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Biomedical subjects

R Rhodes

Publications and source records attributed to R Rhodes.

At least 19 recordsLinked to original sources
PubMed2000

Paternalism.

J. S. is a sixty-five-year-old man who was treated at another hospital with arthroscopic debridement of an infection at the site of a right total knee replacement and was placed on long-term intravenous antibiotics. He signed out of that hospital against medical advice. One month later, he presented at our hospital with recurrent sepsis of his knee. Knee aspiration yielded frank pus with a white blood-cell count of 80,000 cells per cubic millimeter. Gram-staining demonstrated gram-positive cocci. The patient was placed on intravenous antibiotics. The patient appeared cachectic, reporting a sixty-pound (27.2-kilogram) weight loss over the past year. A metastatic workup, including a chest radiograph, an abdominal sonogram, prostate-specific antigen, a complete blood-cell count, erythrocyte sedimentation rate, and a purified-protein-derivative skin test, was negative; however, an occult neoplasm could not be excluded. The patient displayed episodes of confusion, disorientation, and argumentative behavior. Medical and psychiatric consults did not determine whether this behavior was due to previous substance abuse or a primary psychiatric disorder. Nevertheless, psychiatrists at our institution determined that the patient lacked decisional capacity. Attempts were made to salvage the knee replacement, and the patient underwent an extensive surgical debridement of the knee with insertion of drains. He was placed on intravenous antibiotics. The plan was for the patient to be managed with long-term oral suppressive antibiotics. After treatment, the patient was transferred to a skilled-nursing facility. Psychiatrists at the nursing facility deemed the patient to have decisional capacity, and the patient was permitted to leave the facility. He was discharged without antibiotics. Several weeks later, he presented at our hospital with a grossly purulent knee. The orthopaedic options were reviewed with the patient and his brother. Removal of the components was recommended. The patient did not want to "lose" his knee replacement, and he refused surgical intervention. We did not believe that the infection could be either controlled or eradicated with the components in place.

Aged↗
PubMed2000

Residency training.

R. C. is an orthopaedic resident in a teaching program. At the orthopaedic clinic, he examines an elderly, otherwise healthy patient who requires a total hip replacement. He presents the patient to his covering attending physician, who agrees to supervise the joint replacement surgery. The resident discusses the surgery with the patient. The procedure, risks, goals, benefits, and alternatives are presented. The patient agrees to proceed with the surgery. The resident performs the surgical procedure with the attending physician's assistance. The surgery lasts forty minutes longer than the attending physician's usual surgical time, and the blood loss is 300 milliliters greater. Postoperative radiographs demonstrate a well positioned press-fit acetabular component and a cemented femoral component in 6 degrees of varus.

Ethics, Medical↗
PubMed2000

Ethics in practice.

H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a nursing home, where she transfers from bed to chair with maximal assistance. She presents to our emergency department with a painful right hip. Physical examination demonstrates a confused, elderly patient with significant right hip pain and shortening and external rotation of the lower extremity. Radiographs demonstrate a displaced intertrochanteric hip fracture. The patient lacks the capacity for informed consent. Her family is contacted to obtain consent for insertion of a compression screw. The family refuses to give consent, stating that the patient is too old and the surgery is too dangerous.

Aged↗
PubMed2000

Ethical considerations in orthopaedic surgery.

Because our actions as physicians have far-reaching consequences, and because society allows us to do things to others that no one else is free to do, physicians' professional activities fall under the domain of ethical evaluation. We are charged with the obligation to use specialized scientific knowledge, to work in concert with others, and to act for the good of our patients. In fact, acting for the good of our patients is the central tenet of ethical medical behavior. What constitutes the good of the patient, however, is not always clear. In general, we act to limit disease, restore function, alleviate suffering, and prolong life. We understand fully, however, that these goals may conflict with one another. Judgment about what is right for a particular patient leads us to another crucial consideration of ethical behavior, namely, respect for patient autonomy. We recognize that individuals have the right to control their own destiny. Patients have a right, therefore, to make choices about their medical care. As physicians, we must respect those rights. As such, certain ethical behavior is expected of us. We must be honest with our patients. We must provide them with accurate information on which to base their decisions. We must convey to them information about their diagnosis, prognosis, and treatment, even when it is unpleasant to do so. We must be open about our expertise and level of training for a particular procedure. We must respect their privacy and their right to withhold information even from family and friends. In short, we must respect their choices, even if we may disagree with those choices. To truly respect patient autonomy is to understand that, ultimately, the final decision lies with the patient.

