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ABSTRACT Purpose: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. Methods: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. Results: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). Conclusions: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.

RESUMO Objetivo: Descrever o perfil epidemiológico das uveítes atendidas no Hospital Universitário Clementino Fraga Filho - UFRJ. Identificando o padrão de apresentação da inflamação intraocular a partir de critérios clínicos, anatômicos, etiológicos e demográficos. Métodos: Estudo retrospectivo, com base em prontuários de 408 pacientes com doença ativa, atendidos no serviço de oftalmologia no período de março a outubro de 2018. Foram descritos a idade, sexo, acuidade visual no momento do diagnóstico, diagnóstico anatômico e etiológico, aspecto clínico, além dos principais sintomas relatados durante a anamnese. Resultados: Dos 408 pacientes do estudo, 52% eram do sexo masculino e 48% do feminino. A idade média dos pacientes foi de 42 anos, a maioria (84%) entre 19 e 64 anos. Uveíte anterior foi observada em 37,75% dos pacientes, uveíte posterior em 49,75%, panuveíte em 4,66% e uveíte intermediária em 3,43%; apenas 18 pacientes (4,41%) apresentaram diagnóstico de esclerite. Dos 390 pacientes com classificação anatômica, a etiologia foi determinada em 76% deles, com os diagnósticos mais prevalentes sendo Toxoplasmose (35,4%), artrite idiopática juvenil (6,4%), espondilite anquilosante (5,9%) e sífilis (4,9%). ) A uveíte infecciosa correspondeu a 49,7% desses pacientes, enquanto 26,6% eram de origem não infecciosa. A uveíte anterior teve o maior número de casos classificados como idiopáticos (49,4%), enquanto a uveíte posterior teve a etiologia estabelecida em 94% das vezes. Os sintomas mais frequentes foram dor ocular (71,8%) e visão embaçada (56,8%). Conclusões: O presente estudo confirmou a importância histórica da uveíte infecciosa em nossa população, principalmente a toxoplasmose ocular. As uveítes parecem não ter predileção por sexo, mas afetam principalmente jovens em idade ativa, gerando consequências sociais e econômicas. Apesar da evolução nos métodos diagnósticos, a uveíte idiopática continua sendo uma das principais causas. Estudos epidemiológicos apontam para diferentes padrões de uveíte nas populações, estes podem refletir características particulares de cada instituição.

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Background: The Beirut Port Blast on August 4, 2020 is the largest (non-nuclear) explosion on record. St George Hospital University Medical Center (SGHUMC), a leading academic medical centre in Lebanon, adjacent to the Port, sustained a massive loss in lives and infrastructure. Objective: The current study uses the baseline data of an ongoing longitudinal study to explore the prevalence, severity, and predictors of probable Acute Stress Disorder (ASD) among health workers at SGHUMC following the blast. Methods: In the context of COVID-19 tests administered 9-15 days after the blast, SGHUMC staff were asked to complete a questionnaire that included socio-demographic details, the Beirut Port Exposure Inventory, and the Acute Stress Disorder Scale (ASDS). Results: A total of 570 health workers participated in the study. The prevalence of probable DSM-5 ASD [95%CI] was 38.34% [31.41; 45.32]. Many specific exposures were related, on a bivariate level, to ASD be it as a probable DSM-5 diagnosis or its severity as measured by the ASDS. A classification and regression tree (CART) analysis identified the highest risk predictors of probable DSM-5 ASD diagnosis to be: being a female, seeing dead or mutilated bodies, death of a close one, and being scared at the time of the explosion. Nurses carried the highest risks of all health workers with a probable DSM-5 ASD prevalence of 51.28%, (OR = 3.72 [95% CI: 2.22; 6.25]). Being scared at the time of the blast was the most single predictor of probable ASD. Conclusion: Both the prevalence and severity of probable DSM-5 ASD in this sample are higher than most reported in the literature, which may be explained by the severity of the trauma and the ongoing stress in the context of the pandemic. Fear at the time of the explosion was independently the most predictive parameter of probable ASD.

