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Biomedical subjects

T F Ackerman

Publications and source records attributed to T F Ackerman.

18 recordsLinked to original sources
PubMed1994

Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients.

OBJECTIVE: To assess the appropriateness of narcotic-prescribing practices in an ambulatory clinic for patients infected with HIV. DESIGN, SETTING, AND PATIENTS: The medical records of 220 (190 HIV-positive) patients, seen in a clinic primarily designed for the long-term follow-up of ambulatory HIV-infected patients and located in an inner-city, public teaching hospital, were retrospectively reviewed to determine the prevalence and appropriateness of prescribing Drug Enforcement Administration schedule 2 narcotics. Appropriateness was based on published guidelines for the use of narcotics in the treatment of cancer patients. MEASUREMENTS AND MAIN RESULTS: The prevalence of narcotic use among the HIV-positive patients was 15%. Narcotics were prescribed for 38% of the patients who died, 33% of those with AIDS [Centers for Disease Control and Prevention (CDC) clinical class C], 4% of those with AIDS-related complex (ARC) (CDC clinical class B), and 5% of asymptomatic HIV-positive patients (CDC clinical class A). None of the HIV-negative patients seen in the clinic received narcotics. Narcotics were more likely to be prescribed for patients with AIDS than for patients with ARC (p < 0.001) or for HIV-positive patients (p < 0.001). For the three CDC clinical classes, there was no significant difference among the proportions of patients receiving narcotics inappropriately (p = 0.108). Among the risk groups, intravenous drug abusers were more likely to be prescribed narcotics inappropriately than were men who were homosexual (p < 0.001) or individuals who were heterosexual (p = 0.013); transfusion recipients were also more likely to be prescribed narcotics inappropriately than were homosexual men (p = 0.026) or heterosexual men or women (p = 0.032). Narcotics were more likely to be prescribed for patients with disseminated histoplasmosis (p = 0.022), Pneumocystis carinii pneumonia (p = 0.001), candidal esophagitis (p = 0.020), Kaposi's sarcoma (p < 0.001), or wasted appearance (p = 0.043). Inappropriate prescriptions were more likely to be given to patients with dementia (p = 0.005) or wasted appearance (p = 0.019). CONCLUSIONS: Physicians tend to prescribe narcotics inappropriately to patients known to have previously abused drugs and to those who appear wasted or have dementia. Physicians have a duty to prescribe narcotics appropriately as guided by recognized medical indications and the patients' views concerning their current medical needs.

AIDS-Related Complex↗
PubMed1994

A programme for treating chemically dependent medical students.

The first American programme for chemically dependent medical students at the University of Tennessee, Memphis is described. The goals of the Aid for the Impaired Medical Student (AIMS) Program are to provide confidential treatment for chemically dependent medical students, to assure that recovering students are able to resume their education, and to protect patients and others from the harm that may be caused by impaired students. The Program is administered by the AIMS Council, consisting of medical professionals and elected student representatives. The Council oversees the management of cases, including investigation of students who may be impaired, intervention when chemical dependency is suspected, diagnostic evaluation, treatment and aftercare, and post-recovery advocacy for students. The Program's experience includes 18 cases of suspected chemical dependency, with four self-referrals and 14 students referred by third parties. Eleven students have been diagnosed as chemically dependent and have completed treatment programmes. Nine have maintained recovery and eight have graduated. One student subsequently relapsed and committed suicide. Obstacles in programme implementation have involved absence of perceived need, the view that chemically dependent students should be dismissed from school, and reluctance of students to report classmates. Resources have included highly respected student representatives, a supportive administration, assistance of the impaired physicians programme, and medical insurance and professional courtesy to defray costs. Although the number treated has been modest, the AIMS Program is an important vehicle for training students regarding chemical dependency and their professional obligations toward impaired colleagues.

Health Promotion↗
PubMed1984

Patterns of primary care that create dependency.

Significant moral tension exists between attempts to address the medical problems of children in the public primary care clinic and the impact of these efforts on the self-reliance of children and families in providing for their own health care needs. We describe and demonstrate dependency-inducing practices. We discuss the moral reasons why such practices should be strictly limited, as well as the exceptional circumstances in which they are appropriate. These moral concerns suggest changes in how we provide clinic services, which we demonstrate by reference to common practices, such as providing free services, following up on missed appointments, and making arrangements for families with outside agencies. We argue that the mistakes of colonialism may be repeated unless enhancing the self-reliance of families becomes a major goal in the clinic setting.

Attitude to Health↗
PubMed1983

Experimentalism in bioethics research.

Basson's commentary on my proposals regarding the structure and function of research in bioethics provides a welcome opportunity for extended comparison of standard approaches with the suggestions made in 'What Bioethics Should Be.' I begin by noting a common assumption underlying our respective views. I then address points of fundamental difference, indicating why the experimental method proposed in my original essay presents a potentially more productive strategy for examining moral issues in biomedicine. In the latter respect, I certainly disagree with Basson's contention that "we are unable to test" metaethical hypotheses "against reality" (Basson, p. 185) - a proposition which seems no more defensible than the equally untenable claim that we cannot refine methods of natural science research through examination of their usefulness in advancing our understanding of the correlation of events in nature.

Bioethics↗