Clinical Competence↗
PubMed1999

The relaxin-like factor is a hormone.

The relaxin-like factor (RLF) circulates in the bloodstream of humans, interacts with a membrane protein with all the characteristics of ligand-receptor binding, and must therefore be considered a hormone by definition. The polyclonal antibody raised against synthetic human RLF showed no crossreactivity to other structurally related hormones, like insulin and relaxin. The sensitivity of this assay (ED50 at 100 pM) allowed the direct measurement of RLF concentrations in serum. The highest levels were detected in the serum of postpuberty males (190 pM), whereas in females and children, the RLF concentration was one order of magnitude lower.

Adolescent↗
PubMed1998

Genetic links, family ties, and social bonds: rights and responsibilities in the face of genetic knowledge.

Currently, some of the most significant moral issues involving genetic links relate to genetic knowledge. In this paper, instead of looking at the frequently addressed issues of responsibilities professionals or institutions have to individuals, I take up the question of what responsibilities individuals have to one another with respect to genetic knowledge. I address the questions of whether individuals have a moral right to pursue their own goals without contributing to society's knowledge of population genetics, without adding to their family's knowledge of its genetic history, and without discovering genetic information about themselves and their offspring. These questions lead to an examination of the presumed right to genetic ignorance and an exploration of a variety of social bonds. Analyzing cases in light of these considerations leads to a surprising conclusion about a widely accepted precept of genetic counseling, to some ethical insights into typical problems, and to some further unanswered questions about personal responsibility in the face of genetic knowledge.

Beneficence↗
PubMed1998

Ethical considerations for residents.

To help residents understand the moral obligations they have undertaken by becoming doctors, the author presents an overview of the ethical landscape of medical practice. She begins by stating that doctors' primary obligation is to use the knowledge of science in working together with others for the good of their patients. This involves (1) relying on the scientific method (and thus eschewing nonscientific alternatives) and supporting or conducting scientific research; (2) embracing the cooperative model (i.e., when appropriate, working cooperatively with other physicians and other health care providers); and (3) working for the good of the patient to preserve life, cure disease, restore or preserve function, educate, and alleviate suffering. In order to fulfill this complex obligation physicians must be professionally competent, they must respect their colleagues and patients, and they must genuinely care about their patients' well-being. The author then discusses the moral complexity of common encounters in medical practice. She explains the ethical conflicts that underlie issues of paternalism, justice, the use of patients for teaching, and end-of-life care. Since new moral problems are introduced with new technology and since medicine is confronting an increasing demand for services in the face of shrinking resources, she maintains that, more than ever, physicians must be aware of the ethical dimensions of their work and be able to organize their understanding of the issues. To meet the complex and demanding commitments of medical practice and to successfully navigate the ethical challenges that they will encounter, physicians must mold themselves not only to be knowledge and skilled professionals but also to be respectful and compassionate human beings.

Adult↗
PubMed1998

Curriculum revision: reaching faculty consensus through the Nominal Group Technique.

A fundamental concept to initiate change in the curriculum revision process is to overcome resistance to change and the boundaries of self-interest. Curriculum change cannot occur without an "unfreezing" of faculty values and interests. The Nominal Group Technique (NGT) was used to facilitate faculty identification of areas needing change in the undergraduate nursing curriculum. The process led to the generation of numerous independent ideas in which all faculty participated. The revised curriculum which resulted from the NGT process has had full and enthusiastic support of the faculty.

Alabama↗