Form Of Medical Treatment Research Articles

The 18th Annual International Veterinary Acupuncture Society (IVAS)

Hurricane Iniki had her way with the island of Kauai and the leeward side of Oahu, but the great god Peld and the demigod Maui were benevolent and receptive to a last minute change of venue. From Friday, when the devastating storm struck and caused major damage to the Coco Palms Resort onKauai, until the following Wednesday an intrepid group oforganizers moved the site ofthe WAS congress to the Stoeffer Hotel on Wailea Beach on Maui for a very successful meeting. The IVAS does not reject other allied health systems and the program presented several opinions of animal health care including vetefimiy chiropractic, herbology, nutrition and the combination of these modalities on several species of animals. Dr. Allen Schoen, a well-known veterinary practitioner and lecturer from Sherman, CT delivered several lectures during the congress and initiated the program with a discussion regarding the philosophy of acupuncture and the physiology. He described the principles of this type of health care, reminding the new members of the group that it is still a major form of medical treatment for nearly one quarter of the world's population, originating in the Orient over 4000 years ago. Only recently has Western medicine recognized this treatment as a

The risk of transfusion-associated AIDS: offering patients an active role in their care.

This article explores the duty of health care providers to inform patients of the risk of contracting AIDS through blood transfusions that may be necessitated by surgery or other forms of medical treatment. Although the quantitative risk of receiving HIV-contaminated blood in a transfusion is small, the qualitative risk is of a magnitude requiring complete disclosure if a patient's consent to treatment is to be considered adequately informed. Recent litigation confirms the importance of providing patients with the information needed to adequately assess the risks and benefits of proposed treatments that might involve a transfusion and reveals the need to offer the opportunity, where permissible, for autologous and directed donations. A comprehensive program embodying these concerns improves the quality of patient care and reduces exposure to liability for transfusions with contaminated blood.

Neurologic Syndromes and Prolonged Survival: When Can Artificial Nutrition and Hydration Be Forgone?

A recurring lesson in the debate about forgoing life-sustaining treatment for patients with neurologic syndromes is the need to understand the medical realities in such cases. Those of us in the neurological sciences spend a great deal of time working with these cases on a daily basis—trying to define the medical facts and educate ourselves, the public, and the courts. This article will discuss the medical and neurological facts regarding patients with severe and permanent neurological impairment, focusing only on one form of medical treatment: artificially administered nutrition and hydration. The concern of this paper is not the patient's wishes, the family's wishes, or the decision-making role of other key players, but the medical conditions in which it is ethically appropriate to withdraw or withhold artificial fluids and nutrition.

Cruzan: Facing the Inevitable

When the United States Supreme Court upheld the decision of the Missouri Supreme Court that it was not in the best interests of Nancy Cruzan to die of dehydration and malnutrition by withholding from her food and fluids provided by tube the result was deplored by many legal and popular commentators.The criticism suggested a wide range of values and reasoning that were reflected in the various briefs filed in the U.S. Supreme Court in support of reversing the Missouri court decision. The objections might be placed in three categories: the medical, the legal, and the ethical.The medical rationale for reversal of the Missouri Supreme Court categorized provision of food and fluids by tube as a “medical treatment” and, hence, subject to practices that pertain to forgoing other, more obvious forms of medical treatment, such as use of respirators or chemotherapy.

The Role of State Legislatures after Cruzan: What Can—and Should—State Legislatures Do?

In Cruzan, the Supreme Court held that the refusal of treatment is a constitutionally protected right and that the methods for permitting its exercise should be crafted by the laboratory of the states. In June 1990, when the court ruled, there already existed a large and complex body of law concerned with the refusal of treatment which differed, sometimes considerably, from state to state. Generally, withholding or withdrawing life-sustaining treatment has been accepted by the states, but different systems of justification have been used.Competent people are able to make decisions to refuse any form of medical treatment, regardless of their medical condition; competent people can also prepare written instructions describing the medical treatment they would want to receive in the future if incompetent, which have been endorsed by both state courts and legislatures.

Bioethicists' Statement on the U.S. Supreme Court'sCruzanDecision

On June 25, 1990, the U.S. Supreme Court issued its long-awaited decision in the case of Nancy Cruzan, the first to die case to come before it. The purpose of this statement is to clarify the meaning of that case in order to prevent misinterpretation that might lead to serious adverse consequences for hopelessly ill patients, their families, and health care professionals. First, the Supreme Court affirmed the right of competent patients to refuse life-sustaining treatment. Second, the Court did not treat the forgoing of artificial nutrition and hydration differently from the forgoing of other forms of medical treatment. . . .

Alpha-Adrenergic Blockers for the Treatment of Benign Prostatic Hyperplasia

There seems little doubt that alpha-adrenergic blockers can afford a measure of relief to many sufferers from BPH. The exact role this treatment has to play in the overall management of these patients has yet to be clearly defined. A continuing search is being made for more effective drugs, with the hope of finding one that will be more specific in its action on the prostate and produce fewer generalized effects. Whether this will prove possible may depend on whether any further subgroup of alpha receptors more specific to the prostate can be found or whether some method of targeting the drugs to the required region can be devised. If a drug treatment that reduces the size of the prostate can be found, perhaps a combination of the two forms of medical treatment will have a place. At present, it seems reasonable to conclude that there is good justification for using the alpha-blocking drugs available when employed in the manner and for the indications outlined herein.

