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At least 469 records · Page 26Linked to original sources
PubMed1989

Treatment choices at the end of life: a comparison of decisions by older patients and their physician-selected proxies.

Doctors are increasingly faced with the ethical dilemma of making end-of-life medical care decisions for older patients who are decisionally incapacitated. Most often, they rely on family to assist them in choosing what the patient would have wanted. In this vignette-based study, the ability of proxies to choose as the patients reported they would have chosen is called into question. Implications for the use of advance directives for end-of-life care and avenues for needed research are discussed.

Adult↗
PubMed1990

An empirical study of proxy consent for elderly persons.

To investigate empirical assumptions about substituted judgment, three treatment decision scenarios were presented to 43 competent elderly persons and 115 persons related to them. Related subjects who were explicitly asked to make a substituted judgment came significantly closer to the elderly person's preferences than those who were asked to make their best recommendation (p = .005-.067, depending on index used). These results support the use of a substituted judgment approach to proxy decision makers; other results suggest some limitations of durable powers of attorney.

Aged↗
PubMed1997

Criteria for placing older adults in public conservatorship: age as proxy for need.

This study was conducted on a sample of 589 adult public conservatees in Los Angeles County, California, to determine whether the process used to assign them into conservatorship is age-blind, as California law suggests. Findings indicate that age is not associated with the amount of time spent evaluating adults for conservatorship but that increasing age, rather than need, is associated with assignment into Probate conservatorship. The association of age with Probate conservatorship appears to result from the vagueness of the criteria for Probate conservatorship-unable to manage-resulting in the use of age as a proxy for need in the case of decisionally impaired older adults.

Adolescent↗
PubMed1989

Munchausen syndrome by proxy.

Munchausen syndrome by proxy (MBP) is the deliberate induction or reporting of physical symptoms in a child. It is a form of child abuse that can result in death, iatrogenic disease, or the masking of a genuine illness. MBP is suggested by symptoms that do not follow the usual course of illness, particularly if the symptoms only occur in the presence of the same person. MBP may occur when caretakers (usually mothers) perceive that being the parent of a sick child will solve personal conflicts and be socially rewarded, or if life experiences have demonstrated that the price of love is physical illness. When MBP is suspected, the health care team needs to take aggressive action to confirm or disprove it and to protect the child. A social worker confronted with possible MBP must manage a difficult situation that often involves painful team issues as well as confusion over the nature of reality.

Child↗
PubMed1985

The physician/population ratio as a proxy measure of the adequacy of health care.

In the absence of service use and health status data at the individual level in most developing countries of the world, the utility of the physician/population ratio as a proxy measure of health service availability and use in health needs assessment is tested. Data from 60 predominantly developing countries show that the physician/population ratio is curvilinearly related to an indicator of population health status, namely infant mortality. When this relation is linearized by logarithmic transformations, the physician/population ratio accounts for 53% of the variance in infant mortality. There is no significant functional relationship between the physician/population ratio and infant mortality when state-level data in the US are analysed. Implications of these findings are discussed with respect to needs assessment in developing regions of the world.

Developing Countries↗
PubMed1989

Would a healthier population consume fewer health service resources? A life-table analysis using hospital in-patient enquiry (HIPE) bed-usage statistics as a proxy for hospital treatment costs.

The long-term effects upon acute-care hospital costs of reductions of morbidity and mortality from various causes are explored. The daily number of beds used per million population for all diagnostic categories is suggested as a proxy measure of hospital costs. An index of lifetime bed usage for a hypothetical cohort of persons living out their lives under specified age-specific mortality and morbidity patterns is derived. Examples of the application of this index are given for differing assumptions about mortality and morbidity in males. It is shown that reducing ischaemic heart disease or cancer morbidity will lead to increased overall hospital costs whereas reductions in the rate of occurrence of accidents, injuries and poisonings would reduce overall costs. The assumptions underlying the use of the index are discussed and extensions to the population model are proposed.

Actuarial Analysis↗
PubMed1983

Determining proxy consent.

The paper clarifies the relative merits and proper roles of standards of review in the determination of proxy consent for those unable to make decisions concerning their own medical treatment. The "substituted judgment" standard asks which treatment the incompetent person would choose if competent, while the "best interests" test asks which treatment would benefit the patient. The tests are discussed in relation to the moral principles of autonomy and beneficence which provide their justification. I distinguish six types of cases involving incompetent patients and argue that which standard is appropriate depends on the type of case involved. A "rational choice" standard, which asks "What would the incompetent patient choose if his or her choice were rational?", is proposed as a way of determining best interests.

Beneficence↗
PubMed1993

Primary versus proxy respondents: comparability of questionnaire data on alcohol consumption.

