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Biomedical subjects

S R Kaufman

Publications and source records attributed to S R Kaufman.

At least 19 recordsLinked to original sources
PubMed2000

In the shadow of "death with dignity": medicine and cultural quandaries of the vegetative state.

In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self-regulating, yet who are sustained by modern medical practice, destabilize the existing social order in ways that are different from other hybrid forms.

Attitude of Health Personnel↗
PubMed1999

Effects of a home-based family intervention on adolescent alcohol use and misuse.

OBJECTIVE: Systematic evaluation of theoretically and empirically based family programs to prevent adolescent alcohol use/misuse is limited. Data presented here are from a longitudinal study evaluating a home-based universal adolescent alcohol use prevention program. The intervention was designed to enhance protective factors and minimize risk factors identified as influencing adolescent alcohol use. METHOD: A randomized pretest/posttest repeated measures design was used. Adolescents (N = 428; 54% females, 86% European American) and their parents were recruited from three Midwestern school districts. Families were randomly assigned to either a three-session family intervention or a no-intervention control condition. Pretest data collection and the intervention occurred when the adolescents were in fourth grade, and a booster intervention was given in seventh grade. Posttest data collection was completed each year for 4 years in the classroom for adolescents. RESULTS: The intervention was associated with a reduction in alcohol use (F = 5.16, 4/421 df, p < .001) and misuse (F = 3.08, 4/421 df, p < .05) for those adolescents in the intervention condition who were not using alcohol prior to the initiation of the program, but not for those who were using alcohol before initiation of the program. CONCLUSIONS: The results support the possible effectiveness of the family intervention as a universal prevention program for decreasing initiation of alcohol use and subsequent misuse for the majority of adolescents who do not report prior drinking. However, additional intervention approaches appear necessary for adolescents who have already used alcohol.

Adolescent↗
PubMed1998

Foveal outer retinal function in eyes with unexplained visual symptoms or acuity loss.

OBJECTIVE: To determine whether foveal outer retinal dysfunction is common in eyes with unexplained visual symptoms or acuity loss. DESIGN: Prospective study. PARTICIPANTS: Seventy-three eyes of 44 consecutive patients with unexplained visual symptoms or acuity loss, 39 eyes of 39 control subjects, and 12 eyes of 7 patients with known maculopathy. INTERVENTION: Foveal cone electroretinography (ERG) and letter recognition perimetry. MAIN OUTCOME MEASURES: Foveal cone ERG data. RESULTS: Abnormal foveal cone ERG data were recorded in 35 (48%) of 73 eyes (23 [52%] of 44 patients). Among these 35 eyes, amplitude was lower than in normal controls (P<.001) and was correlated with visual acuity and the number of letter recognition perimetry errors (P<.05 for both). The latter was higher in eyes with abnormal retinal responses than in symptomatic eyes with normal responses (P<.01). However, initial symptoms, visual acuity, and macular appearance did not differentiate between these 2 groups. Foveal cone ERG test vs retest data showed consistent results. CONCLUSION: Foveal outer retinal dysfunction is a common underlying mechanism of previously unexplained visual symptoms or acuity loss. Foveal cone ERG testing should be considered early in the evaluation of eyes with this presentation.

Adolescent↗
PubMed1998

Foveal dysfunction and central visual field loss in glaucoma.

