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Biomedical subjects

S H Miles

Publications and source records attributed to S H Miles.

At least 73 records · Page 4Linked to original sources
PubMed1988

AIDS dementia.

For the geriatrician who commonly evaluates cognitive and psychiatric disorders in the elderly, the neurologic consequences of infection with the human immunodeficiency virus (HIV) are of particular importance. The most frequent neurologic disease is the AIDS dementia complex characterized by cognitive, behavioral, and motor changes, occurring in two-thirds of AIDS patients. The pathophysiology of central nervous system HIV infection has been advanced with important implications for both the diagnosis and the potential treatment of this devastating disease.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Evaluating life-sustaining treatments for demented persons.

Decisions to employ, withhold, or withdraw life-sustaining treatments from demented individuals should be centered on the patients' personal needs rather than on physiological abnormalities. To accomplish this, physicians and families need a trusting communication and flexible, comprehensive, and positive approaches to treatment goals and technologies. This article critiques and proposes approaches to such treatment planning.

Aged↗
PubMed1987

Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations.

The profound reluctance of some physicians to care for patients with acquired immunodeficiency syndrome prompted us to review medical responses to other historic plagues. No consistent professional tradition emerged. Many physicians, including Galen and Sydenham, fled from patients with contagious epidemic diseases. Many of their colleagues, at considerable personal risk, remained behind to care for plague victims. This inconsistency suggests that an ethic stressing traditional professional duties may not be ideal for defining the optimal relation of the medical profession to patients with acquired immunodeficiency syndrome. A new professional ethic to guide physicians in the acquired immunodeficiency syndrome pandemic is needed. This ethic cannot be entirely derived from these patients' right to health care, which is primarily a claim against society rather than individual practitioners. Civil and professional proscriptions against negligence or abandonment apply only to therapeutic relationships after they are contracted. However, a professional duty to treat human immunodeficiency virus-infected persons could be based on the understanding of medicine as a moral enterprise. In this context, treating human immunodeficiency virus-infected persons is a virtuous act, which meets both patients' and society's health needs and affirms the moral mission of health care.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The prevalence and design of ethics committees in nursing homes.

A dramatic increase in the number of ethics committees in long-term care facilities (LTCFs) has occurred since 1970 in the 487 nursing homes in Minnesota. Ten percent of the LTCFs had ethics committees which were mostly formed by administrators and nurses. The committees are most often found in large urban facilities with a high percentage of skilled-level beds and a religious name. The committees are multidisciplinary with a median of nine members including two to three nurses, a physician, a social worker, a minister, an administrator, and three other members. Nearly all committees were involved in policy development and staff education. Additional functions included resident care consultation and retrospective case review. More than half of the committees are accountable to administration. Nearly all committees kept minutes. Though all committees incurred costs, only one had a formal budget. Informal evaluation is done in only six committees. No committee had referred cases to the courts.

Bioethical Issues↗
PubMed1987

AIDS and the geriatrician.

Ten percent of acquired immune deficiency syndrome (AIDS) cases are in persons over 50 years of age with 25% of these cases in persons over 60, and 4% in persons over 70 years of age. If the present age distribution holds, there will be 27,000 AIDS cases in persons over 50, and 1100 cases in persons over 70 years of age, by 1991. Older persons are more likely to acquire AIDS through blood transfusions than to homosexual exposure or drug abuse. Changes in the management of blood products will benefit older persons. The nearly 1 million elderly homosexual men, who have been sheltered from the virus by their pattern of sexual activity, will face greater risks as the prevalence of the virus and the age of the carriers increases. The underappreciated neurological consequences of human T-cell lymphotrophic virus type III (HTLV-III) infection, subacute encephalitis, vacuolar myelopathy, and psychiatric disorders will be of particular interest to geriatricians who are often consulted to evaluate neurological dysfunction. Geriatricians will need to become familiar with the spectrum of HTLV-III infection and prepared to counsel patients and extended-care facilities.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Limiting treatment in long-term care facilities: the need for policies or guidelines.

Carefully constructed policies or guidelines for the limitation of treatment in long-term care facilities are necessary to ensure that such limitation is consistent with ethical and legal principles. These protocols can be useful in protecting the rights of the residents, improving service, assuring the accountability of health care professionals, educating staff, and preventing legal controversies. Even the best protocol cannot eliminate controversy regarding decisions about limitation of treatment, but a clearly articulated policy can provide a process for addressing these concerns in a manner that takes into account the rights and responsibilities of all involved.

Aged↗
PubMed1985

Orders to limit emergency treatment for an ambulance service in a large metropolitan area.

We describe a policy allowing paramedics and emergency physicians to honor orders from nursing home records not to perform resuscitation or endotracheal intubation. The policy was adopted by the regional body coordinating emergency medical care and endorsed by the county medical society. The policy establishes community-wide definitions for "do not resuscitate" and "do not intubate" orders. It requires physicians to write such directives in patient's medical records and to update them every two years. It urges long-term care facilities to adopt policies to help ensure good decision-making practices in the formulation of these directives. The policy intends to partially address the unnecessary loss of patient autonomy that occurs when emergency care is administered according to routine orders.

Ambulances↗
PubMed1985

Limited-treatment policies in long-term care facilities.

Two-thirds of the long-term care facilities in Minnesota accept do-not-resuscitate (DNR) orders and 73% accept care plans to limit medical treatment. The major objectives for limited-treatment plans cited by the 16.3% of facilities with administrative protocols for such plans was to provide for the resident's physical and emotional comfort and dignity. Nearly half of the protocols said limited treatment plans were intended to limit emergency care or hospitalization or to allow death to occur. Protocols advocated the alleviation of physical discomfort, anxiety, and social isolation. Tube feedings were not recommended when oral feeding became impossible. Airway suctioning, oxygen, or antibiotic treatment was suggested only as needed to alleviate suffering. Only a fourth of the protocols described a primary role for the resident in these decisions. This study demonstrates that nursing homes are developing administrative protocols for the formulation of limited-treatment plans and suggests that model policy statements describing key decision-making principles, issues, and procedural safeguards could play a constructive role in this process.

Euthanasia↗
PubMed1984

A successful supervised outpatient short-course tuberculosis treatment program in an open refugee camp on the Thai-Cambodian border.

The operation of a tuberculosis treatment program in an open refugee camp of 45,000 refugees on the Thai-Cambodian border is described. Fifty-eight patients received 6 months of supervised daily, outpatient therapy with a protocol employing isoniazid, rifampin, streptomycin, and pyrazinamide. Patient compliance was high, with only 15 of 10,209 patient days being missed, despite a high incidence of minor side effects. Three patients died, 4 defaulted, and 1 moved to another camp for treatment. The therapies of 4 patients were extended because of the need for reduced doses of medications, the development of extrapulmonary disease, treatment failure, and slow resolution of infiltrates on radiographs. There was 1 late relapse. This report demonstrates the feasibility in integrating short-course therapies with program designs to produce high compliance under difficult field conditions.

Adolescent↗
PubMed1982

The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy.

We present a policy for implementing the do-not resuscitate orders by medical residents in a teaching hospital, and discuss decision making, legal and ethical considerations, the primary physician's responsibility, and record documentation. THe establishment of a policy and procedure for implementing do-not-resuscitate orders resulted in greater consideration of patient and family rights and improved communication and sensitivity in dealing with those concerned with the patient's medical care and welfare.

Decision Making↗