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Biomedical subjects

D T Watts

Publications and source records attributed to D T Watts.

17 recordsLinked to original sources

Vitamin B12 replacement therapy: how much is enough?

Vitamin B12 deficiency becomes increasingly common with advancing age. Diverse recommendations exist for initial and maintenance therapy of deficiency states. With cyanocobalamin, the only B12 preparation available in the United States, much greater amounts of the vitamin are retained with a 1000 micrograms injection than with 100 micrograms, with no disadvantage in cost or toxicity. Maintenance therapy using the larger dosage may be necessary to meet metabolic requirements in many patients. Thus, it is recommended that parenteral regimens use 1000 micrograms cyanocobalamin: 5 or 6 biweekly injections for loading, and once-a-month for maintenance. Oral therapy with 300-1000 micrograms per day may be therapeutically equivalent to parenteral therapy.

Humans↗

Geriatricians' attitudes toward assisting suicide of dementia patients.

OBJECTIVE: To identify geriatricians' attitudes toward assisting suicide of dementia patients, with particular reference to the case of Janet Adkins/Dr. Kevorkian. DESIGN: Mailed questionnaire survey. SETTING: Four distinct geographical regions of the US: Far West, Midwest, Southeast, and Northeast. PARTICIPANTS: All 1,381 ABIM-certified internist geriatricians in the four regions; 727 (52.6%) responded. MAIN OUTCOME MEASURES: Positive, negative, or unsure responses to questionnaire items; comparison of responses between geographical regions. RESULTS: Sixty-six percent of respondents felt that Dr. Kevorkian's assistance of Janet Adkins' suicide was not justifiable, while 14% stated it was morally justifiable. Twenty-nine percent felt Janet Adkins' decision to commit suicide was morally wrong, while 49% stated it was not morally wrong. If the responding geriatricians themselves were diagnosed as having a dementing illness, 41% would consider suicide a possible option; 39% would not consider suicide. Twenty-six percent favored easing restrictions on physician-assisted suicide of competent dementia patients, while 57% opposed this. If current restrictions were eased, 21% would consider assisting suicide of competent dementia patients, and 66% would not. Respondents' attitudes showed some significant (P less than or equal to 0.05) variations by geographical region. Where regional differences were observed, respondents in the Midwest tended to show more conservative attitudes toward physician-assisted suicide than those in the Far West and Northeast. CONCLUSIONS: Most responding geriatricians would not consider assisting suicide of dementia patients, and most oppose easing restrictions on physician-assisted suicide. Many, however, could accept the (unassisted) suicide of a competent dementia patient, and many would consider suicide themselves if stricken with dementia.

Attitude of Health Personnel↗

Dangerous behavior in a demented patient. Preserving autonomy in a patient with diminished competence.

When a cognitively-impaired elderly man nearly caused a serious fire at home through his inappropriate use of a gas oven, the incident raised questions about his capacity to live alone. Although he clearly wanted to preserve his independence, the health care team felt obligated to assure his safety. The following discussion of dangerous behavior in a demented elderly man elicits and portrays these conflicting values, and highlights the physician's obligations in such ethically and legally complex situations.

Activities of Daily Living↗

Nurses' and physicians' attitudes toward tube-feeding decisions in long-term care.

We studied attitudes of health professionals toward life-sustaining treatment. A patient management questionnaire sent to staff physicians and nurses in 183 Oregon nursing homes consisted of eight patient sketches which varied age, mental status, and enjoyment of life. Respondents were asked whether they would favor tube-feeding to correct malnutrition in each case. Nurses showed higher preferences for tube-feeding than did physicians (P = .05). For both professions, patient happiness was the strongest and most significant (P less than .0001) influence upon preferences for tube-feeding. Both professions also showed a significant (P less than .001) tendency to give younger patients higher preferences for tube-feeding. Physicians showed a significant (P less than .001) influence of patient mental status upon preferences, while patient mental status did not affect nurses' preferences. Identifiable clinical factors appear to influence attitudes of physicians and nurses toward tube-feeding decisions.

Aged↗

Extraordinary nutritional support: a case study and ethical analysis.

Ethical issues surrounding decisions to limit treatment often focus on dramatic and highly technical interventions, such as mechanical ventilation. Many less dramatic forms of therapy are considered routine, and ethical aspects of their use may be less closely examined. Nutritional support can be crucially important in elderly patients, especially the very frail. Yet, appropriate use of nutritional therapy must consider the circumstances of an individual patient. Where severe underlying illness cannot be reversed, technical means of providing nutrition can represent extraordinary rather than ordinary means of prolonging life. The following case examines the ethical issues in respecting the apparent refusal of nutritional support by a severely debilitated geriatric patient.

Aged↗