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At least 127 records · Page 7Linked to original sources
PubMed1984

Pain and the ethics of pain management.

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

Attitude of Health Personnel↗
PubMed1986

Divided loyalties for physicians: social context and moral problems.

An examination of the notion of divided loyalties dilemmas in medicine, situated within their social contexts, yields insight into the contemporary social and moral position of medicine in the United States. In a review of the literature, the author identifies four concepts important to gaining an understanding of the position that divided loyalties play in medicine and the physician-patient relationship. After describing some of the situations in which these dilemmas affect physicians' responses to patients' health care needs, interests, and choices, the author argues that divided loyalties dilemmas are not rare, and will probably increase with the changes in U.S. medicine. Candor and awareness of the importance of the public belief in physician loyalty are seen as necessary in preventing these changes from becoming destructive of the physician-patient relationship.

Behavior Control↗
PubMed1987

Ethical considerations of informed consent: a case study.

Presentation is made of a case study concerning a patient with chronic obstructive pulmonary disease who was also discovered to have small cell carcinoma. The patient had indicated many years prior to his hospitalization that if he ever had cancer he would not want to receive chemotherapy. He also indicated to his physician he did not want to hear any 'bad news'. The dilemmas posed by the ethical relationship between consultant and primary care physician and between consultant and patient in such a case are explored. The role of a hospital ethics committee in advising the parties involved is also reviewed.

Carcinoma, Small Cell↗
PubMed2006

Acute risk factors for myocardial infarction.

Increased knowledge concerning the triggering of acute cardiovascular diseases has yielded a change in philosophical approach to this field. During the last decade, clinical evidence suggested that the term acute risk factors can be used for the activities and events that suddenly and transiently increase the risk of acute cardiac diseases. External triggers, such as heavy physical activity, emotional stress, eating, cold or heat exposure, coffee or alcohol consumption, cocaine or marijuana use and sexual intercourse are recognized as most important acute risk factors. It is likely that the morning hours may be considered as an endogenous, external triggering independent acute risk factor related to physiological sympathetic arousal. The features of triggering have been best described for an acute myocardial infarction whose moment of onset appears to be the result of a dynamic interaction between an endogenous response to acute risk factors and patient vulnerability. In this article, pathophysiological changes implicated as internal triggering mechanisms are summarized and the terms sympathetic and parasympathetic triggering patterns are introduced. A highly individual approach tailored both to protect against acute risk factors and to reduce patient vulnerability could provide a more complete protection from myocardial infarction and other coronary incidents. Lifestyle modifications, regular physical activity and adequate drug regimens may at least prove able to defer the occurrence of coronary thrombosis, thereby providing time for the development of collateral vessels, plaque stabilization or invasive/surgical treatment.

Autonomic Nervous System↗
PubMedDate not supplied

The problem of astrocyte identity.

Astrocytes were the original neuroglia of Ramón y Cajal but after 100 years there is no satisfactory definition of what should comprise this class of cells. This essay takes a historical and philosophical approach to the question of astrocytic identity. The classic approach of identification by morphology and location are too limited to determine new members of the astrocyte population. I also critically evaluate the use of protein markers measured by immunoreactivity, as well as the newer technique of marking living cells by using promoters for these same proteins to drive reporter genes. These two latter approaches have yielded an expanded population of astrocytes with diverse functions, but also mark cells that traditionally would not be defined as astrocytes. Thus we need a combination of measures to define an astrocyte but it is not clear what this combination should be. The molecular approach, especially promoter driven fluorescent reporter genes, does have the advantage of pre marking living astrocytes for electrophysiological or imaging recordings. However, lack of sufficient understanding of the behavior of the inserted constructs has led to unclear results. This approach will no doubt be perfected with time but at present an acceptable, practical definition of what constitutes the class of astrocytes remains elusive.

Animals↗
PubMed2005

The RAMANITA method for non-destructive and in situ semi-quantitative chemical analysis of mineral solid-solutions by multidimensional calibration of Raman wavenumber shifts.

The "RAMANITA" method, for semi-quantitative chemical analysis of mineral solid-solutions by multidimensional calibration of Raman wavenumber shifts and mathematical calculation by simultaneous equations, is published here in detail in English for the first time. It was conceived by the present writer 20 years ago for binary and ternary pyroxene and garnet systems. The mathematical description was set out in 1989, but in an abstract in an obscure French special publication. Detailed "step-by-step" calibration of two garnet ternaries, followed by their linking, in the early 1990s provided a hexary garnet database. Much later, using this garnet database, which forms part of his personal database called RAMANITA, the present writer began to develop the method by improving the terminology, automating the calculations, discussing problems and experimenting with different real chemical problems in archaeometry. Although this RAMANITA method has been very briefly mentioned in two recent books, the necessary full mathematical explanation is given only here. The method will find application in any study which requires obtaining a non-destructive semi-quantitative chemical analysis from mineral solid solutions that cannot be analysed by any destructive analytical method, in particular for archaeological, geological or extraterrestrial research projects, e.g. Recently some other workers have begun deducing chemical compositions from Raman wavenumber shifts in multivariate chemical space, but the philosophical approach is quite different.

