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At least 1,153 records · Page 64Linked to original sources
PubMed1990

Autonomy and professional activities of social workers in hospital and primary health care settings.

Social workers in hospital settings often experience frustration working in the host setting of a hospital. Some hospital social workers may consider a move to a private primary health care setting to gain more autonomy on the job and the opportunity to provide more direct clinical services and less task-oriented ones. In this article, the authors report a study that compared the autonomy and professional activities of social workers in hospital settings and private primary care settings. It was found that social workers in the two settings do not differ in their level of perceived autonomy and that those in private primary care provide more therapy and counseling. The implications of these and other findings are discussed.

Adolescent↗
PubMed1987

DRGs: justice and the invisible rationing of health care resources.

Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of "interstitial justice," that is, an approach to making justice judgments that is suitable to assessing the social practices and institutions that comprise the interstices of our social life as opposed to its basic structure. Rawls's appeal to "our considered moral judgments" provides us with a useful starting point for this task, which we shall discuss in the first part of this essay. In the second part, we shall actually assess DRGs from the perspective of interstitial justice. What we shall show is that DRGs violate a large number of our considered judgments regarding a just approach to financing health care for the elderly in a cost-effective manner. This is true to such an extent that efforts to reform DRGs and make them fairer, such as the recent effort by Robert Veatch, should be abandoned. In the concluding section of the essay we discuss one especially pernicious feature of DRGs, namely, that they represent an invisible approach to rationing access to health care. In the minds of many this is one of the virtues of DRGs. That claim needs critical examination.

Aged↗
PubMed1991

Getting down to cases: the revival of casuistry in bioethics.

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modern-day casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the 'open texture' of its principles, etc.) and discusses some problems with casuistry as an 'anti-theoretical' method. It is argued that casuistry so defined is 'theory modest' rather than 'theory free' and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting 'deep' interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, not-withstanding these problems, casuistry represents a promising alternative to the regnant model of 'applied ethics' (i.e., to the ritualistic invocation of the so-called 'principles of bioethics'). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of 'moral diagnosis', and (5) be ever mindful of the limits of casuistical analysis.

Bioethical Issues↗
PubMed1997

The role of radionuclide angiocardiography in the treatment of patients receiving doxorubicin-based chemotherapy: a reassessment.

We attempted to evaluate the role of radionuclide angiography in the routine treatment of patients receiving doxorubicin-based therapy in a university hospital setting. We identified 222 cancer patients treated with doxorubicin or who underwent radionuclide angiography with the intent to receive doxorubicin at the University of Iowa in 1989. We examined the cumulative doses of doxorubicin, results of radionuclide angiograms, cardiac risk factors, and clinical outcomes and survival of patients. Of 222 patients, 168 (76%) underwent at least one radionuclide angiogram and received doxorubicin. Only a baseline study was performed in 136 (81%) of these 168 patients. Only 32 underwent follow-up study during therapy; six patients discontinued therapy for an 11-21% decrease in left ventricular function. The mean dose of doxorubicin received was 211 mg/m2, and 193 patients (96%) received a cumulative dose <450 mg/m2. Only two patients (1%) had heart failure. A questionnaire sent to medical oncologists in Iowa showed that use of radionuclide angiography in our institution reflected practice throughout the state. The majority of patients in our population who underwent radionuclide angiography had a single baseline study, which provides little clinically useful information. The majority of patients receiving doxorubicin as currently employed can be safely treated without radionuclide angiography.

Adolescent↗
PubMed1994

Coronary bypass surgery in women.

Cardiac surgeons have long appreciated that coronary artery bypass grafting may differ in its success for men and women. Early studies reported that coronary artery bypass grafting was associated with a higher early mortality in women, although long-term survival was similar in both sexes. A consistent finding was that women were more symptomatic, with a greater number of adverse risk factors at time of surgery, although they had less coronary disease and better cardiac function. Recent studies suggest that their disadvantageous clinical profile remains, but that they are now burdened with increased coronary disease and poorer cardiac function. There is increasing evidence that women are underreferred for coronary angiography, although it would appear that once investigated, they receive appropriate referral for coronary artery bypass grafting. These findings are not universal, and there are significant differences in clinical practice between institutions.