OBJECTIVE: To determine whether foveal function distal to the ganglion cell layer is an independent predictor of central visual field function in glaucoma. SETTING: University affiliated hospital and private practice. PARTICIPANTS: Twenty-seven eyes (27 patients) with normal-pressure glaucoma, 10 eyes (10 patients) with primary open-angle glaucoma, and 47 eyes of 47 matched normal volunteers. INTERVENTION AND MAIN OUTCOME MEASURES: Foveal cone electroretinogram (ERG) amplitude, relative optic cup to disc area and their relations to Humphrey full-threshold 30-2 visual field central 4-point mean total deviation (C4MTD) and pattern deviation (C4MPD). RESULTS: Foveal cone ERG amplitude was subnormal in 14 (37.8%) of the 37 glaucomatous eyes and lower in the glaucoma group compared with normal eyes (P<.01). The C4MTD and C4MPD were lower in glaucomatous eyes with subnormal amplitudes compared with those with normal amplitudes (P<.01 and P<.05, respectively). Amplitude was directly correlated with C4MTD (P<.01) and C4MPD (P<.01). Relative optic cup to disc area was inversely correlated with C4MTD (P<.001) and C4MPD (P<.001). Partial correlation analysis revealed that amplitude and relative optic cup to disc area were independent predictors of C4MTD and C4MPD. CONCLUSION: Foveal function distal to the ganglion cell layer and optic disc cupping independently predict central visual field function in glaucoma.

Adult↗
PubMed1998

Intensive care, old age, and the problem of death in America.

This article, part of a larger anthropological investigation of how death occurs in the hospital, explores the relationship of elderly deaths in the intensive care unit to the cultural conversation about the desire for "death with dignity." Based on participant observation, it provides three case studies that focus on the unfolding of events surrounding patient treatment, decision making, and family involvement. The cases are interpreted in the context of four sources of the culturally defined "problem" of death: (a) how medicine operates as the dominant conceptual framework for understanding both old age and death; (b) the power of the technological imperative to determine events; (c) ambivalence regarding end-of-life goals; and (d) the incommensurability of lay and medical knowledge.

Aged↗
PubMed1997

Construction and practice of medical responsibility: dilemmas and narratives from geriatrics.

A narrative approach is employed in this article about dilemmas and physician reasoning in geriatric medicine in order to explore the moral-medical worlds of urban American physicians. Reconstructed dilemmas, in the form of stories told by 51 doctors, are analyzed as cultural documents of both clinical-moral knowledge and practice and the physician as moral actor. Discussion focuses on ways in which responsibility is constituted and enacted through a particular language of clinical action. This analysis opens the subject of bioethics to a range of infrequently discussed issues that physicians cite as deeply troubling and contributes to a broadening of anthropological approaches useful in the study of bioethics.

Aged↗
PubMed1997

The World War II plutonium experiments: contested stories and their lessons for medical research and informed consent.

During the Second World War medical researchers around the USA injected 18 hospital patients with radioactive plutonium in order to learn its effects on the body. Two documents, a newspaper account and a university committee report, tell divergent stories of the scientists and patients involved in that experiment. This article uses those documents-plutonium narratives-as a catalyst for exploring the problematic representation of past human experimentation, assumptions of moral progress in medical research, and the nature of informed consent today. Informed consent is shown to be an evolving process and discursive practice that cannot be understood apart from its historical and cultural embeddedness.

Bone Neoplasms↗
PubMed1997

Foveal cone function in nonproliferative diabetic retinopathy and macular edema.

PURPOSE: To study results of foveal cone electroretinography (ERG) in patients with nonproliferative diabetic retinopathy (NPDR), with and without clinically significant macular edema (CSME). METHODS: Electroretinograms of foveal cones were elicited, with a dual-beam stimulator-ophthalmoscope, from 18 consecutive patients with bilateral NPDR and unilateral CSME. RESULTS: Analysis of resulting data revealed that mean amplitude was significantly lower in eyes with CSME and in eyes without CSME., compared with that in normal eyes. Mean implicit time was significantly longer in eyes with CSME compared with that in normal eyes, but in eyes of diabetic patients without CSME., mean implicit time was the same as that in normal eyes. Amplitudes were directly correlated and implicit times were inversely correlated with best-corrected Snellen visual acuity in eyes with and without CSME. Eyes with CSME had significantly lower amplitudes and longer implicit times than their fellow eyes without CSME. In addition, eyes with NPDR, with or without CSME, did not exhibit the normal rise in amplitude with increasing duration of light exposure. CONCLUSIONS: Electroretinographic findings showed abnormalities in foveal cone responses in eyes with NPDR, particularly in the presence of CSME. These results may support a functional role for outer retinal dysfunction in patients with diabetic retinopathy and loss of central vision.

