Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of
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The document discusses current concepts of death, including brain death and circulatory death. It addresses the criteria for diagnosing brain death, definitions of death and consciousness, and challenges in determining death. Specifically, it examines the criteria for assessing absence of brain function, debates around organ donation practices, and ensuring death diagnosis standards are grounded in biological understanding rather than transplantation needs.
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End of Life Care An Ethic.docx
End of Life Care:
An Ethical Overview
Center for Bioethics
University of Minnesota
2005
2
Introduction
As medical knowledge and technology increase, so do options for healthcare.
When decisions arise concerning the treatment of dying patients, these options present
complex ethical dilemmas. Many are faced with decisions about the best treatment to ease a
patient’s final suffering. Perhaps a decision will need to be made about whether to allow a
patient’s life to end by terminating treatment altogether. These decisions—regarding their
own care or the care of a dying loved one—confront people from all walks of life.
Beginning with a definition of death in modern society and continuing all the way
through post-death issues, End of Life Care: An Ethical Overview presents significant
ethical issues related to death and dying. We focus on ethical considerations of subjects that
include the benefits and drawbacks of various types of modern treatment, ending life
through physician assistance or termination of treatment, options for preserving the
individual autonomy of the patient, the special situation of terminally ill children, and
conducting medical research. Each section includes key terminology sufficient to form a
basic understanding of the issue and ethical arguments on both sides of the question. A list
of further resources, as well as references throughout the paper, provide quick and easy
access to further information on topics of particular interest.
With advances in modern medicine, people are living longer, and the number of
elderly persons is increasing. As a result, the ethical issues surrounding end of life care
continue to gain importance to all members of society. End of Life Care: An Ethical
Overview offers a broad introduction to a number of these issues. Both basic and
comprehensive, this overview will provide a starting place for those wishing to explore the
complex subject of death and dying for any of a multitude of reasons.
3
CONTENTS
Introduction 2
Part I What is Death? 4
Causes of Death 5
Defining the End of Life and Declaring Death 7
Non-Heart Beating Organ Donation 10
A Good Death 12
Further Resources 13
Part II Common Approaches to End of Life Care 14
Hospice Care 15
Palliative Care 16
Further Resources 19
Part III Ethical Challenges in End of Life Care 20
Access to Care 21
Prognosis 23
Pain Management 24
Withholding and Withdrawing Medical Treatment 25
(Resuscitation, Ventilation, Nutrition and Hydration,
Kidney Dialysis and Antibiotic Treatments)
Medical Futility 31
...
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Development of Perceptions of Mental Health in Society
This document provides an overview of the history of perceptions of mental health from ancient times to the present. It discusses views in ancient Egypt, Greece, the Middle Ages, the Enlightenment, and modern times. Key points include ancient Egypt viewing mental health through religion, Greece recognizing the brain's role, the Middle Ages often attributing mental illness to demonic possession, the Enlightenment emphasizing humane treatment, and the current biopsychosocial model. The document also examines how perspectives have changed due to scientific revolutions, the role of stigma and media, and efforts to reduce stigma through education.
© 2014 Korean Oncology Nursing Society www.kons.or.kr pISS.docx
© 2014 Korean Oncology Nursing Society www.kons.or.kr | pISSN 2287-2434 | eISSN 2287-447X
서 론
1. 연구의 필요성
매년 암 환자 발생률과 이로 인한 사망률은 점차 증가하고 있으
며 2009년에 암으로 사망한 사람은 총 69,780명으로 전체 사망자의
28.3%에 이르고 있다.1) 하지만 새로운 의료기술 발달로 치료뿐만 아
니라 회복이 불가능한 환자의 경우에도 여러 생명유지의 장치를 통
해 생명 연장이 가능하게 되었다. 의학발달이 인간의 건강증진과
수명연장에 기여한 것은 사실이지만 증가된 평균 수명이 죽음에 대
한 인간의 모든 문제를 해결한 것은 아니다. 치료가 불가능한 말기
환자들은 질병의 예방과 치료에 최우선의 목적을 두는 현대의학에
의해 억지로 생명이 연장되는 고통을 겪게 될 수도 있으며, 이러한
현상은 환자들이 인간적 품위를 유지하고 평화로운 죽음을 맞이
하는 것을 방해할 수도 있다.2) 따라서, 임종을 앞두고 있는 암 환자
들에게 생명연장의 무의미한 치료행위가 오히려 고통 받는 기간만
증가시킬 수 있기 때문에 이러한 치료가 진정한 의미가 있는지가
논쟁의 소지가 되고 있다.
