PubMed Health⌕ Search

Biomedical subjects

N D List

Publications and source records attributed to N D List.

8 recordsLinked to original sources
PubMed1995

Age as a factor in critical care unit admissions.

BACKGROUND: Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. METHODS: In response to a hypothetical case scenario, physicians were asked to admit one of two patients to a last available critical care unit bed. An accompanying questionnaire was used to gain a ranking of several admission factors as compared with age, and to gain demographic data regarding the study population. Data were subjected to nonparametric statistical analysis. RESULTS: When age was the only difference between two patients in a hypothetical case scenario, 80.7% of respondents chose the younger patient (age 56 years) for admission, 13.2% chose the older patient (age 82 years), and 6.2% abstained. Following the provision of more detailed medical and social information, however, only 53.5% chose the younger patient, 41.2% chose the older patient, and 5.3% continued to abstain. In a ranking of several admission factors, age was found to be of less importance than severity of presenting illness, previous medical history, and do not resuscitate status, but of more importance than patient motivation, ability to contribute to society, family support, and ability to pay for care. When asked if they supported a definitive age criterion that would restrict all patients over a certain age from access to critical care units, 95.1% responded that they did not. CONCLUSIONS: Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.

Age Factors↗
PubMed1992

Problems in cancer screening in the older patient.

If prevention is to become a structured portion of medical care, a complex societal and professional learning process will have to occur in order to change the practice of medicine. Physicians, together with other health professionals, must work to remove the barriers and to determine the social, medical and personal activities necessary to preserve a high quality of life for their patients over a full lifespan. To accomplish this, the physician must not only treat disease but also promote a healthy living environment. With the increasing amounts of valid information available on the effectiveness of health care interventions, the areas of cancer prevention and control become mandatory pursuits for both the physician and the patient; this must be an integral part of medical practice, especially for the primary care patient.

Aged↗
PubMed1992

Approaches to and effectiveness of current cancer interventions in the elderly.

The effectiveness of early detection depends to a great extent on the particular category of the malignancy. Cancers fall into three categories: 1) Those for which there is evidence that early detection reduces mortality; 2) those for which available evidence indicates that early detection produces no demonstrable mortality reduction; 3) those for which there is insufficient evidence as to the effect of early detection. The use of early detection modalities for these patients is problematic, since such testing can result in unnecessary medical costs and personal burdens. This paper makes some suggestions for practical office screening approaches for cancers of the breast, colon and rectum, cervix, prostate, lung, skin, oral cavity, and endometrium. The evidence relating to screening tests for cancer are reviewed in order to provide a practical approach for the practitioner.

Aged↗
PubMed1987

Perspectives in cancer screening in the elderly.

The concern is whether physicians and the health care system make cancer screening available to the elderly. This question has special meaning in this population as it is apparent that problems in screening for cancer have not been addressed. First, primary care physicians do not emphasize cancer prevention and early diagnosis in the elderly. Second, there is a need to educate the American population about cancer prevention, methods of early diagnosis, and the problems and realities surrounding cancer. The elderly are less aware of and use significantly fewer of the available screening resources. When this is coupled with a health system that does not provide funding for preventive and screening services (Medicare, Medicaid, and most third-party insurance carriers), the potential to deal with this problem becomes extremely difficult. High-quality primary care is the key to cancer screening in the elderly. The physician must take responsibility for health promotion while concentrating on screening. Two good rules of thumb are 1) to screen all patients for cancer and other diseases on a routine basis based upon screening recommendations in the current literature; and 2) to evaluate a normal patient who comes to the physician with a complaint (to assure early diagnosis). It is difficult to decide when an aggressive work-up is needed since older patients are at risk of complications from diagnostic procedures. The elderly are singularly under-represented in most studies of screening and prevention. We are therefore left with the reality that, no matter what set of recommendations is put forward, the physician is acting from incomplete information. The published guidelines are not directed at the elderly. Omission of the elderly from these studies leaves unknown the risks, benefits, and even the actual ability to screen. There is a need for better screening methods. There is evidence in the literature that both the physician and the patient need to be educated. The need for research in screening efficacy is coupled with a need to define methodologies to educate the provider and the patient and to determine how to reach high-risk populations. In the interim, the implementation of the guidelines discussed, with consideration of the current literature, is recommended to the physician as a rational approach.

Age Factors↗
PubMed1983

A cross-national study of differences in length of stay of patients with cardiac diagnoses.

To determine the reason for large regional differences in average hospital length of stay shown in federal discharge abstract data, the medical records of 482 cardiac patients from hospitals belonging to two metropolitan area PSROs of Baltimore, Maryland, and 438 cardiac patients from hospitals in the Metropolitan area PSRO from Portland, Oregon, were reviewed, stratified by diagnosis and complications, and compared for length of stay. Cardiac patients were hospitalized between 2.5 and 7 days longer in Baltimore than in Portland. Federal data on length of hospital stay were basically correct for the diagnostic categories studied. Length-of-stay differences could not be explained by patient differences and appeared to be due to differences in physician practice patterns.

Aged↗
PubMed1981

Ethical considerations in critical and terminal illness in the elderly.

In a Baltimore geriatric center and hospital, a program was developed to individualize the treatment of critically and terminally ill patients. Part of this program was an effort to involve the patients themselves in the discussion of their personal wishes, and the provision of a set of guidelines for staff members to help them individualize the care of the patients. Some of the practical problems involved the the application of these ethical ideals are discussed. Merely implementing the protocol helped staff members to become more aware of these complex questions. Physicians should deal forthrightly with "right-to-die" and associated issues. The decision-making should remain in medical hands, and out of the courts and legislatures.

Aged↗