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Biomedical subjects

M W Ribbe

Publications and source records attributed to M W Ribbe.

At least 55 records · Page 3Linked to original sources
PubMed1996

The role of the social network in active euthanasia and physician-assisted suicide.

OBJECTIVE: To obtain insight into the involvement of a patient's social network in the process leading to the administration of euthanasia and assisted suicide (EAS). DESIGN: Descriptive, retrospective. METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 general practitioners (GPs) in the Province of North Holland and 521 GPs from the rest of the Netherlands and all 713 Dutch nursing home physicians (NHPs). The data were collected over the period 1986 to June 1990 inclusive. RESULTS: GPs and NHPs had discussions most often with the partner of the patient about the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. According to both the GPs and the NHPs the social network practically always agreed with the doctor's decision to administer EAS. The persons who were most often present at the patient's bedside when EAS was administered were the patient's partner and children (29%). Often, especially in the cases of GPs, the decision not to report EAS was determined by the desire of relatives and/or the physician not to involve the relatives in a judicial inquiry. CONCLUSION: To a large extent the social network was involved in the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. This seems to be important both for good decision-making with regard to EAS and for helping relatives to come to terms with the loss of a dear one.

Communication↗
PubMed1996

Ethical aspects of medical decision-making in demented patients: a report from the Netherlands.

In the Netherlands, the medical care of demented patients in the last phase of their life is very often the responsibility of the nursing home physician. Against the background of the public debate on euthanasia and related end-of-life decisions, this article discusses the ethical problems encountered in this field of medicine. Special attention is given to the problems of prognosis and the possible contribution of living wills to decision-making on behalf of incompetent demented patients.

Aged↗
PubMed1996

[Hospital admission of nursing home patients considered but not carried out: role of the nursing home physician and the involved parties and various differences with realized hospital admissions].

The objective of the study was to establish in which way nursing home patients, for whom is refrained from hospitalization, differ from hospitalized nursing home patients. The question was also raised of how the decision to refrain from hospitalization is taken: which point of view and method the nursing home physician has, on which arguments decisions are based and which parties are involved and in which way. The design of the study was retrospective and descriptive. Data obtained from semi-structured interviews held in 1987 with 24 nursing home physicians on 45 situations were compared with registration data on 387 hospitalizations of patients from 30 nursing homes. In the non-hospitalized patients malignancies were relatively more frequent than in the hospitalized patients (29% versus 7%). The mean age of hospitalized patients was 78 and of non-hospitalized patients 80 years. The physical condition of non-hospitalized patients was more frequently judged as poor and the life expectancy as more limited. Already at an early stage nursing home physicians appeared to have a point of view, with which they determined the decision making procedure: in favour of (40%), opposing (35%) and in doubt of hospitalization (25%). In 'non-hospitalizations' there was much more involvement in decision making of family members and nurses, and less involvement of patients and medical specialists than in decisions to hospitalization. Non-medical arguments opposing hospitalization had slightly the upper hand above medical arguments. The decisive arguments opposing hospitalization were in the case of psychogeriatric patients more often of medical origin than in the case of somatic patients. The 'quality of live' mentioned arguments were of limited importance. The nursing home physician needs good communicative qualities in such decision making processes. He has to be skilled to judge competency of patients and, if needed, to balance in the right way the information of relatives, nurses, colleagues and specialists.

Aged↗
PubMed1995

[Characteristics of patients during their stay in a nursing home and at discharge].

OBJECTIVE: To determine the characteristics of patients during stay in nursing homes, and at the moment of discharge or death. DESIGN: Cross-sectional study. METHOD: Data were collected concerning September 30th 1991 using the National Nursing Home Registration System SIVIS, in which over 80% of the nursing homes participate. There were 45,471 patients (23,395 somatic and 22,076 psychogeriatric patients). RESULTS: Frequent morbidity consisted of stroke, neurological disorders, locomotor disorders and dementia. There was a high degree of disability regarding the activities of daily life and mobility. The average length of stay for somatic patients was just over one year, that for psychogeriatric patients almost two and a half years. After rehabilitation, one-third of the patients could be discharged to their homes or to a home for the aged. (Most of the remaining patients eventually died in the nursing home.) CONCLUSION: Residing nursing home patients are mainly characterised by chronic disorders. Consequently, disabilities and handicaps occur in many areas, such as self-care, mobility and psychological functioning. For a number of patients the distinction between somatic or psychogeriatric nursing becomes irrelevant. For all categories of patients the utilisation of care resources is increasing.

Activities of Daily Living↗
PubMed1995

Attitudes of Dutch general practitioners and nursing home physicians to active voluntary euthanasia and physician-assisted suicide.

