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Biomedical subjects

M D Levine

Publications and source records attributed to M D Levine.

At least 91 records · Page 5Linked to original sources
PubMed1977

Ethics rounds in a Children's Medical Center: evaluation of a hospital-based program for continuing education in medical ethics.

Clinical rounds in medical ethics were established in 1971 in a large medical center to provide a forum for the multidisciplinary discussion of moral dilemmas in health care. The rounds consisted of case presentations and analyses by professionals primarily from the fields of law, pediatrics, religion, and philosophy. Five years of experience with these rounds were reviewed. Certain predominant themes emerged from the discussions. The most common involved the process of selecting a decision-maker. The rounds were elevated with regard to their impact and educational value. Although these sessions often did not lead to diametric change in position by participants, they did help to sensitize participants and to clarify and expose critical issues. Ethics rounds may offer a constructive response to the current outcry for more stringent consideration of moral values in hospital settings.

Adult↗
PubMed1977

Infants in a public school system: the indicators of early health and educational need.

The Brookline Early Education Project (BEEP) is a demonstration model in which a public school system in collaboration with a pediatric center has extended teaching and diagnostic services to the earliest days of life. In most cases, enrollment and data collection began three months before the children were born. A comprehensive diagnostic component including health, neurologic, sensory, developmental, and psychological assessments was performed periodically. The present study, the first of several reports, is an analysis of positive indicators of health and developmental need during the first six months of life. At the time of initial surveillance, age 2 weeks, a high yield of physical and demographic findings, along with perinatal stresses, was observed. It was noted that demographic, neurologic, physical, and perinatal stress factors appeared as independent variables. At the three- and six-month checkpoints, there were more overlapping findings between the categories of physical assessment, developmental examination, and neurologic evaluation. Over the six-month period, there was a tendency toward instability of findings: The group of youngsters thought to have special needs at the age of 2 weeks, 3 months, and 6 months differed in composition from each other. Likewise, there was significant flux in membership between the three- and six-month groups with needs. The study may have public policy implications, insofar as early education services should not be constructed to admit only "high-risk newborns" since this would exclude many children whose needs would become manifest later and would take in a number of children falsely identified as in need but with the resiliency to overcome this. The BEEP program has relevance for pediatric practice in demonstrating a component of health care with greater diagnostic and therapeutic responsibility for educational competence in young children.

Child↗
PubMed1976

Children with encopresis: a study of treatment outcome.

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.

Cathartics↗
PubMed1975

The medical ethics of bone marrow transplantation in childhood.

Bone marrow transplantation has been utilized for the treatment of severe aplastic anemia in a program at The Children's Hospital Medical Center. A protocol has been developed to help ensure that the interests and rightful claims of all involved parties will be taken into account. Three cases are presented. In one case all involved parties concurred with the plan for bone marrow transplantation. In a second case the prospective donor was deemed mentally incompetent to give truly informed consent for the procedure. In a third case the parents were unwilling to have their child undergo transplantation. The ethical issues raised in these cases suggest the need for further development of a moral technology to enhance decision-making competence and to aid in the recognition and application of the rights of children without impeding the advancement of pediatric medicine.

Adolescent↗
PubMed1975

Children with encopresis: A descriptive analysis.

During an 18-month period, 102 children with encopresis were seen in a general pediatric outpatient clinic. Through interviews and questionnaires, extensive historical information was obtained. Children were compared with respect to demographic characteristics, bowel-function histories, early training and management, and present manifestations of bowel dysfunction. A wide variety of historical backgrounds and manifestations was observed. It was found that many of the traditional generalizations about encopresis could not be substantiated. It is suggested that a very individualized approach to this problem be adopted and that children with encopresis be investigated carefully to uncover early developmental problems, critical life events, and the precise physiology and dynamics of present bowel dysfunction.

Adolescent↗