Antecedentes: La explosión del Puerto de Beirut el 4 de agosto de 2020 es la explosión (no nuclear) más grande registrada. El Centro Médico Universitario del Hospital St George (SGHUMC), un centro médico académico líder en el Líbano, adyacente al puerto, sufrió una pérdida masiva de vidas e infraestructura. Objetivo: El estudio actual utiliza los datos iniciales de un estudio longitudinal en curso para explorar la prevalencia, gravedad y predictores del probable Trastorno de Estrés Agudo (TEA) entre los trabajadores de la salud en SGHUMC después de la explosión. Métodos: En el contexto de las pruebas de COVID-19 administradas entre 9 y 15 días después de la explosión, se le pidió al personal de SGHUMC que completara un cuestionario que incluía detalles sociodemográficos, el Inventario de Exposición del Puerto de Beirut y la Escala de Trastorno de Estrés Agudo (ETEA). Resultados: Un total de 570 trabajadores de la salud participaron en el estudio. La prevalencia de probable TEA DSM-5 [IC 95%] fue del 38,34% [31,41; 45.32]. Muchas exposiciones específicas se relacionaron, en un nivel bivariado, con TEA, ya sea como un diagnóstico probable del DSM-5 o su gravedad medida por el ETEA. Un análisis del árbol de clasificación y regresión (CART, por sus siglas en inglés) identificó que los predictores de riesgo más alto del diagnóstico probable de TEA según el DSM-5 son: ser mujer, ver cuerpos muertos o mutilados, la muerte de alguien cercano y tener miedo en el momento de la explosión. Las enfermeras tenían los riesgos más altos de todos los trabajadores de la salud con una prevalencia probable de TEA según el DSM-5 del 51,28%, (OR = 3,72 [IC del 95%: 2,22; 6.25]). Sentirse aterrorizados en el momento de la explosión fue el predictor más determinante de probable TEA. Conclusión: Tanto la prevalencia como la gravedad del probable TEA DSM-5 en esta muestra son más altas que la mayoría de las reportadas en la literatura, lo que puede explicarse por la gravedad del trauma y el estrés continuo en el contexto de la pandemia. El miedo en el momento de la explosión fue independientemente el parámetro más predictivo de probable TEA.

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BACKGROUND: Modified measles is rarely reported and thought to be an attenuated, less transmissible form of measles. The occupational safety and management of previously immunized healthcare providers (HCP) facing the global reemergence of measles is controversial and unclear.Aim: We report a measles outbreak with an unusual presentation among our vaccinated HCP at Saint George Hospital University Medical Center (SGHUMC) in Lebanon that occurred during a nationwide measles epidemic. METHODS: We recorded cases at SGHUMC, a 333-bed tertiary-care center, from April 2018 to June 2018. We established a measles clinic for investigating all febrile patients. HCP exposure was linked to influx of index cases through our Emergency Department. Modified measles was defined as any variation in the classic presentation with a pinpoint/vesicular rash, documented exposure and evidence of prior immunity. We performed serology testing to diagnose and/or document immunity and implemented outbreak controls measures including PPE, airborne isolation, and mass notification. FINDINGS: We diagnosed 8 inpatients with classic measles, and 9 affected HCP. We diagnosed 8 HCP with modified measles. One previously immunized HCP developed classic measles despite being immunized and having a positive IgG titer. Our contact tracing revealed a total of 96 exposed HCP with 27 HCP showing non-specific signs of viral illness. We required all the 9 affected HCP to undergo home isolation. CONCLUSION: We believe it is a top priority to achieve adequate measles immunity, especially among HCP that are at the frontline of healthcare systems. This necessitates revisiting vaccination schedules and achieving seroprotective titers to reclaim proper herd immunity.