OBJECTIVE: To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. DESIGN: Descriptive study. METHOD: Data were collected by means of anonymous postal questionnaires to be completed by a random sample of 521 general practitioners from the province of North Holland, 521 general practitioners from the rest of the Netherlands, and 713 Dutch nursing home physicians who were members of the Dutch Association of Nursing Home Physicians. RESULTS: The written responses of general practitioners and nursing home physicians to six statements about voluntary active euthanasia and physician-assisted suicide showed that a large majority had a fairly positive attitude to euthanasia and suicide. This finding also emerged from the scores obtained on a scale compiled on the basis of the statements. General practitioners and nursing home physicians were more opposed to euthanasia and physician-assisted suicide if they had never performed it, if they belonged to a religious group, or if they were older. CONCLUSION: Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.

Age Factors↗
PubMed1995

Skin temperature response to a pressure load: studies in subjects before and during spinal anesthesia.

The Pressure-Temperature-Time method (PTT-method) is a method to investigate skin temperature changes in response to a pressure load. This method was used to investigate the effect of an acute nerve conduction block on the skin temperature increase of the trochanter major, after the pressure load was removed. The PTT-method was used in a group of 30 subjects, undergoing minor surgical procedures, before and during an anesthetic nerve conduction block at L2-L3. In comparison with the results before spinal anesthesia, the skin temperature responses were significantly delayed (p < .01) and slower (p < .001) after the spinal blockade. We concluded, therefore, that the nervous system has an important effect on the recovery of skin temperature after a pressure load.

Adult↗
PubMed1995

Active euthanasia and physician-assisted suicide in Dutch nursing homes: patients' characteristics.

We wished to obtain information about the principal and subsidiary diagnoses, sex, age, marital status, religion and background characteristics of Dutch nursing home patients to whom euthanasia/assisted suicide (EAS) was administered. We performed an exploratory, descriptive, retrospective study involving all Dutch nursing home physicians (NHPs) who in September 1990 were members of the Dutch Association of Nursing Home Physicians (NVVA; n = 713). An anonymous printed questionnaire in two parts was used. Part 1 was intended for all respondents and was expected to give insight into the nature and extent of EAS in Dutch nursing homes. Part 2 was intended only for respondents who had indicated in part 1 that they had administered EAS. They were asked to describe their last case of EAS. The study covered the period from 1986 to mid-1990. There was an 86% response. The respondents described 86 cases of EAS. Sixty-nine of these took place in a nursing home. The majority of patients to whom EAS was administered were suffering from a malignant neoplasm (53%). EAS was administered more often to men than to women. The average age of the patients was 70.9 years. When EAS was administered, the patients on average had been in the nursing home for 13.1 months. Dutch nursing home patients who were given EAS differed in various respects from 'the average nursing home patient'. The principal diagnosis for patients who were given EAS was a malignancy, whereas relatively few physically ill nursing home patients die as a result of a malignancy. The patients to whom EAS was administered were younger and more often male. EAS patients had been in the nursing home for a shorter time than the other somatic (physically disabled) patients who died during the study period.

Adult↗
PubMed1994

[Hospital admission of nursing home patients: patient characteristics and purpose of admission].

OBJECTIVE: To establish how many hospitalisations of nursing home patients are realised annually, the characteristics of these patients and the diagnoses and the purposes for which they are hospitalised. DESIGN: Retrospective and prospective. METHOD: Analysis of national data for the 5-year period 1986-1990 obtained from the registration of nursing home patients (SIVIS) of the Dutch Centre of Health Care information (SIG) and analysis of 385 separately gathered registration data from 30 nursing homes. RESULTS: More than 9000 hospitalisations of nursing home patients were realised annually, over 10% of those who stay in a nursing home for a shorter or longer time. Somatic patients were hospitalised nearly twice as often as psychogeriatric patients, and men about 1.25 times more often than women. The probability of hospitalisation decreased with advancing age. The most frequent reasons for hospitalisation were cardiovascular diseases, digestive tract diseases and femoral neck fractures. The most important purposes of hospitalisation are: to ward off threat to life (31%), to remedy complaints and burdens (29%), to improve the general condition (16%) and diagnostics (16%). The probability of hospitalisation was 2.5 times as large for the elderly living at home as for older nursing home patients. CONCLUSIONS: Hospitalisations are an important part of medical treatment and care of nursing home patients. There is a variation in hospitalisation rates for different categories of patients. Objectives of hospitalisation are diverse. There is a need for research into the effects of hospitalisation on the quality of life.

Aged↗
PubMed1994

[Who decides on hospital admission of nursing home patients?].

OBJECTIVE: To examine how the decision making to hospitalize nursing home patients proceeds, who takes the initiative, which participants are involved and how much time the consultation and decision making take. DESIGN: Prospective. METHOD: Analysis of registration data about decisions to hospitalize nursing home patients, collected from nursing home physicians in 30 nursing homes. RESULTS: In 76% of the cases the nursing home physician took the initiative to hospitalize. 38% of the patients had been consulted, which influenced the decision. 22% of the patients did not participate in the decision, mostly because of poor mental condition. Consultation of family members and nurses compensated only partly for this limited consultation of patients. With the other patients there had been contact, but without influence on the decision. Medical specialists to nursing home physicians were the most important participants in the decision making. Over 40% of the decisions were taken within 1 h, almost 25% between 1 h and 1 day. The duration of the decision making and the possibilities for consultation were mostly dependent of the urgency of hospitalisation. CONCLUSIONS: Because of the limited possibilities for consultation of nursing home patients when hospitalisation is considered, it is important to anticipate early on such situations by discussing this with patients and family members, and to write down the patients' wishes.

