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T Tomlinson

Publications and source records attributed to T Tomlinson.

28 records · Page 2Linked to original sources
PubMed1986

Ethics in primary care: setting aside common misunderstandings.

Ethics, as generally defined, tries to answer the question, "What ought to be done in a given situation, all things considered?" Answering this question in primary care is hampered by some common and recurring misunderstandings--some arising from physicians' misunderstanding of ethical concepts and vocabulary and some arising from ethicists' misplaced emphasis and ignorance of medical settings. Examination and clarification of these misunderstandings illuminate the nature of primary care ethics and the role of the practicing physician.

Culture↗
PubMed1985

Teaching medical students the effects of values and stereotyping on the doctor/patient relationship.

As part of an introductory course on the doctor/patient relationship, a teaching unit was designed which emphasized to students that values, biases and prejudices may affect their behaviors when interacting with patients. The unit included lectures on values, specific readings and a survey component which challenged students' value systems and provided them with the opportunity for exploration of hidden biases and prejudices. The survey component involved a series of trigger vignettes depicting five patients interacting with the same (actor) physician. On a rating instrument, students were asked to rate each patient on ten positive and ten negative characteristics, identify the characteristic which best described each patient and select the patient they would most like to treat. The survey was administered to an incoming class of medical students at the orientation session to a course on the doctor/patient relationship. Students were asked to keep a copy of their ratings and bring it to the small group discussion session on physician values. The data were collected, and a class composite developed and submitted to the course instructors prior to the discussion and processing sessions on values. Specific instructions on how to utilize the materials were provided. The class composite, which revealed that students have biases, served as a focus for discussion and facilitated students awareness that unconscious stereotypes exist in their value systems. This teaching approach provided students with a beginning insight that biases and prejudices affect the doctor/patient relationship and the quality of care patients receive.

Adult↗
PubMed1984

The conservative use of the brain-death criterion--a critique.

The whole brain-death criterion of death now enjoys a wide acceptance both within the medical profession and among the general public. That acceptance is in large part the product of the contention that brain death is the proper criterion for even a conservative definition of death - the irreversible loss of the integrated functioning of the organism as a whole. This claim - most recently made in the report of the Presidential Commission and in a comprehensive article by James Bernat and others - is based upon a series of fallacious arguments. Chief among these is the argument that whole brain-death is the proper criterion for the conservative definition because the brain is the organ that integrates the rest of the organism. A central part of the paper shows that this argument rests upon a confusion between a function and the mechanism that performs it, and replies to the defenses that the Presidential Commission makes on this point. The concluding portion of the paper argues that this issue is not merely of academic interest, but has the potential for undermining the present consensus that supports the use of whole brain-death criteria.

Advisory Committees↗
PubMed1978

Control of intermittent positive pressure breathing (IPPB) by extracorporeal removal of carbon dioxide.

Five lambs were anaesthetized, paralysed, mechanically ventilated and connected to a membrane "lung" to permit removal of carbon dioxide. When part of the carbon dioxide was removed in this manner, the tidal volume was decreased to keep PaCO2 constant. For example, when 70% of carbon dioxide was removed by the membrane lung, total ventilation was reduced by 50%, peak inspiratory pressure was decreased by 45%, and PaO2 was kept constant by increasing the inspired oxygen fraction from 0.21 to 0.27%. The removal of carbon dioxide by a membrane during positive pressure breathing could decrease barotrauma, particularly in poorly compliant lungs. Technically, the extracorporeal removal of carbon dioxide is relatively simple procedure.

Animals↗
PubMed1978

An alternative to breathing.

If carbon dioxide is removed by an extracorporeal membrane lung ventilated with room air, the natural lung can be used for oxygen transport alone; we have demonstrated this in lambs by maintaining lungs "inflated" with 100 percent oxygen at constant pressure and removing all carbon dioxide through the membrane lung. This process is a variant of "apneic oxygenation" without its disadvantages, because the arterial pH, PCO2, and PO2 all remain normal. No nitrogen washout is needed. These studies were carried out in five lambs anesthetized and paralyzed for 24 hours. For carbon dioxide removal, blood from the subclavin artery was pumped through an extracorporeal membrane lung and was returned into the external jugular vein. For oxygen delivery, the lungs were inflated through a tracheostomy tube with 100 percent oxygen to a pressure of 5 cm. H2O. There was no significant change in arterial blood PO2 after perfusion had begun or at the end of the perfusion 24 hours later. The arterial PCO2 remained steady, and there was no change in acid-base balance. The functional residual capacity (FRC) and static lung compliance remained unchanged. The total dead space was 10 to 15 ml. All animals recovered and survived in good health. At equilibrium, alveolar nitrogen partial pressure was always equal to the partial pressure of nitrogen in the ventilating gas of the membrane lung and was the sole determining factor in controlling alveolar oxygen concentration. Direct measurement of pulmonary gas showed alveolar gas at the level of the carina.

Animals↗
PubMedDate not supplied

Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPV-ECCO2R): an experimental study.

We describe a new form of mechanical pulmonary ventilation, low-frequency positive pressure ventilation with extracorporeal CO2 removal (LEPPV-ECCO2R). In a series of animal studies the rate of mechanical ventilation was 0.66, 1, 2, and 4 min-1 at a tidal volume of 3, 10, and 15 ml kg-1. We were able to maintain normal blood gases and normal lung volumes and lung mechanics even at the lowest ventilator rate with tidal volumes of 10 or 15 ml kg-1. Each experiment lasted 7 hours. Our data suggest a possible new dimension in the management of a difficult patient on mechanical pulmonary ventilation.

Animals↗
PubMedDate not supplied

Surrogacy revisited.

Explore the source record for details and available documents.

Fathers↗