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Biomedical subjects

C B Stocking

Publications and source records attributed to C B Stocking.

29 records · Page 2Linked to original sources
PubMed1991

When physicians treat members of their own families. Practices in a community hospital.

BACKGROUND: Little is known about the circumstances under which physicians care for family members. We sought to examine current practice and, in particular, to learn how often family members request medical care or treatment, whether physicians accede to such requests, and what concerns, if any, physicians have about caring for their family members. METHODS: In late 1990 we distributed a pretested, structured questionnaire to all members of the active medical staff (physicians with M.D. or D.O. degrees) of a large suburban community teaching hospital. Of 691 eligible members of the medical staff, 465 physicians responded. RESULTS: Of the 465 respondents, 461 (99 percent) reported requests from family members for medical advice, diagnosis, or treatment. A total of 386 (83 percent of the respondents) had prescribed medication for a family member, 372 (80 percent) had diagnosed medical illnesses, 334 (72 percent) had performed physical examinations, 68 (15 percent) had acted as a family member's primary attending physician in the hospital, and 44 (9 percent) had operated on a family member. In addition, 152 (33 percent) reported that they had observed another physician "inappropriately involved" in a family member's care, and 103 (22 percent) had acceded to a specific request about which they felt uncomfortable. CONCLUSIONS: Practicing physicians often attend and treat their family members and diagnose their illnesses. They may often experience some disquiet in doing so. For physicians, complete medical data, proper training, and sound judgment are essential when family members request treatment.

Attitude of Health Personnel↗
PubMed1991

Amyotrophic lateral sclerosis and life-sustaining therapy: patients' desires for information, participation in decision making, and life-sustaining therapy.

To identify the wishes of patients with amyotrophic lateral sclerosis (ALS) for information, participation in decision making, and life-sustaining therapy and to determine whether these wishes are stable over time, we conducted a prospective survey (baseline and 6-month follow-up interviews) of 38 consecutive patients with an established diagnosis of ALS at the University of Chicago Motor Neuron Disease Clinic. Demographic data, clinical stage of ALS, illness experience, wishes for information, and desires for participating in decisions about life-sustaining therapy were elicited. Patients readily expressed their wishes for specific information on communication aids and ventilator care for respiratory failure. Demographic, socioeconomic, and clinical characteristics did not predict patients' desires for information and decision making. The preferences for information and participation in decisions were stable during the 6-month study period, whereas preferences for cardiopulmonary resuscitation in two hypothetical circumstances were less stable. Changes were unrelated to demographic or clinical characteristics of the patients. Because many patients with ALS change their preferences for life-sustaining therapy, advance directives for end-of-life care must be reevaluated periodically.

Adult↗
PubMed1991

The automated interview versus the personal interview. Do patient responses to preoperative health questions differ?

Laboratory testing of presurgical patients has been shown to be excessive, thereby increasing costs, reducing resources for other health care uses, and increasing risks to both patients and physicians. As one step toward reducing the number of unnecessary preoperative tests ordered, we used an automated method to aid preoperative assessment of 239 patients in Chicago and in Winnipeg. The "HealthQuiz," a small hand-held device containing a computer chip and video screen, uses a decision tree to ask a minimum of 60 health-related questions (the patient's response to certain questions determines the number of questions presented). The device then generates a summary printout of patient answers, the health areas needing further attention, and the laboratory tests most likely to uncover clinically important abnormalities in that patient. HealthQuiz responses are intended to aid the physician and not to replace the personal interview. As an aid, the automated interview highlights possible problem areas for in-depth pursuit by the physician. The need for nonselective batteries of tests is eliminated because recommendations for tests are based on specific elements of a patient's history. To be effective, responses to the HealthQuiz should be the same as responses to similar questions asked by a physician. We tested that premise in this study. Patient's answers to the HealthQuiz were compared with their responses to a randomly selected set of the same questions in a personal interview. Ninety-seven percent of the response pairs were identical, and most of the 3% that differed involved changes from "not sure" replies to the HealthQuiz. Laboratory tests suggested by responses to the two methods of questioning did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Safety practices and living conditions of low-income urban families.

Injuries remain the leading cause of mortality in children and disproportionately affect poor children. Prior injury prevention efforts have neglected the injury prevention needs of these children. One hundred thirty-three care givers of medically indigent urban children younger than 6 years old were interviewed regarding living conditions, previous injuries, and safety practices and knowledge. Functional smoke detectors and fire extinguishers were present in 75% and 27% of homes, respectively. Few respondents, regardless of previous poisoning experience, were cognizant of ipecac, had it in their homes, or had a good response to a possible poisoning. Few homes had locked storage space, and most hazards were stored suboptimally. While the frequency of the use of automobiles was low, rides in a variety of vehicles were common with 63% of children who usually were restrained inadequately. Additionally, 89% of children aged 35 to 59 months and 6% of those younger than 3 years old sometimes bathed without adult supervision. These findings indicate the dramatic need for injury prevention programs focused on low-income urban families. Specific concerns include exposure to fires and burns, falls, hazardous travel conditions, dangerous chemical, choking, and drowning. Lack of information and isolated care givers may result in poor supervision and responses to injury of these children.

Adolescent↗
PubMed1989

The illusion of futility in clinical practice.