말기암 환자는 임종이 다가올수록 정신적인 스트레스가 점점 더
증가하며 말기암 환자와 가족은 죽음에 대한 두려움과 고통을 공
유함으로 인해 서로 힘든 시간을 보내게 된다.3) 결국 심정지가 발생
하는 순간에도 어떻게 대응해야 할 지 충분한 준비를 하지 못한 상
종양간호연구 제14권 제1호, 2014년 3월 Asian Oncol Nurs Vol. 14 No. 1, 32-40
http://dx.doi.org/10.5388/aon.2014.14.1.32
암 환자의 심폐소생술 금지(Do-not-resuscitate: DNR)에 대한
인식과 윤리적 태도
이주연1·최은희2·박경숙3
1중앙대학교병원 내과계중환자실, 2한국성서대학교 간호학부, 3중앙대학교 적십자간호대학
Awareness and Ethical Attitudes Toward ‘Do-Not-Resuscitate (DNR)’ for Cancer Patients
Lee, Joo Yeon1 · Choi, Eun Hee2 · Park, Kyung Sook3
1Nursing Department, Chung-ang University Healthcare System, Seoul; 2Department of Nursing, Korean Bible University, Seoul; 3Department of Nursing, Chung-
Ang University, Seoul, Korea
Purpose: This descriptive study was conducted to investigate awareness and attitudes toward ‘Do-Not-Resuscitate (DNR)’. Methods:
Study data were collected from July 24 to September 30, 2011 using structured questionnaires. Study subjects were 209 patients suffer-
ing from cancer at “C” Univ. hospital located in Seoul and Cancer Patient Coalition in Seoul. The purpose of the study was explained
directly to them. All the data of 209 questionnaires were collected and analyzed without dropping out. Results: In terms of awareness
toward DNR, 61.5% said DNR is “necessary” because “their recoveries are impossible” (51.7%) and “they want dignified deaths”
(41.1%). When it comes to ethical attitudes toward DNR according to demographic characteristics, there were significant differences
both between genders (p < .032) on “Medical staff should tell hopeless patients their conditions openly” and between level of education
and monthly income (p < .013) on “DNR decision should be made according to the guideline, if needed”. Conclusion: The result of
this study suggests that decisions on DNR should be made not by only families and doctors but by patients themselves as well. For this,
sufficient explanations and education programs for DNR need to be developed and DNR decision including both patient’s and fami-
ly’s demand should be standardized.
Key Words : DNR, Cancer, Ethics, Awareness, Attitude
주요어: 심폐소생술 금지, 암 환자, 인식, 윤리적 태도
*본 논문은 제1저자 이주연의 2012년 석사학위논문의 일부를 발췌한 것임.
*This article is based on a part of the first author’s master’s thesis from Chung-Ang University.
Address reprint requests to: Choi, Eun Hee
Department of Nursing, Korean.
The concept of Brain Death
Concept of death, definition death, brain death, brain stem death, whole brain death, Harvard school ad hoc committee, Minnesota Criteria, Sydney declaration 1968, brainstem reflexes, pupillary reflex, corneal reflex, trauma, apnoea testing, apnea, timing, neonates death, CT angiography, organ transplantation, The transplantation of human Organs act 1994, lung transplant. cornea transplant, EEG, TCD, SSEP, Ventilator dependent patient, Large stroke, Hypoxic brain injury, Organ retrieval, India, UK, USA criteria, Cervical spine injury, Polytrauma, facial injury
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Critical Synopsis in Brain Death Determination: A Case Report of Brain Death
This document presents a case report of a 47-year-old woman who was admitted to the emergency room in a deep coma state and acute renal failure following a urinary infection. She had a history of stage 4 lung cancer. After being in cardiopulmonary arrest for an hour, she remained comatose without brainstem or respiratory function. Tests showed the absence of brainstem reflexes and respiratory drive without ventilation. She met the clinical criteria for brain death. The document then discusses brain death, including its epidemiology, treatment, controversies, and clinical and instrumental criteria for determination according to medical standards.
