PubMed Health⌕ Search

Biomedical subjects

L S Libow

Publications and source records attributed to L S Libow.

17 recordsLinked to original sources
PubMed1992

Ethics rounds at the nursing home: an alternative to an ethics committee.

The increased attention in US medicine to medical ethics reflects in large part the "new" demography of a growing elderly population and the conflict of whether decisions regarding medical care should be based on cost-effectiveness or "human-effectiveness." Currently, about 40 percent of the nation's elderly end up in nursing homes where they confront ethical and legal dilemmas that would not arise in their own homes. In the nursing home, difficult medical-ethical decisions generally rely on two approaches: the often used but frequently invalid concept of informed consent and little used ethics committees. At The Jewish Home and Hospital for Aged in New York City we have developed a program of "ethics rounds" as an alternative to ethics committees. We conduct the rounds in the open style of a forum or clinical conference rather than with the aura of a decision-making group. We encourage the participation of patients and family and seek to educate the staff, any one of whom may choose to attend. The rounds consist of a multidisciplinary case presentation, an interview of patient and/or family, a discussion by the staff, and an overview by an ethicist. Staff response to the educational and interdisciplinary aspects of the rounds has been remarkably positive.

Ethical Review↗
PubMed1992

Acute myocardial infarction in a long-term care institution for the aged.

We reviewed the clinical characteristics and outcome of cases of acute myocardial infarction occurring from January 1, 1985, through December 31, 1987, in the population of a long-term care institution for the elderly. The total number of patients in the series was 43. Comparisons were made between those patients transferred to a general acute-care hospital and those who remained at the facility. The most common initial symptoms of acute myocardial infarction in 32 of 48 patients were, in order, dyspnea, dizziness or syncope, precordial pain, and abdominal pain. Nine (of 43) patients were asymptomatic. In the 14 (of 43) patients transferred to an acute-care hospital, cardiac failure, arrhythmias, and cardiogenic shock were much more frequent than among those retained in the long-term care facility. We concluded that a high index of suspicion for the diagnosis of acute myocardial infarction in the institutionalized elderly is indicated. Patients with mild infarction can be retained in long-term care institutions; resulting mortality from cardiac disorders should be low in adequately staffed and equipped long-term care institutions.

Aged↗
PubMed1989

The clinical utility of a comprehensive periodic assessment form for the geriatric rehabilitation patient.

The Comprehensive Periodic Assessment Form is a new format used to document a patient's rehabilitation progress. It is a nonnarrative, semi-graphical form in which is digested on one page many sheets of progress notes from a variety of disciplines. Mobility, ADL, mental, and medical status overtime can be ascertained at a glance. The form has special utility for the aged patient experiencing rehabilitation treatment.

Activities of Daily Living↗
PubMed1979

A portable medical record system for the elderly.

A portable medical record system consisting of a bracelet and wallet card, was given to two groups of ambulatory, chronically ill, mentally clear, older patients. Group 1 included 23 patients discharged from a skilled nursing facility and treated in the community; group 2, 24 patients attending the outpatient department of an acute general teaching hospital. Biweekly follow-up telephone calls to patients and subsequent discussions with physicians demonstrated the usefulness of this system in predominantly nonemergency settings. Overall, the physicians noticed the bracelet during 46% of the visits and the wallet card during 28%. Group 2 physicians, however, noticed the bracelet and/or wallet card more frequently than did group 1 physicians. Reasons for the difference in recognition among the two groups and the implications for future use of a portable medical record system for the elderly are discussed.

Aged↗
PubMed1978

Another type of iatrogenic problem.

Physicians' lack of careful attention to transfer forms for elderly patients being moved from acute-care hospitals to facilities for long-term care can create serious--even life-threatening--problems.

Aged↗
PubMed1976

A geriatric medical residency program. A four-year experience.

Geriatricians are needed to further improve the health care of elderly Americans. The first formalized geriatric residency program in the United States was developed at the Mount Sinai City Hospital Center in New York, and this has produced a second program at the Jewish Institute for Geriatric Care at Long Island Jewish-Hillside Medical Center, New Hyde Park, New York. The goals of this training are to develop special clinical skills to deal with the medical and psychosocial problems of the elderly, and to achieve the ability to develop health care systems for the elderly. Emphasis is on a multileveled system, including home, outpatient, acute hospital, convalescent unit, and long-term institution care. The training period is 12 to 24 months, after an initial 24 to 36 months of standard internal medicine, thus fulfilling the requirements for board eligibility in internal medicine.

Aged↗