Ethical considerations of medical nutritional therapy at end of life: the Israel perspective

Summary: The major ethical dilemma regarding feeding a person at the end of their life in Israel is related to the medical team's ability to not provide food. In addition to the medical indications, the decision-making process needs to include ethnic considerations, religious positions and a strong collective memory related to the Holocaust and post-Holocaust behavior. An Expert group of professionals regularly faced with these dilemmas gathered to address this issue. The group included Nutrition Specialists, Neurologists, Geriatricians, Oncologists and Specialists in palliative care, Nurses, Dieticians, Speech therapists but also Lawyers and Religion experts.The conclusions suggested: 1) One should evaluate the patient's ability to eat safely and sufficiently, assessed by speech therapist and dietician evaluations. 2) If not successful, a discussion between the team, the patient, if available, and the family is initiated. 3) If oral nutrition is possible it is encouraged. 4) If not, artificial nutrition should be discussed. 5) The family's will to never stop providing food and water according to Jewish law has to be acknowledged when the medical team does not suggest nutritional therapy. Emotional aspects, religious beliefs and nutritional indications have to be reconciled and a consensus should be reached

Impact of Infliximab and Cyclosporine on the Risk of Colectomy in Hospitalized Patients with Ulcerative Colitis Complicated by Cytomegalovirus - A Multicenter Retrospective Study

Background: Cytomegalovirus (CMV) is frequently detected in patients with ulcerative colitis (UC). The impact of CMV infection on the outcome of UC exacerbation remains unclear. The benefit of combining antiviral with anti-inflammatory treatment has not been evaluated yet. The aim of this study was to compare the outcome of CMV-positive hospitalized patients with UC treated with antiviral therapy either alone or combined with salvage anti-inflammatory therapy (infliximab [IFX] or cyclosporine A [CsA]). Methods: This was a multicenter retrospective study of hospitalized CMV-positive patients with UC. The patients were classified into 2 groups: antiviral - if treated with antivirals alone; combined - if treated with both antiviral and anti-inflammatory therapy. The outcomes included the rate of colectomy in both arms during the course of hospitalization and after 3/12 months. Results: A total of 110 patients were included; 47 (42.7%) patients did not receive IFX nor CsA; 36 (32.7%) received IFX during hospitalization or within 1 month before hospitalization; 20 (18.1%) patients received CsA during hospitalization; 7 (6.4%) were exposed to both IFX and CsA. The rate of colectomy was 14.5% at 30 days, 20.0% at 3 months, and 34.8% at 12 months. Colectomy rates were similar across treatment groups. No clinical and demographic variables were independently associated with the risk of colectomy. Conclusions: IFX or cyclosporine therapy is not associated with additional risk for colectomy over antiviral therapy alone in hospitalized CMV-positive patients with UC.SCOPUS: ar.jinfo:eu-repo/semantics/publishe