End of Life Care An Ethic.docx
End of Life Care:
An Ethical Overview
Center for Bioethics
University of Minnesota
2005
2
Introduction
As medical knowledge and technology increase, so do options for healthcare.
When decisions arise concerning the treatment of dying patients, these options present
complex ethical dilemmas. Many are faced with decisions about the best treatment to ease a
patient’s final suffering. Perhaps a decision will need to be made about whether to allow a
patient’s life to end by terminating treatment altogether. These decisions—regarding their
own care or the care of a dying loved one—confront people from all walks of life.
Beginning with a definition of death in modern society and continuing all the way
through post-death issues, End of Life Care: An Ethical Overview presents significant
ethical issues related to death and dying. We focus on ethical considerations of subjects that
include the benefits and drawbacks of various types of modern treatment, ending life
through physician assistance or termination of treatment, options for preserving the
individual autonomy of the patient, the special situation of terminally ill children, and
conducting medical research. Each section includes key terminology sufficient to form a
basic understanding of the issue and ethical arguments on both sides of the question. A list
of further resources, as well as references throughout the paper, provide quick and easy
access to further information on topics of particular interest.
With advances in modern medicine, people are living longer, and the number of
elderly persons is increasing. As a result, the ethical issues surrounding end of life care
continue to gain importance to all members of society. End of Life Care: An Ethical
Overview offers a broad introduction to a number of these issues. Both basic and
comprehensive, this overview will provide a starting place for those wishing to explore the
complex subject of death and dying for any of a multitude of reasons.
3
CONTENTS
Introduction 2
Part I What is Death? 4
Causes of Death 5
Defining the End of Life and Declaring Death 7
Non-Heart Beating Organ Donation 10
A Good Death 12
Further Resources 13
Part II Common Approaches to End of Life Care 14
Hospice Care 15
Palliative Care 16
Further Resources 19
Part III Ethical Challenges in End of Life Care 20
Access to Care 21
Prognosis 23
Pain Management 24
Withholding and Withdrawing Medical Treatment 25
(Resuscitation, Ventilation, Nutrition and Hydration,
Kidney Dialysis and Antibiotic Treatments)
Medical Futility 31
...
A critical discussion of the focus on the biomedical perspective in the preve...
The biomedical focus on dementia brought the phenomena of what was considered a normal part of ageing into the medical and scientific field of interest (Bartlett, R and O’Connor, D. 2010). This perspective comes with a strong focus on neurodegenerative decline and deficits. Even though Alzheimer’s disease was around for more than 70 years since noted by Alois Alzheimer, it was only in the 1980’s that the “disease emerged as an illness category and policy issue” (Lyman, A. 1989). The Nun Study of David A. Snowdon, PhD, which started in 1991, brought a new perspective to the research into dementia. It was discovered during autopsies that people who have lived their lives without any signs of dementia, actually had amyloid plaques and tangles in their brains congruent to people living with dementia (Snowdon, D.A. 2003). Biomedical research is at this stage the primary focus of research into dementia, receiving most of the funding budget. According to an article in Therapy Today (July 2012) in the UK alone, £66 million will be allocated to dementia research by 2015, of which only £13 million is earmarked for social science research. In the WHO report on Dementia, Daviglus M.L. et al of the US National Institutes of Health state that “firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline of Alzheimer disease”.
The importance of the research findings of the biomedical model cannot be underestimated. However, considering the facts that t this point there seems to be nothing that can prevent nor cure Dementia, I am of the opinion that more research and funding should focused on creating a life worth living for people who live with dementia.
Dep with medical illness-by Dr.Swapnil Agrawal
This document discusses depression that occurs comorbidly with medical illnesses such as cardiovascular disease and diabetes. It notes that depression is common in patients with these conditions, affecting around 20% of those with CAD and 25% of those with diabetes. Depression is associated with worse health outcomes in these patients, including increased mortality and morbidity, poorer treatment adherence, and worse prognosis. The document explores some of the biological mechanisms of this association, such as effects on the autonomic nervous system, HPA axis, platelet activation and insulin resistance. It emphasizes the need for screening and treatment of depression in medically ill patients in order to improve their overall health.
