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Biomedical subjects

D Koch-Weser

Publications and source records attributed to D Koch-Weser.

At least 19 recordsLinked to original sources
PubMed1993

Decisions near the end of life: professional views on life-sustaining treatments.

OBJECTIVES: How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients' rights to forgo life-sustaining medical treatments and to receive adequate pain control? METHODS: We surveyed 687 physicians and 759 nurses in 5 hospitals. RESULTS: Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. CONCLUSIONS: In summary, many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments.

Attitude of Health Personnel↗
PubMed1993

The authorship and fate of international health papers submitted to the American Journal of Public Health in 1989.

We reviewed the authorship characteristics, editorial processing, and final fate of 126 papers dealing with data from countries other than the United States and Canada and submitted to the American Journal of Public Health in 1989. The acceptance rate of these international health papers was 22%, similar to that of all papers (25%). Authors from developed countries had higher acceptance rates than authors from developing countries, but the highest acceptance rate (36%) was for international health papers with joint authorship from both developed and developing countries. Of 83 rejected papers, 72% were published in other journals. Of these, 45% were published in journals covered by Index Medicus, a figure similar to that for all papers rejected by the Journal.

Authorship↗
PubMed1991

Toward an expanded vision of clinical ethics education: from the individual to the institution.

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual clinicians' skills, but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history and rationale for this approach, its goals, pedagogical assumptions, and design.

Curriculum↗
PubMed1988

Decisions near the end of life.

Designing behavior change programs and evaluating their effects on patient care has been a persistent challenge in research on continuing medical education. The challenge becomes even more complex when we aim to change behaviors that are interactive and highly influenced by the formal and informal institutional context. The authors describe an interdisciplinary continuing education program in bioethics that is designed to effect just such behaviors. The program aims to help hospital and long-term care facilities improve their ability to resolve the ethical dilemmas inherent in terminal care decisions. Targeted to interdisciplinary groups of physicians, nurses, social workers, pastoral counselors, and administrators, Decisions Near the End of Life will provide strategies and tools for examining institutional policies and team practices as well as more traditional information, education, and skill building. The authors describe the program's rationale and design, and raise questions about the potential for developing interdisciplinary, action-oriented CME on other topics.

Decision Making↗
PubMed1985

A case-control study of BCG and childhood tuberculosis in Cali, Colombia.

We conducted a case-control study to evaluate the effectiveness of BCG vaccination in preventing childhood tuberculosis (TB) in Cali, Colombia. We ascertained 178 cases aged 0 to 14 years from the respiratory clinics with cough or fever for at least three weeks and a positive chest X-ray for TB, as well as 320 controls who were from the same households but had no symptoms and negative X-rays. Using matched set multiple logistic regression analysis, we found the age- and sex-adjusted relative risk (RR) of TB among vaccinees compared with non-vaccinees to be 0.84 with 95% confidence limits (CL) from 0.43 to 1.62. There was, however, a significantly lowered relative risk of TB with increasing time since vaccination (RR = 0.83 per year since time of vaccination with 95% CL from 0.74 to 0.94.)

Adolescent↗
PubMed1985

BCG vaccine.

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Animals↗
PubMed1972

Opportunity for FMGs.

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Foreign Medical Graduates↗