1.
Physicians' behavior regarding non-acceptance of oral restriction (nil per os) by dysphagic patient with risk of laryngotracheal aspiration.
Alvarenga, FL, Haddad, L, Silva, DMSD, Alvarenga, EHL
Einstein (Sao Paulo, Brazil). 2020;:eAO4952
Abstract
OBJECTIVE To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. METHODS Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. RESULTS One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. CONCLUSION Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.
2.
The new cholesterol guidelines. Applying them in clinical practice.
Pearlman, BL
Postgraduate medicine. 2002;(2):13-6, 19-22, 25-6 passim
Abstract
In 2001, the National Institutes of Health released the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Compared with previous cholesterol guidelines, the new guidelines contain several significant changes in treatment recommendations for patients with hyperlipidemia. In this article, Dr Pearlman reviews the latest guidelines and offers case examples that demonstrate how to incorporate the recommendations routinely into clinical practice.