Questionnaire data on alcohol consumption obtained from primary respondents participating in a community-based case-control study of coronary heart disease were compared with similar data obtained from their next of kin. The primary respondents were men and women aged 25-64 years who were a representative sample of myocardial infarction cases (n = 58) and controls (n = 456) from the case-control study. The study was conducted in Auckland, New Zealand between 1986 and 1988. When alcohol drinking frequency was collapsed into five categories, exact agreement between primary respondents and next of kin was 64% for cases and 62% for controls. Agreement within one category (plus or minus) was 89% for both cases and controls. Tests of marginal homogeneity showed no evidence that next of kin systematically over- or underestimated the primary respondents' self-reported drinking frequency. With respect to the amount of alcohol drunk, mean differences between primary respondents and next of kin were small (mean difference: 2.25 g per day for cases; -0.77 g per day for controls), although there was considerable variability between individual pairs in the level of agreement. The findings suggest that studies which use proxy sources of data to assess alcohol drinking are unlikely to produce biased estimates of alcohol consumption at the aggregate level, particularly with regard to frequency measures.

Adult↗
PubMedDate not supplied

The SECCAT Survey: II. The Alcohol Related Problems Questionnaire as a proxy for resource costs and quality of life in alcoholism treatment. Study of Socio-Economic Consequences and Costs of Alcoholism and Treatment.

An interview was obtained with 212 patients who had, at a point 12 months previously, been in contact with an alcohol problems clinic. Quality of life (SF-36) was measured and for the preceding 6 months the cost of health and social service resource use was estimated, together with the total abstinent (or controlled drinking) days accrued. Alcohol related health, personal and social problems experienced during that period were elicited using a brief 11-item questionnaire, the Alcohol Related Problems Questionnaire (ARPQ). The estimate of costs correlated more strongly with the ARPQ score (r = -0.32, P = 0.0001) than with abstinent days (r = 0.03, n.s.) or controlled drinking months (r = -0.21, P = 0.002). The lack of relation of total abstinent days to cost is partly because abstainers tended to use considerable alcohol problems clinic resources. ARPQ scores indicating more problems were associated with lower quality of life. The ARPQ can serve as a proxy for resource use and quality of life in alcoholism treatment.

Adult↗
PubMed1986

Munchausen syndrome by adult proxy: a perpetrator abusing two adults.

We present a case of Munchausen syndrome by proxy (MBP) in a symbiotic relationship between a 34-year-old man and his two female partners. In the past, MBP has only been identified in mother-child relationships. The present case, however, extends the syndrome to relationships between adults as well.

Adult↗
PubMedDate not supplied

Self-reported integration as a proxy for acculturation: a qualitative study.

BACKGROUND: It is essential to account for acculturation in any research conducted in multicultural populations. Both unidimensional and bidimensional approaches are used to measure the extent of acculturation; however, neither one of them is optimal. OBJECTIVE: To explore the immigrants' rating of the extent of their acculturation (self-reported integration) in contrast to an external (researchers') measurement. METHODS: Fifteen in-depth interviews with strategically sampled Russian-speaking men and women aged 25-70 years, with varying marital and employment status and living permanently in Stockholm, Sweden, were analyzed using a content analysis technique. The results were validated by means of a series of additional mini-interviews by telephone. RESULTS: The immigrants' self-reported integration corresponded with the researchers' bidimensional measurement of the extent of acculturation of these immigrants. Self-reported integration accounted for the mastering of the formal criteria of integration, resolving of grief concerning the homeland, and fulfilling the internal criteria of integration. DISCUSSION: Self-reported integration may be used as a proxy for acculturation but its application should be tested primarily in other settings and in a quantitative analysis.

Acculturation↗
PubMedDate not supplied

Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for Patient Care?

PURPOSE: To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics. DESIGN AND METHODS: Secondary data analysis of a convenience sample of 481 patient ratings from adult and pediatric critical and noncritical medical surgical patients. FINDINGS: Combining dichotomous patient acuity indicators into multilevel categorical variables allowed evaluation of linear relationships between acuity and patient characteristics indicators. Of the 8 patient characteristics, only participation in care exhibited meaningful correlations with the acuity indicators. According to these findings, acuity indicators should not be substituted for the Synergy Model patient characteristics.

Activities of Daily Living↗
PubMed1998

Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone.

In response to concerns about contamination of human breast milk from silicone gel-filled breast implants, and because silicon levels are assumed to be a proxy measurement for silicone, we compared silicon levels in milk from lactating women with and without implants. Two other sources of infant nutrition, cow's milk and infant formulas, were also analyzed for silicon. The survey took place at the Breast-feeding Clinic at Women's College Hospital in Toronto. A convenience sample of lactating women, 15 with bilateral silicone gel-filled implants and 34 with no implants, was selected. Women with foam-covered or saline implants or with medically related silicone exposures were ineligible. Collection of samples was scrupulously controlled to avoid contamination. Samples were prepared in a class 100 "ultraclean" laboratory and analyzed using graphite furnace atomic absorption spectrophotometry. Silicon levels were analyzed in breast milk, whole blood, cow's milk, and 26 brands of infant formulas. Comparing implanted women to controls, mean silicon levels were not significantly different in breast milk (55.45 +/- 35 and 51.05 +/- 31 ng/ml, respectively) or in blood (79.29 +/- 87 and 103.76 +/- 112 ng/ml, respectively). Mean silicon level measured in store-bought cow's milk was 708.94 ng/ml, and that for 26 brands of commercially available infant formula was 4402.5 ng/ml (ng/ml = parts per billion). We concluded that lactating women with silicone implants are similar to control women with respect to levels of silicon in their breast milk and blood. Silicon levels are 10 times higher in cow's milk and even higher in infant formulas.