The Case of Ms. Nancy Cruzan and the Care of the Elderly

The case of Ms. Nancy Cruzan is the first so-called "right to die" case to be heard by the US Supreme Court. The Missouri Supreme Court had ruled that Ms. Cruzan's parents, who are also her court-appointed guardians, cannot authorize the withdrawal of artificial hydration and nutrition from their daughter. Ms. Cruzan has been in a persistent vegetative state since an auto accident more than six years ago. Even though Ms. Cruzan is only 32 years old, the decision in her case will have serious implications for care of the elderly. Key features of the Missouri Supreme Court decision include their claims that (1) the authority for surrogate decision-making flows from the parens patriae power of the State rather than from the authority of the incompetent person, (2) the State has an unqualified interest in the preservation of life, and (3) the medical provision of nutrition and hydration ought to be considered differently than other forms of medical treatment. Such claims are at considerable variance from accepted standards of ethically defensible decision-making that focus on the well-being of the patient understood according to the patient's own values and life goals. If the US Supreme Court restricts decisions to forgo life-sustaining treatment according to patient prognosis, capacity for decision-making, type of treatment, or state of residence, then a patient-centered standard of medical decision-making will be impossible to sustain and the maximization of life extension will be required without regard to the suffering thereby imposed.

Pseudoepitheliomatous Hyperplasia and Pyoderma Gangrenosum After a Brown Recluse Spider Bite

Brown recluse spider bites may result in extensive soft tissue injury, causing months of disability. We have described a patient who had a series of extensive surgical debridements after envenomation. Despite skin grafting, persistent cutaneous lesions and extensive satellitosis progressed to involve the entire lower extremity. A recent biopsy showed pseudoepitheliomatous hyperplasia and pyoderma gangrenosum complicating the original injury. Although the role of early surgical excision and newer forms of medical treatment including dapsone and antivenom are still in evolution, recent reports suggest that the majority of patients will respond to medical therapy and may not require any surgical intervention.

Les soins prodigués aux enfants : influence des innovations médicales et des institutions médicalisées (1750-1914). Médecine et déclin de la mortalité infantile

How far can medical progress and new forms of medical intervention be held responsible for the noticeable decline of infant mortality which begins as early as 1750 in some countries like France and becomes more marked after 1890 ? In the first period ( end of the XVIIIth - beginning of the XIXth century), few lives are saved but in many countries (such as France, England and Germany), doctors and statemen become conscious of the need for emergency measures to save more babies ; a medical way of raising children begins to be used by the families from the elites ; but therapeutics are still inefficient for infant illnesses. During the major part of the XIXth century, progresses are slow (as for example in the treatment of diphteria), but hygienism tries to fill the gap ; widespread vaccination against smallpox enables medical men to enter into most families. Only at the end of the century, with the massive and often authoritarian diffusion of the pastorian techniques of hygiene and of the first vaccines and serums, can scientific medecine really influence the decline of infant mortality. Comparisons between France, England, Germany and United-States show that everywhere doctors have urged to create dispensaries where mothers could be taught the precepts of the new medicine. Nevertheless, traditional behaviours have survived long in the XXth century. But the decisive decline of infant mortality is already obvious before 1914.

Quality of life: a critical review of current concepts, measures and their clinical implications

Quality of life (Q/L) measurements are used to justify or refute different forms of medical treatment; to identify the sequelae of disease or treatment which are resolved by other interventions including nursing and to provide a basis for allocating resources to those treatments judged to be most cost-effective. This paper reviews some of the difficulties in defining and measuring Q/L and the ethical issues raised in relation to their use in allocation of treatment resources. It is suggested that Q/L tests should include a range of dimensions known to contribute to Q/L and that they are applied at different times during the progression of illness and incorporate information obtained from patients. It is essential that weightings by individuals of dimensions investigated in the test are included. Further research is necessary to determine the effects of coping strategies and personality variables on Q/L.

Two possible cases of trephination from Australia.

Cranial surgery has been performed for thousands of years among a wide range of cultures. Although the extent of its use has varied, ethnographically the operation has almost always been used as a form of medical treatment following cranial trauma or as a remedy for head pain. This paper describes two cases of cranial trauma on Australian Aboriginal remains from widely separated areas of the continent. The position and morphology of the trauma, as well as other associated features, suggest that these individuals underwent some form of surgical procedure. The features are similar to those found on accepted cases of trephination from elsewhere. If these individuals did undergo some sort of trephination, they are the first to be reported from Australia. Confirmation of the diagnosis would also increase our understanding of the geographical range of the technique in this part of Oceania, which was known previously only from parts of Melanesia.

Diagnosis and treatment of keratoconjunctivitis sicca in the dog.

