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Biomedical subjects

P G Peters

Publications and source records attributed to P G Peters.

13 recordsLinked to original sources
PubMed2001

The reasonable physician standard: the new malpractice standard of care?

We are in the midst of a tremendous, but essentially unacknowledged, shift in the standard applicable in medical malpractice cases across the United States. The author provides a preliminary survey of this fluid area of the law, and provides rationales for the changes. At the same time, it is not yet clear whether the net impact of these changes will be for the better or for the worse--particularly in light of the simultaneous increase in societal emphasis of cost-conscious care.

Humans↗
PubMed1992

The physician's decision to use tube feedings: the role of the family, the living will, and the Cruzan decision.

OBJECTIVE: To determine the relative importance of factors influencing physicians to use tube feedings in patients lacking decision-making capacity. DESIGN: Survey. SETTING AND PARTICIPANTS: Four hundred thirty-nine members of the Missouri Academy of Family Physicians. MEASUREMENTS: Using a mailed questionnaire, physicians were asked for a decision about feeding tube placement in an 89-year-old man who was unable to swallow or communicate after a stroke. Changing the conditions of the scenario, we then evaluated the influence of patient age, duration of disability, a living will, the Cruzan decision, and family preferences on the physician's decision. RESULTS: After reading the initial case history, 47% of physicians opposed tube feedings. Physicians who were told that the patient signed a living will specifically excluding tube feedings were more likely to oppose tube feedings than those who were told that he signed only a standard living will (53% vs 42%; P = 0.02). Forty-two percent of physicians who initially suggested a feeding tube changed their recommendation if the family opposed it. Sixty-six percent of physicians who initially opposed a feeding tube changed their recommendation if the family "pushed" for it. Thirty-three percent of physicians who initially opposed tube feedings under the living will scenario would favor tube feedings if the patient had not signed a living will. Twenty-two percent of physicians who initially opposed tube feedings would change to favor them if the issue had arisen before the Cruzan decision. CONCLUSIONS: Among this group of physicians, there was no consensus on whether tube feedings should be initiated. However, it was found that the family's opinion was the most influential factor affecting the physician's recommendation about tube feedings. Most physicians endorsed family preferences for tube feedings even when this intervention was specifically opposed in the patient's living will.

Brain Diseases↗
PubMed1990

A comparative analysis of the loss of amiodarone from small and large volume PVC and non-PVC infusion systems.

The time-course of the adsorption of amiodarone hydrochloride onto flexible polyvinyl chloride (PVC) infusion bags and administration sets has been studied under ambient conditions similar to the intensive and coronary care units at the Repatriation General Hospital--Daw Park. When admixtures containing 900-1000 mg amiodarone hydrochloride in 500 ml PVC infusion bags containing glucose 5% were assayed, a minimal (2.7%) loss of amiodarone was detected at 24 hours compared with glass infusion bottles. There was no loss apparent when 100 ml PVC infusion bags were used compared with 100 ml glass bottles. When PVC administration sets were attached to 500 ml glass infusion bottles, maximal adsorption losses of up to 4.9% were observed in the effluent within one hour of the commencement of the simulated infusion. In Australia, the current recommendations by the distributor of amiodarone, Reckitt & Colman Pharmaceuticals, advise that the administration of amiodarone should be via glass infusion bottles or rigid PVC plastic containers without plasticisers together with non-PVC administration lines. These results do not support this recommendation.

Adsorption↗
PubMed1983

The induction of multiple forms of cytochrome P-450 by SKF 525-A.

SKF 525-A induces several subpopulations of cytochrome P-450 which differ in their chromatographic properties and in their abilities to sequester themselves as metabolic-intermediate complexes. The two major subpopulations induced by SKF 525-A have both similar chromatographic elution profiles on DEAE cellulose and the same molecular weight as the two major forms induced by phenobarbital (PB). They differ from those induced by phenobarbital, however, in the extent to which they sequester themselves as SKF 525-A metabolic-intermediate complexes in vivo. They also differ markedly from the major cytochrome induced by beta-naphthoflavone (BNF) which is incapable of forming metabolic-intermediate complexes with SKF 525-A in vivo.

Animals↗
PubMed1983

Somatic cell genetics and flow cytometry.

Human genes coding cell surface molecules can be introduced into mouse host cells using a variety of somatic cell genetic techniques. Because these human gene products can be detected using indirect immunofluorescence on viable cells, the genes themselves can be monitored and manipulated using flow cytometry and sorting. In this paper, we review ways that we have used cell sorting to develop a somatic cell genetic analysis of the human cell surface.

Animals↗
PubMed1982

Genetic and biochemical characterization of a human surface determinant on somatic cell hybrids: the 4F2 antigen.

We have mapped the gene which codes the species-specific determinant defined by monoclonal antibody 4F2 to human chromosome 11. All human chromosomes, except Y, were included in a group of four human-mouse hybrid lines. Hybrids heterogeneous for 4F2 antigen expression were sorted using the fluorescence-activated cell sorter (FACS) to yield populations homogeneous with respect to the presence or absence of this determinant. Isozyme analysis indicated corresponding genetic selection for or against human chromosome 11. This map assignment was confirmed using a hybrid line which contained only human chromosome 11. Immunoprecipitation of the 4F2 determinant from the 11 only hybrid resulted in a heavy subunit of molecular weight (Mr) = 100,000 and a light subunit of Mr = 41,000. This contrasts with results obtained from nonhybrid human cells of different lineages. These results demonstrate the importance of FACS techniques in the rapid mapping of genes which code human cell surface antigens.

Animals↗
PubMedDate not supplied

Community attitudes and knowledge about advance care directives.

BACKGROUND: Patients and their physicians are increasingly being encouraged to discuss end-of-life decisions. The purpose of this study was to enhance understanding of the public's attitudes and knowledge about medical decision making and advance care directives. METHODS: Eight focus groups of community members discussed their understanding of and attitudes about advance care directives. Transcripts of these discussions were analyzed using coding categories created from the transcripts. RESULTS: Eighty-three people attended the focus groups. Most discussions of advance care directives involved family members in the setting of family or personal illness. Elderly persons commonly confused wills with living wills. Most who had given advance directives did so either to make others follow their wishes or to ease family burdens. Among the great variety of reasons for not using advance directives was a perceived lack of personal relevance, as well as conceptual, moral, and practical difficulties. Participants were divided about whether it was appropriate for physicians to initiate discussions about life-sustaining care with their patients. We discerned three themes affecting individuals' opinions about personal decision making about advance directives: (1) trust in family and the medical system, (2) need for control, and (3) knowledge about advance directives. CONCLUSIONS: Although living wills are advocated by many authorities, and many of our participants endorsed their use, our participants also cited numerous cautions and impediments to their use. As the role of advance care directives changes, physicians will need to be aware of their patients' perceptions, as well as the legalities of these documents.

Adult↗