Depression and Heart Disease - A Cross Cultural View
INTRODUCTION
Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization
(WHO) statements. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the
morbidity and mortality of heart disease around the world . Although the precise pathophysiological pathways linking
these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it
contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate
variability.
In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care (PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in
primary care facilities . This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens
(Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki
(Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona
(Italy) . It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened
for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12); Patients screened were
sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International
Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric
assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems,
according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and
Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also
interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease,
bronchitis/emphysema, stomach disorder and common parasitic disease.
During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter
form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status,
psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders
recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings.
The relationship between depression and heart disease is well documented. Some works compare symptoms of depression
with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that
connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will be compared with the self-reported diagnosis of heart disease across cultures.
Trastorno de trance y posesion
The document reviews literature on dissociative trance and possession disorders (DTD) to assess its clinical utility for inclusion in DSM-5. It summarizes findings from 28 articles reporting 402 cases of DTD worldwide. Key findings include:
- Cases were reported equally among females and males, with possession being more common than trance.
- Amnesia was reported in 20% of patients while hallucinations during possession were reported in 56% and should be an important diagnostic criterion.
- Multiple explanatory models were simultaneously held and appeared complementary.
- Data support inclusion of DTD in DSM-5 provided certain adjustments are made to capture its cultural aspects and presentations across diverse populations.
Human Disease and Genomics
This document discusses human disease from a bioinformatics perspective. It describes major categories of human disease and approaches to identifying disease-associated genes. It compares disease databases and describes how model organisms can elucidate disease-related genetic variation. Key tools for studying disease at the molecular level include DNA databases, genetic and physical maps, protein structure analyses, and functional genomics. Classification systems organize diseases by causes of mortality, global disease burden, and clinical codes.
De vueltas con el futuro
Conferencia en XII Reunión de la Sociedad Aragonesa del Aparato Respiratorio (SADAR), Calatayud, 11/12 de Noviembre 2016
Blinding: History and Current Issues
Blinded clinical trials only became standardized into their current form in the 1980s. The history before this very recent phenomenon has become almost invisible, even though it was challenged right from the start by the AIDS crisis. The challenge to the RCT as the principle image of clinical research continues with the Ebola crisis and Right to Try legislation.
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...Erwin Chiquete, MD, PhD
Erwin Chiquete, MD, PhD
Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This
epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated
factors associated with 4-year all-cause mortality in a Latin American population at high risk.
Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and
cardiovascular mortality in this Latin American cohort.
Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic
atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued
Health registry.
Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease,
and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%),
hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension
(89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality
steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients
with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with
cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality
were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular
disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were
associated with a reduced risk.
Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this LatinDiagnostic Classifications in the 21st Century: how can we capture developmen...
Brain Development; Functional development; Life Span; ICD; DSM; ICD11; DSM5; children; adolescence; youth; RDoC; ICD Field Trials;
Improving End-of-Life Care in Healthcare Administration
This document provides background information on end-of-life care and issues surrounding death and dying. It discusses the controversy around defining death, the history of allowing patients to refuse life support, and improving end-of-life care. Key points include defining a "good" death as peaceful and dignified without prolonging pain, the importance of open communication between providers and patients, and training medical staff to handle death and the needs of terminally ill patients and their families. The role of nurses is also examined, with nurses preferring expected deaths where they feel in control and can minimize patients' pain and suffering.
ueda2012 egypt guidelines 2012-d.edwin
This document discusses evidence-based guidelines for diabetes treatment. It notes that guidelines aim to streamline care but are not mandatory. While guidelines can help optimize care, they also assert authority and can extend disease boundaries. The document questions whether guidelines are judged on scientific quality or the status of the issuing organization. It argues guidelines may aspire to therapeutic futility by treating very minor risks and ignoring individual patient needs and risks. Overall, the document presents a skeptical view of clinical guidelines and their limitations.
Death is a Statistical Matter
What is death, how it should be defined. A view based on bioinformatics and philosophy provides a satisfactory explanation.
Raisons du succès et problèmes éthiques du modèle espagnol de don d'organes
The document discusses the reasons for Spain's success in organ donation rates and some of the ethical issues with its model. Key aspects of the Spanish model include its system of presumed consent, the important role of transplant coordinators in detecting potential donors and approaching families, and educational efforts to increase public awareness and acceptance of donation. Some debates around the model include its reliance on older donors and end-of-life policies that could prematurely declare brain death.
