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Biomedical subjects

J V Hartline

Publications and source records attributed to J V Hartline.

16 recordsLinked to original sources
PubMed1991

Ethical issues in health care institutions. Lesson Four: Allocation of medical resources.

Health care rationing is the subject of the fourth lesson in a five-part WMU/AHRA magazine course on ethics. Since not every citizen in our country is guaranteed the right to basic health care, there exists a rationing system in which health care is allocated on the basis of ability to pay and need, asserts Dr. Hartline. Ethical problems abound within this system. This article addresses the issues and proposes possible remedies.

Ethics, Institutional↗
PubMed1991

Ethical issues in health care institutions. Lesson five: Research ethics.

Well-constructed research protocols provide the mechanism to examine new clinical practices and new approaches to the provision of health care services which can be evaluated in a systematic manner. In order to be consistent with the underlying ethical duties of health care providers, the principle of respect for persons requires fully informed consent of those subjects who can act autonomously. If the subjects have diminished autonomy, special precautions must be taken to protect their interests and welfare if they are to take part in research projects which may be of benefit to them. Research, if it is to be consistent with duties of beneficence, must be directed toward the best interests of the subject. Careful attention must be paid to the assessment of potential benefits and risks, so that the balance of benefit to risk is a favorable one. Considerations of fairness prevent us from inequitably distributing the benefits and risks, thus subjecting the most disadvantaged groups in society to further disadvantage. The requirement for prospective review of research protocols by an IRB is important in protecting the rights, health and welfare of people who take part in research.

Ethics, Institutional↗
PubMed1977

Continuous intragastric infusion of elemental diet: experiences with 10 infants having small-intestinal diseases.

Five infants with gastrointestinal disease requiring neonatal surgery and two infants with nonsurgical disorders were nourished successfully using a constant intragastric infusion of an elemental diet. Two additional patients who developed persistent distension and gastric retention on IED had mechanical obstruction requiring surgery and another died of NEC during treatment. Use of IED avoided the risks of TPN and was followed by successful introduction of standard feeding techniques. IED provides a valuable alternative to TPN in selected infants and newborns. Caution with any enteral feeding method is required in infants at risk for NEC.

Dietary Carbohydrates↗
PubMed1976

Vitamin A delivery in total parenteral nutrition solution.

Vitamin A delivery was studied in total parenteral nutrition as used for neonates. Although the data show that the patient receives more vitamin A than dictated by known needs or advised intakes, delivery to the patient is roughly one third of that which would be predicted from the initial intravenous solution composition. Adsorption of the vitamin to the chamber and tubing is the major factor in decreasing vitamin A administration to the patient. When evaluating nutrition techniques, documentation of nutrient delivery to the patient is essential.

Humans↗
PubMed1975

The use of amniotic fluid bubble stability, L/S ratio, and creatinine concentration in the assessment of fetal maturity.

Amniotic fluid bubble stability and creatinine concentration are analyzed in relation to the L/S ratio and clinical outcome. Bubble stability by the standard method showed 20.5 per cent (31/151) initial disagreement between two laboratories, 53.6 per cent (81/151) correlation with L/S ratio, and did not correlate well with patient outcome. However, a "foamy" test, i.e., foam noticeable at a distance, in both 1:1 and 1:2 dilutions, indicated an elevated L/S ratio and mature pulmonary outcome. Amniotic fluid creatinine levels showed an estimated 5 to 6 per cent risk for RDS at levels we formerly thought to be safe (greater than or equal to 2.0 mg. per 100 ml. with maternal serum less than or equal to 0.9 mg. per 100 ml.), and has many false-negative values. Fetal maturity can be estimated with clinical data and amniotic fluid analysis. Amniotic fluid sampling is necessary in all instances where the clinical data leave a reasonable doubt of actual gestational age and in all cases for elective preterm delivery. We recommend a sequential approach to amniotic fluid analysis. First a bubble stability test (a "foamy" at both 1:1 and 1:2 dilutions indicates pulmonary maturity). If the bubble stability test is not "foamy", an L/S ratio. The risk of RDS associated with creatinine concentration makes this test unacceptable in any case of elective delivery; however, it may be useful as a weighing factor in emergency situations where phospholipid analysis is unavailable.

Amniocentesis↗