Calibration↗
PubMed2004

Replacing positivism in medical geography.

Revisiting debates about philosophical approaches in medical geography suggests that logical positivism may have been prematurely discarded. An analysis of authoritative texts in medical geography and their sources in human geography shows that logical positivism has been conflated with Comtean positivism, science, empiricism, quantification, science politics, scientism and so on, to produce the "standard version" of the all-purpose pejorative "positivism", which it is easy to dismiss as an evil. It is argued that the standard version fails to do justice to logical positivism, being constructed on sources which are at some distance from the logical positivist movement itself. An alternative approach is then developed, an historically and geographically situated interpretation of logical positivism as a deliberately and knowingly constructed oppositional epistemology within an oppressive and anti-scientific culture predicated on idealist intuitionism. Contrasting the standard version with this alternative reading of logical positivism suggests that much may have been lost in human, and thus, medical geography, by throwing out the logical positivist baby with the "positivism" bath water. It is concluded that continuing to unpack the standard version of logical positivism may identify benefits from a more nuanced appreciation of logical positivism, but it is premature to take these to the level of detailed impacts on the kinds of medical geographies that could be done or the ways of doing them.

Geography↗
PubMedDate not supplied

Concepts in nuclear replacement.

This article describes the pathogenesis of early nuclear failure and current philosophical approaches to artificial, biological, and bioartificial nucleus replacement. Necessary in this review is an overview of current approaches to nucleus replacement with prosthetics and various gel materials.

Arthroplasty, Replacement↗
PubMed1985

The pulmonary circulation: the radiology of adaptation.

In this George Simon Lecture, I have tried to present a simplistic yet philosophical approach to the physiological processes of adaptation of circulatory and respiratory function in response to pathophysiological challenge. The objective of the body is to achieve a normal ventilation-perfusion ratio of 1 in order to optimise blood-gas exchange in a wide variety of pathological conditions. It is all a question of the right ingredients (oxygen in atmospheric air and reduced haemoglobin in desaturated blood), in the right copious amounts (100 ml/s), in the right proportion (1:1) and in the right place (alveolar capillary membrane). In order to demonstrate the above concepts, a variety of well known conditions, congenital and acquired, have been discussed in the developing infant lung and the adult mature lung; some primarily cardiovascular, others primarily respiratory; some conditions resulting in permanent and others resulting in temporary and reversible major readjustments of the blood supply to the lung. The emphasis has been to illustrate that simple, unsophisticated radiological techniques may provide a substantial amount of valuable information concerning the remarkable capacity of the pulmonary circulation to adapt to varying physiological or pathological demands in order to conserve our precious respiratory resources. George Simon, like all good doctors, had a tremendous respect for the ability of the body to respond to these challenges. He always emphasised the important basic principles rather than fine minutiae. It is hoped that this lecture in his honour follows these principles which he preached so well.

Adaptation, Physiological↗
PubMed1998

Topics in pediatric plastic surgery.

This article discusses pediatric, plastic surgical problems often encountered by primary care pediatricians as unfavorable scars, tattoos, torn earlobes, and secondary burn deformities. Cleft lip and palate surgery as well as plastic surgery of the adolescent breast will also be summarized. Emphasis is placed on diagnosis, evaluation, appropriate referral, and the expected surgical outcomes as well as the philosophical approach to the child and family.

Adolescent↗
PubMed1998

Immune mechanisms of acute rejection.

An understanding of acute allograft rejection has eluded investigators for many years, despite major research efforts in this area. This understanding may not be achievable, given the current philosophic approach to the study of immune processes. An alternative approach, which is outlined here, would require investigators to develop an appreciation for the strengths and limitations of complex, adaptive networks like the interdigitated inflammatory, immune, and physiologic processes that are at work in transplanted allografts. This alternative approach is offered in the hope that it will provide new insights regarding the nature of immune responses and will be helpful in the design and interpretation of future studies of acute rejection and other transplant-related biologic processes.

Acute Disease↗
PubMed2003

From home to hospital and back again: economic restructuring, end of life, and the gendered problems of place-switching health services.

Economic restructuring in the health services industry in the USA exemplifies general patterns of economic change propelled by neoliberalism, especially industry privatization, diminished social services, and dependence on "flexible" labor and management regimes. Combined with the widespread entry of women into the labor force, an aging population, and minimal assistance for high quality long-term care at the end of life, these economic and social conditions raise a set of difficult policy questions for health services planning. Set in these broad contexts, this paper situates access to and experience of health services in the home, the hospital, and nursing facility, to demonstrate how economic changes have relocated and redefined health services in ways that distinctively impact how people experience the places where they receive care. This place switching of health services externalizes costs of subacute and "daily life care" (the so-called custodial care) to the sphere of the individual, their family, and communities. The theoretical analysis uses current geographical and philosophical approaches to place and space, and considers the tensions between institutionally managed health care space, and the patient's experience of receiving health services in place. The place/space dilemma of health services provision is examined through several interrelated subjects: long-term care at the end of life, gendered characteristics of care giving, the limitations of Medicare and Medicaid, historical changes in hospital length of stay, the restructuring of nursing practices, and the "no-care zone". The analysis is based on examples of stroke and incontinence care to demonstrate the importance of considering place and space issues in health care planning.

