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Biomedical subjects

M R Gillick

Publications and source records attributed to M R Gillick.

25 records · Page 2Linked to original sources
PubMed1984

Health promotion, jogging, and the pursuit of the moral life.

Individual lifestyle was held accountable for health and disease throughout much of American history. Since the advent of the germ theory of disease, the focus on the etiology of disease has shifted to factors beyond individual control. But in the past two decades, there has been a resurgence of interest in the role of personal habits in producing sickness. This paper examines the history of one facet of the health promotion movement--aerobic exercise, primarily jogging. Initially, concepts in exercise physiology were adapted from non-medical fields--such as competitive sports and the military--for use in cardiac rehabilitation. Subsequently, a few physicians generalized their experience with cardiac patients to the general population, concluding that aerobic exercise could prevent heart attacks. This idea of exercise as a prophylaxis was seized upon by the public, who were receptive because of the political climate of the sixties. Once the popular movement was underway, researchers began studying the role of exercise in preventing coronary heart disease, confirming that exercise does confer some benefit. In the seventies, exercise attracted a new, wider audience--not because of the justification for its use provided by the scientific community, but because of the appeal of upright living as a means to personal and social redemption. The case of aerobic exercise provides an instructive example to social scientists and policymakers seeking to understand or to encourage widespread behavioral change.

Attitude of Health Personnel↗
PubMed1982

Adverse consequences of hospitalization in the elderly.

This study prospectively examines 502 general medical patients for evidence of side-effect of hospitalization unrelated to diagnosis or therapy of acute illness. Symptoms of depressed psychophysiologic functioning (confusion, falling, not eating, and incontinence) unrelated to acute medical diagnoses were found in 8.8% of the patients under 70 and in 40.5% of the elderly population (P less than 0.0001). The rate of medical intervention secondary to these symptoms (psychotropic medications, restraints, nasogastric tubes, and foley catheters) was 37.9% among the young patients and 47.1% in the elderly group (P = 0.4). The sample was too small to permit adequate empirical determination of the complication rate from medical intervention (thrombophlebitis, pulmonary embolus, aspiration pneumonia, urinary tract infection, septic shock) but estimates from the literature indicate that each of the interventions studied entails a complication rate of 25-30%. Combining the observed rate of functional symptoms development and intervention, and the literature rates of complications, yields a risk of complications of 1.0% for the young and 5.7% for the elderly (P less than 0.0001). These data indicate that hospitalized elderly patients are at high risk of developing symptoms of depressed psychophysiology functioning and of sustaining medical intervention as a result of these symptoms, with attendant medical complications. We suggest that in incidence of depressed psychophysiologic function needs to be assessed in patients treated outside the hospital, along with efficacy of treatment outside the hospital, to determine whether there are patients for whom hospitalization is not optimal therapy.

Aged↗
PubMedDate not supplied

Choosing appropriate medical care for the elderly.

Decisions about what constitutes appropriate medical care are increasingly necessary in an aging society. Neither patient autonomy, physician beliefs, nor health services research alone can adequately define reasonable care for the individual patient. A new framework is proposed for determining reasonable medical care that involves 4 steps: (1) patients prioritize their goals of care (prolongation of life, maintenance of function, and maximization of comfort); (2) physicians assign a pathway of care based on the patient's prioritization of goals (longevous, ameliorative, or palliative); (3) expert panels define a range of feasible interventions for each pathway; and (4) medical problems are treated with interventions consistent with the pathway chosen. The pathway system has the potential for defining reasonable care by balancing the patient's view, the physician's view, and evidence from the clinical literature.

Journal Article↗