ABSTRACT
This essay describes the author's experience with the application of medical guidelines in the treatment of patients.
Subject(s)
COVID-19 , Delivery of Health Care , Hospitals , Humans , Nasopharynx , Polymerase Chain Reaction , SARS-CoV-2 , Sensitivity and SpecificitySubject(s)
Autoimmune Diseases/immunology , Immunoglobulin G/immunology , Salivary Gland Diseases/immunology , Tuberculosis, Pulmonary/immunology , Adrenal Cortex Hormones/therapeutic use , Aged , Antitubercular Agents/therapeutic use , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/drug therapy , Biopsy, Needle , Follow-Up Studies , Humans , Immunohistochemistry , Male , Mycobacterium tuberculosis/isolation & purification , Rare Diseases , Salivary Gland Diseases/complications , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/therapy , Thoracic Surgery, Video-Assisted/methods , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/therapySubject(s)
Controlled Clinical Trials as Topic/ethics , Controlled Clinical Trials as Topic/methods , Moral Obligations , Physician-Patient Relations/ethics , Placebo Effect , Placebos , Research Personnel/ethics , Researcher-Subject Relations/ethics , Deception , Ethics, Clinical , Ethics, Medical , Ethics, Research , Humans , Psychoneuroimmunology , Research Design , Sensitivity and SpecificityABSTRACT
Analysis of recent U.S. Supreme Court decisions on abortion.
Subject(s)
Abortion, Induced/classification , Abortion, Induced/ethics , Abortion, Induced/history , Abortion, Induced/legislation & jurisprudence , Abortion, Induced/methods , Abortion, Induced/standards , Abortion, Induced/trends , Maternal-Fetal Relations , Pregnancy , Reproductive Rights , Supreme Court Decisions , Abortion, Induced/psychology , Female , History, 20th Century , History, 21st Century , Humans , Judicial Role/history , Pregnant Women , Reproductive Rights/classification , Reproductive Rights/ethics , Reproductive Rights/history , Reproductive Rights/legislation & jurisprudence , Reproductive Rights/trends , Supreme Court Decisions/history , United StatesABSTRACT
BACKGROUND: Postcardiotomy sternal wound complications remain challenging. The prevailing approach for deep sternal wound infection of debridement and flap coverage without osseous closure makes subsequent reoperation difficult. METHODS: An analysis of all patients undergoing cardiac surgery at a single institution between 1986 and 2001 was conducted. Prospective data collection and chart review were used to compare different treatment strategies for sternal complications. RESULTS: Of 5337 patients, 122 had sternal wound complications (2.2%) comprising 15 (0.3%) uninfected dehiscences (El Oakley class 1), 45 (0.8%) superficial infections (El Oakley class 2A), and 62 (1.1%) deep sternal wound infections (El Oakley class 2B). Thirty-two patients with deep sternal infection were treated by debridement, rewiring, and delayed primary closure. There were initial treatment failures in 6 patients (18.8%) and ultimate failures in 2 patients (6.3%), both of whom died. One of these patients had previously received external beam radiation after a radical mastectomy for breast cancer. Median length of stay was 32 days and median time to wound healing was 85 days. Twenty-five patients were managed by muscle flap coverage without sternal reclosure. There were 6 initial treatment failures (24%) but no ultimate failures or deaths (p = NS). Median length of stay was 31 days and median infection time was 161 days. CONCLUSIONS: In patients with postcardiotomy deep sternal wound infection without previous chest radiation, debridement, rewiring, and delayed skin closure is effective. It offers a shorter healing time and probably makes late cardiac reoperation safer. We propose an algorithm for the management of poststernotomy complications.