Thaddeus Mason Pope, "Brain Death Rejected: Expanding Clinicians' Legal Duti...
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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience.
This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation. David Rodríguez-Arias - The Ethics of Organ Donation. an international perspe...
The document discusses the ethics of organ donation policies from an international perspective, comparing practices in Spain and Canada. Spain has an opt-out system of presumed consent that has led to high donation rates but raises ethical questions. Key policies debated include presumed consent, separation of diagnostic and transplant teams, public awareness, and end-of-life practices that could increase potential donors. The document examines whether Spain's utilitarian approach prioritizes social benefits over individual autonomy and risks hardening its initially soft opt-out policy.
Development of Perceptions of Mental Health in Society
This document provides an overview of the history of perceptions of mental health from ancient times to the present. It discusses views in ancient Egypt, Greece, the Middle Ages, the Enlightenment, and modern times. Key points include ancient Egypt viewing mental health through religion, Greece recognizing the brain's role, the Middle Ages often attributing mental illness to demonic possession, the Enlightenment emphasizing humane treatment, and the current biopsychosocial model. The document also examines how perspectives have changed due to scientific revolutions, the role of stigma and media, and efforts to reduce stigma through education.
© 2014 Korean Oncology Nursing Society www.kons.or.kr pISS.docx
© 2014 Korean Oncology Nursing Society www.kons.or.kr | pISSN 2287-2434 | eISSN 2287-447X
서 론
1. 연구의 필요성
매년 암 환자 발생률과 이로 인한 사망률은 점차 증가하고 있으
며 2009년에 암으로 사망한 사람은 총 69,780명으로 전체 사망자의
28.3%에 이르고 있다.1) 하지만 새로운 의료기술 발달로 치료뿐만 아
니라 회복이 불가능한 환자의 경우에도 여러 생명유지의 장치를 통
해 생명 연장이 가능하게 되었다. 의학발달이 인간의 건강증진과
수명연장에 기여한 것은 사실이지만 증가된 평균 수명이 죽음에 대
한 인간의 모든 문제를 해결한 것은 아니다. 치료가 불가능한 말기
환자들은 질병의 예방과 치료에 최우선의 목적을 두는 현대의학에
의해 억지로 생명이 연장되는 고통을 겪게 될 수도 있으며, 이러한
현상은 환자들이 인간적 품위를 유지하고 평화로운 죽음을 맞이
하는 것을 방해할 수도 있다.2) 따라서, 임종을 앞두고 있는 암 환자
들에게 생명연장의 무의미한 치료행위가 오히려 고통 받는 기간만
증가시킬 수 있기 때문에 이러한 치료가 진정한 의미가 있는지가
논쟁의 소지가 되고 있다.
말기암 환자는 임종이 다가올수록 정신적인 스트레스가 점점 더
증가하며 말기암 환자와 가족은 죽음에 대한 두려움과 고통을 공
유함으로 인해 서로 힘든 시간을 보내게 된다.3) 결국 심정지가 발생
하는 순간에도 어떻게 대응해야 할 지 충분한 준비를 하지 못한 상
종양간호연구 제14권 제1호, 2014년 3월 Asian Oncol Nurs Vol. 14 No. 1, 32-40
http://dx.doi.org/10.5388/aon.2014.14.1.32
암 환자의 심폐소생술 금지(Do-not-resuscitate: DNR)에 대한
인식과 윤리적 태도
이주연1·최은희2·박경숙3
1중앙대학교병원 내과계중환자실, 2한국성서대학교 간호학부, 3중앙대학교 적십자간호대학
Awareness and Ethical Attitudes Toward ‘Do-Not-Resuscitate (DNR)’ for Cancer Patients
Lee, Joo Yeon1 · Choi, Eun Hee2 · Park, Kyung Sook3
1Nursing Department, Chung-ang University Healthcare System, Seoul; 2Department of Nursing, Korean Bible University, Seoul; 3Department of Nursing, Chung-
Ang University, Seoul, Korea
Purpose: This descriptive study was conducted to investigate awareness and attitudes toward ‘Do-Not-Resuscitate (DNR)’. Methods:
Study data were collected from July 24 to September 30, 2011 using structured questionnaires. Study subjects were 209 patients suffer-
ing from cancer at “C” Univ. hospital located in Seoul and Cancer Patient Coalition in Seoul. The purpose of the study was explained
directly to them. All the data of 209 questionnaires were collected and analyzed without dropping out. Results: In terms of awareness
toward DNR, 61.5% said DNR is “necessary” because “their recoveries are impossible” (51.7%) and “they want dignified deaths”
(41.1%). When it comes to ethical attitudes toward DNR according to demographic characteristics, there were significant differences
both between genders (p < .032) on “Medical staff should tell hopeless patients their conditions openly” and between level of education
and monthly income (p < .013) on “DNR decision should be made according to the guideline, if needed”. Conclusion: The result of
this study suggests that decisions on DNR should be made not by only families and doctors but by patients themselves as well. For this,
sufficient explanations and education programs for DNR need to be developed and DNR decision including both patient’s and fami-
ly’s demand should be standardized.
