RESUMEN
OBJECTIVE: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. DESIGN: A statewide, anonymous postal survey. SETTING: Connecticut, USA. PARTICIPANTS: 677 Connecticut members of the American College of Physicians. MEASUREMENTS: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. RESULTS: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p<0.001). CONCLUSIONS: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide.
Asunto(s)
Actitud del Personal de Salud , Hipnóticos y Sedantes/administración & dosificación , Cuerpo Médico de Hospitales/psicología , Cuidado Terminal/psicología , Analgesia/ética , Analgesia/métodos , Analgesia/psicología , Cristianismo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Intratable/tratamiento farmacológico , Suicidio Asistido/ética , Suicidio Asistido/psicología , Cuidado Terminal/ética , Cuidado Terminal/métodos , Enfermo TerminalRESUMEN
PURPOSE: We examined the cardiovascular health profiles of benefit-eligible hospital employees who participated in an incentive screen program for 4 years. We also determined if cardiovascular health changes differed between participants (CHAP) who enrolled in structured follow-up risk reduction programs (CHAPplus) compared with those who chose less formal options (CHAPonly). METHODS: CHAP consisted of cardiovascular screens, results counseling, and encouragement to participate in education and behavioral support programs. After adjusting for gender, medication use, and baseline levels of adiposity and physical activity, cardiovascular health changes were tested with repeated-measures analysis of covariance (ANCOVA) among CHAP participants and by CHAP type. RESULTS: CHAP 4-year members (n = 278) were generally healthy and mostly women (87%) with an average age of 40.6 +/- .5 years at baseline. Despite increases in overall (p = .034) and central adiposity (p = .001), cardiovascular health improvements were found for the total cholesterol/high-density lipoprotein ratio (TCHOL/HDL; p = .007), low-density lipoprotein (p = .009), and blood glucose (p = .018) among 4-year CHAP members. CHAPonly employees showed greater improvements in most cardiovascular health indicators than CHAPplus participants, although these differences did not achieve statistical significance. DISCUSSION: Cardiovascular health improvements were associated with long-term participation in a hospital worksite incentive screen program. The cardiovascular health benefits tended to be greatest for CHAP employees who chose informal follow-up risk reduction options (CHAPonly) than those who enrolled in structured programs (CHAPplus).
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Promoción de la Salud/organización & administración , Motivación , Salud Laboral , Adulto , Concienciación , Estudios de Cohortes , Connecticut , Planes para Motivación del Personal , Femenino , Promoción de la Salud/normas , Humanos , Estudios Longitudinales , Masculino , Evaluación de Resultado en la Atención de Salud , Personal de Hospital , Evaluación de Programas y Proyectos de SaludAsunto(s)
Adenoma de Células de los Islotes Pancreáticos/diagnóstico , Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Complicaciones Neoplásicas del Embarazo/diagnóstico , Adulto , Femenino , Humanos , Insulinoma/terapia , Neoplasias Pancreáticas/terapia , Embarazo , Complicaciones Neoplásicas del Embarazo/terapiaRESUMEN
The purpose of this study was to determine the utility of skin testing and erythrocyte sedimentation rate (ESR) as measures of immune function in a population undergoing stress. Eight women were tested one week prior to breast biopsy and six were retested at least four weeks later. All biopsies were negative for malignancy. Control subjects were also tested four weeks apart. ESR values were elevated with stress but the magnitude of this effect was small. There were no differences between groups in skin test responses. Skin testing and ESR may have limited usefulness in the study of immune function in populations under stress.
Asunto(s)
Biopsia/psicología , Sedimentación Sanguínea , Mama/patología , Pruebas Cutáneas , Estrés Psicológico/inmunología , Adulto , Ansiedad/psicología , Femenino , Humanos , Hidrocortisona/orina , Persona de Mediana Edad , Estrés Psicológico/sangreRESUMEN
In July, 1975, the Departments of Internal Medicine at the Yale University School of Medicine and eight community hospitals in southern and western Connecticut formed the Yale Affiliated Hospital Program (YAHP) in Internal Medicine. The YAHP provides a planned and focused program of continuing education for medical staff and housestaff at the affiliated hospitals. Six formats for the over 1,000 rounds, lectures, and conferences given annually are used. The members of the YAHP also cooperate in housestaff and faculty recruiting, evaluation of quality of care and evaluation of the process of continuing medical education itself. This report summarizes the organization, goals and future plans of the YAHP.