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Biomedical subjects

S W Tolle

Publications and source records attributed to S W Tolle.

At least 37 records · Page 2Linked to original sources
PubMed1995

Care of the family when the patient is dying.

Families shoulder many burdens during terminal illness. Their needs grow and change as their loved one's illness progresses. We describe specific physician behaviors that can assist families in coping with terminal illness. Early in serious illness, there are the emotional burdens of learning of the illness and coming to accept a terminal diagnosis, of giving up hope of cure. As terminal illness progresses, patients often need family members to help refocus hope despite the inevitability of death. Patients and families need support, guidance, and encouragement to begin planning for many decisions. Although emotional burdens are felt by most family members, families who choose to have their loved one die at home take on enormous direct caregiving burdens as well. They need information and supplies, including specific teaching of caregiving skills and logistic support. After the death of the loved one, family members have bereavement needs that require ongoing support.

Caregivers↗
PubMed1994

Tube feeding. Internists' attitudes regarding ethical obligations.

BACKGROUND: Little is known about the attitudes of internists regarding their ethical obligation to provide or withhold tube feeding in three clinical contexts when patient preferences are not known: acute pneumonia, severe dementia, and persistent vegetative state. METHODS: A written questionnaire with patient scenarios was mailed to a randomized national sample of 1000 internist members of the American College of Physicians. RESULTS: Response was received from 58% of our sample (n = 581). Only physicians with personal experience with tube feeding decisions were included in the subsequent analysis (n = 326). Respondents were mostly male board-certified internists active in patient care in urban/suburban settings. Physicians demonstrated a predominant attitude for each scenario: 98% favored initiation of tube feeding for the patient with acute pneumonia; 84% opposed initiation of tube feeding for the patient with advanced dementia when depicted with a mixed happy/sad affect; and 80% favored withdrawal of tube feeding for the patient with established persistent vegetative state. Sixteen percent (n = 51) described tube feeding as basic humane care, whereas 84% (n = 265) believed tube feeding is medical therapy. Physicians were more opposed to tube feeding in certain patient scenarios than the literature suggests occurs in actual practice. CONCLUSIONS: Our data suggest that when patient wishes are not known, physician decisions regarding tube feeding are strongly influenced by prognosis. State legislation that categorizes tube feedings differently from other medical treatments conflicts with the judgment of the majority of internist respondents.

Adult↗
PubMed1994

Tube-feeding decisions in the elderly.

Tube-feeding decisions in the elderly can be most challenging. We begin our decision making with the premise that artificial nutrition is a medical therapy and therefore that its prescription is based on a calculation of net benefits over burdens for the patient to whom it is given. When the burdens of this therapy outweigh the benefits of prolonged life, tube feeding may be ethically withheld or withdrawn. For the cognitively impaired and in the absence of known patient preferences, the ratio of benefits to burdens may best be figured after a time trial of therapy. If restraints are needed to keep the tube in place, or if significant medical complications ensue, the burdens of the therapy have outweighed its potential benefits, and the therapy may be ethically withdrawn. State statutes and institutional policies are often confusing and at times in conflict with the ethical choice made by families and health care providers for their loved ones and patients. The options--starting a court battle (Cruzan7), moving the patient to a different state (Busalacchi), or committing civil disobedience--are not best for the welfare of the patient, family, or health care team. We well recognize that what is legal is not always what is ethical. Ethics should lead the law as we consider how to use new health care technologies wisely. We hope that the state legislatures will work to minimize future conflicts by acknowledging that (1) artificial nutrition is a life-sustaining therapy that should not have special status distinct from other life-sustaining therapies and (2) artificial nutrition and hydration are medical therapies that can and should be ethically withdrawn or withheld when their burdens outweigh their benefits.

Age Factors↗
PubMed1992

Sexual advances by patients in dental practice: implications for the dental and dental hygiene curricula.

The occurrence of patient initiated sexual advances toward dental health professionals has not previously been examined. Information from other health care specialties and reports from dental and dental hygiene students indicate that such advances do occur and that providers are rarely educated to deal effectively with them. Utilizing an anonymous survey of 300 Oregon dentists and 300 dental hygienists, this study sought to quantify the frequency of patient initiated sexual advances toward dental professionals and to survey practitioners as to their reactions to and methods of dealing with such advances. The information provided by the 483 (81 percent) respondents indicates that up to 44 percent of providers experience one or more patient verbal advances and up to 23 percent of providers experience one or more patient physical advances during a five year period. These advances are a significant source of concern for many dental professionals. Based upon this information, implications for the dental and dental hygiene curricula are considered.

