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Biomedical subjects

R Steinbrook

Publications and source records attributed to R Steinbrook.

12 recordsLinked to original sources
PubMed1992

Health care workers infected with the human immunodeficiency virus. The next steps.

The tragedy of five patients who contracted human immunodeficiency virus (HIV) infection from a seropositive dentist has alarmed the public. The Centers for Disease Control (CDC) recently revised its recommendations for preventing the transmission of HIV infection to patients during invasive procedures. The CDC abandoned a previous plan to list exposure-prone invasive procedures that HIV-infected health care workers should not perform. The CDC said "expert review panels" should decide on a case-by-case basis whether seropositive health care workers may perform invasive procedures. As of February 1992, the revised recommendations were under review by the US Department of Health and Human Services. Many issues remain to be clarified, such as how these panels will operate and whether decisions will be consistent in similar cases. Disregarding the CDC guidelines or infection-control precautions may further erode public trust and lead to draconian restrictions on HIV-infected health care workers. Physicians and dentists should respond more effectively to public fears about HIV transmission. The challenge is to protect patients while respecting the privacy and livelihood of health care workers.

Centers for Disease Control and Prevention, U.S.↗
PubMed1991

Beyond the Cruzan case: the U.S. Supreme Court and medical practice.

In a landmark decision, the U.S. Supreme Court affirmed a Missouri ruling that sharply limited family decisions about life-sustaining treatment for incompetent patients. The Court held that the Constitution protects the refusal of life-sustaining treatment by competent patients. For incompetent patients, states may require "clear and convincing" evidence of refusal, specifically for the withdrawal of tube feedings, if such a person were in a persistent vegetative state. The ruling left many clinical questions unanswered, such as whether life-sustaining treatment must be given to terminally ill incompetent patients, whether patients may refuse artificial feedings, and what constitutes clear and convincing evidence of refusal. The decision also has potentially harmful consequences. It may undermine family decision making, encourage cynicism and disregard of the law, and promote defensive medicine. Physicians can minimize such consequences by encouraging patients to provide advance directives, such as the durable power of attorney for health care, by urging legislative action, and by setting national practice standards for decisions regarding incompetent patients.

Adult↗
PubMed1990

Informing physicians about promising new treatments for severe illnesses.

Physicians are increasingly informed of promising new treatments for severe illnesses through unconventional communications such as press releases, press conferences, and direct mailings. These highly publicized announcements disseminate information quickly, often many months before new data are presented at medical meetings or published in peer-reviewed medical journals. Such unconventional communications, however, usually do not provide sufficient detail for physicians to evaluate new studies, answer patients' questions, or make recommendations. We suggest that physicians would be better informed about therapeutic advances through (1) expanded information in unconventional communications, (2) increased availability of information from the Food and Drug Administration, (3) early submission and accelerated review of key medical journal articles, and (4) expanded use of on-line computerized information sources. A commitment to inform physicians better about promising new treatments may help save or prolong the lives of patients with severe illnesses.

American Medical Association↗
PubMed1988

Artificial feeding--solid ground, not a slippery slope.

Decisions about artificial feeding arouse more controversy than those involving any other life-sustaining treatment. Because food and water are generally considered basic elements of humane care, representing love and concern for the helpless, it is often thought that they must always be provided. In a landmark decision, the Supreme Judicial Court of Massachusetts ruled that a feeding tube could be removed from a patient in a persistent vegetative state if this was consistent with his previously expressed wishes. The case of Paul E. Brophy, Sr., is part of an emerging medical and legal consensus on the withholding of artificial feeding from adult patients. The view is growing that tube and intravenous feeding should be likened to other medical interventions and not to the routine provision of nursing care or comfort. Competent patients have the right to refuse such feeding. Feeding can also be stopped incompetent patients who have earlier stated such a wish.

Coma↗
PubMed1986

In California, voluntary mass prenatal screening.

A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of "informed consent/refusal." So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.

California↗
PubMed1985

Ethical dilemmas in caring for patients with the acquired immunodeficiency syndrome.

Caring for patients with the acquired immunodeficiency syndrome (AIDS) raises ethical dilemmas about when to provide life-sustaining treatments such as mechanical ventilation and cardiopulmonary resuscitation. In addition, many patients become mentally incompetent and unable to participate in decisions. Homosexual men may want their lover or a friend to make decisions for them, but the patient's partner or friend cannot make these decisions unless he is legally designated. Decision-making guidelines may be hard to implement because caring for patients with AIDS is stressful. We describe three cases that illustrate the difficult ethical dilemmas and stresses of caring for these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Pharyngitis.

Explore the source record for details and available documents.

Adolescent↗