Aged↗
PubMed2002

Treatment, enhancement, and the ethics of neurotherapeutics.

Emerging neurotechnologies, including psychopharmaceuticals, brain stimulation, implantable brain chips, transcranial magnetic stimulation, and brain imaging raise a number of ethical questions. One of the most contentious is the proper role of these technologies in improving or increasing mental and neurological traits and skills in those with no identifiable pathology. The "enhancement" debate centers around a number of concerns and philosophical approaches to the proper role of medicine, therapeutics, and desirable human qualities. Arguements for and against neurological enhancement are reviewed, and historical and social perspectives are offered.

Bioethics↗
PubMed1998

Geriatric neurology.

We can expect to live long enough to develop multiple disorders and receive multiple medications in the face of shrinking medical resources and changing philosophical approaches to aging. Clinicians will be faced with a rapidly aging and increasingly complex patient population. Neurologic diseases account for over ninety percent of those with severe incapacitation. This article lays the conceptual groundwork for the fundamental issues inherent to geriatric neurology; these issues require special attention when training residents, general practitioners, and specialists.

Activities of Daily Living↗
PubMed2004

Effectiveness of a perimenopausal health education intervention for mid-life women in northern Taiwan (#MS03-21-LW).

The purpose of this quasi-experimental research was to assess the effectiveness of a perimenopausal health education intervention for mid-life women in northern Taiwan. The health education intervention included a health education brochure, one-on-one teaching. One hundred seventy-nine women were in the intervention group and 174 women were in the control group. Education effectiveness was assessed by participants' scores on four questionnaires at the beginning of the study and 3 months after initial recruitment. Both groups of women were compared on changes in their scores on health knowledge, level of perceived uncertainty, health behaviors and perceived perimenopausal disturbances. The intervention group had significantly reduced scores on perimenopausal disturbances (P < 0.005) and reported increase practice of healthy behaviors (P < 0.001) compared to the control group. However, a significant decrease of perceived uncertainty was only found in the subgroup of women recruited from the Chinese medicine clinic of the control group (t = 2.22; d.f. = 58; P < 0.05). Chinese medicine physicians assess patients based on a philosophical approach that treats all symptoms holistically. This may have helped reduce patient uncertainty.

Adult↗
PubMedDate not supplied

[Mechanical ventilation and medical futility or dysthanasia, the dialectic of high technology in intensive medicine].

Dysthanasia or any of its synonyms is a consequence of excessive technical science, without any reasonable chance of achieving a therapeutic benefit for the patient. Medical futility is a distressing ethical dilemma of intensive care medicine. Its recognition has led to a precept support in various institutions and organizations. Not withdrawing or withholding mechanical ventilation in certain circumstances can be considered as a paradigmatic model of medical futility. The understanding of this posture implies a philosophical approach and reflexion of medical practice.

Critical Care↗
PubMed2002

A critical analysis of the philosophy, knowledge and theory underpinning mouth care practice for the intensive care unit patient.

In the provision of high quality mouth care practice for the intensive care unit (ICU) patient, the nurse draws on philosophy, knowledge and theory. The complexity of mouth care for the ICU patient is compounded by their medical or surgical condition and the psychological effects of mouth care problems. Effective mouth care practice includes proactive prediction and prevention of complications, and prompt and skilled intervention in the problems arising. Therefore, critical analysis of the philosophy, knowledge and theory relevant to mouth care practice is important. The philosophical approach to mouth care requires the nurse to view the practice from different perspectives. Nursing knowledge has inextricable links with nursing practice that challenges the nurse in her/his everyday work. This application of knowledge to practice is conceptualised as ways of thinking, which is also based on what the nurse might know. Therefore, the judicious use of theory and the necessary skills are essential to provide high quality and effective mouth care practice. The purpose of this paper is to illustrate the ways in which philosophy, knowledge and theory all have an impact on the practice of mouth care for the ICU patient.

Humans↗
PubMed2004

The use of qualitative research methodologies to explore leg ulceration.

Qualitative research is used increasingly within tissue viability and this article specifically presents its use within the body of literature on leg ulceration. This article offers a discussion of the key features of qualitative methodology, such as subjectivity, bracketing, rigour and the analytic process. Furthermore it will be shown that understanding the underpinning philosophical approach is essential for clinicians undertaking qualitative research. The rich data obtained through this approach will be presented, revealing how a person living with leg ulceration can be heard.

Humans↗