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Biomedical subjects

P Backlar

Publications and source records attributed to P Backlar.

25 records · Page 2Linked to original sources
PubMed1996

A survey on use of advance directives for mental health treatment in Oregon.

Oregon is one of three states that allows persons to prepare a legal document-and advance directive-to stipulate the mental health treatment they wish to receive should they lose their decision-making capacity. An informal one-page questionnaire on the use of advance directives for mental health treatment in the state was enclosed in newsletters sent to families and care providers of persons with severe and persistent mental disorders. Responses were received from 156 people; they reported that 64 advance directives had been completed by consumers, 40 surrogate decision makers had been appointed, and ten consumers had used their advance directives when in crisis. In each case, the consumer's wishes were honored. The small response to this preliminary survey suggests the need for further education about advance directives among mental health care consumers, their families, and providers.

Advance Directives↗
PubMed1994

Ethics committees in state mental hospitals: a national survey.

OBJECTIVE: The goals of the study were to examine the composition, operation, and purpose of ethics committees in state mental hospitals, to determine whether committees were accessible to patients and family members, and to identify frequently addressed ethical issues. METHODS: In June 1992 a 41-item survey questionnaire was mailed to chief executive officers of 204 state-operated general psychiatric inpatient facilities. Survey items asked about the facility's attributes, composition of the ethics committee, how the committee functioned, and the issues it addressed. RESULTS: A total of 145 facilities from 46 states responded to the survey, for a response rate of 71 percent. Nearly half the facilities had ethics committees, most of which were recently established. Physicians accounted for the plurality of committee membership, followed by nurses and administrators. Although several facilities gave patients access to committee meetings, few patients or their family members actually attended these meetings. Issues such as patients' danger to others, resuscitation policies, and scarce resources were frequently addressed by many committees but were never addressed by others. CONCLUSIONS: Although many state mental hospitals have established ethics committees in the past few years, these committees may not meet patients' needs because of inadequate representation by patient advocates and family members. Numerous concerns were heard by committees, but no obvious patterns of pressing issues were revealed.

Bioethical Issues↗
PubMed1993

A national survey of ethics committees in state mental hospitals.

In June 1992, a national mail survey was directed to 204 state inpatient psychiatric institutions. This study was implemented following the 1992 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement that hospitals put in place some means with which to address ethical issues. The goals of the study were: 1. to examine state mental hospital characteristics and their response to the JCAHO requirements; 2. to describe healthcare ethics committee (HEC) composition, function, and role; 3. to study patient and family access to a HEC; and 4. to discover ethical issues most frequently addressed. The survey response rate was 71%. Of the 145 responders, 62 had HECs in place, and 53 were in the process of implementing HECs. There were no differences between JCAHO accredited institutions and non-accredited facilities with regard to having HECs. Physicians accounted for 22% of HEC membership, followed by nurses (15%), and administrators (12%). Twenty-six percent of facilities systematically notified patients about existence of the HEC; 71% of facilities had no patient request for HEC services in the last year. A patient's danger to others, and resuscitation policy were issues most frequently (23%) heard by HECs.

Accreditation↗
PubMed1993

Clozapine rationing in a state mental hospital: reviewing a HEC's case consultation.

Clozapine (Clozaril) is a new, powerful, costly anti-psychotic medicine, with a possible serious side effect (agranulocytosis) that entails weekly blood monitoring. In a three hundred bed state mental hospital that is allotted thirty clozapine slots (high costs effectively rationing this drug), a woman with schizophrenia responds minimally to this medication. Her attending physician wishes to withdraw the medicine and give it to another patient with schizophrenia on the ward who might have a better response. The woman's family threatens to make a public outcry. Both the attending physician and the family ask the HEC for a consult.

Adult↗