Subject(s)
Cardiac Surgical Procedures , Sternum/surgery , Surgical Wound Dehiscence/surgery , Surgical Wound Infection/surgery , Algorithms , Antibiotic Prophylaxis , Bone Wires , Debridement , Female , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Male , Prospective Studies , Radiation Injuries/complications , Radiotherapy/adverse effects , Registries , Reoperation , Risk Factors , Surgical Flaps , Surgical Wound Dehiscence/therapy , Surgical Wound Infection/therapy , Treatment Outcome , Wound HealingSubject(s)
Civil Rights , Freedom , Government Regulation , Jurisprudence , Right to Die , Social Control, Formal , Suicide, Assisted , Terminally Ill , Decision Making , Ethics , Euthanasia, Passive , Humans , Mental Competency , New York , Pain , Palliative Care , Personal Autonomy , Physicians , State Government , Stress, Psychological , Treatment Refusal , United States , Washington , Wedge Argument , Withholding TreatmentSubject(s)
Civil Rights , Government Regulation , Homosexuality , Judicial Role , Jurisprudence , Prejudice , Social Control, Formal , State Government , Suicide, Assisted , Supreme Court Decisions , Abortion, Induced , Colorado , Democracy , Euthanasia, Passive , Freedom , Humans , Morals , New York , Personal Autonomy , Public Opinion , Public Policy , Reference Standards , Right to Die , Sexuality , United States , WashingtonSubject(s)
Civil Rights , Right to Die , Suicide, Assisted , Ethics , Euthanasia , Euthanasia, Active , Euthanasia, Active, Voluntary , Government Regulation , Humans , Jurisprudence , Privacy , Public Policy , Quality of Life , Social Control, Formal , State Government , United States , Value of Life , Washington , Wedge ArgumentSubject(s)
Abortion, Induced , Beginning of Human Life , Embryonic and Fetal Development , Fetus , Human Characteristics , Human Rights , Life , Morals , Public Policy , Value of Life , Abortion, Therapeutic , Civil Rights , Cultural Diversity , Decision Making , Ethics , Female , Freedom , Government Regulation , Humans , Individuality , Judaism , Jurisprudence , Personal Autonomy , Personhood , Pregnancy , Pregnant Women , Religion , Social Control, Formal , Social Values , Supreme Court Decisions , United States , Women's RightsSubject(s)
Delivery of Health Care , Economics , Ethics , Health Care Rationing , Health Care Reform , Insurance, Health , Public Policy , Reference Standards , Resource Allocation , Social Justice , Social Responsibility , Biomedical Technology , Community Participation , Cost-Benefit Analysis , Decision Making , Human Rights , Humans , National Health Programs , Patient Selection , Policy Making , Politics , Poverty , Preventive Medicine , Quality of Life , Research , Therapeutic Human Experimentation , United States , Value of LifeSubject(s)
Abortion, Induced , Attitude , Euthanasia, Passive , Euthanasia , Value of Life , Beginning of Human Life , Fetus , Humans , Individuality , Life , Morals , Personhood , Public Opinion , Public Policy , Right to Die , Suicide, Assisted , United StatesSubject(s)
Abortion, Induced , Civil Rights , Jurisprudence , Supreme Court Decisions , Counseling , Fetus , Government Regulation , Humans , Pennsylvania , Politics , Pregnancy , Pregnant Women , Privacy , Social Control, Formal , Spouses , State Government , United StatesSubject(s)
Abortion, Induced , Civil Rights , Government Regulation , Jurisprudence , Social Control, Formal , Social Values , Supreme Court Decisions , Value of Life , Coercion , Contraception , Ethics , Fetal Viability , Fetus , Freedom , Humans , Individuality , Judicial Role , Personal Autonomy , Personhood , Pregnancy , Pregnant Women , Privacy , Religion , Reproduction , Social Justice , Social Welfare , State Government , United StatesSubject(s)
Civil Rights , Decision Making , Euthanasia, Passive , Government Regulation , Jurisprudence , Persistent Vegetative State , Right to Die , Social Control, Formal , Value of Life , Advance Directives , Family , Freedom , Humans , Legal Guardians , Life Support Care , Mental Competency , Missouri , Patients , Personal Autonomy , Quality of Life , Reference Standards , State Government , Suicide , Suicide, Assisted , Supreme Court Decisions , Third-Party Consent , Treatment Refusal , United States , Withholding TreatmentSubject(s)
Abortion, Induced , Civil Rights , Jurisprudence , Supreme Court Decisions , Beginning of Human Life , Contraception , Fetal Viability , Fetus , Government Regulation , Hospitals, Public , Humans , Individuality , Life , Missouri , Personhood , Pregnancy , Pregnant Women , Privacy , Reproduction , Social Control, Formal , State Government , United StatesABSTRACT
A person who becomes demented can be considered as he presently is, a demented person, or in light of his entire life, of which dementia is but the final stage. These two perspectives can provide conflicting determinations of the person's interests and preferences, since what is best for a demented person at the time may not make his life better overall and may be directly contrary to preferences expressed while competent. Reflection on the concept of autonomy--what faculties it requires, what its point is--provides a clear understanding of the rights of the demented patient.