Key Words : DNR, Cancer, Ethics, Awareness, Attitude
주요어: 심폐소생술 금지, 암 환자, 인식, 윤리적 태도
*본 논문은 제1저자 이주연의 2012년 석사학위논문의 일부를 발췌한 것임.
*This article is based on a part of the first author’s master’s thesis from Chung-Ang University.
Address reprint requests to: Choi, Eun Hee
Department of Nursing, Korean.
The concept of Brain Death
Concept of death, definition death, brain death, brain stem death, whole brain death, Harvard school ad hoc committee, Minnesota Criteria, Sydney declaration 1968, brainstem reflexes, pupillary reflex, corneal reflex, trauma, apnoea testing, apnea, timing, neonates death, CT angiography, organ transplantation, The transplantation of human Organs act 1994, lung transplant. cornea transplant, EEG, TCD, SSEP, Ventilator dependent patient, Large stroke, Hypoxic brain injury, Organ retrieval, India, UK, USA criteria, Cervical spine injury, Polytrauma, facial injury
Similar to Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of (20)
Critical Synopsis in Brain Death Determination: A Case Report of Brain Death
Critical Synopsis in Brain Death Determination: A Case Report of Brain Death
A critical discussion of the focus on the biomedical perspective in the preve...
A critical discussion of the focus on the biomedical perspective in the preve...
Depression and Heart Disease - A Cross Cultural View
Depression and Heart Disease - A Cross Cultural View
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...
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Diagnostic Classifications in the 21st Century: how can we capture developmen...
Improving End-of-Life Care in Healthcare Administration
Improving End-of-Life Care in Healthcare Administration
Raisons du succès et problèmes éthiques du modèle espagnol de don d'organes
Raisons du succès et problèmes éthiques du modèle espagnol de don d'organes
Thaddeus Mason Pope, "Brain Death Rejected: Expanding Clinicians' Legal Duti...
Thaddeus Mason Pope, "Brain Death Rejected: Expanding Clinicians' Legal Duti...
David Rodríguez-Arias - The Ethics of Organ Donation. an international perspe...
David Rodríguez-Arias - The Ethics of Organ Donation. an international perspe...
Development of Perceptions of Mental Health in Society
Development of Perceptions of Mental Health in Society
© 2014 Korean Oncology Nursing Society www.kons.or.kr pISS.docx
© 2014 Korean Oncology Nursing Society www.kons.or.kr pISS.docx
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Sohal Ismail - The Netherlands - Wednesday 30 - Oral Presentations Misc. A
Liliana Bisigniano - Argentina - Wednesday 30 - Oral Presentations Misc. A
Liliana Bisigniano - Argentina - Wednesday 30 - Oral Presentations Misc. A
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Identifying Major Symptoms of Slip Disc.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
All info about Diabetes and how to control it.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
share - Lions, tigers, AI and health misinformation, oh my!.pptx
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdf
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In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of
- 1. CURRENT CONCEPTS OF DEATH: BRAIN DEATH AND CIRCULATORY DEATH “ A CONTINUOUS DISCUSSION ABOUT THE DIAGNOSIS CRITERIA AND THE MEANING OF THIS DIAGNOSIS” Dra. María Elisa Barone
- 16. Thanks for your attention!