Wednesday, May 16, 2007
| Topic: |
To Tube or Not to Tube? |
| Presenter: |
Carole R. Roth, Ph.D., CCC, BC-NCD
Director of Speech Pathology, Naval Medical Center, San Diego
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| Location: |
Medical Teaching Facility (MTF) 175 |
Presentation
Abstract: |
If your elderly loved one was admitted to the hospital with aspiration pneumonia under what circumstances would you choose to have a feeding tube placed? How would you assess their wish regarding placement of the feeding tube? If you did not believe they had the cognitive ability to make the decision about the feeding tube, how would you decide? Would it make a difference if your loved one had advanced dementia?
If you are/were a physician caring for an elderly person admitted to the hospital with aspiration pneumonia, under what circumstances would you recommend placement of a feeding tube? How would you assess the patient's or family's wishes regarding placement of the feeding tube? Would it make a difference if the patient had advanced dementia?
This presentation will address the issues surrounding the common use of feeding tubes in medical practice. Although the presentation will focus on the evidence for use of feeding tubes in advanced dementia, use of feeding tubes with other etiologies will be reviewed.
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Discussion
Questions: |
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Is the use of feeding tubes effective in medical management of patients with dementia?
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Do feeding tubes benefit patients?
a. Do feeding tubes prevent aspiration pneumonia?
b. Can tube feeding improve functional status?
c. Is survival improved by tube feeding?
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What is the quality of informed consent for placement of feeding tubes?
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Should there be more stringent guidelines for placement of feeding tubes?
- Does medical training adequately address the evidence and ethics related to use of feeding tubes?
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Discussion
Summary: |
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| Readings: |
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Finucane, TE & Bynum, JP: Use of tube feeding to prevent aspiration pneumonia. The Lancet: Nov 3, 1996; 348; 1421-1424.
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Finucane, TE, Christmas, C, Travis, K.: Tube feeding in patients with advanced dementia: a review of the evidence. JAMA, 1999, 282 (14), 1365-1370.
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Gillick, MR: Rethinking the role of tube feeding in patients with advanced dementia. New England J Med, 2000, 342(3), 206-210.
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Angus, F & Burakoff, R. The Percutaneous Endoscopic Gastrostomy Tube: Medical and ethical issues in placement. Am J of Gastroenterology, 2003, 98(2), 272-277.
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Brett, AS & Rosenberg, J.: The adequacy of informed consent for placement of gastrostomy tubes. Archives Internal Medicine, 2001, 161(5), 745-748.
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