El fruto de la tecnología: debemos nosotros alimentar un paciente anciano a todo costo?

The purpose of this article is to analyze questions on a complex ethic, medical and caring dilemma about reasons to continue or suspend compelled alimentation in really old patients carrying progressive acute dementia. Traditionally, the principle of life holiness supports the idea that life should be extended at all costs and the decision to continue feeding the patients is not questioned. However, revolutionary ideas are arising about attitudes, concepts and value of treatment, conducting an urgent need to discuss this problem deeply. Until when should we compel demented patients to eat, as they do not accept food and have to be fed through a catheter or intraveined alimentation, tying back their hands or using other measures? This discussion occurred in a geriatric institution at Israel, when a doctor's order was not accepted by nurses, as they had a different way of seeing the problem. A national conference on this theme was organized with the attendance of doctors, nurses, social workers and psychologists.El próposito de este artículo es analizar las preguntas que rodean un común pero complejo dilema ético, médico y asistencial, llamado la justificación de continuar o suspender la alimentación forzada en pacientes extremadamente ancianos que sufren de aguda demencia progresiva. Tradicionalmente el principio de santidad de la vida apoya la idea que la vida debe ser prolongada a todo costo y la decisión de continuar com la alimentación, no se pone en duda. Sin embargo, últimamente han surgido gran cantidad de ideas revolucionarias hacia las actitudes, las concepciones y los valores del tratamiento, los cuales han guiado hacia una urgente necesidad de discutir el problema en un sentido mas profundo. Hasta qué punto debemos alimentar a la fuerza un paciente demente, el cual se niega a comer (sonda, alimentación intravenosa), atando sus manos o utilizando otras medidas? Esto ocurrío en un instituto geriátrico en Israel, donde una orden médica de un determinado médico consterno a las enfermeras de planta, las cuales decidieron que en este específico caso su punto de vista no era similar al del médico. El resultado fue una conferencia nacional con la participación de médicos, enfermeras, trabajadores sociales y sicólogos

El fruto de la tecnología: debemos nosotros alimentar un paciente anciano a todo costo?

El próposito de este artículo es analizar las preguntas que rodean un común pero complejo dilema ético, médico y asistencial, llamado la justificación de continuar o suspender la alimentación forzada en pacientes extremadamente ancianos que sufren de aguda demencia progresiva. Tradicionalmente el principio de santidad de la vida apoya la idea que la vida debe ser prolongada a todo costo y la decisión de continuar com la alimentación, no se pone en duda. Sin embargo, últimamente han surgido gran cantidad de ideas revolucionarias hacia las actitudes, las concepciones y los valores del tratamiento, los cuales han guiado hacia una urgente necesidad de discutir el problema en un sentido mas profundo. Hasta qué punto debemos alimentar a la fuerza un paciente demente, el cual se niega a comer (sonda, alimentación intravenosa), atando sus manos o utilizando otras medidas? Esto ocurrío en un instituto geriátrico en Israel, donde una orden médica de un determinado médico consterno a las enfermeras de planta, las cuales decidieron que en este específico caso su punto de vista no era similar al del médico. El resultado fue una conferencia nacional con la participación de médicos, enfermeras, trabajadores sociales y sicólogos

The Intention of Delivery Room Staff to Encourage the Presence of Husbands/Partners at Cesarean Sections

Objective. In recent years, more and more delivery rooms have allowed husbands/partners to be present during a Cesarean section Nonetheless, many still oppose the idea. The study is designed to investigate the attitudes of Israeli gynecologists, anesthetists, operating-room nurses, and midwives on this issue. Design. The study's theoretical model comes from Fishbein and Ajzen's theory of reasoned action. A self-administered questionnaire was submitted to convenience sample. Subjects. 96 gynecologists, anesthetists, midwives, and operating-room nurses. Results. Significant differences were found between the occupational subgroups. Most of the findings supported the four hypotheses tested and confirmed earlier studies designed to verify the theoretical model. Conclusions. The main conclusion drawn is that delivery and operating-room staff need to be trained in the skills needed to promote the active participation of the baby's father in delivery and, if necessary, in a Cesarean section

Psychosocial outcomes of sharing a diagnosis of cancer with a pediatric patient

Purpose: This innovative pilot study was designed to provide research-based evidence on the variables to consider informing a child of his/her cancer diagnosis, so as to minimize the negative psychosocial effects of the cancer experience on survivors. The hypotheses of the study were that 'good information' about cancer, will allow the child a better understanding way to cope with treatment and improve socio-psychological outcomes at adulthood.Methods: Ninety-one adult childhood cancer survivors got the questionnaires while waiting to their routine checkup at a grate childhood cancer medical center in center Israel. Results: To our surprise and not according to the hypothesis, there was a difference between children diagnosed up to 12 years of age and those diagnosed during adolescence. (Participants were divided into two groups according to their age at diagnosis: from birth to 12-years-old and from age 12 to 18). In the group diagnosed at a younger age, those who had received good information were found to have better quality of life, lower mental pain and higher mental pain tolerance than did those in the same group (diagnosed at a younger age) who received not good information. By contrast, in the group diagnosed during adolescence, those who had received not good information scored higher on these measures than did their counterparts who had received good information.Conclusions: Given that information conveyed to children diagnosed with cancer can have a significant impact on survivors' quality of life, further research is needed to determine the precise information to be divulged to children at the time of diagnosis. In the meantime, extreme caution, sensitivity, and careful judgement are required. Clinical Relevance: Findings the current study and of future studies can be used to formulate clear guidelines for assessing a child's readiness and the information to be divulged, so as to improve the quality of life of childhood cancer survivors. Keywords: childhood cancer, information, childhood cancer survivors, quality of life, mental pain, meaning

Vigilance in the Decision-Making Process Regarding Termination of Pregnancy Following Prenatal Diagnosis of Congenital Heart Disease—Application of the ‘Conflict Decision-Making Model’

The decision-making process regarding termination of pregnancy following prenatal diagnosis of congenital heart disease is a stressful experience for future parents. Janis and Mann’s conflict decision-making model describes seven ideal stages that comprise vigilant information-gathering as an expression of the qualitative decision-making process. In our study, we attempted to determine whether parents who face the decision regarding termination of pregnancy undertake a qualitative decision-making process. Data were collected over 2-year period using structural questionnaires. The sample consisted of two hundred forty participants; sixty-nine (28.75%) declared that their decision was to terminate the pregnancy. A significant difference in the quality of the decision-making score was noted between parents who decided to continue with the pregnancy vs. parents who opted for termination (mean score of 10.15 (5.6) vs. 18.51 (3.9), respectively, p < 0.001). Sixty-two (90%) participants within the termination of pregnancy group went through all seven stages of vigilant decision-making process and utilized additional sources for information and consultation. Parents who decided to continue with the pregnancy made swift decisions, often without considering the negative and positive outcomes; this decision-making pattern is considered non-vigilant and ineffective. Identification of future parents at risk of going through an ineffective decision-making process may help health professionals to determine the best way to provide them with information and support