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Biomedical subjects

G R Singer

Publications and source records attributed to G R Singer.

5 recordsLinked to original sources
PubMed1997

Communicating with our patients: the goal of bioethics.

Listening, teaching, understanding, exploring, explaining: these are the foundations of a sound patient-physician relationship. From these skills, we can then proceed to discussions on difficult topics such as preferences for end-of-life care. We can share bad news without destroying hope. We can show what makes the medical profession unlike any other. This issue of The Journal addresses the handling of medical errors, the termination of mechanical ventilatory support, ethical problems in managed care, and confidentiality issues in the computer era. Guidelines for institutional ethics committees also are presented. These are only a sampling of topics that cut to the heart of bioethics, patient communication, and contemporary medical practice. The more that we study such issues, the more we understand the contributions of medical ethics to medical practice, and the better we serve our patients.

Bioethics↗
PubMed1997

Disconnecting the ventilator: life saving or death delaying?

Mechanical ventilators have supported patients with respiratory failure from the era of the polio epidemics to the present. While ventilators can clearly be life saving, many patients receiving this intervention do not survive. In such patients, this treatment is not life saving, but death delaying. Other patients treated with mechanical ventilation may survive, but do not improve to the point where they can become independent of the ventilator. This paper is a review of the prognosis and cost of respiratory failure, ethical issues in removing patients from the ventilator and methods of discontinuing respiratory support.

Aged↗
PubMed1994

Do-not-resuscitate orders.

CPR is a procedure from which approximately 15% of patients survive to discharge. Patients have the right to request DNR orders and health professionals have an obligation to provide the information to make decisions. Physicians and patients should discuss advance directives before hospital admission. Patients without decision-making capacity are dependent on advance directives, surrogates or proxies for DNR orders. The most recent version of the Florida statute has improved the procedural mechanism for writing DNR orders but continues to need further refinement.

Advance Directives↗
PubMed1985

Diet needs of patients referred to home health.

The purpose of this study was to document the dietary needs of patients referred to home health care. The charts of 812 patients taken for care by the Visiting Nurse Association of Chicago (VNA) were reviewed for the physician's diet order, number of restrictions, diagnoses, age, height, weight, and fee source. More than half of the patients had therapeutic diets ordered by their physicians. A quarter of the patients with therapeutic diets had two or more dietary modifications. An audit process was developed as a reliability check of the authors' determination of the appropriateness of the diet. Review of the charts by registered dietitians (R.D.s) showed that three-fourths of the patients appeared to need therapeutic diets. Forty-seven percent might have benefited from a different diet. More than half of the patients for whom the R.D.s recommended a special diet needed two or more modifications. This emphasizes the need for the R.D. to develop a system for monitoring the dietary requirements of all patients referred to home health care. It further underscores the need for collaboration between physician and dietitian. The registered dietitian who works in home health care agencies serving diverse age groups needs to be a generalist prepared to develop a plan for the total nutrition treatment of persons throughout the life cycle.

Adolescent↗