Adult↗
PubMed2002

Munchausen syndrome by proxy in the pediatric intensive care unit: An unusual mechanism.

OBJECTIVE: To present a case of Munchausen syndrome by proxy (MSbP) by a previously unreported mechanism, discussing the occurrence of MSbP in patients in the pediatric intensive care unit (PICU) and the use of covert video surveillance in the diagnosis of MSbP. DESIGN: Report of one case of a child who was proven to be the victim of MSbP while hospitalized in a PICU. SETTING: A six-bed PICU in a military teaching hospital. PATIENTS: One patient hospitalized for evaluation of confusing symptoms, later shown to be the victim of MSbP while on mechanical ventilation in the PICU. The mechanism of MSbP was intentional tracheal extubation by the patient's mother. INTERVENTIONS: Covert video surveillance. MEASUREMENTS AND MAIN RESULTS: After initiation of covert video surveillance in the PICU, the diagnosis of MSbP was confirmed. The patient recovered with some physical sequelae. CONCLUSIONS: Children can be victims of MSbP even in a closely monitored PICU. Covert video surveillance was crucial to confirming the diagnosis.

Journal Article↗
PubMed2001

Accumulation of deficits as a proxy measure of aging.

This paper develops a method for appraising health status in elderly people. A frailty index was defined as the proportion of accumulated deficits (symptoms, signs, functional impairments, and laboratory abnormalities). It serves as an individual state variable, reflecting severity of illness and proximity to death. In a representative database of elderly Canadians we found that deficits accumulated at 3% per year, and show a gamma distribution, typical for systems with redundant components that can be used in case of failure of a given subsystem. Of note, the slope of the index is insensitive to the individual nature of the deficits, and serves as an important prognostic factor for life expectancy. The formula for estimating an individual's life span given the frailty index value is presented. For different patterns of cognitive impairments the average within-group index value increases with the severity of the cognitive impairment, and the relative variability of the index is significantly reduced. Finally, the statistical distribution of the frailty index sharply differs between well groups (gamma distribution) and morbid groups (normal distribution). This pattern reflects an increase in uncompensated deficits in impaired organisms, which would lead to illness of various etiologies, and ultimately to increased mortality. The accumulation of deficits is as an example of a macroscopic variable, i.e., one that reflects general properties of aging at the level of the whole organism rather than any given functional deficiency. In consequence, we propose that it may be used as a proxy measure of aging.

Aged↗
PubMed2002

Race, ethnicity, and genomics: social classifications as proxies of biological heterogeneity.

Over the past century, genetics has experienced a tension between the view that racial and ethnic categories are biologically meaningful and the view that these social classifications have little or no biological significance. That tension continues to inform genomics and is evident in the assembly of biological collections and sequence databases that seek to approximate the genetic variation found in human populations. Although social identities can be useful and convenient proxies of some biological features, for example, in ensuring that genomic resources capture a range of genetic variants found in most human populations, the ways in which geneticists conceptualize the relationship between racial and ethnic identities and genetic variation can be problematic. Inclusion of racial and ethnic identifiers in genomic resources can create risks for all members of those identified populations and influence lay perceptions of the nature of racial and ethnic groups. Thus, the burden of showing the scientific utility of racial and ethic identities in the construction and analysis of genomic resources falls on researchers. This requires that genetic researchers pay as much attention to the social constitution of human populations as presently is paid to their genetic composition.

Ethnicity↗
PubMed2000

Duties to future generations, proxy consent, intra- and intergenerational equity: the case of nuclear waste.

How does one deal with problems of risk transfer if it is the case that increasing risks to future generations decreases the risks to present generations, and increasing the risks to present generations decreases the risks to future generations? In the case of high-level nuclear waste and spent fuel, for example, should billions of dollars be spent to secure the wastes and protect future generations, or should the same monies be spent on present-day needs, under the assumption that future generations will be better able to deal with the waste than we are at present? Although these questions may appear insoluble, they become less so when one recognizes several common ethical and logical errors that beset many discussions of technological risk and duties to future generations. After briefly explaining the grounds for inter- and intragenerational equity, this analysis argues for three propositions about many treatments of inter- and intragenerational ethics: (1) these discussions often err because they frame policy arguments in terms that ignore rights and focus on maximizing welfare or utility, (2) they err because they frequently frame policy arguments in ways that set inter- and intragenerational welfare at odds, when they are not, because they ignore ameliorating practices and the conditions for proxy consent, and (3) they also err because they engage in risk practices that do not match their risk rhetoric.

Journal Article↗
PubMed1983

Bleeding ears: case report of Munchausen syndrome by proxy.

A two and a half year old child presented with "bleeding" ears which proved to be factitious in origin. A previous episode of haematuria, haematemesis and melaena at age 9 months was probably also factitious. A brief discussion of Munchausen syndrome by proxy is presented.

Diagnosis, Differential↗