Keratoconjunctivitis sicca (KCS) is a relatively common eye disease in the dog. The diagnosis is discussed, particularly of the early or mild case. The various types of medical treatment are described, including replacement therapy with artificial tears and ocular inserts, as well as other preparations; lacrimogenics; and other forms of medical treatment, including antibiotics, corticosteroids, mucolytics and hormones. Contraindicated drugs and agents are listed. Surgical treatments, including punctal occlusion, tarsorrhaphy, conjunctival flaps, contact lenses, superficial keratectomy, as well as parotid duct transposition, are discussed and the procedure indicated which is best suited to the case. The choice of treatment according to the severity of the KCS is also given.

Psychotherapy Research: Reflections on My Career and the State of the Art

This is a biographical sketch describing the author's origins and early years as a psychotherapy researcher. The second part of the article is devoted to a discussion of the author's “lived beliefs” that have guided his research over the past 30 years: The practice of psychotherapy should involve creativity and intuition; research is meaningful if it influences practice; psychotherapy involves cognitive and emotional learning—it is not a form of medical treatment; transference was among Freud's most important discoveries; psychotherapy has a great deal to offer under appropriate circumstances; and there are many techniques by which therapeutic results can be achieved.

Fibrodysplasia ossificans progressiva. The clinical features and natural history of 34 patients.

Thirty-four patients wtih fibrodysplasia (syn., myositis) ossificans progressiva are described. Marked delay in diagnosis was usual, but all had characteristic skeletal malformations and ectopic ossification. The clinical features included: four types of malformation of the big toe, reduction defects of all digits, deafness, baldness of the scalp, and mental retardation. Progression of disability was erratic in all, but severe restriction of movement of the shoulder and spine was usual by the age of 10 years; the hips were usually involved by the age of 20 years; and most patients were confined to a chair by the age of 30 years. Exacerbating factors included trauma to the muscles, biopsy of the lumps, operations to excise ectopic bone, intramuscular injections, careless venepuncture and dental therapy. Progression of disability did not appear to be influenced by any form of medical treatment and therefore management of the patients must concentrate on the avoidance of exacerbating factors.

Tympanostomy tubes: the conservative approach.

The clear advantage accruing from the use of tympanostomy tubes in the treatment of otitis media with effusion is immediate improvement in hearing; there are also disadvantages entailed, such as scarring of the drum risk of continuing otorrhea and interference with the patient's normal physical activities. All possible forms of medical treatment should be exhausted (antihistamine decongestants, politzerization) before resorting to tympanostomy tubes. There is a small group of children with severe chronic nasal obstruction and otitis media with effusion for whom adenoidectomy is likely to be required.

Components of illness and type of medical practitioner: A comparative study

The way people choose and use different forms of medical treatment in settings in which there exists competing systems of medicine has long attracted the interests of social scientists, physicians and social planners. Studies of this problem area have mainly been impressionistic, ethnographic and/or anecdotal. Lack of a common set of definitions and methods of procedure has hampered empirical study of factors prompting differential use of facilities. We first review this literature and then describe our attempt to systematically compare the way ethnic groups use physicians and lay curanderos in the Chiapas Highlands. A set of concepts and a method of procedure which proved effective is reviewed. A longitudinal design was employed and women of Ladino and Indian background periodically interviewed in depth regarding illnesses experienced during the preceding two weeks. In this report, we concentrate on the role of type of symptoms in the choice of medical practitioner.

Sounding board. The crisis in methadone maintenance.

IN the United States, during most of this century, maintaining a patient on an addictive drug as a form of medical treatment has created painful moral problems for professionals and public alike. T...

The costs of arthritis and the benefits of joint replacement surgery.

This paper examines first the economic costs and benefits of total hip replacement in Britain and, secondly, the general social and economic factors which may help to determine the future development of both new and established forms of joint replacement surgery. It estimates that there is a monetary benefit to cost ratio of at least ten to one associated with total hip replacement among people aged under 60 and one of at least two to one amongst individuals in the 60-70 age group. Overall, the N. H. S. s expenditure of up to £15 million (maximum) on hip replacement surgery in 1974 will probably generate a total economic return to the community of at least £60 million in 1974 terms. It is noted that joint replacement techniques can alleviate pain and handicap against which other forms of medical intervention are often of very limited value. However, significant risks are involved. The in-hospital mortality rate associated with total hip replacement is put at between 1 and 2% and the national average risk of failure, in terms of the operative outcome not being good or excellent, is estimated at marginally above 10%. For other joint replacement techniques such rates may be higher and the benefits conferred less desirable. It is suggested that the facilities available in this area of orthopaedic surgery are already carrying a maximum work load and that the N. H. S. may not be able to meet future increases in demand, given the very limited resources likely to be available for capital investment in the health services during the remainder of this decade. A lack of adequate knowledge of the social and economic impact of joint replacement techniques could exacerbate possible under-financing of or sub-optimal use of resources in this sector of medical care. It is pointed out there is a possibility that investment in more new specialist centres for orthopaedic surgery could help to reduce or keep to a minimum the hazards inevitably associated with joint replacement.

Diagnosis before treatment.

The essence of a medical approach in psychiatry is the application of a structured diagnostic assessment. Treatment without diagnosis is a form of quackery. Psychiatric therapy, like any form of medical treatment, must be tailored to fit the individual patient.