Aged↗
PubMed1994

[Hospital admission of nursing home patients: a difficult decision?].

OBJECTIVE: To examine how difficult decisions to hospitalize nursing home patients are considered by the physicians and to what patient characteristics this is related. DESIGN: Prospective and descriptive. METHOD: Analysis of registration data about 387 decisions to hospitalize nursing home patients collected among nursing home physicians in 30 nursing homes. RESULTS: The degree of difficulty of hospitalisation was associated primarily with poor physical condition and much less with the mental condition. It was not related to patient age (apart from physical condition and the reason for hospitalisation). Referrals were difficult for e.g. infections and respiratory tract disorders, which may be further complicated by the short time available for the decision making because of the life threatening nature of the disorders. With malignancies, feeding, urogenital and skin disorders, decisions to hospitalize also proved difficult to make. These disorders usually allowed more time for consultation. CONCLUSION: About half the decisions to hospitalize were considered hard to make. Only when there is better insight into the effects of hospitalisation on patient functioning and quality of life will it be possible to determine correctness and professional obviousness of such decisions.

Aged↗
PubMed1994

[Life-terminating actions by family practitioners and nursing home physicians without the patient's request].

OBJECTIVE: To describe deliberate and active termination of life without the patient's request by general practitioners and Dutch 'nursing home' physicians. DESIGN: Descriptive, retrospective investigation. METHOD: Data were collected through anonymous postal questionnaires sent to a random sample of 521 general practitioners in North Holland and 521 general practitioners in the rest of the Netherlands regarding 1986-1989 and to all 713 Dutch 'nursing home' physicians affiliated to the Dutch Association of Nursing Home Physicians regarding 1986-June 1990. RESULTS: 65 General practitioners (10%) and 28 nursing home physicians (5%) had at any time deliberately terminated the life of a patient without explicit request by the patient, 94 and 70 times, respectively. In almost all cases the general practitioners indicated that the patients were suffering intensely; the nursing home physicians indicated this in 65% of the cases; with 66% and 57% of the patients contact was not possible; in 50% and in 65% of the cases, respectively, the family was involved in the decision to terminate the patient's life. CONCLUSION: Termination of life without request by the patient occurs in the practices of Dutch general practitioners and Dutch 'nursing home' physicians, but is rare.

Advance Directives↗
PubMed1994

Susceptibility to decubitus ulcer formation.

The hypothesis of blood-flow recovery time after pressure relief was prospectively evaluated as a measure of a patient's susceptibility to develop decubitus ulcers. This blood-flow recovery time was measured using the noninvasive pressure-temperature-time (PTT) method, which uses a 10-minute test-pressure stimulus. The blood-flow response after pressure relief was measured by means of skin-temperature measurements. The evaluation was performed in a group of 109 elderly nursing home patients. A pressure-index was used as a measure for the intensity and duration of pressure and shear forces, to which a patient was exposed, to measure a set of external determinants that are independent of the susceptibility. Both the blood-flow recovery time and the pressure-index were found to correlate significantly with the risk to develop decubitus. A conceptualization of the relationship between the risk, on the one hand, and the susceptibility and the external determinants, on the other hand, is presented, assuming independence (orthogonality) of both sets of determinants. Based on this conceptualization, a three-dimensional risk-relationship was constructed. It is concluded that the blood-flow recovery time can be considered to be a measure for the susceptibility. Further, the conceptualization provides valuable insight into the risk-relationships and forms a base for future research with regard to susceptibility.

Activities of Daily Living↗
PubMed1994

Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: requests and administration.

OBJECTIVE: To learn how many requests for voluntary active euthanasia and/or physician-assisted suicide (EAS) are made to Dutch nursing home physicians (NHPs) and how often these requests are honored. DESIGN: Retrospective survey. SETTING: The Netherlands. PARTICIPANTS: All Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). MEASUREMENTS: An anonymous postal questionnaire was sent to all Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). Respondents were asked how often they had received an explicit request for EAS and whether they had complied with that request. Those who had complied were asked questions about the last occasion on which they had administered either voluntary active euthanasia or physician-assisted suicide. RESULTS: The response rate was 86% (n = 582). Of the respondents, 88% had never administered EAS in nursing homes. The remaining 12% (n = 69) had received 164 requests for voluntary active euthanasia and 53 requests for physician-assisted suicide in the period 1986 through mid-1990. Of these requests, 74 were granted (51 voluntary active euthanasia and 23 physician-assisted suicide). Dutch NHPs together receive an average of 300 requests for EAS a year. They comply with 25 of such requests annually. CONCLUSION: Not many requests for EAS are made in Dutch nursing homes. Of these requests, fewer than 1 in 10 result in the actual administration of EAS. The data presented are relatively constant for the 4.5-year period studied.

Adult↗