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At least 235 records · Page 13Linked to original sources
PubMed1981

Radiology and risk: an economist's perspective.

This paper, which is an amended version of a talk given to The British Institute of Radiology at a meeting on "Dosimetry and Risks to Patients in Radiopharmaceutical Investigations", picks up the ICRP's concept of detriment and places it firmly in the framework whence it came, viz. cost-benefit analysis. It explains cost-benefit analysis (distinguishing it from cost-effectiveness analysis) and suggests various ways of trying to place a value on human life in order to use cost-benefit analysis as a practical tool of decision-making in policy areas where at least part of the benefit is to be measured in terms of lives saved. The paper suggests that it is important to decide not only who is to value life but also whose perception of risk of death are to be deemed relevant. A practical example in the use of life values is presented for the case of mammography in breast cancer screening.

Adult↗
PubMed2002

The initiation and administration of drugs for advanced life support by critical care nurses in the absence of a medical practitioner.

Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position. The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation. A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer; indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.

Attitude of Health Personnel↗
PubMed2001

Are xenotransplantation safeguards legally viable?

Scientists agree on the need for robust public health safeguards to accompany the imminent introduction of xenotransplantation--clinical transplantation of animal tissue into humans. To protect society in the event of emerging infectious diseases, governments must devise a legally effective means of ensuring compliance with such safeguards. Neither consent law, the law of contracts, nor existing public health legislation can adequately enforce such compliance. Consent law serves as a mechanism of communicating the momentary waiver of legal rights, not as a durable enforcement doctrine. Because it would be essential for recipients personally to comply with public safety measures, the law of contracts would also be unable to compel compliance. Existing public health legislation would also likely be ineffective because it would need to be substantially amended to incorporate the heightened powers necessary for the periodic examination of asymptomatic xenotransplant recipients. Xenotransplantation-specific legislation would be a legally effective means of enforcing public health safeguards since it could require conforming behaviors and could impose monetary fines on those recipients who, having benefited from life-saving intervention, fail to comply. This Article argues that legislation implementing a post-xenotransplantation surveillance system should withstand constitutional scrutiny because it would not be discriminatory and because, although it would violate fundamental rights of recipients, such violations would be justified under existing constitutional doctrines.

Animals↗
PubMed2001

Is success a sin? A conversation with the reverend Peter J. Gomes. Interview by David A. Light.

The difficult task of achieving worldly success while also storing up spiritual treasure is perennially with us, in good times and in bad. Today, however, as the economy has cooled and companies have demonstrated their mortality, questions about meaning and value appear more relevant, even urgent. HBR associate editor David A. Light recently spoke with the Reverend Peter J. Gomes, one of the nation's best-known preachers and the minister at Harvard University's Memorial Church, about why and how it is both possible and necessary to reconcile a life of success with a life of faith. To do so, says Gomes, you must first "get used to it"--come to terms with the age-old tension between being rich in spirit and rich in worldly goods. Second, you should "get over it"--arrive at an understanding of the value and responsibilities associated with power and wealth. Finally, "get on with it"--figure out how you can live your life spiritually while continuing to lead in the business world. For those wondering how to get on with spiritual development, Gomes cites the growing phenomenon of senior executives gathering with peers--out of shared need, not shared accomplishment--to pray, study sacred texts, and share their religious life together. He counsels that it's never too late to get on with it: We can amend life at any time, whether we're 35, 45, or 75. Gomes concludes that business will continue to be one of the most significant forces in American culture, but it will always struggle against people's need for a perspective that is beyond this world's.

Achievement↗
PubMedDate not supplied

[A promising alternative for the treatment of type I diabetes. The implantable insulin pump].

Recent improvements in miniaturization of implantable pumps and the ability of their control by tele transmission allowed implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient died to this day. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them dictating final pump explantation. Dosages of mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin were all lower versus dosages before implantation. Statistically significant difference was demonstrated regarding mean global blood-sugar. Frequency of sever hypoglycemia incidents (4 in our series) and of biological hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing major benefit of the technique. The patients well-being and quality of life were notably amended. Implantable insulin-pump may be offered as a treatment alternative to conventional insulin-therapy, especially in cases of diabetes which are difficult to balance and particularly in cases with frequent hypoglycemic malaise.

Adult↗
PubMed1991

[Percutaneous, transluminal angioplasty of aortocoronary venous bypass grafts--acute success, angiography and clinical follow-up].

In 41 consecutive patients with 49 stenoses of aorto-coronary venous bypass (ACVB) grafts percutaneous transluminal angioplasty (PTA) was attempted. PTA was successful, i.e., the percent area stenosis was reduced by greater than 20% to less than 70% (quantitative measurement with a precision magnifying lens from two orthogonal angiographic views) in 46 stenoses (94%) of 38 patients (93%). In 35 patients (92%) with 42 stenoses control coronary angiography was performed after a mean interval of 189 +/- 186 days. Recurrence, defined as an increase of percent area stenosis to greater than or equal to 70%, was found in nine stenoses (21%) of nine patients (26%). Recurrence correlated with a stenosis length greater than 10 mm before PTA (5/8 vs 4/32 stenoses: p less than 0.01). In recurrent stenoses, the average diameter of the grafted native coronary artery was significantly smaller than in recurrence-free stenoses (1.92 +/- 0.52 mm vs 2.45 +/- 0.50 mm; p less than 0.01). Clinical data were collected from all 38 patients with successful PTA after an average of 30 +/- 17 months following PTA. In this interval, 11 patients had undergone re-angioplasty and eight patients were re-operated; in addition, there were three cardiac deaths. In the 27 surviving patients without re-operation (71%), angina pectoris had improved from a mean of 3.0 +/- 0.7 before PTA to 1.8 +/- 1.0 (CCS-classification) (p less than 0.001). In 19 of the 27 patients (70%) the exercise stress test was negative, in contrast to only three patients (11%) before PTA. Thus, in the majority of patients PTA of ACVB-graft stenoses improves quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Advances in telecommunications concerning epilepsy.

Telemedicine is a rapidly expanding discipline. Looking back on a long tradition of telemetric measurement and transmission of brain electrical data, one might ask how relevant telecommunication techniques have become for clinical work in epileptology. In principle, communication can be either between patient and doctor or between doctor and doctor. The former includes telephone reports on frequency and severity of seizures and on mental and physical state. Because of the special problems of patients with epilepsy, the need for traveling should be minimized. To maintain close contact, telemetric transmission of electroencephalograms (EEG), seizure video-registration, and monitoring of anti-epileptic drug (AED) blood levels from home are desirable, but the technical tools now available are not of sufficiently high performance for these applications. However, physicians and medical units can communicate using high-rate data transfer. There are major problems with this technology. Transfer rates using the internet are not fixed. Moreover, using six digital telephone lines simultaneously, good-quality transmission of a 3-min video may take more than 1 h, restricting interactivity. In contrast to imaging (e.g., magnetic resonance imaging), there is no generally accepted protocol for handling EEG/electrocorticography data. There are also legal problems relating to the responsibility for failures and safety of personal or medical data. Nevertheless, the expenses of installation and use of such equipment appear justified by the expected benefits, for the patients (avoiding travel and multiple investigations, checking diagnosis and therapy, amending quality of life), for the physician (sparing equipment and manpower, accelerating and improving diagnosis), for the epilepsy center (increased database for expert systems, improved logistic and data storage) and, finally, for insurance providers (reduced overall costs). When the neurosurgical procedure is remote from the place of presurgical evaluation, telecommunication should be obligatory.

Confidentiality↗