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Resumo Objetivo Analisar o exercício da liderança transformacional na prática dos enfermeiros em um hospital universitário. Métodos Estudo de métodos mistos explanatório sequencial. Na etapa quantitativa, com amostra não probabilística por conveniência, aplicou-se um questionário de atitudes frente a estilos de liderança adaptado para a frequência de adoção dos comportamentos de liderança transformacional a 152 enfermeiros do referido hospital. Estes dados passaram por testes estatísticos descritivos e analíticos. Na etapa qualitativa, 25 participantes da primeira etapa foram sorteados e responderam a uma entrevista semiestruturada, analisadas mediante análise temática de conteúdo. Resultados Identificou-se a prática da liderança transformacional de forma frequente entre os enfermeiros. Entretanto, eles apresentam dificuldades para exercer esse modelo de liderança, devido a carência de apoio da instituição que, majoritariamente adota uma liderança verticalizada, pela falta de capacitação para os enfermeiros assistenciais, e fragilidades na comunicação e discussão dos problemas antes das tomadas de decisões. Conclusão A prática da liderança transformacional encontra resistências pelo maior exercícios da liderança verticalizada pelos gestores, entretanto os enfermeiros acreditam que uma liderança com comportamento horizontalizado pode favorecer mudanças estruturais e comportamentais da instituição.

Resumen Objetivo Analizar el ejercicio del liderazgo transformacional en la práctica de enfermería de un hospital universitario. Métodos Estudio de mixtos métodos explicativos secuenciales. En la etapa cuantitativa, con muestra no probabilística por conveniencia, se aplicó cuestionario de actitudes frente a estilos de liderazgo adaptados a la frecuencia de adopción de conductas de liderazgo transformacional en 152 enfermeras del hospital. Datos sometidos a pruebas estadísticas descriptivas y analíticas. En la etapa cualitativa, 25 participantes de la primera etapa fueron sorteados, y respondieron a entrevista semiestructurada, revisada por análisis de contenido temático. Resultados La práctica del liderazgo transformacional fue identificada frecuentemente entre los enfermeros. Sin embargo, presentan dificultades para ejercer este modelo de liderazgo debido a falta de apoyo institucional, que mayoritariamente adopta un liderazgo vertical, por falta de capacitación de los enfermeros de atención y debilidades comunicacionales y de discusión de problemas antes de tomar decisiones. Conclusión La práctica del liderazgo transformacional encuentra resistencia por el mayor ejercicio de liderazgo vertical de los gestores, sin embargo, los enfermeros creen que un liderazgo de tipo horizontal podría favorecer cambios estructurales y conductuales en la institución.

Abstract Objective To analyze the exercise of transformational leadership in nurses' practice in a university hospital. Methods Mixed-method explanatory sequential study. In the quantitative phase, a questionnaire of attitudes towards leadership styles adapted to the frequency of adoption of transformational leadership behaviors was applied to a non-probabilistic convenience sample of 152 nurses from the university hospital. Descriptive and analytical statistical tests were used for data treatment. In the qualitative phase, 25 participants from the first phase were randomly selected (draw) and responded to a semi-structured interview that was analyzed by thematic content analysis. Results The practice of transformational leadership was identified frequently among nurses. However, they had difficulties to exercise this leadership model, because of lack of institutional support, since vertical leadership is the most adopted style, as well as lack of training for care nurses, and weaknesses in communication and discussion of problems before decision making. Conclusion The managers' greater exercise of vertical leadership offers resistance to the transformational leadership practice. However, nurses believe that leadership with horizontal behavior can favor structural and behavioral institutional changes.

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INTRODUCTION: One of the most common and potential life threatening complications of pregnancy is pregnancy induced hypertension. This cross-sectional study aimed to investigate the relationship between platelet count and pregnancy induced hypertension. MATERIAL AND METHODS: Twenty (20) patients (subjects) and twenty (20) healthy pregnant women (control) visiting the Obstetrics and Gynecology Hospital University of "Koço Gliozheni" Tirana Albania were registered in the study and followed during their pregnancy. Both, subjects and control participants were subject to platelet count manually performed using standard methods on. RESULTS: The mean platelet count of the control group (38448±235500) was significantly higher than that of the subject group (217050±50780.7) (p<0.03). In the first and second trimester was more prevalent low platelet counting with the mean platelet count (107 ±57.3) and (101 ±63.4), respectively. The mean age at marriage in subjects with PIH was found to be with low platelet count. Regular monitoring of platelet counts in women with Pregnancy Induced Hypertension must be subject of the management protocols.

