical questions unanswered, such as whether life-sustaining treatment must be given to terminally ill incompetent patients, whether patients may refuse artificial feedings, and what constitutes clear and convincing evidence of refusal. The decision also has potentially harmful consequences. It may undermine family decision making, encourage cynicism and disregard of the law, and promote defensive medicine. Physicians can minimize such consequences by encouraging patients to provide advance directives, such as the durable power of attorney for health care, by urging legislative action, and by setting national practice standards for decisions regarding incompetent patients.
Adult↗
Informing physicians about promising new treatments for severe illnesses.
Physicians are increasingly informed of promising new treatments for severe illnesses through unconventional communications such as press releases, press conferences, and direct mailings. These highly publicized announcements disseminate information quickly, often many months before new data are presented at medical meetings or published in peer-reviewed medical journals. Such unconventional communications, however, usually do not provide sufficient detail for physicians to evaluate new studies, answer patients' questions, or make recommendations. We suggest that physicians would be better informed about therapeutic advances through (1) expanded information in unconventional communications, (2) increased availability of information from the Food and Drug Administration, (3) early submission and accelerated review of key medical journal articles, and (4) expanded use of on-line computerized information sources. A commitment to inform physicians better about promising new treatments may help save or prolong the lives of patients with severe illnesses.
American Medical Association↗
In California, voluntary mass prenatal screening.
A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of "informed consent/refusal." So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.
California↗