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Biomedical subjects

J Meeske

Publications and source records attributed to J Meeske.

4 recordsLinked to original sources
PubMed1999

Knowledge of ethical lapses and other experiences on clinical licensure examinations.

While clinical licensure examinations claim to protect the public from incompetent practitioners, serious problems related to issues of validity, reliability, and ethics have been reported. The ethical lapses are difficult to document, and reports of problems have been strictly anecdotal. This study's primary purpose was to verify those anecdotal reports by mailing a twenty-one-item survey to a national random sample of one thousand general dentists who graduated from a United States-accredited dental school between 1980 and 1994. For those who responded (42.9 percent) results show that 23.9 percent did not arrange for follow-up care for the patient even though it was indicated. Eight percent reported knowledge of instances where a lesion was intentionally created; 19.3 percent knew of premature treatment provided for purposes of the examination; 13.7 percent knew of a colleague who coerced a patient into accepting treatment; 32.5 percent reported knowledge of unnecessary radiographs. About half of all respondents agreed that the examination was not an accurate assessment of ability, and a similar proportion doubted that human patients were necessary. A more reliable and valid assessment strategy that does not jeopardize patient care is needed.

Attitude of Health Personnel↗
PubMed1992

The influence of treatment descriptions on advance medical directive decisions.

OBJECTIVE: To determine whether the wording of the descriptions of life-sustaining interventions would affect the choices elderly patients make when completing advance directives. METHODS: Survey. SETTING: General community in Omaha, Nebraska. PATIENTS: Two hundred one community-dwelling elderly were selected from a population-based sample. MAIN OUTCOME MEASURES: Subjects were asked whether they would accept or reject three life-sustaining interventions: cardiopulmonary resuscitation, mechanical ventilation, or tube feeding in three separate hypothetical case scenarios. The three life-sustaining interventions were each described positively, negatively, and exactly as they are worded in a widely used advance directive. Subjects reviewed each scenario three times with three different descriptions of the three interventions. RESULTS: For the three interventions presented in three scenarios, subjects opted for the intervention 12 percent of the time when it was presented negatively, 18 percent of the time when it was phrased as in an advance directive already in use and 30 percent of the time it was phrased positively. One hundred fifty-five of the 201 subjects (77 percent) changed their minds at least once when given the same scenario but a different description of the intervention. Of these 155, 33 percent changed decisions one to three times, 33 percent changed decisions four to seven times, and another 34 percent changed decisions eight to seventeen times based solely on the description of the intervention. CONCLUSION: The decisions patients make about whether to accept or reject life-sustaining treatments are affected by the descriptions of the treatments. These findings emphasize the critical importance of doctor-patient consultation when patients execute advance directives.

Advance Directives↗
PubMedDate not supplied

Advance directives: a policy-capturing approach.

Policy capturing was used to provide insight into those factors that people consider important in the decision of whether to accept life-sustaining medical treatment. First, open-ended interviews with community-dwelling elderly persons (n = 30) were conducted to determine the factors they would consider when drafting an advance directive. College students (n = 53) then made judgments as to whether they would accept life-sustaining treatment for each of 100 hypothetical vignettes comprising a similar set of factors. Results revealed that 1) students made consistent judgments, 2) there was considerable variability in their mean judgments, 3) the most influential factors were mental and physical functioning, 4) mental and physical functioning had an interactive effect on judgments, and 5) subjective estimates of importance were significantly related to policy-capturing weights. This approach for studying the relationship of individuals' values to their acceptance of life-sustaining therapy may be useful in future studies of patient and surrogate decision making.

Advance Directives↗