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ABSTRACT This study was conducted to determine the antimicrobial susceptibility patterns among common pathogens in the intensive care units (ICUs) of a university hospital in northwestern Iran. A retrospective study was done on laboratory records of patients with nosocomial infection who were admitted to five ICUs of Imam Reza Hospital during a 21-month period from March 2010 to January, 2012. A total number of 556 isolates from 328 patients were evaluated. The most common sites of infections included respiratory (51.7%), urinary (24.8%), and blood (10.4%). The most frequently isolated microorganisms were Enterobacter aerogenes (50.6%) followed by Escherichia coli (16.7%) and Pseudomonas aeruginosa (7.5%). Staphylococcus aureus was the most frequent pathogen among gram-positives (39.7%). The rate of methicillin-resistant Staphylococcus aureus (MRSA) was 87.5%. Multidrug-resistant (MDR) gram-negative bacteria were documented in 25.8% of Acinetobacter, 20% of Klebsiella, and 16.6% of Pseudomonas. The most active antimicrobials were vancomycin (93.5%) followed by amikacin (71.5%) and gentamicin (46%). The overall antibiotic susceptibility was as follows: 36% ciprofloxacin, 19% imipenem, 20% trimethoprim-sulfamethoxazole, 20.5% ceftazidime, and 12% ceftriaxone. Due to the high rate of antimicrobial resistance in the ICU setting, more surveillance and control of the use of antimicrobials is needed to combat infections.

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Objective To evaluate the application effect of supervision system of hospital-university collaboration on class teaching of nursing undergraduates,so as to provide reference to promote the link-up between nursing theory and clinical practices.Methods The supervision group of hospital-university collaboration were formed by selecting 30 excellent clinical instructors from university-affiliated hospitals and 12 nursing teachers,they listened to the teachers in classes randomly and recorded,simultaneously filled in rating forms about the class with students.Supervision meetings were held and targeted strategies were put down regularly,their effects were evaluated through interview and investigation methods.Results Professional teachers accepted their suggestions and took some actions to make a change.The results of rating forms showed that the quality of classroom teaching were improved gradually.Conclusions The supervision system of hospital-university collaboration can enhance the sense of responsibility of teaching,contribute to the integration between the hospital and university.It should be continued as a long-run system.

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Introdução A educação médica sofreu transformações ao longo do século XX. Alguns educadores médicos já reconheceram o problema do modelo centrado na doença e focado em condições não usuais de pacientes hospitalizados e a carência do ensino sobre problemas comuns de saúde. O termo ecologia do cuidado médico é como se conhece a relação entre as pessoas e os cenários de saúde. Esse conceito foi introduzido em 1961 por K. White (e atualizado por Green em 2001), que mostrou graficamente a proporção de pessoas que utilizaram serviços de saúde no período de um mês. Esses resultados influenciaram organizações do sistema de saúde, pesquisa científica e educação médica ao longo dos anos. Objetivos Reavaliar a ecologia médica, agora na população brasileira, identificando, no período de um mês, o número de pessoas que apresentaram sintomas, qual atitude tomaram em relação a eles e comparar as queixas apresentadas com o conteúdo dos livros tradicionais de clínica médica. Métodos Entrevistas telefônicas realizadas por auxiliares de enfermagem a 1.065 participantes consecutivos de uma empresa de convênio médico no período de maio de 2008 a fevereiro de 2009 em São Paulo. Resultados Dos entrevistados, 70% eram mulheres e a idade média foi de 68 anos. No período de 30 dias, em 1.000 pessoas: 398 apresentaram algum sintoma; a maioria (292) procurou consulta ambulatorial; 99 buscaram resolver a queixa no pronto-socorro; 59 foram internadas e 1 foi internada em um hospital universitário. Os sintomas mais encontrados foram: dor em extremidades (10%), mal-estar (10%), lombalgia (8%), cefaleia (6%) e dor articular (6%). Foram 5 livros selecionados; Harrinson, Cecil, Current e Tratado de Clínica Médica AC Lopes e Clinica Médica Milton Arruda e colaboradores, um dos sintomas mais frequentes, como lombalgia, é abordado em 4 a 13 páginas, dor em membros em 0 a 4 páginas e fadiga/mal-estar são discutidos em 2 a 4 páginas dentre todo o conteúdo desses livros. Os sintomas...