Adult↗
PubMed1996

Autopsy. A crucial component of human clinical investigation.

OBJECTIVE: To determine the proper role of human clinical investigation, including autopsy, in public health research policy. DATA SOURCES: Medical reports and reviews, and literature concerning the philosophy of medicine. CONCLUSIONS: Autopsy has always been a cornerstone of medical research. Although many pathologists appreciate the research value of autopsies, many other physicians do not. Declining federal support for human clinical research in general, and autopsy in particular, party reflects the popular view that laboratory experimentation-especially that performed on nonhuman animals-can reliably model human conditions. Human clinical research is often difficult, expensive, and time-consuming, but there seems to be no adequate substitute for studies of naturally occurring human conditions. Such studies address many critical medical questions. Autopsy remains an invaluable complement to evolving molecular biology techniques.

Animals↗
PubMed1995

Lichen planus associated with topical beta-blocker therapy.

PURPOSE: We studied two clinical cases that demonstrated an association between topical beta-blocker therapy and lichen planus. METHODS: Two patients developed skin lesions while on topical beta-blocker therapy for open-angle glaucoma. They underwent skin biopsies to determine the origin of the lesions. They were subsequently treated and followed up clinically. RESULTS: Skin biopsy specimens from each patient demonstrated infiltrates consistent with a lichenoid drug reaction. The symptoms resolved after discontinuation of the topical beta-blocker therapy. Neither patient developed a recurrence. CONCLUSION: We suggest that lichen planus is a possible side effect of topical beta-blocker therapy.

Administration, Topical↗
PubMed1995

Decision making, responsibility, and advocacy in geriatric medicine: physician dilemmas with elderly in the community.

This descriptive anthropological study explores the nature of physician decision making in the case of old people who reside in the community. Focusing on physician narratives of actual dilemmas, this article contributes toward a phenomenology of clinical medicine and provides examples of how decisions in geriatrics are influenced by professional values, institutional constraints, and cultural forms. In-depth interviews with 40 physicians revealed dilemmas to have three sources: (1) unresolved questions about how much to intervene in patients' lives to reduce risk; (2) structural, moral, and medical limits to patient advocacy; and (3) the problem of assessing vulnerability and quality of life when pondering placement.

Aged↗
PubMed1995

Managing an uncertain illness trajectory in old age: patients' and physicians' views of stroke.

Uncertainty is a central feature of a chronic illness trajectory, resulting from questions about the effects of the illness on daily life, what symptoms mean, and what the future holds. When chronic illness occurs late in life, uncertainty is magnified, and serious questions arise about whether the individual will be able to weather the disruption and go on with daily life. This article examines illness trajectories from two vantage points, that of older persons who have had a stroke and that of physicians who care for stroke patients, by means of interviews with 36 persons who had strokes and with 20 physicians. Physicians' views of stroke were informed not only by knowledge of physiological processes but also by biomedical ideologies and cultural meanings associated with their patients' ages and impairments. People who had strokes focused on recovery; they assumed the trajectory was open to manipulation if they worked hard enough. The vague medical response to uncertainty affected patients' interpretations; what they were not told shaped their expectations about recovery as much as what they were told. The uncertain trajectory of stroke in old age is one example of how illness experience is affected by cultural attitudes about age, biomedical ideologies, the provision of health care services, and economically driven health policies. The anticipation of recovery by persons who have had strokes and the letdown when recovery does not occur reflect critical dilemmas in biomedicine and in society itself that have implications for health policy.

Activities of Daily Living↗
PubMed1992

Animal rights.

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Animal Welfare↗