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Biomedical subjects

S R Benatar

Publications and source records attributed to S R Benatar.

At least 19 recordsLinked to original sources
PubMed1998

Global disparities in health and human rights: a critical commentary.

Widening disparities in health and human rights at a global level represent the dark side of progress associated with escalation of economic and military exploitation and exponential population growth in the 20th century. Even the most basic universal human rights cannot be achieved for all under these circumstances. The goal of improved population health will be similarly elusive while medical care is commodified and exploited for commercial gain in the marketplace. Recognition of the powerful forces that polarize our world and commitment to reversing them are essential for the achievement of human rights for all, for the improvement of public health, and for the peaceful progress required to protect the "rational self-interest" of the most privileged people on earth against the escalation of war, disease, and other destructive forces arising from widespread poverty and ecological degradation.

Capitalism↗
PubMed1997

The meaning of professionalism in medicine.

The challenges facing the professions (and perhaps especially the medical profession) in the new South Africa are complex and far-reaching. Here an attempt is made to place these challenges in local, global and historical perspectives to facilitate a deeper understanding of their implications. A brief outline of forces influencing the social construction of health services is followed by some sociological and professional concepts of professionalism, and some reasons are provided for the public's concern about the image professionals have of themselves. The inadequacy of defensive responses by professions is emphasised and the need is outlined for introspection and deeper understanding of ethics, human rights and values in relation to medical practice.

Ethics, Medical↗
PubMed1996

Limitation of life support: frequency and practice in a London and a Cape Town intensive care unit.

OBJECTIVES: To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. DESIGN: Prospective survey. Ethical approval was obtained. SETTING: ICUs in tertiary centres in London and Cape Town. PATIENTS: All patients who died or had life support limited. INTERVENTIONS: Data collection only. RESULTS: There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p = 0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p = 0.014) and mean APACHE II scores 18.5 and 22.6 (p = 0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Town. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. CONCLUSIONS: Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.

APACHE↗
PubMed1996

The lungs in rheumatoid arthritis--a clinical, radiographic and pulmonary function study.

OBJECTIVE: To determine the prevalence and spectrum of pulmonary abnormalities in patients with rheumatoid arthritis (RA) in a developing country. DESIGN: This was a prospective hospital-based survey of a randomly selected group of patients with RA who were seen in a rheumatic diseases unit. SETTING: Groote Schuur Hospital and Princess Alice Orthopaedic Hospital, Cape Town. PATIENTS: A group of 104 patients with RA were randomly selected from a total of 330 patients with RA who were seen in the rheumatic diseases unit. All the patients were interviewed and a clinical assessment, chest radiographs and pulmonary function tests were performed. RESULTS: Fifty-six patients (53.8%) had evidence of one or more current or previous pulmonary diseases: rheumatoid nodule in 1 (1%), bronchiectasis in 2 (1.9%), fibrosing alveolitis in 5 (4.8%), pneumonia in 5 (4.8%), asthma in 9 (8.7%), pleural disease in 17 (16.3%) and tuberculosis in 25 (24%). Excluding patients who were smokers or ex-smokers or who had coexistent pulmonary disease, there were 20 patients (19.2%) who had pulmonary abnormalities that could be attributed to RA: rheumatoid nodule in 1 (1%), fibrosing alveolitis in 5 (4.8%) (1 of whom also had pleural disease), pleural disease alone in 8 (7.7%), diffusion defect in 5 (4.8%) and airways obstruction in 1 (1%). CONCLUSION: This study provides clinical and lung function criteria that allow a clinically useful stratification of abnormalities in relation to a spectrum of common causes of pulmonary dysfunction that need to be distinguished from pulmonary abnormalities caused by RA. Pulmonary abnormalities are common and about 20% of RA patients may have an abnormality related to RA.

Aged↗
PubMed1995

Informed consent--a survey of doctors' practices in South Africa.

OBJECTIVE: To examine doctors' practices with regard to informed consent. DESIGN: Cross-sectional, descriptive survey. PARTICIPANTS AND SETTING: All full-time consultants and registrars in the Departments of Medicine, Obstetrics and Gynaecology, Paediatrics and Child Health, Paediatric Surgery and Surgery at the University of Cape Town were included. The overall response rate was 63% (160/254). MEASUREMENT: Data were collected by means of self-administered, semi-structured questionnaires. RESULTS: Most doctors (79%) felt it was their responsibility to ensure that patients and parents were fully informed about diagnostic and therapeutic interventions. Many (62%) supported a patient-centred standard for determining the type and amount of information to disclose. Doctors disclose most of the legally required information except for information about alternative forms of treatment and remote serious risks. They almost never provide information on medical costs. The most common reasons for not obtaining informed consent were the doctors' tendency to 'tell' patients/parents what they intend doing and their belief that patients/parents expect doctors to know what is medically best for them. Language, inadequate communication skills and lack of time were, surprisingly, seldom viewed as obstacles to the obtaining of informed consent. Findings were independent of discipline (medical or surgical) and doctors' status (consultant or registrar). Doctors who treat children were significantly less likely to obtain consent for certain interventions. CONCLUSION: Doctors meet many, but not all, of the legal requirements for informed consent. The findings question whether informed consent as envisioned by the law exists in reality. Cross-cultural research is needed to clarify patients' and parents' expectations of informed consent.

Comprehension↗