Background Medical education has gone through several transitions during the twentieth century, and medical educators recognize the problems inherent to hospital-centered learning: treating rare conditions and involving medical subspecialties very frequently resulting in lack of continuity care. Today, we talk about fragmentation of medical education for both students and patients. This goes far from meeting the real needs of the general population. The expression medical ecology is a conceptual framework to describe the relationship and utilization of medical care by a given population. Introduced by White in 1961 (updated by Green in 2001), the results of these studies have had great impact and influenced ideas regarding organization of health services, research and education. Objectives To analyze the ecology of medical care in a Brazilian population. First, we have aimed to quantify the number of people who demonstrated symptoms in a previous month and considered seeking health care in any one of the following settings: patient does not seek medical care; a physicians office; office of complementary/alternative medicine professional; emergency department; patients home; hospital and university hospital. We have also compared the prevalence of reported symptoms with number of pages of traditional textbooks that discussed these symptoms. Design and Participants The survey was based on telephone interviews in a health insurance company of São Paulo from may/2008 to feb/2009 Results Patients responding (1.065) included 70% women with a mean age of 68 years old; 398 people felt some symptoms in a month; 292 people were in a consultation; 99 have visited an emergency room; 59 were hospitalized and 1 per thousand was admitted in a university hospital. The most prevalent symptoms were: pain in extremities (10%), fatigue (10%), back pain (8%), headache (6%), and joint pain (6%). They are not discussed enough in medical graduation. 5 books were analyzed: Harrinson...

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The publication of the scientific theses and their management are significant for the development of technology and science in the hospital.Therefore.they play an important role iU the hospital management.The retrospective analysis on the theses that published in the last 5 years and embodied by SCI was conducted using the statistics method and analyzed the first 10 departments in the published theses in this paper.The specialty of our hospital and the shortcoming in the scientific research was concluded from the analysis result.The amount of the theses increased steadily,and the research capability of the key subjects and key departments were promoted.The amount and the quality of the theses reflected an important indicator of the development strategy that means to develop the hospital through science.technology and education.Therefore,these conclusions could offer some valuable information to the manage department of t}le hospital.

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In this article some ideas on the discipline construction and development in the school of medicine of Shahghai Jiao Tong University were put forward based on the results analysis of state key discipline application in 2007 and comparison between approval and failure disciplines from team,research,graduates education and lab construction.It will be meaningful for the sustainable development of the school of medicine of Shahghai Jiao Tong University in future.

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The talent cultivation and echelon construction are the embodiment of core competition and the source of sustainable development in the hospitaI.In order to expedite the talent cuhivation based on the talent database an individuation mode of talent cuhivation was established in Peking University People's Hospital.Following this mode the individuation cultivation of talents and echelon construction were achieved,consequently,the scientific research team would be expected to form and develop.

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BACKGROUND: Outpatient procedures account for more than half the operations performed in the United States, but the status of outpatient anesthesia in Korea has not been documented yet. The present study was designed to evaluate the current status of outpatient anesthesia in university hospitals in Korea. METHODS: Thirty-nine university hospitals were surveyed by questionnaire in February 1997. Objects were patients underwent outpatient operations under general, intravenous or regional anesthesia except local anesthesia by surgeon from January 1996 to December 1996. RESULTS: One university hospital started outpatient anesthesia in 1980 and now ten of 39 universities (25.6 %) provide the procedures. In 1995 one of 10 university hospitals has opened day- surgery center having 7 operating rooms and the capability of 24 hours overnight stays. The other 9 hospitals use one of in-patient operating rooms for outpatient procedures. The utility rate per year was 3.06 +/- 1.59 % and 11.49 % in 9 university hospitals and day-surgery center respectively during 1996. Outpatients were mainly classified as physical status 1 and 2 by American Society of Anesthesiologists, and 54.0 38.3 % to 70 % of patients were distributed under 15 years of age. Surgical procedures were relatively simple and 10 surgical departments were participated into the field of outpatient anesthesia. Inhalation techniques and intravenous anesthesia were used predominantly. Complications were sore throat, nausea and vomiting, delayed recovery of consciousness, bleeding at the operative site, fever and so on. CONCLUSIONS: I think that outpatient anesthesia in Korea has grown at very slow rate over the last 4 decades and that it is very low utility rate per year compared to United States. So we have to try to get more interests and supports about the outpatient anesthesia setting.