Coronary Angiography↗
PubMed1991

Gastrointestinal complications in the post-cardiac transplant patient.

Cardiac transplants have emerged as life-extending procedures for patients with diseased hearts. Their frequency has increased over the past decade. Evaluation of the clinical course of these patients has revealed trends toward development of gastrointestinal complications which involve the upper and lower gastrointestinal tracts as well as the accessory organs. This article will discuss the complications that have been seen in the post-cardiac transplant patient as reported at Saint Joseph's Hospital of Atlanta. A more detailed discussion of opportunistic infections caused by immunosuppression therapy will be presented since these are the major complications seen in this institution. This article will share this institution's practice in regard to caring for the cardiac transplant patient. Nursing implications relating to the GI endoscopy specialty will be included. Our experience has shown that although these complications are common, they may be managed effectively through early evaluation with attention to the special needs of the immunocompromised endoscopy candidate.

Endoscopy↗
PubMed1992

Cancer epidemiology in the former Soviet Union.

Cancer epidemiology in the former USSR is predominantly descriptive and depends heavily on cancer registration. Cancer epidemiologists have spent most of the last 35 years "correcting" the serious inconsistencies in reported incidence data, as official cancer statistics are notoriously incomplete and inaccurate. Professional standards of Soviet cancer epidemiologists reflect the prevailing conditions they have worked in, notably, severe censorship, bans on publishing, lack of computers for compilation of data or analysis, loose recordkeeping practices in institutions, restricted access to scientific literature, and limited opportunities for training in biostatistics and epidemiology. In the eyes of a new generation of young scientists, modern epidemiology is not an attractive discipline. Despite having one of the largest and most diverse populations in the world, the scientific productivity of ex-Soviet cancer epidemiologists is small. The increasing number of publications from the former USSR in international journals and of ongoing projects is an encouraging sign that cancer epidemiology in the republics that comprised the Soviet Union may be emerging from its prolonged infancy. Prospects depend on the ability of researchers to weather current economic and political disturbances.

Confounding Factors, Epidemiologic↗
PubMed1978

Medical service plans in academic medical centers.

Medical service plans are of major importance to academic medical centers and are becoming increasingly so each year as evidenced by growing dependence of medical schools on resulting funds. How these funds are generated and used varies among schools. The procedures may affect the governance of the institution, modifying the authority of the central administration or the clinical departments. Recent developments in federal legislation, such as health maintenance organizations and amendments (Section 227) to the Social Security Act, and the future development of national health insurance will certainly have an effect on how academic medical centers organize their clinical activities. How successfully various medical schools deal with the dynamic problem may well determine their future survival.

Faculty, Medical↗
PubMed1983

Acceptance by private patients of resident involvement in their outpatient care.

The attitudes of private patients toward resident participation in their ambulatory care were evaluated. Of 195 patients (29 percent) responding to 667 mailed prospective questionnaires, 143 (73 percent) stated that they would allow resident participation in their care. Satisfactory prior experiences with trainees was the most important factor predicting acceptance (p less than .0001) of resident participation. A majority of "accepting" respondents would allow the following limited delegation of responsibility to residents: history-taking, physical examination, and visit scheduling. The majority (71 percent) desired faculty consultation at every visit. A small, retrospective survey of resident-treated private patients revealed that 70 percent were fully satisfied, 20 percent partially satisfied, and 10 percent dissatisfied. Dissatisfaction by the patients was associated with not knowing beforehand that a trainee would participate in the health care delivery. The private patients usually accepted trainees for outpatient care if: (a) they had been informed in advance, (b) they had not had a prior unsatisfactory resident experience, and (c) the responsibility of the residents had been carefully delegated and the residents closely supervised.

Ambulatory Care↗