The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. This shift is supported by moral reasoning in ancient and modern medical ethics, by public policy, and by case law. Given this shift in ethical obligations, one might expect that physicians would have unambiguous criteria for determining when a therapy is futile. This is not the case. Rather than being a discrete and definable entity, futile therapy is merely the end of the spectrum of therapies with very low efficacy. Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations.

Attitude of Health Personnel↗
PubMed1988

An ethics consultation service in a teaching hospital. Utilization and evaluation.

A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31%. Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.

Adult↗
PubMed1988

Survival after cardiopulmonary resuscitation in babies of very low birth weight. Is CPR futile therapy?

We conducted a retrospective study of outcome after cardiopulmonary resuscitation (CPR) in babies of very low birth weight. Of 158 such babies (birth weight, less than 1500 g) admitted to a neonatal intensive care unit in 1985, 49 (31 percent) underwent CPR. Low birth weight, low Apgar scores, birth asphyxia, pulmonary interstitial emphysema, hyaline membrane disease, and severe intraventricular hemorrhage were associated with the need for CPR. None of the 38 babies who received CPR in the first three days of life survived. Four of the 11 babies who received CPR after the first 72 hours survived. Three of the four survivors had residual neurologic deficits. Survival rates after CPR in infants of very low birth weight are lower than those in older children or adults. CPR may therefore be considered a nonvalidated therapy in this population. If the results of our study are confirmed, CPR should not be instituted automatically in very-low-birth-weight babies as though it were a validated treatment. Instead, it should be administered upon parents' advance informed consent to experimental treatment.

Apgar Score↗
PubMed1988

Life-sustaining treatment. A prospective study of patients with DNR orders in a teaching hospital.

We conducted a prospective survey of attending, resident, and intern physicians who had written a "do not resuscitate" (DNR) order for 93 patients in their care. After writing a DNR order, 11% of respondents would still use chest compression if their patient experienced a cardiopulmonary arrest. Many physicians did not plan to withdraw therapy except intensive care, but most physicians planned to withhold a spectrum of life-sustaining therapies, from hemodialysis (86%) to intravenous fluids (21%). Attending and house-staff physicians generally agreed on whether to withdraw a given therapy or not but frequently disagreed on whether to withhold a therapy or not. After patient discharge or death, 88 charts were reviewed. None of the 88 patients was coded. Physicians initiated 68 life sustaining therapies in 43 patients and discontinued 64 therapies in 34 patients; there was no change in management in 31 patients. We conclude that individual physicians interpret the DNR order differently. These orders often are associated with the discontinuation or noninitiation of life-sustaining therapies other than emergency CPR.

Adult↗
PubMedDate not supplied

Physicians' and nurses' perceptions of ethics problems on general medical services.

OBJECTIVE: To understand the kinds of clinical situations physicians and nurses regard as "ethics problems." DESIGN: The authors prospectively studied physicians' and nurses' perceptions of ethics problems using paired interviews. Individual interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each was asked whether any ethics problems had arisen in the care of his or her patients and, if so, to give a brief description of each problem. SETTING: Three general medical services in a 497-bed community teaching hospital. PARTICIPANTS: 13 physicians (mostly family medicine residents) and 42 nurses caring for 142 patients. MAIN RESULTS: The physicians and nurses thought ethics problems were present in 75 of the 142 patients cases. Physicians and nurses identified ethics problems with similar frequencies; however, they often identified ethics problems in different patient cases or identified different ethics problems in the same case. Physicians and nurses described a variety of problem types. Physicians identified more problems related to quality of life, inappropriate hospital admissions, and cost of care; nurses identified more problems related to patient preferences, family wishes, pain management, implementing treatments, and discharge planning. A fourth of the ethics problems identified by physicians and nurses involved interstaff conflicts. CONCLUSIONS: The physicians and nurses studied considered a broad range of clinical situations to be "ethics problems," and they perceived them to occur frequently. Systematic differences were found between physicians' and nurses' perceptions of ethics problems, and many ethics problems generated interstaff conflicts. Incorporating this kind of information into clinical ethics education programs, and into hospital policies, may represent a useful approach toward improving physician-nurse interaction.

Adult↗
PubMedDate not supplied

Orthopedic surgeons' attitudes and practices concerning treatment of patients with HIV infection.

Concern regarding an occupational risk of acquiring human immunodeficiency virus (HIV) infection may influence surgeons' willingness to operate. A questionnaire survey of all orthopedists in the five cities with the most cases of acquired immunodeficiency syndrome (AIDS) was conducted to assess attitudes and practices. Questionnaires were completed anonymously by 325 of 510 orthopedists. In the previous year, 43 percent had examined or operated on an HIV-infected patient, and at least 90 percent who had had an opportunity to operate on an HIV-infected patient had chosen to do so. Decisions to operate did not appear to be based on hospital requirements, perceived ethical obligations, or knowledge of HIV transmissibility. Most orthopedists (85 percent) claimed the right to order preoperative HIV testing of high-risk patients, but such testing was ordered infrequently. Although most orthopedists believed they could not be compelled to operate and that ethically they could refuse when their health was threatened, they almost always were willing to treat HIV-infected patients.

Acquired Immunodeficiency Syndrome↗