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Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed.

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OBJECTIVES: a) To quantify the use of do-not-resuscitate orders in a tertiary care children's hospital; and b) to characterize the circumstances in which such orders are written. DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: All inpatients who died in an urban children's hospital over a 1-yr period of time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The hospital records of 54 of 69 patients who died were reviewed. Eighty-two percent of patient deaths occurred in the ICU; 13% of patient deaths occurred in the operating room, and 5% occurred in a medical ward. Other findings included the following: 25 (46%) of 54 patients died after attempted cardiopulmonary resuscitation; 13 (24%) patients were brain dead; and 16 (30%) died with a do-not-resuscitate order in effect. Age was associated with resuscitation status: do-not-resuscitate orders were written for five (21%) of 22 infants (< 1 yr of age); seven (50%) of 14 children (1 to 11 yrs of age); and four (80%) of five adolescents who died (p < .002). Fifteen of 16 do-not-resuscitate orders were written for patients who were in the ICU, where they remained until death. Findings in patients when the do-not-resuscitate orders were written were as follows: 15 ICU patients were receiving mechanical ventilation; 14 (95%) of 15 were receiving inotropic agents; 12 (80%) of 15 patients were receiving narcotic analgesics; and one (6%) patient was being dialyzed. At least one therapeutic modality was withdrawn in 7 (44%) of 16 patients. Do-not-resuscitate orders followed documented conferences with physicians and family members in 13 (81%) of 16 cases. These discussions were initiated by physicians in 12 (92%) of 13 cases. CONCLUSIONS: Do-not-resuscitate orders in pediatric patients are written more often in older than younger hospitalized children who die. Most do-not-resuscitate orders are written for patients who are receiving aggressive medical therapy in the ICU.

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Decisions to withdraw life-sustaining therapy are being made more often as patients and healthcare providers increase their awareness of patient rights. The process of withdrawal of mechanical ventilation must be conducted in a humane fashion. An understanding of the ethical, legal and practical considerations for patient management during this type of intervention will enhance the ability of the healthcare provider to participate.

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We developed a supportive care service for a university hospital medical service that serves a socially and medically disadvantaged urban population. The team includes a faculty physician and a clinical nurse specialist who provide primary medical care, family support, and in-service guidance to hospital staff about ethical issues. A multidisciplinary approach incorporates nursing, pastoral care, social work, and other hospital services. We report our experience from November 1985 through May 1987, during which time 222 patients were referred to the team; 212 patients were accepted. The goals and operation of the service are described. The most common (n = 62, 29%) diagnosis on referral was global central nervous system anoxia following cardiopulmonary arrest. Other severe neurological conditions accounted for an additional 79 patients (37%). Comparison of patients on the service with a similar group revealed no difference in survival rate, although hospital length of stay and charges were progressively reduced after implementation of the service. This approach to the care of hopelessly ill patients may serve as an alternative method of treatment in similar hospital settings.

KIE: The authors document the first 19 months of a service dedicated to the care of hopelessly ill patients in a teaching hospital. A comprehensive supportive care team (CSCT) was established to ensure a humane, uniform, and consistent approach to the care of patients for whom aggressive care is no longer warranted. The goals and operation of the CSCT are described, including the components of patient evaluation and development of treatment plans. Results of a study of 212 patients accepted by the CSCT are reported. The authors conclude that the service successfully provided conservative but comprehensive care for the hopelessly ill, and that it increased awareness of ethical issues among hospital personnel, patients, and families.

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