ABSTRACT
Atherosclerotic plaques in the aortic arch are a potential source of cerebral emboli in patients with cryptogenic stroke (Amarenco et al., 1994). We report on seven patients with cerebral infarction, who had atherosclerotic plaques in the aortic arch, diagnosed by transesophageal echocardiography (TEE). Cardiovascular risk factors as hypertension, diabetes, hypercholesterolemia or cigarette smoking were found in all cases. Carotid disease was present in four patients, one patient had atrial fibrillation with left atrial spontaneous echo contrast, which might have been an additional potential embolic source. Intraluminal protrusion of the plaques ranged from five to twenty-four millimeters. In conclusion, even in patients with carotid or heart disease, the aortic arch may be an important source of cerebral emboli. In cases with mobile and pedunculated protruding atheromas anticoagulation should be considered.
Subject(s)
Aorta, Thoracic , Aortic Diseases/complications , Arteriosclerosis/complications , Intracranial Embolism and Thrombosis/etiology , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Aorta, Thoracic/diagnostic imaging , Aortic Diseases/diagnostic imaging , Arteriosclerosis/diagnostic imaging , Echocardiography, Transesophageal , Female , Humans , Intracranial Embolism and Thrombosis/diagnostic imaging , Male , Middle Aged , Risk FactorsABSTRACT
Ethical conflicts occur in rural as well as in urban healthcare institutions. One means of addressing these complex issues is through interdisciplinary discussions by a bioethics committee. There are, however, social, economic, geographic, and demographic variations unique to both environments that can impact ethical issues, and these must be addressed when such a committee is implemented in either setting. The authors describe the rural variations and the implications for nurse administrators who often assume an active role in planning and organizing bioethics committees.
Subject(s)
Ethics Committees, Clinical , Ethics Committees/organization & administration , Hospitals, Rural , Models, Theoretical , Budgets , Decision Making, Organizational , Ethics Committees/economics , Ethics Committees/standards , Humans , Interdisciplinary Communication , Lawyers , Organizational Objectives , Organizational Policy , Patient Care Team , Personnel, Hospital/educationABSTRACT
Big-city medical research centers are not the only institutions facing ethical dilemmas. Bioethical conflicts occur regardless of community location or size. The Presentation Health Care System, Sioux Falls, SD, established a systemwide ethics committee. It owns, leases, or manages 15 rural institutions in four North Central states: South Dakota, North Dakota, Montana, and Minnesota. Of these facilities, 10 are hospitals and 5 are nursing homes. Most are located in small communities stretched along 1,100 interstate miles. The Presentation system began organizing its ethics committee in spring 1985. The ethics committee was to provide educational opportunities for its members, as well as for local facilities. These opportunities were to include subscriptions to appropriate publications, meetings with guest speakers, videos, and group "brainstorming" sessions. An annual ethics conference would provide community education and address the ethical issues confronting affiliates. Organizers scheduled a planning session at a systemwide leadership conference and invited anyone interested to attend. Eventually, 23 representatives of system affiliates were selected as members of the committee. The group meets twice a year. Since 1985, the committee has been holding ethics conferences on a regular basis.
Subject(s)
Bioethics , Catholicism , Ethics, Institutional , Ethics , Hospitals, Rural/standards , Hospitals/standards , Multi-Institutional Systems/standards , Professional Staff Committees/organization & administration , Minnesota , Montana , North Dakota , South DakotaABSTRACT
This article focuses on the application of the ethical principles of double effect versus consequentialism, autonomy, beneficence, utility, and justice. An obstetrical case study is presented and discussion of each ethical principle is used to resolve the conflict. The intents of the article are to promote ethical awareness; provide topic areas to facilitate ethical discussion; enhance nurses' knowledge of the discipline of ethics; and support the necessity of interdisciplinary ethics committees.