Adult↗
PubMed1991

Mentors and role models for women in academic medicine.

Senior mentors and role models have a positive influence on the career advancement of junior professionals in law, business, and medicine. In medicine an increasing number of women are pursuing academic careers, but available senior mentors to provide career guidance are often lacking. We report on the results of a national survey of 558 full-time faculty women, aged 50 years and younger, in departments of medicine in the United States, regarding their experience with role models and mentors. Women with mentors report more publications and more time spent on research activity than those without mentors. Women with a role model reported higher overall career satisfaction. This report, with illustrative examples, may be helpful to other women pursuing academic careers and to physicians who serve as mentors or role models to others.

Data Collection↗
PubMed1991

Discussing life-sustaining treatment. A teaching program for residents.

Ideally, physicians and patients should discuss patient preferences for life-sustaining treatment before the onset of cognitive impairment or a life-threatening illness; however, these conversations often do not occur. We developed an educational program in which residents practiced discussing advance directives with volunteer simulated outpatients and then received feedback from the patient, an observing resident, and a faculty member. Residents found the training sessions to be realistic, relevant, and useful. Resident self-ratings improved significantly on eight items representing knowledge, skills, and attitudes about discussing advance directives with patients. Resident learning occurred in four major areas: technical knowledge about advance directives; introducing the topic to patients; giving patients information; and eliciting patients' values and feelings. We conclude that residents need and want training in this area and that simulated patients act as a catalyst for their learning.

Advance Directives↗
PubMed1990

Emergency physicians' responses to families following patient death.

Responses of emergency physicians when they interact with families after a death and their subsequent contact with survivors were examined. Questionnaires were sent to 138 Oregon emergency physicians and completed by 114 (83%). The number of deaths (mean +/- SD) encountered by emergency physicians was 17 +/- 15 per year. The majority of physicians (76%) usually notified the family in person and spent an average of 15 +/- 11 minutes with the family. Subsequent contact with survivors, such as sending sympathy cards, making follow-up calls, or reporting autopsy results, was relatively infrequent. While 94% of our sample group reported a need for training in this area, less than one half received any training during medical school or residency. We suggest implementation of educational programs for physicians and development of outreach programs for survivors.

Attitude to Death↗
PubMed1990

A bereavement program: good care, quality assurance, and risk management.

Oregon Health Sciences University Hospital implemented a proactive bereavement program based on a faculty research project demonstrating poor sensitivity to the families of deceased patients, their subsequent postdeath adjustment, and feelings about interactions at the hospital. The program has improved support to families at the time of death and established a follow-up system that refers families with adjustment difficulties to an appropriate provider. Educational programs have improved the skills and sensitivity of trainees and staff in responding to stressful patient-family situations concerning death and bereavement. Beyond providing optimal care, a bereavement program benefits quality assurance, risk management, and the community image of any hospital.

Attitude to Death↗
PubMed1989

Women in academic medicine. Combining career and family.

We conducted a national survey to explore how women in academic medicine balance career and family responsibilities. A questionnaire was mailed to all women 50 years of age and under who held full-time appointments in departments of medicine (n = 862), as listed in the faculty roster of the Association of American Medical Colleges. The survey included questions about childbearing and child rearing, attitudes about personal and professional issues, and role models. Of the 694 questionnaires that were delivered, over 80 percent were completed (n = 558). The mean age of the respondents was 38.1 years, and 63 percent had children. The 350 mothers had a mean of 1.9 children; only 3 had 4 or more children. Approximately half the respondents with children had their first child after completing medical training (mean age, 30.6 years), and they were absent from work for a median of 6 weeks post partum; 72 percent took no time off before labor and delivery, and 83 percent were back at work within 12 weeks. The majority were satisfied with their decision to have children and with their careers, despite the fact that 78 percent believed that their career progress had been slowed or markedly slowed by their having had children. We conclude that it is possible for women to combine motherhood with a fulfilling career in academic medicine, but it is difficult, and most such women believe that motherhood slows the progress of their careers.

Adult↗